12/28 Need advise for Lily

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Yes. I would go up to .25. You don’t want to hold a dose longer than 7 days unless it’s a good dose. She’s seeing nadirs in the 100’s but you want to see Nadirs under 100.
 
Hi Sally,

Hope your Christmas went well. :)

I've been keeping an eye on Lily's spreadsheet as usual, and agree that the dose needs to be increased to 0.25IU. According to SLGS, the dose should have been upped a couple of days ago but I didn't suggest it earlier because Christmas. With the dose increase you may well need to monitor more intensely if Lily's response is very strong. Trying to do that on top of all the yuletide stuff might have been a bit too much of an ask.

BTW, I think that the pinks you have been seeing may have a bit of a bouncy element to them, and I do wonder whether sometimes Lily might be dropping a little lower in the second half of the PM cycle.

How is Lily doing with the timed feeder now?


Mogs
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Critter Mom said:
Hi Sally,

Hope your Christmas went well. :)

I've been keeping an eye on Lily's spreadsheet as usual, and agree that the dose needs to be increased to 0.25IU. According to SLGS, the dose should have been upped a couple of days ago but I didn't suggest it earlier because Christmas. With the dose increase you may well need to monitor more intensely if Lily's response is very strong. Trying to do that on top of all the yuletide stuff might have been a bit too much of an ask.

BTW, I think that the pinks you have been seeing may have a bit of a bouncy element to them, and I do wonder whether sometimes Lily might be dropping a little lower in the second half of the PM cycle.

How is Lily doing with the timed feeder now?


Mogs
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Hi Mogs! Our Christmas was nice. I missed seeing most of the family but did cook for my crew. Hope yours was good too.

I was thinking the same thing about the pinks. I will set my alarm a few times at night and check her. She now eats great with her feeder, even the +6 that she used to sleep thru. She has gained some weight and is probably back to her 8 lbs now.
 
tiffmaxee said:
When yiu hold a dose too long ,you end up needing more insulin in the long run.
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I am well aware of this.

Under normal circumstances I would have posted on Sally's previous thread to suggest the dose increase sooner. For right or wrong, I made an allowance for the demands on people's time common at this time of year. I was concerned that with the larger dose and the associated build-up of a larger depot there was a potential risk that Sally might be put into a position where she might have to drop everything else going on with her family in order to intensively monitor Lily for safety. It was an avoidable risk, and only involved a brief delay before the dose could be increased in a much less pressurised environment.


Mogs
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Glad to hear that you had a nice Christmas in spite of covid and the fact that you couldn't get together with the rest of the family. Patty told us how sad she was about that too.

Delighted to hear that Lily's getting on better with her feeder now and, better again, that her weight is improving. (((Lily))) :cat:


Mogs
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Critter Mom said:
Glad to hear that you had a nice Christmas in spite of covid and the fact that you couldn't get together with the rest of the family. Patty told us how sad she was about that too.

Delighted to hear that Lily's getting on better with her feeder now and, better again, that her weight is improving. (((Lily))) :cat:


Mogs
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Thanks so much for keeping up with us Mogs!!!!
 
Critter Mom said:
I am well aware of this.

Under normal circumstances I would have posted on Sally's previous thread to suggest the dose increase sooner. For right or wrong, I made an allowance for the demands on people's time common at this time of year. I was concerned that with the larger dose and the associated build-up of a larger depot there was a potential risk that Sally might be put into a position where she might have to drop everything else going on with her family in order to intensely monitor Lily for safety. It was an avoidable risk, and only involved a brief delay before the dose could be increased in a much less pressurised environment.


Mogs
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I wasn’t criticizing you. I was pointing this out for Sally.
 
Just seen Lily's spreadsheet. Bet you're glad you didn't increase the dose earlier this evening, Sally, with your girl clearing that bounce. :) Hope she levels out soon so you can get some sleep. :bighug:


Mogs
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Critter Mom said:
Just seen Lily's spreadsheet. Bet you're glad you didn't increase the dose earlier this evening, Sally, with your girl clearing that bounce. :) Hope she levels out soon so you can get some sleep. :bighug:


Mogs
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Morning Mogs! Looks like she is might be headed back up. Do you think I should hold off on her increase?
 
Hi again.

Lily didn't drop below the 130 last night so there's a lot of room for improvement at nadir. As Bhooma says above, the increase to 0.25IU is definitely indicated so I'd go ahead with it this morning.

Based on previous days, Lily might bounce a little today.

You OK with this, Sally?


Mogs
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Critter Mom said:
Hi again.

Lily didn't drop below the 130 last night so there's a lot of room for improvement at nadir. As Bhooma says above, the increase to 0.25IU is definitely indicated so I'd go ahead with it this morning.

Based on previous days, Lily might bounce a little today.

You OK with this, Sally?


Mogs
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Yes I am fine with it. I will be able to test her as much as needed. I want o see those blues and greens! Thanks!
 
You doing OK, Sally? I notice that Lily looks to be clearing that bounce big time.

Remember that if you need help and FH is quiet, try tagging Bhooma (Bandit's Mom) or Bron (Bron and Sheba (GA) ). NB: Sometimes tags don't go through so you could also try sending them a PM with the link to your thread. Also, you can always try posting for help on the Lantus board.


Mogs
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Critter Mom said:
You doing OK, Sally? I notice that Lily looks to be clearing that bounce big time.

