7/14 Spot AMPS 184, +13=206, +14=168, =+18=338 PMPS 504, +2=425 Bounce Again?

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Sweet Spot

Sweet Spot

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Good Morning,

Well Spot has stopped bouncing and as this very long thread showed, he is new to blue numbers and we are torn between TR and SLGS Protocols as we see what his body is doing with the 4u insulin.

We definitely weren't comfortable shooting with the 184. We are going to be checking him this morning to see if the number is going up or down. We felt that was the safest step 1 for us, being new to these numbers.

So will keep updating this thread with readings today and any guidance on what the data is showing, so we can learn and be more comfortable, would be so appreciated. If you have time, please look at his ss to see the bouncing cycle this past week or two with TR insulin increase, etc.

Thanks so much,
Robin
 
So did you feed him? If not you can stall and see if he is going up. If you did there will be a food bump. BTW, most of us give .25 increases unless a high dose cat.
 
Looks like he cleared the bounce that was set off from hitting those blues 6 cycles ago on July 10 when he hit those blues.

I agree with Elise, if you haven't fed, test again and see if he is going up, he may have already hit a low point in the early hours and already be on the way up.
 
Thanks for your replies - he has been napping on the couch since the 8am AMPS - so one hour without food so far - but he had eaten right before 8am (a grazer, plus fed prior to shot we thought we would be giving).
 
On this forum, we suggest posting for help if 150 or below. Above that, it's OK to give the shot. I would test again now and if he's up, and you can afford to be one hour late, give him the shot now. You can shift your schedule back 1/2 hour once a day, or 15 minutes a cycle, so you would be back on schedul in two days. Gus is not used to these numbers, he may bounce and it could be a completely boring cycle. But who knows, he's a cat after all. If you are around and can do the odd test, this will give you wonderful data. Much better than getting this opportunity at night.
 
As you haven't shot yet it's 206@+13
I agree with Wendy I would shoot if you can afford to be of schedule for 1hr.
 
Wendy - newbie question again.

We were waiting for the bounce to clear before making a decision on which protocol we are comfortable with - leaning toward SLGS until we have more data and are more comfortable.

You mentioned not posting for help if over 150 as a typical guideline, but the SLGS gives 3 options with Spot's preshot level:

It says, in the 150-200 range, the 3 options are:
  1. Skip shot
  2. Give a token dose of 10-25% normal dose
  3. Feed, test in a few hours, then decide

We have to make that decision in the very new future, so that is why, being new and inexperienced, we were calling out. Our inexperienced opinion does want to see what Spot does with this 4u, but he has been bouncing like crazy with it so far so we haven't had much to go on yet.
 
I meant to emphasize (sorry if I was unclear!) that the protocol doesn't say to "just shoot" with the AMPS he had this morning?
 
OK, if you are planning to go SLGS (it sounded like you were unsure), could you change your subject line form TR to SLGS? It'll help us trying to help you. I think what's also confusing me is the word "protocol". The only protocol here is Tight Regulation. SLGS is a method developed over time on this board. With TR, we suggest people are OK to shoot above 150.

In the SLGS sticky, the part above what you quoted says this:
How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

I've highlighted the part that says "in the beginning". That means as you gather data you can change how you approach lower numbers. Over time you can lower those thresholds as they work for your cat. Are you currently planning on option 3 to retest in a couple of hours and dccide?
 
Cats bounce from dropping too fast or being ina lower numbers than they aren't used to. They also can bounce from too much insulin.
 
tiffmaxee said:
They also can bounce from too much insulin.
Click to expand...
Sorry, I have to disagree, cat's do not "bounce" from too much insulin. You can see some higher numbers with too much insulin, but we only see that with cats who either started on too high a dose or whose doses were raised too fast or too much at once.

There is nothing in Spot's spreadsheet that says too much insulin to me, but rather too little. He's seeing some blue numbers he's not used to (yet), and those are what are causing him to bounce. Even following SLGS, he's spent more than 7 days on 4 units, there's more than enough data for a curve, he's due for an increase to 4.25 units.
 
