? Please help - am sugars in 500s-600s all week

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Ana & Frosty (GA), Mar 8, 2018.

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  1. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Jan 19, 2018
    For the last 3 days, our am sugars have been in the 500s-600s. Please see the spread sheet. Today, despite keeping him on 0.5 units for the last 2 days, he is 559 again. I don’t understand what is going on, and i am really worried about him. Please, any advice or dose suggestion is appreciated. Thank you.

    Ps. I am going to work now, my boyfriend is home and will be doing a curve throughout the day. I will be reading your responses sporadically and updating the spreadsheet whenever i can. I will be on in the afternoon to read your responses and reply after work.

    Thank you,
     
  2. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Hi there. It is always alarming to see them in higher numbers. I looked at your SS and noticed in your comments that he broke into the bread box and ate a some bread on the PM of 3/5 .It can take up to 72 hours to clear some carbs. So, that could be one possible reason for the higher AM the last few days.

    Also, I notice that you are switching up the dose and that can really play havoc on the depot and make it confusing to know where he really is.

    Are you following SLGS? If so, the dose is held for 7 days unless they earn a reduction. I think in lieu of days of missing data, it might be prudent to hold the dose of .50 for the required time and gather as much data as possible to see where he really is on this dose.

    Also, just for caution sake, while he is throwing these higher numbers, I would get a ketone test in once a day until he is out of the blacks.

    How is he otherwise? Is he eating for you? All 5 P's is place, Pooping, peeing, playing, preening and purring?
     
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  3. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Thank you for your response. That’s good to know about the bread. I almost had a heart attack when I saw that 600, but then found the bread. I did not know it could take that long for the carbs to get out of his system. Needless to say, he isn’t no longer allowed in the kitchen.
    He doesn’t play but he’s acting mostly normal.

    I do not know how to test for ketones. I have 3 cats and everyone shares litter boxes. Could you advise, and also, what do I do with that information? If ketones are high, what needs to be done?

    Thanks. Ana
     
  4. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Oct 2, 2017
    Hi Ana. It's super sweet that you adopted Frosty. I have some thoughts but wanted to get a few things from you first...

    To help people help you, as well as keep track of things for yourself, we suggest linking your prior post to the current one. That way others can speed through your history without having to go find each post. Here are the links for your last 2 posts:

    http://www.felinediabetes.com/FDMB/...-2-340-4-178-6-104-8-177.192022/#post-2143074

    http://www.felinediabetes.com/FDMB/...u-going-away-for-10-days.191012/#post-2129908

    Next thing is, can you put in your comments section of your SS which days you were away? It helps fill in more blanks, as when the beans are away, there is more room for error in dosing, cats can be sad or distressed and it affects their behavior, eating, numbers, etc.

    Well done getting some more pm data, it's very helpful. Moving around with doses doesn't allow the depot to stabilize and it's hard to tell what exactly is going and which dose did what. It would be very useful for you to read the SLGS sticky and understand when, why and how to evaluate the data to increase or decrease a dose. We are all here to help and answer questions, but the more you know, the easier it will be to care for Frosty.

    I missed this from your previous thread but wanted to comment on it, so I'll do that here:
    If these are both u100 syringes, 1 unit is 1 unit. You can't do a side by side eyeball comparison and determine that one measures .5 closer to the other's .25 or anything like that because they could be different diameters, different thickness of plastic, etc. They will each measure the exact same amount rather reliably because they are designed to do that.

    Any other blanks you can fill in? Has his appetite changed? Is he eating different foods (besides being a bread bandit that one night)? Does he have access to dog kibble or any other contraband and may be sneaking it without your knowledge? Is his behavior any different at all compared to before these ugly numbers started popping up? Is he having issues with any of your other animals? Does he seem off, constipated, sneezing, not acting affectionate or however he usually acts, hiding, sleeping in different spots than usual, etc. Like Bobbie said, how are the 5 p's?

    I have an appointment to get to this morning, but I will be back later to read and respond. :cat:
     
  5. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Hi,
    Thank you for your reply.

    I am not that tech savvy so I don’t know how to link posts. Thanks for posting the links in your reply.

    We were away the 10 days where there are no sugar checks in the spreadsheet. As you can see, it’s 2/16-25th

    Mayve you’re right about the 0.25 va the 0.5 in different syringes, but then there’s posts from beans who use a caliper to keep the insulin consistent especially between different syringes, and how they are inaccurate. Anyway. I guess there will always be conflicting opinions, but going forward I’ll just have to accept that a 0.5 is a 0.5 across all syringes.

