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12/16 Mocha amps=392/+6.5=342/pmps=375 HELP TR vs SLGS?????

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Mocha aka Cold Play, Dec 16, 2015.

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  1. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    Mocha is only a few months in on juice. But, what is the overall consensus?

    Does she have adequate testing for transition to TR?

    Please read my concern on the below thread at the END of the page.

    I am willing to skydive for my girl, if I thought it would help her. So, I am open to what is best.

    But, stress (her going hypo) is even more difficult for me than the healthy person. I have damage to my central nervous system that is not under control after 7 years, so unlikely.

    http://www.felinediabetes.com/FDMB/...02-4-5-260-pmps-hi-4-493.149315/#post-1559313
     
  2. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Kari, I know how frustrating and scary seeing these numbers.

    I can't offer dosing advice. I can offer what I learned from Smokey. We started Lantus in October. He had been on 2 others. Just now I think (anti jinx) he is finally following the rules. And I am also following them better. Smokey (is on his own protocol ) adjusts to change on day 5. Not 3 for TR and not the 7 for SLGS. I just had to wait it out. Even though Mocha PMPS was high last night his AMPS is lower than yesterdays so that is a bit of progress. Does he get fed more during the day than at night? Maybe his feedings need to be space more evenly. This is just a thought. Hang in there it will get better.
     
  3. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    I was happy to hear when I ordered from Mark's and my vet was questioning pulling Lantus, that Lantus is by far the best for felines. So, I won't allow him to stop it. I will change vets if it comes to that.

    I agree, Mocha is a late responder. She takes her own time and keeps me guessing!

    Her food consumption is higher in the morning and late evening (so up to 9 am and from 7:30 pm to 10:30 pm). She has been getting 1/2 can more due to her spiking and being so hungry. But, generally, she is getting 3 1/2 cans from 6:30 am to 10:30 pm and each 1/2 can is split into 2 servings with the water added of 1/4 cup H20 per 1/2 wet can or 1/8 cup h20 when dividing that 1/2 into 2 portions. But, afternoon she is not eating much so that amps number should be lower than the pmps.But, I don't see that consistent either.
     
  4. Andy & Pimp

    Andy & Pimp Well-Known Member

    Joined:
    Oct 18, 2015
    Sorry Kari I have no advice over switching protocols. I would say read them both thoroughly again and decide which sounds best to you. TR can be stressful but offers the best chance of remission. I had to change my way of proceeding with Pimp a little bit to get some results.
    Don't forget that absorption of insulin can vary as much as 50% from shot to shot.
     
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  5. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

    Joined:
    Feb 14, 2011
    You do test enough for TR, that is for sure! Given Mocha's numbers, one thing you could consider is doing TR for a while until her numbers start to come down more consistently into, say, upper blues/low yellows (just as an example target-range), and then after that you can reevaluate: if you feel comfortable with TR, you can stick with it, but if you'd rather slow the pace, you could switch to SLGS. The nice thing is that you aren't "locked in" - you can switch methods as you need. The only thing we'd ask is that you keep your signature line up-to-date with which method you are following at any given time.

    Just a little food for thought!
     
  6. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Kari

    One of the things the TR protocol will allow you to do is hold doses longer when Mocha sees good numbers. That can be very beneficial for healing. I'm concerned about the time she is spending in these higher numbers and TR will also allow you to increase doses a little faster than SLGS.

    While there are definitely slow responders....and my Gracie could be one.....if she wasn't seeing at least blue nadirs in six cycles after an increase, I followed the protocol and increased the dose. I did not worry about giving her more time at a dose unless she was getting into blue or green numbers within six cycles and I suggest you consider the same. Remember I'm talking about her BG after an increase and not during a bounce. If it weren't for that yellow nadir yesterday, I'd be suggesting you increase her after four cycles currently.

    It has to be your decision considering how available and able you are to test. Even when she's high, you need to get at least one other test during the cycle so at night, a before bed test is a good idea. And remember that a dose that looked fine a couple weeks ago, might not work now.

    Is there any indication of an infection or inflammation? Just want to be sure these numbers are not caused by anything else. And I'd be testing ketones daily, as well.
     
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  7. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    I like that idea. I do think she is not in a good place right now and I want her to have a more even range to bounce within. I need to box up this house and in between understand the TR. I made cheat sheet cards for SLGS and I need to do the same with TR. I can't handle flipping thru 20 pages in a crisis.
     
