? 12/25 Ivy Amps 218,+2.5 163,+4 111, +7 112, +10 291, Pmps 335, +2.25 246,+4 227 Libre/Dose Increase?

Staci & Ivy

Staci & Ivy

Member Since 2022
https://www.felinediabetes.com/FDMB...-189-4-295-7-267-9-253-pmps-283-3-220.284890/
Amps 218
Good morning and Merry Christmas to all who celebrate. :bighug:

Yesterday was flat yellow all daytime cycle. Night was mostly blue and yellow, all on Libre, so numbers are higher on a handheld meter. Not thrilled with her numbers and thinking out loud (aka a threat) of an increase to 3.25 units tonight after 8 days at 3 units Lantus.
Her numbers overall are better lately but not really seeing under 100 on a handheld meter.
Any opinions? I know it’s not the best day to ask for advice as so many are busy today.
Thanks for any opinions.

Wishing everyone peace and joy.
And of course a safe surf to all sweet kitties :cat:
 
allicatmeow said:
Merry Christmas Staci and Ivy!! I would say yes to an increase, like you said, no under 100s happening here. :bighug:
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Merry Christmas, Alli, Smudge & Penny! Thanks for your input. Makes me feel better with your feedback :):bighug::):bighug:
Enjoy the day with your family.
 
Christie & Maverick said:
Since you are following SLGS you would hold the dose. You have been getting a lot of nadirs under 150 and into the 60s two days ago.
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Hi Christie, those values are on the Libre sensor, so they are higher on a handheld meter.
That’s why I mentioned I'm not seeing green numbers on a handheld meter.
When I get a green on my spreadsheet I indicate it’s a Libre number so upon looking at the SS someone would read it’s from a Libre (I understand at a glance it may not be apparent)
 
Christie & Maverick said:
Sure, I get it, but we have to go off of the Libre data we do see, since you don’t check every test with the handheld. And with that data, nadirs are under 150.
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I know the Libre nadirs are under 150, but not on a handheld. I’m comfortable with the Libre enough to know how it reads at this point.
I know when I see numbers on Libre under 50 to get ready to test on handheld meter.*The meter usually needs to read in the Lo range for actual handheld meter number to be under 100.
I really use the Libre as a guide to tell me when I need to poke her for blood readings when she goes low.
 
Increasing is not reasonable, when following SLGS. What is 53 on handheld? What is 64? What is 136? With all due respect, I’ve been around a while, but of course am only sharing my opinion :) and shall happily bow out now.
 
Merry Christmas :cat:,
If I am looking at the Libre data, SLGS would have you hold this dose (she might just be ready to show you some libre greens today or tomorrow).

Although the libre reads lower, we really don't know how much lower and in what ranges as compared to a handheld meter. For example if the libre is 150, what is that on the handheld? I pick 150 because that is the top of the range for nadirs when following SLGS but replace 150 with any BG that's 90-150 which is the nadir goal.
Truth is comparing meters is an exercise in futility. Many people here have tried it with pet vs human meters. I'd wager it's the same with libre vs handheld.
I have often speculated that my Cleo may have gone lime in the wee hours of the night and when I didn't test. But if we didn't see we won't base dosing decisions on may have.
 
Christie & Maverick said:
Increasing is not reasonable, when following SLGS. What is 53 on handheld? What is 64? What is 136? With all due respect, I’ve been around a while, but of course am only sharing my opinion :) and shall happily bow out now.
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And @Angela & Cleo Christie and Angela, I greatly respect your knowledge and opinions. I truly mean no disrespect at all. I just want to say that to start. And I always appreciate your making the time and caring enough to weigh in.
The Libre vs a handheld meter is like comparing Celsius to Fahrenheit in a way, from what I’ve learned over these 9 or so months. Or translating one language to another…

For example a 53 Libre is usually right around 150 on handheld. So a 64 Libre is like a 160-170 handheld. A recent167 Libre was 214 on handheld.
And a 136 will be a higher number on a handheld meter.
As I’ve noted, when I see her read Lo on the Libre (which is under 40 on Libre) is when she will read under 100 on a handheld meter when checked.
So that’s the only reason I’m even considering an increase since I'm not seeing any Lo Libre reading lately (which I would check with an ear prick to verify).