    Another reason I increased the dose prior to going away is bc I decreased it to 0.25 without him technically “earning” a decrease just to see if we can get him off insulin before we leave. Didn’t work and his numbers tended higher as u can see so I went back up to 0.5.

    I know the SLGS “protocol” by heart, I know I haven’t been following it since we got back but that’s because his numbers are so alarming. Right now we are trying our best to stick with 0.5 units and not to freak out too much and make any changes, but it’s difficult esp being a PA. My clinical judgement says give more insulin, but it’s probably complicating things even more. Trial and error.

    While I was gone I pre drew the insulin bc there was NO WAY she could draw the micro doses. Before everyone FREAKS OUT and tells me what i already read about the lubricant in the syringe and insulin going bad, i already read the article that says it’s not recommended, but i had NO CHOICE. It was either no insulin or that. I wasn’t gonna take a chance of her giving him too much accidentally, because that could = death. I did my research and that was the best I could do. Either way, I would try to teach her next time (again) as I realize it’s difficult to tell how much he actually got while we were away. BUT, when we got back his sugar was excellent - 100 at +10 and 150 prior to the next dose. I gave 0.5 units, and then all hell broke loose.

    As for your last questions, everything is the same, other than the bread. He’s not allowed anywhere near any other food. He’s no longer allowed in the kitchen. He’s acting normal. Just the sugars are giving me palpitations.

    Thanks.
    Ana
     
    Last edited: Mar 8, 2018
    Reason for edit: typos
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  6. MyTitan (GA)

    MyTitan (GA) Well-Known Member

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    Jul 20, 2017
    Good morning Ana and BF. I'll second what's been said here. You have to be consistent and follow the protocol for SLGS. Try not to panic on high numbers they will come down as you find the dose that works for Frosty. Take a look at Titans 2017 SS as we started his dosing back in July/Aug. solid black numbers for awhile. He ended up being an Acro kitty plus I think we were also dealing with IAA and that took awhile to beat back. I was advised many tymes to hike up my patience pants and wait for good results. It worked and I know it can for Frosty. Good luck we will be watching for progress, Ed .
     
  7. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    As far as the calipers are concerned, most peeps that are using them ( myself included) are using them on the same brand syringe. I think what Stacey was saying is not to compare one syringe against another brand. Once you start using calipers and if you change syringe brands then you would have to start over with your calculations.

    I will try to talk you through linking a previous link to a new thread:

    Find the previous thread you posted and open it up. Go to the URL box ( the first box at the top left) It will have your thread info. Click on it and highlight it. Then right click with your mouse and a drop box will appear and you will see cut, copy and paste. Highlight copy and then hit Ctrl and C for copy ( assuming you are using a PC not an Apple) Then when you start a new thread in the message body left click and hit paste and the blue link should appear.

    Keep posting and keep asking questions as that is how we all learned. We are here to help and I think now that you are back and can be consistent with the dosing and keep gathering all the data you can so we can help you figure out where he should be.
     
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  8. Stacy & Asia

    Stacy & Asia Well-Known Member

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    No worries, I think many of us start out with a learning curve, not just for FD, but for forums and SS things too. I know I did. To link to your prior post, go to your prior post, copy the URL at the top of your browser, start a new thread, and paste the URL in that new thread.

    Ah I see it now, totally missed that. It's less confusing if you leave all the rows for those days, add the AM and PM shot amounts and just note that you were away and no testing was done. Without that, it just looks like one day he was doing something and the next day something else, when in fact there are several days in between. It will make it easier for others reading your SS to interpret the data to see it that way.

    There is no conflicting opinion here. I use calipers too. It's not so much to keep consistent doses between different syringes as it is to keep consistent doses within the same manufacturer of syringes. Some of those lines are printed slightly askew and the zero line may be on the zero, but it also may be printed where the .5 should be instead. It's maddening. As you know, humans require much larger doses, so being off a hair wouldn't make a bit of difference to someone taking 20 units in one go, but to cats on tiny doses, a hair's difference can be huge. If I were going to switch syringe brands, I would not be able to use my same caliper measurements, I would have to recalculate all the measurements for that specific brand of syringe.

