2/8 Disco PMBG 77,stalling,+12.5 66, +13 56,+13.25 56,+13.5 49,+13.75 49,+14 39,fed 2tsp LC

Yesterday 2/6: http://www.felinediabetes.com/FDMB/...-5-314-7-355-pmps-332-1-5-291-6-5-270.225303/

Hoping for something more ☀️ than lemons today!

 

fingers crossed! he seems to be clearing bounces in 3 cycles and his 3 cycles are up!

 

Come on Disco, the beach is more fun than hanging out in a lemon tree!!

 

I hope Disco slides down today.

 

Hope he does make the beach.

 

Since you're following TR and haven't seen a green in 6 cycles, it's time for an increase. Looks like 3 u is the next increment for Disco.

 

Sue can you clarify for me (don't mean to hijack the thread)? I thought if you see green that you hold the dose for 10 cycles?

Increasing the dose:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
• Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
• Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.

http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

 

No, on TR you can increase after 6 cycles since seeing a green...I think maybe you're thinking of SLGS - where indeed you do hold the dose longer - it's less aggressive than TR and slower to increase....

 

I just edited my post at the same time you posted. I got the quote from under the TR guidelines.

 

I tend to be as aggressive as TR will allow - increasing every 6 cycles if Luci is showing me a lot of yellow and pink...I'm looking pretty much at 2/4 - 2/7 - I'd be getting an increase ready if it were me.

 

Makes sense. Thanks for the clarification.

 

All questions are good questions It just takes time to get to know your cat and what makes sense for you - when I'm feeling better I'll be increasing Luci's dose - although at this stage of the game remission is unlikely for her - but I do like to see her in lower numbers for her general well being.

However, Disco is relatively new at this and has a much better chance at remission - so now is the time to give him those pushes he needs. He has just recently seen some better numbers so we know he's capable of getting there...but sometimes these kitties need a little bit more of a push to get them back into those better numbers...and we do the sugar dance, up/down, up/down...adjust that dose until we hit the perfect dose and down the dosing ladder they go...until they hit the OTJ trial! Lots of kitties make it and the early days are the time to get there! It's always exciting to help the newbies across that line

 

Thank you for your guidance, the days go by and I get a little muddled and I really appreciate the clarification. I will increase him tonight as I’ll be around most of the weekend.

I have a question and maybe I’m just pessimistic but I’m not sure if he will go into remission because he has some pancreas damage from his inflammatory bowel disease and one of his G.I. profile tests is always elevated. His labs from October are on his spreadsheet but I will look back and see what his previous tests were because we ran different panels where I used to work.

Previous labs attached, done in May 2019 (he had labs run every 6 months)

 

I couldn't really read what the attached labs said - you may want to put that into your SS - under a new tab that you can name 'Labs'. I'm no expert either - but there are people on the forum who are more educated about those things and if it's there could be useful in the future for review.

In the meantime, don't give up on hoping for remission - kitties have the amazing ability to heal their pancreas' unlike us hoomans - once ours is damaged it is forever damaged - felines have the ability to re-grow new pancreatic cells! Also, I've accepted that although Luci may never go into remission - she's pretty healthy and happy and I still have her with me after two years - ok, so she needs medicine twice a day to stay alive and healthy - so do many other people and animals - it's ok...we have an understanding and she's a member of the family - so deserves our help to survive - I hope someone does that for me someday too She loves me for it (I think!)...sometimes I'm not so sure...but LOL - she's worth it!

 

Thank you for your kind words and support! I added the last 3 lab panels Disco had run from the clinic I worked at in Virginia into his spreadsheet. Thx for recommending I do that. I've always felt that Disco loves me the most of the 3 kitties I have now, he purrs non-stop and demands loving and now that he has diabetes, that love has grown. I'm so glad he doesn't hide from me as I test him so often, but almost the opposite--he comes around when he hears the test strip container pop open--of course, treats are involved, LOL

 

Isn't it amazing how they 'adapt' to the testing routine? I know a lot of folks have trouble in the beginning - I'm one of them...but these cats are smart and they adapt ... and next thing you know, they're practically leading the way! Gotta love it!

 

***Note—I meant to post this on Sat 2/8 not Fri 2/7***

After a day testing every 2 hrs, Disco’s PMPS is 77, so he’s going low in the evening just to trick me this cycle! Is this right—not feed him and test again in 30 minutes? If he is lower in 30 min, is that when I feed 2 tsp HC gravy or do I feed LC then unless he’s below 50. I will read over my notes again but I wanted to get this posted so I could get an answer so hopefully somebody will see this and help me.

 

Hi Teri, Can you update your spreadsheet?

 

Although I'm not experienced enough to offer dosing advice, here is some info

from the sticky

How to Deal with Low Preshot Numbers (the following guidelines apply to those following the Tight Regulation Protocol only):
You just tested your cat’s preshot number, and there is a much lower than usual number staring back at you. What do you do?

There is no one-size-fits all answer, but there are some general guidelines. As with everything else, each cat is different (ECID) and each caregiver is different too.

