8/25 Charlie PMPS 281 +4.5 263

Yesterday

Shooting back up into the reds. Ugh.

 

Re: 8/23 Charlie AMPS 427 +4 409

Good morning, Jill!

Hugs to you. I know those reds are frustrating. We'll help you try and get ahead of them. It's your 5th cycle on 1.25u, so let's give Charlie a chance to maye make something more of this dose yet - she did have that one nice dip into the blues on the 23rd on this dose. Still, if she doesn't show some more movement in the next couple of cycles, I'd say you're looking at another 0.25u increase:

QUOTED from TR PROTOCOL Sticky:
"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.
--- 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."
(TR Protocol Sticky)

Chin up!
Hugs,
Jane

 

Re: 8/23 Charlie AMPS 427 +4 409

Thanks for the reminder of the protocol. Thing is: From looking at Charlie's spreadsheet, I'm really not confident that we can see when her nadir is. I know the theory says it comes around +6, but some of the data seems to show that hers could even be at +8 (see Aug 12th evening, for example). Also on Aug 22 and 23 in the evening, she had a lower point at +7. The evening of Aug 6th, she was lowest at +9. And what would explain the low point on Aug 18th that took her to a number of 58 (when she was only on 1 unit)?

I'm happy to increase again to see if it has an impact, but also a bit worried about doing so since I am not clear on when her nadir is to even know how to follow the protocol.
Any thoughts on what times are important test times to get today during the day to fill out the data collection?

As always, thanks for your input. Stomach still hurting real bad so I'm not at my clearest.

Jill

 

Re: 8/23 Charlie AMPS 427 +4 409 Please Help me find her nad

Hi again Jill

I've had a quick look at Charie's SS (but I'm in the middle of making cat food right now, so I want to take a few minutes when I'm done to really focus). Let me try, in the meantime, to give you some feedback. From looking at Charlie's SS, so far, her nadir seems to be travelling (i.e. moving around along the cycle timeline) depending on what else has been going on. She *tends* towards a mid-cycle nadir (typical for Lantus), but as you yourself have noticed, sometimes she dips to her lowest point earlier, sometimes later. (A mid-cycle *surf* can of course also make it harder to really pick out the nadir.) What I'm seeing on the SS is a still unregulated cat, whose "normal" BG patterns are not yet emerging clearly because other factors (like, bounces and bounce-clearing phases, for example) are affecting the cycles a lot of the time.

Where dosing is concerned, I don't think you need to be worried about not seeing a regular nadir for Charlie yet. Her patterns will become clearer as she becomes better regulated. What we'd look for in order to go forward with dose changes is simply the lowest point of the cycle, for now. Once Charlie *is* better regulated, it will become easier to see what type of nadir-kitty she is. I know this may not be a very satisfying answer - and the others may well pick up patterns out of Charlie's SS that I'm just not seeing - I do try to read a couple of dozen SS a day, and I hope I'm getting better at interpreting them, but I'm sure there are things I miss that others pick up on. Though I know they're really busy, I'm hoping Jill and/or Libby will stop in and give their input - you can always drop them a PM, too, for some SS interpretation :smile: But fwiw, these are my thoughts on where she is right now.

I'd go for a (+6) next. Depending on where she is then, you can try picking out *this* cycle's nadir by getting a (+7), or (+8), or even both if she'll let you. I do tend to err on the side of too much testing though :mrgreen: I'm so sorry your stomach is still giving you such grief! I hope the meds kick in really soon so you'll feel a whole lot better!

Back to cat food making! I hope this helped a bit. I'm sure others will pitch in too.
Hugs,
Jane

 

Re: 8/25 Charlie AMPS 427 +4 409 Please Help me find her nad

Thanks Jane. Just got this now so we'll do a +7 and +8. As this seems to be a bounce day, maybe finding the nadir from today's cycle is not the best anyway. I was just thinking that overall, we may be missing some data in certain shot times. If so, we will try to fill that in over time. We already appreciate your input as it seems like another dose increase may be nearing.

