1/1/2018 Silver AMPS 364; +4=286; +6=250; +7=245; +10=297' PMPS 313 nice flat curve if a bit high

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Juliet, Jan 1, 2018.

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  1. Juliet

    Juliet Guest

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    http://www.felinediabetes.com/FDMB/threads/12-31-silver-amps-295-2-324-6-229-8-243-pmps-301.188861/

    Well I think he got a fur shot last night which might explain the high morning. Very hard to tell if I should increase dose on Wednesday as his curves have been mostly on bouncing days but even when I have got evening checks with a low blue PMPS he has not gone near green. I feel I should increase....anyone else jump in? I will wait til Wednesday though as that is a week since last increase.
     
    Last edited: Jan 1, 2018
  2. Alicia & Maggie (GA)

    Alicia & Maggie (GA) Well-Known Member

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    Sorry about the fur shot. Hope he comes down and you see blues and greens very soon.
     
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  3. Juliet

    Juliet Guest

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    Not bad.....don't think he's heading for blue today though. Was hoping to keep pink OUT of his 2018 ss.
     
  4. carfurby

    carfurby Well-Known Member

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    In some ways it looks like he can use more insulin, but you did get a 126 on the 27th. Then there is the 175 on the PM of the 29th. It's possible he dipped down lower during the day. With SLGS it says to hold the dose if the nadir is between 90 and 149. You may want to hold the dose this week and get another curve next weekend to decide about the dose.
     
  5. Juliet

    Juliet Guest

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    I am hoping not. He has already been on this dose nearly a week with no sign of any green. Clearly this is too low a dose for him. We have never seen a nadir yet that is green. All I am seeing is pink and yellow - a few reds and the very occasional blue. Everywhere I have read says you need to be more aggressive if you want a second remission. I obviously can't do TR but I don't want to be too laid back either. I cannot do curves every Saturday either.
     
  6. Juliet

    Juliet Guest

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    That 126 was several days ago as well. Nothing but pink and yellow since with one blue.
     
  7. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    @Juliet asked in another condo about how to be aggressive when using SLGS vs TR.

    To be honest, I'm not entirely sure. I'm tagging @Jill & Alex (GA) since she's the most experienced person when it comes to SLGS. (I'm not sure how much she's around but she is likely to respond when she gets the tag.)

    I think the hard part is your schedule. If you can't be comfortable shooting and leaving the house -- and Silver won't reliably eat if you're not home or another cat will raid Silver's bowl -- then I would likely be apprehensive, too. I would stick to SLGS as closely as you can and raise the dose preferably on a Friday evening (or even Friday AM if it takes Silver a cycle or so to respond to an increase) so you can maximize getting tests in over a weekend and have a sense of what's happening. I would do everything humanly possible to not skip a shot or reduce the dose if you're home to monitor. Those are my first thoughts.

    Just a housekeeping note: If you have questions, can you ask them in your condo and tag people to respond? If you ask a question relating to your cat in someone else's condo, we run the risk of getting into a discussion and hijacking the original poster's thread. It also means it will be harder for you to go back and find information later if it's not in your kitty's condo.

     
    Last edited: Jan 1, 2018
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  8. Juliet

    Juliet Guest

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    Jill already previously responded. That I can't increase if I don't know what his nadir is - whichever method I am following. Unfortunately the schedule can't be changed, neither can my ability to leave food out. I have looked at all the options and it is NOT possible for me to do that. Silver never has a problem eating - and if I were to leave food out for him to graze on if he were to drop low - he would eat it all within a few mins of me putting it down, no matter how much I left out.

    However, given that my schedule cannot be changed (and surely we have others on the board that have jobs - I just happen to have a 2 hr commute to mine) how do I do the best for Silver? Leave him permanently in high numbers is not the answer so I must be a little aggressive to get him down. He is very rarely in any other colour but pink, red or yellow. Everyone says - oh but look - he was was at 7 six days ago and 9 two days after that - but I can't hold to what he was several days ago but where he is NOW surely. I have been testing a lot the past few days over the holidays catching nadir on many occasions and I often test in the evenings. No sign of any green low nadir at all.

