8/27 Artemis AMPS 417 +1 426 +2 385 +4 325 +6 335 +9 304 PMPS 411 +2 396 +10 322

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Confused by these spikes. Any explanations other than a fur shot that I didn't realize?
@tiffmaxee @Sienne and Gabby (GA)

@Diane Tyler's Mom :
Can I hold for shorter than 7 days this time as you eluded to in your previous comment on 8/25?
I think I want to get Artemis to the most appropriate dose as quickly as possible.
The main reason is because I will be traveling long distance with Artemis from Sept 8th thru Sept 18th and it will not be possible to get anything but AMPS and PMPS BGs.
 
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Would it be possible for you to add a blank line after 8/19 when you did the last shot of Vetsulin, and before starting glargine. Then you can label that line "start glargine" or something like that. It's helpful for us to see at a glance key dates like insulin transition.

On 8/21, I don't see any insulin dose. Did you skip insulin both AM and PM that day? Due to the depot style nature of glargine, it's important for us to know if there were an days insulin was deliberately skipped or if there was a fur shot. I put something like "FS" for fur shot for the insulin dose when it happened.
Twinkleboots said:
Confused by these spikes. Any explanations other than a fur shot that I didn't realize?
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I can think of three possibilities. One is what we call a bounce. From the definition in the New to the Group Sticky Note:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

The second possible reason, is some glucose toxicity setting in. It just means his body is getting used to higher numbers. Increasing his dose as he needs it, will help get over that.

The third possible reason is something we call New Dose Wonkiness, or NDW. We don't know exactly why, but some cats will show temporarily higher numbers in the early cycles after a dose increase, so that could be what you are seeing today.

Twinkleboots said:
an I hold for shorter than 7 days this time as you eluded to in your previous comment on 8/25?
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Is there a particular reason you are following SLGS for dosing? If he's eating all low carb wet or raw food, TR is an option. Tight Regulation does allow increasing the dose sooner. However, it also required testing at least 4 times per day, the two preshots and at least one additional test per cycle, which sounds like it won't work while you are travelling. It is possible to follow TR for a while, then switch back to SLGS if needed. By the way, I took Neko on both long car rides (3 days each way) and plane trips, and still managed to follow TR.
 
Wendy&Neko said:
On 8/21, I don't see any insulin dose. Did you skip insulin both AM and PM that day?
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No. He got his insulin. The spreadsheet just didn't save it when I entered them. Already fixed it once, but apparently it really likes to keep those cells empty. Third try is a charm.

Wendy&Neko said:
I can think of three possibilities. One is what we call a bounce. From the definition in the New to the Group Sticky Note:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

The second possible reason, is some glucose toxicity setting in. It just means his body is getting used to higher numbers. Increasing his dose as he needs it, will help get over that.

The third possible reason is something we call New Dose Wonkiness, or NDW. We don't know exactly why, but some cats will show temporarily higher numbers in the early cycles after a dose increase, so that could be what you are seeing today.
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Hopefully it's ndw. Suspect he's bouncing because I think he was diabetic for quite a while before the vet saw it. He's had plenty of care but the mouth ate up a lot of the attention and my concerns about his incessant obsessive hunger always fell on deaf or incompetent ears.

Wendy&Neko said:
If he's eating all low carb wet or raw food,
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The low carb wet food is to help manage his weight and skin sensitivities. Also he eats wet because it's easier for him to eat. He has no teeth anymore. Resorption over the years and finally just took the remaining out last year with the last flare up, didn't want to risk invasive procedures when he's any older.

Wendy&Neko said:
However, it also required testing at least 4 times per day, the two preshots and at least one additional test per cycle, which sounds like it won't work while you are travelling.
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TR will not work after that travel either. I need to get this to a manageable and safe level for him as quickly as possible. Simply can't take on more in my life at this moment. I'm traveling because I'm starting a new job. One that will require a cross country move and one that's a lot more cognitively demanding, time demanding, and includes up to 25% travel. We've also been homeless this year. So we're coming from a place of practicality turbulent and unstable nature. Moving towards stability. Whatever route I take needs to be one that allows him to be safe as quickly as possible, feel as well as possible while adjusting for me to do it as mindlessly as possible and easy enough for a sitter to eventually do. The amount of testing I'm doing now will not be an option in about a months time.
 
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If you can follow TR (4 tests per day) for the next week, you can make a little bit faster progress. Let's see where he is after six cycles at this dose, then evaluate his dose.

By the way, you are currently testing a lot more than you need to. Not that data is bad, but you'll be going through test strips at a faster rate than you need to. For a lot of cats, their lowest numbers are somewhere in the middle of the cycle, then they start going up again. Once you see his numbers turn around and go back up, you can put away the test kit for the rest of that cycle. Another tip, often cats will give you a heads up what the rest of the cycle will look like by the +2 or +3 test, when compared to the preshot number. If it's about the same as the preshot, it'll be a typical Lantus/glargine cycle with some downward movement. If it's higher, it'll be a quiet cycle with little action. If it's quite a bit lower, then it's a more active cycle needing more monitoring.

People who work can try to work their shot schedule so they can get a +2 before they head out the door. Then based on the numbers, they can put extra food out or higher carb food it's going to be a more active cycle. That food is what keeps kitty safe.

From that New to the Group Sticky Note:
Example of an ACTIVE, but NOT necessarily typical Lantus and glargine biosimilars cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar/Semglee cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir/Biosimilars: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
 
Wendy&Neko said:
If you can follow TR (4 tests per day) for the next week, you can make a little bit faster progress.
Click to expand...
I'll make some time to read into TR. I might be able to swing it except for maybe Thursday. If I can get faster results on it and not be committed to a continuation of the TR schedule.

Wendy&Neko said:
People who work can try to work their shot schedule so they can get a +2 before they head out the door. Then based on the numbers, they can put extra food out or higher carb food it's going to be a more active cycle. That food is what keeps kitty safe.
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Great thanks for the practical tips and examples. Really appreciate it!
 
When following TR, you can increase after 3 days/six cycles, if you are only seeing numbers above 200. Even with high 100's you can still increase that fast too. You don't have a lot of time, but if you follow TR for the 2 weeks, then you can get to a better dose faster.
 
Wendy&Neko said:
When following TR, you can increase after 3 days/six cycles, if you are only seeing numbers above 200. Even with high 100's you can still increase that fast too. You don't have a lot of time, but if you follow TR for the 2 weeks, then you can get to a better dose faster.
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Ok I think that's what I want to do then. I might need help though. Will I do 3 test per cycle or 2? If I'm not able to catch a PMPS +4 to +8 will it be a problem as night nadir is lower?
 
4 tests per day, 2 per cycle. More is always better, but that's the minimum. There are other differences. Testing more allows you do increase sooner because you have a better idea how low the dose is taking the cat. With TR, the other big difference is that the point at which the dose is reduced moves from 90 down to 50.

If you can get a +2 or ideally +3, it'll still give us a clue if he's going low at night.
 
Wendy&Neko said:
4 tests per day, 2 per cycle. More is always better, but that's the minimum. There are other differences. Testing more allows you do increase sooner because you have a better idea how low the dose is taking the cat. With TR, the other big difference is that the point at which the dose is reduced moves from 90 down to 50.

If you can get a +2 or ideally +3, it'll still give us a clue if he's going low at night.
Click to expand...

Sounds like there's no reason not to do TR for this week then, would you say so?
 
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