1/10/21 - Squeaky! AMPS=114 +7=78 PMPS=132

Hi JanD,

Not an expert at all, but I would guess you keep the same dose as before? My understanding is that switching toSLGS will just change the way to adjust the dose from here on?
 
With SLGS you take reductions if he goes below 90. Once a week you do a curve to make a decision on if you need to adjust his dose. Since Squeaky is so hard for you to test, you could look back at his numbers from the previous week to see where his nadir is and make the decision on whether to adjust. Note for lurkers, this is advice just for Jan due to her circumstances with Squeaky.
 
Hi JanD,Not an expert at all, but I would guess you keep the same dose as before? My understanding is that switching toSLGS will just change the way to adjust the dose from here on?
If you are switching to SLGS, he earned a reduction yesterday be going below 90. His new dose should be 3.5 units. I'll type more in a minute.
With SLGS you take reductions if he goes below 90. Once a week you do a curve to make a decision on if you need to adjust his dose. Since Squeaky is so hard for you to test, you could look back at his numbers from the previous week to see where his nadir is and make the decision on whether to adjust. Note for lurkers, this is advice just for Jan due to her circumstances with Squeaky.
I'm glad to see a post from you. I was looking for one yesterday. I hope today will be a better day for you and Squeaky. :bighug::bighug:

Hi Karen and Carla, thank you for your messages! I printed out the SLGS instructions and of course they baffle me, so I'm very glad y'all posted some instructions. Yes I thought we were in for a reduction, Carla since he has been below 90 many times the last several days. Yay.

So now that I'm reducing I'm good for a week unless he goes below 90 again? And if he doesn't then I need to do a curve?

Thanks a bunch!!! :bighug::bighug::bighug::):D:woot:
 
That is correct.
It's still a good idea to get at least one mid cycle test in.
Glad to read you have decided to switch to SLGS! I hope it works out well for both of you.

Thanks Carla and Lyla. Well we will see how it goes! Anything that helps me sleep better is a good idea. And also fewer ear pricks for Squeak.

BTW he is doing much better today, he came and told me so too.

Carla, the only reason to get mid-cycle tests is to see if he goes below 90, right? So if his numbers are a bit higher I could skip, right? He is comfortable with 4 tests a day. Six is already getting too much. I like to keep him comfortable. :)
 
Carla, the only reason to get mid-cycle tests is to see if he goes below 90, right? So if his numbers are a bit higher I could skip, right? He is comfortable with 4 tests a day. Six is already getting too much. I like to keep him comfortable. :)
The reason to get mid cycle tests is to make sure he's not going too low and to keep him safe. If he is in higher numbers you may be able to skip, but some cats are high at PS time and drop low during mid cycle. If you don't get those mid cycle tests you'd think they were high all of the time. You have to figure out what works for you and Squeaky.
 
Just to add to what Carla said - mid cycle tests help paint a full picture of the dose and how squeaky is responding. It's always nice to keep in mind lantus is dosed based on nadir (which can and do move around). So yes we want to see if he goes <90 but you also want to know if he's not and if you need to increase the dose.
 
The reason to get mid cycle tests is to make sure he's not going too low and to keep him safe. If he is in higher numbers you may be able to skip, but some cats are high at PS time and drop low during mid cycle. If you don't get those mid cycle tests you'd think they were high all of the time. You have to figure out what works for you and Squeaky.
Just to add to what Carla said - mid cycle tests help paint a full picture of the dose and how squeaky is responding. It's always nice to keep in mind lantus is dosed based on nadir (which can and do move around). So yes we want to see if he goes <90 but you also want to know if he's not and if you need to increase the dose.

Thanks Gals, What works for us is 4 tests a day. So I need to figure out what circumstances exactly require more testing. If I'm doing a curve once a week, won't that give us a good picture of what's going on?

I suspect I will learn more and understand more as this moves forward.

Also I suspect that while it's great to be perfect, being good enough is probably still good enough! I've made so many mistakes so far and Squeaky is not only still alive, but also he does seem to be improving. So I'm considering perfection at this is not a total requirement.

Sometimes you just gotta scrape by. I have realized that the loss of sleep is pretty much wrecking my life. I feel crummy all the time. So I definitely don't want to wake up to test unless it's necessary. I might just time the tests so I can go to sleep right after and at least get 6 hours of sleep in a row before waking up to test PM nadir.

Your thoughts are so appreciated!
 
What works for us is 4 tests a day. So I need to figure out what circumstances exactly require more testing.
Aside from the 4 tests per day, which is fine by SLGS standards, and the weekly curve, I would say additional testing may be ‘safety’ testing.