I really feel badly Christie if I somehow made you feel badly to want to bow out of the conversation. I’m sorry, truly. I do value all of your and Angela’s generous help. :bighug:
 
It is not a matter of making comparisons, I agree, having also done numerous tests between my AT2 and human meter in the past. The crux of the issue is that we know that the Libre can read lower so one needs to use the handheld when making a decision to reduce, which you are already doing. So now, what information do you want to use when making dose decisions to increase? The bottom line is that you either need to read the Libre as is, or run a curve or spot checks with the handheld to know for sure that nadirs are not under 150 per SLGS. While one can say they know the Libre well enough, it is still speculation whether what you are seeing in 50s -60s is on the handheld. Can’t really have it both ways.
 
Staci & Ivy said:
I really feel badly Christie if I somehow made you feel badly to want to bow out of the conversation. I’m sorry, truly.
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No need to be sorry at all, I am not offended in the least :). I have been around for going on 7 years, whether that counts as “expertise” aside, I also have been around long enough that I happily share my perspective and try to provide reasons behind my thoughts/suggestions and you are welcome to take it into consideration or not. Being a peer reviewed forum, others may also not agree with my opinion, which is perfectly fine. All good hon :bighug:
 
Please consider this.
What you're asking is an opinion on taking a little from this dosing method and that dosing method. Take a look at this post . (It's one of my favorites to read and reread).
When giving an opinion on dosing it's a HUGE responsibility and one that should not be taken lightly. In that respect, we look at the spreadsheet and the method chosen by the caregiver. There are safety checks and balances in place to keep kitty safe this way. Ultimately, Ivy is your kitty and you hold the syringe. :cat:
 
Christie & Maverick said:
It is not a matter of making comparisons, I agree, having also done numerous tests between my AT2 and human meter in the past. The crux of the issue is that we know that the Libre can read lower so one needs to use the handheld when making a decision to reduce, which you are already doing. So now, what information do you want to use when making dose decisions to increase? The bottom line is that you either need to read the Libre as is, or run a curve or spot checks with the handheld to know for sure that nadirs are not under 150 per SLGS. While one can say they know the Libre well enough, it is still speculation whether what you are seeing in 50s -60s is on the handheld. Can’t really have it both ways.
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Christie & Maverick said:
So now, what information do you want to use when making dose decisions to increase?
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I feel like I am using the data I have gathered and my understanding of how the Libre reads to make increase decisions.
I understand if she is under 149 on a handheld we want to hold a dose.
But I’ve also been told she’s not seeing enough nadirs under 149, so give an increase.
So I’m trying to use that advice and knowledge from the forum to determine if an increase is warranted.
I would never want to put Ivy in danger.
I don’t understand when you say I can’t be sure that the Libre 50s and 60s readings are on a handheld. I have tested them many times. That’s how I came to learn she’s actually safe in those numbers on a handheld meter.

I’m not sure what ear prick spot checks will do since she has the Libre, Which acts as a curve or spot checks, I feel. :(
 
Angela & Cleo said:
Please consider this.
What you're asking is an opinion on taking a little from this dosing method and that dosing method. Take a look at this post . (It's one of my favorites to read and reread).
When giving an opinion on dosing it's a HUGE responsibility and one that should not be taken lightly. In that respect, we look at the spreadsheet and the method chosen by the caregiver. There are safety checks and balances in place to keep kitty safe this way. Ultimately, Ivy is your kitty and you hold the syringe. :cat:
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I have read and reread this post, which is excellent, I agree. I understand the huge responsibility of advising. That’s why I ask for help. Because I respect all of the knowledge of all of you who know sooo much more than I do.

I’m not sure how I’m mixing and matching protocols.

I am following SLGS, I have lowered her reduction point, as advised, to try to steer her to stay in lower numbers to try to heal in them. I’m good with that.
I use the Libre to guide me to check her numbers when necessary to keep Ivy safe.
I have gathered a lot of data to understand her bg numbers on a handheld meter vs a Libre.

So I feel what I’m asking is this… since she’s not seeing bg consistently under 100 on an handheld meter after 9 days, do I hold or increase?
Because if she went low enough on the Libre, I would be ear pricking much more. But she’s not. :(
Is she just bouncing into the 200s from spending more time in lower numbers for her and I should hold the dose, per SLGS?
 
Mikanmama said:
Ho Ho Ho! Merry Christmas, Staci and Ivy! :)
Wishing you a very lovely day!

You've been on this dose for something like 9 days?
You are so familiar with the margins Libra gives, upping seems reasonable, but I'll tag
@Angela & Cleo for her expertise.

