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? 9/23 Rocky - amps +77, waited 25 mins no food +79, hour +82, 90 mins +108.. Skip amps or reduce?

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Jim (NJ), Sep 23, 2019.

  1. Jim (NJ)

    Jim (NJ) Member

    Joined:
    Jul 21, 2019
    Hello All,

    Rocky has been doing good and ran into some very low numbers this morning. We usually feed him at 6:50am est but his amps 77 so waited 25 mins to test again @ 79. Not sure what to do at this point as this is his lowest numbers yet, he also slept all last night so I feared he might of been below 50. I will be home for most of the day and have some HC ff gravy & supplies on hand. This would be my 1st hypo experience so of course it has me worried for my guy. If anyone can please advise as its approaching an hour from his normal shot/feed time and its got me in a bit of a panic. Thank you!
     
    Last edited: Sep 23, 2019
  2. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Looking through your spreadsheet, this would be a much lower number than you have shot before. Doable with the preparation you have, but still nerve-wracking the first time you do it! So let's be cautious right now.

    You are still stalling on his food, right? Let's see what happens in the next hour-- if he starts coming up on his own without food, great, otherwise we'll have to think some more.

    Can I ask, how did he come to the dose of 4U? I see he was diagnosed several months earlier, can I guess that this was a vet-directed increase in 1U increments before you started testing in August?
     
  3. Jim (NJ)

    Jim (NJ) Member

    Joined:
    Jul 21, 2019
    Yes I have been stalling on feeding him, just did another test at 7:53am @ 82. So his numbers have come up by 4 over the past 2 test in the hour. I was just prepping his food as I saw this post and was going to shot him with 3.75u but have held off to respond back.

    Yes that is exactly what occurred with the Vet & solo star pen as there is no way to do 1/2u. Ive since learned different on the forums & have Relion syringes on hand. He was diagnosed when we had blood work done in the high 400's for a dental cleaning and they started him on 2u. After several weeks he was still high so they went to 3u, then few more weeks to 4u. That is when I did the research on my own and started doing curves and got him off the gylcobalance food and onto an all wet diet. Since we changed his diet that is when you see the drastic drop off from 400's into 100-200 steady. I thought he was going to have a reduction earlier in the month but then bounced and has seemed to be steady back in 100-200's. Maybe its now finally his time now to start earning reductions as it seemed like he was soo close.
     
    Last edited: Sep 23, 2019
  4. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    OK, those numbers are pretty flat. This is a judgement call.

    You hold the syringe. If you feel you are ready, with high carb food/gravy, honey, plenty of test strips, and the hypo instructions printed, and you are going to be able to monitor him throughout the day, I think you can shoot the 4U.

    If you shoot, please get a +1 or a +2 reading-- we want to see where he goes from here and be able to take action early if needed. Post with the numbers as you go, I will be in and out today but will be checking! And of course there will be lots of people around if you get into hairy territory.
     
    Sue and Luci likes this.
  5. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Should add for emphasis: you are in charge here. If you are uncomfortable with shooting, then definitely take the skip or a reduced shot!

    Even if you skip, though, you should still get a +2 or +3. That 4U you've been shooting means there is a big depot in play, and if Rocky has decided to start moving out of his blue/yellow period, he'll have a lot of fuel to work with even without a new shot this morning.
     
  6. Jim (NJ)

    Jim (NJ) Member

    Joined:
    Jul 21, 2019
    Ok so its now been 90 mins from his normal meal & shot time, so I feel like I have to make a decision by 2 hours, correct me if I am wrong on throwing off his schedule. I just did another test 8:30am and hes at 109 now with no food. I will be home and can keep an eye on him, but I do have work to do so I cant just sit all day with him just monitoring. I personally think Id feel safer with a reduce shot or skipping, but is your recommendation his normal dose 4u or skip? Im not educated enough to know but just thought reduce shot wouldn't throw off his system as much as skip, while keeping the chance of sub 50 at bay. If he is pushing towards a reduction then I dont want to prevent or stall if by changing his schedule today. Thank you soo much!!
     
  7. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    I work from home as well...and I set a timer to get frequent tests - Luci likes to dive, dive, dive. It would be great to get some mid cycle tests...it would help to see how low he's going on this dose. The decision to shoot or not is more difficult because you don't know how low this dose is taking him. This is when you need to know his nadirs - so you can make a determination of whether or not he's earned a reduction.
    If you're using a human meter a 50 is the 'take action' number. And I see from your signature you're doing TR..so first things first - get those tests - as often as you can today. I've tested Luci while on conference calls - with my earphones in my ears - so it can be done. It's just a matter of 'multi-tasking'....you can do it.


    Please update the SS as to his numbers this morning - I saw them here and there in your comments above...sounds like he's on his way up...but for how long and how low the insulin is taking him on a regular basis, we can't tell from his SS.

    I think I'd skip this shot this morning and get plenty of tests to fill in all those blanks. Let's see what his nadir is looking like on that full depot.
     
  8. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Oh, I misunderstood, thought you were still keeping pretty close to the usual shot time even with the stall. Hmmm. That means that you'll also have to work to get things back on schedule later if you shoot now (we usually move 15mins per shot, or one 30min move per day). So take that into consideration.

    If it were me, I would shoot if I were confident I could monitor enough to keep him safe. If a cat is starting to get into better numbers and (maybe) ask for reductions, it seems counterproductive to prevent the official reduction by skipping and reducing doses on the fly. Also, you have already shot a 110 and 117, so this isn't too much lower.

