2/5 Quincy - Why is he no longer regulated?

[April & Quincy]

https://www.felinediabetes.com/FDMB/threads/2-4-quincy-so-frustrated.242602/#post-2734487

Previous post above.

I'm just confused as to why he was so great in October and then his BG started rising and it's never seemed to come back down to blues. Maybe here and there but nothing stable. It seems like something is up but maybe, as I just read the links JaxBenji posted, his pancreas is "resting" at the moment and just can't chip in at all. I just want to make sure I'm not doing anything wrong.

 

[JaxBenji]

Yay good job on your condo and to tag someone so they get a notification just put the "@" symbol in front of their screen name. So I would be @JaxBenji - I'm sure more experienced folks will chime in when they can

 

[April & Quincy]

Yay good job on your condo and to tag someone so they get a notification just put the "@" symbol in front of their screen name. So I would be @JaxBenji - I'm sure more experienced folks will chime in when they can

Thank you.

 

[tiffmaxee]

Hi. Which method are you following, TR or SLGS? It looks like neither. You are holding the dose too long unless he’s dropping into lime green numbers and I can’t tell because I don’t see mid cycle tests at night. So we only have half of the picture. Cats don’t all nadir T +6 either. Some do earlier, some at the end of the cycle. I suggest you get a +2 and if it’s a lot lower than the pretest, set an alarm at night around +5 to see if the bg has dropped lower. A lower +2 is often a sign of an active cycle. The night of 1/28 he likely dropped under 100 and bounced in the morning which is why you saw a pink amps the next morning.

Your signature says SLGS so you need to do a curve on day 7.

 

[Gill & George]

Link to yesterdays thread here
https://www.felinediabetes.com/FDMB/threads/2-4-quincy-so-frustrated.242602/#post-2734493
(if you link it on your new thread we can look back for history easily and quickly, we use the date and a new thread so we can see the new threads of folk needing help or progressing, mostly because we get a lot of traffic, you can change the title at any point during the day, asking a new question if one crops up and use the ? prefix, so we know to come and have a special look)


I liked Wendy's suggestion of running a curve, are you able to do that today? tomorrow?
And as Elise has suggested moving the tests around can help build a better picture of her patterns than always testing at the same times, I remember an experienced member likening the ss to a jigsaw puzzle, when I was a newbie, if you can fill in more blank spaces it's easier to see the full picture
I'm not sure if we are seeing his true nadirs... he may not be nadiring at +6 until they are well regulated cats can and do nadir any time between shot and pmps (some times later if you get particularly long duration. Before he was regulated George nadired at +1 and +12 and anytime in between, though more often it was around +5

Two pm cycles make me wonder if he is having lower numbers at night
namely 2/1 and 2/3, on both of those the +2 was significantly lower, often when we see that it's an indication that the cycle is going to be active, in other words they'll continue to drop through the cycle to their nadir and then rise. So if you are able to get a test in the pm +4 range that might help.

I think you are struggling against glucose toxicity, it seems to affect some cats more than others. When that sets in a dose that was getting you into good numbers some weeks ago, can have the feeling of going off, and you might have to go up higher to see the same effect.
The longer you hold onto a dose that isn't getting him into good numbers the more likely kitty will become affected by glucose toxicity.
Part of your problem is with SLGS you have to hold the dose for 7 days, I don't think this is helping your guy. TR would allow you to adjust the dose more frequently and reductions are taken at a lower level (you've already been moving the reduction point because he wasn't holding on to the reductions and see enough green), if I were in your position I would give TR another look, and consider changing to that. Would that be something you would consider?

 

[LindyNova]

Hi April, I'm no expert, but we've been in this sugar dance for around the same time. I really just want you to know you are not alone in your thinking.

I think you are doing most everything right, but maybe a tweaking of your threshold for reductions may be in order, and change to (a modified) TR...or.... and I hesitate to say this....but maybe an increase is in order. Do not fear the greens!!

My personal goal is to have as many greens and low blues while keeping Novie safe---hoping that this will allow the pancreas to heal if that is at all possible.

I have started holding doses longer, even tho I am using the TR dosing method, and since our 1 year mark, waiting until Nova has gone 3x<50 and 1x under 40 for reductions. When she doesn't show a green in, say 6 cycles, then I raise. It seems to be working for us, in a bouncy way....she shows more greens now than ever before. Maybe Quincy needs to experience a bit lower numbers over the time frame on a particular dose.

I don't know what the heck is up with Nova, but she seems to be bouncing every chance she can get (mini bounces if you will... and they take longer to clear), throws low-to mid greens and then stays in the Blues/high greens until she spits out a lime. Crazy cat!

