? Phoebes amps 366 1/25 help

My husband got up 1 before me and fed phoebe. I need to give insulin at 8. We have to leave for work at 730? Help if I take him to work then come back T will be 830. Could I just do bg then feed and shot?

 

I'm not sure where you are located and if you have left for work yet. It's almost 9AM where I am. It's a good idea to post +1 or 15 minutes instead of actual time.

You can shoot late if you need to. You can than safely move the shot back in one 30 minute increment per day or 2 15 minute increments per day. If your schedule won't allow that, you can skip the shot if you need to.

 

Sorry yes it would be +1. I just did bg 429, fed her gave her 2.5. Called vet with values from ss

 

I'm glad things worked out.

 

Congrats on your otj! Gives us hope.

 

Just as an FYI, it is better to try to shoot as close to every 12 hours as possible. However, life can interfere! If you are early or late by 30 min., it will not likely make a difference unless you cat is very sensitive to a shift in time. With Phoebe's numbers being this high, shooting early shouldn't be an issue. (Shooting early acts like a dose increase; shooting late acts like a dose reduction.) If you need to move shot time back by an hour, I really doubt it will be problematic. What I would suggest, though, is to get a test at +10 and post and ask for someone experienced to look at Phoebe's SS to make sure it's OK to shoot an hour early. Or, like Carla noted, shoot 30 min early at PMPS today and tomorrow.

 

I will shoot 30 mins early today and tomorrow. So instead of 8 I will test at 730 and inject correct?

 

If you shot at 8:30 this morning, you would shoot at 8 tonight and 7:30 tomorrow morning (7:30 is your normal shot time, correct?). Normally we recommend you only change the shot time by 15 minutes at a time or 30 minutes a day, but as Sienne said, Phoebe's numbers are so high that it shouldn't cause any problems for you to shoot earlier. I also recommend posting and asking for confirmation that it is okay to shoot early, if that is possible with your schedule, especially if you decide to move it up by the entire hour tonight.

 

She usually gets her night inject at 800. Which I did last night. Then this am it was 9 am. Sorry it's just not going in my head but will feed dinner at 530. So should I test at 730 or 8

 

+10

+10 would be 7pm. And when I do the bg and post here do I do a 911 so I get answer quickly? Then undo 911 after I get suggestion?

 

We try to reserve the 911 for life-threatening situations, so it'd be better to use the question mark .

Another variable in the mix here is that an early shot can sometimes act like a dose increase, so if you are going to do the half-hour shifts I would hold off on the vet-recommended increase until you have gotten back on schedule-- just stick to the 2.5U for now.

When people are saying "early" here, they're talking in reference to the "9" shot time of this morning. So, if you are planning to shift by a half hour tonight and tomorrow, that would be:

tonight: shoot at 8:30pm (this is at +11.5 relative to the morning's shot, so "early")
tomorrow: shoot at 8:00am (your normal time, but also "early")
tomorrow night: shoot at 8:00pm (+12, back on schedule!)

make sense?

For testing and asking opinions, your +10 time would be 7pm, as you say. This is just so you don't get taken by surprise if Phoebe picks today to start going low-- you might get a lower-than-usual number at pre-shot, so we want the +10 to tell us whether she's going up or down at that time so we know if it is safe to shoot early.

 

OK That makes sense thank you so much!! I need to quit reading every post it gets overwhelming and jumbled. I mean everyone else's posts. You peeps are wonderful!

 

You can always put your question in the subject line like you did this morning.

 

Thanks, @Nan & Amber. I had to bail out of the Board as I had a meeting. Looks like you've got it all sorted out.

As far as posting for advice, I'd take that test two hours after dinner, so that the number isn't food influenced. You said you'd feed at 5:30, so it may be a +10.5 test at 7:30 for advice, and you test/feed/shoot at +11.5 (8:30). Of course, you would not feed between those two tests, so both those numbers would be without food influence and give a good picture of what direction things are going. I hope that didn't muddy the waters.

 

Nope. All good. I fed her at 5 before I saw this post. So I can test at 7, and shoot at 8. Thank you.

 

If you shoot at 8, that would be a whole hour earlier, so getting back on schedule in one go? I think the general opinion from the very experienced folks like Sienne and Tricia was that that should be totally fine but definitely post for any revised opinions once you get that 7pm number!

