Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by ppp, Dec 4, 2017.
Is this bouncing? Advice for tomorrow?
No way to know without any nighttime mid-cycle testing, SS shows no shot for 2 days at AMPS?
Your meter should record the numbers for you in it's memory, so even if you forget to put it into your spreadsheet, you can go back and see what it was.
Without the data for the last couple of days, it's impossible to really know what's going on, but I see a couple things
Lantus craves consistency.....You're changing his dose too often. Lantus dosing is based on how low it takes them, not the Pre-shot numbers and then it takes at least 6 cycles for the depot to stabilize and really see what it's doing.
You need to hold the dose for at least those 6 cycles and get both Pre-shot tests (AMPS and PMPS) as well as (IF possible) a mid-cycle test on the AM cycle and at least a "before bed" test on the PM cycle (more if you can, especially if you can't get mid-cycles during the day due to work)
PM tests are even more important since most cats do go lower at night, so getting at least a "before bed" test will help let us know what's going on, as well as keeping him safe. If he's dropping too much or too quickly, you may need to set an alarm to wake up and test again
Next, I can't really figure out what your "Remarks" mean, but it's important to get the shots in as close to every 12 hours as possible. If you shoot an hour late one time, you should shoot the next dose an hour late too. You can work your way back to your chosen shot times by moving it back 15 minutes per cycle or 30 minutes per day.
For the sake of others, I will say that simply noting a deficit is really not helpful. I suppose it is frustrating to want to help but not feeling you have enough data.
Still, it is what it is, and I still have to decide what to do today.
Hi and welcome, what do we call you?
A couple of things regarding your SS, it's a tool for others to help you, so if you don't shoot for whatever reason, put "NS" (for no shot) in the unit column so that it's obvious no insulin was given rather than you just forgot to fill in that cell. It also helps to put in remarks why you skipped: "AMPS too low" or "furshot" or "wasn't home", etc. so others know what's going on there and can help guide you.
What are the food numbers in your remarks? Is that like 5.5 ounces of food given? Some measurement? If you can clarify that in your SS, it helps others to see what's going on.
Like Chris said, it's hard to know where to go without shooting a consistent dose and Lantus dosing is based on nadir (how low the dose is taking the cat) as opposed to AMPS and PMPS like some other types of insulin. I would stick with the dose you have now for a few days and try to get a mid cycle test (anything in between is helpful, +2, +10) somewhere in the am & pm and then reassess. Check out the stickies at the top of this forum. The new members one is a great start, and you can review the ones for the TR protocol and the SLGS method and see which one looks like a better fit for you. All the dosing strategies are laid out in those stickies, it depends which one you want to follow, but both are similar in that you keep a dose for a minimum amount of time before increasing or decreasing and that you shoot 12 hours apart.
Thanks. My name is Pat. Maybe one of these days I'll get around to adjusting my profile and adding a pic of Tut.
I had not noticed the "NS" recommendation before. Have added. (Hopefully this will not happen again!) [New strategies.]
Yes, remarks refer to food; I had thought of this for my info .... most people don't record food at all so didn't think others would try to read "food" sections. (Yes, it's time & ounces; but not complete, just hints for me to compare changes in his eating.) (I think he's over-eating, but, he is still looking thin relative to the 'body profiles' I found here .. he is a large/long cat.) If there's any protocol for this, I'd be glad to use it. (I'm actually kind of surprised that this is not part of the spreadsheet; I've seen postings on 'manipulating BG with feeding'. (But, perhaps -- just as I find, it is too much extra to do reliably.)
I have read (but doubt I have taken in! and do go back to review) what's here (not all the links!)
As to methods, I'm afraid I am past the SLGS (?) with the vet having put him on 3 units to begin with (which I modified -- first because I had to rely on a pet-sitter, early on.) It doesn't seem to make sense to go back to a very low dose and start over.
On the other hand, I'm not sure it makes sense to take the risks of hypoglycemia that 'tight regulation' seems to involve, for a cat whose life is almost certainly going to be short, given other health problems.
So, I do feel stuck ...perhaps it is not fair to ask for help when I'm not in a pattern that others can recognize.
Aw, he was hiding from you? It looks like you figured out how to get him for shots, a lot of people give shot and test treats (low carb) to help with reluctant kitties, some of them look forward to shots/tests because of it.
It's great that you are recording food, it does help fill in some of the blanks, many people do that, I just haven't seen the ounces listed like that (boy you're on top of the game there), it usually reads like "2 tsp 8% tiki cat" or something like that. The percentage being the carb content of the food. I don't know of any food protocols per se, but certainly people here are dealing "more to love" kitties.
I don't follow SLGS and therefore have no real experience with it, but I'm almost positive you would not start over at a very low dose, I think you'd just start from where you are at the moment. Given Tut's other serious health issues and remission not being a main goal, SLGS would make a lot of sense in your situation. TR will get you where you want to be faster, but yes, it's aggressive and you will have to monitor more to catch/prevent hypos. Of course it's entirely your choice.
Here's a good post that helped me a lot in the beginning, particularly the link about new members advice for other new members:
Please, ask all of the questions you need to ask, it's not a matter of fairness, it's just that there's only so much one can say without having more data. It's not likely some of them can be answered in a way that will be useful specifically to Tut and they can't be answered without a whole lot of guesses and generalizations because the feedback you get here is based on the method or protocol you are following and the data you are collecting and recording in your SS.
Hey we get it Tut has some special conditions ( a few of the kitties here are in complicated situations too) but you are here and there are very experienced people here that can help you even with that but one thing every suggar parent will need is patience lots and lots of it so hang in there .
The protocol you choose to follow is the one that in the end works better for both of you, but either one you choose one important thing is that Lantus requires consistency so shooting same dose AM and PM for a period of time is what you'll want, also testing before shooting for safety and we do recommend that you test at least once before you go to bed to make sure he is safe during the night.
I don't think you would start over either but according with SLGS protocol you'll have to keep the current dose for at least a week unless Tut goes below 90 (if that happens you lower the dose to 1.25 on his next shoot ) and then evaluate to see if you need to adjust the dose. Also you should try an keep the same dose AM PM if he is a little bit low on the preshoot test post here and ask for help
Per advice received, tried to put my 2 ongoing threads together by editing title (to "Dosage Help") but there are still 2 threads. (Don't see how to change date, as advised.)
Link to other condo:
I will take another look at the protocols.
Just want to say thanks for all the help. And let all know that Tut is (today), again, a happy guy! (remarkable turnaround since this disease hit, even at these higher BG numbers)
Hi Pat, the learning curve is quick if you spend some time checking out the stickies on top of the forum. Ask any questions you have, so many people here are willing to help. It is overwhelming at first, we were all in your shoes when we first got the dx of Feline Diabetes, you found the right place to be.
A happy Tut is a good thing
Just to throw into the mix - my vet put Silver on 2u twice a day and I listened to the vet advice for the first two weeks as he kept increasing. The forum kept telling me to start doing SLGS and reduce to 0.5 (even tho he was at 2). I ignored for a while. Believing listening to the vet was more correct. However when his number kept increasing - into black numbers - I asked the vet to give me ten days to try it a different way. I reduced to 0.5u; followed SLGS and he was OTJ before the ten days were up. Vet didn’t comment except to say she was surprised Silver would allow all that testing. He was OTJ for three years.
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