? 08/19 Tommy_AMPS 146

Your ss says SLGS but you are not following that method. To switch to TR you need 2 tests every cycle. You can choose to follow SLGS and modify your reduction number if you choose to do that add the reduction number to your signature and ss. It’s not usually advised for cats new to fd. Read over the instructions again. With SLGS reductions are held for SEVEN days.
 
tiffmaxee said:
Your ss says SLGS but you are not following that method. To switch to TR you need 2 tests every cycle. You can choose to follow SLGS and modify your reduction number if you choose to do that add the reduction number to your signature and ss. It’s not usually advised for cats new to fd. Read over the instructions again. With SLGS reductions are held for SEVEN days.
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Elise, when you're suggesting to "modify reduction number" - do you mean frequency or increment?

I've been reading SLGS guidelines over and over again, and as a general guideline it instructs not to shot at 150 or lower or proceed with drastically reduced dose; but I understand that those are general recommendations and since most cats are different, those can be adjusted as further spelled out in the instructions. I'd say we are in the lowered threshold territory now but the following suggestion from the instruction is a bit unclear: "remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL" . Does this mean flat and greater then 90 at PS time? Could you please clarify
 
It’s not suggested to modify SLGS unless you have lots of data. You have on.y been at this fir less than two months. It’s best to follow the method exactly as written. There’s no such thing as a failed reduction with SLGS. Does are always held fir 7 days. We dose based upon nadirs and not preshot bg. . You don’t test enough to shoot that low. Look at spreadsheets of others. If you can get the necessary tests and follow TR you have an excellent chance at remission. It’s possible with SLGS but will take longer.
 
tiffmaxee said:
It’s best to follow the method exactly as written. There’s no such thing as a failed reduction with SLGS. Does are always held fir 7 days. We dose based upon nadirs and not preshot bg.
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Would 2 midcycle tests qualify for TR and would these test need to be staggered from time to time? What are the best increments for tests, e.g. between +4 and +6 and +8 and +10?

If staying on SLGS, could you please clarify what does this statement mean: "remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL" . Does this mean flat and greater then 90 at PS time?

just tested at +5, BG is at 110 and likely heading toward nadir.
 
Two mid cycle tests would be great. Actually if you get a +4/ and it is higher than the preshot that’s all you need. Varying tge times fir subsequent tests is a great way to determine nadir. Once you have data you can shoot anything over 90 if you can get extra tests. I hope you do give TR a try.
 
You are too new at this to modify SLGS yet. And you need to get a second PM test each and every night to try TR. It would be great if you could do some curves on Tommy. Right now we don't know when his onset is, or typical nadir. Once you know those data points, you can decide the best times to test. With Neko on Levemir, a +4 wasn't very useful as her onset was after that. A curve is recommended every week if following SLGS, and is good practice in the beginning in TR to learn onset and nadir times. Note nadirs can and do vary by cycle somewhat, especially on Levemir.

As I said before, Tommy is very new at the feline diabetes dance. He's doing extremely well at it. It takes a while for their body to get used to the new hormone (insulin). That means you need to have patience. He could still be bouncing from the greens he got a couple days ago. We don't know how much lower he got on the 17th as there was only the one mid cycle test each day. Bounces take up to six cycle to resolve. Today is cycle three. Again, have patience. This is the really hard part of FD for us caregivers who just want them better NOW.
Tommy_15 said:
I've been reading SLGS guidelines over and over again, and as a general guideline it instructs not to shot at 150 or lower or proceed with drastically reduced dose
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That's the part of the SLGS guidelines that is prefaced by "in the beginning". If you keep reading down, there is a section starting "With experience, you may find that lowering these thresholds may work well for your cat". Read that part.
 
Wendy&Neko said:
It would be great if you could do some curves on Tommy. Right now we don't know when his onset is, or typical nadir. Once you know those data points, you can decide the best times to test.
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We did 2 curves over past weekends and lately are doing 2 tests in between the shots staggering test time to capture the trend as we can. Looking over the numbers, as I see it for now, there are 2 clear trends. One, if starting BG is high at 300+, the outcome of the shot is a flat curve down from high value to low with small dip around +8/9. If starting BG is in lower 100s, e.g. 120+, with the dose of 1.5u, the BG would keep climbing some toward +3, onset around +4, nadir at +8 and rise again to preshot or close BG. we had only one nadir in green territory with 1.5u shot but starting BG was the lowest @108 at that particular day of 8/17. May be I'm missing something, but not sure why PM trend would be much different if Tommy's sleep/eat schedule stays pretty much the same. He eats right after the shot, leftovers are free for him to come back and he usually comes back asking for food in 8 hours after the shot. At that time food will be out till +10 then hidden. We are trying to do 2 shots during the day when we can. As Elise suggested, now we will do one at around +4 and if I understand correctly, if BG is higher, the second test would not be much of a value. But if BG is flat or starts going down, will need to do 2nd at +7 to +9, correct? Not sure it make sense or not


Wendy&Neko said:
He could still be bouncing from the greens he got a couple days ago. We don't know how much lower he got on the 17th as there was only the one mid cycle test each day. Bounces take up to six cycle to resolve. Today is cycle three. Again, have patience. This is the really hard part of FD for us caregivers who just want them better NOW.
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We've seen wild bounces earlier from 200 to 400. But last week with a set does of 1.5u, looks as BG was managed to stay in lower blue (under 150 at PS).

Wendy&Neko said:
That's the part of the SLGS guidelines that is prefaced by "in the beginning". If you keep reading down, there is a section starting "With experience, you may find that lowering these thresholds may work well for your cat". Read that part.
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I believe I memorized SLGS guidance for now and understand BG of150 threshold at PS for beginners . What is not clear: If staying on SLGS, could you please clarify what does the following statement mean: "remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL" . Does this mean BG flat at PS time and greater then 90 ?
 
Tommy_15 said:
generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL" . Does this mean BG flat at PS time and greater then 90 ?
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Both Lantus and Levemir produce gentle curves down to nadir (with a goal of nadir being in the 90-149 range), then slowly rising back up. With Lantus, the preshots tend to be the higher points of the cycle. With Levemir the higher points tend to be a couple hours later, so you could see the highest numbers just before onset. It's not unusual to see nadirs near preshot time.
Tommy_15 said:
We did 2 curves over past weekends
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A curve is defined as one cycle/12 hours with tests every two hours, or 1.5 cycles/18 hours with a test every 3 hours. I don't see that on the spreadsheet.
 
Wendy&Neko said:
Both Lantus and Levemir produce gentle curves down to nadir (with a goal of nadir being in the 90-149 range).
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That's where confusion is. is 90 to 140 a healing range for cat and what's the reason to keep BG at nadir to be that high when nadir is the lowest point on the curve?

Wendy&Neko said:
A curve is defined as one cycle/12 hours with tests every two hours, or 1.5 cycles/18 hours with a test every 3 hours. I don't see that on the spreadsheet.
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We did it every 3 hours. Not sure why would not that qualify for a curve?
 
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