Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Juliet, Feb 20, 2018.
Nice start for Silver. I hope he keeps surfing today.
Should I be thinking about increasing or fattening up his dose? He’s still mostly in blues.
If you are following SLGS, you would hold the dose. Technically with SLGS, you would have reduced the dose with those numbers below 90. I would hold the dose. Have you decided if you are going to use a lower number than 90 as a reduction number? If you are, you may want to add that to your signature line so people will know when they are offering advice.
I’m only reducing dose per the accucheck. I am simultaneously checking both meters. He has not earned a reduction yet. That 3.2 the other day was 5.3. Not quite earned. I’ll hold til the weekend. Mostly blues is not what I am aiming for. I don’t get responses when asking for advice except from you and occasionally Stacy so not much point updating signature.
It makes is hard to give advice when you are using the other meter. If you note that in your subject line it will remind people of this in case anyone else does check in. I hope you see more green soon.
I only use it to double check any low number and it should not make any difference whatsoever.
It’s not that you’re double checking that makes a difference, it’s that you are double checking and using the meter you don’t use regularly to confirm that the number on the meter you do use every day is “safe” to shoot. That is what makes a difference because like I wrote yesterday, it’s just not going to match up and be reliable in the way you think. A 50 on one meter isn’t always going to be an 86 on the other. This is why we can use human meters instead of Alphatrak because using the same meter will show trends because it is consistent with itself (and itself only, even 2 meters of the same brand wouldn’t necessarily be consistent with each other).
I hope this is the same in Canada or else my example won’t make sense, but you know how they size women’s clothing in the most arbitrary way? Men need to know their waist measurement and inseam and can go buy pants pretty much anywhere and they should fit. But for us ladies, we get some random size number like 4 or even worse S, M, L. A size 4 in one store could be a size 8 in another store/brand and yet again a size 6 or a size 2 in different ones. So this would be like you going to Macy’s and insisting on buying pants in a size 4 from several different designers because at Gap you are a size 4. It just doesn’t scale like that (sure wish it did for meters and clothing).
You’re misunderstanding me completely and utterly. That’s ok. I’ll continue to do what I need to do. I was not asking advice on MY choice to check on the other meter when I see a low number. I know what I am doing and why I am doing it. I do not need to explain my reasons further.
It does seem we are misunderstand each other, I’m not attacking you and you absolutely don’t have to justify or explain anything to me or anyone else. I only brought this up because you ask for help, ideas, and opinions and you’ve made comments to the effect of nobody wants to help or you’re at this alone, but that’s not what I’m seeing, it makes people uncomfortable to suggest anything that could potentially cause Silver harm because of the 2 meters being used and nobody knows what the number actually is, because you can’t leave food out, etc. I hope that makes sense. Was just trying to clarify why you’re perhaps not getting the responses you are looking for and some things to think about to help others help you and Silver. What you do with the info and Silver is entirely up to you.
What I meant by you being at cross purposes with what I am saying is - I am not using two meters. I may OCCASIONALLY grab a test with the accucheck for my own curiosity. NOT to base decisions on. I have decided to reduce his reduction number from 90 to 60 but that is nothing to do with the other meter. Hence me saying it should make no difference to advice. I don’t really care. If people want to boycott my thread that’s fine. But unfortunately it is Silver who will suffer from that boycott and that makes me sad.
I’ve had a lot going on over here and haven’t been on the board as much as I’d like to be. I completely didn’t realize you’d picked a reduction number and it is 60, I’m sorry I missed that. I was of the impression you were doing reductions at 90 based on the other meter. That alone will be helpful for others to know, would be good to add “reductions at 60” to your signature so people know you made that modification and aren’t asking why you didn’t reduce at 90.
We’re all here to support each other and we’re in it for the kitties. Do what you can do, take the advice for what it’s worth, keep what you like and toss what you don’t, but know that anything people take the time to offer or suggest is coming from a good place and we all just want to help.
