Need help on Fearless and his spiking BG levels

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fearlessmom

fearlessmom

Member Since 2017
Today is day 6 of testing (every 3 hours), day 10 on insulin. Vet started him on Lantus 2U 2x/day. On day 1 of testing his BG never dropped below 400. The next day it was down to 49, so vet lowered dose to 1U. Day 2 BG went up and down before a spike to 345 end of day. Day 3 was 303, 141, 93, then spiked to 515, at which time vet increased dose to 1.5U. Day 4 started at 131 so lowered dose to .75U. Count dropped to 45, 47, then up to 151, and spike to 332 end of day, at which time vet suggested only giving .5U and staying there. However, yesterday started at 549 so I gave 1U. Counts dropped to 346, 168, then spiked back up to 483 and 556 end of day. Today started at 321 so stayed with 1U. Counts dropped to 273 and 165 before spiking again at 585. How long must we wait before we see a more stable reaction to the insulin? How much does his low carb food affect his reading? We keep wet food (FF, 3-5% carb variety) out all the time so he can feed at will, at the vet's suggestion. However, he seems to eat the most in the morning, when he gobbles up 3-6 ounces (1 to 2 cans) before lunch, then appears to get full and only snacks after that. But the spikes in his BG are happening mid- to late-afternoon to evening. How long does it take for food to be metabolized in a 6.5 pound cat? Should I be feeding him less? Is the insulin just not working after 8 hrs? Not only is it supposed to be long-acting (12 hours) but the vet said the affects may carry over longer. That could explain the really low numbers on testing day 2, after 5 days of 2U 2x/day, and maybe on Day 4 when counts dipped midday, but the rest of the results are a mystery to me. If it is rebound (and not a result of when food is given) how long will this last? Has anyone seen results like this before? Vet says he'd rather see highs rather than low counts, but Fearless shows no signs of hypoglycemia when he is in 40-60 range. I worry what the highs are doing to his internal organs. Afraid to raise the dose above 1U until I next speak to vet. Any advice?
 
Welcome to the group.

The first bit of advice/suggestion I can give you is to set up a spreadsheet for Fearless. Most of us rely on looking at a spreadsheet in order to better understand what's going on with your cat. Given how often you're testing, it's very hard to read the list of numbers and keep them straight in one's head. Here's the link to how to set up your spreadsheet. Let us know if you need help.

There are a couple of issues that you need to be aware of. Unless Fearless is a very large cat, the initial dose of insulin was probably too high. (Initial dose = 0.25 x ideal weight in kilograms if you're planning on following the Tight Regulation Protocol. It's even lower is you're going to follow Start Low Go Slow. These approaches to dosing are described in the sticky notes at the top of the board.) With too high of a dose, it's no surprise that Fearless may have experienced a drop although it's more likely that the drop was an marked response to insulin and it will even out.

It takes 5 - 7 days for most cats to start seeing a response to Lantus. Lantus is a depot-type of insulin. Think of this as there being a small bit of every dose that goes into storage. Because insulin is being "stored," it means that Lantus can have a greater duration than shorter acting insulin. It also means that it's less potent and more gentle. In other words, there is less risk of hypoglycemia. It also means that because there is a depot, Lantus likes consistency. Unless there is an indication that the dose is too high, and the two dosing methods we use have different points for when a dose reduction is indicated, you want to hold the dose for a specific period of time. Changing the dose too soon means that the depot doesn't stabilize and you end up with wonky numbers.If you're not already doing so, Lantus also does best when shots are as close to 12 hours apart as you can get them.

The other thing that's happening is that with these big drops in numbers, Fearless is bouncing. When numbers drop low, drop fast, or drop by a large amount, the liver and pancreas overreact and dump a stored form of glucose along with counterregulatory hormones into the bloodstream. These compounds cause blood glucose (BG) to spike upward. It can take as long as 3 days for the bounce to clear.

I feel like I just wrote a book. I hope I didn't confuse you. There is a great deal of information in the sticky notes at the top of the board. The amount of information that is in those notes is, frankly, overwhelming. Please let us know if you have questions. The people here are very generous with their time and knowledge. Please let us know how we can help.