  8. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

    Joined:
    Sep 23, 2015
    Thanks for checking in. My heart still goes out to you and the loss of your sweet girl. :bighug: I only hope that I would be as strong as you, to be back on the forum and lending a helping hand to others. There must be healing in doing so. That is my wish for you!

    Your explanation makes sense and I think she is lagging behind at this point and needs help. Her bouncing is ridiculous. :banghead:

    I agree about the night test. I just had a rough day with blood yesterday from her, despite so many pokes. Some days are better.:smuggrin:

    I checked her gums again, as she had a chronic infection from tartar before the cleaning in August. But, she looks good with my grandma glasses and a light nearby.:)

    I have checked ketones (esp when she was peeing on the carpet runner, too easy to test:() but she was always negative.:D

    But, I feel time is of the essence right now to begin getting some traction. Time for those New Year's Resolutions!:joyful:
     
  9. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Yes.
    Given the stress factors you've described, I would hold off switching to TR at this time. However, I would find someone who is willing to help by going beyond simply copying and pasting advice.

    The SLGS Method was written with a whole lot of flexibility in it which seems to have been lost over the past year. SLGS is a thinking man's protocol... not steps to be followed. As written, it's a method designed to allow what you learn and eventually know about your cat to guide you when making decisions. For example, notice phrases like, "In the beginning we suggest following the guidelines..." and "Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide." and "With experience, you may find that lowering these thresholds may work well for your cat." and "Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat." and "We usually...". Get my drift? These are guidelines, not rules. In the beginning, following guidelines is great, but eventually your data and observations are worth their weight in gold.

    I see @Marje and Gracie has posted above. If I were in your shoes, she'd be one of the first persons I'd ask to help me. Perhaps she would be up to and willing to help. I'd be willing to pitch in, but I can't be here everyday.

    This is obviously a condition which has to be given a lot of consideration. I'm glad you mentioned it. In most cases, this journey is about both the cat and the caregiver... not just the cat and BG numbers.


    Just my thoughts...
     
  10. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

    Joined:
    Sep 23, 2015
    Thanks so much!

    Hopefully, someone will keep an eye out for me and my sweetie (she was sweet before this but now super sweet medically). I have asked a few people to follow my threads but I don't know that everyone is comfortable with the dosing directives and not much data history yet.

    It seems I need to get comfortable with TR and not be confused with the variance. I hope to start bringing her to the new place at least a week before we move. Right now it is a literal construction zone with nails on the exposed floor. I want to give her time to adjust but she is not really the skittish girl anymore. The 2nd cat is nervous as a pin drop.....literally. She saw a plastic container yesterday on the counter and did a run backwards off the counter. That girl needs more time there, once I can take things she is used to and the smells die down (super sensitive).

    Your words of wisdom were needed.
     
  11. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    I had not read about the 50% variance. What increases that? Just her metabolism? Nothing that I can do?

    I have found that I must do only the rolling technique for the shooting. I tried it a few times and one was a miss but I had far more issues with not rolling. Now I put on my enlargement glasses (which give me more vision) and roll and shoot to the exposed skin. I know before I was shooting under the roll, which can't be right.
     
  12. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    It's absorption and there's really not anything you can do. Those numbers are based on humans but there's not likely any reason why it wouldn't apply to cats. Many things can affect absorption from cycle to cycle and you'd drive yourself bananas if you tried to control that ;) It's one of those things we just have to not worry about.

    @Jill & Alex (GA) :bighug: You and Libby taught me just about all I know about FD and I appreciate the vote of confidence.

    Kari...I'd be glad to help you and Mocha. It's probably a good, slow way to get back "onto the horse".

    I'd like to spend a little xtra time studying her SS today and you can let me know what you'd like to do....TR or SLGS and whether you want to start now or after you move.
     
  13. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I want to second what Marje posted. There are advantages and disadvantages to either approach. I do think that TR gives you more of an opportunity to get numbers our of the higher ranges than SLGS given that doses are evaluated more often. As Jill noted, now may not be the right moment to switch but that's up to you.

    It is absolutely stressful when you see your kitty in low numbers. I do want to underscore a point, though. Low numbers are not the same thing as a symptomatic hypoglycemic episode. If you are paying attention and testing, you are able to intervene to prevent a symptomatic hypoglycemic event. If you page through Gabby's SS, you can see that she was not an easy cat to get regulated and can and does throw me curve balls. There is also a point where you become confident in your ability to manage those low numbers. There are lots of people here who will have your back and coach you should Mocha's numbers drop. No one expects you to become a pro overnight.

