Taco 10/14 see first post for BG numbers,tough day !!

Discussion in 'Lantus / Levemir / Biosimilars' started by Cindy&Taco, Oct 14, 2018.

  1. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    Not being a Lev user, I struggle to understand a Lev spreadsheet. What I was trying to figure out, since it has been a long day, was how this active cycle would play out, ie.; when it would normally/likely start to be non-carb influenced. What I was looking at was 9/26, 9/23, 9/20, 9/11, 8/31 - all a.m. cycles.
     
  2. Carol in Chicago

    Carol in Chicago Member

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    Apr 5, 2017
    You did great with this Cindy. I think the take away her is what it does take to bring him up. It seems he is not as responsive to gravy as we might have thought, so in the future honey might have to be the "go to" for action. I don't know if one episode can be definitive re: carb sensitivity, but I think it is safe to say he is hard to bring up. The next question is how much honey is needed because as you say, he had gravy all day. From my experience, I keep note of the amounts of karo / honey and would also want to have a syringe available to dispense if required as my Rose won't always eat a plain sugar. Now if we mix it with butter that seems to be something she finds irresistible! :rolleyes:
     
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  3. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    @Red & Rover (GA) On 9/23, there was a feeding around +9 that could have bumped the numbers on the 23rd. As for the rest of the cycles, remember that readings can be within 20% of each other. On Lev, I noticed nadirs to be somewhat fluid.:rolleyes:

    Carol makes a good point. Some cats need higher carbs. Maybe stock up on some HC in the 20% range. You may also find that you need different levels of carbs at different parts of the cycle. Early in the cycle if they are going low, you will need higher carbs because the insulin action is building. Later in the cycle when the insulin is waning, a lower carb HC may be enough.
     
  4. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    I have ALWAYS gotten him up with HC, I dont know what happened this time :(
     
  5. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    That 80 (albeit honey influenced) at +8 looks nice.
    The information that you gathered today is good to have the next time you have to decide whether or not to shoot (especially a possibly carb influenced number).
     
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  6. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    Cindy - I have to go out and pick up the bus person and others that I dropped off at a restaurant and take them up to campus.

    There are experienced eyes on you. Please post before shot time for advice. Hopefully, you will be able to get some sleep tonight.

    And hugs to @MrWorfMen's Mom and @Carol in Chicago for stepping in when there were few people online earlier.
     
  7. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    YES!! For sure thanks to them and you also :bighug: I'm just figuring out what to do about his feeding, then , I guess shot. My daughter and I will most likely stay up all night if we have to and see what he decides to do. :bighug::bighug::)
     
  8. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    Thank goodness, the university library is still open and my password still works. I remembered on the drive up that @Rosie & Bailey also gave tremendous support during the day. Thank you.
     
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  9. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    YES! A sweet person that came along to get help :)
     
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  10. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    If I shot 1 hour late this AM because of low BG, do I shoot one hour later at PM, I need help with this please :)
     
  11. CassAndGordy(GA)

    CassAndGordy(GA) Well-Known Member

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    Sep 23, 2016
    Yes. 12 hours after you gave the AM shot. And then best practice is to "walk it back" 15 minutes each shot until you're back at your regular time. :)
     
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  12. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    I know you are coming in late, but would 1u be ok if he doesnt drop anymore,? he's been kept safe for over 12 hours with intervention.
     
  13. CassAndGordy(GA)

    CassAndGordy(GA) Well-Known Member

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    Sep 23, 2016
    Its up to you ultimately, but bare in mind that if you do such a reduced dose, you're still may have some Lev action from the depot. I've never really been to comfy with dosing advice. =( but I am an "err on the side of caution" type of person.
     
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  14. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    ok :) so if I skip tonite, do I just go back to his normal schedule,if it warrants shooting his same dose from this AM, which had a reduction and is at 2.75?
     
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  15. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Hi Cindy, I'm back and just checking in to see how you and Taco are faring. You have been one very busy lady today. Taco has you well trained as his servant! :woot:
    As a Lev user with a long term diabetic, my inclination in your situation, after the day you just put in, would be to skip tonight and let the depot drain a bit. I am always a little leary of a some insulin sensitivity after that run of greens that Taco is not really used to. He may bounce a bit but better safe than sorry and you need to get some rest so you can continue to look after the little man. If you skip, you can then go back to your preferred time schedule because in essence all you are doing is extending this cycle.

