10/30/31 - Squeaky! AMPS=435 +7=263 PMPS 81 Skip +.5=97

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Jan D & Squeaky, Oct 30, 2020.

  1. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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  2. Ti-Mousse

    Ti-Mousse Well-Known Member

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    Hope he goes down a bit with the increase! Great idea to put a platform by the LB to help little Squeaky.
     
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  3. carfurby

    carfurby Well-Known Member

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    Good luck with the new dose.
     
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  4. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Hi Lyane! Thanks for the good wishes!!!!!
     
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  5. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Thanks Carla! Well, we'll see! Hoping for the best!
     
  6. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Last edited: Oct 30, 2020
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  7. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Yikes, if it goes down, or up, isn't the response the same???? feed..... Surely no shot.

    help help help Everybody must be busy doing something else.... Yes I'm a nervous catmom
     
  8. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Well he's not looking so great if nobody gives a response in a few minutes I'm feeding not testing

    Okay gave him 10 pieces of raw pork; put a little honey on his tongue

    Hope someone shows up soon

    Okay at about 25 minutes he went up to 97. I gave him some more pork, it was cooked. He doesn't seem very hungry.

    Still nobody helping. Friday night, huh.
     
    Last edited: Oct 30, 2020
  9. Scdal

    Scdal Member

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    I am no expert and pretty new myself but I think his insulin depot is kicking in due to the recent dose increases. My cat does this. I always have to feed when my cat has low BG. If I don't, his BG continues to fall until I have to skip a shot.

    If you are able to monitor him every hour tonight, In my opinion, once his BG rises above 90, I would give him his insulin but only if you can monitor him. If you don't, his BG will quickly go to the other extreme and go way high. At least this is what happens with my cat. I have to follow the Tilly method and if his BG is low go ahead and feed and shoot when BG starts rising.

    Again, I am pretty new to this as well so if someone else answers you might want to see what they recommend. Someone told me to use my intuition. You know your cat better than anyone. I get frantic when my cat's BG gets low and frantic when it gets high. It is like being on a roller coaster with all the ups and downs.
     
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  10. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Thanks Susan. I know they have the token dose of .25 but why can't I give a small dose like 1 unit?

    Seems if I give him the 2.5 units his BG will just plummet. We have hardly ever been down this road and I don't know what to expect, except I know he hates the ear tests.
     
  11. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    He didn't want to eat much after the last ear prick. Either he gets mad or upset and often won't take anything. Instead he went over and lay down to go to sleep.

    So now I have given him a little canned pork. Two spoonfuls. A novel food and he ate it.

    So in the absence of understanding what to do, looks like I am skipping his shot. I am concerned if I shoot, his BG will go too low. And no help.
     
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  12. Scdal

    Scdal Member

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    Another thing, 81 is normal BG for a cat. I have given my cat his full insulin dose at 84 BG. So don't panic, you and your fur baby are going to be OK!

    If no one answers, I am retired and am always up late if no one else responds. I have had that happen to me many times when I have been frantic and no one answers. It is a scary position to be in.
     
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  13. Vyktors Mum

    Vyktors Mum Well-Known Member

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    Don’t shoot I’m just checking the spreadsheet

    Ad no more honey, not sure why you gave that?
     
  14. THH

    THH Member

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    I think skipping is probably best, especially if he's getting fussy about being tested.
     
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  15. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    So glad y'all are here.

    Okay, he is always unhappy about the ear pricks. And the honey. Well I was concerned that his number would keep dropping. I am still learning the mechanics of this whole thing. And didn't have any guidance, concerned he might end up hypo.
     
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  16. Vyktors Mum

    Vyktors Mum Well-Known Member

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    Ok for tonight I think you might have to skip, unless you can wait a couple of hours now for the food to wear off and test again and consider shooting then but that will put you right off schedule.
     
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  17. Scdal

    Scdal Member

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    Can you check his BG again and see what it is? If you look back at your spreadsheet, the last time you skipped a shot your cat went up to over 400 that afternoon.

    Thank goodness Vyktor's mom has come on board. She is good. Listen to her. Don't give honey ever again when your cat is at 81. Don't even give it at 50.
     
