? ??? Taffy AMPS 74!!! Now, what?? Full dose?

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Taffysmama

Taffysmama

Member Since 2016
I printed out the protos yesterday, easier for me to read and go back to. (Computer screen puts me to sleep.)

Still unsure how to proceed.

I am getting a feel for Taffy's reactions to his doses, but...

This morning is our first drop below 100...AMPS 74, and I rechecked (70). Had breakfast. Dose ready.

Today is another day I'll be out from +3 to about +11, just before dinner.

I am going ahead with 2u dose and then recheck at +2 and +3...sounds good??
WAIT, eidt here, maybe not. Reading thru the protos and I'm just unclear. I am trying to do TR, but I don't know if I am following it. I just don't get all of it or understand some of the lingo and don't see guidelines for this situation as in SLGS.

Maybe reduced dose is in order?? He ate already.
 
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If your were following SLGS, he would have earned a reduction down to 1.75 units, by going below 90. There is a separate sticky note on shooting low numbers for TR. The reduction point for TR is 50 on a human meter. If you want to follow TR, please put that in your signature so people know when giving suggestions.

Since you are new to low numbers, and cannot be around for. Good part of the day, I would shoot a much reduced dose or skip today. In future, if you are faced with a low number, do NOT feed, stall and test 20'minutes later to see if he is coming up. Since you fed, the food would influence any numbers now.
 
BTW, if you're following TR Taffy did not earn a reduction with that 74. Reductions on TR are taken under 50. If you're following SLGS they Taffy did earn a reduction since reductions are take under 90.
 
Seriously. I can't get it straight in my head. I see where it states "don't mix the protocols" but I see no guidelines on the TR about low AM number. Only in the SLGS does it have guidelines. What to do????

I have to shoot now, or I won't get a good test in before I leave. I guess I'll just shave a a drop and then leave him food.
 
Wendy&Neko said:
If your were following SLGS, he would have earned a reduction down to 1.75 units, by going below 90. There is a separate sticky note on shooting low numbers for TR. The reduction point for TR is 50 on a human meter. If you want to follow TR, please put that in your signature so people know when giving suggestions.

Since you are new to low numbers, and cannot be around for. Good part of the day, I would shoot a much reduced dose or skip today. In future, if you are faced with a low number, do NOT feed, stall and test 20'minutes later to see if he is coming up. Since you fed, the food would influence any numbers now.
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Thanks for the response. I have not put my protocol in my signature because I don't really know what I am doing!!! LOL

I don't understand...why would his numbers change in 20 minutes if I didn't feed him? I rechecked about 5 minutes later and he was 70.
 
Doodles & Karen said:
BTW, if you're following TR Taffy did not earn a reduction with that 74. Reductions on TR are taken under 50. If you're following SLGS they Taffy did earn a reduction since reductions are take under 90.
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I did read that, but I just didn't see clearly what to do in this case. His AMPS is pretty new low compared to previous. And I don't understand all of the lingo and information on reductions. Reductions are a one time dose reduction or holding? SO, to me if I was doing TR and read that I did not "earn" a reduction with a 74 than I would assume to give his regular (current) dose. What am I missing?
 
Taffysmama said:
SO, to me if I was doing TR and read that I did not "earn" a reduction with a 74 than I would assume to give his regular (current) dose. What am I missing?
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Yes that is correct. Eventually you will work up to shooting anything above 50 when following TR. It's not recommended to shoot your first green preshot if you are not home to monitor. Does that make sense?
 
thanks. I don't have time to read that now. running late already. I'll take your advisement and skip his dose, but can you explain why I would skip, rather than give reduced dose?
 
Doodles & Karen said:
Yes that is correct. Eventually you will work up to shooting anything above 50 when following TR. It's not recommended to shoot your first green preshot if you are not home to monitor. Does that make sense?
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Yes, absolutely. But why skip altogether rather than reduce. What is the reason?
 
You could have given a one time much reduced dose just to keep something in his depot, but erring on the side of caution and keeping everyone safe is what we try to do here. He is coming down from a bounce, you have not shot a green before so you have no data to show what he might do, and you will not be home to monitor. Also, we recommend skipping with a green pre-shot test when you don't have a lot of data yet, which you do not.
Skipping is my suggestion, too.
 
Wendy&Neko said:
Here are the guidelines on shootingnlow numbers for TR. http://www.felinediabetes.com/FDMB/...regulation-shooting-handling-low-numbers.147/ Print them off, they are good to have aroundnif the power goes out.

