1/1 Tibby AMPS 345 Should I increase the dose?

I'm not sure if I have enough data to increase his dose. I've been testing out TR though my spreadsheet says SLGS. I didn't get any readings last night, but he seems high today, and has been on average since the last dose increase.



https://felinediabetes.com/FDMB/threads/12-31-tibby-amps-289.240776/#post-2709644

 

Hi Amy - Happy New Year I don't give dosing advice but when I click on your SS link, it's asking me to sign in. Do you know how to change the share settings to "anyone with a link"?

 

Should be fixed now. I didn't realize the new page in the sheets would need new permissions.

 

I see it now! FWIW, I'd rename your "Relion" tab something like "2020 Relion" and your alphatrak tab "2020 AT" or something along those lines.

And I see in yesterday's post you are exhausted For night time, I'd get a +2/+3 and decide if I need an alarm or not generally following these guidelines:

• If the +2 is about the same as the Pre-shot, usually they're going to have a fairly "normal" cycle...slowly dropping to nadir and then slowly heading back up until the next PS
• If it's higher than the PS, that can indicate the beginning of a bounce and those are the cycles where you can usually get by without testing as much
• If the +2 is lower than the PS, that's your "early warning"....those are the cycles where it's important to try to get more tests in...but if you can't, you might want to leave some higher carb food down for kitt

And, if you schedule allows it, getting a +2/+3 in the AM cycle would follow the same guidelines (they are really insightful tests to the cycle).

Hopefully someone else will stop by about dosing - i see @Tomlin and @Wendy&Neko have been by before.

 

Are you still using TR for dosing? If so, yes on the increase and could you update the subject line on your dosing method.

 

I'm still not sure about the TR thing. I'll update, but I'm not sure how well I can do it.

 

I'm still confused as to how you know whether to adjust the dose if you don't manage to get nadir info in three days. I won't be able to get that data during the day, and to do so at night would involve staying up. I'm so used to doing a curve for my info, and I used to schedule those on weekemds.

 

What are the issues with following TR? Looks like you are testing enough. And Tibby needs more juice.

 

Oops, I was answering your question before you asked. . My post right before your question has the answer.

So should I increase for his evening dose?

 

Sorry, posted at the same time. You don't need to hit the exact nadir time - and the timing can vary cycle to cycle anyway. Same issue happens with SLGS, you just have higher reduction points. If you can get a before bed test, and it's at least +2 or +3, you are OK for the night cycle. During the day, can you get a +2 out the door in the morning, or at something as early as a +10 as you come home? Or come home for lunch.

Yes on the increase.

 

Not sure if you have seen this link:

https://www.felinediabetes.com/FDMB...ion-possible-with-a-full-time-job-yes.129378/

I know many who have decided to try TR have found it to be helpful

 

I can do the before bed test. I'm not sure I can get the day time tests at all, and I can't come home for lunch. I'll give it a shot and see if it's enough data, but teaching isn't very flexible.

Since I haven't been able to collect much data while working, I relied more on the curves that I would do on weekends because I never felt sure I was getting nadir info otherwise.

 

I have read that a few times, but I don't have much flexibility, or maybe I'm overestimating how much data I need. I don't know that I would get good enough data during the week.

 

Are you able to do what @Wendy&Neko has mentioned?

 

A lot of people, if possible, get up a bit earlier so they can shoot and get a +2 as they head out the door. The +2 is a good indicator of whether they'll be an active cycle. And you can use it to load an autofeeder (if using it, I highly recommend one) with with appropriate carb foods. I've also seen someone who is away most of the 12 hours get a +10 from the PM cycle, then an AMPS and if kitty is heading down, it's also a good indicator of an active cycle to follow.

 

Sorry, just saw your response above .!

I like the idea of giving it a try. I know some will get up early enough before work to give insulin and get the +2 and the question would be if you could get another before you do a pre shot check?

 

I get up now at 5am to leave at 6-6:30. I usually don't get home until 4pm at the earliest. So I might be able to squeeze in some +1 or +2 tests and maybe a +10 or +11 during the day, maybe. I'm not seeing how that gives enough of a picture to know what's happening during the day. Even if I manage the extra test before I leave, I'm not getting anything near his nadir.

 

I understand and will say that there are different comfort levels for management .

One other thread that may help....you have to read through & it is a bit long, but worth reading. I think you will get some additional info & thoughts on the subject. You may have already seen it, but I figured I would send just in case you haven’t .......

https://www.felinediabetes.com/FDMB...tion-slgs-myths-debunked.111088/#post-1173098

 

I read through most of it, but didn't see how you adjust the dose if you don't know the nadir. His numbers have gone so high lately that I see he needs an increase today, but I'm on break and can get a lot of data. When I'm back to work next week and can't find his nadir for three days, how will anyone know what to do with his dose?

Also, I'm a little concerned that I'm raising his dose a lot while on TR this week. That's a huge shift for me after not raising his dose more than .25 per week, and I've never had it at 4.5 before. Do cats usually get worse on TR before they get better? He's actually drinking more this week as well.

 

Sorry for the delay.....could not get on the site for Some reason

Again, I understand your concerns. I personally prefer more info for dosing decisions as well .

Maybe start a new thread titled: “Concerns/Questions About Switching to TR” to get additional input from others just to hear more thoughts and that may help with a decision. @Wendy&Neko is a good resource for TR & others are always happy to share their experience as well.

