? Phoebes amps 366 1/25 help

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Phoebes said:
So that we would be back on schedule tonight. And move her up to 3 units as per vet.
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No, I think we probably want to wait on the 3U for a little longer than that. The thing that is tricky about Lantus (also one of its strengths) is that it has a "depot"-- part of each shot is "saved" and available for use later. This makes cycles on Lantus (eventually) pretty stable and flat, but it also means you have to be very careful about doing lots of increases (or early dosing) in a row, because you don't necessarily see the full effect of a particular dose until the depot fills up. If you've gone ahead and done another increase in the meantime, you could end up with too much insulin, which can be very dangerous.
 
Nan & Amber said:
No, I think we probably want to wait on the 3U for a little longer than that. The thing that is tricky about Lantus (also one of its strengths) is that it has a "depot"-- part of each shot is "saved" and available for use later. This makes cycles on Lantus (eventually) pretty stable and flat, but it also means you have to be very careful about doing lots of increases (or early dosing) in a row, because you don't necessarily see the full effect of a particular dose until the depot fills up. If you've gone ahead and done another increase in the meantime, you could end up with too much insulin, which can be very dangerous.
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I agree which is why I suggested to hold the dose but, I do see Karen's point about dropping and bouncing. And that said, since she started off much lower today, I think holding is best.
 
The other thing I was just thinking about is that these are Alphatrak readings, so they are scaled higher than what a lot of us are used to seeing (most of us use human BG meters because of the cost savings on strips). That 304 on a human meter is probably somewhere in the mid-200's.

I think conservative is the way to go-- we want to keep Phoebe safe!
 
Nan & Amber said:
The other thing I was just thinking about is that these are Alphatrak readings, so they are scaled higher than what a lot of us are used to seeing (most of us use human BG meters because of the cost savings on strips). That 304 on a human meter is probably somewhere in the mid-200's.

I think conservative is the way to go-- we want to keep Phoebe safe!
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+2 bg is 407
 
Interesting. I bet she went even lower than 304 last night-- this looks like Karen's predicted bounce, as I don't think she's ever gone higher at a +2 before.

I don't know if we've talked about this yet, but a bounce is when a kitty's body responds to low BG numbers it isn't used to by working to get the numbers back up. It's an annoyance when you're trying to figure out doses, but it could be a good sign that at least she's hitting those low numbers! Lots of cats go lower in the nighttime cycle-- this is one reason we always say to try to grab at least one mid-cycle number. Even if it's just a +2 or +3 (+4 would be better) before-bed number, it will help figure out if Phoebe is one of those lower-at-night cats, and plan accordingly.

By the way, we've been talking about getting some ketone sticks and doing some testing-- any success yet?
 
Nan & Amber said:
Interesting. I bet she went even lower than 304 last night-- this looks like Karen's predicted bounce, as I don't think she's ever gone higher at a +2 before.

I don't know if we've talked about this yet, but a bounce is when a kitty's body responds to low BG numbers it isn't used to by working to get the numbers back up. It's an annoyance when you're trying to figure out doses, but it could be a good sign that at least she's hitting those low numbers! Lots of cats go lower in the nighttime cycle-- this is one reason we always say to try to grab at least one mid-cycle number. Even if it's just a +2 or +3 (+4 would be better) before-bed number, it will help figure out if Phoebe is one of those lower-at-night cats, and plan accordingly.

By the way, we've been talking about getting some ketone sticks and doing some testing-- any success yet?
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Yes just brought those home. She already has peed probably while I'm gone. So will have to figure out how to get the urine. She is skittish in litter box. But good lord I have a wet cold nose, and am getting tons of love bites!! :)
 
With her bouncing and an increase today, I would try to get as many PM test as you can tonight and for the next few cycles in case she starts to clear the bounce on top of an increase there can be some downward momentum.
 
Phoebes said:
So like +2 +4 after the 8 pm shot?
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That would be great. The +2 number helps you know if the cycle is going to be active. For example, if the +2 number is the same or less than the pre shot numbers, it is very likely to be an active cycle. But that said, sometime kitties won't indicate their intentions. (because they are cats and do their own things sometimes :rolleyes:) A +4 would give you an idea of what is happening to the pre -shot number after onset of the insulin occurs.
 
How about a +3? Are there some nights where, if you got a dropping number at the +3, you could delay the ambien and stay up longer? A lot of us have similar constraints, but there's always a way to work around them. If it's not possible to do midcycle at nighttime (I also had serious trouble with that due to my own sleep issues), there are some strategies.
 
Phoebes said:
Would a +2 and +3 make a big difference?
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The +2 usually indicates how active the cycle is going to be. But if you can only get one test before you go to bed then make it the +3 which is around onset. And like Nan said, if you see a big drop by then you could give some LC food to slow down the cycle and , you might be needing to stay up some to make sure Phoebe is safe before going to sleep.
 