The short answer is that most kitties can be shot at +12, almost regardless of the number, once you are data ready to do so. The exception is that shooting 30s or 40s is not recommended for most cats, so if a cat is lower then usually the best option is to wait until they are at a shootable number to shoot. What constitutes a shootable number will vary by cat, but we don't suggest or recommend shooting a preshot number less than 50. While you’re waiting, the depot is draining, so you want to get the insulin in as soon as it makes sense to shoot.

If it is your first time shooting green, then we will likely suggest that you stall the first time, even if the number is 80-100. That will let you collect data on what your cat will do when you stall. One thing you can do if you are having a low cycle is to get a +10 and +11. Those will give you a good idea of how quickly the cat’s numbers are rising (or not) when preshot time arrives.

Beyond the general guidelines, there are other factors we consider when we are helping someone with a low preshot.

• If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative.
• If the cat is not a food spiker or tends to have an early onset/early nadir then they may not want to shoot as low. If the cat has a late nadir, then they will HAVE to learn to shoot low.
• We will also be more conservative in some cases because of the person – if you are not able to monitor then you want to be more careful, or if you are not sure that you can get back to the board to keep us updated throughout the cycle. Trust me, if you shoot low, we will be watching for your updates and we will worry if we don’t see them.
• We have to be a lot more careful with the cats who eat only dry food, because they don’t have access to the tools the rest of us use to keep our cats safe.
• Also, when it comes to very low preshots, there is an unwritten rule that whoever helps that person shoot low should expect to sit with them through any low parts of the cycle. There have been times when I knew a cat’s number was likely shootable, but I also knew that I could not be around to help if the shot resulted in low numbers later in the cycle. For safety’s sake, if I could not find someone else who would be available to support for the next several hours, I would most likely suggest that the shot be reduced or skipped. I will not encourage someone to shoot low and then abandon them.
• There are a lot of other scenarios, and you always want to keep your cat in mind.

Some general rules when stalling (ECID):

• 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
• 40s or lower – you have a couple of choices.
  • When 40s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.

• • If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
    
    • Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

• Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

http://www.felinediabetes.com/FDMB/...y-to-shoot-handle-lower-pre-shot-numbers.147/

 

Oh my gosh I’m in such an anxiety state I posted this on 2/7 and it really is 2/8

 

Updated and the 77 is tonight Sat 2/8, not yesterday—my error

 

That's OK. No worries. 77 is a good number. Update your spreadsheet. I'll tag @Wendy&Neko @Sienne and Gabby (GA) and @Chris & China (GA) as I'm pretty sure one of them has access to fix the thread.

 

Test again in 15-20 min after you PMPS to see if Disco is coming up. On Feb. 3 you skipped a low number and Disco ended up going really high that night.

 

Are you able to monitor tonight? Plenty of strips? MC and HC food? Syrup on hand?

 

Thx for including the TR sticky, too. It looks like i should shoot but im about to retest him now

 

Yes to all the above

 

Ok. Great.

I think you can still change the title of this thread so you can catch a more experienced person to help out. In this title change the date to 2/8 and your pmps number and state that you are stalling.

 

66 at 8:38pm, was 77at 8:03pm

 

How long can you stall for? It will affect your shoot time tomorrow. How comfortable are you with shooting a lower number that what you've seen before?

I'll tag a few more people for you.

@Christie & Maverick
@Sue and Luci
@MrWorfMen's Mom
@Bron and Sheba (GA)

 

No food. Stall and test and see if he is headed higher. He is probably breaking a bounce and so heading lower fast. Feed only if he drops below 50. Test every 20 minutes so you can catch him rising and shoot then.

 

I just changed the title and the date on this thread Hope that doesn’t confuse too many people

 

Sorry. Just saw this. When was his shot due?

 

Stalling and I can test every 20 minutes somehow half an hour went by when I just re-tested him but I’ll do it every 20 minutes now I promise

 

8:15pm, its now 8:48pm

 

I will stay up with him and I can be home all day tomorrow

 

Update his SS so other members can see his numbers without having to read the whole thread. Will give you something to do in between tests to take your mind off his numbers!

 

Updated spreadsheet, he still dropping he’s 56 now at 8:55pm

 

Any history of ketones for Disco?

 

No

 

Wow! He is on a tear!

Some general rules when stalling (ECID):

• 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
• 40s or lower – you have a couple of choices.
  • When 40s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.

• • If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
    • Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

• Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you. The

 

You are using a human meter, right?

 

I am so anxious I’m shivering, trying to read and absorb everything

 

Are you able to stall longer to see if he will rise on his own without food? Stalling longer will affect your shoot time for the next few days.

 

Yes ReliOn Prime

 

Don't worry. Soon you will be a pro this.

 

Disco is still in safe numbers. Is he acting normal?

 

Sorry..I did see that on your signature but I wasn't sure.

