? 5/27 Sammie AMPS 403 +9 241

Discussion in 'Lantus / Levemir / Biosimilars' started by Sarah & Sammie, May 27, 2020.

  1. Sarah & Sammie

    Sarah & Sammie Member

    Joined:
    Nov 24, 2017
    Sammie is bouncing all over. She is due for a curve. Will it be reliable given all the bouncing?
     
  2. AmandaE

    AmandaE Well-Known Member

    Joined:
    Mar 18, 2019
    Good Morning!

    I personally think it might be worth it to do a curve. Typically with a bounce I wouldn’t do a curve because bounce numbers aren’t a good representation of what your kitties BG levels are during a typical day, but; I had a quick peek at Sammies numbers and to me it looks like there is a chance that Sammie isn’t actually bouncing, rather, it looks like she typically has higher blood glucose levels in the day than at night.. this pattern is really common among sugar cats!

    I also see that in your evening tests you have caught a couple of Sammies nadirs which are below 150, in SLGS this usually signifies that you hold the dose for another 7 days. That being said, Sammies diagnosis was in September so I wonder if it might be worthwhile to do a curve, and then based on the results consult with some experienced members to see if it would be advisable to increase the dose by 0.25u to get Sammies mornings a little lower.

    No pressure to take on this idea, you are following SLGS so you are doing what the protocol says... just my two cents.

    by the way, Sammie is just SO cute!!
     
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  3. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    I see Sammie was diagnosed in 2017. Was he in remission?
     
  4. Sarah & Sammie

    Sarah & Sammie Member

    Joined:
    Nov 24, 2017
    Never. She’s been really difficult to regulate. Typically any time she is at 3 units she falls too low after awhile.
     
  5. Sarah & Sammie

    Sarah & Sammie Member

    Joined:
    Nov 24, 2017
    Thank you for your tips. She’s been diagnosed since 2017 actually. I’m a little worried to increase her dose because of the scares we’ve had with her being low. I may just need to get used to seeing numbers in the 100s!

    I agree she is pretty cute!
     
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  6. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    I’d gradually lower the no shot number provided you can monitor closely if need be. She’s high too much of the time in my opinion. However if you aren’t able to test more often I dint know. I’m used to TR and always got a +3 to see if the cycle might be an active one. Maybe ask opinions of those who have followed SLGS for a long time. I worried about renal threshold and wanted to be under it. Have you run a fructosamine recently?

    @carfurby has done SLGS for years. What do you recommend?
     
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  7. AmandaE

    AmandaE Well-Known Member

    Joined:
    Mar 18, 2019
    I completely understand... you have to do what is right for you, but don’t be afraid of those green and blue numbers, they are safe BG levels and healing numbers!

    It is so scary when you start seeing lower numbers but it is good! And remember if there is a number that is too low for comfort you can always steer the BG values upward by feeding medium or high carb! I gave Mowgli some med carb today because he went low fairly quickly at +2, the MC slowed the drop and now he’s surfing!

    ETA: also for what it is worth I started on SLGS last year :)
     
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  8. Sarah & Sammie

    Sarah & Sammie Member

    Joined:
    Nov 24, 2017
    I know at the before bed shot I’m supposed to be alert if her glucose has dropped since the pm shot. But how low of a number do I need to start being concerned about? For me, 140s seems terrifying but maybe that’s not low enough to worry/stay up for?
     
  9. Sarah & Sammie

    Sarah & Sammie Member

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    Nov 24, 2017
    Her labs were last done in October I think. The vet is only accepting urgent appointments for right now as we are in a red zone.
     
  10. AmandaE

    AmandaE Well-Known Member

    Joined:
    Mar 18, 2019
    Your question seems straight forward but to me it is kind of loaded...

