? 8/4Milo +2 218 +4 180 +6 108 +7 84 +8 109 +11 109 PMPS107 +1 125 +2 101 +3 110 +4 116 +6 142 +11 398

Discussion in 'Lantus / Levemir / Biosimilars' started by Danielle & Milo, Aug 3, 2015.

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  1. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    Hi everyone! Milo and I are new to the diabetes world and he is currently on Lantus -One unit, twice daily. His numbers have been all over the place the past several days. Can anyone tell me how Lantus works and give me some advice? He is on his 4th cycle of this dosage.

    Here is a recap of the past few days:

    Friday, July 31st

    -BG test reading: 509 at 7:30am - Gave 2 units of insulin
    -BG test reading: 360 at 11:15am
    -BG test reading: 266 at 7:22pm - Gave 1 unit of insulin
    -BG test reading: 177 at 10:13pm

    Saturday, August 1st

    -BG test reading: 134 (His lowest number since on insulin) at 7:15am - SKIPPED INSULIN DOSE!!!!!!!
    -BG test reading: 342 at 12:30pm
    -BG test reading: 427 at 7:20pm - Gave 1 unit of insulin
    -BG test reading: 291 at 12:00am

    Sunday, August 2nd

    -BG test reading: 394 at 7:15am - Gave 1 unit of insulin
    -BG test reading: 224 at 12:30pm
    -BG test reading: 636 at 7:15pm (His HIGHEST number he has ever been since diagnosed)
    -BG test reading to determine if false reading: 641 at 7:20pm - Gave 1 unit of insulin
    -BG test reading: 367 at 12:30pm

    Monday, August 3rd

    -BG test reading: 383 at 7:20am - Gave 1 unit of insulin
    -BG test reading: 414 at 10:30am

    ***I still need to work on uploading my spreadsheet for him
     
  2. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    HELP! Anyone?
     
  3. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Welcome to the forum Milo and Danielle.... the greatest place you never wanted to be....

    There are several sticky's at the top of this forum that you will want to read. Tons of Info...

    first off, the Lantus dose is based on how low they go during a cycle ( 12 hours)
    It was a good call to skip the other day until you get more data.
    And yes, getting that ss up will help tremendously. We all look at it.

    Try not to react to the high numbers ( I know that's hard) .....
    they are normal and a response to the low numbers... we call it a bounce.
    It was likely a response to the 134....
    Milo's body isn't used to normal glucose ranges anymore so it dumped hormones and his glucose shot up.
    For now.... keep the dose at 1 unit....
    He's looking good and after you are able to shoot continuously without skipping.... we'll be able to evaluate whether or not he'll need an increase or a decrease.
    The depot has to fill up ( see the sticky) before we truly know how he responds to this dose.

    And when it is time to increase or decrease, we use 1/4 increment changes.....
     
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  4. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015

    Thank you! This is helpful! I will be doing the spreadsheet tonight! He has been up and down and the lowest was the 134 a few days ago. He was so high last night in the 600s!!!!! I hope his +6 reading is better
     
  5. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Jul 9, 2012
    I know the highs are scary at first but it's okay.
    The first thing to learn is not to increase the dose because you see a high number. Consistency is the key with Lantus.
     
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  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Hi, Danielle and welcome to you and Milo to Lantus and Lev Land. This is the best place you never wanted to be!

    I'm glad Rhiannon directed you to the sticky notes at the top of the Board. They contain an overwhelming amount of information and it's even more overwhelming if you read all of the links. The good news is there isn't a test! The even better news is that everyone here will help you make sense out of the information. The people here are very generous with their time and knowledge -- we've all been new to managing our kitty's diabetes.

    One thing to keep in mind is that Lantus is a depot type of insulin. This is what makes Lantus a long-acting insulin. The depot is like a reservoir. A little bit of every dose goes to fill the reservoir. It can take up to a week for the depot to fill and with every dose change, it can take several days for the depot to stabilize. This is the long way of saying that you're still in the process of getting Milo's depot filled.

    Rhiannon's interpretation of Milo's numbers is much the same as mine. Milo bounced after seeing that 134. Not only did he bounce, by skipping the shot, his numbers soared.

    Please let us know how we can help.