Some potential scenarios:
In SLGS, you can shoot any number above 90. So, if you get a number under 90 at preshot, you may need to stall, withhold food and retest. That is one potential scenario.

Another scenario where you would want to retest in a cycle if you see a lower number. While SLGS has a reduction point under 90, and the goal of SLGS is to keep kitty above 90, we know that we don’t want any kitty to drop into un unsafe number. The extra testing would be intended to make sure Squeaky is rising and is staying safe.

Under 50 - absolutely will require tests and following the low number protocol of feeding HC/honey/karo.
https://felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/
https://felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/
In the 50’s-90 - you’ll want to monitor via extra tests to make sure he is safe and coming up. You have been doing good so far feeding these types of numbers from what I can tell on your SS. How many tests, I can’t really give you rules. Every scenario is different and depends on where you are at in the cycle, nadir, etc. If it were my cat and I saw him in the 50’s (and others would probably agree), I would be testing again after feeding (at the latest an hour later) to make sure he wasn’t dropping below 50. 60’s to 90’s depends. This is where ‘know thy cat’ and the data you have collected is important. How easy is it to bring Squeaky up, how carb sensitive, etc.

Again, the goal of SLGS is to keep kitty above 90, but in case you see a lower green number, some food for thought.

If you see a big drop in numbers from preshot to the next test - this could be another scenario for extra testing consideration too.

Maybe others have more advisement, but some potential scenarios (but not all) to consider for additional tests beyond the 4 per day.
 
is another characteristic of the slgs protocol that you don't shoot a preshot that is lower than 90?
That is correct. From the sticky:

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, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.
 
I might just time the tests so I can go to sleep right after and at least get 6 hours of sleep in a row before waking up to test PM nadir.
What about getting a +2 or +3 and then deciding if you need to set an alarm? This is what a lot of us do - generally speaking:
  • If the +2 is about the same as the Pre-shot, usually kitty is going to have a fairly "normal" cycle...slowly dropping to nadir and then slowly heading back up until the next PS
  • If it's higher than the PS, that can indicate the beginning of a bounce and those are the cycles where you can usually get by without testing as much
  • If the +2 is lower than the PS, that's your "early warning"....those are the cycles where it's important to try to get more tests in...but if you can't, you might want to leave some higher carb food down for kitty
I only get up in the middle of the night to test if I know it's going to be an active cycle, I'm going to the bathroom and want to test (lol, IDK), or I am thinking about increasing and want to make sure he's not doing anything funny at night (like dipping lower when I don't think he is...Jax has had a late nadir on occasion).
 
If I'm doing a curve once a week, won't that give us a good picture of what's going on?
A curve once a week might tell you what his nadir is unless he is bouncing on curve day. If you are able to it is better to have the extra tests to help you see what is really going on. I can't get mid cycle tests during the night when I work, but I always try to get a before going to sleep test to make sure Furball stays safe at night.
 
is another characteristic of the slgs protocol that you don't shoot a preshot that is lower than 90?
That is correct. From the sticky:
What about getting a +2 or +3 and then deciding if you need to set an alarm? This is what a lot of us do - generally speaking:
  • If the +2 is about the same as the Pre-shot, usually kitty is going to have a fairly "normal" cycle...slowly dropping to nadir and then slowly heading back up until the next PS
  • If it's higher than the PS, that can indicate the beginning of a bounce and those are the cycles where you can usually get by without testing as much
  • If the +2 is lower than the PS, that's your "early warning"....those are the cycles where it's important to try to get more tests in...but if you can't, you might want to leave some higher carb food down for kitty
I only get up in the middle of the night to test if I know it's going to be an active cycle, I'm going to the bathroom and want to test (lol, IDK), or I am thinking about increasing and want to make sure he's not doing anything funny at night (like dipping lower when I don't think he is...Jax has had a late nadir on occasion).
A curve once a week might tell you what his nadir is unless he is bouncing on curve day. If you are able to it is better to have the extra tests to help you see what is really going on. I can't get mid cycle tests during the night when I work, but I always try to get a before going to sleep test to make sure Furball stays safe at night.

Thank you all for your comments...... OVERWHELM! Okay let's take this one day at a time! I appreciate your guidance and help!!!!! Very very much!!!!!

So what I'd really like to do is go to bed around 10 pm. The way things work with Squeaky, his PMPS can range from 8 to 10 pm. So if I have to get a +2 or +3 then sometimes I have to stay up until 1 pm. That's not workable all the time. Then I have to check again 3 or 4 hours later. BAD sleep.