    You did a great job with him today.:D Shout outs to everyone who stepped in to help out. :bighug::bighug::bighug:
     
  16. CassAndGordy(GA)

    CassAndGordy(GA) Well-Known Member

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    Sep 23, 2016
    Linda answered this above, but yes - if you decide to skip tonight, you can go back yo your regular shot time tomorrow
     
  17. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    Oh gosh, thank you all so much. YES!!! He did pull quite the stunt today. I really don't think he's finished. But I can tell he's feeling better since the last hour. I will skip his shot for tonight. I'm still afraid to go to sleep, because I know how quickly he decides to go low fast. After that pink last night, I was thinking about a dose increase, but, he got us again. Thank you all so much again.
     
  18. Cindy&Taco

    Cindy&Taco Member

    Joined:
    Oct 21, 2017
    putting this here for ease ;
    Before AMPS +11 63, +11.5 49, + 11.75 46
    Taco 10/14 AMPS 55,+.25 59, +.50 72,+ .75 74,+1 89,+1.50 65,+2 53,+3 70,+ 3.50 65,+4 58,+4.50 55,+5 65,+5.50 70,+6 61,+6.50 54,+7 76,+7.5 77,+8 80,+8.5 80,+9 77,+ 9.5 66,(+10 65,gave 2 tsp hc including the meat and gravy,)+10.5 97 Skip shot +11.5 113,Back to original time , +2 128 (12am), +3 158,then PM meal,+5 260,+11 471
     
    Last edited: Oct 15, 2018
  19. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I think Taco will probably appreciate the pokey break as much as his Mom will enjoy some decent sleep.:)
     
  20. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    If you just look at the numbers today, it was a lovely cycle. Taco had an amazing stretch of healing green that was wonderful for his pancreas. Although hard on you. :bighug: I'm not sure you needed to give as much HC as you did. Generally they can surf with LC once you've got them solidly above 50. It's cycles like today that can help Taco's body learn that normal BG numbers are good and that he doesn't need to bounce as much. The path to regulation starts with some serious green stretches. There is no worry about insulin sensitivity to a long stretch of safe greens. My civvie tested in the high 40's, we just don't want cats on insulin to register there as it leaves no margin for error.

    As an example of what a Lev cycle might look like, and how to use food to manipulate the numbers, take a look at @Jill & Alex (GA) Alex's SS. When Jill started Alex on Lev, she tested a lot, mostly as a teaching tool for herself and others, as whe was one of the early Lev users. The * symbol marks when food was given. See how flat those green cycles can be. I loved giving Neko her Lev shot with her in the 80's. cause for her, it often meant movement of no more than 10 points the entire cycle.

    With Lev and it's later onset, you do have to learn to give insulin at lower BG numbers. Neko would occasionally give me a number in the 40's before preshot. I would just stall 20 minutes, not feed, test again, and she was always up enough to shoot. I then had 4-5 hours before onset so plenty of time to get her numbers up with regular LC. Many Lev kitties have their lowest point of the cycle around preshot time. Though unnerving, it did mean I was usually home for the lowest point of the cycle. It actually gave me more freedom.

    Since you skipped tonight, your new AMPS is whenever you want to, as long as it's 12 or more hours from this morning. Get some rest. Tomorrow is another day.
     
  21. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

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    Jan 11, 2010
    Sorry that I was out this afternoon and then again this evening, so I couldn't respond to my tag from @Red & Rover (GA) . I agree that skipping the shot was the thing to do. Rusty was a Levemir kitty, but his nadir was almost always in the middle of the cycle--not toward the end. ECID. I hope you can get a good night's sleep tonight. You did a great job today (with "a little help from your friends"). :)
     
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  22. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    I'll have to disagree with some things. First, my daughter wakes up at 9am to start Tacos routine and woke me up telling me Taco was at 63, so we tested again and got a 49 then a 46. Now, at that point I gave some medium carb and brought his BG up to 55 and I DID shoot his earned dose,2.75, I made that decision, but, 1 hour late, so then ,say,I had to go to work and leave him, Taco does not seek food when he drops, so he would have bottomed out, no doubt.All day, every 30 minutes he was fed medium or HC GRAVY,in very LITTLE quantity. It did help somewhat, but not like it had in the past.
    Maybe it's that I don't like to see him go so low so fast, and he has such erratic BG numbers. I don't like this TR protocol, and am switching to the SLGS.
    I did try to surf with the LC, and was advised to go back to the HC, when that person saw Taco drop again and I'm thankful for the help I got,which I believe were correct calls for what was going on. Everyone did the best they could in the situation. We worked on Taco for 13 hours and he stayed safe and is alive. Had I not been home he would not be.
     