    That's awesome that you have read and retained the SLGS guidelines. The best part of following SLGS or TR is a lot of the trial and error has been done by those long before you got here, and you only have to tweak things, eventually and slightly, to your cat, no need to reinvent the wheel. There are other stickies at the top they may give you more detailed info on how long acting basal insulins (Lantus/Levermir) work, specifically the depot insulin concept. I'm still going back and rereading things often, it's a lot to digest and I'm always picking up something new or understanding something that I wasn't ready to comprehend the last time I read it.

    Rapid, short acting, "in and out" insulins are designed to pull high numbers down right away, Lantus is not. Not only is Lantus bad at pulling down high numbers, but if you try to adjust the dose based on the preshot number you are looking at, you mess up the depot and could likely have an insulin overdose. Dosing is based mostly on nadirs and not so much on preshot numbers. I've often found higher preshot numbers equal more unpredictability for the cycle: sometimes a crazy dive and a wild ride, sometimes a whole cycle of coming down only 20 points an hour.

    Being that we can control so many parameters, you'd think it would be quick to get a cat regulated, but it just isn't the case. Some cats just snap to it, regulate right away and go OTJ, some take a little longer and do the same thing, some take a lot longer. I think many vets also give the impression this should all happen in under a month and that's just not the case for many cats, which certainly doesn't make it hopeless!

    So many factors to consider and you have a lot of unknowns since Frosty came to you with diabetes. Was it his scavenger diet that did him in (gorging on leftover pretzels, hotdog buns and chips in Central Park perhaps :p)? Does he have some underlying condition like pancreatitis that caused the diabetes? Does he have bad teeth or some other medical issue or infection that interferes with regulation? Did he have a previous home, was he given steroids that caused the diabetes? Maybe his pancreas works perfectly well to make insulin and he just can't use it properly? You may or may not ever know (even if you'd had him since he was kitten), but I think how they get diabetes tells some of the story to how things will go with regulation and some of those things will reveal themselves in time and you can rule them out.

    The beginning requires so much patience, when I say beginning, I mean the first several months. We have a saying around here, it's a marathon, not a sprint. I know it's frustrating, but the picture will become clearer, things will unfold and the patience will pay off. You can check out Asia's SS to see where we started and compare it to now. It was ugly, frustrating, and progress was much slower than I would have liked for a cat that already had kidney disease! :blackeye: Each cat is different.

    Nobody is here to flog you. :bighug: We all do the best we can and sometimes have to make decisions that amount to the lesser of two evils, such as your example of predrawing syringes. I would have done the same. I'd much rather be faced with potentially less potent insulin while away a short time than trust someone unfamiliar with how this works to draw up tiny doses and then leave my cat alone for 12 hours without testing. It sounds like the dose amounts were consistent while you were away, so I think we can rule that out.

    That is good news that he's feeling okay and everything is the same. :cat: It looks like he is bouncy, it could be the .5 dose that triggered it, hard to say. Bouncing is normal and not necessarily a bad thing (it at least means the insulin is working and Frosty is responding to it). I would suggest the best thing to do going forward is to stick with the same dose, am & pm for a week, get all the test data you can, and re-evaluate on the weekend when you can do a curve and ask some people here to check out Frosty's SS and try to see what patterns are emerging.

    Didn't mean to write you a novel, but hopefully there some things in there that ease your worry and frustration a bit. I've been where you are, most of us have, it gets better. Keep posting and asking questions. Frosty is lucky to have found you. :)
     
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  9. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Dec 9, 2017
    Another -- maybe easier -- option is the following:

    - go to the page of your previous thread
    - hit ctrl+L or cmd+L if you're on a mac => that will highlight the URL in the address bar
    - hit ctrl+C or cmd+C to copy the URL
    - you can now leave that window or close it, go and create your new post, and hit ctrl+V or cmd+V to paste that address wherever you like.

    Hope this comes in handy!
     
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  10. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    About testing for ketones, a lot of peeps use the urine ketone strips, but you have to catch them in the box and test immediately or some peeps use a ladle that they get right under the urine stream while kitty is in the box. I was never able to catch Bubba as he is quite private with his box habit.

    So, I invested in a ketone meter and used the same some blood for BG's and ketones. I would get both meters with the strips ready for ease. I use the Abott Precision meter. It was about 25 bucks. The strips however are pricey. I found them the cheapest at Universal Pharmacy in Canada.

    The good thing about ketone meters is that ketones will show in the blood immediately where as with urine testing it can take 4-8 hours for ketones to register.

    If you decide to get a ketone meter let me know and I will link the guide to reading results for cats.
     
