? Please help

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Juliet

Member Since 2017
Hi,
Silver's numbers are all over the place and I do not know what to do. I was away for a week with a petsitter who could not manage testing so I halved his dose and let her shoot without testing - not the ideal solution but all I could do in the circumstances as I had to leave in a hurry. When I came back he gave me a nice low green as an AMPS but ever since, apart from one day in the yellows, I'm getting pinks and reds. Before, when he was 0.5u I was still getting reds and pinks with the occasional green AMPS to confuse me. I don't know if this is bouncing and therefore too much insulin or not enough. I commute to work so am out 12 hours a day and cant test as much as I would like. I try to get evening tests but I cant manage to stay up late enough to get any decent +4, +5 or +6 numbers so I really am limited to the weekends to see what's going on.

Can anyone offer any help? His teeth are good, bloodwork is good. Only been out of remission a couple months due to some silly vet wrongly prescribing steroids for diarrhea which disappeared on its own after I stopped the steroids (vet thought he had IBD but he was wrong).

I'm at my wits end and I do not know what to do. His ss looks like a skittles factory.
 
I think probably some glucose toxicity has set in and you may just have to increase until you break through it

Even before you left there were times you skipped shots when even our most conservative method would have said to shoot the schedule dose (like on 11/7/17)

Lantus works best when it doesn't have to "pull down" high numbers. We say "Shoot low to stay low" because that's how it works best!

I know you work full time so it's hard to get mid-cycles on the AM dose but do try to always get at least a "before bed" test on the PM cycle....you don't have to stay up all night unless the "before bed" test gives you reason for concern!! A +2 can tell you a lot about what might be going on later in the cycle!!

Also, read the sticky on Can I do TR with a full time job? ....even if you're doing SLGS, there are some good tips on how you can feel better about leaving for work when you've shot
 
Thanks Chris. I don’t want to do TR when I am gone 12 hours or more a day. I skipped just one shot because my “no shoot” number was reached. I can’t take the same risks with his life when I am gone so long. It’s very scary to shoot a low number and take off for work.
 
Did you Double Check that 94 on 11/21??

I agree with Chris get a test in the pm cycle, I would even add that a +1 can give you an idea of what the cycle ahead might hold. Especially if the PMPS especially if he is in blue/green, I found that if there was an absence of a food bump at +1 or even a drop at +1 then I could bet money on the cycle being active.
A drop from a red PS to a yellow +1. might also give you an indication that he is dropping fast and that is resulting in a bounce.
Juliet said:
Thanks Chris. I don’t want to do TR when I am gone 12 hours or more a day. I skipped just one shot because my “no shoot” number was reached. I can’t take the same risks with his life when I am gone so long. It’s very scary to shoot a low number and take off for work.
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I don't think Chris was suggesting TR, just that in the Sticky about doing TR on a full time job, there are some great tips on how to gather data as and when you can and how to use that data in order to safely adjust dose. A lot of the tips are applicable to SLGS.

As you have not been able to gather much data since you've been back it is impossible to say if he is high and flat or dropping low (for him) midcycle and then bouncing up high by next PS.

I think if you could run a curve on your next day off(looks like you are running one today), grab a spot check (or two if it's possible) in he PM cycle on a regular basis (at any time be that +1 or +11 or anything in between, whatever works best for you), some extra spot checks at the weekend in am and pm cycle may also be very helpful. A few days of doing that may make it easier to see what's going on.
 
Gill & George said:
don't think Chris was suggesting TR, just that in the Sticky about doing TR on a full time job, there are some great tips on how to gather data as and when you can and how to use that data in order to safely adjust dose. A lot of the tips are applicable to SLGS.
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Exactly.....I wasn't suggesting you do TR....just read the tips on how others have been able to work full time jobs and still keep their kitties safe while still giving insulin
 
Ok I’ll take a look thanks.

Double check the 94? Not sure what you mean - is that the 5.2 amps I had? What should I double check?

