Angel 9/12 AMPS:157 +4:281 +6:308 +10:291 PMPS:315

[Cherish Gallagher]

http://www.felinediabetes.com/FDMB/threads/lantus-sliding-scale.183796/#post-2040322

After reading about TR we've decided to go that route. thanks for everyone's advice and input.

Do you think it would be ok if we increase to a fat 1.0 starting tomorrow morning instead of 1.25 or does TR require you move up and down in .25 increments ? From looking at Angels SS it kinds seems like 1 might not be enough but 1.25 is too much. Also her nadirs ( we still can't seem to figure out any kind of consistency with her nadir) are kinda split between some being in blues and some being yellows/pinks. Blues are definitely way fewer though.

 

[Doodles & Karen]

You want to hold the 1u dose at least 6 cycles from the green on 9/10 to make sure she has cleared the bounce. Although it looks like she tried last night and didn't make it to green but may have triggered another bounce. We find it better to follow the protocol with increases/ decreases in the .25u unless you're just trying to tweak the dose. It's also fine to increase during a bounce but not advised on a bounce clearing cycle. It's also common to go up and down with the same dose. Just because it was too much or not enough last time doesn't mean you'll get the same results next time.

 

[Chris/China (GA)/Garfield]

We usually save the "fat" and "skinny" doses for when we're really "dialing in" a dose, so for now, I'd stick with the .25 dose changes

Cat's insulin needs can (and do) change....just because 1.25 got her low before doesn't necessarily mean it'll do it again

 

[Cherish Gallagher]

You want to hold the 1u dose at least 6 cycles from the green on 9/10 to make sure she has cleared the bounce. Although it looks like she tried last night and didn't make it to green but may have triggered another bounce. We find it better to follow the protocol with increases/ decreases in the .25u unless you're just trying to tweak the dose. It's also fine to increase during a bounce but not advised on a bounce clearing cycle. It's also common to go up and down with the same dose. Just because it was too much or not enough last time doesn't mean you'll get the same results next time.

Oh, so I start over the count when she hit green on 9/10? This is so confusing

 

[Doodles & Karen]

From the TR sticky. Feel free to keep posting daily. It is confusing but by posting and asking questions it becomes more clear. That's how we all learned and what we're here for

INCREASING THE DOSE:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

 

[Cherish Gallagher]

From the TR sticky. Feel free to keep posting daily. It is confusing but by posting and asking questions it becomes more clear. That's how we all learned and what we're here for

INCREASING THE DOSE:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Consecutive! Got ya!

 

[Doodles & Karen]

Consecutive! Got ya

It's hard to live with the bounces and not look at "each" cycle. Some kitties eventually stop bouncing and some bounce all the way OTJ.

 

[Cherish Gallagher]

It's hard to live with the bounces and not look at "each" cycle. Some kitties eventually stop bouncing and some bounce all the way OTJ.

So what if in those 6 consecutive cycles she has zero greens but some blue and some yellow and pink?

 

[Doodles & Karen]

Lantus is dosed on how low they go. I usually look at 6-10 cycles. With her getting into the 70's 2 days ago you know this dose gets her there.

I'm on my phone now so that's a short answer.

 

[Kris & Teasel]

So what if in those 6 consecutive cycles she has zero greens but some blue and some yellow and pink?

I think the nadir numbers mentioned in the protocol guidelines above cover that. It's always the nadir you look at to assess a dose with Lantus and not the PS. The PS is only considered when you're trying to decide whether you should stall without feeding, shoot the full dose right away, go for broke and shoot on a dark green, etc.

 

[Kris & Teasel]

And just to keep it interesting, sometimes the PS is the nadir. Teasel does that a lot. He doesn't have a shallow curve with a middle section nadir very often ... likes to make it interesting for me.

 

[Beenie (GA)]

PS is the nadir

That's always fun
Angel -nice start to the day!!

 

[Cherish Gallagher]

From the TR sticky. Feel free to keep posting daily. It is confusing but by posting and asking questions it becomes more clear. That's how we all learned and what we're here for

INCREASING THE DOSE:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

So because she hit 157 yesterday (even tho it was a preshot but that was her nadir, do I restart the counting for cycles before I can increase her dose?

 

[Cherish Gallagher]

And just to keep it interesting, sometimes the PS is the nadir. Teasel does that a lot. He doesn't have a shallow curve with a middle section nadir very often ... likes to make it interesting for me.

I do or don't count the preshot as the nadir in that case?

 

[Girlie's mom]

I'm with you there, Angel - this is so confusing!

Good questions, though: you're getting some great answers that are certainly helping me understand some things better. This sugar dance isn't easy! But it's great to see them slowly improve, isn't it?

 

[Kris & Teasel]

I do or don't count the preshot as the nadir in that case?

I just scan the last several days to see what the lowest BG number was and use that. Lowest in a cycle = nadir, regardless of where it falls. It's possible that I've missed an overnight number sometimes or one in the day when I didn't test but that's where my experience with how he generally behaves comes in. I know I've made boo boos on occasion but that's part of the FD dance.

Over time you'll get a good feel for what Angel has done or is likely to do. That's when you can be a bit more sure of your decisions. You have to be willing to make a mistake here and there and learn from them. An unexpected low number is scary but once you've been there a few times and know what to do, how she reacts to carb level, how long she takes to come up, etc. they won't be as daunting. Never to be taken lightly but you'll be calmer dealing with them.

ETA: I'd say a willingness to accept that you will make a mistake now and again is important. As long as you try to do the right thing based on Angel's responses and know how to steer her with carbs you'll be fine. And you can always post here for help.