Those are just my thoughts. I know someone who has more experience can guide you better. Just hang in there!

 

[Adrienne & Molly (GA)]

I'm doing the same song and dance. Molly is up to 3 units now I just keep going til that magic dose is achieved. She seems fine the 5 P's they call it. I know it's frustrating!

 

[Gill & George]

I have started holding doses longer, even tho I am using the TR dosing method, and since our 1 year mark, waiting until Nova has gone 3x<50 and 1x under 40 for reductions. When she doesn't show a green in, say 6 cycles, then I raise. It seems to be working for us, in a bouncy way....she shows more greens now than ever before.

The under 40 drop for a reduction is for long term diabetics, so though appropriate for Nova, not for quincy at this time. For a newly diagnosed diabetic we recommend the reduction when they drop under 50, sometimes we can be more aggressive if kitty doesn't hold reductions (on TR) well, if Lindy were to change to TR, she should follow it as it written until Quincy proves he won't hold reductions or has some other issues that indicate we need to be more aggressive with the strategy. ( I know you weren't suggesting it, but just wanted to clarify)

.but maybe an increase is in order.

quite possibly, but when we raise a dose it's based on having a really good idea of what his nadir is in other words 'how low is this dose taking kitty?'
With so much missing in the pm cycle and no curve run since.....7/2020 do we really know how low this dose is taking quincy?
So though he may well need an increase, I think that we first of all need to establish how low the dose is getting him.

From the guidelines for SLGS
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

For some reason this bit of the SLGS guidelines falls by the wayside, but it is probably IMHO the most important bit of SLGS, otherwise you are flying blind so to speak. It leads to you not being able to hold on to reductions, holding onto doses for too long.

My personal goal is to have as many greens and low blues while keeping Novie safe---hoping that this will allow the pancreas to heal if that is at all possible.

That's a great goal! Even if healing enough of Mr P is not possible, if you can get nova regulated that is good for the rest of her organs and her general well being, I was lucky that George went into remission, honestly, my goal was regulation, I didn't dare think of remission till we got to the OTJ trial.

 

[April & Quincy]

Hi. Which method are you following, TR or SLGS? It looks like neither. You are holding the dose too long unless he’s dropping into lime green numbers and I can’t tell because I don’t see mid cycle tests at night. So we only have half of the picture. Cats don’t all nadir T +6 either. Some do earlier, some at the end of the cycle. I suggest you get a +2 and if it’s a lot lower than the pretest, set an alarm at night around +5 to see if the bg has dropped lower. A lower +2 is often a sign of an active cycle. The night of 1/28 he likely dropped under 100 and bounced in the morning which is why you saw a pink amps the next morning.

Your signature says SLGS so you need to do a curve on day 7.

Good ideas. I am doing a modified SLGS but I know I'm holding doses too lon . I think I have hope he'll drop down once he's on it for awhile but I guess not. I know I need to do a curve, I'll definitely do one in the next few days.

 

[April & Quincy]

Link to yesterdays thread here
https://www.felinediabetes.com/FDMB/threads/2-4-quincy-so-frustrated.242602/#post-2734493
(if you link it on your new thread we can look back for history easily and quickly, we use the date and a new thread so we can see the new threads of folk needing help or progressing, mostly because we get a lot of traffic, you can change the title at any point during the day, asking a new question if one crops up and use the ? prefix, so we know to come and have a special look)


I liked Wendy's suggestion of running a curve, are you able to do that today? tomorrow?
And as Elise has suggested moving the tests around can help build a better picture of her patterns than always testing at the same times, I remember an experienced member likening the ss to a jigsaw puzzle, when I was a newbie, if you can fill in more blank spaces it's easier to see the full picture
I'm not sure if we are seeing his true nadirs... he may not be nadiring at +6 until they are well regulated cats can and do nadir any time between shot and pmps (some times later if you get particularly long duration. Before he was regulated George nadired at +1 and +12 and anytime in between, though more often it was around +5

Two pm cycles make me wonder if he is having lower numbers at night
namely 2/1 and 2/3, on both of those the +2 was significantly lower, often when we see that it's an indication that the cycle is going to be active, in other words they'll continue to drop through the cycle to their nadir and then rise. So if you are able to get a test in the pm +4 range that might help.

I think you are struggling against glucose toxicity, it seems to affect some cats more than others. When that sets in a dose that was getting you into good numbers some weeks ago, can have the feeling of going off, and you might have to go up higher to see the same effect.
The longer you hold onto a dose that isn't getting him into good numbers the more likely kitty will become affected by glucose toxicity.
Part of your problem is with SLGS you have to hold the dose for 7 days, I don't think this is helping your guy. TR would allow you to adjust the dose more frequently and reductions are taken at a lower level (you've already been moving the reduction point because he wasn't holding on to the reductions and see enough green), if I were in your position I would give TR another look, and consider changing to that. Would that be something you would consider?

