2/24 Silver AMPS 250 +3=286 +5=290 +7=238 +10=176 PMPS 252 +2=257 +3=203 +5=191

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Juliet, Feb 24, 2018.

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  1. Juliet

    Juliet Guest

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  2. carfurby

    carfurby Well-Known Member

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    It's possible he went lower yesterday during the day while you were at work and you couldn't see it. This could be a bounce from that. If he doesn't come down today and give you a green, I would increase the dose back to 3.25 units.
     
  3. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Could indeed be a bounce. I'd look to see what happens with this dose over the week-end (if you can get some tests in today and tomorrow) and decide based on that.
     
  4. Chubba (GA)

    Chubba (GA) Well-Known Member

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    I hope Silver comes back down for you today. :bighug:
     
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  5. Juliet

    Juliet Guest

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    I really do not think so. That is not his usual pattern. His nadir is late remember. He spikes and gradually comes down so the lowest he goes is his preshot. Yes. Already increasing. There will be no green today. More than likely he will be up into pink.
     
  6. carfurby

    carfurby Well-Known Member

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    The problem with that is that most of the time the nadir is the same time, but sometimes bouncing can make the nadir move. Either way the extra tests you can get in today should give you an answer. All we can do is the best we can around our work schedules.
     
  7. Juliet

    Juliet Guest

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    Yeah I know. I feel like I am in a losing battle though. We saw very low green and therefore had to reduce - but obviously that was a mistake as we are now in high yellows. 286 at +3 :banghead::banghead: I should not have reduced but how else do you come down the dosing ladder?
     
  8. Juliet

    Juliet Guest

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    Looks like he’s missing his tutu and wants it back.
     
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  9. carfurby

    carfurby Well-Known Member

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    Unfortunately that's part of the dance to go back and forth in dose sometimes. There's a saying around here that it's a marathon, not a sprint. :bighug:
     
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  10. Juliet

    Juliet Guest

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    Yes I’ve heard that before but I am going away in 7 months and he will be off insulin when I am gone for almost three weeks. That’s why I need him on a much lower dose by then. Dont have the time for a marathon.
     
  11. Tracey&Jones

    Tracey&Jones Well-Known Member

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    I think Silver needs more insulin.

    The case for a bounce - His nadir's are late based upon the curve data collected - 2/10 was +10 - 2/11 was +8 - 2/12 was +10 and on those days Silver seemed to pop up a bit for PMPS. So for 2/20 - that PMPS of 50 (which regardless of meter) was one of the lowest numbers he has been at and he might of actually been coming up for a lower number at +8 to +10 range.

    That all said - it is cycle 8 since the dose reduction and you have not seen a green. At this point, I would expect a bounce to clear. ECID though. In fact the lowest number is 146.

    So back to original statement...I think Silver needs more insulin.

    I was gone for 3 weeks when Jones was first diagnosed..I lowered his dose to the dose suggested here and I came back to a cat in greens and blues. September is a long time away and no one can predict where Silver will be by then. Stay in the now as much as you can.:)
     
  12. Juliet

    Juliet Guest

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    Yes I agree - he needs to go back up again. So I should not have reduced him in the first place right? He is a long-term diabetic and I didnt see any guidelines as to what long-term diabetic should do when following SLGS when it comes to reductions.

    If he was coming up when I saw the 50 would that not have put him in hypo when I was at work and I would have seen signs of that when I got home? Funnily enough - he has absolutely no signs of diabetes at all which is surprising, he is not super hungry, he pees and drinks normally and is happy and purring all the time.

    I am trying so hard to stay in the now and not think about Sept but I have to book a flight and make decisions much sooner than that and its hard to do that. Its my biggest stressor.

    Everyone keeps telling me I can't look at what he was several days ago and that his nadir may have changed. I don't think so though - he is up at +3, up at +5 and only coming down again now at +7. He seems to have a very small window for coming down as the same pattern will start over again at PMPS in just 5 hrs time.

    Anyways, thanks for the advice, I will increase him with tonight's dose and think more carefully next time he looks like he's earned a reduction as they don't seem to work with him.
     
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  13. Tracey&Jones

    Tracey&Jones Well-Known Member

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    I haven't either. I reduced when Jones goes to 70 or below and I have waited about 6 six-8 cycles before going back up if I don't see the green again. Which is fast tracked but he as been FD for over a year and with Jones he is on prednisolone which is the most likely culprit for the FD. I have that marked in my signature that I have individualized dosing. My reduction number is lower (which I have noted in my SS) and I will to go back up quicker than the 14 days (which I should not in my SS).

    You may have not seen signs, as per my reply the other day in another thread. Some cats don't show signs unless they are really low. An ER vet told me one time that hypo was an absolute - at a certain BG the brain can't function and then you see symptoms. Not sure I understood all that, I am sure it is a small range and when a particular cat hits it - then you see the symptoms. Sometimes non-diabetics will be in the 40 range with no issues. The thing with FD kitties - is that they have insulin on board which is not natural - it is an additional factor to keep in mind.

    And some of his upward movement is not a huge swings - 2/10 and 2/11 weren't in my mind.