 
Hello and welcome. There is a lot of good information on the Sticky Notes at the top of this forum. Take a read through and feel free to ask questions about them. One thing to note is that Lantus is a depot insulin (there's a sticky note on that), which means it slowly builds up the dose over time. For that reason, we typically hold our initial doses at least 7 days, unless they go low. So dropping the dose down the second day was the right thing to do. However, the depot can take 6 days to stabilize, so the 1 unit dose should have been held longer before increasing. Your kitty Fearless was probably doing what we call bouncing after the 49 on the second day. Bouncing leads to temporary higher numbers. Here is an explanation from the New to the Group Sticky Note.

Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

In that same Sticky Note are the directions to creating a spreadsheet that Lizzie referred to. We find it an essential tool for figuring out how to do the dosing. And I see Sienne just posted the link to the spreadsheet instructions while I was typing.
 
I've just accessed the spreadsheet and will begin to create one for Fearless. Thanks for "talking me down off the ledge." I need to have patience and be consistent. And try not too worry about the wonky numbers I've gotten thus far.
 
Regulation is a process, it takes a while. Some cats take longer than others. Sounds like you are doing a great job testing so I look forward to seeing the spreadsheet. :bighug:
 
Made an attempt to enter data amassed thus far, though now realize SLGS method I believe my vet put us on needs more time with consistent insulin dosing. So I'm starting over as of 4/1 with 1U (actually, based on my cat's ideal weight should be just under [.91U]) but since the syringes sold to me by my vet only have 1U increments, it is nearly impossible to adjust by .25U as mentioned in the SLGS Sticky Note. So should I insist on getting different syringes? These are VetOne 3/10cc low dose. Hard to believe there is a syringe narrow enough to show .25U markings. Where do you get them?
 
Here is what and where I order my syringes from:
https://www.adwdiabetes.com//produc...-5-16-with-half-unit-markings-100bx_16367.htm

They have half U hash marks, which is recommended, especially for small dosing.

Here is instructions and pics for dosing "in between" hash marks:
http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

I actually use calipers to measure dosing. If you are interested let me know and I will hunt down the post on calipers.

Didn't say "welcome" before, so, Welcome! :bighug:

ETA - here is the dosing with calipers:
http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/
 
Where are you located? If in the US, you can buy 1/2 unit marked Relion syringes at Walmart for pretty cheap. They are the ones designed for children to use. Or the ADW site Lizzie pointed you to has a good selection if you are in the US. You may or may not need a prescription for syringes, depending on location.

It'll help us help you if you put a few more bits of information in your signature, like date of diabetes diagnosis, type of meter - even though the SS shows the AT, not all people open the SS before commenting, and type of food or any special things you think we should know about your kitty. Maybe even your name. :) Also add SLGS if that's what you think you are following for dosing.

I just read your opening post and have a couple of comments about food. My second kitty had some urinary issues too. The best thing for them is an all wet food diet, with plenty of water added. If you haven't been to the catinfo website yet, Dr. Pierson is a vet with a focus on feline nutrition. This is her page on diet and urinary issues. And you can ignore the recommendations on Young Again - any dry food just isn't good at all for cats, especially those with urinary issues. Here is Dr. Piersons recent post on this forum about that. Plus it's expensive and some cats tire of the taste easily.

Thanks for setting up the spreadsheet - I can see why the first few days seemed hectic. :eek: Good plan on sticking with 1 unit for now so we can see how it's doing. I have a couple of questions. I noticed that on 3/29 you skipped the shot at first then shot 5 hours later. Is that correct? If you do end up shooting later, then the following shot should be 12 hours after that. If you can't afford to be that far behind, skipping is the best option. You can move a shot time 1/2 hour a day, or 15 minutes a cycle if you need to move the time around. Another comment, it's helpful to get the odd test in the evening as well. A test before bed can provide a lot of information. A lot of cats go lower during the night.

That's it for now. Feel free to keep asking question. There is a lot to learn at first, but it does get easier.
 