     
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  7. purrdydolly

    purrdydolly Member

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  8. Danielle & Milo

    Danielle & Milo Member

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    Thank you! To make matters worse we just found out today that the vet gave us the WRONG syringes and we were giving him more insulin that we thought! He was on the U100 instead of the U30 but I bought the right ones tonight. I shot a fur shot this morning so his numbers have been high today and tonight we start his 6 cycle over with 2 units twice a day for the next 3 days (6 cycles). I made sure I got the insulin in tonight.

    Questions:

    1.) What happens if he will not eat before I shoot? That was the case tonight. He ate immediately after I shot
    2.) Where do you shoot at and what method do you use, tent or roll? I shot him on the scruff tonight and it went in fine
    3.) How often do you feed your kitty?

    I am still lost on all of this and have been reading but it is a lot.
     
  9. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    Milo's +2 reading was still too high at 501 :( with 2 units of insulin
     
  10. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    POSTED MILO'S SPREADSHEET!!!!
     
  11. Brashworks

    Brashworks Member

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    Jun 21, 2015
    Yay!!! Looks great! Well done.
     
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  12. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011

    Would you clarify this for us? You should be using u-100 syringes. Those go with Lantus & Levemir, both U-100 insulins. This is really important.


    As long as he's eating some, I wouldn't worry too much. Lantus begins its action a couple of hours after the shot, at least in most cats, and as long as he's not obviously sick and not eating, most of the time you would go ahead and shoot.

    I pulled up a hunk of scruff and put the needle in near the body and shot. For 2.5 years, and it worked just fine.

    Most people feed their cats more than twice a day. If a cat will graze and not binge themselves on any food you put down, that's ok. You'd want to pick the food up at +10 so they haven't eaten in the 2 hours prior to the preshot test.

    If you've got a gorger, which is what I had, you'll need to be more restrictive on the feeding. Punkin would've eaten everything I put down immediately, and it helps even out blood sugar if food is eaten throughout at least the first few hours of the cycle. We fed Punkin 3oz of food with his shot and 1.5 oz at +3, both am and pm cycles. It worked for us. As you get more tests in, it might be that you need a different food plan for your Milo, but that's a pretty good plan to start with.

    The amount you feed should be enough to hold his weight stable if he's about the right weight. Those amounts were for punkin - you'll want to adjust for Milo.
     
  13. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    Thanks Julie for your story and information/advice!!

    In regards to the syringes, I was told that I should NOT use the U100 syringes for Lantus because they do not have the .25 or .50 markings which is what I need. I now use the U30 syringes/needles.
     
  14. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    Danielle, I was just reading through your last post on Main Health and saw that someone said it was critical for Milo to eat before you shoot. That's not true with Lantus or Lev. It IS true of the older insulins that begin their action faster in the body. As long as Milo isn't sick and you can reasonably anticipate that he will eat, go ahead with the test/feed/shoot process.

    My other problem is when I give him insulin sometimes he moves on me and then I miss and it gets on his fur and then other times I feel like I am not getting it into his fat like this morning he got insulin on him and i am not even sure how much insulin I got in him and correctly :(

    Everyone does fur shots - where not all of it goes in. The important thing is to not reshoot. Just let it go and give the next shot 12 hours or so later.

    Just saw your reply about the syringes. Would you copy the link to the syringes you're now using and post it here? I haven't gotten to the discussion yet in your other post about the syringes, but I want to make sure you're using the right thing. I'm still looking.
     
  15. Danielle & Milo

    Danielle & Milo Member

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    Julie - I just posted your comment on the main forum too so people can weigh in. Chris helped me with the changing of the syringes. Sorry I do not have a link to share for the syringes I use, but they are the Reli On 3/10mL, 31 gauge syringes, 8mm
     
  16. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Or if it's easier, you can take a photo of the box, then upload it as an attachment to post it here.

    I got to the part where the syringes markings were each 2u. But your new syringes should still have a label that says "u-100" on them.
     
  17. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    just look on the box or label and see if you see u-100 on there. It sounds like they are probably ok.
     
  18. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    @julie & punkin (ga) ...she is NOW is using the correct syringes....earlier she was using U100 syringe that held a max of 100 units and each line was TWO units

    Now she has the Relion 3/10mL 31 gauge 8mm syringes from WalMart
     
  19. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    The important part of is that they are still u-100 syringes, though, Chris, not how much total the syringe holds. I'm just trying to confirm that she is using u-100 syringes.
     
  20. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Yes...they're U100 syringes...I sent her a picture of the box I use and she took it to Walmart with her....she's got the same ones we use
     
  21. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    ok - perfect - thanks for clarifying that! She said she was using u-30 syringes and that's not u-100!
     