May Santa be good to you, Staci!
:bighug::bighug::bighug:
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Hi Kit, thank you for your input and tagging Angela :)
I wish you all a wonderful day, Merry Christmas :bighug::bighug::bighug:
 
I’m going to suggest just one more time that you do a few things. First, pick one meter and only double check lows. Second, stick with mostly lc. Third maybe try TR but only if you d the above without deviation. I know it does d not work for you in the past but you have learned a lot so maybe TR would work better for you now.

In the end you hold the syringe and need to live with the choices you make.

Happy holidays.
 
Staci, it comes back to one of my original questions to you. Are you using the Libre for dosing decisions?

SLGS dosing method would have you perform a curve after 7 days. If dosing decisions, which consist of decreases AND when to increase, are based on the Libre then the data says to hold the dose. If those decisions are based on a handheld meter, then we would need to see curve data on a handheld meter (BG tests every 2 hours for 12 hours or every 3 hours for 18hours) to be able to opine.

I'm not being obstinate. I'm just trying to be as clear as possible. While YOU understand the trends and comparisons between the two meters, I don't. So in the interest of safety for someone else's cat, MY opinion for an increase can only be based on what I see and what the method says to do.
 
Good meowning Staci and Ivy

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tiffmaxee said:
I’m going to suggest just one more time that you do a few things. First, pick one meter and only double check lows. Second, stick with mostly lc. Third maybe try TR but only if you d the above without deviation. I know it does d not work for you in the past but you have learned a lot so maybe TR would work better for you now.

In the end you hold the syringe and need to live with the choices you make.

Happy holidays.
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Hi Elise, Happy Holidays to you, too!
So I do use one meter, the Libre. And I check the lows with a handheld as you suggest.
(The only time that I would generally use a handheld is if the libre isn’t working or to double check a low, Libre value). if I do put something on my spreadsheet that is other than a Libre. I indicate it is on the contour meter so that that is obvious to the reader.
I am only feeding 6% low-carb on a steady basis.
The only time I may give 9.25% or 12.5% of her homemade lamb diet is when she either goes low and I need to bring her up or if I am heading out the door in the first few hours into onset when she has been known to drop low (and I do that just for safety measure but not on a daily basis).

In terms of TR, my concerns are that she’s hard to bring up with carbs and she’s have to drop to 40 since over a year diagnosed. And, she seems to take more than 3 days to get going on a higher dose when increased. I feel like I would be giving too much insulin after quick increases for her to acclimate to a higher dose.
Then when I have to decrease and she has an overly full Depot it’s a really rocky numerous days until she depletes that higher Depot. That’s why I’m more comfortable going slower while she seems to get going in a higher dose.
Isn’t that why they say “know thy cat?”
I’m not being snarky here. I’m truly giving you feedback of what I’ve learned about how she reacts to doses and that’s why I’ve been trying to stay within SLGS.
 
Angela & Cleo said:
Staci, it comes back to one of my original questions to you. Are you using the Libre for dosing decisions?

SLGS dosing method would have you perform a curve after 7 days. If dosing decisions, which consist of decreases AND when to increase, are based on the Libre then the data says to hold the dose. If those decisions are based on a handheld meter, then we would need to see curve data on a handheld meter (BG tests every 2 hours for 12 hours or every 3 hours for 18hours) to be able to opine.

I'm not being obstinate. I'm just trying to be as clear as possible. While YOU understand the trends and comparisons between the two meters, I don't. So in the interest of safety for someone else's cat, MY opinion for an increase can only be based on what I see and what the method says to do.
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Lol much as what I have been saying since oh about 6:00 this morning :)
 
Hi Staci :)
Looks like you've got yourself a puzzle on christmass day :kiss:
I'm nowhere near others' in terms of experience to offer dose advice so I'll share what I'm picking up from the conversations here.
Looks like there's no straightforward conclusion that others can easily say increase. In compared to the last time she was on this dose Ivy's doing really much better. Ans since you're following SLGS why don't you give it another couple of cycle to have a bit more data and perhaps Ivy will show you more of what she needs.
If it was me I'd be inclined t keep the dose for now. It's true that she doesn't show much greens but at the same time pinks rescued significantly. Which would lead me to hold the dose for just a little while longer than trying to push for more greens.
I hope this makes sense to you. It's really just my impressions.