Thanks for the info on injecting Lantus. Now I'm concerned because my vet never told me NOT to inject the insulin back into the vial. He also said to roll the vial for 30 seconds. If I have been rolling and injecting back into the vial for a week, is my insulin bad now?? BTW, Fearless has no other medical conditions. His litter mates both had UT infections last year. I always add a bit more water to their wet food. They get 1/8 c. dry as a treat in the morning, but since being diagnosed Fearless gets nothing but wet. The reason I was hoping I could start feeding low carb dry like Young Again is because I am recently retired and would like to travel at some point. Have a cat sitter who can come in 2x/day to give injections and feed wet food but wanted to be able to leave a self-feeder with good quality dry to supplement. On dosing: on 3/29 first test was 49, called vet, told me to wait to dose. 2 tests (4 hrs) later he was @ 160 so gave 1U. That was @ 11:45 am. Gave eve 1U @ 10:15 pm, 10-1/2 hrs later. Tried to stay awake another hour and a half but couldn't make it. :-(
 
You aren't the first one whose vet forgot certain details about the insulin. The rolling back and forth is what you do for other older insulins which he may be more used to. Your insulin may still be fine. Keep using it but handle it correctly going forward. It's only been a week. If Fearless's numbers start going up, or the insulin vial looks like it has floaties or isn't clear any more, that's also a sign it may be going off.

Many of us here use autofeeders to keep our kitties safe while we are gone - even those who work a full time job. The Petsafe 5 autofeeder is a popular one here. It can be used with wet food. There is a small spot under the tray you can put a small ice or gel pack or you can put an ice cube on the food to keep it cool and it'll melt to add water.
 
Problem with wet food auto feeders is that I have three cats and there's no way I can tell who is eating what unless I'm here (or separate them at night). That's why I was considering a low-carb dry in a self-feeder for times I would be gone longer than a few hours. What do others here do when they go on vacation?
 
It's much easier (and better for the cats) if all are on low carb wet food. You can leave bowls of watered down wet food down for grazing. The water will help it from going crusty. If it's warm out, an ice cube will help.
 
I meant it's difficult to know if Fearless is eating enough (my vet says he should always eat during/after a shot) when his brothers might be hogging all the wet food. I mean, how many bowls can I leave out?? Don't get me wrong, I want to do what's best for him, but being able to track his food intake is important too, isn't it?
 
Included in the Lantus sticky on proper delivery is a note "Lantus is NOT as fragile as we once thought ... don't freak out if you drop your insulin or accidentally leave it out on the counter over night. Chances are the insulin is just fine!" For the first time since starting Fearless on Lantus 3 wks ago, I left the insulin on the kitchen counter (temps in the room 60-65 F overnight). With all the high numbers and all the variables (injection location, amount and timing of food delivery, stress around testing, etc) that can affect BG levels, this is just one more thing to worry about. Can anyone tell me definitely that they left a Lantus vial at room temp for 12 hrs and there was no change in its effectiveness?
 
fearlessmom said:
Included in the Lantus sticky on proper delivery is a note "Lantus is NOT as fragile as we once thought ... don't freak out if you drop your insulin or accidentally leave it out on the counter over night. Chances are the insulin is just fine!" For the first time since starting Fearless on Lantus 3 wks ago, I left the insulin on the kitchen counter (temps in the room 60-65 F overnight). With all the high numbers and all the variables (injection location, amount and timing of food delivery, stress around testing, etc) that can affect BG levels, this is just one more thing to worry about. Can anyone tell me definitely that they left a Lantus vial at room temp for 12 hrs and there was no change in its effectiveness?
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I don't think that kind of statement can be made. We hope for the best and watch the numbers afterward. When you have bouncing going on as well there are just too many variable at work. My opinion is that the bouncing is a much bigger factor.
 
I am a newbie and not at all one who should give advice, HOWEVER.... my Vet tech reminded me, re the Lantus pen, that people carry it around in their purses all day, unrefrigerated.
So it's ideal to keep it still and in the fridge... but unlikely, thought not impossible, that not refrigerating or rolling it will make it go bad already.
What my Vet Tech told me is that the refrigeration and gentle handling is probably what makes it possible for us cat dosers to use it for longer than people would, ie for 3 months

And of course, I could be wrong... but wanted to offer what little info I have to help you feel a bit better.
 