Wendy,

With all due respect - as I said in the first line of today's post, we were unsure....he just got into blue this morning...which is why changing my signature wasn't done yet. Being unsure, we were sitting between TR and SLGS "protocols" (which in a medical definition is simply a detailed set of instructions to guide the care of a patient) because to us it appeared, when a cat is new to this low AMPS reading, the "protocols" went a bit in different directions.

I am sorry if we are causing frustration on the forum.

Above all, I err on the side of caution and go with my gut - especially when new to a treatment. I don't know how Spot will respond and I can't "undo" a crash once I shoot.

I do appreciate the invaluable information and support we have received....I really do......

Thank you
 
Wendy&Neko said:
Sorry, I have to disagree, cat's do not "bounce" from too much insulin. You can see some higher numbers with too much insulin, but we only see that with cats who either started on too high a dose or whose doses were raised too fast or too much at once.

There is nothing in Spot's spreadsheet that says too much insulin to me, but rather too little. He's seeing some blue numbers he's not used to (yet), and those are what are causing him to bounce. Even following SLGS, he's spent more than 7 days on 4 units, there's more than enough data for a curve, he's due for an increase to 4.25 units.
Click to expand...
I misspoke. What I meant was it can look like a bounce if getting too much insulin or numbers can stay high from too much as well as too little. Sorry if I confused anyone.
 
I meant to add that the vet we had seen last month gave us even more conflicting information - she said, to be safe, never shoot if under 200. She was pretty forward thinking and in sync with everything I am reading in the forum, but that was her comfort zone. So you can see why we are like a deer in the headlights. We didn't know if he would settle from the bounce into blue this morning - had no idea. It was what we woke up to and, therefore, a decision had to be made.
 
Sweet Spot said:
+2 reading is 168 - skipping insulin shot - will change signature to SLGS
Click to expand...
Sometimes you just have to go with your gut. As time goes on, you will get more comfortable shooting lower numbers. When you shoot lower, the kitties usually don't have big drops like they do when they are in higher numbers. If you were around today to monitor, shooting the 168 would have given you a lot of valuable information as to how Spot reacts to insulin with blue numbers. And that said, again, you need to feel comfortable with it. I get that.

Remember, the more you can get spot under the renal threshold into lower numbers, the more and faster healing to his pancreas and the more he gets used to those "lower " numbers and will bounce less .

Your vet's recommendation of not shooting anything under 200 is probably due to the fact that most of her clients do not monitor like we do.

We are here for you so keep asking questions. :cat:
 
Sweet Spot said:
she said, to be safe, never shoot if under 200. She was pretty forward thinking and in sync with everything I am reading in the forum, but that was her comfort zone.
Click to expand...

I understand you wanting to go with your gut but with all due respect to your vet, if I had never shot Lantus below 200 at PS George would not be of the juice, nor would any of the 300 or so kitties that have gone OTJ on this forum.
I think that number is more applicable to those using the old fashioned fast acting insulins, so she may not be as up to date as she gave you the impression.

The point of TR is to get kitty into normal numbers for as long as possible those are numbers 50-100 being in these numbers are what will give you kitty's pancreas the best chance to heal and therefore remission(you would never get there if you didn't shoot below 200 on Lantus). Getting good glycaemic control as quickly as you can gives your kitty the best chance of remission, this is why you have a number of us encouraging you to shoot. You have quite a lot of data, I agree with Wendy, it seems like he needs more insulin (whichever method you are following his nadirs have been over 150 for over a week that calls for an increase to the dose even on SLGS), there is nothing in the numbers that suggest he has gone too low (under 50 human meter), though it might not feel like it you have quite a safety margin.

At some point (don't wait too long) you are going to need to take the plunge so to speak if you want to get him out of the sea of red/pink he is getting. I know you have had a very difficult journey so far, so much has been going on:bighug::bighug:. Remember with Lantus you have a few hours to get food into Spot, onset is not till around the +2+3 mark, so if you had shot and seen him continue to drop you can feed snacks in those hours leading to onset to keep his BG surfing along.