  22. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Danielle, would you fix Milo's ss with the actual amount of insulin that he got with the other syringes? So if you drew up what you thought were 2u, it was 4u - can you fix the ss so it shows that? It'll be important for helping figure out dosing as you move ahead.

    Thanks for bearing with me on the syringes - I also had the wrong syringes and was giving punkin his shots in u-40 syringes, which meant he was getting 2.5x as much insulin as I thought. That's why I was confused by the u-30 and wanted to make sure we had it all straight!
     
  23. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Yeah...she misunderstood the difference between a U100 syringe that holds 30 units and a U100 syringe that holds 100 units

    It's a matter of the "U"...on her Health post I explained what the U means when it's in front of the number

    She is still unable to access her spreadsheet to edit it....I set it up for her and she had to get a Google account and download the app, etc. etc. etc....then we found the mistake in the syringes so things have been kind of hectic

    I changed the dosage when we found out about the problem with the other syringes...it's correct now
     
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  24. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015

    Sorry all! I am bad at this :( I just said it wrong!
     
  25. Danielle & Milo

    Danielle & Milo Member

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  26. MaineLove

    MaineLove Member

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    Jun 26, 2015
    Since we are on the subject of syringes, we went to WalMart today and got U-100 syringes. I gave the gal the old packaging Capacity 3/10 mlcc Gauge 30 Length 8mm(5/16"). She brought me a pack of 100 in a bag and I paid for it. When I got home (26 miles later) and opened the bag what was in it was Capacity 3/10mlcc GUAGE 31 Length 8mm(5/16"). From what I can deduce the needle is just smaller around than the 30. Is this correct? and OK to use?
     
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  27. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    So it sounds like the gauge is the only difference, Kathe? If so, yes, that's the thickness of the needle. You can use whatever you want on that.
     
  28. Brashworks

    Brashworks Member

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    Jun 21, 2015
    I would think so, as long as they are marked U100. Coral Sea (great name! and beautiful cats the both of them) might enjoy the thinner gauge.
     
  29. MaineLove

    MaineLove Member

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    Jun 26, 2015
    That was the only difference! Systems go here!
     
  30. MaineLove

    MaineLove Member

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    Jun 26, 2015
    Yes! they are U100. I guess these smaller gauges are for babies and children and now good for small cat bodies. She does well with her shots.

    Thanks to you from the girls (Mother Coral and Joy Daughter). Their former Pet Parent was a veteran. He served on the Coral Sea an aircraft carrier and Joy was named after a destroyer, Turner Joy. Both girls were show cats! They came to us because the breeder wanted to place them together and since we were retired we agreed we could handle the two beautiful ladies. They have been a part of our family for two years. Thanks for the compliment.
     
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  31. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    ****UPDATED***** GOOD NEWS!!!!!!!!!

    At +6 last night Milo was 353 (YAY bye bye 400s....for now)

    His AMPS was 263..............DO I SHOOT HIS 2 UNITS STILL? He is eating now!

    HELP!!!!!!!!!!!!!!!!!!!
     
  32. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    Anyone? Please help!!!!!! I am stalling for 30 minutes!
     
  33. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    SHHOOOOTTTTT!!!!!

    As long as you're home to test today, he's over 200, so you shoot the scheduled dose.......If you're really concerned, get a +1 and a +2 to see where he's going

    This is GOOD news!!
     
  34. Patricia & Noodle

    Patricia & Noodle Well-Known Member

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    I'm here, let me take a look at your SS. Maybe someone else will come along too.

    Edit: Chris beat me to it :) Go for it!
     
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  35. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015

    YAY!!!!!!!!!! Thanks Chris! I NOW know if this happens again what to do! This was a first for me! Thank you for your help!!!!

    Hopefully Milo is taking a GOOD turn today!
     
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  36. Danielle & Milo

    Danielle & Milo Member

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    DONE!!! :)
     
  37. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    ***UPDATE*****

    Milo's +4 reading was 180! YAY! He laid in my lap afterwards and climbed up and licked my face, my heart just melted. He was thanking me for making him feel better
     
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  38. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    ***UPDATE****

    At +6 Milo is 108!

    So if he is BELOW 200 for Lantus, do not shoot correct? His insulin time is 7:30pm
     
  39. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Yeah for nicer numbers! Not sure what time zone you are in, just know you 7:30 isn't mine.

