Trying to be braver

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Voula

Voula

Member Since 2014
My Lucy has days where she surfs along in blue numbers for up to +19. So because I am not very brave I have slowly been reducing the time I let her surf in blue numbers before dosing as I have seen her glucose levels do not drop too low so tonight I gave Lucy her insulin at +13.5. I felt very anxious because the +12 was lower than the previous test so I was anxious about dosing at a falling number in case the glucose levels dropped too low but after waiting till +13 I thought it looked like Lucy was going to surf in the blue numbers again. I emailed our vet and she said she would give the full dose of 3 units at the usual time but I could give 2 units if I felt very anxious. After waiting some more I decided to give 3.00s units and I will monitor Lucy closely tonight. The vet said bravery will more likely lead to remission and after studying lots of spreadsheets on the board I see how others give insulin with falling numbers and lower numbers than I have done and everything has been fine. I know for the more experienced members of the board it must seem like I am worrying about nothing. Thank you for reading my post.
My previous post:
http://www.felinediabetes.com/FDMB/threads/31-1-15-lucy-pmps-169-1-169-2-167.132338/
 
VERY nice shooting!!!! Yes, some of us have been at this for a long time, but we never forget how stressful it was when we first started the sugar dance, and how scary it was to start shooting lower numbers. You are among people who truly do understand!!!

Surf it safely, Lucy!!!
 
Thank you Amy. I am getting used to dosing between 150 and 200 but it is just that the reading at +12 was lower than the reading at +9 which made me anxious. Yes it is stressful and it is good to know that others felt and feel the same.
 
Hi Amy. I was looking at Trixie's spreadsheet and smiled when I saw "Bruce concert n/s". :) How many times have you seen Bruce in concert? He toured Australia two years running and he was so good. No other concert will ever match up now. :)
 
It's totally normal to be anxious as you move your no shot number down. So we definitely don't think you are worrying over nothing. The sugar dance is one that both cat and caregiver have to learn. Shooting low numbers is definitely nervewracking, but the more you do it, the more confident you'll be.
 
Voula said:
My Lucy has days where she surfs along in blue numbers for up to +19. So because I am not very brave I have slowly been reducing the time I let her surf in blue numbers before dosing as I have seen her glucose levels do not drop too low so tonight I gave Lucy her insulin at +13.5. I felt very anxious because the +12 was lower than the previous test so I was anxious about dosing at a falling number in case the glucose levels dropped too low but after waiting till +13 I thought it looked like Lucy was going to surf in the blue numbers again. I emailed our vet and she said she would give the full dose of 3 units at the usual time but I could give 2 units if I felt very anxious. After waiting some more I decided to give 3.00s units and I will monitor Lucy closely tonight. The vet said bravery will more likely lead to remission and after studying lots of spreadsheets on the board I see how others give insulin with falling numbers and lower numbers than I have done and everything has been fine. I know for the more experienced members of the board it must seem like I am worrying about nothing. Thank you for reading my post.
My previous post:
http://www.felinediabetes.com/FDMB/threads/31-1-15-lucy-pmps-169-1-169-2-167.132338/
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Yes, I totally agree that it is very stressful when you don't know how Lucy will react. I can tell you having been through this once before with Sami and back again for a second round, it doesn't always get easier. But your vet is right bravery is more likely to lead to remission. If you can be there to test and provide the appropriate food if necessary then it is sometimes better to take a risk, you might be very pleasantly surprised.

Good luck to you and Lucy.
 
Tina & Sami said:
Yes, I totally agree that it is very stressful when you don't know how Lucy will react. I can tell you having been through this once before with Sami and back again for a second round, it doesn't always get easier. But your vet is right bravery is more likely to lead to remission. If you can be there to test and provide the appropriate food if necessary then it is sometimes better to take a risk, you might be very pleasantly surprised.

Good luck to you and Lucy.
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Thank you Tina. I am home and tested Lucy's glucose every few hours and she is still surfing along in blue numbers which is so good to see. If I had waited longer to give Lucy her insulin like I did other times waiting for her glucose levels to rise some more before giving her the insulin then her glucose levels would probably have kept rising even after the next insulin dose and that is what happened the last few times I stalled too long on giving Lucy her insulin dose.
 
Another thing you have to remember when considering stalling the shot

Lantus has an onset of about 2-3 hours, so even when the PMPS is lower, the shot isn't going to "kick in" for several hours. You're also feeding at shot time and that will usually give a food spike.

We start our "no shot" limit here at 150, but as you learn how kitty responds to food, that number gradually drops...so that eventually you'll shoot anything over 50! (and "no shot" doesn't really mean "no shot"....it means when you first start this dance, we just want people to stall long enough to post and get someone with experience watching over them during that cycle)

You and Lucy are making great progress!! With so many things we warn about that could go wrong, it's not surprising when people are a little freaked out to shoot lower numbers!
 