    As I said in yesterday's condo - yes I am following SLGS but as many people have said, it is to be adapted to individual cat. I followed it rigidly in the beginning - skipping shot and giving a reduced dose - following EXACTLY what SLGS said to do - and was promptly told I had messed up the depot because I did that and that I was supposed to have tailored SLGS. So everyone seems to tell me something different. I prefer hard and fast rules on what to do - hence me following the SLGS but obviously I am not supposed to do that. \

    So, as far as I see it - what I had planned to do is:

    1) not shoot a green AMPS and if its a low blue - I will be reducing the shot. I will not take risks no matter what the protocols say. I am the one holding the syringe and do not want a dead cat when I get home from work.
    2) if I see a low blue PMPS or a green PMPS then I am okay with shooting if I am home to test several times that evening.
    3) i will be doing weekly curves as much as is possible - I do have a life and am not home EVERY Saturday. I will then follow SLGS as to when to increase/decrease dose based on that particular day's nadir. I have no choice in that as I can only do a curve once a week.
    4) as for increasing the dose just now - it depends on what he shows me today as I am home and testing. I have not seen a blue in several days so if his nadir is above 150 today in either cycle, then I will increase to 2.25.

    If anyone thinks any of the above is completely off then let me know but I need to have some solid guidelines moving forward as I am getting so many mixed messages and cannot cope much more. Makes me want to log off for few days but I know I can't do this on my own either. I just wish we were all on the same page when it came to advice giving.
     
    Last edited: Jan 1, 2018
  9. Juliet

    Juliet Guest

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    And yes, I agree with you 100% about not skipping/reducing IF I am home to monitor which I very rarely am. Throughout the whole of January, I have to be out three nights a week getting physiotherapy so testing will be seldom except AMPS, PMPS and before bed test.
     
  10. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Your schedule and leaving food out are the limiting factors. That said...

    With SLGS, the approach suggests that you get a curve once a week. If you're not sure where onset and nadir fall, can you get at least one curve over the weekend and/or when you're home? The difficulty occurs if Silver is bouncing. A bounce cycle is unlikely to tell you where nadir is so all you can do is try to maximize testing when you are home so you can base decisions on the data. You do the best you can.

    I would encourage you to gradually work your way down to shooting lower numbers. Historically, people like Jill who where here when TR was first made available (and everyone did something like SLGS) were told they were going to kill their cat by shooting low numbers. Shooting low didn't happen overnight. There are very few people who arrive here who are willing to shoot low numbers. I typically tell people to gradually work their way down to shooting anything above 50 (if using TR) so they have data to fall back on and they feel comfortable with shooting progressively lower numbers.

    If you left a LOT of food out, would your other cat hoover everything up? That might be one other option. You might have to try this on a day that you're home to see what happens.

     
  11. Juliet

    Juliet Guest

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    I cannot leave food out period.
    I will try for a weekend curve but I am at church every Sunday for five hours and I am not home EVERY Saturday.
    I am quite happy shooting low numbers WHEN I AM HOME. I will NEVER shoot a low number and leave him 12 hours. Period.
     
  12. carfurby

    carfurby Well-Known Member

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    I just wanted to point out the blue numbers so you can take them into consideration when you make your decision if you are going to increase the dose. :bighug::bighug:
     
  13. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    This is the link to the dosing ruler for BD syringes. The information on how to use the ruler is in the article on Management of Diabetic Cats with Long-Acting Insulin that's linked in the TR sticky note.

    Thanks to @Wendy&Neko for knowing where to find the info.
     
  14. Juliet

    Juliet Guest

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    Thanks....
     
  15. Juliet

    Juliet Guest

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    Yes I know....I am just worn out with all of this....getting more and more confused by the day. Just gonna have to trust my instinct and do what I can with the limitations I have.
     
  16. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    The advice given to find out how low the dose is taking Silver is offered to keep him safe. However, you hold the syringe. You "can" do whatever you'd like.

    Here's the the thing...
    None of us are veterinarians. Safety comes first and foremost. The advice and/or suggestions we make are made strictly on observation, experience, and data accumulated by the caregiver. For any of us to responsibly recommend dose increases or adjustments, we rely on the data you've collected. None of us will put ourselves in the position of harming your cat based on conjecture. We need info only you can provide.

    Many, many suggestions have been made... not only how to collect that data, but feeding methods to help keep Silver safe. Time after time, you've told us that you cannot do any of them. That's fine, but when it gets to that point it's up to you to figure out and focus on what you CAN do to keep Silver safe.

    "IF" you're looking for help and advice from amateurs (FDMB members), it's your responsibility to give them the necessary information required for them to offer suggestions and advice which will keep Silver safe. I'm not saying that to be mean. I'm saying that because we're volunteers who want to help and are trying very hard to help, but we need your help in order to help you. Since you have reasons why numerous suggestions won't work... it's up to you to figure out how you're going to get the info required for us to recommend dosing adjustments. I think I can speak for most... no one wants to make suggestions or offer advice when it could have the potential of harming Silver.

