? Did I shoot past a good dose? How to proceed?

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Juliet, Dec 5, 2017.

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  1. Juliet

    Juliet Guest

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    Hi. Silver was occasionally getting good numbers at 0.5 and he went below 5 so according to SLGS I reduced him to 0.25. Again I got a below 5 so reduced again to fat zero. That seemed a failed reduction given his numbers so I increased back to 0.25 and back to 0.5 per the protocol.

    Unfortunately I had to make an emergency dash to UK and my sitter could not figure out testing. Rather than leave him with no insulin the five days I was gone, I had her shoot 0.25 without testing.

    And it’s been all downhill since. I got a green preshot the day after returned then it’s pinks all the way with a few yellow thrown in. Now at 1.25 and I’m wondering a) did I shoot passed the vest dose 2) do I keep increasing now per the SLGS protocol or 3) reduce back to 0.25 to see if I can get the good dose back.

    Anyone ?
     
  2. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Hi I'm not a big expert but you didn't had such great numbers at 0.25 either so maybe wait the whole week at this dose so that you can allow the depot to form and get a curve before changing the dose?

    Maybe one of the experts will jump in soon
     
  3. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Hi there. It's hard to know what is going on without some testing during the day. Looks like you can only test on weekends during the day? With the test that you got last Sunday, it does appear that he needed the increase back to 1.25. It looks like to me that the reduction to keep him safe while you were in Scotland really drained the depot and now you are playing catch up.

    Also, since he is a long term diabetic the reductions should not be taken until 3 times under 50 or once below 40 with TR and I am not sure if that pertains to SLGS as the guidelines do not address for long term diabetic and reduction. I hope someone with more knowledge with SLGS will weigh in. I am tagging @carfurby . It appears when you took him to a drop that all heck broke loose I think I would hold this dose and get as many test in as you can during the daytime cycle even if it's only a +2 to see how the cycle is heading.
     
  4. Juliet

    Juliet Guest

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    He’s not a long term diabetic. He was diagnosed in 2014 but only on insulin for three weeks to OTJ. Only back on again two months since loss of remission. SLGS says to drop dose immediately they go under 5. I followed correctly. Unfortunately I do have to work so there will never be day time tests unless I am home st the weekends. A lot of people must have to work and be in same situation I guess and I get as much testing as I can in during the evening. I don’t know how it’s possible to do more than I am. I leave the house at 6:30 and his shot time is 6am. There’s no way I can even get a +2 in day time cycle.
     
  5. Stacy & Asia

    Stacy & Asia Well-Known Member

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  6. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Working full time is not easy (I have a full time job too and can't get back home at lunch) don't stress about midday tests , you just get as many tests as you can whenever you can, at night is usually a good time (+3, +4 or very early in the morning +10,+11 depending on your schedule), or weekends and day offs you will slowly get more data.

    One thing you may want to consider is getting a timed feeder so that he can have something to eat when you are out.
     
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  7. Kris & Teasel

    Kris & Teasel Well-Known Member

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    This is a true conundrum. I honestly don't know what to say. The overall pattern at the low dose level before your trip is erratic and looks like bouncing to me. The average BG for that period would be on the high side. Since then the pattern looks very much like too low a dose but I wouldn't swear to it in court. If I was in your shoes, I'd follow the SLGS guidelines closely for a good length of time to see what happens. There might be a degree of glucose toxicity built up and there's no way around that except by careful dose increases. Try for before bed tests on work days and a curve on a day off.
     
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  8. Toro & Ovi

    Toro & Ovi Member

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    We've had the same question marks when we started with Toro. You can check Toro's SS for AT2 and see the similarities.
    The answer for us was simple: Toro was not yet at the right dose and the occasionally good numbers are somehow normal on a not regulated kitty.
    I believe this answer applies to Silver, too.
     
  9. Juliet

    Juliet Guest

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    Unfortunately I can’t do that. I have two cats and the other is overweight and must be restricted. Silver gets fed twice a day since he was a kitten. He’s never been free fed.
     
  10. Juliet

    Juliet Guest

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    Working on that - getting three or four tests a day. Unfortunately this weekend I have a two day conference so they’re as good as working days. I’m thinking I’ll do a mini curve on Friday night - AMPS to + 6 which is pretty much his nadir. It’s the best I can do this weekend and should give me an idea of whether another increase is needed. I’m disappointed I keep having to increase as those few good numbers at 0.25 were good.
     
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  11. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    There are micro chip feeders that you might want to look into for Silver.

    As far as long term diabetic, it is my understanding that once a diabetic always one but, maybe only be on insulin for 3 weeks before going OTJ makes for different criteria. Hopefully some of the veteran peeps will weigh in as to the reduction point for you.

    Working full time is a problem for many and my hat goes off to you all. You are doing the best you can.
     
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  12. Juliet

    Juliet Guest

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    I think we are happy with the feeding schedule as is.
     
  13. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Here is your post from yesterday: http://www.felinediabetes.com/FDMB/threads/12-04-silver-amps-239-pmps-391-4-353.187551/
    and your other one from today: http://www.felinediabetes.com/FDMB/threads/12-05-silver-amps-326.187585/
    Due to the number of cats on this forum, we suggest starting just one post a day. If you have a new question on the daily post, just change the subject line and add the "?" prefix.

