7/29 kit PMPS 57,+4.25 80,+4.8 79,+5.3 72,+5.8 73,+6.5 66,+7 61,+7.5 55,+8.25 56,+9 64,+9.5 61

yesterday
https://www.felinediabetes.com/FDMB...210-4-75-204-7-5-184-pmps-172-2-5-193.232794/

day 53 in kit's switch to lantus/relion from prozinc/alphatrak2
day 2 of her decrease to 4.5U
day 34 of TR

in between bird watching, napping and breakfast, kit's working on filling that depot today.
she also turned in a rather respectable second night with the cat mate. only a little bit left behind in the locked spot this morning. now, if we could only get her to flip on the coffee pot right before AMPS

have a great day everybody,
^jw

 

I hope Kit turns around and slides down for you.

 

They used to make coffee pots with timers. Wonder if they still do? Looks like the depot is filling. Have a great day.

 

110 @ 6.5

which feels like a big drop since 2.5 so

gave 0.25oz LC 6%. ate willingly.

definitely want to see her in the greens if possible today, but having to balance ability to monitor closely this afternoon.

let's see what you do kit.

 

105 @ 7
no food and test in 30 min probably

 

99 @ 7.5
no food. test again in 30min

 

91 @ 8
dropping gently, gonna let her continue to ride with no more food.

eta: test again when outside the 2hour food influence ~8.75

 

Beautiful numbers for Kit , she is surfing nicely

 

83 @8.75
now with no food influence.
let her ride.
will check again before "last licks" opportunity around 9.5

 

79 @9.5 after BG gave 0.2oz LC 6%. thinking she didn't really need food but now
@10.5 she dropped to 62

thoughts?

 

trimming the title
here's the play-by-play
7/29 kit AMPS183,+2.5 201,+6.5 110,+7 105,+7.5 99,+8 91,+8.75 83,+9.5 79,+10.5 62 still dropping

 

@Chris & China (GA) saw you online, any ideas for us this late in the cycle?

 

@10.5 + 20min holding with a 64

not sure if she wants a reduction or is playing the game of slide into the plate at PMPS. oy!

 

I’d see if she wants a reduction. I just was checking my emails.

 

we have not fed and are just testing like every 20min ...
anything else we should be doing?
and if she goes below 50 then we give HC at this late point in the cycle?

totally new scenario for us here. don't have a plan

 

56 at 11+ 10 min

 

If she goes below 50 you can give hc I think. It would be surprising so late in the cycle. That must have been a partial fur shot after all the other day.

 

getting pretty darn close.

ok, so the if we give HC what does that mean for the PM cycle ?

eta in t-12 min she'll be at just 2hours without food

 

I personally think that it’s turning out that she needed that .50 reduction after all. You could feed her now some mc and see if she comes up so as not to mess with the PMPS.

 

so if we feed her now that means
1. we reduce by 0.5U
2. we shoot knowing the PMPS is food influenced.

is that what you mean?

 

She seems to get a pretty good food bump (from the +1's on your spreadsheet) so keep that in mind.

You are not shooting the number your cat is at now – you are shooting the number your cat will be at when the insulin kicks in. You need to know what that number will be. You are then using the lag time (aka overlap and carryover) to your advantage. It is important to note that while Levemir may typically have a later onset than Lantus or Basaglar, that is not true for every cat. Know thy cat.

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.

Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.

Using the overlap by shooting low is a great way to take advantage of Lantus/Levemir’s long, flat cycles, once you have learned to do so safely.

~ written by Libby and Lucy

 

@Wendy&Neko @Marje and Gracie Thoughts?

This time I would take a .25 reduction if needed. Last time I would have done the .50. As I recall Wendy mentioned it was kind of experimenting.

 

ok, and can you clarify about the MC from post #20 above?

 

My thought was to prop her up a tad before you shoot. How long before shot time?

 

we are t-2 from 11.5

we do PMPS at 6:35p local
feed and then shoot at 6:50p local

 

So don’t feed and do the PMPS next. That’s in 20 minutes?