I thought you were making your dosing decisions on the other meter. I didn't realize you had picked 60 as your reduction point either. That is why I suggested you put it in your signature line. I check in on multiple cats and it's not easy to remember every little detail about each cat. If the information is in the signature line, I can find it easily and offer better advice.
Hence me getting frustrated as I knew we were misunderstanding each other all three of us so I was about to give up and stop posting. No worries. I will update my signature. My number is 3 hence me not putting in signature as I use Canadian numbers. There are only two of you commenting in my condos anyways and I thought you both knew.
Right now I am holding the dose. My concern right now is that his lowest point is preshot. The times @Stacy & Asia you see him coming up at PMPS is where I have fed him at +8 or +10 (noted on ss each time) and that is reason for increase. His nadirs seem to be at preshot which makes it very difficult for me to know if I should increase. I don’t want him in blues all day as I should be aiming for greens.
Personally if he stays in blues during day and green preshots I think I should increase to 3.5 or fatten the 3.25 to get him in greens all day. The concern for me is if he should switch things up and decide to be a normal cat who comes down after preshot in a normal curve. Then we are in trouble. If he keeps doing what he is doing then an increase is safe. But what if he doesn’t .....?
Okay ignore the above....I clearly don't know what he is doing. He is at 50 and I reduced and shot 3u. I don't even know if I should have shot anything. I think this is what would have happened over the weekend if I hadn't fed him at +8 and +10. I sure hope that his preshots are still his lowest number. He is fine and all his p's are ppperfect. Will test in an hour. @carfurby @Stacy & Asia given how low he just went - should I reduce by more than .25. This is a scary low and lowest I have ever seen (even when he was in remission).
What is the “no shoot “ number ?
The "no shoot" number depends on which approach to dosing you're using. If you're new to managing your cat's diabetes, the no shoot number is 150 and with SLGS it's 200. You post and ask for help if you're a newbie if your PS is at either of these points. Once you're data ready, with TR you don't shoot numbers below 50 and with SLGS, below 90. Since you're using 60 as your reduction point, that would be your no shoot number. In any of these situations, you would only shoot if you had supplies (strips and HC food) and were able to monitor.
BTW, I can't open your spreadsheet. It indicates that I need permission. Could you check to make sure that your share settings are for anyone with the link?
Oops I already shot the dose as last time I gave a BCS and he landed in pink and his preshots are his lowest point. I’m not a newbie but not doing TR either.
Silver definitely earned the reduction. I think as long as he is at a safe number tomorrow at AMPS, you should stick with the 3.0 units. You don't want to take him down too fast and have to go back up.
Are you able to get more tests in tonight?
If you changed his reduction number or 60, then you would reduce by .25, which you did. The problem with shooting is that it may act much the same as if you gave 3.25 anyway because of the depot. There is no concrete no shoot number with SLGS, when you don’t have enough data, the guidelines recommend not shooting anything under 150, but not sure how to interpret that if you have data. But in general, green isn’t the goal with SLGS, it’s the goal is flat numbers over 90 (which is pretty much blue with a tiny allowance for green).
I’m guessing he will get the typical food bump he usually does, but after that, he will probably go down. On the 16th you shot a 79 and he was 77 at +4 and likely went a lot further down after that in order to have that 58 preshot the next morning. If you can’t keep him safe with checking his BGs tonight because you have to sleep, please give him lots of high carb food before you turn in.
Yes I’m home all evening. About to get a + 1 in ten mins to see his high his food spike is.
The only reason I can’t do TR is because I can’t get a daytime test in during the working week. My goal is remission not even green all day. I have been shooting under 150 for weeks.
Remember - he is flat most of the cycle from the food bump to preshot. Preshot is his lowest. So the day I shot the 79 and he was at 74 at +4 he likely did NOT drop much further. His preshot likely as low as he went. I have a lot of curves to prove that.
That’s good data to have. Curious what your other monitor said if you checked the 50 with it, since they should be closer at lower numbers?
