? Charlotte +11 219; safe to shoot reduced dose??

Gill & George said:
Can you grab a test before you head out to work?
Grab a +11 and and amps?
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Sorry I missed this earlier. Yes I can get a + 11 and hopefully a amps. I was trying to shift her back some as we got out of whack with that earlier drop a few days ago so it’s messed up the timing. If she is in the hundreds I am worried about giving her .1 units however bc I won’t be home to test until 10 hours later. She is fed by my daughter and mom but they can’t test. What to do if this should happen in the morning???
 
She's flattened out.

Feed iLc if you would usually at this time. Or just leave her be for now.
Perhaps a +9 or +10?

On your signature it says slgs. Is that still correct?

As for tonight, with work, what's the latest you can realistically monitor till?
 
Gill & George said:
She's flattened out.

Feed iLc if you would usually at this time. Or just leave her be for now.
Perhaps a +9 or +10?

On your signature it says slgs. Is that still correct?

As for tonight, with work, what's the latest you can realistically monitor till?
Click to expand...
Work is tomorrow morning. So I would like to be in bed no later than 11:30 pm. She is due for insulin at 8:30 pm so I can’t get too many checks in. I get up at 6 am unless she has me awake with her shenanigans! I didn’t change anything to TR bc with my work, I can’t be late or call in. Can we not get her into a possible remission via SLGS method?? I can do a +9/10 as well
 
Charlotte’s mom said:
Can we not get her into a possible remission via SLGS method??
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I was just double checking that you were still doing that so I could advise you how to proceed with your chosen dosing method.
Charlotte’s mom said:
Sorry I missed this earlier. Yes I can get a + 11 and hopefully a amps. I was trying to shift her back some as we got out of whack with that earlier drop a few days ago so it’s messed up the timing. If she is in the hundreds I am worried about giving her .1 units however bc I won’t be home to test until 10 hours later. She is fed by my daughter and mom but they can’t test. What to do if this should happen in the morning???
Click to expand...
Getting a +11 is really helpful. Knowing whether she is in the rise at PS, can influence your decision.
I always tried to think that I was shooting the number George would be at onset, not what I was getting at PS. So if she is already rising at AMPS, by the time she onsets, between the normal rise she gets after eating and the effect of the insulin cycle waning she will likely be higher by onset (typically around +2)

So lets look at todays cycle, she dropped like a rock at +1, this morning she was clearing a bounce, she hit those 40's, that sent her into pinks and last nigh she started clearing, this morning she was still clearing (that amps was the clue, it was lower than +7). So she dropped 70pts by +1, the good news is the KD(HC 27%) slowed her, and you were able to manage her BG with it and with the MC later (the temptation treats, cloud things a wee bit for the reasons I explained before).

So tomorrow morning, it's not the absolute figure you should be looking at, when you are making your decision, but rather how that compares to the last test you got in the evening. If this were me though, given the situation that you are in at the moment I would probably get up one hour earlier and get a +11. As that will give you a surer picture of whether the amps is rising falling or flat.
If she were dropping or flat at amps tomorrow, that increases the probability of an active cycle. So if faced with that, there are two options
1) skip
2) shoot, but take cautionary action with food to steer the cycle.
With your mum and Daughter being there, if you were worried, you could get them to feed higher than usual carb in the early part of the cycle so that you effectively abort it. Getting them to feed much like we did today with HC say at +1 and +2 then moving onto MC at +3 and +4. If you overdo the carbs she might be a bit high by pmps, because you will have effectively shortened the duration by feeding the higher carb food. When I had to leave George and he was dropping I would usually err on the side of caution, and opt for higher carbs than I would if I was able to monitor.

Now as for the dose tonight, with slgs and that 72 she earned a reduction.
So you could do a micro dose by holding the plunger firmly down, inserting into the vial/pen and then releasing, as you release the plunger a small amount of insulin will be sucked up. I usually found this was about 1 drop.
Another option is to measure 0.1u, then see how many drops that is. (I found for me that was about 3 drops), but lets say if you did that and you found that it was 4 drops, you could draw 0.1u, then squeeze out 2 drops, so that will leave you with another 2 in the syringe and that would be what you would shoot.
She really doesn't look ready to come of insulin, but you need to find a way of being able to get insulin into her as well as keeping her safe, that might mean needing to feed slightly higher LC food in an attempt to slow her drops. I would also strongly recommend keeping away from the kibble and the temptation treats as their effects can skew her BG's.