     
  14. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    What do you think Gabby's spiking is from today? Looks like doing well for long stretches.

    What is the recommendation....is the stress going to respond better with TR earlier on (i.e. start it now, so she has more control in a few weeks). The day of the move, I can't imagine she would drop low. That would be the only concern, since I have to manage the move.

    Also, I see all these digital doses. Is this more common with TR? It requires some type of an added device to read digitally the amount. Where are they found and what do they cost? I am only used to the .25 increments or .50

    Thanks again for helping this newbie.
     
  15. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    I think that she is not getting enough leverage with SLGS and it seems the directive is to at least give her opportunity to try TR. As for timing, I am uncertain. I asked Sienne, because my inclination is to help her now, so the actual move does not result in inability to bring her down for a longer time. It seems that bringing her in for a soft "landing" when I can monitor her well (even despite some packing remaining) in her familiar surroundings would create the best foundation to stabilize her after the move.

    She will be taken daily to the new home, maybe a week or more and let her explore. I think her scent will go first and then take the 2nd cat over as well. And, let the 2nd cat explore on her own.

    I will follow what y'all say.
     
  16. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    Let's think about the timing on changing the approach...I need to run out for now and I'd like to study her SS but it might be best to hold off until you move.

    Many of us are Dosing with Calipers. It can give you a lot more accuracy and consistency. It is not required and cats can become regulated without using them but, for us, it really helped with giving a more accurate and consistent dose.
     
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  17. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    I use digital calipers to measure Gabby's insulin. That's why you're seeing such "fine tuned" dosing. Syringes are quite variable in where the lines are so any shot can be off by some amount.

    As for why Gabby's numbers look like they do, my best guess is that she dropped lower than the 50 on her SS last night. If you look at the +3 vs the +5, that was a big swing upward. I'd interpret where she landed this AM as a bounce off of low numbers. The other possibility is that I have been reducing Gabby's dose because her appetite has been poor. (She's having some medical problems.) She finally started eating better last night and it was a new type of food. The carbs are not appreciably higher than her usual food but at other times when I've tried a new food, she's had a spike in her BG numbers. A larger quantity of a new food may be contributing to the spike. And then again, my favorite explanation for some of the things our kitties do is, "Because she's a cat!" They do not like to be predictable.

    As for stress, stress can definitely cause numbers to rise. In some cats, though, stress (e.g., a vet appt) will result in a drop in numbers. Go figure. If you look at Gabby's SS around 4/5/2014, I had a move from Chicago to Columbus, OH. Gabby's number were good while in the car and then spiked a bit that evening. She was pretty much back to normal within a couple of days. Cats are remarkably resilient. My best advice around the move is to play it by ear. Remember, your furniture carries your cats' scent. Being in an empty, strange environment may not help to familiarize your kitties but there's no way to know that.

     
  18. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    There are a few things they enjoy with their scents. Some are used less frequent and my plan is to take the larger piece of furniture that they both like and keep it there when they go.

    I read somewhere to rub their faces with a sock and rub the sock on the things that are new to them. Waiting for paint fumes to die down and then will have a plan. I think Mocha will be fine. She adjusted to this house by running all over. She was never scared from the get go, just did not like being touched.

    But, Latte, is another issue. She literally knows if you move an item from one place to another. It can even be a picture. She finds it and checks it out. She is amazing. Got new push carts and both of them went nuts rubbing their face on the wheels. Did not have their scent but they were attracted to it. But, I appreciate the heads up. I think some of their blankets and some cat homes will be moved before they visit. All our furniture is going, so it should not be shocking except for the fact that the floor/walls are different and the stress of moving noise.
     
  19. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    What you were referring to (I think) about scent transfer is when you're introducing a new cat into your home.
     
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  20. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    @Jill & Alex (GA)
    I agree completely. I'm new here (only 3 months) Smokey doesn't followed either protocol. I kept telling people when asked which I was following it's "Smokey Protocol". The protocols are guidelines and I'm sure work as written for most. They are not laws and you will not go to prison if you don't follow them exactly. ECID, EBID, ESID (every situation..). I had trouble with both only because I find it easier in chart format. If this, do this. I learned there are a lot of unwritten instructions, if you will not in either. I guess they come from the experience of the established members. I can't print either out from my tablet and scrolling and clicking back and forth especially in a emergency is to difficult and I usually lose my place.

