Lily 11/17 AMPS 234

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Sally and Lily said:
Lily is doing well, eating good and her AMPS is at a level I can give her insulin with hardly any anxiety! Hope everyone has a wonderful day! :)
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Ok, as I was giving Lily her shot, I am not sure if she got it or if I got it because I stuck my thumb just not sure if it was before or after Lily. :banghead: I guess we will see with her numbers today.
 
Sorry for not getting back till now (trying to sort some stuff and lost track of time thanks to the PTSD - hence why I normally set alarms).

I'd suggest grabbing another test at +4.5 to see whether she's dropped further. Will check back with you in 10 mins. (Setting an alarm! :oops: )


Mogs
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More reading for you, Sally, from the Lantus stickies:

Becoming Data Ready and Handling of Low Numbers

For the way Lily is responding to her Lantus and with such a small dose, she may not give you much time to follow the SLGS dosing method (reduction of 0.25IU earned when kitty drops below 90 for Start Low, Go Slow, below 50 for Tight Regulation). Therefore I think it would be helpful to gen up on how to work with lower numbers sooner rather than later. Even when following SLGS, there are some very helpful pointers on when to test and how to interpret the readings you take in the above sticky.

As always, post for help when you need it: it helps to have someone provide a bit of support when you first start working with lower numbers. It can be quite daunting at first, so the bit of assistance from members experienced in managing kitties at lower numbers helps a great deal. (I speak from experience! :) ) As treatment continues confidence will grow and the techniques will become second nature.


Mogs
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Sally and Lily said:
She is at 114 at 4.5!!
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Sally and Lily said:
I tested her at +5 and she is 108
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That's a really nice steady surf in blue numbers.

Given that Lily's responding so well even without a fully established Lantus depot, I think you need to prepare yourself to see green numbers very soon, possibly in the next cycle, as the depot starts to fill.

It's kinda weird when one starts seeing greens. It's typically a mix of "Holy cow!" panic at their lowness and cautious delight at seeing your little one back in really healthy numbers again. :)


Mogs
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Critter Mom said:
That's a really nice steady surf in blue numbers.

Given that Lily's responding so well even without a fully established Lantus depot, I think you need to prepare yourself to see green numbers very soon, possibly in the next cycle, as the depot starts to fill.

It's kinda weird when one starts seeing greens. It's typically a mix of "Holy cow!" panic at their lowness and cautious delight at seeing your little one back in really healthy numbers again. :)


Mogs
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Well, you are right she is 86 at +6.
 
Critter Mom said:
That's a really nice steady surf in blue numbers.

Given that Lily's responding so well even without a fully established Lantus depot, I think you need to prepare yourself to see green numbers very soon, possibly in the next cycle, as the depot starts to fill.

It's kinda weird when one starts seeing greens. It's typically a mix of "Holy cow!" panic at their lowness and cautious delight at seeing your little one back in really healthy numbers again. :)


Mogs
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Should I give her some more lc?
 
Excellent. You're at the stage where it's getting more likely that you might need them to steer Lily's numbers through the lowest part of the cycle.

The technique is very similar to what you did with the LC yesterday, but at the lower end of the range a little bump from, say, some MC food will enable a kitty to surf safely in the lower part of the normal range so as to allow the pancreas to get as much rest as possible.

What are your thoughts about how Lily's responding thus far? Are you feeling OK about it?


Mogs
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Critter Mom said:
Excellent. You're at the stage where it's getting more likely that you might need them to steer Lily's numbers through the lowest part of the cycle.

The technique is very similar to what you did with the LC yesterday, but at the lower end of the range a little bump from, say, some MC food will enable a kitty to surf safely in the lower part of the normal range so as to allow the pancreas to get as much rest as possible.

What are your thoughts about how Lily's responding thus far? Are you feeling OK about it?


Mogs
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I think she is doing great but I have anxiety! What is an example of mc food?
 
Critter Mom said:
Roughly...

LC = <10%

MC = 10-19%

HC = >=20%

IIRC FF Gravy Lovers beef variety is 20% (HC), the other flavours are 15% (MC).

Temptations treats are c. 30% (VHC!). Many dry foods are also in the 30s.


Mogs
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Critter Mom said:
Good, held her. I'd suggest another tsp LC and test again at +7.

It's a lot of tests at the moment but the purpose is to establish how sensitive Lily is to carbs. It will help you learn what to feed and when to steer her numbers safely.


