? 3/23 Bella AMPS 305 ??? I have a dosing question

https://www.felinediabetes.com/FDMB...ce-bella-amps-243-6-216-pmps-161-3-65.287991/

Good morning,

So I guess Bella’s AMPS of 305 is from the 63 she had last night +3 PMPS. I also feel like we messed up since we only have 3% and lower and gravy lovers FF and nothing in between. Still trying to understand exactly how it works.

I also want to understand better (sorry if it seems like I’m asking the same questions) but how does a number below 90 earn her a reduction? If her nadirs this week were all over 150 I thought we would have to increase to 0.75 again and then last night she had the 63 now I’m being told to decrease.

 

Please don't apologize for asking questions!

With SLGS every drop below 90 is a reduction. Dosing is based on nadirs and not preshots. Have you thought about following TR? You test enough for it.

 

Have a read through the dosing methods, if you haven’t had a chance Dosing Methods

As I mentioned yesterday evening, when following SLGS any time you get a BG of under 90 you reduce by 0.25u per the dosing method, regardless of how the other BG values and cycles went. Many members start off with SLGS but since you aren’t feeding any dry food and if you are able to continue to test more frequently, you may want to consider following TR instead.

 

I have looked at it but focused on SLGS so let me read about TR.

We cut the dry food out when diabetes was suspected about 2 weeks before her actual diagnosis. Once we found out how bad it was for her we cut her off cold turkey and she wasn’t even phased by it. She’s always loved wet food more.

 

I just read the TR method and wow that was a lot of information and I’m so confused. I don’t know if I’m ready for. Also as I understand it it’s 0.25 per kg of body weight, Bella’s weighed 4.7 kg so she would get 1 unit? If that’s right then that’s a lot more than she gets especially since she just earned a reduction and should be getting 0.25.

 

If you switch to TR, you would not decrease the dose unless she dropped below 50 on a human meter. So you would continue to hold the 0.5U dose for now and see hot it goes in the next 2-3 days. With that nadir of 65 last night, you don't have room to increase just yet.

This formula is used only when calculating the initial dose when starting insulin.

TR might seem daunting but you'll figure it out. We've all been there

 

No need to change the dose if you are wanting to try TR since you’ve already started insulin, that formula is just recommended for new caregivers who haven’t started insulin yet. If you want to try TR stay with 0.5u for now and please change your SS and your signature. If you want to stay with SLGS a little while longer, that’s fine too, but then members may likely come by and tell you you should have reduced this morning. If you have other questions about either dosing method, just ask

 

So if I choose TR do I keep her on the 0.5 until she gets a number 50 and under? I’ll be traveling soon and she’ll be with my mom so I just want to keep it as easy as I can for her as well.

 

When will you be leaving and for how long? Will your mom be able to test the same or more if necessary while you are gone? TR is an aggressive dosing method, so it sometimes requires more frequent monitoring of BG levels and intervening with higher carb food depending on how active the cycles are. Would your mom be able to do that in your absence?

 

Yes, that’s right, one of the differences between SLGS and TR is that generally with TR you would take a reduction with a BG under 50 instead of 90 as done with SLGS.

 

We will be away April 3-6 and she is home because she’s retired but testing makes her a little nervous and I don’t test that much either as I work full time. My husband is home right now from a work injury but will be going back to work soon but part time. He can test +6 amps but not earlier once he goes back. I don’t know if TR is the right method for us right now. How often do we need to test her?

 

Well, why don’t you try TR for now, since you have a little time before you leave, and I’d really like to see more greens on the SS. Continue to test at least as much as you do now, and more if for example like last night, she started dropping but got into the 40s. You’d want to test more frequently and intervene with HC when under 50. Here is the post on handling low numbers, you can see there is a recommendation for frequent testing until Kitty’s BG stabilizes above 50. How to Handle Low Numbers

 

So to make sure I understand TR-we keep her on the 0.5 dose until we see a number 50 and under?

 

With TR we typically hold doses with green nadirs for 10 cycles. She’s only had one green nadir over the last 10 cycles, but I’d probably be inclined to see if she can do any more greens in the next couple cycles. If not, following TR you could actually increase back up to 0.75u.

 

Okay, I think we’ll try it. So we’ll keep her on the 0.5 for a few more cycles and then see if we need to adjust it to 0.75.

 

Great, yes, she picked a bad time to show you a green , but maybe she’s just getting the hang of things on 0.5u. If not, 0.75u might help flatten things out to get in better ranges and lower nadirs overall.

 

@Bellas_mom_2020
Hi Jen good luck with switching to TR.
Anyway you can put a bland line above 3-23 and put Switched to TR and highlight it just so it stands out

 

im trying to figure out to write it and highlight it. I added a row, is that right?

 

One other thing you might want to do if you can is get a variety of tests at different times on different days. Don’t get too settled down with just +3s and +6s, since nadirs can and do move around, and on some cycles, it seems like +2 would have been good since for many cats, that’s often a good test - if lower than preshot, that indicates a more active cycle where numbers will likely drop a bit more quickly.

I liked the +2 with Lantus because I tended to give a little LC snack at +2 already, and if I saw a pretty good drop from preshot, usually more than 20% I’d prop up the numbers a little with some higher LC like a 6-9%, especially if we were starting with a blue preshot and he was already into high greens by +2. It will likely take a bit of experimenting to see how Bella reacts to the insulin and finding out how carb sensitive she is, which is why getting data points at different times, not just at +3 or +6 helps fill in some of the gaps. Even getting some later cycle tests when you are able here and there, can give a lot of good information. Just some more food for thought.

 

I can try, it’s just been our routine to test at +6 because we give her a snack at that time. Sometimes my husband isn’t around to check other time and I definitely am not around during the week to check the +2. When I’m home more I can test more.

 

No worries, it was just a thought , we can work with what you’re able to do. I had meant to ask you what your feeding schedule is usually like, so hearing that Bella gets a snack at +6 is helpful. As I mentioned earlier, when Mav was on Lantus, I got used to feeding snacks earlier in the cycle, since he was prone to bouncing, and I found that it often helped to flatten his numbers out. It’s called feeding the curve, maybe something to review and see if feeding some small snacks earlier in the cycle will help Bella?

Using food to manipulate the curve

It can often happen as well for many cats that if you feed after nadir, since after nadir, the BG is already coming up as the insulin effect wanes, those extra carbs after nadir can put the brakes on any remaining duration the insulin has.

I’ll stop sending you stuff to read now, I think I’ve given you enough for one day

 

There is definitely a lot of information to take in and I’m overwhelmed. We feed her 6:45 am, 1:00 pm, 6:45 pm, and around 10:00 pm (Eastern time)