? Sammie 1/22 amps “high” Need shot advice

Double checked on alphatrak both monitors give me a “high” reading. (Above 600 on human meter) I have to leave for work in 20 minutes. What do I do?

 

It looks like Sammie was as high as (747) on 12/8 and you gave her 2.5 units. I think the cut off is (750) for the Alphatrack reader...anything above reads HI - so this is essentially the same number.
I wouldn't skip the shot...
Is she eating? Does she have a history of ketones? Behaving normally?

 

She is eating and seems herself, though I didn’t have much time with her this morning. I recently reduced her down to 2.75. I went against the rules today and gave 3 units.

 

For SLGS , That (78) reading on the 19th would have earned a reduction to 2.5. Which you gave that night, but increased again to 2.75...and now 3 units.
I'd be hesitant to increase back to back - especially with limited data to see how low the dose is taking her.

 

The 78 earned a reduction down to 2.75. She had been at 3 units. I had only given her 2.75 that morning because I was afraid of giving a full dose at 206. I gave 2.5 that night because I was concerned about giving a full dose at 218.

It seems that 3 is too much and 2.75 is too little. What do I do in that situation?

 

Will help to draw attention to your thread if you put a question mark icon at beginning of thread .....also I know how chilling seeing a HI can be . Elmo bounces there and it makes my stomach flop

 

Thank you for the tip. It was scary! It’s never happened before.

 

Glad to help More experienced members will have wisdom about this soon . Also, the more data on SS you can provide the better they can help you and beautiful Sammie.

 

If someone could advise if I should move back up to 3 units or continue with 2.75 units that would be helpful.

 

Bumping this up for more eyes on

 

I'd add " need shot advise" to your thread title

 

Bumping up to top again ...

 

@Sienne and Gabby (GA)

 

Sienne is a moderator and very experienced great help .

 

It looks to me like you are basing your dose on the pre-shot numbers. Lantus dosing is based on the nadir -- the lowest point in the cycle. Thus, you were correct to reduce the dose after the 78. You should have been holding that dose for a week since you're following SLGS.

Lantus is different than shorter acting types of insulin. It isn't the kind of insulin that does well if you are trying to "shoot down" the numbers. Some of the high numbers you're seeing are likely due to bouncing. Sammie may be seeing lower numbers during time when you can't test and his numbers "bounce" into high numbers by shot time. Bounces are the result of numbers dropping low, dropping into a range your cat isn't used to, or numbers dropping quickly. As a result, the liver and pancreas release a stored form of glucose along with counterregulatory hormones that cause numbers to spike. More spot checks will help you to see if this is the case.

 

Should I go back to 2.75 and hold for a week?

 

If it were me, I would likely go back to the 2.75u. You also don't want to make rapid changes in the dose. Lantus is a depot insulin. Every time you make a change, the depot has to catch up. Fast changes in the dose tend to cause wonky numbers.

 

Oh okay. It just looked like you shot a full 3 units on the 10th when the PMPS was (183).

If you aren't comfortable shooting numbers in the 150-200 range and think the 3 units is too much it would seem the 2.75 is more appropriate.
In looking at your data. It looks like your +2 numbers are generally the same or higher than PMPS numbers, so shooting in the 200s might be alright. I understand being hesitant.
I'd think about what numbers you are comfortable shooting and some days grab a +11 before the AMps, so you can see which way Sammie is heading.
If it's a number you aren't sure about, then you have time to stall, retest and ask for help.

 

I find this all incredibly confusing. At 2.75 her numbers were too high pre shot and at spot checks during the day. Even at 3 units she was too high most of the time pre shot.

 

That night I delayed three hours until she was in the 400s

 

Hi @SammieCat!

A couple of things: Ari pointed this out

It also goes alongside with what Sienne said:

Did you give 3 units this morning because of the high PS number? If so, to reiterate, Lantus dosing is based on nadir - the lowest number you see - NOT the highest.

The high number this morning might have been a reaction to a lower number that Sammie saw last night. Of course, we don't know for sure. To know this, it's best to get a test or two within each cycle, whenever you can manage.

Also if you're following SLGS, you need to hold the dose for at least 7 days and then evaluate the dose. The only time you would change the dose is if kitty has earned a reduction by going under 90.

If you follow TR, you would be able to change the dose faster (every 6 cycles) but there are a few requirements you have to follow in order to follow TR (no dry food and you need to test enough every day).

Please take your time and re-read the careful responses you received today and ask us questions if you're still confused.

