11/7 Cleo AMPS=128 +1.5=273 +4=289 +6.5=250 +8.5=164 +10.5=98 PMPS=79 +1=163 +3=161 +9=57 +10.5=34

Yesterday

Yesterday's recap
AMPS 86
+1 178
+2 215
+5.5 215
+7.5 170
+11.5 61

PMPS 73
+1 107
+2 92
+4 121
+6 153
+9 144


I don't know what happened to Cleo's numbers but I'm so happy it has happened!!!
I'm not sleeping anymore, but who care?

Have a wonderful weekend!!!

 

Me too! Delia, this is fantastic. So happy to see your girl in the blues and greens!

Marilyn and Polly

 

Nice blues and greens.

 

very late nadir but blues and greens are lovely!!

 

A very nice cycle. Good girl, Cleo!

Ella & Rusty

 

At pmps +10.5 she was 34, so I gave a drop of honey and some food. Can I shoot at next shot time as usual or I have to wait?

 

I'm still uncomfortable giving dosing advice but I would test in 15 minutes to see what her numbers are

 

@Chris & China can you help her?

 

Thank Suzi, now she is 51. But shot time is in an hour.

 

@julie & punkin (ga) need your help. When can I shoot considering that she ate at +11.5?

 

hang on - let me look at what's happening.

 

can you bring the spreadsheet up to date, please, while I'm reading. I don't think these most recent numbers are in there, are they?

 

Just updated in this moment

 

you can take off the 911. I'll stay to help you. But i'm umclear exactly what's going on. Is this your amps for 11/8?

 

In an hour is amps time for 11/8

 

ok i see it there now.

are you going to be home afterwards?

 

Yes I'm going to be at home

 

ok, first she did earn a dose reduction, so her new dose would be 3.0u.

I would still recheck her 30 minutes after the 58 - numbers can wobble and drop back down.

I would not feed her anything now until shot time, unless her blood sugar has dropped back less than 45, and see where she is then. I copied this part below from the "shooting and handling low numbers" sticky. It's not exactly your situation, but it points out the things to be concerned about when you've fed late in the cycle because of low numbers. Which I should hasten to add, was exactly the right thing to do when you had a number in the 30's. But I think it's helpful to look at them:

• --- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

​

How much did you feed her at +10.5?

I'm scanning back to try to see how much of a bump in numbers she gets from eating - she has so many bouncing/clearing bounce cycles that i'm only seeing a few "normal" +1s that could tell us how much food spikes her numbers. On 10/15 at amps she only went up a few points from eating. On 10/9 she went up about 80 points, although that may have been the high right before the bounce broke.

My first thought is that I would delay shooting by 30 minutes so that you've got a test that's 2 hours after she ate, so it's not influenced by the high carbs you had to give her. Can you be late shooting?

 

Thank you Julie.
I can delay the shooting. At +10.5 I gave a drop of honey and 12.5 g of low carb food. Usually she ate 25 g of this food at each meal

 

I hate to admit I don't know how much 12.5 grams are - i'm thinking a paperclip = 1 gram, so maybe that's about a spoonful?

How long from now is it til you shoot? Is your +12 in about a half hour?

 

Yes, it's correct.

I think is about a teaspoon.

 

She is 47 at +11.5. And now?

 

Here's the full info from that sticky:

HOW TO DEAL WITH LOW PRESHOT NUMBERS
The following guidelines apply to the Tight Regulation Protocol for Lantus or Levemir only:

You just tested your cat’s preshot number, and there is a much lower than usual number staring back at you. What do you do?

There is no one-size-fits all answer, but there are some general guidelines. As with everything else, each cat is different (ECID) and each caregiver is different too.

The short answer is that most kitties can be shot at +12, almost regardless of the number, once you are data ready to do so. The exception is that shooting 30s or 40s is not recommended for most cats, so if a cat is lower then usually the best option is to wait until they are at a shootable number to shoot. What constitutes a shootable number will vary by cat, but we don't suggest or recommend shooting a preshot number less than 50. While you’re waiting, the depot is draining, so you want to get the insulin in as soon as it makes sense to shoot.