    On this forum, we suggest that it's OK to shoot anything above 150 on a human meter, so it'd be a bit higher on that AlphaTrak. If you get a lower number at PMPS time, do the test and post the number here for help. But do not feed. There are a few options for what you can do, skipping the shot is just one of them. One of the options is to stall 30 minutes without feeding, to see if the numbers are coming up, hence we ask you not to feed.

    Have you taken a look at the Tight Regulation Protocol (TR) and Start Low Go Slow (SLGS) method Sticky Notes? People here choose one or the other for determining doses. If you do pick one, put it in your signature, so we stop asking you. ;) It also impacts what we might get you to do tonight.
     
  40. Danielle & Milo

    Danielle & Milo Member

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    ***UPDATE****

    At +7 he was at 84. I am guessing I will not be giving him his 2 units of insulin tonight at 7:00pm.

    Thoughts anyone?
     
  41. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    If you are using the SLGS method for dosing, Milo would have earned a reduction to 1.75 units. If you are using the TR protocol, the reduction point is 68 on the ATrack.

    I would test again in 1/2 hour. At 68 on the AT is the point where we take action and give high carb food.
     
  42. Danielle & Milo

    Danielle & Milo Member

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    I want to do the TR method and have started that. I also just added this to my signature :)
     
  43. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    I think what Wendy meant was IF he's below 150 (about 200 on the AT I think) at PMPS time, DON'T feed, and post and ask for help

    Right now, you might want to go ahead and give him a teaspoon or two of his regular low carb food to see if you can get him to surf (stop dropping and stay where he's at now)
     
  44. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Sounds good, you definitely test enough for it. Let's see what the next test brings.
     
  45. Danielle & Milo

    Danielle & Milo Member

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    I just fed Milo a few tablespoons of his regular food to keep him stable. I will test at +8 which is in 35 minutes.
     
  46. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Actually Chris, she should post here if he's below 200 at PMPS time. She is using the AT meter - not exactly sure what the 150 on a human meter is compared to the AT, but it's higher than 150. Eventually you will shoot even lower numbers without asking, but it's good to gather the data to do so first.

    Danielle, could you also update Milo's spreadsheet with the latest numbers? It's a tool we use a lot.
     
  47. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Yes...I edited my comment Wendy to take into account the AT
     
  48. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Great to see progress - we love those green numbers - that's your goal and VOILA, Milo just gave you a bit of it!

    I saw you gave him a couple of bites of low carb - awesome choice. Feeding a little bit of regular low carb when they hit green can help a kitty surf - stay flat in greens - for a while. Well done!

    He may very well bounce from hitting the green number today - if so, don't worry. That's a normal response by his body to a range he's not used to anymore. There's more on bounces in the second post here. Bounces are important to understand because you don't increase the dose in response to high numbers from bouncing. Instead, you focus on that sweet 84 he got today and celebrate that says this is a good dose for the moment!

    You don't need to intervene til he drops below 68, and at that point you'll have time to take action and give him some carbs to pull him up. He's doing great.
     
  49. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Just a housekeeping note

    When you start a new post each day, you put the date, name and the AMPS number in the title and as the day goes on, just add the newer values, so today's title line would read

    8/4 Milo AMPS 263,+2 218,+4 180,+6 108,+7 84 (since you're using the AT, I'd add (AT) to it too)

    That way, as the day goes on, the people that watch the forum will be able to easily see Milo's "whole day" in numbers so if they see something important, they can let you know without going through and reading all the comments
     
  50. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    oh - i wanted to add 2 things.

    1 - we ask everyone to start a new thread (condo) every day. It keeps the length of the condos manageable.

    2 - just wanted to point out on Milo's ss - if you look at 8/1 ambg 134 - that caused a bounce that lasted 3 days. Count forward 3 days from 8/1 and you get to this morning, and VOILA, a yellow - the beginning of him clearing the bounce that resulted in the green number this afternoon.

    As he gets more used to being in normal numbers, the bounces will lessen in both intensity (he won't go as high as those ugly black numbers) and duration (they won't last 3 days). It's a process.
     
  51. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    Good job on the title!! That makes it a lot easier for people to see how Milo's doing!

    That 109 is probably a mix of the snack you fed him and the fact that it's later in the cycle and the insulin is starting to wear off..there MAY be a bounce starting too, so don't get discouraged if he continues going up and is higher than you'd like later on....He cleared his last bounce...he'll clear the next one...and the one after that..and the one after that....etc..etc....lol
     
  52. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    **UPDATE**

    Milo's PMPS is 109!!!!