 

I’m confused about what her dose should be. 2.75 units was too little determined by the curve on 1/04. 3 units is too much based on the nadir of 78 on 1/19. Which should it be? If she consistently has preshot numbers in the 400s and the aim is for it to be around 300 according to SLGS, then what do I do?

I have the SLGS page pinned to my phone which I’ve been referencing but considering her numbers I am unclear.

 

What happened on the 4th isn't what's happening now. Insulin needs change all the time. What didn't work a couple weeks ago may work now.

For right now: you reduced to 2.75 units 6 cycles ago but also gave a reduced dose of 2.5 units. Reducing the dose means you'll need to rebuild the depot. Then giving a further reduced dose will only disrupt the depot again.

It's confusing I know. But Lantus, with its depot, likes consistency and patience. You need to allow time for the depot to do its thing and it takes about 6 cycles for the depot to fill.

Plus, not having tests in between cycles doesn't give us a clear idea of what's going on and how the dose is working. I know SLGS doesn't require you to always test in between but it's very encouraged and helpful to do so.

I think your goal for now is to hold the dose for 7 days (2.75 units - unless another experienced member says otherwise) and get more spot checks in between the cycle.

 

Does that mean I’m supposed to do a curve on a weekly basis? That’s just not practical.

Every time I post I’m told to add more data. I started doing before bed tests. I’m a working student. I’m often out of the house for 12 hours at a time and I don’t have anyone at home to help me.

 

Yes, with SLGS, you need to do a curve at the end of the 7 days. Many do it on the weekend or on their day off. A test every 2 hours for 12 hours is common practice.

Unfortunately, without data, it's very difficult to know what's going on. SLGS is already the most hands-off dosing method we follow. Doses are held for longer and reduction points are higher for safety because caregivers aren't required to test as much (as opposed to TR, where CG are required to test at least 4 times a day).

You can only do your best. Having a cat with feline diabetes is not easy and the way we recommend treating it here on FDMB does involve more time as opposed to how FD is traditionally treated with vets (no home testing and fructosamine tests done every couple of weeks). The way we dose here, in my opinion, is safer, more accurate, and less expensive. Not to mention, more likelihood for remission and avoiding major hypoglycaemic episodes that can be fatal or DKA which can also be fatal. Time is the only thing that needs to be sacrificed.

(I don't mean to scare you, of course. But working in the vet med field and seeing how cats are treated when they're diagnosed with diabetes, often puts fear in my heart. Following the advice here on FDMB has put me more at ease. I know I'm doing the right thing and keeping my cat as safe as I possibly can, but also treating his diabetes effectively.)

I encourage you to look into other people's threads here on Lantus. Learn from them and see how they manage their cat's diabetes day to day.

 

I know all this is stressful and you do have to take care of yourself too. When people talk about extra testing, they are often telling you what would help others help you and Sammie better. They won't always know or remember your schedule and how many hours you have to be away. The before bed tests are helpful, as are any extra you can get. It's important to know when the nadir (lowest number/ peak activity of insulin) is, and to test around that time if possible, since that's what dosing is based on.
Does Sammie seem to feel ok?

 

I know the suggest is in the interest of helping. I’m just spread so thin already, it’s hard to add one more thing into my day or week.

It’s hard to tell if Sammie is feeling well or not. She is generally subdued and doesn’t like to play. She spends nearly all of her time sleeping. She did bat at the other cat a few days ago. That’s about as much energy as we see from her.

 

I wonder if this post on using TR with a full time job will be helpful for you? I realize the focus is on TR which requires more testing but some of the text as well as the suggestions that people made may be applicable. Throughout Gabby's FD, I worked a full time job. Fortunately, I didn't have a long commute. Unfortunately, there were days when I would bolt home at shot time and go back to the office for meetings. I can work long hours.

As for more testing, admittedly, I'm a testaholic. With either TR or SLGS, the minimum number of tests is your pre-shot test and ideally, at least one additional test during both the AM and PM cycles. I moved my shot time to 5:00 so I could get an additional test before I left for the office. Because Gabby had an early nadir, this worked well for us.

Looking at Sammie's SS, that black this morning makes me think that Sammie may have seen lower numbers last night and she bounced to black. Getting a "before bed" test every night may help you to anticipate a lower than expected cycle. You don't want to miss a number that requires a dose reduction.

Managing FD isn't for sissies! We balance our devotion to our kitties with all of the other things -- work, school, social life, family obligations -- with caring for our cats because they return that devotion. When you have a minute, look at the link to Gabby's Legacy in my signature. Read over post #7.

 

Thank you for sharing