Gypsy: 8/13/18 AMPS 66, +8 134, +10 88, PMPS 64, +2 101, +9.5 89

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Arkali

Arkali

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Hi, all!
Apologies if I formatted my post wrong. It's my first time following the daily-post protocol :-) Anyway, Gypsy's about an hour and a half off from her AM shot. Her 6 a.m. reading was 91, and she's eaten a smidge, but her shots are at 9 / 9. I'm planning to run a curve today from 6 a.m. through probably 10 p.m. Her meter runs a bit low I think--despite her low numbers, she's been showing no signs of hypo. That said, my question is would you drop her down to .5 units today? I've been trying to hold at least a couple of days, but I'd also like her numbers to come up a smidge. I'll be calling the vet today to schedule a follow-up visit. They've been fairly insistent that they want to run a curve, but I'm hoping since I'm running one today, they won't feel the need. We'll see.

Thanks in advance!
 
That 36 you got is an automatic reduction. Looks like she is heading for remission. If your that far off schedule I would skip and wait to next shot time. If you do give it remember next short will be 12 hrs after first, then you work your way back to normal time over a few days.
 
Good morning. I see you are following SLGS. That means anytime you see a number under 90, you must drop by 0.25u. Do 0.5u at your next shot. As Paula said, anytime you see a number in the 30's, that's an immediate reduction, but with SLGS, it's recommended to do it under 90.
 
Thanks, all. Just did her AM shot and went down to .5u. I'll be running a curve today, so lots of numbers (as long as Gypsy cooperates, but so far, so good).

@Olive & Paula -- she's on schedule. I just don't do her shots until 9 a.m. / 9 p.m. just to reduce danger of oversleeping / missing a dose or whatever. Plus 6 a.m. / p.m. is kind of chaotic around here. I'd started to wait until 9 a.m. for feeding too, but we have three kitties and they're all pretty insistent at 6 a.m. Also, they free-feed / graze, so based on earlier feedback I just left her times as they were. That does lead to her first test (the 6 a.m. one) being recorded the day before, but other than that, she's square.

Thanks for the advice! Dosage reduced!
 
Here's your post from yesterday. We like to have the previous post linked in the current one so it's easy for people to quickly go back and see what's been going on

Did you shoot a 66? (or 63?)

I really can't stress this any more.....you're playing a very risky game by shooting insulin at those low numbers with limited experience and data.

I'm glad you're home today and able to test! She may be totally fine, but I'm worried for Gypsy

Please keep your subject line updated with the latest test results so we can help keep an eye on you guys today
 
Chris & China said:
Here's your post from yesterday. We like to have the previous post linked in the current one so it's easy for people to quickly go back and see what's been going on

Did you shoot a 66? (or 63?)

I really can't stress this any more.....you're playing a very risky game by shooting insulin at those low numbers with limited experience and data.

I'm glad you're home today and able to test! She may be totally fine, but I'm worried for Gypsy

Please keep your subject line updated with the latest test results so we can help keep an eye on you guys today
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Will do. on the updates. And I'm home every day, so she's not really left alone. I'll be taking her in to the vet today for a follow-up. Thank you for all your advice. She was at 106 at 8 a.m., then down to 66 preshot. Not really sure what was up with that. Yes, I did shoot--.5u and will be taking her BS again in about an hour and a half.

Edit to add: I've been shooting anyway because she free-feeds, so she's constantly getting food in her, she's on a pretty low dose of insulin and it's a long-acting one, and also because I'm somewhat concerned about changing her dosages all the time, if that makes sense? But I've been monitoring her very carefully.
 
Another thought about you following SLGS... in the sticky, it says it is not suggested or recommended that you shoot a number below 90. Were you aware of this?
 
Keep close tabs on her. Since you are new at this I wouldn't let her get lower. But you shot the 66 I wouldn't let her get below 60. How many hours after shot is vet appt? If she is to low in vets eyes they might want to intervene.
 
Her shots are at 9 a.m. / 9 p.m., vet appointment is at 2:45. I think this meter reads VERY low. I'll be taking it in to verify with the vet.

@Mandy & Rex , thanks. I'm actually winging it a little. The vet wanted her on 2u daily of Lantus, and we're lots lower than that. I think part of what's been so confusing for me is how quickly her blood sugar came down. Factored in with switching meters and the new meter being so much lower than the old one. I'll take her blood sugar again here in about 30 minutes.
 
I've been here over 6 months & one thing I've learned is that the people that have been doing this for several years definitely know more about Diabetes & insulin than most Vets do.
Lantus insulin usually starts with 1 unit & the increases are done slowly after the Lantus has time to build up in the "Depot" Have you read the Yellow sticky notes about how this insulin works?

