26/01 Hercules increased dose AMPS 153, +11 50, PMPS 126, +3 65, +4 59, +5 50

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Hercule's mum, Jan 26, 2021.

  1. Hercule's mum

    Hercule's mum Member

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    Last edited: Jan 26, 2021
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  2. Lina and Simba

    Lina and Simba Member

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    Nice blue AMPS from Hercs! I hope he slides down politely for you :bighug:
     
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  3. JaxBenji

    JaxBenji Well-Known Member

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    Good luck with the increase - work the juice, Hercules :cat: Have a wonderful day, Karen :bighug:
     
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  4. Hercule's mum

    Hercule's mum Member

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    Thank you Susanne! No signs of any effect in the fist cycle, but I guess I shouldn't expect any efects until cycle 4?
     
  5. Hercule's mum

    Hercule's mum Member

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    I have been monitoring the whole day, and things looked pretty boring. He just came by ravenous and I checked and he is at 50 at +11! :eek:
    Wasn't sure what to do, but really wanted to feed him, so I gave him his dinner early. 50g LC. He is a big eater, so I am sure if he is still low in 30 minutes I can give him some HC.
    What should I have done?
    and what to do about his dose tonight?

    Many thanks for your help!
     
  6. JaxBenji

    JaxBenji Well-Known Member

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    Hi Karen! I’m on my phone but just wanted to check in. You are fine feeding him. Has it been 30 min since feeding? I’d test again. I’ll switch to my computer in a few min.

    Unless someone w more experience comes on, your options for PMPS are to skip or to wait two hours from when you fed provided Hercules is holding his own above 50 (but then your amps will be off too but you can work your way back).

    just wanted to quickly comment since board is quiet. Will switch to my computer.
     
  7. Hercule's mum

    Hercule's mum Member

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    +11.5 and he's gone up to 92. I guess he is very food responsive!

    @tiffmaxee @Bandit's Mom @Wendy&Neko - anyone around?
    I imagine I can shoot because he has gone up significantly with the meal, but I screwed up my schedule and not sure what to do... Skip PMPS feed and continue as usual? Is he become a very late nadir cat? Not sure I can spend another night up....
     
  8. JaxBenji

    JaxBenji Well-Known Member

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    You might be able to shoot but not on time. If you shoot a food influenced number then Herc could drop even more once the new dose of lantus onsets. I'll write more but want to post this.
     
  9. Hercule's mum

    Hercule's mum Member

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    Thanks Susanne.... Today is his first day on the new dose and I wasn't expecting a big difference. The fact that it did made a big difference is what is worrying me...do I want to biuld a higher depot given this?

    He usuaully stays up for quite a while after shot, or at least recently this has been the pattern.... I just am so shocked fast he went down that I am worried whether I knwo when to check him for him to be safe, if that makes any sense...
     
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  10. tiffmaxee

    tiffmaxee Well-Known Member

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    You need 2 hots without food to beable to shoot as this is food influenced.
     
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  11. tiffmaxee

    tiffmaxee Well-Known Member

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    I’m on my phone and need to finish what I’m doing.
     
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  12. Hercule's mum

    Hercule's mum Member

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    Ok, I understand what you are saying, but not why I wouldn't shoot... Isn't the logic that we shoot where we think he will be when onset comes along? I was just thinking I switched his food schedule by 1 hour, but usually the whole first 4 hours after shot he does not go down?
     
  13. Hercule's mum

    Hercule's mum Member

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    Thanks Elise, I 'll hold the shot for now...
     
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  14. JaxBenji

    JaxBenji Well-Known Member

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    I'm on my computer now :) Can type faster and more coherently :p Here's what I would do:

    (1) don't feed anymore unless Herc drops again
    (2) get AMPS+12 - this would be your PMPS time but you cannot shoot since you fed at +11 and we do not want a food influenced number
    (3) If Hercules is flat or rising, test again at AMPS+13 - this would be 2 hours since you fed at +11. Provided Hercs > 50, you can shoot as long as you can monitor.

    If you aren't comfortable shooting, you can skip but it does pay off shoot low. I'll give examples from Jax's SS for you to mull over.
     
  15. JaxBenji

    JaxBenji Well-Known Member

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    And forgot to add, if you shoot at AMPS+13, then your morning AMPS will be delayed by an hour. Here's how to adjust back to your regular time.
     
  16. Marj & Djoko

    Marj & Djoko Member

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  17. Hercule's mum

    Hercule's mum Member

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    Thanks again Susanne. I shot him at 54 4 days ago, which is almost the same. So I got the BOS... I just think I am misunderstanding a few things, or perhaps as usual Hercs don't quite behave as expected... We are supposed to shoot low, so Why not shoot when propped up?