    Those who have stuck around to offer help have done so out of the kindness of their hearts, but you have tied our hands. We need information from you to help. With all due respect, if you want dosing advice from any of us here, but can't figure out how to find out how low each dose is dropping Silver... how to make it work in your life... your best bet it to work with a professional... your vet. They have the training, know your cat, and are equipped to deal with the consequences of their advice/actions.

    It pains me to write a post like this, but I thought it would be best to be straight with you rather than beat around the bush.
    :bighug:
     
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  17. Juliet

    Juliet Guest

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    I hear you. But don’t you see my reasons are valid reasons? I have a job. I must be gone 12 hrs a day. I am not being unreasonable when I say I can’t monitor as much as you all say I should. Of course I need the help of this forum and I hope I people won’t drop me.

    I do the very best that I can but that doesn’t seem to be good enough. And as we all know vets DO NOT have the training on this. I do need the advice here and I just hope some are willing to help me - or rather Silver.
     
  18. PussCatPrince - GA

    PussCatPrince - GA Well-Known Member

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    Don't bite me coz I iz your pal but can you miss the church thing or shorten the amount of time to just service hours?
    Obviously you can read from that we don't do the church thing so will likely not 'get' the import. It's just me likely seeing this a bit simple where it may not be.

    You need more hours from somewhere & we both know we have only so many free/spare hours so something has to give and that cannot be work as work pays the bills .

    For me I have altered work as I have Phil to take up slack & we both adjust our budget. However you do not have a Phil - although you would be welcome to borrow the blighter when he gets on me nerves - so no-one to take up financial slack . That leaves the hours not at work and all the way far across the world & from a complete but well meaning heathen, Sunday seems to have some hours if church hours can be shortened. <---- I do realise that church can be very important and also a huge part of community. I see that here. Maybe those at your church community can work something out with you. Anyway. Don't bite me. I just want to help and if we were near I certainly would.


    Seems Ty and Silver are both vacuum cleaners when it comes to food.
     
  19. Juliet

    Juliet Guest

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    Thanks for your response. Sometimes I do duck out of church but I am on staff and need to be there an hour prior and an hour after. I do duck out on the occasion. But it doesn’t go down well for a staff member to do that. And yes. I’ll probably get slammed from someone saying I’m discounting suggestions. I guess I really am on my own here. Stinks really as I think I do get enough evening tests for people to advise me. Somone once said on here that the essentials were AMPS, PMPS a mid cycle and a before bed test. All of which I get so somehow I’ve ended up in the black books here.
     
  20. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Juliet, the amount of times you test is NOT the problem right now. The problem is you're asking if you should increase the dose based on current data. None of us can answer that at the moment without knowing how low this dose is taking Silver.

    Here's why:

    • we know the 1.75u dose dropped Silver to 139 @ AMPS (+12) on 12/21. You gave a reduced dose that morning and yet the next day he dropped again.
    • 167 @ PMPS (+12) on 12/22 - the third cycle after the BCS dose of 0.5u.
    • we know the 2u dose dropped Silver to at least 126 @ PMPS (+12) on 12/27
    • we know the 2u dropped Silver to at least 175 @ PMPS (+12) on 12/29
    • no mid-cycle tests were done on the last two because you were at work (unavoidable)
    You want to increase the dose.

    I/we can't recommend a dose increase because we have no idea of how low the insulin is taking Silver. Was he on his way up or on his way down when the above tests were taken? I probably have more spreadsheet reading experience than almost anyone currently posting on the board and I can honestly say my answer to that question is "I don't know".

    Do you see the problem if any one of us suggests a dose increase? If he doesn't need an increase, his numbers could plummet during the night or when you're at work... without having the benefit of food available to him to bring his numbers up. I/we simply cannot suggest something that could hurt Silver.
     
  21. Juliet

    Juliet Guest

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    I’ve already decided not to increase dose based on advice - I’m doing a curve first. Maybe you missed me saying that. I will never put Silver at risk and I’m taking the advice.
     
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  22. Juliet

    Juliet Guest

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    I’m doing a curve right now actually. How many do I need ?
     
  23. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    You're on a quest to find how low the dose is taking Silver. You'll have to see how it goes.
     
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  24. Juliet

    Juliet Guest

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    Well so far it’s yellow and pink all the way. Sooo if the curve continues this way then what do I do? Raise or lower according to SLGS or wait until I’ve done two or more curves - that would be three more weeks away.
     
  25. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dose adjustments should only be made once you're comfortable knowing how low the dose is taking kitty... no matter which dosing method is followed.
     