I'm shocked you're giving insulin at such low numbers.What did you do when you saw the 31? That's considered "Swimming with the sharks" a dangerous place to be. Food can help with her #'s not going too low but sometimes you need to intervene
with high carb food or even honey. A lot of Vets aren't even familiar with this slow acting type of insulin.

You came to this forum looking for advice? I think you need to listen to what they are advising you. The low numbers are nothing to mess around with. It may look like a tiny bit of insulin but Insulin is very powerful,not something you want to misuse.

You really need to read the information so you better understand about the insulin & please listen to what the people here are telling you. They only want the best for your Gypsy!

Best of luck to you. Please be careful.:)
 
Human meters run lower than pet meters. If your vet is using pet meter it probably will be okay. The nadir will be hitting at the time of your visit.
 
Thanks, @JoyBee&Ravan --I'd be panicking more if I weren't also testing her periodically with a One Touch meter. The OneTouch Meter reads much higher (30 points). When she tested in the 30s (the lowest she's been has been 36), I gave her some Temptations to bring her blood sugar up a bit too. I'll also note that she's displaying no symptoms of hypo--none. I've been watching her like a hawk. I'll be testing again in about 10 minutes. Running a curve today.
 
Olive & Paula said:
Human meters run lower than pet meters. If your vet is using pet meter it probably will be okay. The nadir will be hitting at the time of your visit.
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Hi, @Olive & Paula -- the vet uses the One Touch (human meter). I'm pretty sure they also have a lab, but they may want me to switch back to the One Touch. At the same time, I don't know how helpful that would be as two meters won't test alike, even if they are the same brand. Heck, sometimes the same meter won't test the same. But I'll take my meter in with me just to get a better idea of what's going on with my meter.
 
FYI- not all cats will have hypo symptoms before a seizure hits. Dry food takes longer to get glucose up as it has to digested first. Karo or pure maple syrup should be the first thing you use every 15 minutes until safe glucose numbers are reached THEN you still continue to test, feed tsp amounts every 30 minutes until.......... Here are the instructions for treating low numbers.

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
 
Arkali said:
Hi, @Olive & Paula -- the vet uses the One Touch (human meter). I'm pretty sure they also have a lab, but they may want me to switch back to the One Touch. At the same time, I don't know how helpful that would be as two meters won't test alike, even if they are the same brand. Heck, sometimes the same meter won't test the same. But I'll take my meter in with me just to get a better idea of what's going on with my meter.
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meters have a 20% variance. Something to remember.
 
In your subject line, just keep updating your test numbers but don't remove the older ones.

Like today could say 8/13 Gypsy AMPS 66, +2 69, +4 ##, +6 ##, etc. etc.

If your subject line does get too long, then you go back and remove some of the results that no longer are as important (like earlier in the day)

By doing it like that, those of us that are scanning the forum can easily keep track of how everybody is doing without opening each post. Anything we see that concerns us, we start with those posts before others.
 
Chris & China said:
In your subject line, just keep updating your test numbers but don't remove the older ones.

Like today could say 8/13 Gypsy AMPS 66, +2 69, +4 ##, +6 ##, etc. etc.

If your subject line does get too long, then you go back and remove some of the results that no longer are as important (like earlier in the day)

By doing it like that, those of us that are scanning the forum can easily keep track of how everybody is doing without opening each post. Anything we see that concerns us, we start with those posts before others.
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Gotcha. Will update. Thank you.
 
Just made it back from the vet--will update Gypsy's sheet in a minute. Vet was really proud of how Gypsy's doing and the records we've been keeping. I gave y'all all the credit :-)

So, Gypsy's gained about .6 pounds. Which is awesome--she was so gaunt when we took her in a couple of weeks ago.

For those following the meter saga, these were Gypsy's numbers on three different meters:
My One Touch: 132
Vet's One Touch: 113
Relion: 83

So a fairly significant difference. Vet's fine with us staying with the Relion, she's just made some adjustments. She said if I use my One Touch, not to shoot under 150 (under 120 on the Relion). She wants Gypsy to come off the juice for a week to let her body kind of adjust to the dietary change and everything and then in a week to run another curve. I asked if I should test in this week, and she said it would be a good idea if I don't mind--so twice daily at her AM / PM times. I'm also going to email her a link to Gypsy's spreadsheet so she can monitor us remotely.

So, the near-term plan is to finish today's curve, no insulin for a week unless her numbers start doing something crazy, test twice daily for the next week, then run another curve in a week.

The vet said we all get gold stars. She also said maybe Gypsy is a unicorn, so we're crossing our fingers.
 