Remember that if you need help and FH is quiet, try tagging Bhooma (Bandit's Mom) or Bron (Bron and Sheba (GA) ). NB: Sometimes tags don't go through so you could also try sending them a PM with the link to your thread. Also, you can always try posting for help on the Lantus board.


Mogs
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Yes, we are doing well! Thanks for the reminder Mogs, hope she will level out but I will keep checking her tonight. Have a great night and really appreciate you!!:bighug::bighug::bighug:
 
Hi Sally, just an observation. Even with SLGS, you held onto the 0.1u a little longer than you needed to, after 7 days of the same dose, and nadirs above 150 you can increase. You are testing enough to get a sense of how low the dose was taking Lily. Best not to let her get too used to the higher numbers. Good luck with the increase :)
 
Christie & Maverick said:
Hi Sally, just an observation. Even with SLGS, you held onto the 0.1u a little longer than you needed to, after 7 days of the same dose, and nadirs above 150 you can increase. You are testing enough to get a sense of how low the dose was taking Lily. Best not to let her get too used to the higher numbers. Good luck with the increase :)
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Thanks Christie!
 
Hi Sally,

Happy New Year to all of you.

I've been following along as usual and I notice that Lily's in higher numbers again. There's been no obvious trigger for a bounce so I am wondering whether it's possible you might be seeing something referred to here as New Dose Wonkiness (NDW). Here's info about it:

https://www.felinediabetes.com/FDMB/threads/new-dose-wonkiness-ndw-and-failed-reductions.46012/

While it's more often seen a bit sooner after a dose increase, as the first couple of posts in the above thread advise, the phenomenon may occur several days after a dose increase. In particular, there's a recommendation to be alert to the possibility that there may be a sudden improvement in numbers as the dose 'settles'.


Mogs
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Critter Mom said:
Hi Sally,

Happy New Year to all of you.

I've been following along as usual and I notice that Lily's in higher numbers again. There's been no obvious trigger for a bounce so I am wondering whether it's possible you might be seeing something referred to here as New Dose Wonkiness (NDW). Here's info about it:

https://www.felinediabetes.com/FDMB/threads/new-dose-wonkiness-ndw-and-failed-reductions.46012/

While it's more often seen a bit sooner after a dose increase, as the first couple of posts in the above thread advise, the phenomenon may occur several days after a dose increase. In particular, there's a recommendation to be alert to the possibility that there may be a sudden improvement in numbers as the dose 'settles'.


Mogs
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I was wondering why I haven’t seen any improvements in Lily’s BG ! This would explain it. Thanks for watching out for us Mogs!! Happy New Year!!
 
Hi Sally,

There's no guarantee that NDW is what's going on here, but after bouncing it's the next thing to consider, especially as one needs to be watchful for an improvement as the dose depot gets better established. Remember that infections and the like can also elevate BG levels (but hopefully that's not the case here!).

While I'm here, would you consider moving onto the Tight Regulation dosing method? It is a more aggressive protocol (doses increased faster, reductions earned when BG goes below 50 instead of the 90 threshold used in SLGS) but you're testing frequently enough and if Lily keeps sitting in this higher range it might be the better way to proceed.

Here's the link to the dosing methods sticky so you can review the differences:

Lantus Dosing Methods: SLGS and TR


Mogs
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Critter Mom said:
Hi Sally,

There's no guarantee that NDW is what's going on here, but after bouncing it's the next thing to consider, especially as one needs to be watchful for an improvement as the dose depot gets better established. Remember that infections and the like can also elevate BG levels (but hopefully that's not the case here!).

While I'm here, would you consider moving onto the Tight Regulation dosing method? It is a more aggressive protocol (doses increased faster, reductions earned when BG goes below 50 instead of the 90 threshold used in SLGS) but you're testing frequently enough and if Lily keeps sitting in this higher range it might be the better way to proceed.

Here's the link to the dosing methods sticky so you can review the differences:

Lantus Dosing Methods: SLGS and TR


Mogs
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Yes Mogs, we can move to TR if you recommend. I want to do all I can for Lily and do appreciate your input!
 
Hi Sally,

I'm going to tag @tiffmaxee to ask her to please review your spreadsheet and ask her whether she thinks NDW might be at work here (in which case it might be better to hold the 0.25IU dose for at least a couple more cycles to see whether it will clear and BG levels improve) or whether to make the switch to TR in the morning (in which case tonight will be the 6th cycle on 0.25IU and, in line with the TR guidelines, the dose would be due for an increase to 0.5IU starting tomorrow morning).

How do you think you'd like to play things yourself, Sally? (Remember to take into account how you're fixed for monitoring if considering the dose increase tomorrow - you haven't had time to plan for it, so I thought it best to check how you're set.)


Mogs
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Critter Mom said:
Hi Sally,

I'm going to tag @tiffmaxee to ask her to review your spreadsheet and ask her whether she thinks NDW might be at work here (in which case it might be better to hold the 0.25IU dose for at least a couple more cycles to see whether it will clear and BG levels improve) or whether to make the switch to TR in the morning (in which case tonight will be the 6th cycle on 0.25IU and, in line with the TR guidelines, the dose would be due for an increase to 0.5IU starting tomorrow morning).

How do you think you'd like to play things yourself, Sally? (Remember to into account how you're fixed for monitoring if considering the dose increase tomorrow - you haven't had time to plan for it, so I thought it best to check how you're fixed.)


Mogs
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Sounds good. I am good to monitor in the morning.
 
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