    I know it is. Been there and done that.
    Jones has done the same with me lately. Up to 0.75 down to 0.5u up to 0.6 units, down to .50 - earned today.

    I look at the last 14 days to see if there is a pattern and look at that. To me a month doesn't mean much as a month is a long time in cat time.
     
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  14. Juliet

    Juliet Guest

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    Thanks. I did wait until he was 50 to reduce. You know - on the other meter that 50 read 94. That’s why I get to wondering whether he was ever really at 50. Maybe I should change my reduction point to 40. I don’t know why Freestyle measures so low. I was on the phone so I’ve mussed his +9. Will have to make it a +10 and pmps. Although I think I’m going to have to see him at +10. They’ve been shouting for food for a while. That will mean his PMPS is on food spike and will be higher.
     
  15. Juliet

    Juliet Guest

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    So I dont understand why - but he is still climbing all the way to +5 then only does he start to come down. So now he hit blue at +10 and if I hadnt just fed him, would be a little lower at +11 and either slightly up at preshot or still dropping. But I just fed him as he has been asking for hours and so the next four to five hours he will climb and we start all over again. Anyone else have a cat climb and keep climbing after food? He doesnt seem to start using the insulin until after +5 either. So, onset at +5, nadir - still not tooooo sure when that is. +10? +11? preshot? I can't withhold food from those eyes or the piercing yells until his preshot at weekends.

    I will test him at preshot but I guarantee it will be yellow again....and his shot will be back up to 3.25....he may onset earlier as he won't get more food at preshot so we may see lower numbers earlier this evening.

    Anyone got ideas how I fix this food spike? I am giving FF Classics 3/4 of a can am and pm with a 1/4 can at bedtime.
     
  16. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Nether of you have seen any because there aren't any written guidelines for long-term diabetics when following SLGS. SLGS wasn't created to intentionally push BG numbers down into the range of a healthy cat (50 - 80 mg/dL) like TR.

    That said, there is some leeway in the SLGS guidelines once a caregiver "knows thy cat"... knows their kitty's response to food and insulin. Let your experience with Silver... what you have learned about Silver's response to food and insulin... be your guide.

    However, whenever one deviates from the norm (no matter which protocol, method, or customized plan one is following), they're assuming an even greater responsibility for keeping their cat safe. Greater responsibility = careful/frequent monitoring + access to a food supply so kitty can bring their blood glucose up on their own. Since we know that's not an option, you'll probably find it necessary to run him in a little higher numbers than you'd like to see (to keep him safe).

    Looks to me like Silver has become a late nadir cat... for now anyway. While it's not exactly common for Lantus kitties to have late nadirs... it's not rare, either. That doesn't mean he won't switch things up on you at any given time.
    *Usually* food spikes can be controlled by feeding strategically timed small meals frequently. While you may be dealing with food spikes, I think you're also dealing with a late nadir kitty. Given your circumstances, I'm not sure if there's anything you can do. You might just have to roll with it for now and hope things change for the better.

    The good news is overall, Silver does seem to be doing better. How does he seem to be feeling?
     
  17. Juliet

    Juliet Guest

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    He’s doing great. You wouldn’t think there was anything wrong. I do want the low numbers tho as I am hoping he will earn a second remission. Anything is possible. But I won’t take unnecessary risks either. Most of my dosing decisions are judgement calls.
     
  18. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    I know it may not seem like it, but that statement is the best part of this whole thread! :)
    Yes, anything is possible and I certainly wouldn't give up hope!
    Good. None of us want that to happen.

     
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  19. Juliet

    Juliet Guest

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    He’s my world. And very much spoiled.

    BF9D3214-A59B-402E-86FB-7FCD30CF55AB.jpeg
     
  20. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Ha! He's such a cutie!!!
     
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  21. PussCatPrince - GA

    PussCatPrince - GA Well-Known Member

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    @Jill & Alex (GA)

    You've actually touched on something I am tussling with . A change of my mind set over 'numbers' but I won't clog Juliet's thread with my musing.

    Silver is so beautiful and his name so totally is him.
     
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  22. Juliet

    Juliet Guest

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    Clog away. I might find something helpful.
     
  23. PussCatPrince - GA

    PussCatPrince - GA Well-Known Member

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  24. Juliet

    Juliet Guest

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    The higher PMPS is due to food spike as fed at +10.
     
  25. Juliet

    Juliet Guest

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    The boy is going to hate me tonight but I’m going to test him hourly til bedtime. Need to find out where his onset currently is. He was fed at +10 and there’s no real difference between preshot and +2 so let’s see if he is down at +3. Hoping he’s not up as last food would have been five hours ago at that point.
     
    Last edited: Feb 24, 2018
  26. Juliet

    Juliet Guest

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    Ok so onset IS between +2 and +3 where it should be. It’s just the food spike that keeps him high to +5. Fed earlier today so I’d see where onset is without food. That’s good info @Elizabeth B. So now to figure out where exactly his nadir is. That could be trickier as it’s already time for bed for me. Will try and stay up another couple hours but can’t set alarm for +10 where I think his nadir is. Will be wrecked the next day if I do.
     