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  18. Vyktors Mum

    Vyktors Mum Well-Known Member

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    You save honey and HC food for a drop under 50 on TR but everyone gets a bit panicky when they’re still learning and does something like you did tonight lol I’ve seen much worse!
     
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  19. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Okay so now I'm all confused.

    What should have happened?

    The instructions say, if low number, below 150, stall and ask for help. Test again in 20 minutes. Watch for signs of hypoglycemia.
     
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  20. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Okay I tested at about +.5 (30 minutes) and it was 97. I posted it on the spreadsheet at 1 hour, that was all it would allow me to do.
     
  21. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Something for future use.....it will help if you'll occasionally get a +1 so you can get an idea of how much of a "food bump" he usually has. Knowing that information can be really helpful when making a decision whether to shoot the scheduled dose, shoot less, or skip it altogether.

    If the number goes up after stalling, it's usually going to be OK to go ahead and shoot the scheduled dose as long as you have plenty of supplies and can test as long as necessary, even if it means staying up very late. Always get a +1 and +2 if you shoot a lower Pre-shot number so if you need to intervene, you can do it early.

    One thing to keep in mind....with Lantus, it doesn't usually start to kick in for 2-3 hours, so you're not shooting the number he's at right now....you're shooting the number he'll be at in 2-3 hours
     
  22. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    What needs to happen next? Test at +6?

    Whatever we do, I need something easy, now I'm exhausted.
     
  23. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    That is helpful and good information, thank you chris.
     
  24. Vyktors Mum

    Vyktors Mum Well-Known Member

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    Sorry no one caught you in time so they could hold your hand through shooting so low for the first time but you’ll get another opportunity soon enough.

    So when you’re stalling you don’t feed. The reason you’re stalling is to see if the number is coming up by itself (without food). It’s not that you can’t shoot a falling number when you know your cat but, when it’s the first time shooting green it can be reassuring to know the number is coming up by itself. That 97 is food influenced so we can’t tell if kitty’s coming up by themselves now.

    That’s why I’d suggest skipping tonight unless you can get way off schedule.

    81 isn’t anywhere close to a hypo number so there was no need to treat it with honey, watching for hypo, just means watching to make sure the numbers don’t get too low
     
  25. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Truth!!!
     
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  26. Vyktors Mum

    Vyktors Mum Well-Known Member

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    If you haven’t shot you don’t need to worry about trying for a nadir. Just get a before bed test for interests sake.
     
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  27. Scdal

    Scdal Member

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    The guidelines confused me as well. I really think the notes need to be revised so us beginners understand better.
    The Tilly website helped me understand it a lot more. I learned that you have to shoot low to stay low. If you will look at other people's spreadsheets, you will see people giving their full doses of insulin at a lot lower than 81. It is hard not to panic. I am upset tonight because my cat jerked when I was giving him his insulin. He got mostly a fur shot. I know his BG is going to go high so he is not going to get his midnight snack tonight. Hopefully that will keep his BG down a little.
     
    Last edited: Oct 30, 2020
    Reason for edit: didn't link to post
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  28. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Thanks Vyktor's Mum, I definitely am a baby and need my hand held through this...... :confused:

    Yes I tried not to feed but then got worried about hypo so food happened.

    I am not sure what you mean by... "unless you can get way off schedule." You mean shooting late (which I didn't understand is really much of an option) would just readjust the entire shooting schedule. Yes we are only about 1 hour 10 minutes later than 8:30 and I could do that.

    Okay I thought hypo was also a set of symptoms and not so closely tied to a number, but he was at 81 and I had no way of knowing if his number was continuing to go down in that moment. Actually he is often kind of lethargic, he was a bit restless, so I became concerned.

    So if you were me what would you do? Shoot now? But then I'll have to monitor him every hour right?

    Thank you for all your help.
     
  29. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Before bed? That is like right now.
     
  30. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    So I can just wait and get a AMPS?
     
  31. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Susan what is the Tilly website? Does it explain better?
     
  32. Vyktors Mum

    Vyktors Mum Well-Known Member

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    and this was a very smart thought. You will probably end up shooting a number like that without a second thought but you’re not there yet and if the choice is between potentially too high for a day or too low for a minute then you want to go with too high for a day. Most people want someone to hold their hand the first time they shoot low or have low numbers, so you’re not alone there :)
     
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  33. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Get some sleep....go back over this thread tomorrow with a clear and rested brain. Better too high for a day than too low for a moment.