Yes, skip since you cannot monitor. If you were going to be home, that would be different suggestions.
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Yes, I printed this, but can't read in depth just now. I did spot this, however, which further confused me. It states the no shoot # is 50, but I thought that was when you "earn a reduction". This is all very confusing.

"New members without much data collected, but are following the TR Protocol in the Lantus and Levemir Insulin Support Group should ask for guidance when presented with a preshot number less than 150 mg/dL. Once you've collected data to support your decisions, the TR "no shoot" number is 50 mg/dL."​

I am skipping a dose this morning, per the advice. I'll still test to see where he's at before I go, but I guess I just don't understand why a skip rather than a reduced dose. I see the responses about the depot and because I'll be gone today. And I get it, safety first. Just trying to understand all of this! Seems like there are a lot of "rules" and "guidelines' To follow, but exceptions to everything!
 
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Taffysmama said:
Seems like there are a lot of "rules" and "guidelines' To follow, but exceptions to everything!
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There is a lot to learn and yes exceptions go without saying along with something you'll read here...ECID (every cat is different). You always hold the syringe, we're just providing suggestions based on some pretty long term experience. In time, everything you're reading will be come second nature. However even some of us long timers still need help from other members.
 
Taffysmama said:
Seems like there are a lot of "rules" and "guidelines' To follow, but exceptions to everything!
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I'm glad you have decided to skip this morning. I know it's all somewhat confusing at first. It took me a long time to understand most of it. Yes, there are guidelines, and there are exceptions, and ECID. We, who have been around a long time have gathered enough data by watching and helping others to know when skipping would be the best option, and I believe with all the exceptions you have stacked up (not enough data, coming down from a bounce, never shot a green before, won't be home) tell us that advising a skip would be the best thing for your cat in this scenario. I'm just glad you asked for advice.
 
Thanks, all! I'm glad to have your advisement! Aside from just my general learning curve in understanding all of this stuff, in the mornings I am an even less competent thinker! I am not a morning person, and now, lately, I am turning out to be not a great night person, either!
 
;)Hi
The no shoot number of 50 is there as a safety cut off, a number to make sure you have pros and experience onboard with you so you can keep your cat safe..consider it your Yoo-hoo...need advice please before I do anything number if you are doing TR!

Some of this you just have to ride thru before it makes sense, some of it you just have to take on faith that it's what to do. The 50 is low enough that there's not a lot of room for them to drop safely if you shoot without knowing the cats established patterns... Especially if you can't be home to catch what may happen and bring them up.

I think I see where your confusion is coming from. 50 is a number you are seeing two places so it's easy to blur the two parts of the protocol together, especially running on info overload and fumes for rest.

Dropping below 50 on TR earns the cat a reduction. So you see that number there, AND
In TR 50 is ALSO the number at which you don't shoot without lots of data and expert eyes on to help decide. You aren't confused, you just need to keep those Rolodex cards with the crib notes separated! :bookworm:;):bighug:

Hang in there, this will get easier and make more sense, and good news is in the interim you have lots of really good help!:bighug::bighug:

When looking at which to follow look at your schedule, figure out can you test during the cycles? Reason being because you are adjusting the doses more frequently, it is agressive, with fewer cycles between adjustments you need to be able to know what effect that is having. It's really up to you. The concept of it terrified me initially :nailbiting: but I realized I was testing enough, and could continue even after I went back to work, so it was do-able.

Weigh the options, kind of digest whether you can reasonably test enough for TR i.e. Those mid cycle tests, and see what your comfort level is. You can start one and switch, you just need to make sure you have decided on something to try because the dose advice is very different depending on which you are doing.:bighug::bighug:

ETA: good choice to skip, think of it as a fur shot if skipping is going to bum you out;)
 
I am glad you skipped this morning. With a depot insulin, often what you shoot the cycle before has more influence over the current cycle than what you shoot for that particular cycle. And as Dyana said, we have seen what can happen often enough when cats are breaking a bounce that we use safety as our guide. When you've go time later today, heck out what happened with Gizmo today when Lizzie shot low for the first time. http://www.felinediabetes.com/FDMB/...0-2-5-46-3-66-3-5-71-4-78-5-117-7-133.168426/And look how late she had to keep steering his numbers with food. We knew you had to be out of the house at +3 and couldn't monitor long.

You will find it informative to read some of the other new members posts, because they are facing the same situations and have similar questions as you. Neko took ages before giving me her first low number, but I had"watched" a lot of other members handle it and did fine when it happened with no one around to help me.
 
