08/15 George PMPS 90 libre 115 relion; +1 75 libre; +2 65 libre; +3 47 libre 65 relion
- Thread starter George’s Mom
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Bandit's Mom
Member Since 2019
It looks like you've broken through some glucose toxicity like Wendy pointed out. Stopping the kidney restore might also have contributed. He has definitely flipped a switch and flattened out. He might not need R going forward. You want to find a good dose of L that you can shoot consistently twice a day. When cats suddenly decide to turn around, it can be a hairy ride down the dosing ladder for the caregiver!
George’s Mom
Member Since 2022
Agree! Thing I like about R is that it’s short lived. So I can ward off a big bounce without adding to Depot and without a very long nadir to wait on. But 100% want to find the stable L dose for him, we were getting closer until this craziness all happened.
Waiting to see what happens with his numbers. We are at PMPS+8.75 right now. He looks like he’s bouncing to me, but it’s not a steep bounce (at least not yet). So I think I’m waiting until his BG > maybe 200 or >250 to think about shooting some R or deciding on next L dose. But I know that Idk what I am doing though.
Bandit's Mom
Member Since 2019
If you look at his numbers in the last few days, he is higher only after a skip. So rather than skip and give R, it might be better to give L more consistently.
George’s Mom
Member Since 2022
Understood and agree. I was just reading about the glucose toxicity link from @Wendy&Neko yesterday. So if this is what’s happening, then his insulin needs may be reduced because he’s hit some sort of breakthrough? Should I give him 3L now even though it’s only +9? Both the red and blue above are variables to me. That or give him some R to make it to +12. Here is his latest BG graph using libre:
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Bandit's Mom
Member Since 2019
Why give him R if he's only 150? Wait till +11.5 and shoot L. I think you are shooting later these days because of previous stalls? You can make up 30 mins per day.
Hopefully @Wendy&Neko will be around by then too advise on L dose.
Hopefully @Wendy&Neko will be around by then too advise on L dose.
George’s Mom
Member Since 2022
Agree. Only thinking R if he had a big bounce and was over 200 or 250. He’s still sitting fairly low. 137 @ +11.
Bandit's Mom
Member Since 2019
Wow. I guess that's on the Libre? You could get a +11.5 with the ReliOn and maybe stay with 3u. He definitely looks like he needs much less insulin than 7u but it's anyone's guess how much less!
Bandit's Mom
Member Since 2019
BTW, some of the coloring of the cells in your SS needs to be changed. Between 50-99 is dark green and between 100-199 is blue. Lime is only below 50.
George’s Mom
Member Since 2022
OMGosh! I am just now coming up for air with my work (I work from home). This is why AMPS needs to be 8am! Because it’s already 2pm and I am just able to think about this again. He remained low until about an hour ago. I know R isn’t the answer but I’m giving him .5R for now. It gets into his system faster and doesn’t last as long. Plus maybe his depot needs drained a bit?
I’ll fix coloring. I tried to match, but apparently I screwed it up.
Are you skipping the shot again? If so, please put Skip or NS (no shot) in the AMPS units cell.
I'm having a hard time figuring out when you shot PMPS last night. If you delay several hours, then in the Units columns, you'd put 3L@+15.75, showing that you delayed 3.75 hours. And PMPS cell would show what you tested before you shot. Then you'd put the rest of the test numbers where they normally would go in relation to the shot, +1, +2 etc. To show the numbers you got while you delayed, you'd "load up" the +11 cell. So it would look something like 110;115@+12; etc up to the last test before the real PMPS one.
I agree with Bhooma, let's lay off the R for a couple cycles and see where he goes. I definitely wouldn't shoot it below 300 at this point. Lots of changes happening with George. Use of R will confuse the situation when trying to figure out his new Lantus dose.
I'm having a hard time figuring out when you shot PMPS last night. If you delay several hours, then in the Units columns, you'd put 3L@+15.75, showing that you delayed 3.75 hours. And PMPS cell would show what you tested before you shot. Then you'd put the rest of the test numbers where they normally would go in relation to the shot, +1, +2 etc. To show the numbers you got while you delayed, you'd "load up" the +11 cell. So it would look something like 110;115@+12; etc up to the last test before the real PMPS one.
I agree with Bhooma, let's lay off the R for a couple cycles and see where he goes. I definitely wouldn't shoot it below 300 at this point. Lots of changes happening with George. Use of R will confuse the situation when trying to figure out his new Lantus dose.
George’s Mom
Member Since 2022
This is very helpful. I was unsure how to match up the delay with the AMPS/PMPS columns. I’ll fix this by tonight if not sooner. I shot last night 3L @ PMPS +3.75. I didn’t shoot any more L. I did shoot the .5 R earlier only because I wasn’t sure on the L and he was climbing so I wanted to ward it off. Thinking I get him back on track with L at his normal PMPS time which is 8pm CST. Thinking 3 units? 4 units?
The TR protocol answer would say his dose is 6.5 units. He didn't earn a reduction by going under 50, and the lower numbers you saw could have been the 7.0 unit dose depot talking. The larger depot can influence 4-6 cycles after the reduction, longer with larger doses. One more thing, and a reason to be careful with R at the moment. For some cats, the use of R in once cycle can play out with more action the next cycle. This could also have been what you saw last night. Once we find out whether he has IAA or not, that can be another factor in later action from R.
Now that I've told you the protocol answer, what to do tonight? I think 3 units is too low, as likely will be 4 units. But you also need to get some stability in his dosing. You could try 4.0 units if you want, at least for a few cycles. Breaking glucose toxicity doesn't usually result in large decreases like that though. But you need to get a dose you can stop skipping, and build the depot back.
Now that I've told you the protocol answer, what to do tonight? I think 3 units is too low, as likely will be 4 units. But you also need to get some stability in his dosing. You could try 4.0 units if you want, at least for a few cycles. Breaking glucose toxicity doesn't usually result in large decreases like that though. But you need to get a dose you can stop skipping, and build the depot back.
George’s Mom
Member Since 2022
Well, I don't know what I'm doing here. Using my overanalyzing approach, I tried to think about how much Lantus is in his system.
If over 6 cycles, he received a total of 24 units, then that means about 4 units per cycle on average. I know it is NOT that simple and that we are just winging this, but it's nice to see that my overanalytic brain came to about what you expected me to do.
So then, he's now up to 220 on his libre sensor. Given the mess I've created with skipping, being late, and all of the things... I think 4 units makes a lot of sense. I'd love to give him .5u R to get his # back down a bit, but I am hearing you to hold off on R. So I am going to shoot 4 units of L here in the next 20 minutes for his PMPS (8PM) dose. Thanks for riding the crazy wave with me!
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George’s Mom
Member Since 2022
Aaaand I fur shotted the 4 units. Almost all made it in, but he moved and yes a little Lantus smell and a tiny bit of liquid. I bet he got 3.5 of it. Still itching to give him the .5u R.
PMPS 262 Libre, 241 ReliOn, 312 AlphaTrak.
PMPS 262 Libre, 241 ReliOn, 312 AlphaTrak.
Put the R in the back of the fridge for a couple days. 