    Also, do you have any views on dropping the dose increase or stick to it?

    What would you have done if if you a 50 at +11?
     
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  18. Hercule's mum

    Hercule's mum Member

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    Not sure I understand? I thought we used this when we need a fast response or worried about a hypo?
     
  19. JaxBenji

    JaxBenji Well-Known Member

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    I've shot a 50 on Jax :eek: But he has generally had flat cycles -

    On 2020, see:
    • 09/15 PMPS - very flat cycle
    • 09/10 PMPS - very flat cycle
    • 09/17 PMPS - very flat but he did earn a reduction...he was also on the dose for awhile so a reduction as probably coming; I remember easing up on the MC to see what he would do
    • 09/25 PMPS was <50 and I skipped - Jax recovered from the skip just fine (I did not want to be off schedule else I could have delayed)

    I see your other questions and will try to respond :bighug:
     
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  20. JOJI and Kit

    JOJI and Kit Well-Known Member

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    after susanne has answered your other q's i can give you some strategy notes from our life w a late nadir kitty and how we try to keep up w her.

    you're doing great, karen :bighug:
     
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  21. JaxBenji

    JaxBenji Well-Known Member

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    You want to know his fasted number to make sure you aren't shooting <50 and therefore putting Herc in a low number situation when the new Lantus onsets (plus any overlap that may happen too).

    As for what I would do - I probably would have fed if I was early in my FD journey with Jax just like you did. Now, I probably would have not fed and retested in 20 minutes to see if he was rising or not and then decide what to do about feeding/shooting.

    The Handle Lower Pre-shot Numbers sticky really outlines various approaches. Worth a read (or re-read or re-read :p...I read the stickies ALL of the time).

    Thanks @JOJI and Kit for the reminder there are other approaches - they were guided with help from one of the mods I believe and I'm sure can share their experience.
     
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  22. JaxBenji

    JaxBenji Well-Known Member

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    I see +11.5. So don't feed and test at +12. Assuming Herc stays >50, can you be off schedule to shoot at AMPS+13?
     
  23. JaxBenji

    JaxBenji Well-Known Member

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    And you can remove the 911 - you can take it off completely or replace with the ? mark :bighug:
     
  24. JaxBenji

    JaxBenji Well-Known Member

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    Forgot to answer this one - on TR, Hercules didn't earn a reduction, so if you shoot, I'd shoot the full dose. There is an option to shoot a reduced dose (I don't have enough experience to tell you what this would be...maybe 50%?), but you'd need to keep in mind you would still have the depot to contend with the first part of the cycle.
     
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  25. Hercule's mum

    Hercule's mum Member

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    Just got the +12 and is 126. This is on his usual LC....
    I can be off schedule. Nervous about keeping this dose going forward if has caused such a big drop in the first cycle....:nailbiting:
     
    Last edited: Jan 26, 2021
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  26. JaxBenji

    JaxBenji Well-Known Member

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    And perhaps a little bounce I think? I'm not an expert here :cat: I wouldn't feed and would get +13 - he will likely be safe to shoot. I personally won't be around (I'm east coast in the US and will be starting to make dinner around then :)) but perhaps others will be on.

    PS - your SS says 126 at +12 (not 142).
     
  27. Hercule's mum

    Hercule's mum Member

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    Ooops... fixed. the constant conversion drives me crazy sometimes....
    Don't worry. i think we'll be fine! :)

    @JOJI and Kit - curious about whether you think Hercs is a late nadir or a contant bounce-breaking cat.... and the strategies for the former...
     
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  28. Christie & Maverick

    Christie & Maverick Well-Known Member

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    So...here's the thing. I see it mentioned a lot about needing a "fasting" number before you can shoot. That's not entirely true. Yes, normally until you get an idea of how food influences numbers, it is best to withhold food 2 hours before shot, in case the carbs artificially inflate the preshot number. However, that is usually more important for newbies who are just gathering data about how the insulin is working, and how carb sensitive their cat is. Once you have an understanding of that, this suggestion of not feeding 2 hours before shot can be relaxed. It is certainly more relevant when dealing with lower preshot numbers.

    In your instance, you gave LC food which is perfectly acceptable. Certainly, if you had given HC food that would be more concerning, because what may happen is that the HC food bumps up the preshot number to the point where you think it is safe to give insulin, only to then have a really busy cycle when the HC wears off and the insulin dose kicks in. Make sense?
     