I think I should increase the dose but I’m scared I’ll induce bouncing? I’m terrified I’m killing my cat with my ignorance on this.
 
Juliet said:
Double check the 94? Not sure what you mean - is that the 5.2 amps I had? What should I double check?
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Just that it was an oddly low out of place number, if something looks suspiciously low, it's a good idea to test again, could be a wonky strip, not enough blood, etc. it will confirm that it's a valid number vs a bad reading
 
I have a few random low greens. Can’t exactky double check it now tho. It was a few days ago. Strips are a new container.
 
As Stacy said, the number seemed a little out of place.
Occasionally you can get a dodgy ready. Do if something seems out of place it can be a good idea to grab a second reading right there and then.
I'm not saying it was definitely off, just looks a little off in there.
 
Juliet said:
I think I should increase the dose but I’m scared I’ll induce bouncing?
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With that 94 (5.2) in there and given the lack of midcycle data I would gather a little more data (good job today) before you make a decision either way.

On SLGS with that 94 in there you wouldn't really want to increase the dose.

Are you able to grab any spot checks tomorrow?
Can you over the next couple of days get spot checks on the pm cycle? (anytime between +1 and +11 included)
I think so that you can make a more informed decision on his dose you really need to have a little more data. Today's cycle looks high and flat, now that might be because his numbers are high and flat and this dose isn't getting him anywhere, or it might be that he dropped low for him in the last couple of days, and is now bouncing. Because all we have essentially is amps and pmps we have no way of deducing what he may be doing. Any tests anywhere in that pm cycle may help us with that.

I'm sorry, I know it's not helpful.
 
Any time I tested and got a number that was out of sync (either suspiciously high OR low), I would get an immediate second test. There are times when you get a bad strip or a bad reading. Double checking never hurts!

I'm one of those people who also worked full time. I also followed TR. From what you've indicated, I'm not sure my strategy would work for you especially since I didn't have a long commute. I knew I could be home by 5:00 for my PMPS. That allowed me to get an AMPS at 5:00 and then get a couple of tests in before I left the house at 7:30. Gabby had an early nadir so those early in the cycle tests were very helpful. It also let me know if I needed to leave high carb food out. If you don't have one, a timed feeder can help you to feel more secure that Silver has access to food when you're gone.

You might also think about trying to sneak in some random tests.Getting tests before you leave and as soon as you get home, even on days off, can be useful. "Sleep" testing is also good -- if you wake up for whatever reason during the night, get a test. These are very valuable especially if you're not home during the week to get spot checks. Like Gill said, it can be a challenge but the meter is the best way to get a handle on Silver's patterns and you're at a disadvantage without the data.

 
I really wish I could do more testing. I get up so early as I have a TWO hour commute. I get up and test, shoot, feed. jump in shower and out the door in space of only 45 mins. Evening times I can try and get a bit more testing in. Its hard for me financially as the strips are very expensive here. I can barely afford them using 2 a day. If I do a few tests in the evenings I will not be able to afford to treat him. I am doing the best I can on a low income with a 12 hour day. I feel I am failing him but at least I manage to do an AMPS and a PMPS. The vet told me not to bother even with that.
 
Gill & George said:
With that 94 (5.2) in there and given the lack of midcycle data I would gather a little more data (good job today) before you make a decision either way.

On SLGS with that 94 in there you wouldn't really want to increase the dose.
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Some folks have said that 5.2 may be off - but I have a few random greens so I do not know. I am nervous about keeping the dose the same when he is so high. It is sooooo confusing and I am not helping by my inability to get in several tests a day. I will get a few more tomorrow if I can. I got a new set of strips but I do not know when I can manage to get another tub of them so I have to use them carefully.
 