fearlessmom said:
Included in the Lantus sticky on proper delivery is a note "Lantus is NOT as fragile as we once thought ... don't freak out if you drop your insulin or accidentally leave it out on the counter over night. Chances are the insulin is just fine!" For the first time since starting Fearless on Lantus 3 wks ago, I left the insulin on the kitchen counter (temps in the room 60-65 F overnight). With all the high numbers and all the variables (injection location, amount and timing of food delivery, stress around testing, etc) that can affect BG levels, this is just one more thing to worry about. Can anyone tell me definitely that they left a Lantus vial at room temp for 12 hrs and there was no change in its effectiveness?
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As they have already mentioned Lantus can be out of the fridge BUT is important to consider that when not refrigerated it's life is of 28 days according with the manufacturer
 
I usually keep it refrigerated but left it out one night. Am I to infer from your comment, Veronica, that the life span of my Lantus is now 28 days after one night on the counter?
 
I wouldn't assume that the life of the pen is kaput because you left it out one night. Basically, see what the numbers tell you.

I may have missed this but is there a reason you're not able to get tests during the PM cycle?
 
fearlessmom said:
I usually keep it refrigerated but left it out one night. Am I to infer from your comment, Veronica, that the life span of my Lantus is now 28 days after one night on the counter?
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Thats not easy to know since it was only one night but I think is something to consider and monitor if his numbers start changing in a month or so
 
We test 7 am and every 3 hrs until 7 pm. Someone else here said I might want to get a test after 7 pm, but didn't realize that meant testing throughout the night. Or am a reading the SS wrong? Time to re-read the instructions I guess.
 
I just saw on your spreadsheet that you gave a skinny 2 unit dose on a lime green pre shot number. I have to leave soon so I can't follow your progress. This is too low a number to give insulin. In the interest of safety and expediency, please give Fearless a small meal (a Tbsp?)of high carb gravy style food NOW. Retest 20 minutes after to see where he is. Repeat the high carb small meal if he's still low or dropping. Retest 20 minutes after that. The goal is to abort this cycle so you have time to regroup and ask for specific dosing advice from experienced members here on this forum. I'll tag a few:
@Tuxedo Mom
@Bobbie And Bubba
@Doodles & Karen
@Chris & China
@Sienne and Gabby (GA)
 
Kris & Teasel said:
I just saw on your spreadsheet that you gave a skinny 2 unit dose on a lime green pre shot number. I have to leave soon so I can't follow your progress. This is too low a number to give insulin. In the interest of safety and expediency, please give Fearless a small meal (a Tbsp?)of high carb gravy style food NOW. Retest 20 minutes after to see where he is. Repeat the high carb small meal if he's still low or dropping. Retest 20 minutes after that. The goal is to abort this cycle so you have time to regroup and ask for specific dosing advice from experienced members here on this forum. I'll tag a few:
@Tuxedo Mom
@Bobbie And Bubba
@Doodles & Karen
@Chris & China
@Sienne and Gabby (GA)
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just got this tag, I was logged on still but not on. I will watch for Fearless.
 
I can't stay but thank goodness Bobbie is here. That 67 on a pet meter is FAR too low to shoot. I will hang around a little bit but I have to leave soon.

How long ago did you shoot? Please do another test NOW!!
 
fearlessmom said:
Already fed extra food this morning. Just took another test. BG = 156
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That 156 could be a food spike, so you will need to continue testing. If it was done at +1 the food influence should wear off by +2.


ETA It is also possible that the numbers dropped lower during the night and Fearless could do a bounce this cycle. The only way to know for sure is to continue doing some tests.

Please do not shoot a low number like that. Anytime you get a low number you should:
1.Retest to make sure it is correct...sometimes you can get a wonky number
2.Stall WITHOUT feeding and retest in 20-30 minutes to see which way the numbers are going
3. Post for advice
 
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welcome to the group. In my opinion Fearless is looking great.
What I learned that Vets cannot provide what I can provide for my cat. And at this point you will be better off understanding and deciding his dosage.
I thank this group for helping me understand that.

I believe you should work with .25 increments up and up and hold each dosage accordingly to TR. And it seems that you have enough testing to follow TR.
In TR we need more data on 2 and see whether Fearless gets a reduction. It is hard to tell from his data whether he dipped below 50s (actually 90s as you are using alphatrack, missed that info) .

If he is indeed gone below a few times, the next reduction would be to 1.75 and then measure at that dosage. Let him stabilise for at least 6 cycles and then determine the next move.
 