 

sounds good

60 @11.5
and now clear of food influence from the earlier LC

t-17 to PMPS

 

and you are still thinking to take
a 0.25U reduction
yes?

 

I think she’s going to solve the question for us. I predict another reduction soon. I think it will be .25 as at this point you aren’t in the high dose situation but you have time to see what others think.

I’d feed her regular food to start tonight and see what she does with it.

I would not reduce tonight. She didn’t earn it yet.

 

We cross posted so want to make sure you saw that I would not decrease tonight.

 

ok, so if she's 50 or above at PMPS, no reduction. got it.

yeah, when she is in the 60's for PMPS we give an entire LC meal rather than the mixed LC + tiki.

 

PMPS 57

feeding
this will be our lowest shot every .... not by a lot, but still

 

With meter variance it’s about the same. I’d get a +1 and +2 and maybe add a little mc which I’m betting you did.

 

uh, yeah, sure. we thought of that
good idea. we're adding 0.3 oz of MC 15% now.
kit thinks you're the best.

 

No reduction, she didn’t go below 50. If she does go below 50, take a 0.5 unit reduction. I will tell you why the 0.5, which isn’t really protocol. Protocol doesn’t even mention 0.5 increases above five units, that’s just our experience. Original version of the TR protocol said 0.5 unit changes if kitty is on “higher doses”. With Neko, who was a special case cause she was seeing radiation therapy changes plus IAA breaking, 0.5 unit reductions worked until about 3.5 units. Turns out I later found a document with the old TR referencing high doses as around that size. And I have seen it in one or two other cats, not all. For Kit, cause she was higher dose but we don’t know why, and she held her last 0.5 unit reduction and is still on a highest dose, I would try the 0.5 one more time. If this is simple glucose toxicity breaking or whatever, I see a change in her. Worst case the 0.5 fails and you go up 0.25 units. Best case, more sleep.

 

we shot 4.5U, so no reduction this cycle.
thanks for all those details on the 0.5 and high dose. we've been digging thru all the things to read and couldn't find it in the proto.
so when/if she goes <50 next, we will reduce by 0.5U

and a +3 bc onset


thanks for all the help.

now we have added one more learning scenario to our "adventures with kit"

 

Good job!! Always something new to learn with these sugarcats since they're all individuals! They all staunchly refuse to read the rules too!

 

Super! And this is why this forum is the best. Lots s of experience.

 

thanks for jumping in on our crazy ride!
seat belts on; helmets strapped firmly under chin.

 

And there's that food bump!!

OK...what you got planned next Kit?

 

So I have a question in case this comes up again. Joji was increasing at ,25 until she hit 5.0 and then started .50 increases. At what point will she go back to decreasing at .25 increments?

 

99 @+2
fed 0.25oz LC 6%. ate willingly

 

113 @+3
not feeding, let's see what she does.
test again a little after +4 to see where she is after 2 hours of no food support

 

Nice job shooting!


I figured I'd give you my BOS. I don't have use for them anymore and you've DEF earned them! Dust them off because they haven't been used in a while.

 

The answer is not one size fits all. In Kit's case specifically, the answer is when 0.5 decreases fail. In the back of my mind is the thought that Kit was seeing some glucose toxicity, which is now broken. When that happens, there can be a bit of a crazy ride down dose for a spell. Being at a higher dose can make for some overfull depot. These last couple larger decreases may be all she needed. Time will tell.

 

thanks for checking in on us and giving us your BOS.
kit is definitely making us work for it , but she's so cuuuuuuttttttteeeeeee

 

80 @4.25 and not fed for just over 2 hours
deciding what to feed next...

eta: going with 0.25oz MC 15%. eating willingly. test again in 30min just before +5

 

I think that’s a good move. My internet was down. Hoping it stays on but you really don’t need me any more.

 

tbh, i'm never quite sure about LC or MC except for when it's clearly LC

always so thankful for your confidence in us. still so much to learn.