If she happens to be really high at pmps tonight (pink), and it seems as though she is bouncing, you could try shooting through the bounce tonight, that means you would hold the 0.1u tonight, taking the reduction tomorrow morning, this can help reduce the bounce.
As you are able to test until +3, tonight.
If this were me, I would plan to shoot (unless she was to low/below 90 for slgs) then I would get a +1 and +3, (if she were dropping at +1 then do like we did this morning.
If numbers were dropping at +3, give her a higher carb meal, and leave food out for her. (do you have an auto feeder?)
 
Gill & George said:
I was just double checking that you were still doing that so I could advise you how to proceed with your chosen dosing method.

Getting a +11 is really helpful. Knowing whether she is in the rise at PS, can influence your decision.
I always tried to think that I was shooting the number George would be at onset, not what I was getting at PS. So if she is already rising at AMPS, by the time she onsets, between the normal rise she gets after eating and the effect of the insulin cycle waning she will likely be higher by onset (typically around +2)

So lets look at todays cycle, she dropped like a rock at +1, this morning she was clearing a bounce, she hit those 40's, that sent her into pinks and last nigh she started clearing, this morning she was still clearing (that amps was the clue, it was lower than +7). So she dropped 70pts by +1, the good news is the KD(HC 27%) slowed her, and you were able to manage her BG with it and with the MC later (the temptation treats, cloud things a wee bit for the reasons I explained before).

So tomorrow morning, it's not the absolute figure you should be looking at, when you are making your decision, but rather how that compares to the last test you got in the evening. If this were me though, given the situation that you are in at the moment I would probably get up one hour earlier and get a +11. As that will give you a surer picture of whether the amps is rising falling or flat.
If she were dropping or flat at amps tomorrow, that increases the probability of an active cycle. So if faced with that, there are two options
1) skip
2) shoot, but take cautionary action with food to steer the cycle.
With your mum and Daughter being there, if you were worried, you could get them to feed higher than usual carb in the early part of the cycle so that you effectively abort it. Getting them to feed much like we did today with HC say at +1 and +2 then moving onto MC at +3 and +4. If you overdo the carbs she might be a bit high by pmps, because you will have effectively shortened the duration by feeding the higher carb food. When I had to leave George and he was dropping I would usually err on the side of caution, and opt for higher carbs than I would if I was able to monitor.

Now as for the dose tonight, with slgs and that 72 she earned a reduction.
So you could do a micro dose by holding the plunger firmly down, inserting into the vial/pen and then releasing, as you release the plunger a small amount of insulin will be sucked up. I usually found this was about 1 drop.
Another option is to measure 0.1u, then see how many drops that is. (I found for me that was about 3 drops), but lets say if you did that and you found that it was 4 drops, you could draw 0.1u, then squeeze out 2 drops, so that will leave you with another 2 in the syringe and that would be what you would shoot.
She really doesn't look ready to come of insulin, but you need to find a way of being able to get insulin into her as well as keeping her safe, that might mean needing to feed slightly higher LC food in an attempt to slow her drops. I would also strongly recommend keeping away from the kibble and the temptation treats as their effects can skew her BG's.

If she happens to be really high at pmps tonight (pink), and it seems as though she is bouncing, you could try shooting through the bounce tonight, that means you would hold the 0.1u tonight, taking the reduction tomorrow morning, this can help reduce the bounce.
As you are able to test until +3, tonight.
If this were me, I would plan to shoot (unless she was to low/below 90 for slgs) then I would get a +1 and +3, (if she were dropping at +1 then do like we did this morning.
If numbers were dropping at +3, give her a higher carb meal, and leave food out for her. (do you have an auto feeder?)
Click to expand...
Wow!! You sure know your lantus and it’s effects!! So I don’t have an auto feeder unfortunately. I will probably have my daughter and mom feed her a MC food for now. Right now she is at 139. Dropping still from 3 hours ago. Gosh she is confusing me!!
 
Charlotte’s mom said:
You sure know your lantus and it’s effects!!
Click to expand...
This is from the basics new to the group sticky, it's a piece of, IMHO opinion, valuable info that helps to get the action of Lantus straight in your head. If you then compare what you are seeing to what you would expect, it can offer clues to how a cycle may play out.
Example of an ACTIVE, but NOT necessarily typical Lantus/Basaglar cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar 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. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+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/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
 
Gill & George said:
This is from the basics new to the group sticky, it's a piece of, IMHO opinion, valuable info that helps to get the action of Lantus straight in your head. If you then compare what you are seeing to what you would expect, it can offer clues to how a cycle may play out.
Example of an ACTIVE, but NOT necessarily typical Lantus/Basaglar cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar 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. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+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/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
Click to expand...
Ok. This is much clearer. I should have Charlotte take notes bc right now she is not following protocol!! And while we see all of this in a typical cycle, these cats are fed ad lib LC, correct?? I don’t have specific times I always feed except of course before each shot. At night she doesn’t always eat before I shoot but if she is in the 200s I don’t worry as much bc I know she’ll eat in at least an hour within shooting. She seems to want to eat more at will at night.
 