And I'll reiterate that no matter what the number, I'd counsel against raising the dose on this shot, it would be like doing an extra-large increase and, Phoebe being a cat and all , you can't really predict her response.

 

Omg Nan I am now confused again. I was going by what Tricia said she said since I was feeding at 530, test aT 730, then shoot at 830. So since I fed her at 5, which is a half hour earlier, I thought I just move everything up 30 mins?!!! So please tell me what I should do testing her at 7. Because she ate at 5, not 530. I definitely do not want to do it wrong!!!

 

If you shot at 9am this morning, the best thing to do would be to shoot no sooner than 8:30 tonight and (if high enough in the morning) you could shoot at 8am to get back on schedule

The only reason we're suggesting testing at 7:30 is so that when it's shot time (8:30) we know for sure that the numbers are still going up and it's safe to shoot....You'd still test at 8:30 too

We generally Test/Feed/Shoot all within about 5-10 minutes. Test to make sure they're high enough for any insulin, Feed to make sure they're at least willing to eat and not sick, and Shoot (usually while their head is in the bowl)

With Lantus, it doesn't "kick in" for usually 2-3 hours, so as long as Phoebe is willing to eat, she doesn't have to eat any particular amount before shooting

As long as you don't feed for the 2 hours immediately before shot time, you're good.....we just want those Pre-shot tests without the influence of food for 2 hours

 

What Sienne had suggested is another option too that would be OK this ONE time as long as Phoebe isn't really sensitive to insulin

If you shot at 9am, test at 8pm tonight (or 7:55pm)....if she's high enough then (which we suspect she would be), you could shoot at 8pm after testing/feeding just this once.....the 7:30 test time was suggested so you'd have some time to ask for opinions before shot time at 8pm

Shooting an hour early can be OK if the cat is high enough and not really sensitive to insulin, but it's always best to stay to as close to 12 hours as possible as a general rule

 

I think you're fine, and I wasn't trying to suggest a change in plan myself, I was just responding to your last message that said

which made me think you had decided to shoot the full hour early tonight yourself.

Chris has just explained some of the issues we're trying to balance here.

 

Ok so testing at 730! And shooting and feeding at 830 if numbers are high enough. Sorry I just had the 2 hours after eating. Smh thank you @Nan & Amber for stopping me!! Jesus this is alot. Thank you @Chris & China.

 

Personally, if you test at 7:30 and post what you get here, I think it's highly likely that you could shoot at 8pm tonight with the kind of numbers Phoebe has been seeing and then you'd be able to shoot at 8am in the morning

 

@Chris & China @Nan & Amber +10.5 on phoebe is 374

 

I'm not qualified to make the call about 8pm vs 8:30pm, but I'm sure that someone who is will pop in soon!

 

I think you'd be fine to shoot at +11 tonight (which would be 8pm)

I'd plan on getting at least 1 other test in tonight (preferably more)......can you get a +2 tonight? (at 10pm if you shoot at 8pm)

 

I also agree that since you're giving an early shot, you should stick with the 2.5U dose tonight

 

Thanks, Chris!

Crashing now and logging off, but will be checking in the morning to see how things are going!

 

Yes I can do +2 bg. So I should give her the 3 units at +11?

 

I would stick with the 2.5 since you're giving an early shot

 

Ok playing it safe. Giving her 2.5 at 830. Is that ok then start the 3 units tomorrow so I will be awake to observe.

 

Let's see what tonight shows first

 

I think you'd be fine to go ahead and shoot now (at 8pm) tonight

 

I did
Just couldn't get back to say it. Thank you.

 

Do you have time to check her 20-30 minutes before shot time in the morning, so if she is lower than you are comfortable shooting, you can post for advice? Whoever is up at that time (not me, I'm a night person) can also help you decide if it's a good idea to go ahead with that increase or not.

 

Yes I am getting up so I can do that. I am a night owl as well. Mornings stink. But kitty comes first.

 

Phoebes preshots bg is 304. Do I shoot 3U this am?

 

That is her lowest pre-shot number yet. I'd like to hear what some of the more experienced folks have to say about this. The number is still quite high, but the factors here are:

1) the "early" shot last night may have acted like a temporary dose increase, so this would be two increases in a row
2) the increase recommended by the vet, 2.5U to 3.0U, is the higher of the two increments we usually go in (the other increment is to increase only by 0.25U). That was justified by the fact that Phoebe has been running in such high numbers (nadirs over 300), but with this lower pre-shot, barely over 300 itself, I am not sure.