Going off the insulin all of a sudden is not a good idea. I really wish you'd trust what the people here are telling you. It sounds like the vet is not familiar with how Lantus insulin works

Were you feeding dry food to Gypsy? Some of the Kitties here that were taken off dry food & put on low carb wet food have gone into remission.They were very gradually tapered off the insulin.

It can be real confusing listening to your vet & to the people here at the same time but The people here know what they're talking about. They have lived with diabetic kitties for many years & have hands on experience with how to use Insulin the correct way to try to get kitty into remission.

Just stopping her insulin will be starting all over again. If you read how the Lantus insulin works you'd understand.

The people here are generously giving you their well earned advice because they really love their cats & want to help your kitty . They donate their time to pay it back because people here did the same for them. You can go on anyone's Spread Sheet & get an idea of how we lower the dose gradually or raise it gradually.

We were all like you when we started. Scared, not knowing what to do. But gradually we understood what an amazing bunch of information is given here buy wonderful people that just want to help.
 
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Prediagnosis, she was on dry food. But as soon as I came here (which was immediately after she was diagnosed but before she came home), I decided to switch her to wet food, so she's been on Fancy Feast since she came home.

I'll reread the protocol. I'm honestly so confused right now. The vet told me one thing with sliding scale, and everyone was all, "No, not with Lantus!" which I agree with, and then it said to hold the dose for the week and reevaluate her dosage, which I tried to do, but she started coming down so quickly that everyone advised coming down again on her dosages. Coupled with switching her meter (which reads decidedly low), I'm just kind of flailing right now. I'm glad she's doing so well, certainly, but I really don't know what I'm doing (clearly). Sorry!

Anyway, I will reread and see if I can understand it better. I don't want to cause a setback because she is doing really well, but I'm kind of lost. Sorry--I know I'm being really dense and I'm not trying to be. Not trying to be stubborn either, I promise.

Thank you all--I can't tell you how much I appreciate your help and patience!
 
Arkali said:
So, the near-term plan is to finish today's curve, no insulin for a week unless her numbers start doing something crazy, test twice daily for the next week, then run another curve in a week.
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Hi Anne. I hope that plan works out for Gypsy, but chances are you'll soon see her BG numbers begin to rise as the insulin depot diminishes. The depot usually drains within 6 cycles (3 days), but I think you'll be seeing the effects much sooner.

Gypsy is responding very well to Lantus. It's a shame your vet is pulling the plug on her progress now, but I'm sure you'll stay on top of what's happening and change your course when necessary.

Good luck and let us know if/when/how we can help!
 
Jill & Alex (GA) said:
Hi Anne. I hope that plan works out for Gypsy, but chances are you'll soon see her BG numbers begin to rise as the insulin depot diminishes. The depot usually drains within 6 cycles (3 days), but I think you'll be seeing the effects sooner.

Gypsy is responding very well to Lantus. It's a shame your vet is pulling the plug on her progress now, but I'm sure you'll stay on top of what's happening and change your course when necessary.

Good luck and let us know if/when/how we can help!
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@Jill & Alex (GA) , I'm actually going to look back over the SL, GS protocol. I'm not really comfortable with cutting her off insulin cold turkey either. I'm just lost and confused right now as to what to dose her at (.5, I'm guessing?) I'm going to reread the protocol and try to figure out what I'm doing. *sigh* If anyone has suggestions, I'd appreciate it. I'm kind of flailing right now. Her next BG test is in two hours, PM shot is in three hours.
 
Arkali said:
Her next BG test is in two hours, PM shot is in three hours.
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Let's see where she's at then

There's no reason you should be testing and then waiting an hour to shoot either. Lantus usually takes 2-3 hours to start to kick in, so most of us Test/Feed/Shoot all within 5-10 minutes.

You Test to make sure she's high enough, Feed to make sure she's at least willing to eat and not sick and totally refusing, and Shoot....usually with their head still in the bowl!

Even if she doesn't eat a "normal" meal, you should still have 2-3 hours to get her to eat more
 
Arkali said:
If anyone has suggestions, I'd appreciate it.
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If you're following SLGS, my suggestions would include:
  • Stick with the 0.5u dose for now. Gypsy "earns" a 0.25u dose reduction if she drops below 90.
  • Re-read, study, and follow the guidelines in the section called "How to handle a lower than normal preshot number" in the SLGS Method. You've been shooting insulin on LOW preshot numbers blindly... without having any data to support your decisions. For Gypsy's sake, I'll be blunt. You're very, very lucky you haven't had to deal with a what easily could have turned into a horrific catastrophe by shooting so low with such limited data, knowledge, and experience.
  • Post every day so others can help/offer suggestions and advice as events unfold.
I think this is a good place to start. I'm sure others will add their own thoughts.

What do you think?
 