Thank you so much Chris. We got an AMPS of 7.4/133 so I am stalling as I am not confident yet to give Lucy insulin with a blood glucose of under 150. I am slowly reducing the level at which I am confident to dose. We got our first negative urine glucose test this morning. :D:cool:
 
That's fine....just don't feed her and retest her in about 20 minutes...Hopefully she'll be heading up and that's your clue to SHOOT!!

GREAT news on the negative urine glucose!!
 
I forgot and fed Lucy her breakfast :). My guess though if past patterns are any guide she will be at about the same level for some time. So I am waiting a little longer to test again seeing as I fed Lucy this morning without thinking about the don't feed rule to see if the BG is rising. I read the Roomp / Rand article and for much lower numbers they recommend one option as feeding and then testing again. Or is this only for very low numbers do you know?
 
What I have noticed though is that low carb food doesn't seem to make a difference to Lucy's glucose levels which is interesting that there is no food spike.
 
Generally, if they have a PS under 50, we might try feeding a little and retesting

This is where the fact that the onset of the shot isn't usually for several hours comes into play

The other option is to give a BCS just to give her some insulin...but as long as you can test today and have plenty of supplies, I'd suggest pulling the trigger and shooting!
 
I am dosing now as I just tested and the BG is 10.5/189 so I can see it would have been safe to dose at 7.4/133. All part of building confidence. :) Thank you Chris again.
 
Chris & China said:
Generally, if they have a PS under 50, we might try feeding a little and retesting

This is where the fact that the onset of the shot isn't usually for several hours comes into play

The other option is to give a BCS just to give her some insulin...but as long as you can test today and have plenty of supplies, I'd suggest pulling the trigger and shooting!
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What is a BCS?
 
BCS....Big Chicken Shot (or Big Chicken Sh*t Shot)

When you give a reduced dose when they haven't "earned" a reduction...like when you are shooting a lower number and can't be home to test
 
Less stalling more shooting :) you are starting to see some nice runs of blues with her and yay for a neg urine glucose result. I still remember how happy I was to see one of those!
 
Serryn thank you. I am a coward when it comes to giving insulin at lower numbers. :) But I have been stalling less now and that is good. I do think the dental a few weeks ago has also made a big positive difference along with the increase to 3.00 units.
 
Good luck with continuing to lower the number at which you delay. Any time you are home and have the opportunity to watch her closely, then that's when you take the deep breath and just DO IT. I can't remember the number of times I've said to myself "well, let's shoot it and see what happens", while my hands were shaking. It's very good data to gather for those times when you cannot be around to monitor. It really helped my confidence a lot.

If your goal is remission for Lucy, you will eventually have to get used to a lot more green on her spreadsheet. It's been a while since she's seen some. Every time you delay a lot, it's like a dose reduction, so it'd be good to see if you can get back to 12 hour cycles to see what this dose can really do.
 
Chris & China said:
BCS....Big Chicken Shot (or Big Chicken Sh*t Shot)

When you give a reduced dose when they haven't "earned" a reduction...like when you are shooting a lower number and can't be home to test
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LOL! I was reading through my notes when Sami was on insulin before and I had this in my spreadsheet and I couldn't remember what it meant. I might be taking a BCS tomorrow morning. LOL!
 
Wendy&Neko said:
Good luck with continuing to lower the number at which you delay. Any time you are home and have the opportunity to watch her closely, then that's when you take the deep breath and just DO IT. I can't remember the number of times I've said to myself "well, let's shoot it and see what happens", while my hands were shaking. It's very good data to gather for those times when you cannot be around to monitor. It really helped my confidence a lot.

If your goal is remission for Lucy, you will eventually have to get used to a lot more green on her spreadsheet. It's been a while since she's seen some. Every time you delay a lot, it's like a dose reduction, so it'd be good to see if you can get back to 12 hour cycles to see what this dose can really do.
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Thank you Wendy. I saw last night when I gave the dose at +13.5 that the BG did not fall but remained nice and steady. I was ready to dose again at +12 this morning if the levels were the same as last night and then we got a lower reading under 150 which made me anxious again. I am gaining confidence as now when I see the lower numbers above 150 I don't feel anxious to give the dose. Next challenge is to dose at lower BG levels to gain more confidence doing that too.
 
You're making progress! I may throw a monkey wrench in, however. I think you should increase her dose to 3.25u. From our TR guidelines:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
You've got 6 cycles at this dose (after the skipped shot), but you also had 14 cycles at 3.0 before those skipped shots and this dose is only getting her into the 100's. Your goal is to get everything in the 50-120 range. When she stays in blood sugar range that is higher than normal (50-120), her body gets used to it as the normal range. The consequence of that is that it will then take even more insulin (increasing the dose) to push her blood sugar back into the normal range. That's called Glucose Toxicity.

