? 8/27 - Wally - SLGS - AMPS 436, +4 54, +4.5 88, +5 97 +6.5 198 +9 498 PMPS 433 +2 613

Discussion in 'Lantus / Levemir / Biosimilars' started by Ginger Cat, Aug 27, 2020.

  1. Ginger Cat

    Ginger Cat Well-Known Member

    Joined:
    Nov 2, 2017
    Here we go again. The last time I increased his dosage to 1.5 units, he crashed so we lowered to 1.25 but it wasn't enough. He had a great nadir yesterday at 298, then bounced up to 598 PMPS.

    I fed him a tiny bit of karo syrup but mostly low carb FF and he responded well so I'm wondering do I just shoot 1.5 if his PMPS is high enough???

    Reading through the SLGS vs. TR, I'm wondering if I should follow TR for this boy. Any thoughts/inputs welcome.

    Prior post: https://www.felinediabetes.com/FDMB/threads/need-dosing-advice.233759/#post-2613834
     
    Chris & China (GA) likes this.
  2. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    It’s a personal choice. Yes read the TR protocol again. You use an AT. One thing that has never been clear to me with a long term diabetic is when to decrease even with TR. With a human meter it’s 3 times in the 40’s. Would it be three times 60-68? Would it be 3 between 58-68? That’s why I prefer a human meter. I’d love clarification on this. Tgat 54 would earn a decrease I think even with TR. One thing I did with Max was to start increasing and decreasing in 1/8 increments. Used digital calipers. Any lurkers that decision was on,y for Max and possibly for Ginger given the history. Nobody else should consider this.
    @Sienne and Gabby (GA) @Wendy&Neko @Marje and Gracie Thoughts?
     
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  3. Ginger Cat

    Ginger Cat Well-Known Member

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    Nov 2, 2017
    He's now up to 198 at +6.5 without any additional food.
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Add that +6.5 to your subject. Hoping one of the mods will reply before PMPS.
     
  5. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    You test more than enough so I don't know why not

    I think I'd try it if he's high enough (which I'm betting he will be) My 2 reasons for recommending the 1.5 again is because he's probably going to be pretty high by PMPS and we occasionally recommend what we call "shooting through the bounce"....that's giving the same dose ONE more time to help give some added support. Also he is a long term diabetic so a lot of us wait until they drop 3 times instead of once

    He'd been on the 1.25 for 13 cycles and never dropped into green so I think he needs more than 1.25

    I'd love to hear what others think about this too!
     
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  6. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    The mods are not the only ones who can help with dosing. The role of the moderator is to help ensure smooth running of the board, not just in LBL land. Just had to put that out there because I've been seeing a few people tag only mods or ask for mod help on dosing. Anyone who has experience and confident on dosing can chime in. The beauty of a peer reviewed board is that multiply people can help and others can help if the suggestions need tweaking. Off the soap box now.

    On the dose, today's 54 on the AT means he does not want an increase and might need a decrease. It would have been really helpful to get an earlier test in the day, so you could hace seen he was dropping and given him some food to slow the plunge. And ideally have prevented him going low and instead spending more time in healing green numbers. Since Wally seems to be fond of diving, you might want to start getting a +2 to see if he's letting you know when he's going to dive. If the +2 is a lot lower than the preshot, it'll be quite an active cycle that will need intervention in terms or more monitoring and/or manipulation with food. You might want to check out this post on manipulating the curve with food.

    On the question of decreases, we go back to the basics on Earning Reductions. Unfortunately, TR and SLGS were written with human meters in mind, so we can't really give you exact guidance on the reduction values for an AT. We do know that 68 was chosen as the cutoff for AT vs 50 for the human meter, but we don't know for sure that it's equivalent. We also don't know what 40 on a human meter means on the AT. Plus, you really do need to decide if you want to follow SLGS or TR to be able figure out if today's numbers mean a decrease. With SLGS, we've been using 90 as the same cutoff for both AT and human meter. If you are following SLGS, reduction is earned.
     
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  7. Ginger Cat

    Ginger Cat Well-Known Member

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    Nov 2, 2017
    He actually did eat more food around 10:30 am as he only ate 2/3 of his breakfast this morning, so he finished the final 1/3 at that time. So that was about 3 hours before I took his 1:30 pm reading. Since I'd been testing him so much and his ears were raw I wanted to give him a little break... I can only image how low his +2 actually was.
     
  8. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Cats are sneaky animals that way!
     
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  9. Ginger Cat

    Ginger Cat Well-Known Member

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    Nov 2, 2017
    I agree that the 1.25 didn't seem to be enough. He's definitely come full circle today, starting at 436 and now PMPS at 433. Will check after +2 to see if he's again going down....
     
  10. Ginger Cat

    Ginger Cat Well-Known Member

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    Nov 2, 2017
    He's up to 613! +2 PMPS. I don't think he's ever been this high.
     
  11. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    That's a big bounce!! Dropping so low today freaked out his liver and lots of stored sugars and hormones were released to bring him back up fast.

    This too shall pass.

    Yo Wally!! No bouncing in the house!!
    [​IMG]
     
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  12. Ginger Cat

    Ginger Cat Well-Known Member

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    Nov 2, 2017
    I wish he'd listen to you, Chris. check out his numbers from this a.m. Down to 237
     

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