    First, for you to know what is safe for Sammie, I think it is important for you to identify when Sammie typically has insulin onset, as well as when Sammie's typical nadir hour is. If you know this already it is a great step. If you aren't sure, try looking at some of the curves you have done in the past and see if you can tell at what time post shot the insulin seems to start working (onset) and when Sammie is typically lowest (nadir), some cats have floating onsets and nadirs so don't be too frustrated if these numbers jump out to you. Mowgli's typical onset is around +1.5 to +2.5 and he typically has a nadir of +4 to +6.

    How is knowing onset helpful? let's use an example like this: You know that Sammie has an onset of +2. After your shot, you grab a test at +2 and Sammie is already lower than the pre shot reading. Right away you know that it will be an active cycle, there has been action already and you are JUST at the onset time suggesting there will action for a few more hours until Sammie hits nadir, and that more tests are needed that night to be sure that Sammie stays safe. If it is much lower, you may even want to consider feeding MC to slow the action of the insulin. This is also why knowing the approx nadir time is important, you want to have a good idea of how long it will be until Sammie can turn the BG drop around naturally on his own.

    Let's use another example, Let's say you know Sammie's nadir is at +6. You test at +2 and Sammie's BG is actually higher than the PMPS, it should be a relatively normal cycle (you say to yourself). Before you go to bed you grab a +5 and Sammie's BG is safe, but much lower than you expected. You know you have to get a couple of extra tests in to make sure that Sammie stays safe, but you work tomorrow so you want to know how long do you need to stay up... Because you know that around +6 is usually the lowest point in Sammie's cycle, if he is rising after +6 you can feel a little relief that you can go to bed without worry, so you grab a test at +6 and it is about the same as +5, you grab a +6.5 and it is higher, now you feel ok to go to bed because Sammie hit his nadir at +6.

    These are just examples and of course every cat is different so its really important to understand these insulin responses specifically in Sammie.

    SO now, what numbers should you be concerned about? Every cat is different (frustrating answer I know) but there are a few things that you can consider:
    • First: anytime you're concerned (whether you think you should be or if you think you might be overreacting), you should post here, hopefully someone will be around for you to bounce ideas off of and get their perspective.
    • Second, we know for sure anything below 50 is dangerous and should be steered with food or sugar like karo or honey
    • Third: in SLGS you definitely want to be on higher alert when you see values 90 and under, especially until you're comfortable and confident in knowing what Sammies cycles are like.
    Every cat is different, but I will tell you the strategy I use with Mowgli. When I am assessing whether or not Mowgli needs further monitoring, I personally use a +2 reading combined with the colors in the spreadsheet as an indicator. Basically, if at +2 Mowgli is at the same number or lower, i feel the need to monitor more closely for that cycle because it is probably going to be active. Here are a few examples of how I might react using this color strategy:

    Example 1: at PMPS Mowgli has a yellow reading, at +2 he gets a blue reading, I know that I need to keep monitoring his cycle because he has 2 more hours before he hits his nadir at minimum and 4 more hours at maximum because I know his nadir can be anywhere from +4 to +6.

    Example 2: at PMPS Mowgli has a yellow reading, at +2 he has a green reading... in 2 hours he has skipped blue all together, for me, this is too fast and too much of a drop. When this happens I will give him MC and take a reading at +2.5 or +3 to see how he is trending. I would do the same thing if my PMPS was yellow and my +3 was green. In cycles where this happens I usually test until Mowgli is safely past nadir.

    Example 3: At PMPS Mowgli has a Green reading, at +2 he has a blue reading... this signifies to me that it will be a fairly typical cycle because his BG raised a bit before onset. I will get a +4 / before bed reading and depending on what it is I will reassess from there. When I have green AMPS / PMPS I might give him MC for his meal, and leave some LC out for him. When I first started getting greens at the beginning of a cycle i would get a +1 and +2 to see if he was trending up or down, now I feed MC and get a +2 or +3

    I want to say, this is what works for Mowgli and I and it might not work for you and Sammie, that being said I use the same strategy for AMPS and PMPS, although I cant get as many day time readings while i'm at work. Luckily right now during covid I'm working from home. I test less now than when I used to because I have gotten to know Mowgli and his patterns, of course, he throws in a surprise from time to time but I found this color strategy helpful when I was trying to identify his patterns and which numbers were safe for him or not. I also found if he 'skipped a color' from pre shot to +2 that he was more likely to bounce in the next cycle.