    A long term diabetic is a cat that has been diabetic over one year. Even though Silver went into remission, that just made him a diet controlled diabetic, but still a diabetic. So he is long term. However, there are no provisions for changing the SLGS based on long term or not. So just follow the SLGS guidelines. Since he came out of remission, it will likely be harder to get him back into remission the second time. But still possible.

    As for dose, some cats see an initial good reaction to starting back on insulin, but then you have to keep increasing. Gather what data you can with half curves or the PM. All data is good data. But I don't think you are on too high a dose. A "reset" will likely do more harm than good.
     
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  14. Juliet

    Juliet Guest

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    I was advised to do a new thread. It’s hard to follow conflicting advice.
     
  15. Wendy&Neko

    Wendy&Neko Well-Known Member

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    The suggestion in today's thread was to change your subject title, not start a new thread. But it's OK. I've included the links but it can be confusing to have multiple posts in one day.

    Here is a post on Tips for New Members.
     
  16. Juliet

    Juliet Guest

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    There’s a lot of protocol to follow here. I’ve already read that post. Thought it would be more important to help the cats. I feel I am being told off today 1) incorrectly posting twice 2) not getting daytime tests in 3) not free feeding - when all I’m asking for is help understanding his numbers. Makes me hesitate to ask for help :nailbiting:
     
  17. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Hi. Please 're read the posts. Truly none of them are scolding you but just trying to give you and silver the best info and guidelines they can to help. Trust me I feel bad when I make a mistake or don't get something right the first time (I am a Virgo after all who is devoted to my sugar cat !), but that's on me, from in me. Not these helpful folks being hard on us. They're really not. The help is given freely with love and their experience and folks like you and I are very lucky they are here. Try to take a deep breath and figure out what steps you can make work. Just like ecid, ebid! Hugs
     
  18. Darnell & Sprocket

    Darnell & Sprocket Member

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    Hi Juliet, breathe for a moment. It takes time.
    My suggestion as I am also a petsitter (mostly past due to my own circumstances) and if you have a professional or even a really great not so busy petsitter then she/he need to learn how to test.
    This is becoming something petsitters are needing to learn now with more cats getting diabetes. Its scary to start but with practice she can do it. She already takes care of your cat n does the shots so the cat trusts her. And as I know, the cats know the petsitters are there to care for them plus extra spoiling too.
    So I would ask the petsitter to learn about it with research n videos then come over on a weekend and you can teach her how your cat likes it done.
    Then you can get some daytime bg tests or when he goes low n needs monitoring when you gotta work.
    Good luck. Tell that sitter she can do it.
     
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  19. Juliet

    Juliet Guest

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    She can’t. She’s 80 years old and cannot do it. I live in this country alone and do not have any resources so I cannot hire anyone. I do the best I can.
     
  20. Juliet

    Juliet Guest

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    Thanks
     
  21. MJW

    MJW Well-Known Member

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    Feline diabetes is a tough disease. It is so frustrating when increasing doses don't automatically bring lower BG's. I don't understand it. Maybe the damage is increasing faster than the dose? Or maybe the feline system is just complicated and nonlinear. Her numbers will come down eventually if you follow a protocol. You aren't in the danger zone yet. Best wishes.
     
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  22. Juliet

    Juliet Guest

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    Thanks. Yeah I don’t understand it either.
     
  23. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Sorry if I cam across as scolding.:bighug: I didn't mean to do that. :oops: Just with as many people as we have on this board, the Tips can help make sure you aren't missed and get the most experienced set of eyes on you to help you help Silver. Those of us scanning the board looking to see who we can help want to optimize our time. Some of us, like me, have lost our sugar cats, but remain here to help others.

    Insulin is a hormone, not a drug. You often don't see incremental improvement in numbers with incremental increases in dose. Just keep increasing as per SLGS and you WILL get to a dose that moves Silver. However, I can almost guarantee it will be a frustrating journey. It sure was for me. Lantus teaches patience, but I wasn't the best student. :p
     
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  24. Juliet

    Juliet Guest

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    That’s ok. I’m so stressed out about him that I’m probably more sensitive. He and his sister have been my sole companions for 11 years and this is breaking my heart. I feel I am killing him slowly as he seems worse since he started on insulin. Thinner and hungry all the time. But I’m guessing that without insulin he would be even worse.

    I expected that I WOULD see incremental decreases in his numbers with the incremental dose increases? Not sure I understand that bit.
     
  25. Stacy & Asia

    Stacy & Asia Well-Known Member

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    You might not, and if you do, it could take 6, 8, even 10 cycles on that dose to see it. If you look at other cat's SSs and go back before they found a good dose, you'll see what I mean. Some cats show a bit of improvement with each increase until the right dose is found and then it looks magical. Some cats look blah up several increases until close to the right dose is found before you see much of a shift. The good news is it all looks like magic when you get there, the bad news is, it can take awhile to get there.
     