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  26. Juliet

    Juliet Guest

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    Ok thanks. So this curve should tell me then.
     
  27. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    I'm not so sure that would be be my conclusion, but like I mentioned earlier, you hold the syringe.

    If he went lower on 12/29 (PMPS of 175), he could be breaking the bounce today or tonight with lower cycle(s) to come... since we're currently at six cycles from that 175.

    That's why I said to see how things go before jumping to conclusions...
     
  28. Juliet

    Juliet Guest

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    Will wait a day or two and see if he is in fact in a bounce and may drop lower. Nice flat curve but still too high. Would be nice if this was just a bounce.
     
  29. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Sometimes you'll see movement in the cycle following a flat yellow curve...
    good luck!
     
  30. Juliet

    Juliet Guest

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    Thank you. I appreciate you mean well and thanks for popping back in. I’ve been pretty upset today by your comments.
     
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  31. Tracey&Jones

    Tracey&Jones Well-Known Member

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    I am liking the curve data you got today. I am seeing a bit of pattern...he nadirs around +6 or +7. Do you see that?

    Kinda of flat, but you can see he is working the insulin!
     
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  32. Juliet

    Juliet Guest

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    Thanks @Tracey&Jones he does seem to be improving from a month ago.
     
  33. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Juliet --

    The reason I suggested that you get a second curve given it's been a holiday weekend is to see if there was bouncing. Getting one curve and that curve happening when a kitty's numbers are bouncing doesn't really help you with dosing. It would be like basing your dose on a test at the vet's office when your kitty was stressed and numbers were artificially high. With Lantus, dosing decisions are based on how low the numbers go.

    I know that Jill was going right to the point and often those words are tough to hear. What I would suggest is taking a step back and not getting too locked in to the way you're thinking about things. There is a sticky on whether using TR is possible if you work. I realize that you're following SLGS but TR is more demanding and you may find some ideas in that sticky note that you can adapt to your situation. It may help to try to think creatively.

    FWIW, I was Gabby's sole caregiver. I work full time. I clearly have more flexibility than you do (mostly due to a minimal commute time) but there were times I had to rearrange a meeting so I could run home, give a PM shot, and go back to the office. Let me put this in a slightly different perspective. If this were your child, could you find a way to modify your non-work commitments? I know I had to make sacrifices with my social life when it came to managing Gabby's FD. But, that was my choice. Not everyone can or is willing to make those choices.

    Another possibility is to consider Prozinc instead of Lantus. With Prozinc, you are able to slide the dose based on pre-shot numbers. There will still be some of the same issues about testing and food availability but you may find it a bit more forgiving than Lantus. You may want to visit the Prozinc board and ask a few questions from knowledgeable users who can give you better insight than I can about whether Prozinc will allow you more flexibility. Both Prozinc and Lantus are insulins that the American Animal Hospital Assn recommends for treating FD.


     
  34. Juliet

    Juliet Guest

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    I have NO social life as I am sick. I only go out in the evening to my medical appointments. And Silver IS as important to me as any child. Church on Sundays is a work commitment. I am staff. I get a lot of evening tests. More than many I see on this board in fact. I do not understand why I am a target the last couple days. I do the best I can on very little income. I did do the curve. Still high yellows.

    I have just bought a new vial of Lantus.
     
  35. Dyana

    Dyana Well-Known Member

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    Juliet, we just want to help you. I do see that you are getting lots of evening tests. That is good! I used to have to do that with J.D., as I work long hours during the week, too.
     
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  36. Juliet

    Juliet Guest

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    Thank you. I do need the support and I know it looks like I’m not listening but no one seems to understand Im doing ALL that I can for him. And I AM holding the dose as advised so dont understand the last couple days. Really.
     
  37. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    We really do our best to understand. Everyone has limitations unless there's a houseful of people who are around and who can all test, feed, and shoot -- and even then, mistakes happen. We're all trying to problem solve with you. It's as hard for you as it is for us when we think we have a helpful idea/suggestion and keep getting shot down. That's why I suggested that you think as creatively as possible.
     
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  38. Juliet

    Juliet Guest

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    I’m ok with continuing exactly as they are. I do a weekly curve and get several evening tests in. Which I’ve been told are good as cats tend to run lower at night. So I can base dosing decisions based on the curve and the extra tests. I believe that is adequate info.
     
  39. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Please be aware that not all cats run in lower numbers at night. Some do and some don't. I've yet to find anything that is an absolute when it comes to a cat.
     
  40. Juliet

    Juliet Guest

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    Thanks. I’ve booked some vacation days on weeks that I can’t do a Saturday curve. I’ll not make any hasty decisions re increases. Heck I want to reduce and get him OTJ.
     