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Arman Matin said:
It is hard to tell from his data whether he dipped below 50s. If he is indeed gone below a few times, the next reduction would be to 1.75 and then measure at that dosage. Let him stabilise for at least 6 cycles and then determine the next move.
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Fearless is using a pet meter so reduction level with SLGS is 90 and with TR is 68. The dose is definitely too high and needs to be reduced.


ETA A reduction should have been taken on April 13 with that 57 reading
 
Tuxedo Mom said:
Fearless is using a pet meter so reduction level with SLGS is 90 and with TR is 68. The dose is definitely too high and needs to be reduced.


ETA A reduction should have been taken on April 13 with that 57 reading
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Ah yes totally missed that . So yes totally agree with the reduction.

BTW I hated my alpha track 2. It was one of the main reasons why I didnt like testing. The strips needed a lot of blood with not knowing whether it was drawing blood and lots of re do s.
Once i switched to Relion it made such a difference. I could actually see the blood being drawn in and it only need the tiniest amount. And the price savings helps so much
 
I have used the AT2 meter for over 2 years and LOVE it. I am in Canada and cannot get the Relion meter, but I do have another human meter I keep for backup. The AT2 meter uses a very small drop of blood but has to be drawn from the side of the strip.
 
@fearlessmom

How much longer is it until your +2 time? I would definitely suggest another test at +2 once the food is wearing off and then it will depend on what reading you get when the next test should be set for.
 
Tuxedo Mom said:
I have used the AT2 meter for over 2 years and LOVE it. I am in Canada and cannot get the Relion meter, but I do have another human meter I keep for backup. The AT2 meter uses a very small drop of blood but has to be drawn from the side of the strip.
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Maybe i just wasnt using it right. i gave up on them after a month or so.
 
Welcome to the group and good job testing Fearless and getting the spreadsheet set up. . It's best to read all the sticky notes on the top of this page however a few things particularly helped me in the beginning. One is understanding that Lantus is a depot insulin What is the Insulin Depot . Basically, it takes a about 4-6 cycles at minimum to see what a dose can do and Lantus is dosed based on how low they go, not how high they are. Shooting today was a bit low but experienced folks following TR would shoot anything over 68 on AT pet meters so that 67 while a bit risky isn't the end of the world and thankfully you're there to keep testing.

The other thing we all get frustrated about is "Bouncing". High numbers can be caused but low numbers (too low or lower than the cat is use to) or caused by a large drop in numbers. Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles). This is found in The Basics New To the Group Sticky

It's important to get a before bed test in every night if possible. Some of those higher numbers on Fealess's morning's are likely caused because he went lower at night or had a big drop. On SLGS and TR we only increase by .25u increments. With SLGS you reduce the dose by .25u anytime Fearless goes under 90 so he did earn a reduction for tonight's shot so down to 1.75u. With SLGS you'll hold that 1.75u dose for 7 days before changing the dose unless Frealess goes under 90 again. If he goes under 90 again he earns another .25u reduction. Below is from the Start Low Go Slow sticky.

Ask questions, and post often. We're all here to help.
 
Hey there, do you have another test in yet? As Mary Ann said, the +1 could be a food spike and it will be important to keep testing as that was a very low number to shoot 2 units on. He could start a bounce from going so low but it would be prudent to test through the nadir to make sure he won't drop again.

I am so glad that you found this forum as there is lots of good information here and people with experience to help.
 
You are correct. Fearless just experienced a big bounce (400). Thanks, Karen, for explaining everything so well. Will continue testing as usual today and hopefully get back on track within 3 days. Also, just ordered syringes with 1/2U marks to ensure more accurate dosing. Vet only sells full U syringes.
 