    If you happen to get up later in the night, grab a test (which is why a lot of us drink a big glass of water in the evening...so we "have to" get up)
     
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  34. Vyktors Mum

    Vyktors Mum Well-Known Member

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    Tilly is where our TR comes from, it’s just been tweaked slightly.

    If it’s before bed now I wouldn’t even worry about another test tonight. but good luck sleeping right away with all the adrenalin that was probably rushing through you lol.
     
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  35. Vyktors Mum

    Vyktors Mum Well-Known Member

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    And please update your thread title before bed so people don’t keep popping in here panicking that you need help all night ;)
     
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  36. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Thanks for the validation, and I will probably need hand-holding several times, I tend to need some guided repetition, especially for things like this...... I am learning but still nervous. And still have times, like tonight, when I think, "I can't do this....".....
     
  37. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Okay thanks for the reminder. I did take the 911 down. I'll get the helps out.

    Thanks for your calming presence.
     
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  38. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Okay so what's the difference in behavior if the number is coming up by itself without food, or not?
     
  39. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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  40. Vyktors Mum

    Vyktors Mum Well-Known Member

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    You’re welcome, now go to bed you’ve had enough excitement for one night lol I will come back in a bit and answer any questions that got missed so the answers will be waiting for you in the morning :)
     
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  41. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Thank you that is very thoughtful of you. someone just posted this on FB feline diabetes website:

    "In the future when PMPS is low you don't shot. Test every 30 mins & get some readings to determine if BG is going up or down. 81 is not really a number to get stressed out about. 60 or below is when hypo can occur. That's when you can get freaked out. Your vet should have explained normal BG in cats & what is to low & to get concerned. When all else fails test & test again & don't shot into low numbers. Good luck[​IMG]"

    I think I need some guidelines I can print out and refer to when I'm emotional and can't think.

    Part of "our" problem is he doesn't like the BG tests so I try to minimize. When people say test every 30 minutes I get uptight. Sometimes after testing Squeaky doesn't want to receive treats or eat. Especially if the ear pricks are fairly close together in time, he is either mad or upset I think.

    And right now, he's not interested in going over to his food dish, but if I hand feed him he will eat. His BG is low, shouldn't he be hungry?

    Thanks so much, I will be amazed if he and I can make it through this together, we have come this far ...... I am struggling with my own medication issues so I don't feel great all of the time, making this much harder.

    Cheers and thanks and many many :bighug:.
     
  42. Scdal

    Scdal Member

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    No
    Just Google Tilly diabetes and it should show it. It is a feline diabetes website. Go down and click on the Lantus protocol. It helped me understand how to handle low numbers. Someone on this forum suggested it to me and it was a real help. My cat tends to go low in the mornings. If I hold and don't feed, he continues to drop until it is too late to shoot. The Tilly website has various options. When my cat is low, I feed him and check again 30 minutes later. If his numbers are rising, I give him his full dose of insulin. I have given him his full dose 8 units when his BG was 84. I monitor him until he gets up above 120 and I feel it is okay to give him a break. Remember, you are going to have to shoot low to stay low.
     
  43. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    If you want to see an example of "shooting low to stay low" on TR, take a look at China's spreadsheet.

    Of course we didn't start out shooting when she was really low...we started shooting at 150 and gradually reduced how low I'd shoot but I got to where I'd shoot anything over 50.

    It's scary at first though! You see your cat go from 350 to 200 and then somebody tells you to shoot a 150 and you're like "Are you crazy? If I do that, they'll drop to zero!!"....it doesn't work that way
     
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  44. Vyktors Mum

    Vyktors Mum Well-Known Member

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    Ok so 81 isn’t what I’d call a low number. It’s the lowest preshot you’ve seen so far but it’s well within the normal range which is 50-120. The normal range is your goal with TR. The normal range is where Squeaky’s pancreas will have a chance to heal so the more time he spends there the better. Hence why ultimately you do want to ‘shoot low to stay low’.

    This is also why Squeaky wasn’t hungry, he wasn’t low. When a kitty gets super hungry from low numbers they will generally be numbers under 50 or even lower. Vyktor was freefed and the only times he ravenously devoured what was in his bowl he was in the 30s.