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  11. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    That is easier! Thx. The reason I do it my way with a word doc is because I edit the link.
     
  12. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Jan 19, 2018
    Yes, I would definitely rather check the blood level rather than urine, because there is no way I would be able to do all that.

    My question is, what do I do with the data? How will it change my management? Will it tell me whether or not I need to increase his insulin dose? That is my main question.

    Thanks,
    Ana
     
  13. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Oct 2, 2017
    It would not really help you with dosing, testing for ketones is a way to try to avoid DKA, a dangerous and very expensive to treat condition that requires hospitalization. Some cats are more prone to ketones than others. Some cats have ketones even in euglycemic numbers. Asia has never had ketones, even in blacks, but it doesn't mean she never will.

    As far as what you do with the data, assuming the reading is anything but negative, you would make sure Frosty is eating well, has plenty of water, is getting enough insulin and doesn't have any infections. If ketones are above a certain amount is basically means get to a vet fast. Hopefully Frosty is not prone to ketones, but it's a good idea to check or them somewhat regularly.
     
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  14. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Ok, sounds good. Please send me the values for interpretation, I’ll look into getting it on amazon.
     
  15. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    If Frosty would start throwing ketones the dose would be tweaked to make sure enough insulin is getting into him safely while making sure he is getting enough calories and water.

    If that were to ever be the case, peeps here would help guide you through it.

    I use to put the result of the ketone reading right into the same cell as the BG. If it were negative I would say Ketones Neg. if I got a reading 2.4 or higher ( that is when ketones show up in kitties on a human meter) I would put that number in the cell.
     
  16. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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  17. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Actually it would help with dosing. We would want to get as much insulin safely into kitty as possible. Sometimes feeding some more calories to accomplish that would be necessary while making sure we add lots of water to the food as the water helps to rid the ketones.
     
  18. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Although those numbers above 600 are distressing to see, Frosty is not solidly in the 500-600 range. Just two days ago, he saw some lovely blues. He's probably bouncing, either from the blues, or from fast drops. Last night between PMPS and +2 and between +2 and +4, he had drops of over 100 points. That can cause a bounce. I might also have set my alarm for a +6 to see if that drop had continued. If you haven't seen it yet, here is the definition of a bounce:

    Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

    One more thing, high numbers like this are not a 911 emergency. Could you remove the 911 from your first subject line? We save those for medical emergencies. My Neko also like to bounce to black at the beginning (and she liked bread too). And that was on a human meter so higher than your AT. Although distressing, it's not uncommon for newly diagnosed cats to bounce to ugly numbers.
     
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  19. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Thanks, Bobbie. Yes, in that way it would, I just meant as a general monitoring device, it's not used to help make dosing decisions as much as to monitor ketones and prevent DKA. Absolutely, if ketones are in the mix, dosing needs and rules shift to accommodate the situation, but if no ketones, it does nothing to help you find the right dose. Sorry if I confused anyone. :facepalm:
     
  20. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    That’s interesting that this is not an emergency. If a person’s blood sugar was 600, I would absolutely send them to the emergency room and they would be placed on an insulin drip. To me, this IS an emergency. I am THIS close to taking him to the vet, but wanted to see if anyone could give me some advice. It seems the advice is to keep the dose the same, which doesn’t really make sense. The last 2 curves I did showed the lowest he has gone was 200s. He went as low as 100 on 0.75 last weekend, so shouldn’t I increase the dose to 0.75?
     
  21. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Yes, but he's not staying over 600. He's peaking there then coming down with insulin. He was down to 225 already today.

    Please hold the dose at least 6 cycles. It takes that long to stabilize the depot so we can see how this dose is doing. Bouncing around the dose will do you no favours. The SLGS dosing method says to hold 14 cycles. The TR protocol is more aggressive, and even it says to hold at least 6 cycles. Lantus teaches patience. (never my strong suit).

    To help limit those fast drops, which can set off another bounce, try breaking his meals into smaller meals. Maybe a small meal around +1 and +2 will give him fresh carbs when the insulin onset, and slow his numbers from dropping as much.
     
  22. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    I know how upsetting it is to see those higher numbers but a kitty in higher numbers without ketones is not the same as a human whose numbers are in the 600's .

    It looks like he is all ready coming down so I would hold the .50 for the required time and let the bounce and the bread carb load clear which can take up to 3 days or 6 cycles from then and see where he lands. Also, because the depot has been disrupted with switching doses, it would be a good idea to see after the .50 depot fills where he is.
     