 

Re: 8/25 Charlie AMPS 427 +4 409 Please Help me find her nad

You're welcome. We can chat a bit later if you want - like yesterday :mrgreen: I'll have another look at the SS and compare with some others, just need to finish cat food.
Hugs!
Jane

 

Re: 8/25 Charlie AMPS 427 +4 409 Please Help me find her nad

If you want to, you can test her every hour on the hour. This is called a curve. This will give you some indication as to what her nadir (lowest #) would be at what time (ie. +4, +5, +6 and so on). You can do a 6 or a 12 hour curve to determine when she drops and when she starts to rise again.

I've done 6 and 12 hour curves with Blackie and in the beginning, her nadirs were typically +5-+6. Now they're at +3. This will help you, and the experts to see how Charlie is doing.

I know it's frustrating. You'll get there, and you'll have a ton of help from the people on here. You are in at the right place. :YMHUG: Jane is right though... This is only the 5th cycle of this dose, and it will take time for Charlie to accept it, and settle down. Usually it takes about 3-5 days for a dose to settle, sometimes longer. It all depends on the kitty.

 

Re: 8/25 Charlie AMPS 427 +4 409 Please Help me find her nad

Hi Angela! Just to avoid confusion: The term "curve" can be used several ways. One is the "typical Lantus curve":

QUOTE from "Lantus/Levemir New to the Group" Sticky:
Example of a typical Lantus curve:
+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.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

The second meaning is "doing a curve", i.e. testing at certain intervals throughout one insulin cycle (Curve Instructions). Around here, the "standard/full curve" entails testing every 2 hours. A "mini-curve" entails testing every 3 hours. One *can* test every hour, but it's not always useful to do so.

The only other point I'd like to reiterate is the issue of Glucose Toxicity. When glucose toxicity is a factor, it is sometimes permissible (even necessary) to be more aggressive than the protocol guidelines strictly suggest. In order to help a cat out of the habitual high numbers, one would often *not* wait longer than 3-5 days - indeed, sometimes it's the right choice to go right for the next increase at Cycle 6, or in some cases, even a cycle or so earlier than that.

Jane

 

Re: 8/25 Charlie AMPS 427 +4 409 Please Help me find her nad

Actually, a full curve is testing every 2 hours. A mini-curve, is testing every 3 hours. Spot checks can be just as valuable.

I want to build on Jane's comments about nadir. The nadir is not necessarily a fixed point. While it may tend to be at a particular time, I would not become wed to the idea that your cat's nadir is always at a certain time. In addition, the nadir is not always mid-cycle. Just like with everything feline, every cat is different (ECID). If you look at Gabby's SS, her nadir is often at +4. She has an early nadir. However, her nadir has been as early as +2 and as late as +8. She likes to keep me guessing!! Just like some cats have an early nadir, some cats tend to have a late nadir. The value of getting spot checks is that not only do you have the opportunity to fill in the blank spots on your SS, you may catch information that you would otherwise miss if you get into the habit of testing only at certain times.

 

Re: 8/25 Charlie AMPS 427 +4 409 +6 400 Help find her nadir?

Forgive me. I thought a curve was done every hour. Please accept my apologies.

 

Re: 8/25 Charlie AMPS 427 +4 409 +6 400 Help find her nadir?

No problem, Angela, don't worry! I just thought I'd clarify (and it seems Sienne and I cross-posted again :mrgreen. No worries!
Jane

 

Re: 8/25 Charlie AMPS 427 +4 409 +7 400 +8 355

Charlie's +8 was less than her +7 again.

 

Re: 8/25 Charlie AMPS 427 +4 409 +7 400 +8 355

:lol: Charlie is teaching us all that age-old lesson: They're CATS! They will not be categorized :mrgreen: Looks like Charlie was surfing around 400 or so since the cycle started (the AMPS, +4 and +7 are all within meter variance range of each other, so that'd be considered a surf). Looks like her nadir this cycle, if such it be, is a late one.

I'm not too happy to see her up there in those colours... I'm leaning towards an increase. How would you feel about that, Jill? (I've asked for more eyes too, to be sure I'm not jumping the gun.)
Jane

 

Re: 8/25 Charlie AMPS 427 +4 409 +7 400 +8 355

Hi Jill, I cant advise on dosing. For curves, I did some every hour curves on Jasper and if allowing for meter variation, his nadir could be anywhere in a several hour stretch, or stretched over sevarl hours. I thought his nadir was the lowest number in a cycle that I happened to get, so I tested him pretty frequently. I am no expert, I do look at many spreadsheets each day to learn. Looking at Charlies sheet, it looks to me like her nadir is generally during the middle of the cycle. You have to use the lowest numbers you get to help guide dosing decisions.
I hope you feel better soon!