  23. Rosie & Bailey

    Rosie & Bailey Well-Known Member

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    Sep 4, 2018
    Hope Taco is doing well today, and you got a good night's sleep.:bighug:
     
  24. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I too am wondering how you and Taco are doing today. :)

    Cindy, you have to set your own tolerances and I can understand your reasoning for wanting to switch to SLGS after the day you put in yesterday but I really think there are other options for you to think about.

    If you look back on your spreadsheet, you have shot a green reading about 7 times before yesterday, all at lower doses, and possibly not food influenced (I didn't check the food notes thoroughly to confirm this). Yes you had to steer him to some degree but he surfed along in absolutely perfect numbers that weren't straddling the edge of safety. You could stick with TR but up your pre-shot reading limit and consider reducing the dose for a cycle when you have a situation where Taco throws a low number especially one you really have to address with food right before pre-shot time.

    With my girl I found there were times when I would skip a dose but my preference was to either do 2 longer cycles (I was lucky in that I usually had that luxury) or give a reduced shot for one cycle just so I could shoot and keep up the momentum when I got a lower reading. If I had to feed an extremely low BG before pre-shot, I found Levemir was more forgiving than Lantus when it came to switching up doses a bit. In some ways, Levemir struck me that its behaviour had a touch of in and out as well as depot insulin characteristics and I didn't lose momentum when I decided to use reduced doses or extend cycles to accommodate my schedule, save my sanity and keep my girl safe.

    Just some food for thought.
     
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  25. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    Yes, you're right :) I have shot greens, but they were much higher, Taco started his day yesterday with a 46 at +11.75, that's 15 minutes before his AM shot :nailbiting: I had to think quick and act and decide .The only and best thing I could do at the time was try and get his BG up so I could shoot on time, but, 15 minutes was impossible, so ,after I got him up,I have to admit I was horrified and put my big girl panties on and DID shoot,1 hour late at a .25 reduction. I knew it was going to be a long day because the gravy was not working like it had in the past, and to be honest, I had never just used the gravy to bring him up, I had used the meat AND gravy, and I wanted to follow instructions :) AFTER I finally used the meat&gravy, I got good results. I gave him 2 full teaspoons of the meat &gravy and he ate that. I was having a big problem with him just lapping gravy, we were forcing him and he would NOT finish it. So now I know, just give him the meat and gravy, if that happens again ;)

    I wanted to shoot a reduced last night SO bad, but, for fear I guess I decided to skip. Besides mine and my daughters nerves were shot. I knew what I would get today. I learned so much yesterday and can't thank you enough for being there for Taco.

    I know that I will not shoot Taco at less than 55, I will wait like I did yesterday, so, does that put me in the SLGS catagory? I would like to have more play, sort of speak,I would like to hold his doses a bit longer than 3 days, he seems slower to accept a dose increase or decrease.

    I feel as tho if I don't follow 1 of the 2 protocols, I won't get willing help.

    I know it's all up to me and there's really nothing anyone here can do physically at times of crisis, I just need cyber understanding support. That's all :) And I got that yesterday from some, even tho not all were on the same page :)

    The decisions I made were based on the information I got from some and some I had to make on my own. I like that. :) I just don't like someone telling me I should have done it a different way, after the fact.And when I'm working on Taco, I cant go look at someones SS and try and compare anything. NO 2 SS are even closely comparable.
    I know I have held doses longer than I should have, but, those were when I was in another group and couldnt get an answer and didnt know what to do. So Taco got too used to that dose.
    I dont think 3 days is enough for Taco, I need to take a closer look at what the dose does after the 3rd day. I know I stayed on that 1.75 too long :( But again I was counting on someone to coach me. I need to make decisions on my own.
    So now that I just wrote a book :eek: I can say yesterday was not a waste,but, definitely a learning experience. Thanks to all that gave me support and helped me make decisions that I could not have done on my own :bighug::kiss::bighug::kiss:
     
  26. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Cindy, I hear you loud and clear! You did a brilliant job yesterday and you are right. This isn't a one size fits all situation by any means. One of the pat quotes you will hear around here is ECID or Every Cat is Different. Along with that goes "know your own cat". If you feel you need to hold a dose longer than 3 days to truly see the effects, then do it. Maybe you need to hold a dose for 4 days or 5 days. There are those who follow the TR protocol to the letter and it works a charm. There are those whose kitties don't read the rules (my girl was a prime example) and some adjustments have to be made. And this isn't just about kitty.....it's also about the people who are taking responsibility for keeping kitty safe while aiming at an ultimate goal of decent regulation or remission.