79 @4.8 no food. test in 30

 

Beautiful numbers for Kit, she's really giving you a run for your money, you are doing such a great job

 

Doing good.....Keep on surfing Kit!! ....and stay away from the trampoline!

 

Now is time to get on your surfboard Kit!

 

yeah, she just cat naps during these 30min in-betweens, while i'm all checking the spreadsheet and re-re-re-reading some past post and trying to figure out fractional bg times

72 @ 5.3 no food.
test in 30 just before +6 at which point it'll be 90min without food

 

73 @ 5.8 no food
test in 30. final stretch to two hours no food.

hold onto it, kit.

 

well, so much for sleep...

66 @6.5
time for some LC or MC .... one of those scenarios where i don't feel like i have a clear answer
i think i'm tending to LC.

eta: 0.25oz LC 6%. ate willingly

 

Yes LC. If you feed higher carbs, you have to wait a couple hours for it to wear off to see if she's climbing on her own. With LC you don't have the wait. I'm all about sleep in these situations.

 

61 @7

let her ride, no food?
or LC prop?

i'm tending to no food.

 

Either is fine. You know your girl best.

 

gonna run this piece of the experiment with no food and test again @7.5

 

Go Kit.
Ride this wave for all it's worth.
Hope your experiment works.

 

55 @7.5

little LC lifter
0.25oz LC 6% ate willingly
test again in 30min

 

Yikes Kit. Cut your mom a break. Up please.

 

should i give more or higher carb?
i don't think i've seen you say "yikes" before ...

 

No. I just feel for you. I hated the pj parties. If she drops under 50 she earns a reduction which I think will happen if not tonight then perhaps tomorrow. She’s being stubborn. I hope she either earns or or goes up soon.

 

no kidding
56 @8.25

if i do feed her something now, she's less likely to hit the reduction this cycle
if i don't feed her and test again at the 60min since last food mark it'll be just before +9 with still some time to prop for the mad dash to PMPS

decisions, decisions ....

any thoughts?

eta: @8.5 fed 0.4oz LC. ate willingly
heck, even i want a snack now. lol

 

You can leave the food and test again in30 mins from last test

 

hi!
what does "leave the food" mean?
i did wind up feeding her 0.4oz LC @8.5 and plan to test @9

 

trimmed the title
7/29 kit PMPS 57,+1 119,+2 99,+3 113,+4.25 80,+4.8 79,+5.3 72,+5.8 73,+6.5 66,+7 61,+7.5 55,+8.25 56

64 @9
no food
test in 30

 

Sorry... when I said leave the food ... I meant not feed at +8.5 and test at +9.
I thought you were wanting her to drop under 50 to earn a reduction.

 

61 @9.5

 

i think she's trying; she keeps coming close.
so if not this cycle, then likely the next.

 

Sorry. I fell asleep. You pulled an all nighter! I never did that. Once Max went two hours without food. I would call it a night. I would have stopped feeding at 8.5 and see if she earned a reduction. He was carb sensitive though so even the snacks brought him up unless it was time to reduce. It’s hard with Kit as she isn’t carb sensitive and has a late nadir. There’s no right or wrong way to handle her. I hope you can nap today.

 

This is Joji, the unexperienced. Holding off going to work to keep eyeballs our Kit so that JW can sleep off her all nighter! Kit showed up about 6 years ago at the public garden where I work, and we adopted her after a few years. They are very understanding for my lateness due to our diabetic Kitaibelia! Here's the plant that she was named for by our director in case anyone is interested: https://www.missouribotanicalgarden...inderDetails.aspx?taxonid=293584&isprofile=0&
Sorry if this is too off-topic! Catching up on all of the rules and regs.

 

Hi. Thanks for sharing. We do that a lot here. We are like family! What a great place to work!

 

i ***know***
i was so full of resolve @7 and then by @8.5 i just totally caved.
i was just telling joji that was my regret of the night's choices.
but then as you say, i had to balance it with kit's late nadir and not-so-carb sensitivity.

i have no idea what her plan for us is today.
never a dull moment.
thanks for being on our team