If it is your first time shooting green, then we will likely suggest that you stall the first time, even if the number is 80-100. That will let you collect data on what your cat will do when you stall. One thing you can do if you are having a low cycle is to get a +10 and +11. Those will give you a good idea of how quickly the cat’s numbers are rising (or not) when preshot time arrives.

Beyond the general guidelines, there are other factors we consider when we are helping someone with a low preshot.

• If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative.
• If the cat is not a food spiker or tends to have an early onset/early nadir then they may not want to shoot as low. If the cat has a late nadir, then they will HAVE to learn to shoot low.
• We will also be more conservative in some cases because of the person – if you are not able to monitor then you want to be more careful, or if you are not sure that you can get back to the board to keep us updated throughout the cycle. Trust me, if you shoot low, we will be watching for your updates and we will worry if we don’t see them.
• We have to be a lot more careful with the cats who eat only dry food, because they don’t have access to the tools the rest of us use to keep our cats safe.
• Also, when it comes to very low preshots, there is an unwritten rule that whoever helps that person shoot low should expect to sit with them through any low parts of the cycle. There have been times when I knew a cat’s number was likely shootable, but I also knew that I could not be around to help if the shot resulted in low numbers later in the cycle. For safety’s sake, if I could not find someone else who would be available to support for the next several hours, I would most likely suggest that the shot be reduced or skipped. I will not encourage someone to shoot low and then abandon them.
• There are a lot of other scenarios, and you always want to keep your cat in mind.

Some general rules when stalling (ECID):

** 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
** 40s or lower – you have a couple of choices.

• When 40s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
• If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
• --- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.

Using the overlap by shooting low is a great way to take advantage of Lantus/Levemir’s long, flat cycles, once you have learned to do so safely.

~ written by Libby and Lucy

I've bolded the part about how to handle 40's at the end of the cycle like this. What do you think? Want to give her a little more low carb and see if that'll bump her up a bit?

 

If I give a little more food now, then how can I understand if bg is raising or it is food spike?

Sorry, maybe it is a stupid question. But I'm not always sure to understand everything I read.

 

Right, you have a valid concern. That's what the sticky is saying. It's ok to wait 15-20 minutes and test again to see if she's coming up on her own without food. Would you prefer to do that?

 

and no questions are ever stupid. this is your precious Cleo - you definitely want to make sure you understand!

 

Retested: +12 is 44. Gave a teaspoon of lc food.

 

Are there other options than stalling? I think I can stall even an hour, now is her regular amps time.

How much have to wait now to see if I can shot?

 

ok cleo, time to come up! enough hanging out in the 40's!

Delia, i'm trying to think ahead for you on what you might do next. I wouldn't shoot the 40's, and since you've just fed her you're going to want to delay the shot a little bit longer. It's 11pm here - so i'm good for maybe 20 more minutes. I'm thinking you'll want to wait til she's rising to shoot, so it may be a while.

 

Thank you for your help Julie and sorry if I kept you awake. I whish you a very good night

 

I think I'd follow this:

** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.
​

You've shot the 70's several times. I think because she's just eaten, I'd probably want her that high before I shot. Then you'll want to keep monitoring.

One option that I'll just toss out there - I don't know how tired you are and it looks like you've been up all night - is to give just a token dose. When I wanted to drain the depot some and try to not have low numbers in the subsequent cycle, I'd give punkin a 1/2 dose shot, then return to the regular dose with the following shot. Reducing that far seemed to interrupt the streak of low numbers. In your case, that would mean this morning's shot would be around 1.5u and then you'd return to 3.0u tonight. I don't know how that would work for Cleo, but I'll mention it in case you want to try it.

I'm still with you for a little bit longer. Don't want to leave you yet!