Hopefully you've had a good day and didn't eat to much (it's my thing at Christmas Day ):woot:
:bighug::bighug::bighug:
 
Fistuk & Shelly said:
Hi Staci :)
Looks like you've got yourself a puzzle on christmass day :kiss:
I'm nowhere near others' in terms of experience to offer dose advice so I'll share what I'm picking up from the conversations here.
Looks like there's no straightforward conclusion that others can easily say increase. In compared to the last time she was on this dose Ivy's doing really much better. Ans since you're following SLGS why don't you give it another couple of cycle to have a bit more data and perhaps Ivy will show you more of what she needs.
If it was me I'd be inclined t keep the dose for now. It's true that she doesn't show much greens but at the same time pinks rescued significantly. Which would lead me to hold the dose for just a little while longer than trying to push for more greens.
I hope this makes sense to you. It's really just my impressions.

Hopefully you've had a good day and didn't eat to much (it's my thing at Christmas Day ):woot:
:bighug::bighug::bighug:
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Thank you, Shelly. Your perspective is quite helpful. Not the best day for a puzzle around here :(
I’m always concerned about glucose toxicity setting in versus giving too high of a dose.

And I know everywhere hates the Libre. I’ve had 4/4 doctors suggest using it. lol. Can you believe I was actually very resistant to using it before I tried it? But they saw how difficult a cat Ivy is to handle. :(

I hope you’ve had a lovely Christmas Day :)
:bighug::bighug::bighug:
 
Hi Staci. Merry Christmas to you.
Those lows you are always mentionning about when you tried TR, were they on the Libre? Maybe now you have a better understanding of what 'Low" on the Libre means, and you would do well with TR? When I look at your SS, I don't really see where Ivy did not go up fast. From what you explain, it seems if I understand well, that a 50 on the Libre is not actually a very low number. I would tend to say like Elise and advise you to give TR a try, now that you know a lot more, and keep the MC for when Ivy really needs it, when you would use it if you used only the handheld meter, and not when she is in very safe numbers.
 
Angela & Cleo said:
Staci, it comes back to one of my original questions to you. Are you using the Libre for dosing decisions?

SLGS dosing method would have you perform a curve after 7 days. If dosing decisions, which consist of decreases AND when to increase, are based on the Libre then the data says to hold the dose. If those decisions are based on a handheld meter, then we would need to see curve data on a handheld meter (BG tests every 2 hours for 12 hours or every 3 hours for 18hours) to be able to opine.

I'm not being obstinate. I'm just trying to be as clear as possible. While YOU understand the trends and comparisons between the two meters, I don't. So in the interest of safety for someone else's cat, MY opinion for an increase can only be based on what I see and what the method says to do.
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To try to clarify, I use the Libre as a road map. It guides me as to what’s happening. If anything is of concern, I test with a handheld. I make dosing decisions based on a handheld meter.
I had 4/4 docs suggest the Libre since she’s so difficult. I was resistant to it. I understand everyone here hates the darned thing. (I do think we will be seeing more and more people using them as time goes on).

I know you’re not trying to be difficult and I really appreciate all your words and your thoughts. And neither am I, I’m not really sure what a curve of me poking her every two hours would tell us any different than the Libre does. Other than just verify all the times I’ve poked her in the last 9 to 10 months to confirm the numbers.
I can certainly try a curve and see what I get. If that would make you more comfortable.
 
Staci & Ivy said:
Thank you, Shelly. Your perspective is quite helpful. Not the best day for a puzzle around here :(
I’m always concerned about glucose toxicity setting in versus giving too high of a dose.

And I know everywhere hates the Libre. I’ve had 4/4 doctors suggest using it. lol. Can you believe I was actually very resistant to using it before I tried it? But they saw how difficult a cat Ivy is to handle. :(

I hope you’ve had a lovely Christmas Day :)
:bighug::bighug::bighug:
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Well, I know that at the end of the day you have to make the decisions because you know Ivy best. Which makes it a bit difficult. Would have been much easier to just follow a manual or even a protocol without needing to consider individual variations. But that's not life ;)

I hope you can come to a decision to you feel more peaceful with than not :bighug::bighug::bighug:
 
Staci & Ivy said:
For example a 53 Libre is usually right around 150 on handheld. So a 64 Libre is like a 160-170 handheld. A recent167 Libre was 214 on handheld.
And a 136 will be a higher number on a handheld meter.
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Your SS does not support this extrapolation of data. Just looking at December, LO Libre readings on 12/2, 12/9 and 12/17 yielded 79, 110 and 151 respectively on the Contour.

MY opinion for an increase can only be based on what I see and what the method says to do. Per SLGS and your SS, I would hold the dose.

