3/4 Sebastian PMPS 248 +1.5 325 +10.5 250

Gill & George said:
you may want to stall without feeding and wait for the rise.
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I still don't understand what the point of this is. How is he going to rise if he's not eating? He didn't really eat any of his dinner or overnight food, so wouldn't that be what's causing the lower than normal numbers and we need to get food in him?
 
Justin & Sebastian said:
I still don't understand what the point of this is. How is he going to rise if he's not eating? He didn't really eat any of his dinner or overnight food, so wouldn't that be what's causing the lower than normal numbers and we need to get food in him?
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At the end of the insulin cycle the numbers will rise.

Problem is that every cycle doesnt last exactly the same amount of time.
Many factors affect the duration. So sometimes duration could be 11hrs and other times 13hrs, longer in some cats.
 
Think of insulin be realeased gradually into his system when you shoot, onset, start of insulin cycle at around +2 then insulin concentration increasing to a peak roughly around +6, then gradually reducing until duration is over at around +12.
 
Okay, but he hasn't eaten in like 11 hours, so isn't it an artificial low? Also, didn't someone tell me you don't want to stall more than 30 minutes? If the cycle is taking +13 and we're only waiting 30 minutes, how does that help? This just seems completely counter-intuitive to me right now.
 
When you get a lot nger duration of +13 or +14, that's when you get carry over and overlap.

Look in the new to group sticky there are explanations and links to the terms so that you can understand how Lantus works.
 
Gill & George said:
When you get a lot nger duration of +13 or +14, that's when you get carry over and overlap.

Look in the new to group sticky there are explanations and links to the terms so that you can understand how Lantus works.
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I've read it I'm just not understanding how it applies to his general situation with being ketone prone and having previously been told he needs to eat and get his insulin above all else, and his current situation where he hasn't eaten in so long.
 
Justin & Sebastian said:
Okay, but he hasn't eaten in like 11 hours, so isn't it an artificial low? Also, didn't someone tell me you don't want to stall more than 30 minutes? If the cycle is taking +13 and we're only waiting 30 minutes, how does that help? This just seems completely counter-intuitive to me right now.
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It doesn't end abruptly, I can't advise you to shoot a number that is lower than usual because I won't be there to help you when you get it, unless he is below 50, you should probably shoot and assist feed if necessary. You will have a couple of hours at least before the next shot onsets.
The fact you are not using HC gravy the last couple of cycles will have impacted the cycle. Which may be also contributing to the drop.
In most cases the stall helps the CG rather than the cat. But do not shoot and stall of he is below 50.
Look at the how to handle low numbers that gives you an example on how to proceed if they are below 50 at the end of the cycle.

I suggest you tart a new condothe +11 asking for someone to help you through it. I'm waiting for an a so will be off line any minute.
 
Sorry, on my phone , didn't see I was on new condo.

The 86 is ok to shoot, get a +1 and +2
If +1 is the same or lower give more food, and also at +2.

I'm waiting to be called through so I will be gone imminently, not back on line for an hour or two.
 
+2 86. I have to head out for about an hour so I'm feeding him a little more with 1tsp of HC gravy on top to slow the onset and I'll check him when I get back.
 
Just got back home.

Justin & Sebastian said:
+1 is 80, giving him some more food
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Looking good at +1

So +1 is flat.
What does that tell us?

No food spike, if duration was up and you fed we would expect a little bump up in numbers. The fact that there is no food spike, would tend to suggest that we are getting a little bit of Carryover, last nights cycle isn't up yet, this is good, it's what helps keep the numbers low and yield the flat curves that Lantus and Lev are well known for.
Now what remains to be seen is what happens at onset, typically around +2, as he onsets we might expect a little drop or for the numbers to remain the same, as this mornings shot onsets and last nights shot reaches end of duration.

The idea of feeding a little more food at +1 when you've seen the numbers remain flat is to make sure he has a little extra food/carbs on board to counteract any sharp dip you might otherwise get at +2 when he onsets.

Justin & Sebastian said:
+2 86. I have to head out for about an hour so I'm feeding him a little more with 1tsp of HC gravy on top to slow the onset and I'll check him when I get back.
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Still flat at +2, so looking good.
I would have probably ideally stuck with LC, if you were sure to be back at +3. However if there's a chance you are going to be held up then I understand the choice, just wanted to explain that when faced with this sort of pattern/situation LC would be a better choice, if you have a variety of LC perhaps LC in the higher end of the range 7-9%.

He may be onsetting a little later than your average cat, but I'm not so sure, because you've been changing carbs and feeding schedule and that will skew the numbers somewhat. Once you settle down into a regular feeding pattern and food type it will become more apparent.

Have you read this
http://www.felinediabetes.com/FDMB/...y-to-shoot-handle-lower-pre-shot-numbers.147/
 
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+3 110
Gill & George said:
I would have probably ideally stuck with LC, if you were sure to be back at +3. However if there's a chance you are going to be held up then I understand the choice, just wanted to explain that when faced with this sort of pattern/situation LC would be a better choice, if you have a variety of LC perhaps LC in the higher end of the range 7-9%.
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Yeah, I ideally I would have stuck with the normal food but dr's apt + ride share, wasn't sure exactly when I'd be back. But it worked out and I'm here on time. And the +3 is 110 so doesn't look like we bumped it too badly.