Hi, @Chris & China ! Thanks--I'm only offset today because I'm running a curve. Way too much detail, but the standard routine is up at 6, take BS (that's actually +9), then PSAM @ 9 a.m.. But with the curve, I've been doing tests every 2 hours, which is kind of overlapped with her PMPS tonight. They pretty much eat all day, so food goes down at 6 and 6, but I make sure she eats. Hope that's clear.
 
Arkali said:
And only shoot tonight if she's over 90, correct?
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Right

Arkali said:
standard routine is up at 6, take BS (that's actually +9), then PSAM @ 9 a.m..
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If you don't want to shoot until 9am, that's fine....you can still feed at 6 (no food after 7) and then Test at 9am/Feed/Shoot

You should always test immediately before shot time....just a short amount of time can sometimes make a big difference in the number you get

It's important to feed at the right times....the way insulin works has a lot to do with feeding too
 
Arkali said:
Thank you, I will. And only shoot tonight if she's over 90, correct?
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Not necessarily. You'll want to follow the guidelines in the sticky:

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.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Basaglar, and Levemir users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:
  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near usual preshot numbers:
  • Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, your goal is to achieve flat numbers that are greater than 90, so there is no need to push a cat into numbers lower than that.
 
Chris & China said:
If you don't want to shoot until 9am, that's fine....you can still feed at 6 (no food after 7) and then Test at 9am/Feed/Shoot

You should always test immediately before shot time....just a short amount of time can sometimes make a big difference in the number you get

It's important to feed at the right times....the way insulin works has a lot to do with feeding too
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I do on the test / shots. I put her on her little "station" (area on my desk), take her BG levels, then immediately shoot.

Ack. I've been feeding wrong. I generally feed at 6 and 6 and it's just freely available for them to eat all day. I'll start picking it up at 7 though.

Thank you!

One quick question. The guide says:
Hold the dose for at least a week:
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
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If you drop down .25unit because the BG fell to 90 or lower, is that the NEW dose, or is that drop temporary for that shot only? And does the 90 threshold apply to anytime you test in the cycle or only preshots? I think I'm kinda / sorta lined out. At least for the next day or two.
 
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Arkali said:
If you drop down .25unit because the BG fell to 90 or lower, is that the NEW dose, or is that drop temporary for that shot only? And does the 90 threshold apply to anytime you test in the cycle or only preshots? I think I'm kinda / sorta lined out. At least for the next day or two.
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That threshold applies to any time during that cycle. However, post for advice.. Back to back reductions usually don't work (just don't look at Rex's SS :rolleyes:). You're doing well!
 
Arkali said:
If you drop down .25unit because the BG fell to 90 or lower, is that the NEW dose
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That's the new dose.….we call it "earning a reduction"....We hope they will "earn" their way all the way to zero!!

You'd hold that dose for 7 days (on SLGS) UNLESS she drops below 90 again. If she drops below 90 again on the new reduced dose, ask for advice....sometimes we may have you hold the dose, but usually we're going to suggest a lower dose

Arkali said:
does the 90 threshold apply to anytime you test in the cycle
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Anytime....At Pre-shot or anywhere in between
 
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Oh! Thank you for explaining it. That makes sense. Would you stick with .5 tonight? I feel like I should She's all over today , but she's been stressed too.
 
64 now. So no shot, correct? I'll test her at least once more tonight, probably in a couple of hours, but plan for the next shot to be .5 in the AM?

Thank y'all for walking me through this!
 
Chris & China said:
Yes, if she's high enough
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Which would be 150+ or 90+? This is my confusion kicking in again. :banghead: I'm thinking in Gypsy's case on the Relion that it would be okay if she's +90?

Somewhat related--I had her shot ready to go. I recapped it and stuck it back in the fridge, but I'm wondering if I should just chuck it and start fresh in the morning?

Thanks!
 
I just want to say again to everyone here thank you so much for your patience with me. I'm sure you probably wanted to shake me a time or three because I was having trouble getting it, but thank you!
 
+2 was 101. Not too shabby for no shot. That's probably the last test for the night. There will be a plus 9 in the morning at 6 a.m., then we'll see for tomorrow. Even though I'll be up for a couple of more hours (work has been less than optimal today, and deadlines loom), I feel like I did her curve and got her numbers, so mission accomplished. I bet Gypsy will be glad to lounge around tomorrow :-)
 
Dosing question for today: We're two hours off from AMPS (9 a.m.) At 7:30, she was 89. Should I:
a) Hold her shot if she's still below 150?
b) When she gets her next shot, should I reduce to .25? (she's currently on .5, but hasn't been there long.)

Thank you!
 
My opinion is to hold the 0.5u because you shot that once and it is possible the 0.75u depot is still in play. But don't shoot if it is still under 150.
 
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