Mogs
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She is 74 at +7 but she just got thru with her small LC
 
The BG readings you took over the last couple of weeks - especially in the first weeks - are really helpful because they show how Lily's pancreas is doing:

1. She got a fair bump in BG from her morning and evening feeds.

2. BG dropped again a few hours later, showing that the pancreas was producing a pulse of insulin after she ate (but just not enough right now).

3. Numbers slowly reduced over the course of the cycle, as shown by the fact that her PS BG readings were back in the blues. This indicates that her pancreas was producing a basal trickle of insulin between feeds, just not enough to get her into non-diabetic levels.

Those pulses and trickles will still be in effect now and will serve to enhance the effect of the Lantus and that may be a factor in her numbers dropping later in the cycle as you saw at the end of yesterday's cycle and also in the later part of the middle of the cycle today. This is overall a good thing but once the depot builds up to any degree it may see Lily getting into the low end of the normal range, possibly a little bit under the lower limit of the normal range (50 on a human meter) in need of carb intervention to see her safely to the end of the cycle.

The SLGS protocol gives a threshold of 90 (human meter) for dose reductions, i.e. if a kitty drops below 90 then the dose should be decreased by 0.25IU. Given that you're already on 0.25IU BID that leads to to the catch-22 of Lily needing some insulin but if you reduce by 0.25 that would lead to the dose being zero. However, in circumstances such as this, with Lantus there is the option to go to a dose of 0.1IU and I think that that is a good option for you to consider unless you want to go straight away to TR and only reduce the dose if Lily drops below 50. Given the way that Lily is already responding to her Lantus that is likely to involve a lot of intensive monitoring and an inversely proportional amount of sleep, especially as you've not had a chance to build up much data for Lily on Lantus and there would be doubly the need for very close monitoring.

Some members would advocate your switching to TR straight away. I tend to be more conservative in my approach to insulin treatment (especially when Lily's already getting good numbers without the 0.25IU depot fully established). If I was in this situation I'd be inclined to take the reduction in line with SLGS guidelines (i.e. BG dropped below 90), go down to the 0.1IU dose and gather more data. The dose can always be increased again should the 0.1IU prove to be not quite enough. Also, you can opt to switch to TR at any time. I'm tagging Elise (@tiffmaxee) to ask her to look at Lily's spreadsheet and to review this suggestion to see what thoughts she has and what she would recommend.

I'd also suggest adding a small LC meal (substantial feed instead of a couple of tsps) to Lily's regular routine at +3 (and maybe, after a little more data is gathered, another one at +6) to see if it might give her levels a little bit of a boost through the middle of the cycle (again, you'd still need to keep an eye on BG levels just in case her pancreas might 'sputter' and produce a pulse of insulin on top of the Lantus dose leading to a drop in BG levels). There's a lot of trial and error involved to find out what works for each kitty.

What do you think yourself, Sally?


Mogs
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Sally and Lily said:
She is 115 at +8
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I'd say you're good till +9 now, Sally. If she drops back again at +9 try feeding her a 'mini meal' of LC to see whether that might help hold her levels up for the rest of the cycle. Again I'd suggest grabbing the tests at AM+11.5 and then PMPS so that you'll have a better feel for whether she's rising or dropping when making your dosing decision this evening.


Mogs
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Here's the sticky from the Lantus board on fine dosing:

https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

About 3/4 of the way down there are pictures of how to measure the really small doses (0.1IU and 'drop').

Just to make sure I'm clear, according to SLGS Lily earned the 0.25IU dose reduction today (the 86 and 74 rdgs).

I'd be grateful if you could let me know what you'd like to do.


Mogs
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Critter Mom said:
Here's the sticky from the Lantus board on fine dosing:

https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

About 3/4 of the way down there are pictures of how to measure the really small doses (0.1IU and 'drop').

Just to make sure I'm clear, according to SLGS Lily earned the 0.25IU dose reduction today (the 86 and 74 rdgs).

I'd be grateful if you could let me know what you'd like to do.


Mogs
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Thanks Mog. I really would like to drop her dose to 0.1IU. I think that is the best thing to do for my schedule and I think Lily will do well with it. Appreciate all your great info. I have a lot of studying to do!
 
Critter Mom said:
I'd say you're good till +9 now, Sally. If she drops back again at +9 try feeding her a 'mini meal' of LC to see whether that might help hold her levels up for the rest of the cycle. Again I'd suggest grabbing the tests at AM+11.5 and then PMPS so that you'll have a better feel for whether she's rising or dropping when making your dosing decision this evening.


Mogs
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Mogs she is 130 at +9, should I hold off on feeding her a little?
 
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