 

Another option is to try the 18 hour cycle. Since it's the weekend, you can wait until +18 and dose her then, provided she is high enough, then skip tonight and dose tomorrow morning. That will also help drain the depot and give her time to rise to a safe number.

 

I didn't want to see pink numbers again so reducing the dose isn't the preferred option, but I can't stall more than an hour.

 

Do you see Wendy's suggestion above too?

See where she is in an hour and decide from there. She's doing really well, so I think she'll get back on track fairly soon from whatever you do.

 

18 hour seem a good alternative.

 

It would have less of an impact than skipping entirely.

 

Julie don't worry about me. Just tell me if I understand all and then go to sleep

I will test every 20 minutes without feeding to see if bg raises. When I see a 70 I will shoot.
If the numbers didn't raise in an hour I'll do 18 hours cycle.

Right?

 

Good luck Delia. Cleo has had a great last couple of days. Looks like you know what to do.

My pillow is calling my name.

 

58.

 

Good night Wendy! Thank you so much!

 

58 - good! we like to see her up a bit higher.

Yes, that's what I was thinking, but of course, it's up to you.

 

Come on, Cleo.....keep rising and quit worrying your mamabean

 

ok, i've run out of steam and i'm going to go to bed. You've got good instincts with Cleo - you'll do just fine!

good night!

 

Hi I have just come online Julie.
I see Serryn is online too. I will tag her to see if she can assist if needed
@Vyktors Mum are you able to help here if needed.

 

Good night Julie. Thank you again, I'm so grateful for your help

 

Hi Delia,
You are doing a great job looking after Cleo.
I have tagged Serryn and she will be able to help you if you need more help/ or have questions.

 

Hi Bron, I think the emergency is gone. I have only to wait to see when I can shoot safely.

Only a question: I know I can anticipate the shoot of 30 minutes a day. If I shoot late this morning, can I shoot 30 minutes earlier this evening?

 

Well, well great excitement here today

i wouldn't shoot 30 mins early this evening unless Cleo has bounced up to the rafters. If you do get this shot in I would just pull her back 15 mins if she's still motoring along in blue and green.

ETA that's some nice shooting you've been doing and she has justly rewarded you

 

Ok, thanks Serryn. I will wait another half hour and if numbers doesn't raise I will give some food and wait +18 to shoot.

 

Sorry....got caught up giving Sheba her insulin.
Thanks Serryn for looking in.......
I agree with Serryn Delia about not shooting early.

 

+13.5 was 34-38. I tested two times. I definitely will not shot.
I gave a portion of lc food and a drop of honey.
I will shoot at + 18.
Thanks to all, you are wonderful people!!!

 

I would test again in 20 minutes to make sure Cleo is rising and not falling.
Will you post the result please as we will be watching.

ETA when you have time, can you update the subject line please Delia so we can see what is happening at a glance?.....thanks

 

60 at +14

 

Yes, I will start today's condo, since this is of yesterday

 

60 is good. Honey only lasts a short time so I think I would test again in 1 hour to see she is not dropping again.

 

OK. I have to wait until +18 to give her regular meals, right?

 

No you can feed her now. She is probably very hungry.
Just don't feed for the two hours before you are going to shoot at +18 unless she drops below 50 again.

 

Ok, but should I give food at +18 also? She usually eat 5 meals: ps, +1 +2 +3 +4. How much food should I give now and how much at shoot time?

 

That is a good question.
I have not done the +18 shooting thing myself but I would think that you would need to give her a good snack now and then at +18 she would need to have what she would normally have at shot time and the +1+2+3 and +4 food after she has had the insulin, so that she has the food to work with the insulin in her body.....does that make sense?

Her feeding regime is going to be a bit out of wack until you get back to the 12 ...12 regime. She will probably end up eating a bit extra but that should not hurt her.
Just to check I will ask Serryn @Vyktors Mum

 

Thanks Bron, I just gave her the usual dose of a meal. I started a new condo here