    If you can grab a weekly or even biweekly curve you will slowly start seeing Sammies patterns.

    I realized I kind of turned this into a ramble... sorry if its scattered and a little unclear, also sorry i wrote 'let's say' and 'you' so many times :p. I think what I would say to summarize is: get to know sammie's onset and nadir, when in doubt post for help, familiarize yourself with the stickies, and know that every cat is different so don't feel the need to compare yourself to other members or other cats successes / failures to Sammies.
     
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  11. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    It might be helpful if you put Sammie's name in your subject line.

    As for a curve, it does look like Sammie prefers going lower at night lately. But it's been a while since you had much daytime data, so it wouldn't hurt to do a curve, maybe tomorrow?
     
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  12. Sarah & Sammie

    Sarah & Sammie Member

    Joined:
    Nov 24, 2017
    Sorry thanks.

    Can’t tomorrow, but I’m able to on Friday
     
  13. Sarah & Sammie

    Sarah & Sammie Member

    Joined:
    Nov 24, 2017
    Wow thank you so much for such a thoughtful response!
    I appreciate the examples using Mowgli's numbers, as well as the color coding. It made it easier to process.
    The vet thinks Sammie will never make it into remission at this point. (Its been 2.5 years since her diagnoses.) Now its just about getting her numbers as regulated as possible while avoiding extremes.
     
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  14. AmandaE

    AmandaE Well-Known Member

    Joined:
    Mar 18, 2019
    When I started I was really discouraged about the idea of remission... until one of the members here told me their story. Their cat had to take insulin for 4 years and then he suddenly went into remission for the rest of his life!! It isn’t impossible!!

    I think it’s better to start with more realistic goals though. You’ve set a good goal with getting Sammie regulated... you never know, after Sammie is regulated the idea of remission could come further into focus. Never say never !!

    I think it is important to focus on Sammie... how does she seem to be feeling? Is she happy? Healthy? Nice fur? Playful? If Sammie doing well in all of those categories it’s a total win! If she goes into remission that’s a happy bonus :)
     
  15. Sarah & Sammie

    Sarah & Sammie Member

    Joined:
    Nov 24, 2017
    554E46C5-2DAF-487D-BF0E-D01D89151AB2.jpeg
    She is up and down. She’s had a couple of urinary infections the past year and she also has IBD. Her fur is patchy in recent months but it’s hard to know if that’s from the IBD. She hasn’t played in years. Sometimes she sleeps in my room alone all day, but she lately she has been spending time looking out the window and hanging around the other cats (Though if it were up to her she would be an only kitty. Interesting because she was raised with another cat and was fine with it.) She purrs a lot and likes licking water from the bathtub. Pic of her with water droplets on her face and nose is included.
     
  16. AmandaE

    AmandaE Well-Known Member

    Joined:
    Mar 18, 2019
    She is SO CUTE! I love her little face!!

    IBD is definitely tough, poor Sammie. For what it's worth that picture has a nice fluffy coat. RE the patchy fur: I wonder if she has some sort of allergy that is giving IBD and patchy fur, Im sure you've already assessed for that. It sounds promising to me she is spending more time with the other cats and i have definitely heard that even something like looking at birds out the window can keep cats stimulated 'cat tv' as Jackson Galaxy calls it :p

    My sister has a cat who loves drinking from the tub! it's just so funny! My civvie Nyx LOVES the bathtub (when it is dry) she scratches the corners and rolls all around in there haha, cats are so funny! they're just the best!
     
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