Gill & George said:
He may be onsetting a little later than your average cat, but I'm not so sure, because you've been changing carbs and feeding schedule and that will skew the numbers somewhat. Once you settle down into a regular feeding pattern and food type it will become more apparent.
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So far it's been looking like he onsets at +2 - +3 but like you said, lots of changes. He's settled into the kind of food he wants to eat, now we just have to nail down the schedule and delivery method.

Gill & George said:
Have you read this
http://www.felinediabetes.com/FDMB/...y-to-shoot-handle-lower-pre-shot-numbers.147/
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I have, but I know with his history of DKA and the recent p'titis flare things are bit atypical so I'm still trying to work out how closely to follow that, when to stall and by how much, when to hold the shot (if ever), etc.

Olive & Paula said:
In spite of all, those are beautiful numbers.
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I know right? This is right where we want to be. I was thinking we might need to increase the dose but now it's looking more like this is good and he was just bouncing the last couple days.
 
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Justin & Sebastian said:
I have, but I know with his history of DKA and the recent p'titis flare things are bit atypical so I'm still trying to work out how closely to follow that, when to stall and by how much, when to hold the shot (if ever), etc.
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Absolutely with his recent health issues you want to shoot as long as it's safe. The idea of getting those extra tests is to forewarn you so you know what to expect. Because I was out and on my phone I didn't see that you had got a +11.75 and a +12, those two numbers were flat, so you could see he wasn't diving at that point. So chances were that it was going to be less 'exciting' of a cycle. There was every chance that the BG would be rising as the insulin onset, causing the numbers to level out.


The following examples all have the same amps and +10 but I've changed the +11 to illustrate how that might influence your thought process
  1. 114 @+10, 110@ +11, 70 @amps,
  2. 114 @+10, 72@ +11 and 70 @amps
  3. 114 @+10, 55@ +11 and 70 @amps
Example 1, amps is dropping so you may need to pay a little closer attention, and be prepared for an eventful cycle, expecting that you will need to steer early on, you might expect to see a drop at +1

Example 2 numbers are flat as they come into amps, so though you might expect an interesting cycle, there is a greater chance that they will start to rise by onset. I would expect a +1 that was rising slightly or the same.

Example 3 same amps as the others, but number is on the rise, so I would expect a food bump at +1, perhaps even more than a food bump as it appears as we are at the end of duration.
 
Last night he started clearing his bounce dropping into green fro amps, the lower numbers possibly also a result of not much food last night and the cutting out of the gravy food. Then shooting this morning while still low, has led to him spending 9 hours or so in the green/blue range, the yellow +9 may indicate the start of bounce or just the end of this mornings cycle.
 
Gill & George said:
just the end of this mornings cycle.
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So just hypothetically if that's what's going on, that would be this morning's dose starting to wear off and the yellow numbers are, for lack of a better term, his "resting" BG? If that's the case,would that indicate this is a good dose and over time that upper range will come down?

Gill & George said:
may indicate the start of bounce
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And then in that hypothetical, could I expect to possibly see multiple bounces at a particular dose? After some of the reading I was sort of under the impression you might get an initial bounce after adjusting a dose but then it would regulate and stabilize. If there's the possibility of more than one bounce, how do we factor that in to the regulation window for determining dose increases or decreases? Does each bounce basically restart the timing window, or do you just go off the lowest point?
 
Justin & Sebastian said:
If that's the case,would that indicate this is a good dose and over time that upper range will come down?
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Not quite, what tells us that this is a good dose for now is that he is getting down into those greens. It's possible that overtime he'll spend more time in green and the overall range will drop at this dose.
But it's more typical for his insulin need to vary over time, this might mean that he will need less insulin, indicated by him dropping below the reduction point (below 40 for Sebastian as he is a long term diabetic), or there is also the possibility that the dose goes 'stale' and those nadirs on creep up and you need to take the dose up a tad. It's not unusual to have to go up and down with the dose.

Justin & Sebastian said:
After some of the reading I was sort of under the impression you might get an initial bounce after adjusting a dose but then it would regulate and stabilize. If there's the possibility of more than one bounce, how do we factor that in to the regulation window for determining dose increases or decreases?
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Not always, some kitties, stop bouncing, I've known others to bounce right till they went into remission. Some kitties over time as they spend more time in green and blue will start to bounce less, the bounces are less prominent and don't last as long. Hard as it is to see those pinks when he is bouncing, we ignore those, our dosing is not based on the bouncing, but on the nadirs when they clear those bounces, so the 80 today. Bear in mind that bounces can clear at night too, so that pm data, is important in trying to determine how low he is going.

I would hold on to this dose for the mo, with that 80 in there and the food change, we might expect to see his numbers lower.
 
Okay, that all makes sense.

I'm going to start trying to get pm +2 more consistently. And with his low numbers today I was going to play it by ear for tonight. If it looks like he's rising still I'll just get the +2 but if it looks like he's coming back down again I'll wake up and get some mid-PM cycle checks also.
 
Justin & Sebastian said:
Okay, that all makes sense.

I'm going to start trying to get pm +2 more consistently. And with his low numbers today I was going to play it by ear for tonight. If it looks like he's rising still I'll just get the +2 but if it looks like he's coming back down again I'll wake up and get some mid-PM cycle checks also.
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Sounds like a good plan.
 
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