? 10/14 - Apollo +4 - 229, +2 - 305, PMPS - 395, reduced dose by .25 anyways

I tried staying awake, but I only got 4 hours sleep the night before. Now I woke up and this tsey was 43! Waiting for 20-30 minutes to see if it goes up so I can give him a token dose, or should I skip altogether??

 

Do not shoot.

 

Can you get a re-test right now to see if it was a bad strip?

If you get a number like this in mid-cycle, you would feed a little high-carb snack and test in 30mins. Pre-shot is a little different. With a lot of data, caregivers will sometimes do the 20 min stall without food to see if their cat comes up. I am a little nervous in this case because we really don't know Apollo's patterns yet. I would not let him go more than 20mins without any food, no matter what.

 

Not shooting! I thought I was supposed to hold off for 20-30 minutes and check again and if it goes up, a toke .25 dose is ok? But I should just skip his AM dose altogether from what I understand you're saying. Right, no toke dose, just go ahead nd feed and resume tonight with regular dosing??

 

Just tested again and he's up to 59....token .25 dose ok??

 

Well, he's earned himself a 0.25U reduction by going under 50!

If you shoot, I think you can shoot the new 0.75U dose. Whatever you choose, I would definitely keep monitoring him in the early part of the cycle, until you're sure he's started his next bounce.

Edit: I am revising this-- it's very aggressive advice, really more suited to an experienced caregiver doing the Tight Regulation protocol on the Lantus board. Although you could shoot if you are monitoring, for a newbie, you're probably better off skipping this morning and shooting the 0.75U tonight. Sorry for the confusion...

 

See edited advice in previous message... I was being too aggressive for this board, if you have already shot don't worry I'll stay with you until the bounce starts.

 

I have a doctors appointment I leave for in 4 hours, and will be gone around 3 hours. I don't think I should give more than .25, a token dose for his depot.

 

If you're not going to be around during the middle of the cycle, I think no more than a token dose.

Expanding on the advice (and reversal) I gave above, for any folks reading this thread: on the Lantus board and doing TR, people routinely shoot numbers all the way down to 50. It's quite safe if you are monitoring and know your cat. However, the ideal way to do this is to start with a higher "no-shoot" number (150 on the Lantus board, 200 on this board) and slowly work your way down shooting lower and lower numbers. Getting a pre-shot of 43 that then sneaks over the line to 59, in your first few days of Lantus, is jumping into the deep end with both feet, and too aggressive at this time.

 

A skip might be even better...

 

Agree Nan

 

Beings it's only day 3 on Lantus, I think you might be right. If I was going to be here all day to monitor, I'd do the token .25 dose. But, having to go to the VA and missing any monitoring past +4 worries me. We'll see what reading I get today. He's eaten and he seems to be totally fine. I have no other planned activities this week after the VA today. Will start again with 1 unit tonight, he should be plenty high enough. Then tomorrow AM, if he gets into the 300's I'll reduce to .75 and check evey few hours. I want to check if .75 is a better dose that I can give AM and PM. Hope I don't sound confusing.

 

smart move. I have to say if it were me I'd skip lol but then I'm a chicken bawk bawk

 

me tooooo.

 

Hi Dave,

The 1 unit dose is too high.

You need to reduce the dose next time you give insulin. I see from your signature that you are following TR. The TR protocol indicates that, after a reading below 50 the dose should be reduced by 0.25 units immediately.


Mogs
.

 

Sounds very good, one comment though, expanding on Mog's point:

I'd just plan on making 0.75U the new dose. Apollo has earned that reduction! We do sometimes do something like your plan of possibly doing one more shot of the higher 1.0U dose. It's called "shooting through the bounce," and is designed to try to tamp down (even just a little) the bounce that is surely coming from that reduction-earning low. Not sure it applies to this evening's shot, though, since you're skipping this morning, so I'd stick with 0.75U tonight.

One of the things that is really hard to get used to with Lantus is that we don't dose by the pre-shot numbers, we dose by the nadir (lowest point). That's somewhat true of all insulins, but it's really true of Lantus. It's not that the pre-shots are irrelevant (as you discovered this morning!) but they aren't the most important thing to look at while dosing. With the depot and the slow action of Lantus, it doesn't have the quick responsiveness of a fast-acting in-and-out insulin like vetsulin, so acting based on "what he's doing right now" with a pre-shot doesn't work well as a strategy. By the time your action takes effect, he's probably doing something different! Changing directions with Lantus is kind of like steering an ocean liner-- it works, and you can do it, but you can't turn on a dime.

The only time we do do this kind of rapid dose change is when they do what Apollo did this morning and request a reduction with a low number. Other than that, we take the long view over several days, and see how low a dose is taking them in general, and then (after several days) adjust the dose accordingly. It takes patience, but it's less frustrating in the end than frequent dose changes that result in bewildering and contradictory responses .

This is all a really good thing, by the way, Apollo telling you he needs less insulin !