  26. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I agree. Looking at a variety of other spreadsheets is a valuable exercise. It'll give you an idea of how variable a kitty's responses can be and how long it can take to get them settled down.
     
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  27. Juliet

    Juliet Guest

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    Thx. This is getting a bit too much for me actually. I can’t do a curve every weekend. I do have a life outside of this and already I am getting into trouble at work for leaving work sharp every day so I can go home and give him his insulin. No job=no money to treat him. I’ve cancelled two Christmas events because they fall on a Saturday - the only possible day to do a curve - and I’m just at the end of my coping ability.
     
  28. Juliet

    Juliet Guest

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    And I work 12 hrs a day and am exhausted. The last thing I want is to be in the computer in my rare few hrs off. I’m exhausted.
     
  29. Stacy & Asia

    Stacy & Asia Well-Known Member

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    It's exhausting and seems all consuming in the beginning. It's a lot in the beginning! Steep learning curve, massive amounts of patience and yes, some plans needing rearranging. It does get better. :bighug::bighug::bighug::bighug:
     
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  30. Toro & Ovi

    Toro & Ovi Member

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    You are taking all these in a too dramatic fashion...try to enjoy your life, if you can't do the complete curve try to fill the missing spots. Christmas is Christmas, you shouldn't miss it. :)
    I believe you already do enough tests to keep Silver safe and if you follow the SLGS, the chances of something bad happening are, in my opinion, pretty low....SLGS is one more than safe protocol.
    If you insist to worry, wait till you see greens - that's the moment you shall start worrying. :)
    Cheers.
     
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  31. Juliet

    Juliet Guest

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    Thanks. Someone mentioned today I wasn’t getting enough tests in as there were no day time tests. I’m planning a mini curve Friday night if I can stay up late enough to get to his nadir.
    I have shot greens before the first time round. It’s more the fact that if I can’t get a curve in how will I know to increase dose or not.
     
  32. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Juliet, just keep doing the best you can and know that no one is judging or scolding you. We are all here to help each other and do the very best we can. Working full time and more than an 8 hour day makes for a very different situation.. We are here to help not to judge or scold. Keep posting with concerns and questions and we will be here to assist. :bighug::bighug::bighug:
     
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  33. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    I saw that there were not test through the day time and realized that you worked outside the home and weren't able to get test except the PM cycle and weekends. It is what it is and no judgments here. Just keep doing what you can and let us know how we can help. Hugs and more hugs :bighug::bighug::bighug:
     
  34. carfurby

    carfurby Well-Known Member

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    I'm sorry things are so frustrating right now, but you taking the time to treat Silver is helping him. You are helping him to be healthier and get better. It may take time to see the results, but you will eventually. We have a saying around here: It's a marathon, not a sprint. I work full time and have no one to help me treat Furball. I can't get day time tests in or middle of the night tests during the work week. I just get tests in when I am able to. That's all anyone can do.

    As others have said, the best thing to do is just follow the SLGS guidelines for increasing and decreasing the dose. Please post here if you have questions. We are here to help. :bighug::bighug::bighug:
     
  35. Gill & George

    Gill & George Well-Known Member

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    Juliet sorry that it's all getting on top of you, we all understand how exhausting dealing with FD is.:bighug::bighug::bighug:

    As for the dose I agree with Wendy, it doesn't look like you've skipped past a god dose, so just keep following the SLGS guidelines.
    Those pm tests you've been getting really help build a picture, well done.

    :bighug::bighug::bighug:
     
  36. Juliet

    Juliet Guest

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    Thanks everyone. It’s been a tough day but hopefully tomorrow better. No sign of improvement with this new dose.
     
  37. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    I am glad that others weighed in to the SLGS method and reductions as I was not very clear on that. Also, glad that others confirmed that the dose is good for now as I suspected. Silver is lucky to have you in his corner.
     
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  38. Juliet

    Juliet Guest

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    Thanks. I sure hope so. It’s been so discouraging lately. But thank you everyone for supporting my mini meltdown today.
     
  39. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Juliet take a big breath and do as much as you can, I wish I could tell you there's some magical way to go about diabetes and a full time job but there isn't you'll feel tired sometimes, you'll probably end up missing a shot once in a while too ( I got stuck in traffic for over 3 hours once so I just had to skip the shoot) and well as they said life in general gets in the way, but the important thing is you are doing your best so cut yourself a little slack and as I said get tests whenever you can it doesn't even have to be always at + something any data is good, do curves when ever you can try and follow the SLGS protocol as close as you can ( specially on testing before shooting, when to lower the dose and when to skip a shot to keep him safe)

    It will require LOTS and LOTS of patience but he will start feeling better and you'll see that all the effort and sleepless nights are worthed and you can vent here when you need it we get it
     
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  40. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Juliet, we have all been there with the meltdowns. That is what is great about this forum; we are here to help and support each other. :bighug:
     
  41. Stacy & Asia

    Stacy & Asia Well-Known Member

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    My "patience pants" were soaked with all of the tears I cried in the beginning! Yep, we've all been there and having this place to vent to is just as helpful as the FD advice! :bighug::bighug::bighug:
     
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