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  29. Hercule's mum

    Hercule's mum Member

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    Thanks Christie, yes it makes perfect sense!
     
  30. JaxBenji

    JaxBenji Well-Known Member

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    Thanks, Christie! I knew I had read something like this before and couldn't come up with it so was just going off of what was safest given my experience trying to help her. I shall save this for reference for later :bighug:
     
  31. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Adding onto what Christie said. He's continuing to rise without additional food on board. That means it's his natural rise at the end of the cycle. You can shoot.
     
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  32. Marj & Djoko

    Marj & Djoko Member

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    emergency is an elastic concept - isn't always urgent at the office? :)
     
  33. Marj & Djoko

    Marj & Djoko Member

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    I will do the same next time otherwise ppl are less likely to respond to your qst. It does bring attention to the thread!
     
  34. Hercule's mum

    Hercule's mum Member

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    Thanks. Have done it! 1U again :nailbiting:
     
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  35. JOJI and Kit

    JOJI and Kit Well-Known Member

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    we don't have enough experience reading many, many different cats' spreadsheets to weigh in meaningfully on that question. i'm sure others with that knowledge will chime in.

    but we can tell you about kit and how we have benefited from our data collection.

    first, same here. no doubt about it.

    next, let's look at a couple of kit examples always bearing in mind that every cat is different and as you gather more data on hercules, you'll understand better and better what to do for him. also, we are likely doing any number of things sub-optimally or whatever and are counting on the wisdom of others to comment and help us improve.
    so with that. here we go... a few glimpses into kit's world at around +11:

    09/16/2020 am cycle
    after propping kit up w food for most of the cycle she pulls out a 49 at +11 :eek: so without feeding, we tested again 20min later and she was 53. by pmps she was 56. we skipped back then, but today we would not because we have more experience now w shooting low and with kit.
    09/22/2020 am cycle
    +9.5 102, +11 59, +11.5 49 :eek: and again without feeding pmps 50, a number safe to shoot based on the TR guidance. even with the 50, we used one of the techniques from the shoot low sticky that is characterized as "tricky" nota bene: we had just been talked through the technique by marje a few days prior and elise was watching our back that particular day. and even though we saw her rise, we chickened out with a BCS (big chicken shot). today we would not have shot BCS, but rather the full dose which on that day was a reduction from the am shot amount. in fact, if you look at 1/18/2021 am cycle you'll see that's exactly what we did (but no reduction bc she wasn't <50). more about that morning down below.
    looking at these examples and a host of others from kit's world, what is our current approach?
    given that she:​
    • seems to be a bit carb resistant (but note this is changing somewhat recently :rolleyes:)
    • will present as "flat" or "high" in the early part of the cycle and then pull a fast one in the last approximately third of the cycle
    • is pretty easy to test and one if us is usually around bc work-from-home during covid
    we try to do late day testing to help us see where she's heading. for us that means a +7 if we can and +9.5 on a lot of days. we've come to like +9.5 because it gives a nice space to test for the food impact if we decide to give her a snack. while the guidance is 20-30min to see impact, kit really likes to take her time and we notice she'll start to show impact closer to 30min. she's not very good at telling time. by experimentation, we've also noticed that if she's dropping below 90/80ish near the end of the day or if she's gotten a lot of food support during the cycle, she has a less dramatic arrival to pmps w a little food support at +9.5.

    we basically love her heaps, but trust her only a little to signal early in the cycle where she's going. and finally just to keep it real, let's circle back to that 1/18/2021 am cycle. we are getting slightly better at anticipating when she might break a bounce, but we still can completely misread the situation like on 1/19/2021 pm and then we get a morning surprise like that amps 51 :eek:

    well, that's a lot to read. take your time; hopefully it helps a little. and feel free to ask q's :bighug:
    ^jw
     
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  36. JaxBenji

    JaxBenji Well-Known Member

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    I second this one. When Jax used to drop low at the end of the cycle, I got a +10 and would feed accordingly, sometimes MC even.
     
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  37. Hercule's mum

    Hercule's mum Member

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    oh-oh! He dropped a lot again +3 is 65 :(

    I need to give a talk tomorrow... drooling would not be an effective speech technique....
     
  38. Hercule's mum

    Hercule's mum Member

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    Yes, I made a point of waking up late in he night cycle for this reason. He seemed to be going lower towards the end. I'll definetely be less blase after +7....

    This two big drops today is making me want to drop the dose back to 0.75....
     