I think that you misunderstood me.
Staci & Ivy said:
I understand everyone here hates the darned thing. (I do think we will be seeing more and more people using them as time goes on).
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I never said nor ever implied this and it is NOT what I think about the Libre! I myself have used the Libre device and know how valuable it can be with a difficult cat and I would not hesitate to have another put on her if for whatever reason someone else had to take care of my cat when I can't.
Staci & Ivy said:
I make dosing decisions based on a handheld meter.
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You have made decrease decisions based on a handheld.

Staci & Ivy said:
If that would make you more comfortable.
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Ivy is not my cat, she's yours. My comfort has no bearing on YOUR decision to increase the dose.
 
Since you are using the Libre, follow SLGS based upon Libre numbers, which means you hold the dose now. I’d only recheck with the handheld to see if you need to give mc or hc due to being line on the Libre. Make dosing suggestions based upon ONLY THE LUBRE. That’s my advice FWIW.
 
Angela & Cleo said:
Your SS does not support this extrapolation of data. Just looking at December, LO Libre readings on 12/2, 12/9 and 12/17 yielded 79, 110 and 151 respectively on the Contour.
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I agree…. I do think I misunderstood you Angela :(

Yes. All those December Lo’s you pointed to do give a varied handheld result. That’s why I check with ear prick when she hits “Lo” on Libre. Because it will vary, “how low” is that bg actually on a handheld?? So I check with ear prick.

The Libre Lo reading seems to be a catch all for anything under/ around 150 on a handheld meter.

I guess I still struggle with how often they should be in lower than 150 (on handheld) nadirs to consider an increase? (And is she bouncing into Libre yellow from lower numbers, or is she just plain in higher BGs)???

My reason for opening this dialogue today was that I’ve not been seeing under green100 nadirs on handheld meter consistently on this dose. I wasn’t sure if I should need to see them on Most days.

The last under 150 nadirs (on handheld) were 4 days ago (based on the Libre readings in the 40s & 50s on 12/21).

I was trying to give you the comfort of assisting me with a dosing decision in doing a curve if needed.
I understand I hold the syringe and she’s my cat.
But I’m coming here asking for help. So I want to help you feel comfortable to help me.
I will hold her dose for now and see what happens. :)
 
tiffmaxee said:
Since you are using the Libre, follow SLGS based upon Libre numbers, which means you hold the dose now. I’d only recheck with the handheld to see if you need to give mc or hc due to being line on the Libre. Make dosing suggestions based upon ONLY THE LUBRE. That’s my advice FWIW.
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I’ve always been advised here over and over to double check any low numbers on a handheld meter to know what’s actually going on. So that’s what I’ve been doing.

And I think that’s helped to bring her into much better numbers over time. Her SS looks much better than ever I think.
But I think she can do better. I just need guidance to help me get her there safely.
 
cecile & bella said:
Hi Staci. Merry Christmas to you.
Those lows you are always mentionning about when you tried TR, were they on the Libre? Maybe now you have a better understanding of what 'Low" on the Libre means, and you would do well with TR? When I look at your SS, I don't really see where Ivy did not go up fast. From what you explain, it seems if I understand well, that a 50 on the Libre is not actually a very low number. I would tend to say like Elise and advise you to give TR a try, now that you know a lot more, and keep the MC for when Ivy really needs it, when you would use it if you used only the handheld meter, and not when she is in very safe numbers.
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Hi Cecile, Merry Christmas to you and your family.
Thanks for popping in with your thoughts.
The lows when I did TR were on both the Libre and Handheld meter. I think the hardest part for me was she would bounce so high then dive so low and very fast, especially heading into Amps. And I never knew what to do. When I would stall she would continue to dive lower. It was difficult to know what to do and sometimes guidance was unavailable as it’s very early am so few people are around.

Plus Ivy seems to really take 5 or 6 days to really get going in a higher dose. I feel TR moves too fast for her. (Not sure if others feel the same or not?)

I am really only feeding her 6% LC food. Only use 9.25% or 12.5% if she drops low on handheld meter or I need to keep her safe if I’m headed out for a few hours from shot time through +3 at onset.

I do feel I have a better understanding now in general, yes.
And having to let her drop to 40 really terrifies me.
So that’s my thoughts right now.
Still not sure Ivy and I are cut out for TR based on how she reacts.
But I keep considering if we could try it again….
:bighug::bighug::bighug:
 
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