 

Was thinking he'll be back in the upper 300s to lower 400s tonight after getting no juice this AM, so I was going for full dose this PM with the hopes that .75 can be started in the AM. If you look at my SS, Both mornings I skipped a dose he went up to the 400s. You folks are the pros, I'll drop to .75 tonight

 

He hasn't been thru the 7-10 cycles to build his depot up yet. He'll be back in the upper 300s to lower 400s tonight after getting no juice this AM, so I was going for full dose this PM with the hopes that .75 can be started in the AM. If you look at my SS, Both mornings I skipped a dose he went up to the 400s. You folks are the pros, I'll drop to .75 tonight

 

Yup, you're right! This is almost certainly the effect of bouncing rather than the skipped shot (that ocean liner again, the response isn't that fast usually). This is a good observation to keep in your back pocket, for the next time he requests a reduction. If the low isn't at pre-shot , and if it's a day when you can stay home to monitor, "shooting through the bounce" is probably a good technique to try for him.

Once he's up in the stratosphere, though, you're fighting against his body's safety mechanisms, and you aren't going to win that one. Better to start the new 0.75U dose tonight so you can re-start the clock on cycles to stabilize that new depot. And maybe be able to get a good night's sleep!

 

Only about 16 hours sleep over the last 3 days. Have appointment at the VA today, no time for a catnap even. Gonna try for one when I get home, before his scheduled PMPS.

 

LOL Dave. A sense of humor goes a long way!

 

Do you have a chance to get another test in before you have to leave for your appointment?

 

Any updates?

 

Heeded everyone's advice and lowered his dose .25, or 25%. Gonna check at +2 and +4 and give updates, but I think/hope they will be fine. The 43 this AM sure had me worried. Was so glad to see it go up in a half hour even tho I couldn't shoot even a token dose. Crossing my fingers things will be better tomorrow in the AM.

Thanks everyone for all the great advice!!

 

Ok, he dropped more at +2 today then he did yesterday at a higher dose! Yesterday's drop from PMPS to +2 - 318-242= 76, tonite's drop from PMPS to +2 - 395-305= 90
So I'm a lil worried since I dropped .25 to .75 and still got a big drop like that. He seems fine, we'll see what +4 brings, I just know I need real sleep soon.

Thoughts anyone??

 

I know how hard you're trying to make sense out of all this, but please just trust me when I tell you there's nothing linear or predictable about diabetes treatment.

You just have to follow the dosing method and have patience.

 

Just wanted to clarify something for people reading this post. This technique:

is also a more advanced move. It's not something you want to try right in the beginning of learning your cat's FD patterns, or on a day when you can't monitor closely. Even if you know your cat bounces. Some cats barely touch down on low numbers and bounce immediately, but some cats like to surf the lows a bit before starting the ascent. For that second type, shooting the larger dose overlapping their surf would mean that you could be fighting the low numbers all day, so "shooting through the bounce" is not something you'd want to do with a cat like that.

Just wanted to add that clarification, and reiterate the point that the first stage of FD is all about data-gathering and learning your cat's patterns so that later you can manage the numbers as efficiently as possible. Safety first, always!

 

Dave --

Please re-review the stickies on the Lantus board. @Nan & Amber (GA) were giving you good directions. You want to look at the information related to becoming data ready. Those of us experienced with TR will shoot low numbers -- however, you need to have considerably more data in order to do so safely. There's not always an experienced person around to provide guidance so it's helpful to know where to look for answers.

 

Mornin' Dave. You have gotten some great advice. If you want to see some drops/bounces take a look a Nova's spreadsheet. When I look at the numbers you are getting with this lowered dose and even the bounces Apollo has following them, I am encouraged. Why? Because I see his numbers go down instead of up after his morning and evening meals (Nova rarely does that) I have seen experienced members say that is a sign of an active cycle, and you are doing exactly what you should be by testing every hour or so. I wish I had that opportunity every day.

Anyway....I'm curious....under what circumstances was Apollo diagnosed? Was he sick and being treated with antibiotics or steroids? Has he finished his treatments? Does he have a chronic illness? Or, was it like Nova...she was overweight, and possibly stressed at home (inbred as well, I've learned later) I ask because sometimes an illness can raise blood sugar, and once treatment has finished, and as they get well, their BS drops quickly into normal numbers once they stabilize with insulin.

Read & re-read the stickies on the Lantus forum. Great info there. I think you are doing an awesome job, and are getting some great guidance.

Have a good day!

 

Wow another 76 point drop. What's weird to me is that last nite the difference between the +2 and +4 was also a 76 point drop, only it was a reading of 166. I won't make it to a +6 tonite. All things being equal, I think/hope we'll be ok. Tomorrow, I have nothing scheduled during the day so I will try and do readings every 2 hours from AMPS to PMPS, to see how the .75 dose works throughout the whole day and see if I can figure out when his nadir happens.

 

Morning Dave and Apollo,
I cant give dosing advice but wanted to say you are doing a great job!

KEEP UP THE GOOD FIGHT!
j

 

Wow, look at Apollo go, hitting low yellows last night! I think he's starting to like the lantus!

If you're able to today, it'd be great to get a reading or two to see what he's doing (even if you can't get a full curve). Finding the nadir can be a tricky thing, so even just the occasional tests sprinkled around at different times on different days can be helpful in giving you some more information.

I hope you were able to get some sleep last night even with getting the middle-of-the-night data. You have to take care of yourself, too!