 

Teri,
Can you change your spreadsheet so it reflects the @+ time rather than your actual time?



so 66@+.5, 56@+1

 

Yes

 

test in 15 min from 8:55

 

Fixed

 

Tested at 8:10pm is 56 still

 

That's good. So he isn't falling any more. If he heads higher in 15 minutes, feed and shoot.

Right, @Judy and Freckles ?

I would say full dose since you can expect him to bounce quite a bit.

 

That's good that he stopped dropping. Test again in 15 minutes.

 

Yes, interactive and yelling for food but he always does lol

 

I think a lot of it depends on Teri's confidence level.

Freckles is going low tonight too, so hopefully someone with more experience can chime in.

 

Thank you!

 

Teri, you may be stuck with us rookies tonight! lol. Good thing there is good information in the stickies!

"Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you."

 

I am getting my confidence from you guys but yes I think I would be fine comfortable with giving as usual 3u

 

49 @ 9:21pm

 

Come on Disco... up you go a little bit.

I'm not able to stay up much longer as I have to get up early tomorrow morning.

 

It looks like the insulin usually starts taking effect on Disco at about @+2. Would you agree Teri?

 

and his nadir is around @+4?

 

I apologize, but this past week has been so up-and-down I can’t tell. And I am still unclear when his nadir is but I think you are right at +4. I feel like it hasn’t been the same days in a row or maybe it’s just I don’t know what I’m looking at

 

I agree that it's not a clear cut nadir! Cats! lol I think we should keep in mind that kitties tend to go lower at night.

So you are 1.5 hours past your usually shot time. That will take you 3 days to get back to your regular schedule if you shoot. Does that work for your schedule?

I still think we need to see Disco's numbers rise before you shoot though.

 

Still 49@9:35pm, was 49@9:21pm

 

If a more experienced person doesn't chime in soon, I'm wondering about a reduced dose because I'm not able to stay with you to help out much more than about 20 minutes or so.

 

Yes I am retired and can do what I need to to get him back on track

 

I am here but of little use

 

I’m so conflicted about those reduced doses from what I’ve read But I also felt that way about skipping and I’ve done that once as recommended

 

I think he is dropping at a slower pace now. How about feeding him his usual meal amd shooting a 2.75 since a drop below 50 earns a reduction?

 

Feb. 3 you skipped. What was the situation that night?

 

Test 15 minutes again from your last test.

 

He had a 62 at +11.25 before PMPS due and the advice I got was to skip, I’d have to look back at that thread

 

There doesn't seem to be more experienced people on the forum tonight. I'm really hesitant to give dosing advice. The 3u that he got the last two cycles has increased his depot, so it's hard to say how much of the depot will be influencing tonight's cycle.

 

there have only been 2 cycles on the 3U. would the depot have built up that quickly?
how much time has elapsed since his shot was due? 1.5 hours?

 

39@ 9:59pm

 

FEED and skip shot

ETA: Feed LC only

 

The way I understand it, each cycle increases the depot a little bit more each time.

Ok. He's going to low for my liking. Give him some LC food. I vote for no shot. Test again in 15 min.

 

Disco... what the heck are you doing??

 

Just fed ~2tsp of LC Sheba Purrfect Portion Pate

 

I'll stay up with you a bit longer. My own Freckles needs to start going up too. I think Freckles and Disco are in kahoots together for this PJ party. Seeing low numbers is exciting but a bit nerve wracking sometimes! lol

 

How much is Disco's regular supper portion?

 

2oz Darwin's raw with 1/2 can Fancy Feast Classics.That is what he gets in the morning and evening and during the day he gets the Sheba, one portion which is 1.3 ounces, sometimes he gets two of those, but nothing within two hours of pre-shot tests of course

 

Yes, I’m trying to remember to breathe and I appreciate you staying up with me because I think I’ll be up a while maybe someone else will chime in when you really have to go to bed!

 

Do you spread his food across his pm cycle?

 

I'm suppose to help a friend move tomorrow morning.... no sleep in for me! lol

 

37@ 10:19pm

 

Does it make sense to stall any more? It's 2 hours since his shot/meal time. He must be ravenous.

 

No, usually sleeping and he is too so not yelling for food

 

I say feed him and skip shot.

 

no we're not stalling anymore. The shot is aborted. Will he eat MC food after his regular meal or does he get full fast?

 

I don't understand this. His numbers should be going up by now. I'd hate for you to feed MC and then his numbers are on the moon.

 

Maybe this is a really late nadir for Disco?

 

He will eat anything anytime I’m feeding him now and skipping shot

 

I don’t know how I would be dealing with this if I had a full-time job, he was not diagnosed until after I was retired and moved back to Oregon. I’m breathing a little easier and it’s about five minutes till his next test. Do I still need to continue to test every 30 minutes for a while until he starts going up or will he just normally start going up because he ate?

 

Ok. Good. Test again in 15 minutes. Poor Disco's ears or feet...

 

Good that you are breathing easier! lol Yes, I would continue to test until he is over 50.

 

35 @ 10:37pm

 

Feet! He’d need more ears than 2 by now