 

Re: 8/25 Charlie AMPS 427 +4 409 +7 400 +8 355

If you factor in meter variance of 20%, your +7 and +8 are pretty much the same. You'll know if you get a +11 if it's a dropping number. I think the drop "appears" bigger because of the way we color-code things on the SS.

 

Re: 8/25 Charlie AMPS 427 +4 409 +7 400 +8 355 +10 313

+10 is lower still. Charlie likes to keep us guessin'.

 

Re: 8/25 Charlie AMPS 427 +4 409 +7 400 +8 355 +10 313

Any chance of a (+11)?
Jane

 

Re: 8/25 Charlie AMPS 427 +4 409 +7 400 +8 355 +10 313

Still going down. Now at 293.

?

 

Re: 8/25 Charlie AMPS 427 +4 409 +7 400 +8 355 +10 313 +11 2

Don't worry quite yet, Jill. What you have here is basically a surf :smile: Post the PMPS, and we'll see where we are, ok?
Jane

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

+12 at 281. Still going slowly down. Assume I should shoot the normal amount now, right? Or wait until it starts going up again?

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

Doing quick SS review, be right with you.
Jane

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

Ok, Jill. Looks to me like Charlie's shed is filling nicely, bringing her out of those reds/pinks into yellow. That (+11) to (+12) is essentially a surf, too slight a drop to *really* be considered a drop. Still, good that you're cautious.

First: Can you monitor this cycle closely? Got enough strips? Food>? HC/karo etc.?

Second: You have more than one option. If you're really not comfortable, you can shoot now, but give a BCS dose (reduced dose) - comes with downsides, but is an option. OR you can stall for 15-20 minutes, see if you get a rise as insulin wears off, and shoot full dose (basically would be now-ish) - would mean it would be best of you could monitor this cycle. There are a couple of other choices I guess but I wouldn't go for those (skipping shot, for instance, isn't warranted I think, for this kind of number).

So, can you monitor? And what are you comfortable with?
Jane

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

I will be out for the next few hours but after that can be home to monitor the cycle. The last few days (Aug 23 and 24) I think we had a similar pattern so I'm not too worried that she'll crash in the next few hours. Is that logical? Or do I need to be concerned? Once I'm home, I do have the essentials: high carb food, maple syrup, etc.

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

We have enough strips.

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

How many hours out of the house? (Sorry to be short - want to make sure you don't stall too long and get shot time way off schedule.)

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

That 313 and 293 and 281 look pretty much the same to me, given meter variance. I would shoot the full dose, now.
She will come up once she gets some food in her, and if you have to leave for a few hours (like 3, right?), then leave some more food out for her, for just in case, as you walk out the door (right after you get that out-the-door-test).

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

Hard to say.

3? 4?

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

Are you leaving now? Or can you get a +1 or +2 before you leave?

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

Yup, that seems ok, 3-4 hours. Dyana's plan sounds good. Feed, leave food out, get a test right at you leave and one right as you come home, and go from there. Full dose.

Are you comfortable with that, Jill? How long did you stall now,m 30 mins? Remember to adjust shot time back carefully and take pre-shots into account as you do.
Jane

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

We're going to shoot the full amount. My stomach hurts anyway so I'll probably be back sooner. Stalled for only 15 mins

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

Hope you have a good time out and about. Please let us know how she is, when you get back.

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

Perfect (that it was only a 15-min stall). Go ahead. Update as soon as you have the next follow-up BG, ok? THANKS for the back-up, Dyana!
Take care of yourself and your poor tummy!

Jane

 

Re: 8/25 Charlie AM 427+4 409+7 400+8 355+10 313 +11 293 +12

Hope you get the dose figured out for Charlie. She's lucky to have a bean who cares so much for her. Hope you feel better soon.

 

+4.5 = 263.

Hanging in there without too much of a drop.

Jill