About the syringes, if you have Walmarts near you, you can get their brand syringes from their pharmacy called Relion. I used those and they have 1/2 unit markings and are very cheap, 100 for 13 bucks. I use the 3/10 capacity , 31 gauge, 8 mm length. Below is what .75 of a unit looks like to help you with the reduction.


upload_2017-4-15_10-27-53.png
 
fearlessmom said:
You are correct. Fearless just experienced a big bounce (400). Thanks, Karen, for explaining everything so well. Will continue testing as usual today and hopefully get back on track within 3 days. Also, just ordered syringes with 1/2U marks to ensure more accurate dosing. Vet only sells full U syringes.
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Yep, there's the bounce! You can relax on testing but, if you could get a mid cycle one that would be good. All data is good data. With bouncing, it can take 3 days or 6 cycles to clear. Some cats clear them quickly. So, no matter how high the PMPS number is today, just give the 1.75 ( eye ball it the best you can ) and be patient with the higher numbers for the next few days.
 
I would encourage people who are lending a hand to read the thread. Fearless' caregiver is in Canada. Walmart may not be an option and shipping from a US location can be prohibitively expensive.

@fearlessmom -- We encourage everyone to open a new thread (we refer to them as "condos") on every day that you post. You can link the condos together in your first post of the day by cutting and pasting the URL of the previous day in the new thread. This helps because we know what's current and you can change the subject line if you need help. It also means that when you have a daily thread, it's not excessively long.

A couple of observations...

Fearless' numbers dropped to 57 on 4/13. When using an AT meter, as was noted above, this means he earned a dose reduction at his PMPS on 4/13. The range for a dose reduction that we're basing this on is if you are following the Tight Regulation protocol. You have the option to follow TR or Start Low Go Slow (SLGS). It would be helpful if you read over both approaches and decide which you prefer. TR has the advantage of being based on research but it is an aggressive approach and you must get a test regularly during the PM cycle. SLGS has been used for quite some time here but was not developed exclusively for Lantus or Levemir. With SLGS, the numbers are a bit higher for when you reduce the dose.

Not having information about what is going on with Fearless' numbers during the PM cycle makes it very difficult to know what's going on. It's entirely possible that his numbers dropped even lower last night and continued to drop until AMPS. A bounce may have then started.

When you said you fed extra food, was this higher carb or his usual, low carb food?

 
Sienne and Gabby (GA) said:
I would encourage people who are lending a hand to read the thread. Fearless' caregiver is in Canada. Walmart may not be an option and shipping from a US location can be prohibitively expensive.
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Are you sure about that? Her signature says she lives in St. Louis, MO, USA . I skimmed though this thread, started on 4.2, and did not catch that she had moved from St. Louis to Canada since then.

Thx for addressing the new thread a day as this thread is very long to try to get through when there is a pressing issue as today low number.
 
Sienne and Gabby (GA) said:
I would encourage people who are lending a hand to read the thread. Fearless' caregiver is in Canada. Walmart may not be an option and shipping from a US location can be prohibitively expensive.

@fearlessmom -- We encourage everyone to open a new thread (we refer to them as "condos") on every day that you post. You can link the condos together in your first post of the day by cutting and pasting the URL of the previous day in the new thread. This helps because we know what's current and you can change the subject line if you need help. It also means that when you have a daily thread, it's not excessively long.

A couple of observations...

Fearless' numbers dropped to 57 on 4/13. When using an AT meter, as was noted above, this means he earned a dose reduction at his PMPS on 4/13. The range for a dose reduction that we're basing this on is if you are following the Tight Regulation protocol. You have the option to follow TR or Start Low Go Slow (SLGS). It would be helpful if you read over both approaches and decide which you prefer. TR has the advantage of being based on research but it is an aggressive approach and you must get a test regularly during the PM cycle. SLGS has been used for quite some time here but was not developed exclusively for Lantus or Levemir. With SLGS, the numbers are a bit higher for when you reduce the dose.

Not having information about what is going on with Fearless' numbers during the PM cycle makes it very difficult to know what's going on. It's entirely possible that his numbers dropped even lower last night and continued to drop until AMPS. A bounce may have then started.

When you said you fed extra food, was this higher carb or his usual, low carb food?
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Usual low carb food.
 
Bobbie And Bubba said:
Are you sure about that? Her signature says she lives in St. Louis, MO, USA . I skimmed though this thread, started on 4.2, and did not catch that she had moved from St. Louis to Canada since then.

Thx for addressing the new thread a day as this thread is very long to try to get through when there is a pressing issue as today low number.
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Yes, St. Louis. I believe I have enough info at this point to work with w/out starting a new thread. I'll start a new thread if I have any follow-up questions.
 
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