There are some cats who do better with less changes. Again, every cat is different. With that being said, I do see that back on 11/24/20 you were at 4.25 which was prior to your trial with TR, so I don’t think it was the dosing that resulted in the increase in insulin.

The drinking is a concern. Is Tibby feeling well otherwise? Do you check for ketones? I always ask especially when clinical symptoms occur just to be safe.

 

That previous 4.25 wasn't even for a full cycle though, and I had to drop his dose on the SLGS protocol. Then he started a nice downward trend, but then started to go back up again. Such a yo-yo.

He does feel well. He's playing and doing his usual routine. I just noticed slightly more urine than usual in the litterbox lately. I haven't been checking for ketones, but I'll go get some testers. He hasn't usually had any issues with drinking in quite a while. Maybe it's just a fluctuation lately.

I would start a new thread, but my main question is how to adjust a dose in TR without knowing the nadir. I'm kind of assuming I wouldn't. I'll see if I can get good data while working, but I also have to be well-rested for teaching.

 

OK, I just realized we are allowed to teach from home on Wednesdays, so I could get nadir data on weekends and Wednesdays. Would that time frame work for TR? I'd still try to get data inbetween.

 

I am happy Tibby is feeling well .

I see why you would like a different method/strategy to manage the DM . If TR is an issue, keep in mind that with SLGS, there is flexibility once you have data (which you do) & know your cats patterns (you do!).

I am going to tag @Marje and Gracie because I recall her helping another member (Irish Pat) awhile back with “maximizing” SLGS....meaning SLGS is simply a set of guidelines to follow if you are managing this on your own vs. if you have someone who is able to help you. There is flexibility. My thought is that if TR is not going to work out, there is a way to use SLGS but with the help of a moderator to assist with decisions/dosing .
Obviously, safety is always first, & there is a way to improve your cats regulation even if TR is not the best option due to schedule. Where there is a will there is a way.

I am hopeful the tag will work....there have been some issues with it as of late . Fingers crossed there is not a problem.

 

Yes, if you can get three days a week (including weekends), that would absolutely work. And remember, nadirs can and do change, so don't worry about always getting a +6. A couple hours on either side is usually enough to get you a good idea how low he's going. And from tests early in the cycle (+2 or +3), will often give you an idea how low they were going. What is more important is trends, not exact numbers. Knowing he hit greens at all says a lot.

 

@Wendy&Neko —tagged Marje as well in case there become any issues with TR . Hopefully this works well for Tibby and you see great results !

 

I don't know that I could predict anything from a +2 or +3. To my eyes, his data is all over the place. It'll form a pattern for a while, but then he'll have a nadir at his PMPS or AMPS or the curve will go up instead of down. But he's nowhere near the greens on any reliable basis, so it can't hurt to try TR out.

But today, I did his PS shots and two other data points, and looking back on it, this is what I'm afraid a workday would look like. Would that be enough? If it were a workday, I'd be going to bed right now, so that +2 would be it until morning.

 

And thank you all SO MUCH for all your help today answering my questions. Tibby thanks you too.

 

Hi Amy, If you spend some time looking at other cat's spreadsheets you might feel a bit better. Wendy is right, nadirs move around A LOT. If you look at my Ruby's spreadsheet, she was all over the place at the beginning. I stared at her spreadsheet looking for a pattern, any pattern, but none could be found. Things started turning around, especially around the first two weeks of December 2020, where you will see there are lots of lime green numbers shortly after her shots. I was scrambling a lot to feed her medium and high carb foods to keep her up through +6. Cats will do this especially when they start getting regulated, which hopefully will happen for Tibby soon. If you're working, the autofeeder will be your best friend in these instances. I am home all day so monitoring is easier for me and I caught as many numbers as I could but I know I miss a lot of action when I'm sleeping. We can't live for our cats' diabetes. Seems like if you can follow her for three days a week that would be great. We can only do as much as we can.

 

What a stunning fur man ! I love his black & white—-he’s in his tux !!

Try and see how it goes ! Time will tell if you are comfortable and if meets your and Tibbys needs. If it doesn’t, there are other options with respect to getting better regulation (as mentioned in my previous response).

 

Got it. I just need to catch up, read through some of Tibby’s condos, and look at the SS.

 

Thank you ! & Happy Years again!!

 

I have helped several members doing SLGS fast-track their cats, most recently, Brady (Irish Pat) was one as was Robert’s Henry. Typically, that method involves cats whose BGs are over 300 all the time and/or cats, like Henry, where the dose was dropped way back when it shouldn’t have been. Tibby doesn’t really fall into those categories.

I agree that his best chance is through TR. It sounds like Amy has some flexibility in testing.

Amy (Tibby’s mom): you are correct to ask how we know to change the dose if you don’t get the exact nadir. With the tests that you have been getting, there are some of us that can tell potentially where the BG went in between those tests. Of course, there are some SSs where there are no tests at night or none during the a.m. cycle and we won’t guess on those and take a chance of getting a cat overdosed. But if you have a couple tests a cycle, we can look at patterns and advise you on when increases are needed.

You might also want to look at Mikey’s SS. Mary is a teacher and did TR.

 

You’re welcome and to you, as well, Amy.

 

I am sure there are MANY ......the particular one I mentioned just happened to come to mind, specifically Re: how you expanded on how SLGS can be used with help from someone on the board.

Happy Amy’s first choice will work out
& she has options if there are any issues.

 

Yes...good example!