    Please don't feel you won't get support if you deviate from the exact instructions of TR. Life happens and our kitties are all individuals. I would venture to guess that most folks despite essentially following TR to the letter, have at some point in time, deviated from the exact protocol. We virtually adopt every kitty who comes into this forum and no one is going to deny you support just because you choose to change the rules a bit to suit you and Taco. My view is that TR is a set of guidelines that can be used as a baseline for dealing with each individual kitty. Only time and experience will let you know if you need to tweak the guidelines to suit the needs of you and your kitty.

    From my perspective, right or wrong, Taco wasn't very interested in eating yesterday and the fact that the steering started very early in the cycle made it imperative not to fill him up with food too early such that he wouldn't take something later if needed. If he had been willing to eat more LC food when it was offered, that might have changed some suggestions we all made along the way. But that wasn't the case and all you can do is deal with the situation as it unfolds.

    You will no doubt get some different opinions about how to deal with Taco from different people. It's ultimately up to you to decide what you feel is right for Taco and what you and your daughter are willing/able to do. The opinions offered here are given with the best of intentions but they are not orders even if sometimes it may seem that way. I was on my own with my kitty, so my decisions sometimes meant I had to take precedence over my kitty's needs because I really needed a few good nights of sleep or some social time. It's a balancing act and too often we get focused on the cat and forget that the people involved have limitations too. :bighug::bighug::bighug::bighug:
     
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  27. Cindy&Taco

    Cindy&Taco Member

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    Oct 21, 2017
    Yes! I agree totally. Taco has no boundaries, and he is king of the home, him and his litter mate have been here the longest, besides our 14 yo CHI, but ,you know cats are different :) He has not followed ANY rules ;) He LOVES to be high, you should see him today vs yesterday, ALL BRIGHT EYED and bushy tailed, roaming around like he's IT! Yesterday, all he did was sulk and sleep, he looked awful :( I know we've got to get those numbers down ! Before he was diagnosed, he gave us no clue that he had diabetes. I caught him drinking an excessive amount of water,by chance. He did lose some weight, but, at 15 pounds his vet was elated because he said Taco was grossly obese. I disagree.He's always been a big cat and is down to 14 ish, his brother, George is 22 pounds and healthy.George looks exactly like the kitty you have as your avatar. Then there's adopted brother Boots, who thinks he's spider man, all day. They sure are all different! We'll get through this, I know we will, maybe lots more steep mountains to get over, but, I think each one will be easier to get over. I do know after yesterday, I'll need a little less hand holding and maybe none, but, I'm happy to know it's there if I need it. Thank you again for your reassurance :bighug:
     
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  28. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    If you let us know how you want to do things differently, by putting the exceptions in your signature, then we can help. Having a no shoot below 55 doesn't put you into SLGS category. SLGS means holding the dose 7 days (unless reductions are earned) and reductions at below 90 and not shooting below 90. Some experienced SLGS peeps take reductions at a bit lower. We have had numerous people say they need to hold a dose at least 5 days for their cat. Just document what you are doing if that's what works for you and Taco. For example, even though Neko was a long term diabetic, I did reductions at 50. She had acromegaly and if she went below 50, she needed less juice and held her reductions.

    Now is the time to experiment and find out what works for Taco. And it's OK to change your mind later when you learn more about how Taco works the Lev.
     
  29. Cindy&Taco

    Cindy&Taco Member

    Joined:
    Oct 21, 2017
    Ok, well then I need to read over the protocols until I understand them better, I'll remove the SLGS from my signature until I figure out what's best for Taco. The way you have the SLGS explained above ,I don't understand it, especially the part,quote,(SLGS reductions at below 90 and not shooting below 90. Some experienced SLGS peeps take reductions at a bit lower. )I don't understand if you get a reduction because the cat is below 90, say the cat is 85,then you dont shoot your dose with the reduction for that cycle at all? I'll try to figure it out.
     

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