    Looks like no shooting insulin?

    Can I still feed him is night meal?
     
  53. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    HELP!!! What do you all think about the PMPS of 109? His scheduled shot time would be 7:40 CST and I would need to test him again at 7:30pm
     
  54. Shiloh & Rhonda (GA)

    Shiloh & Rhonda (GA) Well-Known Member

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    Sorry...I was still on the other post. I would go with no shot, and feed him his regular meal.
     
  55. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    That's not the PMPS...it's the +11
     
  56. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    Sorry all the 109 is the +11. I will be doing the PMPS in 30 minutes and will post it here for advice on whether or not to shoot. Please watch!
     
  57. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    OK....Depending on what the real PMPS is, you're going to have some choices (and we HAVE seen cats bounce up 100 points in an hour, so it's not out of the question)

    I think it's probably safest for you to give less insulin since he's come down so much from yesterday and if he's still below 200 (and we don't know enough about him yet) that it's your best option

    Once you get more data on Milo, you'll learn to shoot lower and lower Pre-shot numbers, but right now we don't have that data.

    With the errors in syringes and everything you've already been through, I'm tempted to tell you to start over with the correct dose for his weight (11lbs) which would have been 1U on Tight Regulation

    Let's see if we can get some other opinions @Wendy&Neko @julie & punkin (ga)
     
  58. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    if it's over 150, just shoot on time, feed as normal, and get a +2 to see what he's got in mind.

    If it's under 150 and you're uncomfortable with it, wait 30 minutes WITHOUT FEEDING, retest and see if it's rising. If so, shoot.

    If you want to readjust those numbers to 200 because you're using an AT, you can, but if you look at the Tight Reg protocol the only difference they say for an AT is to reduce the dose at 68 instead of 150. So . . . it's up to you. We have nothing that gives us a different scale for ATs.

    Many cats will rise quickly after +10 or 11. Don't know what Milo will do today, but at this point he's had a great day and has been mostly surfing along for several hours. It would be surprising if he didn't bounce from this long stretch in good numbers.
     
  59. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    I will wait to see what his PMPS is in 15 minutes. I don't want to shoot 2 units if he is below 150.

    I am really not sure what to do........
     
  60. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    No matter what, since you'll probably be dealing with a lower Pre-shot than you've ever shot before, you'll want to plan on getting a +1 and +2 so we can see how he's doing
     
  61. Danielle & Milo

    Danielle & Milo Member

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    Jul 31, 2015
    So I will test him and depending on that number, do I feed him after even if I am giving him ONLY 1 unit of insulin?
     
  62. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    I would just keep going as she is, Chris. He's having a good response and is in good numbers - the goal is flat and in the 50ish points above 68, and he's nearly there already. Just me, but I'd keep going.

    Danielle, if you can't monitor tonight, that might change things. I think of it as making progress to get a cat to this point and personally, I wouldn't back away from it. The 2u is what's given him this great surf today and brought him out of the black numbers.

    It's up to you, though, Danielle. As we like to say, you hold the syringe.
     
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  63. Shiloh & Rhonda (GA)

    Shiloh & Rhonda (GA) Well-Known Member

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    Julie, I think you meant reduce the dose at 68 instead of "50" rather than 150?
     
  64. Danielle & Milo

    Danielle & Milo Member

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    So I should shoot the 2 units as long as he is OVER 68?
     
  65. Critter Mom

    Critter Mom Well-Known Member

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    I know that I'm a relative novice Lantus user, but I'd support the above on the grounds that the drop from AMPS to nadir today was quite large.
    .
     
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  66. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    I agree with Julie if your nerves can handle it....If he's below 150 at PS, if he were my cat, I'd stall, don't feed and test again in 30 minutes....if he's going up, shoot the 2 units and get a +1 and +2
     
  67. Shiloh & Rhonda (GA)

    Shiloh & Rhonda (GA) Well-Known Member

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    Aine...so much for crashing?
     
  68. Danielle & Milo

    Danielle & Milo Member

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    Ughhhh I don't know....it all depends on the PMPS #..........................10 minutes
     
  69. Critter Mom

    Critter Mom Well-Known Member

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  70. Critter Mom

    Critter Mom Well-Known Member

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    If Danielle were to dose on a low preshot, how long would she need to be able to stay awake to monitor if Milo goes too low during the next cycle?
    .
     