You know, in the winter I have to sleep more. Also I'm trying to heal a physical condition, and this is not doing me any good. What I want more than anything is to be able to sleep straight through from 10 until 7 or 8 am. I am very sleep deprived right now. I need to get more rest. Sorry for complaining so much. There has got to be a way to do this.

One of my friends who had a diabetic cat, didn't do any of this. She just gave the shot twice a day. No BG tests at home, at all. Her cat went into remission. I am just wondering, can't this be a bit simpler? Or maybe manipulate the food or numbers so I can sleep at night?
 
A curve once a week might tell you what his nadir is unless he is bouncing on curve day. If you are able to it is better to have the extra tests to help you see what is really going on. I can't get mid cycle tests during the night when I work, but I always try to get a before going to sleep test to make sure Furball stays safe at night.

So he had a 78 today after reducing his shot to 3.5. This means next Sunday he gets another reduction, right?
 
Hi Jan,

The 78 today means an automatic reduction of 0.25 on the next available shot. Since you didn’t take the reduction tonight, you could take it tomorrow am and shoot 3.25.

That being said, sometimes back to back reductions don’t hold well, and today’s cycle was still influenced by the 3.75 unit depot that was built up.
 
So he had a 78 today after reducing his shot to 3.5. This means next Sunday he gets another reduction, right?
we aren't using SLGS, but i'm pretty sure that like with TR, all reductions are immediate. meaning, the next time you shoot after going below 90, you reduce by 0.25u

edit to add: looks like tanya and i cross posted :bighug:
 
Hi Jan,

The 78 today means an automatic reduction of 0.25 on the next available shot. Since you didn’t take the reduction tonight, you could take it tomorrow am and shoot 3.25.

That being said, sometimes back to back reductions don’t hold well, and today’s cycle was still influenced by the 3.75 unit depot that was built up.
we aren't using SLGS, but i'm pretty sure that like with TR, all reductions are immediate. meaning, the next time you shoot after going below 90, you reduce by 0.25u

edit to add: looks like tanya and i cross posted :bighug:

Wow! Okay learning curve! Reduction tomorrow! :bighug::bighug::bighug: Many thanks!
 
Aside from the 4 tests per day, which is fine by SLGS standards, and the weekly curve, I would say additional testing may be ‘safety’ testing.

Some potential scenarios:
In SLGS, you can shoot any number above 90. So, if you get a number under 90 at preshot, you may need to stall, withhold food and retest. That is one potential scenario.

Another scenario where you would want to retest in a cycle if you see a lower number. While SLGS has a reduction point under 90, and the goal of SLGS is to keep kitty above 90, we know that we don’t want any kitty to drop into un unsafe number. The extra testing would be intended to make sure Squeaky is rising and is staying safe.

Under 50 - absolutely will require tests and following the low number protocol of feeding HC/honey/karo.
https://felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/
In the 50’s-90 - you’ll want to monitor via extra tests to make sure he is safe and coming up. You have been doing good so far feeding these types of numbers from what I can tell on your SS. How many tests, I can’t really give you rules. Every scenario is different and depends on where you are at in the cycle, nadir, etc. If it were my cat and I saw him in the 50’s (and others would probably agree), I would be testing again after feeding (at the latest an hour later) to make sure he wasn’t dropping below 50. 60’s to 90’s depends. This is where ‘know thy cat’ and the data you have collected is important. How easy is it to bring Squeaky up, how carb sensitive, etc.

Again, the goal of SLGS is to keep kitty above 90, but in case you see a lower green number, some food for thought.

If you see a big drop in numbers from preshot to the next test - this could be another scenario for extra testing consideration too.

Maybe others have more advisement, but some potential scenarios (but not all) to consider for additional tests beyond the 4 per day.

Thanks Tanya, I'm quiet enough to be able to study this. And I've printed it out. I think that Squeaky is pretty reliable (eating when his BG gets low) and his numbers don't seem to drop quickly and dramatically. He only had 1 time in 4 months when he went lime green and we weren't actually sure that it was real. Lately it seems his numbers are leveling out. That is good.

So if the goal is to keep kitty above 90, won't he eventually get better and start showing really healthy numbers between 50 and 90? I guess then we keep reducing until he is off insulin all together right?

Thanks for taking the time to explain all of this! :bighug: :bighug: Amazing how many times I need to repeat stuff to get it in my brain LOL. :rolleyes:
 
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