    I think I've tee'd off a few people with my stubbornness and blunt replies (diplomacy has never been my thing) because I couldn't see in writing where they are coming from. I personally need easy to follow chart, need to know why someone wants me to do opposite of what guidelines state. And where does it say that.

    I'm hoping Smokey is starting to get in line here or I'm getting better at it but lately it seems to be working better. And it's all because of everyone here.

    I feel you just validated my feelings that it's okay to veer off guidelines a little. Thank you.
     
  21. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

    Joined:
    Sep 23, 2015
    We have been here about the same amount of time....may our fur babies settle in soon.:) Such a bumpy ride and I realize it may continue from time to time, but would like a little less bounce. Reminds me of being on a school bus as a kid when they hit a bump and you went flying!
     
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  22. Vyktors Mum

    Vyktors Mum Well-Known Member

    Joined:
    Nov 15, 2011
    You will be in awesome hands with Marje :)
     
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  23. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    They will settle no doubt about that. It is like the bus ride, bumpty, bumpty, bumpty. This is were the patience pants are needed. Total cooperation from the "kid" would be nice though.
     
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  24. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    Yep. Patience, with a Capital "P." I think Smokey and Mocha are together in mischief @ the moment. I would be happy just with some yellows lately! Gee!
     
  25. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Has Mocha been checked for a urinary tract infection lately? Between her high numbers and her peeing outside of the box, it just makes me a little suspicious and diabetic cats can be prone to UTIs based on the excess sugar in their urine.

    I know you said she cannot get up where the dry food for Latte is but I'd just absolutely be sure she isn't fooling you ;) I'm just trying to be sure we brainstorm anything that could cause these numbers (other than just that she might need more insulin).

    Another thing I'm seeing is some interesting numbers ....look at 12/8..she got to 162 and then it looks to me like her insulin just pooped out on her. While bounces can occur quickly, when I see numbers go up that fast, it makes me think she lost duration. She was at 521 at PMPS and 115 the next morning at AMPS..and 404 at +2. So I have to wonder....was the 115 her BG on the way up? Which might indicate she got lower sometime during the night.

    Just so I understand....there are several tests that one BG occupies two hours of test times. What does that mean? Did you test her each hour and it was the same or did you test her on the half hour in between? So, for today, for example, the test in the +6 and +7 blocks, was that test taken at 2 pm which would be +6.5? If so, the way we would record that so we all understand it is to put 342 @ 6.5 in the +6 box. Then manually color the box by clicking on it, then scrolling up to the pitcher in the tool bar and click on it, then select the pink color.

    For right now, I would suggest leaving her at this dose. If you can get a +2 test in the evenings and then the test before you go to bed, we could start getting a little data. Why +2? Because the +2 will give us an idea of whether she might have a dud cycle, a Lantus cycle, or a potentially active cycle. If the +2 is similar to the preshot, then you are likely to see a typical (i.e. active) Lantus cycle. If it's much lower than the preshot, you might expect her to drop faster and be pretty active. Look back at the evening of 12/6. She was 230 at PMPS and 116 @ +3. I bet you a +2 test would have shown a BG that was much less than the PS and then you would have known it was going to be a pretty busy night.

    Please let me know if you have questions and I'll check in later tonight and in the morning.
     
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  26. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    You have done your homework!

    Let's see. No, she has not been tested. This is something she does not do when her numbers are lower, say 300 and under. It is not consistent. It seems to be associated with even frustration about the wanting constant food, when the sugar spikes. But, she is also in a confrontational stage with Latte right now. She has come to where I am typing at least 10 x in the last 3 hours and Latte is behind my table in the corner of the room's bookcase, snuggled up. Mocha wants to get up to her face and I keep telling her gently "no." She does this every morning, when Latte is peaceful on the floor (again near me) but several feet away...but I see it. She goes up to her, like a bully, and wants to get in her face and smack her. All that to say that some urine is probably a territory thing. It happened when we got the 2nd cat and she just periodically has done it. Even well before the 2nd cat. When we adopted her they claimed that was why they returned her. I think there are some behavior issues. But, she will use the box and has today. But, sometimes she did not today. But, it is near the box and the litter is clean. Just outside the entrance. May she be having more leg issues with the sugar spike? I think so. She does not like to be petted today, her spine is sinking again. It was horribly like that when she was diagnosed. The insulin made it better but it goes in and out based on her counts. All that to say....I have no idea shy she does it. But, I believe it is complicated. If it was an ongoing issue, I would think she would just avoid the box all together. Her stools are in the box.