    You mentioned you’re still having some trouble with testing, you said sometimes he won’t take the treats and he gets mad at you. Does this mean you can get a test everytime you need to but he’s unhappy about it or that sometimes you can’t get a test? It is important to be able to get a test anytime you need to and most kitties learn not to mind it pretty quickly. I’m suspecting that he’s picking up on some stress from you and therefore he concludes that it’s a stressful horrible thing you’re doing to him. It might be worth putting a post on health for testing tips. Say exactly what you’re doing now and anything else you’ve tried, people will have tonnes of ideas for you I’m sure. If it is a stress thing one thing you could try is doing a stupid little dance and shaking out your body b4 you test to help you relax (just make sure no one’s watching ;)) humming or singing while you do it can also help. I honestly believe that cats are pretty psychic - if you think it’s bad he will too, when in reality it’s no big deal for him - just ask all the other cats here :cat: if he doesn’t want the food treat after he doesn’t want it (though you should always offer) just give him a little scritch tell him what a good boy he was and carry on, don’t make a big deal out of it. Vyktor lost interest in treats very quickly.

    By getting way off schedule I meant if you shot say 2hrs after the usual time then your next shot wouldn’t be due until 12 hours after that and you’d have to work your way back slowly to the usual shot time. For a lot of people this is not an option.

    All of the stalling and shooting late or skipping is really more for the human than the cat. It’s you that needs to be ready, you need to know your cat and be confident monitoring and dealing with any low numbers (under 50 for TR) that’s why it’s usually better to have someone holding your hand at first.

    I have never seen a cat have a symptomatic hypo (and this is all you’re trying to avoid) with a number as high as 60 on a human meter - that poster may have been thinking about a pet meter where 68 is equivalent to 50 on a human meter. Most cats wouldn’t even have symptomatic hypo in the 40s but there’s not much wriggle room there hence why you want to keep above 50. Vyktor’s lowest ever number was 31 and he was just hungry.

    Relax and don’t be so hard on yourself, of course you can manage, you’re actually doing a great job and you can only keep getting better from here :cat: I hope you’re having a lovely sleep now :) you’ve got to conserve your energy for future pajama parties ;)
     
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  45. thebigfuzz

    thebigfuzz Well-Known Member

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    Hi Jan!!!

    Sounds like you had a bit of an exciting night! :eek:

    Just got home from work, sorry I wasn’t there for you...

    I remember a few weeks back that you were planning on printing some things for reference material, have you had a chance to do so yet? I also have a few sheets of paper in my binder to take some notes of things I learn while browsing other peoples condos. It helps, especially when we encounter situations that we may not have experienced yet. In truth, sometimes we need to make decisions based on those learnings, in case someone isn’t readily available to help. Bounce days are good days to learn and study for possible future scenarios :)

    hope you and Squeaky have a great night!!!! :bighug:
     
  46. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Sleep well tonight, read today's post tomorrow and take notes. You might also want to print off this Sticky Note Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers

    You will get a change again to shoot green.:)

    There seems to be some confusion going around. Tilly was the name of a cat. LOL. This post, the first part, explains the evolution of the TR protocol (it started with the German protocol) and someone with a cat name Tilly, evolved over time and what you are reading is document as part of the Diabetes-Katzen forum. What we have here is the same Tight Regulation protocol.
     
  47. Butters & Lyla

    Butters & Lyla Well-Known Member

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    Sorry I missed the tag, Jan:bighug:. I am getting back on my more normal schedule, which means i turn into a pumpkin in the early evenings. I didn’t see it until this morning. Team Squeaky did great last night!
     
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  48. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Hey Chris, I am finally getting around to studying people's messages so here I am. This message from you is helpful, I have a question..... how does it work? If I shoot at 50 how far down will it go? Thanks a bunch! Hope you are doing well.
     
  49. tiffmaxee

    tiffmaxee Well-Known Member

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    When you shoot low you are hoping for a nice flat cycle not dropping under 50. Check at Joji and Kit and Jaxbenji. Lantus won’t kick in until +2 generally.
     
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  50. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Okay yes I get that that is the goal. But if the cat's BG is low, doesn't the insulin make it go lower? Chris' post implies that if the BG is high, the insulin will cause a larger drop and if the BG is low, the drop won't be as much.