Charlotte’s mom said:
And while we see all of this in a typical cycle, these cats are fed ad lib LC, correct??
Click to expand...
I'm not sure what you mean?

George didn't/doesn't free feed, he's a greedy guts.
Initially I fed at PS and at +6.
Later I changed this to
main meal at PS then snack at +1 +3 +5 (because I had the luxury of being at home if he was showing an active cycle I would change that to steer his numbers) I kept the pm and am cycle programmed feeds the same.
Once he got regulated I changed his feeds to PS +3 +6 +9, that's what he still get's even now he is OTJ, FD kitties do better with food spread through the cycle.
I usually tried to avoid feeding in the latter half of the cycle, in some cats feeding in the latter half of the cycle can shorten duration and result in bumping the numbers up.

I do think you should be feeding more than at just amps and pmps, not in volume, same volume, but spread it out over PS meal and then some mini meals in the early part of the cycle.

as an example
I fed 3ounces at PS then 1ounce at +1 +3 +5 (he got extra if I needed to bump numbers up)
 
Gill & George said:
I'm not sure what you mean?

George didn't/doesn't free feed, he's a greedy guts.
Initially I fed at PS and at +6.
Later I changed this to
main meal at PS then snack at +1 +3 +5 (because I had the luxury of being at home if he was showing an active cycle I would change that to steer his numbers) I kept the pm and am cycle programmed feeds the same.
Once he got regulated I changed his feeds to PS +3 +6 +9, that's what he still get's even now he is OTJ, FD kitties do better with food spread through the cycle.
I usually tried to avoid feeding in the latter half of the cycle, in some cats feeding in the latter half of the cycle can shorten duration and result in bumping the numbers up.

I do think you should be feeding more than at just amps and pmps, not in volume, same volume, but spread it out over PS meal and then some mini meals in the early part of the cycle.

as an example
I fed 3ounces at PS then 1ounce at +1 +3 +5 (he got extra if I needed to bump numbers up)
Click to expand...
Yes I do feed in frequent small meals when she seems to get vocal or she seems to be more needy. That is what I meant. I don’t give these small meals at any specific times like + 3,+6 etc. She will get it offered at breakfast then mid morning, lunch, midafternoon, dinner then before bed. I usually have to feed again sometime in the night bc she is all over me until I get up. These meals are all like a heaping teaspoon in size. And she doesn’t usually finish what I give her at any of these meals unless she is diving like this morning then she will lick the bowl clean. Maybe a dehydrated chicken treat now and then but not routinely.
 
Sounds like she is getting small regular snacks, which is good, I was worried she was only getting food at amps and pmps (some vets still suggest this) and that, in our experience is not what works best with Lantus.
I would avoid feeding regular food snacks in the latter half of the cycle.
With George I found that the FD treats didn't affect is BG so if he got really vocal about food I'd give him a couple of pieces of that (it's what he got for his pokey treat as well).
Some folk who find their kitty doesn't do well with going without food for long periods poach a bit of chicken breast, cut it into small pieces and give those as a little treat later in the cycle without much effect on BG. ECID though some kitties can get a bump even from these low carb snacks.
 
I just wanted to let you know that it's late here for me(gone 11pm) and I am of to catch some zzz's.
Hopefully you have some info to help you make an informed choice tonight and tomorrow.

Perhaps grab a +11 and if she's still dropping post up, alter your title to reflect the most recent numbers, and ask for help if you think it's likely to be a difficult decision come pmps that way you give folk a chance to get back to you.
 
Gill & George said:
I just wanted to let you know that it's late here for me(gone 11pm) and I am of to catch some zzz's.
Hopefully you have some info to help you make an informed choice tonight and tomorrow.

Perhaps grab a +11 and if she's still dropping post up, alter your title to reflect the most recent numbers, and ask for help if you think it's likely to be a difficult decision come pmps that way you give folk a chance to get back to you.
Click to expand...
Thanks for all of your help today!! Much appreciated!
 
So... in about 15 minutes, I will need to give Charlotte insulin again. Bc she went below 90 today, she should get another reduction, correct? And this will be about a drop bc she was already at .1 units. I can monitor her for +1 PMPS and +3 but need to go to sleep after that. Thoughts from all the gurus?? George and Gil have gone to bed. Thanks!!
 
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