The conservative move would be to wait until last night's early shot has worked through the system and to see where she goes from 304 today on the usual 2.5U, but again, wait until you hear from more experienced folks on this. We do want to get her numbers down.

 

Going to tag a couple people who might be online now to increase chances of getting expert eyes on this in the next half hour:

@Bobbie And Bubba , @Doodles & Karen, good morning! Any thoughts on the dosecrease (or not) this morning?

 

Thank you Nan

 

Is Phoebe off the steroids now? And she eating okay?

 

I have to read the thread, brb

 

Yrs eating good and yes off steroids long time.

 

Are you shooting 12 hours from last night's shot? Are you following TR or SLGS (I don't see it in your signature).

 

I just tried to quickly read through yesterday's thread and it looks like she is coming down. And I think what I am getting is that you are back on your regular schedule time which is 12 hours from the last shot, correct?

 

No not doing tr or lgs. I am trying to get the hour back from yesterday gave 2.5 last night but was hoping to start at eunits as vet prescribed.

 

So you would be shooting 30 minutes earlier today, correct?

 

Yes

 

I'd increase by .25u. There's a chance she is dipping into yellow at night after those +4 tests and zooming back up. It you're following TR you can increase again in 6 cycles if needed.

 

If you are shooting earlier today and since she has come out of the reds and started off 304, I think I would hold the 2.5 dose

 

So that we would be back on schedule tonight. And move her up to 3 units as per vet.

 

Ok I will do the increase by .25. And get bg at +2 +4 today thank you

 

Good point, can you monitor her today if you increase?

 

No, I think we probably want to wait on the 3U for a little longer than that. The thing that is tricky about Lantus (also one of its strengths) is that it has a "depot"-- part of each shot is "saved" and available for use later. This makes cycles on Lantus (eventually) pretty stable and flat, but it also means you have to be very careful about doing lots of increases (or early dosing) in a row, because you don't necessarily see the full effect of a particular dose until the depot fills up. If you've gone ahead and done another increase in the meantime, you could end up with too much insulin, which can be very dangerous.

 

Yes

 

I agree which is why I suggested to hold the dose but, I do see Karen's point about dropping and bouncing. And that said, since she started off much lower today, I think holding is best.

 

The other thing I was just thinking about is that these are Alphatrak readings, so they are scaled higher than what a lot of us are used to seeing (most of us use human BG meters because of the cost savings on strips). That 304 on a human meter is probably somewhere in the mid-200's.

I think conservative is the way to go-- we want to keep Phoebe safe!

 

+2 bg is 407

 

Interesting. I bet she went even lower than 304 last night-- this looks like Karen's predicted bounce, as I don't think she's ever gone higher at a +2 before.

I don't know if we've talked about this yet, but a bounce is when a kitty's body responds to low BG numbers it isn't used to by working to get the numbers back up. It's an annoyance when you're trying to figure out doses, but it could be a good sign that at least she's hitting those low numbers! Lots of cats go lower in the nighttime cycle-- this is one reason we always say to try to grab at least one mid-cycle number. Even if it's just a +2 or +3 (+4 would be better) before-bed number, it will help figure out if Phoebe is one of those lower-at-night cats, and plan accordingly.

By the way, we've been talking about getting some ketone sticks and doing some testing-- any success yet?

 

Yes just brought those home. She already has peed probably while I'm gone. So will have to figure out how to get the urine. She is skittish in litter box. But good lord I have a wet cold nose, and am getting tons of love bites!!

 

With her bouncing and an increase today, I would try to get as many PM test as you can tonight and for the next few cycles in case she starts to clear the bounce on top of an increase there can be some downward momentum.

 

So like +2 +4 after the 8 pm shot?

 

That would be great. The +2 number helps you know if the cycle is going to be active. For example, if the +2 number is the same or less than the pre shot numbers, it is very likely to be an active cycle. But that said, sometime kitties won't indicate their intentions. (because they are cats and do their own things sometimes ) A +4 would give you an idea of what is happening to the pre -shot number after onset of the insulin occurs.

 

The only problem with that is I take ambien sleep pills to sleep, not sure I could cohertly take that +4

 

How about a +3? Are there some nights where, if you got a dropping number at the +3, you could delay the ambien and stay up longer? A lot of us have similar constraints, but there's always a way to work around them. If it's not possible to do midcycle at nighttime (I also had serious trouble with that due to my own sleep issues), there are some strategies.