  39. Hercule's mum

    Hercule's mum Member

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    50 g LC and 40 minutes later and his BG has not moved.... Gave a tbsp of HC
     
  40. Hercule's mum

    Hercule's mum Member

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    His Bg slipped further down. 2 tbsp HC +4.25
     
  41. Hercule's mum

    Hercule's mum Member

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    another 30 minutes and he is still going down :eek:
    +5 and he is at 50.

    This is new territory for me. I never seen him not react to all this HC.
    Gave him another 2 tbs of HC and a lick of honey.

    I'll check in 30 minutes. What do I do if it is still going low? @Bron and Sheba (GA) you around?
     
  42. Christie & Maverick

    Christie & Maverick Well-Known Member

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    He's flattening out, you're doing just fine, test again in 30 minutes.
     
  43. Hercule's mum

    Hercule's mum Member

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    His numbers seem a constant down to me? He has eaten a whole can of food with gravy on top of his usual food...
     
  44. Christie & Maverick

    Christie & Maverick Well-Known Member

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    Don't forget about meter variance ;), anything within 20% is considered flattish.
     
  45. Hercule's mum

    Hercule's mum Member

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    Got it!
    But is a clear, ordered downward trend....
     
  46. Hercule's mum

    Hercule's mum Member

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    Anyway... more honey if lower? Thanks for your help!
     
  47. Hercule's mum

    Hercule's mum Member

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    phew! Finally has gone up. Probably the honey?
    Assume I need to test in another 30 minutes to make sure it is not just honey peak? I really must get some sleep...
     
  48. Christie & Maverick

    Christie & Maverick Well-Known Member

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    See what the next test is, he's half way through the cycle already.
     
  49. Christie & Maverick

    Christie & Maverick Well-Known Member

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    That's a good jump up, another test in an hour would help determine if it was honey or whether he's on his way up because he's hit nadir.
     
  50. Hercule's mum

    Hercule's mum Member

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  51. Hercule's mum

    Hercule's mum Member

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    99 at +6 He has slipped lower in the cycle sometimes. I need a nap, but will be back in an hour.
     
  52. Hercule's mum

    Hercule's mum Member

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  53. Lina and Simba

    Lina and Simba Member

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    Wow, Hercules was really working that juice last night! :eek: I hope you got some sleep, too! Well done on shooting the full dose :bighug:
     
  54. Hercule's mum

    Hercule's mum Member

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    oh, Lina Thanks for the support! I am a wreck! You were amazing to spend all those nights awake.... My seminar this afternoon will be very entertaining I am sure :eek:
     
  55. Bandit's Mom

    Bandit's Mom Well-Known Member

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    LOL, Karen! But he's seeing great numbers. All the late nights will pay off. :)
     
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  56. Lina and Simba

    Lina and Simba Member

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    I agree with Bhooma, it is worth it and will pay off! I was fortunate to be on my winter break through the worst of it, now with uni work piling up I’d be a wreck. Bonus of tonsillitis on top :confused: good luck for your seminar! Cat naps to the rescue :bighug:
     
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  57. Hercule's mum

    Hercule's mum Member

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    So here is the hard question... I can see that it totally paid off with Simba. But to be honest given Hercs age, time he was likely to have had undiagnosed diabetes, and time on insuilin (>6 months), is remission really a possibility? I have very little hope. If remission is not a possibility, is it really worth it? I do wonder if it isn't better to keep him at a dose where he is mostly in blues and yellow, so I am not poking him every hors and tittering into a hypo?
     
  58. Lina and Simba

    Lina and Simba Member

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    I think Simba's a bit of an exception in terms of how quickly he responded to insulin + diet change... If I remember correctly the highest chance for remission was in cats that had been treated with insulin for less than a year? Someone correct me if I'm wrong. But then again, look at @Diane Tyler's Mom 's SS where Tyler reached remission just a few days ago after more than a year on insulin. There's lots of other kitties spreadsheets that look like they're headed into remission too. The contrast for Hercs SS prior to Lantus and on Lantus is visible as well. He's only one one unit at the moment, too. All I'm trying to say is that I think remission is a real possibility for Hercules and I hope it comes true for him. :bighug:
     
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  59. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Hi Karen, Tyler went into remission on 1-24-21 after 2 years and 4 months
    I never thought he would but with the advice of everyone here to be patient
    I kept plugging away, I did have to increase him plenty of times and the bam he started doing very good and I had to keep decreasing his dose.
    You are early in the game and I think Hercules will have a chance for remission.
    Just hang in there :bighug::bighug::cat:
     
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  60. Hercule's mum

    Hercule's mum Member

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    Thank you Diane! Tyler is a real inspiration! So happy for you and him!
     
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  61. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    :bighug::bighug::cat:
     

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