I totally understand your nervousness, but there is also a risk for her to be sitting in higher numbers. At this point you are aware of & focused on the risks of her going into low numbers, but the alternative also has consequences. I think you would be pleasantly surprised if you shot a lower number. What is happening when you stall is that the insulin is wearing off. Shooting while the last dose is still in effect and the BGs are in good numbers is a way of increasing the overlap - the time when the last shot is still effective and the current shot is taking effect. That is an AWESOME way of getting control of BGs and getting rid of the higher numbers.

I'd really, really encourage you to just decide that you are going to shoot the full dose into everything over 50 at +12 as long as you're going to be home to monitor. That's the path to regulation.

Libby wrote a post a while ago about shooting a dropping number:

Re: Tight Regulation Protocols: Myths Debunked

Here’s another misconception I have seen floating around LL from time to time:

“Don’t Shoot a Dropping Number”

I LOVE when I have an opportunity to shoot a dropping number! It’s a great way to take advantage of the overlap provided by Lantus and Levemir. Low or dropping preshots are a GIFT that helps us move our cats closer to tight regulation. This is a Tight Regulation forum, so grab it!

Remember, you are not shooting the number your cat is at now. You are shooting the number he will be at hours from now, when the insulin kicks in. You have probably noticed that once your cat starts to rise, he/she can rise very quickly. If you shoot, you will also be feeding, which can also contribute to the rise. If you wait for the rise to start before shooting, you might be behind before you even get started. When you have an opportunity to get the insulin in before the rise starts, rejoice and SHOOOOOOT!!! Feed as usual and monitor the beginning of the cycle. Feed strategically in the first couple of hours if you need to prop him up until the rise begins. He will still rise, but probably not as fast or as far because the insulin will be there before he needs it.

We do have guidelines for “Shooting Low Numbers,” but those guidelines are primarily an educational tool to help caregivers learn to shoot low. Once you know your cat’s response to food and insulin, then usually you will have the best results from shooting at +12, whether the number is high, low, rising, falling, whatever. Of course, common sense applies. 30s are not shootable, and 40s are not shootable unless you have TONS of data to show that it is ok for your cat (if you are wondering if that is you, it is not. ;-) Almost nobody should be shooting 40s and if you are in that category then you already know it). You do not want to shoot if there is any reason to believe you will not be able to keep your cat safe.

These insulins are not at their best when we ask them to pull down high numbers. They are GREAT at grabbing onto lower numbers and holding them flat. SHOOOOOOOOT!!!

Lucy (PZI and Lantus) -- Jazzy (acromegaly) -- Kris Kringle (KK) (Levemir and R)
 
Thank you Julie for all that good information and your suggestion to increase the dose. We have had a few disruptions to the current dose so I am going to stay with it a few more days and see what happens after six cycles where I give the same dose every twelve hours. In the last six doses I delayed the last two doses a bit though not by much. You are right that I have been more focused on the risks of too low blood glucose than too high. I will look at the information you provided again.
 
Hey Voula

I agree with Julie that it's time to take the next dose increase of 0.25u but also understand your reasoning on holding the dose a bit longer. However, if you decide to hold the dose a bit, then I think you need to commit to shooting every dose on time as long as it is safe to do so. By safe, I mean:
  • the PS is over 50
  • you have ample supplies including HC food and karo/syrup/honey
  • you are able to test for as long as you need to.
We can help you look at the numbers and decide if you would be shooting a dropping number or shooting a second dip. There is a difference. A dropping number is where the kitty starts higher at one PS and then drops to the next PS so the lowest number is at the second PS. A second dip is where the kitty has a nadir, comes up, and then at the end of the cycle, comes back down a bit, but not as low as the nadir. This is very typical of lantus and levemir.

Shooting those first blue numbers on time with a full dose is scary and then the green ones are also scary. But we'll be sure someone is on board with you before you shoot your first green number.
 
Thank you Marje. I will post and ask for support next time I am uncertain what to do. Sometimes because of the time difference there have been only a few other members on the board when I have posted and I have not gotten any replies so I have delayed as I was unsure and anxious about what to do. That can't be helped if there aren't many people online at the same time. We have also had some interruptions because of my commitments outside the home the past few weeks and so with lower numbers than I am used to I skipped a dose this week as I was not going to be home all day. The vet suggested I give a lower dose if I was anxious and wouldn't be home to test Lucy's glucose so that is an option I had not thought of too. I think I may have seen a second dip yesterday but other days the readings get lower towards the end of the cycle and stay lower into the next cycle too. Thank you again.
 
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