SLGS also aims to get kitty into normal numbers, but you just get there much more slowly, adjusting your 'no shoot' numbers as you go along.

Low numbers are scary, but though those blues seem low to you, they are not really, a bit like Spot's liver, you too have become accustomed to seeing those pinks and reds, so anything lower seems scary, we've all been there. But soon those reds and pinks will be scary, if I tested George and got a red, I would be sh**ing my pants (excuse my french):)
 
Thanks Gill -

Up until a few weeks ago, with my dad's death and month of travel, I know most of you know we couldn't up his dose much at all - we weren't there to monitor him plus he had the stress of travel. So we have a long ss of awful colors.

We have been really happy to see some blues and yellows popping up with the dose increases that began recently (when we were finally back home and could focus on him). We know he has a long way to go...absolutely....but we will get there. We just have to go at a pace we feel comfortable with.

The nasty bouncing into the black was just as concerning as the first time drop into blues - that is why a bit slower pace for us, until we have a clearer picture, is the direction we are heading. Remember, we are only a few weeks into this - everything else since my dad's death was to give him "some insulin" but we couldn't monitor, so could only give a little. For us, we are very new.

Others may look at Spot's spreadsheet, without knowing our history of events, and see two months of treatment...but we don't - we only see the past few weeks. Everything before then was just holding on for dear life and giving him a little until it was safe to begin true treatment.

Again, thanks for your input..........
 
Sweet Spot said:
I am sorry if we are causing frustration on the forum.
Click to expand...
Not frustration, I was just confused. I had thought you were following TR but considering going to SLGS. This is why we ask people to choose one or the other and let us know. As you can see, it really does change how we advise people. Sorry if that upset you.

I too can relate to having a kitty with a spreadsheet looking like a sea of pink and red, with the odd spot of blue and yellow. Neko has two high dose conditions that meant we had to go a lot higher to find a dose that got her spending more time out of those high numbers. Spending time in pinks and reds is hard on kitties. Their kidneys really have to work a lot harder. Even if your goal is not remission, getting a kitty regulated and spending more time under renal threshold than above is good for their health. They'll also just generally feel better in good numbers. I've seen both sides. Neko's spend way too long in high numbers at the beginning so that now I hate it when I see any pinks and even yellows irritate me on her spreadsheet. Right now she's getting a steroid that makes it harder to control. So that's why I may seem to be pushing to get Spot's numbers down into a healthier range for him. But I too can relate to how seeing that blue number in your meter after ages of seeing pink can be unsettling.

Over time, and I know it hasn't been long:bighug:, you will become more confortable with shooting lower and lower numbers. You've shot 235 before and that was almost 40 points lower than your previous low of 274. Next time maybe you'll feel comfortable shooting in the 190's. Today will be a good day to get a couple more checks in to see what the cycle might have been like if you shot. That will be great data for next time you see blue. So far you've seen a small food spike and then him come down from that. It looks like Spot tends to have a late nadir, so does Neko. When she was on Lantus, I saw her nadir as late as +13. Bobbie's cat Bubba is also a late nadir Lantus cat. What it does mean for us, is that our cats may be at their lowest point of the cycle when we give insulin, or close to the low point. That can be rather unnerving at first until you get used to it.
 
Breathe..... and then ..... breathe again recognizing that learning to cope with and understand the numbers you get on your meter takes time. It's ok. Spot has the very best thing a kitty can have... two people who love him and take care of whatever he needs. Lucky kitty. :cat::):) Lucky humans.

I have been at this sugar dance for over a year and have spent most of that time following SLGS and if you look at my ss you will see that we've made progress. It has not been quick but he's better than he was in January and recently he made another jump in being better because he had some pricey but needed dental work done. From my experience, the main difference between the two treatment plans seems to be speed. With tight regulation you are adjusting doses more quickly so you can make progress with bringing the numbers down much more quickly. Part of the decision is to consider your goal. My initial goal was to simply help Radar feel better and was not necessarily remission. Because it's summer I have more time and more energy to focus on my kitty and push him closer to remission. But soon I will have to go back to school and then my life is simply not mine anymore and we may have to go back to SLGS. But my kitty is also one of the lucky ones and he doesn't really care which method of treatment I'm following. He just wants to play with his ping pong ball and watch the birds and nap in a warm patch of sunlight. :joyful:

One thing to be aware of is that since Spot is a new diabetic you have a window of a year when there is the best chance of remission. Of course every cat is different and when they are done with the juice they are done. Your meter is a powerful tool and in combination with your ss and the wealth of knowledge here you will begin to make sense of the numbers. But it takes time. You can switch to the tight regulation at any time and the fine people here will help you learn what to do if and when you decide you want to. :bighug::bighug: It's really ok. Breathe. Relax. Drink in the beauty and magic of summer and rest. And hug your Sweet Spot too. And we will be here when you need help.... or have questions
 
Wendy AND Jan.......
Thanks so much for your sweet, thoughtful posts........enjoyed reading both of them so much!

We will get there, we will - I won't let my fear (a little self admitted PTSD from recent loss) interfere with his health long term, for certain.....so glad we have all of you holding our hand along the way.........

As for today, we will celebrate the color blue!
 
No intention of skipping the PM dose - we are going to test him within the hour to see how he is doing (assume he is heading up by now)
 
Oh good. I'm not operating on full today and thought the +13 was pm cycle not knowing when you shoot or where you are located.
 
I'm not sure if +18 is the right way to say it, but given he hasn't had insulin today I thought this is the way I should state it, until he gets his evening dose?

Anyway, he is rising fast now (+18=338)

Unsure if it is another bounce from hitting the blues, a ding from skipping insulin or combo of both. Regardless, everything that happens gives me more information and data to see what his particular body does.

I certainly have learned from today's events/decisions that:
  • He is again rising fast from the blue like a few days ago (possible bounce on the way)
  • He didn't maintain blues throughout the day, without insulin, so definitely his body crying out for more (more confidence for me to shoot with lower numbers) and/or he is a big bouncer from lower numbers this early on, and I have to get used to that

So here is my "plan" if you don't mind telling me what you think (if you have time...I know I have taken a lot of time already).

Trying to start fresh/clean slate.....we were thinking of making tonight "day 1" and dosing him at 4.25u - an increase of .25u which he is due for, no matter which protocol he would have been on (TR or SLGS)

Sound like a good idea?
 
I think taking him up to 4.25u makes sense given the lack of nice numbers.
Let's see what others think.
You haven't taken up too much time, we've all been there at the beginning, just keep asking.:bighug::bighug::bighug:
 
Sounds like a good plan. The depot is drained so hopefully he won't pull any fast ones on you tonight. And paws crossed he won't be too much higher. :confused:

Chances are the early blues you saw in the cycle was the carryover from the dose last night. When that tapped out, he started rising. In a perfect Lantus world, the carryover helps kitty stay fairly flat after the shot and up until the onset of the next dose 2-3 hours later. That's what makes nice flat cycles in Lantus and Levemir.
 
Thanks Gill and Wendy.......

Paws crossed - absolutely!

Will post his PMPS tonight - going to give it at 730pm Mountain Time, USA - if any questions/concerns, will certainly ask! Giving his ears a break until then, which Spot is grateful for.............
 
Well Spot sure keeps my blood pressure up these days..........

I recognize not giving the morning insulin plays some role......but just like he did a little over 72 hours ago, he went from blue to black again. Just did a PMPS and got a 504.

We increased him to 4.25u tonight, as planned.

My brain is just in shut down mode tonight after thinking and thinking all day.

As always, any assessment and expertise you have to share, at your convenience, will be very much appreciated.........

Thank you again,
Robin
 
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+2 is 425
Signing off for the night.......will see what Spot has up his sleeve for us in the morning........
 
Just stopping by with encouragement! Breathe. Now that you're back to some normalcy after the tough time you've had and the travel, it will be easier to learn from Spot what works for him. And the help on this board, amazing! The longer we dance this sugar dance, the easier the steps become.

Marilyn and Polly
 
Thank you for the encouragement, Marilyn and Polly! (Could Polly be any cuter?? I don't think so!!).........
 
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