  41. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Juliet

    I am not trying to be nosy about your Saturdays and I know you’ve said you can’t be there all day but, does your schedule on Saturdays give you the flexibility to do an 18 hour curve where you test every three hours for 18 hours...or as much of 18 hours as you can. I know you need rest due to your recent brain surgery but would testing every three hours give you more flexibility on Saturdays to get out and do what you need to?
     
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  42. Juliet

    Juliet Guest

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    I could try that. Almost all Saturdays I am home and I do do a weekly curve. So I didn’t understand why I was being told I don’t have enough data. I have more data than many on the board.
     
  43. Marje and Gracie

    Marje and Gracie Well-Known Member

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    It isn’t that you don’t have enough data. It’s that the data doesn’t show you how low he is going. There is the suspicion from experienced eyes that he could be going into green which means this is a good dose for him....he’s just still bouncing on it.

    Please understand, Juliet, no one is criticizing. We are just trying to come up with ways for you to catch any possible greens.

    I always liked Julie’s Jill’s analysis of the SS: think of it as a puzzle that you have to put enough pieces in to see the picture. You are doing what you can and we just have to hope that you/we can see the piece of the puzzle that tells us how low he’s going on this dose.

    Also, remember what Jill said. You hold the syringe. If you ask us for our opinions, we are always going to err on the side of safety and be honest about where that is.

    Silver is your responsibility and you know him best. You can look at the data and patterns and make your own decision. If you feel you are criticized for it, although no one here means it in that way, then you can either explain it for the sake of knowledge (understanding we might not agree, but that’s ok) or you can decide he’s your cat and you don’t owe us any explanations (which is true).

    But, truthfully, one thing we learn here is we all need to be thick skinned. The written word can often sound so much more critical than the spoken word would ever be intended to be.
     
    Last edited: Jan 2, 2018
  44. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    You weren't being "targeted", Juliet. Three days ago I posted in your thread because of a conversation that was going on about the difference between TR and SLGS being as simple as one could increase every 3 days while practicing TR, but had to hold the dose for a week while following SLGS. That seems to be a very common misconception these days. For many different reasons the issue had to be addressed. The most basic reason is whether one waits 2 days, 3 days, or 10 days before making dose adjustments... one has to know how low the dose is taking kitty prior to making a dose adjustment. This is why I stopped by to comment in the first place... after I read the on-going conversation.
    A copy and paste job of my comments from post #20 above because it spells it out why you were being asked for more data:

    Juliet, the amount of times you test is NOT the problem right now. The problem is you're asking if you should increase the dose based on current data. None of us can answer that at the moment without knowing how low this dose is taking Silver.

    Here's why:

      • we know the 1.75u dose dropped Silver to 139 @ AMPS (+12) on 12/21. You gave a reduced dose that morning and yet the next day he dropped again.
      • 167 @ PMPS (+12) on 12/22 - the third cycle after the BCS dose of 0.5u.
      • we know the 2u dose dropped Silver to at least 126 @ PMPS (+12) on 12/27
      • we know the 2u dropped Silver to at least 175 @ PMPS (+12) on 12/29
      • no mid-cycle tests were done on the last two because you were at work (unavoidable)
    You want to increase the dose.

    I/we can't recommend a dose increase because we have no idea of how low the insulin is taking Silver. Was he on his way up or on his way down when the above tests were taken? I probably have more spreadsheet reading experience than almost anyone currently posting on the board and I can honestly say my answer to that question is "I don't know".

    Do you see the problem if any one of us suggests a dose increase? If he doesn't need an increase, his numbers could plummet during the night or when you're at work... without having the benefit of food available to him to bring his numbers up. I/we simply cannot suggest something that could hurt Silver.

    The above explains the reason why I was looking for more data... because in order to keep Silver safe... no one could give you the answer to your question about whether you should increase/decrease/maintain the dose without it.

    A note to everyone: Just because it's the end of the week and a curve was done (SLGS) or three days have passed at a particular dose (TR), does not mean the caregiver/any caregiver has caught the low. Please, for safety's sake, don't adjust kitty's dose until you feel comfortable knowing you caught the low.

    I'll bow out now.
    Wishing you all the best! :)
    ~ Jill
     
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  45. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Heh! That my analogy, Marje. Leftover from my days on the board with Jojo... way back when. :D
     
  46. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Ooooooppps! The only one I had seen use it in the last several years was Julie but I admit, while I read most of your posts...not all of them.

    Sorry for the ”miscredit”;) I fixed it....just to be accurate.
     
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