I thought I did link my previous post?

Yes, I can definitely do a curve in the next few days but I just keep thinking it's pointless since he's high anyway.

As for TR, my work schedule may not allow it. It's something to think about. Thank you for your thoughtful answers!

 

[April & Quincy]

Hi April, I'm no expert, but we've been in this sugar dance for around the same time. I really just want you to know you are not alone in your thinking.

I think you are doing most everything right, but maybe a tweaking of your threshold for reductions may be in order, and change to (a modified) TR...or.... and I hesitate to say this....but maybe an increase is in order. Do not fear the greens!!

My personal goal is to have as many greens and low blues while keeping Novie safe---hoping that this will allow the pancreas to heal if that is at all possible.

I have started holding doses longer, even tho I am using the TR dosing method, and since our 1 year mark, waiting until Nova has gone 3x<50 and 1x under 40 for reductions. When she doesn't show a green in, say 6 cycles, then I raise. It seems to be working for us, in a bouncy way....she shows more greens now than ever before. Maybe Quincy needs to experience a bit lower numbers over the time frame on a particular dose.

I don't know what the heck is up with Nova, but she seems to be bouncing every chance she can get (mini bounces if you will... and they take longer to clear), throws low-to mid greens and then stays in the Blues/high greens until she spits out a lime. Crazy cat!

Those are just my thoughts. I know someone who has more experience can guide you better. Just hang in there!

Thank you! We do sound very similar. I appreciate your experience. I do wonder if he needs to see lower numbers for awhile to stick with the lower numbers of that makes sense.

 

[April & Quincy]

I'm doing the same song and dance. Molly is up to 3 units now I just keep going til that magic dose is achieved. She seems fine the 5 P's they call it. I know it's frustrating!

It is!

 

[Gill & George]

I thought I did link my previous post?

you did, sorry I didn't see it, it's been a long day eyes have gone square.

thinking it's pointless since he's high anyway.

Not pointless, if it shows his high you take the dose up, if you discover he is nadiring at other times and is getting into lower numbers you hold.
It's what allows you to decide, without the data you it's impossible to know which direction to go in.

 

[Gill & George]

I meant to add the random spot checks as Elise described are also important.

 

[April & Quincy]

The under 40 drop for a reduction is for long term diabetics, so though appropriate for Nova, not for quincy at this time. For a newly diagnosed diabetic we recommend the reduction when they drop under 50, sometimes we can be more aggressive if kitty doesn't hold reductions (on TR) well, if Lindy were to change to TR, she should follow it as it written until Quincy proves he won't hold reductions or has some other issues that indicate we need to be more aggressive with the strategy. ( I know you weren't suggesting it, but just wanted to clarify)


quite possibly, but when we raise a dose it's based on having a really good idea of what his nadir is in other words 'how low is this dose taking kitty?'
With so much missing in the pm cycle and no curve run since.....7/2020 do we really know how low this dose is taking quincy?
So though he may well need an increase, I think that we first of all need to establish how low the dose is getting him.

From the guidelines for SLGS
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

For some reason this bit of the SLGS guidelines falls by the wayside, but it is probably IMHO the most important bit of SLGS, otherwise you are flying blind so to speak. It leads to you not being able to hold on to reductions, holding onto doses for too long.


That's a great goal! Even if healing enough of Mr P is not possible, if you can get nova regulated that is good for the rest of her organs and her general well being, I was lucky that George went into remission, honestly, my goal was regulation, I didn't dare think of remission till we got to the OTJ trial.

I definitely do need to do a curve and I will in the next few days. But one curve will not help me find his nadir, will it?

 

[April & Quincy]

you did, sorry I didn't see it, it's been a long day eyes have gone square.

Not pointless, if it shows his high you take the dose up, if you discover he is nadiring at other times and is getting into lower numbers you hold.
It's what allows you to decide, without the data you it's impossible to know which direction to go in.

I can decide that based on one curve?

 

[Gill & George]

I definitely do need to do a curve and I will in the next few days. But one curve will not help me find his nadir, will it?

No not one on it's own, a weekly nadir needs to be part of his SLGS routine, overtime it will help.

Between now and running the curve grabbing some random spot checks will help.
By random I mean 'mix it up' Are you able to do this with your work schedule?

 

[LindyNova]

I thought I did link my previous post?