 

Would a +2 and +3 make a big difference?

 

The +2 usually indicates how active the cycle is going to be. But if you can only get one test before you go to bed then make it the +3 which is around onset. And like Nan said, if you see a big drop by then you could give some LC food to slow down the cycle and , you might be needing to stay up some to make sure Phoebe is safe before going to sleep.

 

This might help you a little with the different test times. It is in the stickie The Basics New to the Group Stickie

Example of an ACTIVE, but NOT necessarily typical Lantus cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

 

Very helpful ty

 

Phoebes preshot pmps value 459 ketones neg

 

Glad the ketones are negative. Since you increased this AM, sometimes kitties get what we call New Dose Woniness (NDW) and their numbers actually go up temporarily instead of coming down and it usually happens the 2nd or 3rd cycle after the increase. So don't be too concerned if that happens. The good news is that you will be able to get a good night's sleep.

 

So still can shot the 2.75?

 

Yes. You want to hold the dose unless a dose reduction is indicated.

 

When you hold the dose you mean continue same or don't give it? @Sienne and Gabby (GA)

 

Hold the dose means to shoot the present dose. So tonight you will shoot 2.75 and hold that unless a reduction is earned. Since you are using an Alpha Track meter your reduction number would be 90 ( I am assuming you are following SLGS since you are so new to this dance?)

 

Angela, keep asking questions as that is how we all learned.

 

I thought all the protocols were written for human meter numbers?

 

(Regardless, I think Angela is planning to make a switch to a human meter soon anyway).

I agree that Start Low, Go Slow (SLGS) is a good approach here-- it's one of our protocols used to help guide dose decisions, and is described in detail in one of the "sticky"s at the top of the Lantus forum.

 

Yep yep!

 

They are but, reduction numbers are given for those using pet meters like the AT2. For TR it is 68 and for the method SLGS it is 90.

 

With her numbers this high am I still doing +2 +4

 

I think you are safe tonight to get some sleep with out testing her. But, if you want to grab a test right before you call it a night, all data is good data and is helpful to see trends.

 

+2 is 416 good for the night?

 

+4 374

 

Get some sleep.

 

Actually there is no reduction numbers cited for pet meters in the SLGS method. The only reason there is one for the TR method is because R & R specifically indicated the pet meter reading to be used with TR. The 90 in the documentation is based on human meter readings only. I have questioned this before but never got any clarification. Based on my year+ of pet and human meter comparison testing, I would estimate the AT2 meter reduction point for SLGS would be in the 115 to 125 range but that is based on my own comparisons with my specific human meter rather than anything scientific.

 

Thanks for the clarification Linda. Isn't 90 the number that is used here on the forum for SLGS?

 

You are correct Bobbie. 90 has always been the number every one uses but I personally don't think it should be. The 90 for human meters was arrived at (not sure how) to build in a "comfort zone" to avoid riding that "tight" line between regulation and too low used in TR. By using 90 as a reduction point when using a pet meter, you lose a good portion of that "comfort zone" and therefore dosing becomes somewhat of a hybrid method somewhere between TR and SLGS.

If you look at the human number references of 50 as a warning of low numbers in TR and the 90 reduction point in SLGS, you have a cushion of 40 extra points in SLGS. If you use 90 with a pet meter knowing the low number warning for the pet meter is 68, it reduces the SLGS "cushion" to 22 points, almost a 50% reduction which I think is significant. Because the difference in pet meter and human meter readings gets larger the higher the reading, the "cushion" suggested when using a pet meter should likewise allow for a larger point difference which is why I think the reduction point with pet meters needs to be higher than 90.

 

Hello!

Interesting discussion on the reduction point question! Never really thought about that in detail.

Angela, I see you've changed the subject line to 1/25. As this thread is pretty long and you were (I think) planning on switching from the Alphatrak to human meter today, it is probably a good time to start a new thread for the new day. The lantus forum is so busy, we usually try to keep to the rule one day=one thread. The first post of a new thread usually contains a link to the previous thread so that people can get caught up easily.

And, good morning!

 

Yes will be switching to human meter today. Good morning. Just wanted to get the last AT reading this am to see where she stood. I will start a new thread. Titling switching to HM. ty

 

great! see you at the new thread!