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  23. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    So the next time I will be able to do a curve is Saturday. Is that enough time to judge the 0.5 dose? That’s more than 6 cycles but not an entire week. After that i would like to adjust it because it’s likely none of us will be home next week to do a full curve.

    Yes, he is coming down but only to the 200s. There was a time when I didn’t like seeing 200s even as a pre shot number, and now it’s his peak. It’s so crazy that things changed so much in such a short amount of time. He was doing so well before all this.
     
  24. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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  25. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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  26. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Wow! So it was developed by cat owners and then published?!

    Have you guys considered working with a vet to publish or study the SLGS protocol? It actually goes more along the guidelines that vets recommend (BG 70-150 and a pre short value of 300 or less), and I personally feel is safer, esp for people who DON’T work a 9-5 job and commute far for work. Maybe it’s also bc it’s closer to the guidelines for humans, I don’t know. But I’m just more comfortable with it.
     
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  27. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    For the reason you mentioned: peeps not working a 9-5 job is how the SLGS Method came about . It is for safety for the kitties. While TR can get kitties into better numbers faster, it is possible to get a kitty into remission using SLGL.

    Everyone needs to use the protocol or method that feels comfortable to them.
     
  28. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Oct 2, 2017
    They should get it published!

    A couple things to keep in mind, humans would take these insulins and perhaps follow similar guidelines, but also use a bolus insulin for meals, so they know they won't have to stay higher for 12 hours like our cats would. That is not generally done for cats, so the basal insulin has to handle the fasting load as well as with food (which is why more frequent, smaller meals make sense if you think about it). Also, people don't often heal their pancreas and up and go off the juice like cats do, the TR protocol was developed with an aim to tightly regulate BG, it was based off of a tremendously successful human study, and the data supports better remission odds (especially in the first 4 months of diagnosis) than what most vets would prefer (run numbers higher to keep them safe). It's not for everybody and some cats will go OTJ no matter what you follow.
     
  29. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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  30. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Did you grab another test? That's a big jump.

    ETA: whenever you get a number that is lower than expected or higher, grab a second test to make sure the test strip wasn't bad.
     
  31. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    My boyfriend did it. Im not home. When I first started getting these crazy numbers, I did a control test, and it was normal. I believe it. I’ll check at 6 before his next feeding.

    I’m thinking of going up to 0.75 units because we had 5 cycles of 0.5 and it’s running very high.
     
  32. Wendy&Neko

    Wendy&Neko Well-Known Member

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    At the same time, you say you are on the SLGS regime because you personally feel it's safer. Both TR and SLGS can be safe, but it means following the guidelines for increasing. With SLGS, that means waiting 7 days. Even the more aggressive TR says to hold at least 6 cycles or three days. What'll it hurt to wait the end of tomorrow before deciding what to do? Bounces can take 6 cycles to resolve and numbers can wobble all over the place in the mean time. You may not be getting a true reading of what this dose can do while he is still bouncing. Again that word = patience. :bighug: Been there done that, I know how frustrating those high numbers can be.
     
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  33. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    OK, 0.5 it is. Thanks for the support.
    pmps is 543. It's not unusual for him to have his +10 be a few points higher than the +12 number.
    I'll post his curve on Saturday. Thanks for your input, everyone.
     
  34. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    The reason I feel SLGS is safer is because it has higher target glucose levels than TR. I personally feel that 40-80 is too low. I know it has been shown to be safe, but no way would it be safe with my schedule. I prefer the 70-150 target blood sugar range.

    I decided I’m not going to test until tomorrow morning since I won’t be changing the dose regardless. I want to give the cat a break from getting stuck, and no point in my having a panic attack over the numbers if I’m not gonna be changing insulin until I do the curve tomorrow.

    Thanks everyone for your help. I also have to look into ordering the ketone blood monitor.

    Ana
     
  35. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Just looked at the spreadsheet and wow, you have got some bouncy cat there!

    :bighug: Makes those patience pants harder to wear, but hang in there.

    I get wanting to give yourselves (him and you) à testing break. However, if you have the courage to grab just one before-bed test, that is data that can help interpret tomorrow’s preshot number, and make an educated guess about what happened during the night.

    Not saying this to discourage you from the break, but don’t underestimate how valuable this kind of data can be, even if you know you’re not going to touch the dose.

    I hope he gets off that trampoline soon!
     
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