This might help you a little with the different test times. It is in the stickie The Basics New to the Group Stickie

Example of an ACTIVE, but NOT necessarily typical Lantus cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
 
Glad the ketones are negative. Since you increased this AM, sometimes kitties get what we call New Dose Woniness (NDW) and their numbers actually go up temporarily instead of coming down and it usually happens the 2nd or 3rd cycle after the increase. So don't be too concerned if that happens. The good news is that you will be able to get a good night's sleep.
 
Hold the dose means to shoot the present dose. So tonight you will shoot 2.75 and hold that unless a reduction is earned. Since you are using an Alpha Track meter your reduction number would be 90 ( I am assuming you are following SLGS since you are so new to this dance?)
 
Bobbie And Bubba said:
Hold the dose means to shoot the present dose. So tonight you will shoot 2.75 and hold that unless a reduction is earned. Since you are using an Alpha Track meter your reduction number would be 90 ( I am assuming you are following SLGS since you are so new to this dance?)
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I thought all the protocols were written for human meter numbers?
 
(Regardless, I think Angela is planning to make a switch to a human meter soon anyway).

I agree that Start Low, Go Slow (SLGS) is a good approach here-- it's one of our protocols used to help guide dose decisions, and is described in detail in one of the "sticky"s at the top of the Lantus forum.
 
Nan & Amber said:
I thought all the protocols were written for human meter numbers
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Bobbie And Bubba said:
They are but, reduction numbers are given for those using pet meters like the AT2. For TR it is 68 and for the method SLGS it is 90
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Actually there is no reduction numbers cited for pet meters in the SLGS method. The only reason there is one for the TR method is because R & R specifically indicated the pet meter reading to be used with TR. The 90 in the documentation is based on human meter readings only. I have questioned this before but never got any clarification. Based on my year+ of pet and human meter comparison testing, I would estimate the AT2 meter reduction point for SLGS would be in the 115 to 125 range but that is based on my own comparisons with my specific human meter rather than anything scientific.
 
MrWorfMen's Mom said:
Actually there is no reduction numbers cited for pet meters in the SLGS method. The only reason there is one for the TR method is because R & R specifically indicated the pet meter reading to be used with TR. The 90 in the documentation is based on human meter readings only. I have questioned this before but never got any clarification. Based on my year+ of pet and human meter comparison testing, I would estimate the AT2 meter reduction point for SLGS would be in the 115 to 125 range but that is based on my own comparisons with my specific human meter rather than anything scientific.
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Thanks for the clarification Linda. Isn't 90 the number that is used here on the forum for SLGS?
 
Bobbie And Bubba said:
Isn't 90 the number that is used here on the forum for SLGS
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You are correct Bobbie. 90 has always been the number every one uses but I personally don't think it should be. The 90 for human meters was arrived at (not sure how) to build in a "comfort zone" to avoid riding that "tight" line between regulation and too low used in TR. By using 90 as a reduction point when using a pet meter, you lose a good portion of that "comfort zone" and therefore dosing becomes somewhat of a hybrid method somewhere between TR and SLGS.

If you look at the human number references of 50 as a warning of low numbers in TR and the 90 reduction point in SLGS, you have a cushion of 40 extra points in SLGS. If you use 90 with a pet meter knowing the low number warning for the pet meter is 68, it reduces the SLGS "cushion" to 22 points, almost a 50% reduction which I think is significant. Because the difference in pet meter and human meter readings gets larger the higher the reading, the "cushion" suggested when using a pet meter should likewise allow for a larger point difference which is why I think the reduction point with pet meters needs to be higher than 90.
 
Hello!

Interesting discussion on the reduction point question! Never really thought about that in detail.

Angela, I see you've changed the subject line to 1/25. As this thread is pretty long and you were (I think) planning on switching from the Alphatrak to human meter today, it is probably a good time to start a new thread for the new day. The lantus forum is so busy, we usually try to keep to the rule one day=one thread. The first post of a new thread usually contains a link to the previous thread so that people can get caught up easily.

And, good morning!
 
Nan & Amber said:
Hello!

Interesting discussion on the reduction point question! Never really thought about that in detail.

Angela, I see you've changed the subject line to 1/25. As this thread is pretty long and you were (I think) planning on switching from the Alphatrak to human meter today, it is probably a good time to start a new thread for the new day. The lantus forum is so busy, we usually try to keep to the rule one day=one thread. The first post of a new thread usually contains a link to the previous thread so that people can get caught up easily.

And, good morning!
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Yes will be switching to human meter today. Good morning. Just wanted to get the last AT reading this am to see where she stood. I will start a new thread. Titling switching to HM. :) ty
 
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