The other recommendation I can offer too is to look at other spreadsheets, I did that as I was reading the condos like Wendy recommends, you can start to see what the number patterns they are talking about in the SS look like.
 
Hi Taffysmama! You've already got some great advice here, but I just wanted to add not to worry about not quite understanding everything, including the two protocols and the difference between them. It's a lot of info to comprehend, so just keep asking questions about what you don't understand - even if it means asking the same question again and again, eventually someone will explain things in a way that clicks your lightbulb on (I know this from experience!) It will take you a little while to get into the swing of how Taffy reacts, and even then I'm sure he will throw you some surprises - but we're all here to help :-) Glad you skipped this morning, at least you can spend your day away from home with no worries about him.
 
Ok, so PMPS at 400. I skipped AM shot, so what can I learn from today? He didn't dip down after the AMPS, he continued to climb. Next time he has an under 100 AMPS, I hope I can stay home to shoot, and watch and test so I can see what happens. Now how many (more) cycles do I stay at 2u?
 
Hi Julie,

I wanted to clarify a little more about the low preshot. I found it just as confusing and it took me a while to realize that there are phases, and some of the different guidelines apply to different phases.

In the beginning, we discourage people from shooting lower numbers until they have "data", meaning test results, to show what their cat will do. Cats all have their own patterns and responses, and it takes some test results to see what their patterns are. If a person is testing a lot then they may be able to gather the information they need fairly quickly. If they are only testing preshots and a curve once a week, it's going to take longer to see the patterns emerge.

If you take a look at the sticky on "shooting and handling low numbers" for those following Tight Regulation, notice part one is on "becoming data ready." I think a person who tests quite a bit can become "data ready" within a week or so. What is important in my opinion is to first determine if the cat's dose is about right - sometimes people arrive here with inappropriate dose increases (too large of an increment, too fast of a dose increase) and it's important to be confident the dose is pretty close before shooting low. Shooting low means shooting the full dose into normal numbers. Often we can tease out enough information to see if the dose is about right by asking how it was arrived at.

Once you've got enough information to be pretty confident on the dose, then you want to gradually reduce the preshot number. Think of that as phase 2. Lantus and Levemir are both depot insulins, meaning that they build up in the body and slow release. They are excellent at holding blood sugar fairly flat - even to the point where a tightly regulated cat might only have their blood sugar move 10 points in an entire day. They work best when they start at a lower preshot number, so starting at 60 might mean a completely flat cycle while starting at 300 might mean that the kitty drops to 60 and climbs back up to 300 again by the next preshot.

I wrote this post a while ago for this situation - take a look and see if it helps explain. Of course the details applied to Mocha and not necessarily to Taffy, but you can get the gist of the idea from it.

Getting those green preshots is an absolute gift, but you want to be able to be home to monitor afterwards the first few times so that you can keep Taffy safe. I think you have enough data to be able to shoot green numbers now, IF you were going to be home. Shooting green numbers would be considered a final phase of getting a cat tightly regulated using a depot insulin. Stalling is a good first-time strategy so you can see if the last shot is beginning to wear off before you shoot again. You don't NEED the last shot to have worn off - once you're experienced (as you are getting) having the overlap from the end of the last shot still working is a great way to gain control of blood sugar and flatten out the cycles. Lantus takes a couple of hours in most cats to "onset" (begin working to lower blood sugar), so you are shooting the number he'll be in a couple of hours.

The safest thing to do is to simply practice this when you're going to be home for the cycle afterwards. Having had one green preshot today means that you will likely be given this opportunity again before long, so reading now and getting prepared for the next time will help you feel more confident when it happens again.

Hope some of that helps. Definitely ask questions if it seems confusing.
 
You have to have at least 6 consecutive cycles at a dose before evaluating what it can do. And since this dose got him to green, we recommend holding at least 10 consecutive cycles. Note that a fur shot or skip starts the cycle count over. The good news is that this dose got him to green and paws crossed it'll do it again soon.
 
Gussie's mom said:
The post Julievreferenced really helped things make sense to me..I can't tell you how many times I read and reread it...I copied it onto a page on my computer and referenced it often...
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Me too. Julie had to work hard to convince me I wasn't going to kill Ivana by shooting low, and once I got up the courage to try it, I was amazed at the results.
 
Taffysmama said:
With support and if I could have been home all day yesterday, I totally would have shot that low. I would have been nervous, but I want to get Taffy's #s down! Now we went backwards a bit. But, I get it, it was safe since I had to leave.
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its ok, as they say in this dance the one guarantee is that you will get the chance to do something you did another way~:p You will get your chance still!;)
 
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