I did actually - the other meter read 5.2 (94) and it read 5.3 (95) when he was at 58 the other day. Not as close as I would like. I am presuming he is somewhere in the middle of the two as I do know that freestyle measures on the low side. I just tested at +1 and he is only 113 so the food bump didnt bump as high as usual. A little worried. Will try and stay up as late as I can. It is 7:45 pm now and I will get a test at 8:45 pm. I usually go to bed at 10 but will try and last til 11.
Gonna test hourly until I go to bed.
Those are not very close at all! And I want to say I read in Canada the meter variance allowed is 15% instead of 20%, don’t quote me. I think rather than in the middle, one of them is wonky and one of them in the allowable 15% or 20%.
Testing hourly is a great idea.
It’s 20% allowance same as USA but I don’t like the big variance. If I was still using the accucheck alone I’d presume he was at 94 and perfectly safe when he might not be if he’s really at 50. So you can understand why when I see 50 I am dubious. On accucheck no reduction is earned.
And both meters are new so doubt one is wonky.
@Stacy & Asia @carfurby given that his lowest point is preshot how am I going to know when it’s safe to go to bed? I always feed him at bedtime so I can feed extra but he didn’t spike that high with food tonight.
I haven't been following Silver's progress but just wanted to encourage you to post when you need to!
I have a handful of people who are my usual support. Every now and then I get a new person encouraging me on my condo.
Sometimes it's hard to give advice if you don't think you have anything of value to add or nothing more than what others have posted already.
Don't let that bother you too much. When we are in a pinch, you'll have people here to help.
For your question about when it's safe to go to bed: took a quick glance at your SS and the pm cycle on the 18th-- you shot 3.25 on a 79. So comparing it tonight, shooting 3 on a 50-- in my opinion that's not that much difference. If you can get a +4 you might be able to decide if he needs a snack to help him surf until morning. Or if it's possible, set an alarm for a later test too.
Thanks. Appreciate your comments. Many have left posting in my condos on purpose tho so my support had shrunk greatly. People do not understand my British way of speaking and get offended at me. Constantly.
A lot of times when we shoot low, the cat will surf. Hopefully Silver will surf tonight. You next test should give you an idea of what he's going to do. Are you able to give him more food before you go to sleep tonight if he needs it?
Yes. I usually feed him at bedtime anyways.
Sorry I misread what you said. I think you are saying you can feed him at bedtime.
We cross posted. How soon until you can get another test? I'll be up for about another hour then I have to get some sleep for work tomorrow.
It's not a matter of newness, I think one may be defective. You could call the companies and inquire if you wanted to go through the trouble, they will probably tell you to get their testing solution to check accuracy.
Let's say the "real" lab number is smack in between the 50 and 98, say 74, + or - 20% of that wouldn't make either of your meter numbers accurate. The lowest the 98 could be and remain accurate is 80, the highest the 50 could be and remain accurate is 60. But anyway, this is why it's best to stick with one meter, it makes your head spin and it's frustrating to not know.
As far as keeping him safe, I can only answer you what I do, and I either stay awake until numbers are coming up, or I sleep for small increments and set my alarm to get tests until I know numbers are coming up. Sometimes, knowing where her nadir is and where she likes to drop, if she's been surfing, I make sure she has food and turn in at long last and just hope for the best (usually towards the end of a cycle). I know you can't do that, so you just have to do what you think is best, my suggestion would be to carb him up and send him high.
Oh, and not carb him up now, of course, see how things play out until you have to turn in and carb him up at the last possible moment and get a test 30 mins after to make sure he's going higher.
I just did. 155. Very odd. Dunno why still climbing. I rarely get a +1 so if I saw just the preshot and this 155 that’s a heck of a food bump. He usually goes up about 6 Canadian points betwen preshot and +2 so 2.8 to 8.6 about usual.
I don’t have high carb in the house. He is climbing still at +2 so I think he will be safe. Will test at least twice more.
I'm of no use with this as neither confident or experienced enough to be of good help
So here is a dreadful joke instead.
Q What do cats eat on a hot day?