    All that said... if you are currently 90mins off, then it might make things easier all round to skip today and get back on schedule tonight. If Rocky is starting to think about moving to better numbers and asking for reductions, it won't take him long to get back on track!
     
  9. Jim (NJ)

    Jim (NJ) Member

    Joined:
    Jul 21, 2019
    I proceeded to feed him and shot 3.5u @ 8:50am, 2 hours past normal shot/meal time.. I tried to measure 3.75u on the Relion syringes but its just so close for me to distinguish even following the guide posted here on the forums. I guess I need some practice with the drawing & measuring still. I will get a +1 & +2 to start, I made notes on the spreadsheet but Im not sure how to accurately reflect the changing of time without throwing everything else off. I guess the 108 is considered his amps now but with a 2 hour time delay?
     
    Last edited: Sep 23, 2019
    Nan & Amber (GA) likes this.
  10. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Yup. Maybe the easiest way to do it would be to stack the numbers in the AMPS column (77, 82@0.5, 109@1.5) and then explain in the notes. Then the rest of the day the +X numbers will correspond to the actual shot time.

    I'll be watching to see how he does!
     
    Sue and Luci likes this.
  11. Jim (NJ)

    Jim (NJ) Member

    Joined:
    Jul 21, 2019
    Great, Thanks for the suggestions and your help. Edited it as so. What do you suggest for what time I should feed/shot him with everything being pushed back 2 hours. Do I just plan to proceed at his normal time or push it back some to adjust from this morning delay?
     
  12. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    We ususally make adjustments by 30mins per day-- either all at once, or else 15mins at each shot. I think you could move the time by 30mins tonight (so, 1.5hrs "late"), then keep moving it over the next few days.
     
  13. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    I usually only move by 15 minute increments... otherwise it can act like an increase.
     
  14. Jim (NJ)

    Jim (NJ) Member

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    Jul 21, 2019
    +2 @ 133 .. just went back to finish his breakfast after getting his test done.
     
  15. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Yes, I am being more aggressive about the time change, just because he's 2hrs late from this morning and as far as the depot is concerned, even the revised shot will be 1.5hrs late. There is of course some concern with having overlapping activities from the shot this morning when you shoot 11.5hrs later, but I'm not too worried about that unless he's dropping at shot time and/or back in greens already. So, let's see where he is tonight!
     
  16. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Great! He's moving up, but not zooming.

    Love his profile pic, by the way-- he's adorable!
     
  17. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Any midday tests?
     
  18. Jim (NJ)

    Jim (NJ) Member

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    Jul 21, 2019
    Thank you! I actually got very busy today so I got in tests when I could. +5 138, feed him meal at +6, just tested now for +8 217.
     
  19. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
  20. Jim (NJ)

    Jim (NJ) Member

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    Jul 21, 2019
    +186 pmps, proceeded with 4u and will test at +3 & +5 before I have to goto bed tonight.
     
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  21. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Interesting way to wake up this morning. :D Well done eventually shooting. Once they are flat or rising without food when you are stalling, you are usually OK to shoot.

    Your signature says TR, but if you are following TR, you are holding this dose way too long. We hold doses no more than 10 cycles if the numbers aren't where you want them to be. Most of the nadirs are mid blue. The goal is to get the majority of time in green. He's not there on 4 units. When you can monitor, and measure on the syringe, an increase to 4.25 would be appropriate.
     
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  22. Jim (NJ)

    Jim (NJ) Member

    Joined:
    Jul 21, 2019
    Its been a very busy week and I just got to updating Rockys spreadsheet & chime back in here. His numbers were in the blues all week but he has been in the greens all day today. Yesterday it was the flatest line Ive seen from him yet and I get the feeling he might have dipped below 50 today. He seems very tired and not walking on the tip of back paws. We have HC food on standby but Ive been holding off hoping for a sub 50 since I feel like delaying his shots earlier this week prolonged it.

    @Wendy&Neko I thought in the low/mid blues is a good thing. He was in the 400's for soo long, we thought he has been doing great and trying to get a reduction. I never thought of increasing dose nor has anyone ever advised me that to before. That is what I guess confuseses me in regards of green that it is so close to 50, just feels like such a fine line to walk. So we want him in 50-100 but not below 50 correct? When hes been in the green it causes me and my wife to panic as we are worried about him going into hypo. Alot of the days we cant be on standby to test him all day and both work 2 jobs. Luckly Ive been able to do remote alot to assist but that is going away soon. So maybe alot of it is my misunderstanding of this all, as we thought you essentially never want him below 50 and can be fatal. But in order to get a reduction he has to go below 50, we just want to minimize the amount of time he is below 50 if caught correct? In todays case of a 58 & 57 test, with variance in testing strips and the way he is acting today. He has been sleeping alot & not walking on the tip of his bsck paws, seems sluggish. Should it be presumed he went below 50 and we just didnt get a test during that period or do you have to test an actually below 50 before you can reduce. Im sorry if Im ranting, we just love our guy and concerned for his health. We want to do the best for him, but just get very stressed out with him near hypo levels and not being able to test him many times a day. Thank you for your help!
     
    Last edited: Sep 28, 2019
  23. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Nice greens today, but I don’t see any low numbers, just close. I am not sure what dose you have been giving lately as that part of the spreadsheet is blank.

    I would hold a dose with nadirs in the 50’s, but not one with just low blue, very high green nadirs.
     

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