Yes, I can definitely do a curve in the next few days but I just keep thinking it's pointless since he's high anyway.

As for TR, my work schedule may not allow it. It's something to think about. Thank you for your thoughtful answers!

TR can work even if you work. I do. But then again, I'm lucky that I live close to my work to get home for mid-cycle tests and food. Check out Nova's spreadsheet. I set an alarm anywhere from +5-6pm depending on the before bed test. Since I have not invested yet into an autofeeder, this is when the Noves gets her mid-cycle feeding & test.

The curve(s) will help you to see the time that Quincy most often nadirs at. I used to alter +2, +4 to +3, +5 just to fill in that spreadsheet.

 

[April & Quincy]

No not one on it's own, a weekly nadir needs to be part of his SLGS routine, overtime it will help.

Between now and running the curve grabbing some random spot checks will help.
By random I mean 'mix it up' Are you able to do this with your work schedule?

Right now I am because I'm virtual but I won't be for much longer and then I won't even be able to grab a +6. It'll be strictly AMPS PMPS and +2 before bed. So I can do what I can for now but it won't last.

 

[LindyNova]

Thank you! We do sound very similar. I appreciate your experience. I do wonder if he needs to see lower numbers for awhile to stick with the lower numbers of that makes sense.

It does make sense. When you get more comfortable with lower numbers... as the saying goes...shoot low to stay low. Although our cats may have a different idea and go all bouncy on us.

 

[April & Quincy]

TR can work even if you work. I do. But then again, I'm lucky that I live close to my work to get home for mid-cycle tests and food. Check out Nova's spreadsheet. I set an alarm anywhere from +5-6pm depending on the before bed test. Since I have not invested yet into an autofeeder, this is when the Noves gets her mid-cycle feeding & test.

The curve(s) will help you to see the time that Quincy most often nadirs at. I used to alter +2, +4 to +3, +5 just to fill in that spreadsheet.

Unfortunately I cannot come home during the day and I'm gone 10 hours but I'm virtual for now so I can do what I can. So you're saying some days do +2 and 4 and some days do +3 and 5?

 

[Gill & George]

Right now I am because I'm virtual but I won't be for much longer and then I won't even be able to grab a +6. It'll be strictly AMPS PMPS and +2 before bed. So I can do what I can for now but it won't last.

Do what you can now, worry about what to do when you go back to work later.
Do you get weekends off? days off?(sorry I know this all sounds so personal)

I can decide that based on one curve?

yes and some random checks.
He has seen low blues on this dose, at +6 , but perhaps he has had his nadirs earlier, or later? You just need to have a poke around, do it now while you can.

 

[Gill & George]

So you're saying some days do +2 and 4 and some days do +3 and 5?

yes that would be ideal if you can, throw in a +7 or +8 now and then some cats nadir late.

 

[April & Quincy]

Do what you can now, worry about what to do when you go back to work later.
Do you get weekends off? days off?(sorry I know this all sounds so personal)


yes and some random checks.
He has seen low blues on this dose, at +6 , but perhaps he has had his nadirs earlier, or later? You just need to have a poke around, do it now while you can.

I do get weekends off so I can do curves or more checks then. Yes , his nadir could be different than +6 for sure!

 

[April & Quincy]

Thank you all for help! It means so much!

 

[Gill & George]

I do get weekends off so I can do curves or more checks then.

That's great, yes scheduling curves for then would be great.

Is he a good eater, can you leave food in an autofeeder for him?

If you are gone 10 hours, when you go back to work you may able to get a +1 or +2 or a +11 perhaps in the am cycle, depending on how his shooting schedule fits in with your work day.

 

[April & Quincy]

That's great, yes scheduling curves for then would be great.

Is he a good eater, can you leave food in an autofeeder for him?

If you are gone 10 hours, when you go back to work you may able to get a +1 or +2 or a +11 perhaps in the am cycle, depending on how his shooting schedule fits in with your work day.

Yes , he loves to eat and I do use an auto feeder when I'm at work.

 

[LindyNova]

Unfortunately I cannot come home during the day and I'm gone 10 hours but I'm virtual for now so I can do what I can. So you're saying some days do +2 and 4 and some days do +3 and 5?

Long work days are rough for testing and feeding. get in random tests when you can while you're at home. As far as curves go....Pretty much, but when I did curves (on the weekends, of course) I switched it up weekly when I could, every two hours, even and odd hours.

 

[April & Quincy]

Long work days are rough for testing and feeding. get in random tests when you can while you're at home. As far as curves go....Pretty much, but when I did curves (on the weekends, of course) I switched it up weekly when I could, every two hours, even and odd hours.

Okay, good to know.