  71. Shiloh & Rhonda (GA)

    Shiloh & Rhonda (GA) Well-Known Member

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    Danielle, breathe! And wait. You can't know what is going to happen until it happens. Don't guess at it. Just let us know when you test.
     
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  72. Danielle & Milo

    Danielle & Milo Member

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    I am nervous.................................
     
  73. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Remember Danielle.....just because you see a drop from 500 to 200 doesn't mean if you shoot a 200 he's going to drop to -100....Lantus just doesn't work that way

    If he's going to earn a reduction, he's going to show you by dropping below 68
     
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  74. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    yes, thanks Rhonda - the reduction point for AT is a 68 instead of 50 on a human glucometer.

    Too many 150's!!!;)

    His drop earlier today was because he was clearing a bounce from 3 mornings ago. He didn't go below 68AT. Reductions occur when you go below 68AT.

    Remember dosing with Lantus is based upon how LOW the dose causes the cat to go, not the high numbers. He's had a gorgeous surf today - what some people work for months to see.

    Danielle, if you look at the TR Protocol page:
    • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
    • Reducing the dose:
      The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus Tight Regulation ISG safe by suggesting and taking appropriate reductions.
      • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

    but now I feel like I'm pressuring you - and I don't mean to do that, just to give you the information you need to make the decision. All these folks are telling you to decide based upon the preshot. I will leave you with this info and let you figure out what you want to do. Whatever you choose is fine.

    No way to know that you won't have to stay up monitoring. If you can't then that should be considered.
     
  75. Danielle & Milo

    Danielle & Milo Member

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    We will be able to monitor him if we shoot the 2 units as scheduled.

    PMPS in 5 minutes......
     
  76. Critter Mom

    Critter Mom Well-Known Member

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  77. Robin&BB

    Robin&BB Well-Known Member

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    (I was brewin' the pm java; looking @ SS) ... so we have a 109 @ +8 & +11?
     
  78. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Aine, what are you talking about asking if she can monitor more than 12 hours? There's nothing to say this would be an extreme hypo. The kitty that is in that situation got 17 units. This is not that situation.
     
  79. Danielle & Milo

    Danielle & Milo Member

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    PMPS = 107.........................What do I do?
     
  80. Robin&BB

    Robin&BB Well-Known Member

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    This is a depot insulin ... can you stall for say 30 min & reck?
     
  81. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    What I'd do is STALL, DON'T feed and test again in 30 minutes and see if he's coming up (as long as you can move your shot schedule back tomorrow morning)
     
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  82. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Here are the "official" guidelines for dealing with a lower-than-you're-used-to preshot. Take a look and see what appeals to you, Danielle. It's fine to stall, it's fine to reduce the dose, it's fine to skip the shot if you are unnerved. Everyone will respect your choice.

    These are all in human glucometer #s - the Tight Reg protocol says to add 18 to the human glucometer numbers for an AT.



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

    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
     
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  83. Robin&BB

    Robin&BB Well-Known Member

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    Yes, I agree with that, Chris.
     
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  84. Critter Mom

    Critter Mom Well-Known Member

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    I am quite aware that this is not the cat that received the overdose, Julie.

    I am concerned about the fact that Danielle has had several very stressful days and may possibly be feeling quite drained as a consequence. I have read on this board many a time in the past year or so that when a cat goes low it may be necessary to monitor the cat beyond the length of the cycle in question. I am also aware of the oft-repeated guidance not to give insulin at preshots lower than 200 without being data ready. Danielle doesn't have much data.
     
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  85. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Julie is (once again) correct, Danielle

    There's really no wrong thing to do...every thing you do at this point gathers data on how Milo responds so the "next time" you have more experience and data
     
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  86. Robin&BB

    Robin&BB Well-Known Member

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    Danielle, the thing about Lantus is that it is a "depot" insulin (effect can last somewhat beyond 12 hrs) ... hence, why you may want to just STALL for a little while: Not feed, not shoot; just stall & see if he's still rising after a bit.
     
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  87. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    He's essentially been surfing flat for the last 5 hours, which is great. Remember that you will have a couple of hours after preshot before he onsets and starts going down again. Food and the insulin wearing off in this current cycle will cause him to go up again before onset. However, how tired you are and how late you can monitor plays into the decision making. In the short term, a 20-30 minutes stall without feeding is an option.
     