  27. Tracey&Jones

    Tracey&Jones Well-Known Member

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    So you feed him two hours early so to speak?
     
  28. Juliet

    Juliet Guest

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    I did today. It’s hard to make him wait 12 hrs between feedings when I am at home. It’s a necessity during the working day.
     
  29. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Good data to have, and at least you know the amount of food you usually feed sends him up for 4-5 hours.
     
  30. Juliet

    Juliet Guest

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    I only give him 3/4 a can FF. Should I feed less?
     
  31. Sean & Rufus

    Sean & Rufus Well-Known Member

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    To maintain weight it's 20 cals per pound
     
  32. Stacy & Asia

    Stacy & Asia Well-Known Member

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    How much you feed him depends on his weight, if he's not overweight and what you feed maintains his weight, I wouldn't mess with it.
     
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  33. Christie & Maverick

    Christie & Maverick Well-Known Member

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    Sorry to butt in, but I think Juliet is wondering more about feeding to manage the drops or the rises in BG?
     
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  34. Tracey&Jones

    Tracey&Jones Well-Known Member

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    Sorry can you remind me what FF he is eating and the %. If I remember correctly there is a certain one or two that he gets?
     
  35. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Yes, but she can only feed him at AMPS, PMPS and before bed (except for weekends), so maybe it would be ideal BG wise to eat less food at once, but not less food overall (unless perhaps he is overweight) and she doesn't have the ability to leave food out or split up his meals any differently than she's already doing.

    Also, Juliet, if you change the way you feed him on the weekends, it will skew the data for the weekdays because he may respond differently, it can get dangerous when you are dealing with green numbers. It's good to experiment and get the data when the numbers are higher, but in order to make accurate dose changes, you want to replicate as much as possible the same data conditions you have during the weekdays since you have no wiggle room there.
     
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  36. Juliet

    Juliet Guest

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    Not necessarily. ECID
     
  37. Stacy & Asia

    Stacy & Asia Well-Known Member

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    I'm not sure if she's gone to bed, but I think they were seafood varieties if I remember correctly?
     
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  38. Christie & Maverick

    Christie & Maverick Well-Known Member

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    Understood...like I said, sorry to butt in.
     
  39. Juliet

    Juliet Guest

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    Not really. No. @Stacy & Asia is correct.
     
  40. Christie & Maverick

    Christie & Maverick Well-Known Member

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    Alright, good to know.
     
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  41. Juliet

    Juliet Guest

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    Yes I totally agree. But it’s very hard to resist those pitiful “you’re starving me to death” eyes. I would never normally leave a cat food 12 hrs without food. I must five days a week but when I don’t have to I’d rather feed smaller and more often. Yes I know and accept that I won’t know what Monday to Friday is doing which is why I don’t make mid week dosing decisions.
     
  42. Juliet

    Juliet Guest

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    That’s right. It is in my signature.
     
  43. Juliet

    Juliet Guest

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    You’re not butting in at all. I wish I could feed during day. When money isn’t so tight I’ll save up for a couple automatic feeders. But I have two cats and will never know who is getting what.
     
  44. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Ok. You are right, ECID. It was a generally accepted number. I was trying to be helpful. Sorry.
     
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  45. Juliet

    Juliet Guest

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    He will only eat Fancy Feast seafood. Had nothing else for 12 years.
     
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  46. Juliet

    Juliet Guest

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    I wasn’t really asking if he was getting too much or too little food but the amount per serving. I wasn’t clear.
     
  47. Tracey&Jones

    Tracey&Jones Well-Known Member

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    You can experiment and see how Silver reacts to those smaller meals/more often and it would be great data, however, it isn't your norm and it might just end up frustrating you and causing an unclear picture.

    I wish you had more options but life isn't like that is it?:blackeye:
     
    Last edited: Feb 25, 2018
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  48. Juliet

    Juliet Guest

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    Nope.
     
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  49. Christie & Maverick

    Christie & Maverick Well-Known Member

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    Just thinking outside the box, is there anything wrong with trying to break up smaller meals in the evening? I know it's not possible during the day, but that may flatten things out in the evening and Silver won't see a huge spike post pm meal?

    ETA: looking at tonight...food spike didn't actually happen?
     
  50. Stacy & Asia

    Stacy & Asia Well-Known Member

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    I know, that’s the worst! Asia gave me some number in the 30s once and I didn’t want to make her full so I only gave her little bits at a time but she was so hungry and gave me pathetic “why are you doing this to me, can’t you see I’m starving” eyes! Ugh! I felt like a terrible person right then. :blackeye: We are powerless to their charms!
     
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  51. Juliet

    Juliet Guest

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    I fed him at +10 that’s why. I do try and do the smaller more regular meals at weekends but @Stacy & Asia and @Tracey&Jones are right in the fact that I won’t know what’s going on during the week that way.
     
  52. Juliet

    Juliet Guest

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    And Silver has the loudest yowl ever. I swear my landlord can hear him at 4am three floors up!
     
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