    The only food she gets is seldom I am not focused and a phone rings or something and I can't beat her to remove Latte's food in her favorite box in the floor. I can't find somewhere in proximity to feed both and restrict Latte's. I do feel it is unfortunate because when Mocha's food portion is gone, I need to take Latte's or Mocha will have her face in the box and go for the food. She knows where to look. I even have to grab any stray kibble. But, Latte is great about cleaning up dropped kibble. She almost needs a high cat tree that once Latte is, Mocha won't go. But, they are so expensive and I don't know that Latte would like it.

    When I look at overall, I see that a blue often is resulted in a spike to red or black. Why, I don't understand.

    I do know how to split the boxes, just thought it made sense to me. It actually means she was tested in the middle of those slots. A +9 to +10 box with a single number represents a single test @ 9.5. I can change it going forward to notate the exact time. So I assume people probably use the first box slot.

    Isn't a +3 in pm cycle as good as +2? That is when I try to wrap up the night. I see that her declines are later so if I check @ +3, it will give more indication where she is headed and perhaps avoid an extra poke unnecessarily.

    Have a good night. Thanks for the input.
     
  27. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    You know her best but I just wanted to throw that out there. When she does occasionally get Latte's food, is it always dry?

    Often, that would indicate a bounce. When the liver has become accustomed to higher numbers, any lower number (not necessarily a low number but just lower than the high numbers they've been at) can cause the liver to release glucagon, glycogen, and other counterregulatory hormones to bring the BG back up to where the liver recognizes as normal. The longer a kitty spends in normal numbers, the more the liver adjusts, and, hopefully, minimizes or stops bouncing.

    That would be helpful, thank you. You can see examples on Gracie's SS.

    Lantus cats "typically" onset around +2 and that's why that test can be helpful. However, I know Mocha does not always like tests so it's your decision. Just keep in mind that if she's dropping and you don't catch her at +2, then it could potentially be a little harder to get her slowed down at +3 but it's just a suggestion and only you know what is best for her and for all the other things you all have going on.

    Good night! See you tomorrow.
     
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  28. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    Yes, Latte is primarily "dry" from Purina one Chicken, grain-free. She has fish allergies and this is the only food I can find that is nutritious (w/o all the "meal") and she tolerates w/o ripping @ her hair. It also gives her the freedom of having a set aside "station" on our kitchen counter that Mocha's little legs can't propel her to. The Purina Chicken is not that cheap, in terms of dry. I have tried so many dry and landed on this one the best.I am going to "stick" by Latte as she eats so she has less chance of run ins w/ Mocha if I turn my back to do something quickly. I will make a habit of that. She has only got into her food 3 times since I put her on insulin. And the portion size is not huge that Latte has because she is a heavier girl. But, I will focus on this not happening.

    And, Mocha's Purina Beyond is $1 a can and she burns thru 3 1/2 to 4 (if she is really high in glucose). It is expensive but only 2% carb. Since she was getting it before with gum problem, it only made sense to keep it when I learned how great the carbs were. She is also VERY fussy.

    And, not only is Latte allergic to fish and fish oil but she is only a "gravy licker" from any wet. I tried everything Pet Supplies Plus could think of in the premium lines to supplement her diet and she hated them all! I found one she likes by mere accident as a carb boost for Mocha and Latte was sitting right under her as if feed that to me! It is an Iams product. I would love that they could eat the same but it does not seem to be possible. Latte loves that but it also over $1 a can and she would have allergy issues if consumed frequent because still a fish product but for some reason that one is the only one that did not irritate her.

    I am not able to work and have no income from the car accident, so I have to be prudent. Supplies are expensive. Neither will touch the Fancy Feast line or eat any fresh cooked chicken or turkey.
     
  29. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    Have you tried the dry Purina Beyond Grain Free for Latte? I've read from someone research (I've got to learn to bookmark these things) it's suppose to be one of the top 5 dry foods for ingredients and it doesn't contain the carrageenans.
     
  30. Mocha aka Cold Play

    Mocha aka Cold Play Well-Known Member

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    Sep 23, 2015
    That is what she gets. It is the brown bag with chicken. I can't ever remember the name and the bag is upstairs. It is a great product but not one that Mocha should get to.
     
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