  88. Robin&BB

    Robin&BB Well-Known Member

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    Sep 28, 2013
    Also please note, Danielle - that in the (very good) instructions above in Julie's post, the low #s shown are HUMAN GLUCOMETER lows: Your hypo zone on Alpha Trak, starts at 68.
    I'd stall, see where he is in a 1/2 hour, then decide. You really probably shouldn't shoot 2.0U unless he's up around 175, IMHO. Not on an overnight cycle.
     
    Last edited: Aug 4, 2015
    Reason for edit: typo; moving toooo fast in responding!
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  89. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I disagree with the comment about stalling an hour. That is too long and can be harder to get back on schedule. From the instructions Julie posted above:

    ** 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.

    And note, 68 is not the hypo zone, 68 is the level at which we take action and feed high carb foods, and when kitty earns a reduction. Many of our OTJ kitties test lower than 68 on AT, we just want to have a margin of safety when kitty is on insulin and that 68 includes that buffer.
     
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  90. Robin&BB

    Robin&BB Well-Known Member

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    @Wendy&Neko - who said to stall an hour? Please look at my SS headings. Danielle is using an Alpha Trak. The numbers are 30% to 40% higher on an Alpha Trak.
     
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  91. Robin&BB

    Robin&BB Well-Known Member

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    And Danielle is also pretty new at this. Erring on side of caution is safer for her...
     
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  92. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Danielle...if it's too much for you, you can skip....Milo will probably go high by morning and we just start over tomorrow...no long term harm done

    If you'd feel more comfortable shooting a lower dose, that's fine too...it gives him "some" insulin to keep him from going too high

    If you shoot 2 units, you're still in control as long as you're testing....

    BUT if you give ANY insulin tonight, you have to be willing and able to test as much as necessary to keep Milo safe

    As long as you're testing, YOU are in control of his blood glucose.....if he drops too low, you just break out the high carb food or Karo/honey/syrup

    Let's see where he is at 8 and let us know what YOU are most comfortable with....There's no "wrong" answer
     
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  93. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    you did
    We do not know for sure that AT numbers are 30-40% higher than those on a human meter. The only thing we know is that the 68 AT is equivalent to the 50 human meter. You might want to check out this post by Jill on a Think Tank thread.

    And Chris is right, Danielle you hold the syringe and it's your decision to make, based on your circumstances and what you feel comfortable with. All options Chris listed are valid ones to take. What you do now may be different in the future when you have more experience.
     
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  94. Robin&BB

    Robin&BB Well-Known Member

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    @Wendy&Neko Sorry, I meant to type "1/2 hour" on that post; my error in typing; I apologize.

    I am really not trying to argue with you here, Wendy; I had agreed with your earlier post re: stalling. But please look at the glucometer notes page attached to BJM's signature. (Alpha Traks are calibrated differently than human glucometers; hence the difference in "safe" ranges.
     
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  95. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    The only official guidelines we have for ATs is on the TRP protocol - which says to reduce at 68AT and to add 18 points to human numbers for AT. I don't know the source of BJM's chart.

    However, this really isn't the place to debate AT numbers.

    When you've got your next test, Danielle, would you edit your subject line and post it? Since you haven't shot yet, your count is still from the previous shot, so at 30 minutes, it's +12.5. That signifies that you haven't shot yet.
     
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  96. Robin&BB

    Robin&BB Well-Known Member

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    Yes, for Danielle and Milo, safety is key!
     
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  97. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    If I can make a gentle suggestion..

    I can barely follow what's going on in this condo and if I can't follow the discussion, I doubt that Danielle can. This is like trying to sort out one voice in a crowd of people who are yelling.

    I .realize people are trying to be helpful There are times when too much help isn't a good thing. I'd suggest letting Chris, Julie, and Wendy handle the discussion. They were here offering guidance initially and have the experience to lend a helping hand.
     
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  98. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    I got a text from Danielle's husband....she had to leave, but DH is on board with helping with testing/shooting

    Milo was at 125 at 8pm (her Pre-shot after stalling 30 minutes) so she told him to shoot 1 unit and test again in 1 hour

    She will update when she can
     
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  99. Robin&BB

    Robin&BB Well-Known Member

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  100. Robin&BB

    Robin&BB Well-Known Member

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    By all means. Critter Mom and I were on with Danielle earlier today, all day. More than happy to step aside rather than contribute to any confusion here.
     
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