    Yes we want to keep BG between 50 and 100 right? Ideally...... geez if we would ever get there.....
     
  51. tiffmaxee

    tiffmaxee Well-Known Member

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    When you shoot low cats tend to have a flat cycle. You would shoot and feed a meal which will prevent a drop too low. That is exactly what Chris was saying.
     
  52. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Exactly....if you shoot in the 300's, the same dose might drop kitty down to the 100's (for a 200'something point drop) but if you shoot at say 70, there may be only a drop of a few points.

    A perfect lantus "curve" is basically a straight line
     
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  53. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Wow! Who knew? This is important information. Now you see, I read that "How to handle low numbers" post and all it talks about is hypoglycemia. It doesn't give the slightest bit of understanding about low numbers -- what is a low number, what is a hypoglycemic number, what is a healthy number, if you shoot an over 50 number what happens etc. This is why when Squeaky went down to 81 and nobody was here to help, I gave him honey. I thought, oooh. Too low. If I shoot it might kill him.

    No wonder so many newbies on this board are scared to death to have greens or to shoot if there are greens. You all do a fantastic job AND I think that post needs some improvement.

    1. Okay Elise, usually we feed then shoot. Your comment said shoot then feed. Do you mean, test (results are under 100) feed, shoot, feed.

    2. Okay I've been told if numbers are lower than 150, stalling (not feeding, test to see if going up or down) is necessary. What am I missing here? Please connect the dots.

    3. I am not sure I understand Chris' comment about a perfect lantus curve yet, but help me understand the other stuff first. Since hopefully we will start dealing with more blues and greens soon, hopefully.

    THANK YOU SOOOOOO MUCH :bighug::bighug::bighug:
     
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  54. PerfumedCatMom

    PerfumedCatMom Well-Known Member

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    Following this thread!
     
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  55. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    No, I think what she meant was after you do the Pre-shot test, you're also going to be feeding then shooting so the food is going to help "prop up" that Pre-shot test. That's why getting the occasional +1 test is important so you can learn what kind of "food bump" your cat usually has. It's always Test/Feed/Shoot...You test to make sure they're high enough for insulin at all, then Feed to make sure they're at least willing to eat and Shoot, usually while their head is in the bowl.

    The "stall at 150" is for when you're still newer to the sugardance, don't have much experience or data and don't fully understand how your insulin works. As you gain more experience, more test data and learn how your cat responds to both food and insulin, that "stall point" starts to come down until you're shooting lower and lower Pre-shots.

    When you first start treatment, you're first curves are going to be kind of all over the place....there usually isn't anything even resembling a "curve" but as your cat becomes better controlled, you'll usually start to see something like this [​IMG] The PS is at the top left of the smile, the nadir (lowest point) is the bottom of the smile and then as the insulin wears off (or a bounce starts), it climbs back up high by the next PS.

    Gradually, the smile "flattens" to something like this: [​IMG] The PS to nadir to PS isn't as "deep".

    Eventually, what you want for a "close to perfect" Lantus curve is more of a grin...with the PS to nadir to PS only varying by a small amount. (Like China's numbers....her cycle, from beginning to end would only move like 20 points)
    [​IMG]

    Make sense?
     
  56. thebigfuzz

    thebigfuzz Well-Known Member

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  57. Jan D & Squeaky

    Jan D & Squeaky Well-Known Member

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    Wow what a lovely explanation! I am going to lift all this great information I'm getting and organize it into an article and present it to Wendy for a post for beginners to read.

    Okay so something seems to be going amiss here with Squeaky. His curves were flatter 2-1/2 months ago when we started. Now they are way extreme. And this morning I've learned when his numbers go over 600, it's causing vomiting. Yes the bounces are shorter in duration but they are more extreme. @Wendy&Neko -- WENDY, MOVING THIS DISCUSSION TO 11/16/20 THREAD IN LANTUS.

    So why does this seem to be getting worse instead of better?
     
    Last edited: Nov 16, 2020
  58. tiffmaxee

    tiffmaxee Well-Known Member

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    Hi Jan. This thread is dated 10/30. It’s confusing. How about starting a new one with today’s date? Thanks. :):confused:
     
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