A Mice cream.
Neither meter is defective. Guaranteed. I have three accuchecks. All the same. Not defective. There is a huge variance betwen freestyle and accucheck and I have been saying that for weeks.
Lol!! Silver is purring quite contentedly beside me not caring about all this fuss.
Yeah his preshot his his lowest so I am not staying up all night. He is a weird cat and climbs over 100 points with food bump; surfs up there til +8 then comes down to low preshot. Can’t stay up that late.
It does seem like Silver's nadir may be the PS number tonight. If that is the case he may keep going up and you won't need to carb him up.
My cat gets huge food spikes too. Quick look at his SS and you can see 200+ food spikes. We are working on that currently. He's high dose, so it could be due to acro. Which is a whole different story.
The way I use the meter variation is like this: I look at the number before the current one. I decide if it's a rise or decrease based on that 20%. If it's within the 20% I consider it the same number. I also look at the preshot and highest test to decide if the number I just got is a decrease or not.
I've shot as low as 54 I believe but did a BCS dose (shooting 16 units on a 54 is enough to make me completely lose my mind the first time) I follow TR.
The 155 at +2 makes me think he will do just fine tonight.
167 at +3. Why still climbing?
I haven’t been able to check in because I’m completely overwhelmed with work, but wanted to stop by and let you know I’m thinking of you!
Thanks. I was going to stay up and see if he was safe but he is still climbing at +3.
Yeah, I’m up anyway and will gladly chill with you. Hamilton is bouncing himself from a weird low, so I’m in the same boat. Though, Hamilton curves with a bit more mercy than Silver, so I’m lucky there. So far, it looks like Silver’s doing his typical food spike. Maybe he’ll start coming back down in the next hour or so.
Gosh, you’ve got a tough case! Perfect call on the reduction, but don’t judge the dose before he clears this bounce. Give him 24-48 hours and be as patient as you can manage. You’ve got this!
Probably a bounce, he's not been as low as 50 that you know of and it probably scared him just as much as it scared you!
Well I’m still up but dunno how much longer. I’ll grab a +4 and feed him his bedtime snack and head to bed. It’s good as I want him in low greens but then the dosing decision gets harder.
Yeah him nadiring at preshot is a horrible time to nadir.
Compared to your other green preshot cycles, those numbers look normal/similar.
It could be Silver's version of a bounce or that he sees a later onset along with a later nadir.
I hope I am not faced with 50 at AMPS. I likely will want to skip.
And just a note to all, communicating over text is sooo hard and I completely understand the hurt people can feel when it seems like someone is dismissing the help you’re offering out of the goodness of your heart. I’ve said it before and I’ll say it again, Juliet isn’t intending to be dismissive and sometimes it can be hard to list all the reasons why the suggestion might not apply. I’ve also noticed she’s been under stress at work and home and her frustration with Silver’s numbers is understandable. He’s a super tough case. No one told Silver the rules.
Hang in here with us, if you can. And try and read her posts with a contemplative tone more so than dismissive. It is truly a cultural divide.
Thanks Elizabeth. Appreciate that.
Must go to bed now it’s 10:45 and I am up at 5:45am. Fed him a full can of low carb FF instead of his usual 1/4 can at bedtime. Hopefully raise him for the next three or four hours and I’ll be up in seven hrs. Best I can do to keep him safe.
With regard to the PM cycle on 2/20, I suspect that the 50 at PMPS may have been when numbers were on the rise. Unfortunately, when we have to work in order to afford strips, there's no way to know just how low numbers go when we're not home. As others suggested, what you saw may have been a bounce.
The other possibility was that Silver happened to have a late nadir. It can help to remember that while a cat's nadir may routinely be at a particular time, it may not always be at that time. Gabby's nadir was typically at around +3 -- except when it wasn't. Our kitties tend to like to keep us guessing!
Actually his preshot is his lowest. I already know this. He won’t have gone lower than 50.
Just our of curiosity, how did you know that the pre-shot number was Silver's lowest?
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