Juliet said:
I really wish I could do more testing. I get up so early as I have a TWO hour commute. I get up and test, shoot, feed. jump in shower and out the door in space of only 45 mins. Evening times I can try and get a bit more testing in. Its hard for me financially as the strips are very expensive here. I can barely afford them using 2 a day. If I do a few tests in the evenings I will not be able to afford to treat him. I am doing the best I can on a low income with a 12 hour day. I feel I am failing him but at least I manage to do an AMPS and a PMPS. The vet told me not to bother even with that.
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You are doing great, follow SLGS and you'll both be fine and safe. Don't even think you are failing him, you do your best and this is what matters. If 2 tests/day is all what you can do, that's what you shall do, it's way much better than none.
That single green - ignore it for now as was some time ago and may have been off from a lot of reasons - wait as long as the protocol asks for and if the numbers will call for an increase, just do it. It looks like you use a human meter so you'll have to modify a little bit the spreadsheet you use in order to keep him safe - instead if 1.0-5.5 shall be 2.8-5.5. Under 2.8 you'll have to take extra cautious approach, like have HC food on hand and be ready to feed him with it. Cheers and don't be afraid, kitties are more resilient than us.
 
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Toro & Ovi said:
You are doing great, follow SLGS and you'll both be fine and safe. Don't even think you are failing him, you do your best and this is what matters. If 2 tests/day is all what you can do, that's what you shall do, it's way much better than none.
That single green - ignore it for now as was some time ago and may have been off from a lot of reasons - wait as long as the protocol asks for and if the numbers will call for an increase, just do it. It looks like you use a human meter so you'll have to modify a little bit the spreadsheet you use in order to keep him safe - instead if 1.0-5.5 shall be 2.8-5.5. Under 2.8 you'll have to take extra cautious approach, like have HC food on hand and be ready to feed him with it. Cheers and don't be afraid, kitties are more resilient than us.
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Thanks for the encouragement. I got a yellow at +4 last night. I did increase the dose to 0.5 but I ran out of half unit marking syringes so I think its more like a fat 0.5 (1u with a fat drop squeezed out, leaving two fat drops left). I still have a 22 in the morning. I am using a human meter Aviva Accu Chek.

I know with SLGL I dont drop dose til under 5 (90) correct?
How do I know when to increase dose - I did - but should I have?

What is my "no shoot" number if I am going out for the next 12 hours?

Thank you. I don't know what I'd do without the help I get here. I am still so confused with the high numbers I am getting again. He occasionally gives me a yellow or blue day and I am pleased, then nothing but reds and pinks again. I fear he is starving himself while being always hungry and I can't seem to get him into normal numbers. So upsetting.
 
I'm not very familiar with SGLS but please see the sticky notes attached to this forum, you'll find all the necessary details there:
Sticky LANTUS & LEVEMIR - START LOW, GO SLOW METHOD (SLGS)


 
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If you've run out of syringes with half unit markings, there are a couple of options. The goal is consistency. You can fill a syringe with your dose using a colored liquid and use that as a sample syringe and compare all of your shots with that syringe. Another option is one that many of us use given that many syringes are not consistently marked. You can get a digital caliper. You measure the dose using the calipers and then use that on all subsequent doses.

Juliet -- if you're struggling with the cost of strips, have you thought to approach DCIN (Diabetic Cats in Need) to see if they can lend a hand? Also, look on the Supply Closet board here periodically. Sometimes, people don't know to post in the Supply Closet so you may want to check on some of the insulin boards (e.g., Prozinc) or the Grief forum. (I know, it sounds a bit ghoulish but most of us have been happy to donate to a member we know is financially stretched and doing whatever they can to manage their cat's not inexpensive diabetes.)


 
Juliet said:
I haven’t approached DCIN as I do have a job and likely wouldn’t qualify.
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Juliet...please contact DCIN....I'm a case manager and specifically asked and was told you could apply and we'd be able to help with strips so you could test more often.

You'll need to fill out our Compassionate Assistance Program form and just explain your circumstances

Feel free to send me a private message if I can be of further assistance
 
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