01/01/2011 Spitzer PM+12=98, PMPS=249

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BJM

BJM

Member Since 2010
In the spirit of the new year, I'm starting with a new spreadsheet.

Spitzer has survived my messed up schedules, errors of commission, ommission, and more and is still a loving, shnuggle-puss.

He woke me up this morning to let me know the food bowls needed attention. Everyone in the household is eating more food because the Special Kitty Turkey and Giblets and 9-Lives Turkey and Giblets also are lower calorie. While it may be better for him to keep the carbs down to 5 or less, he and his mother are now losing weight. I may resume buying the Friskies Turkey and Giblet pate @ 7% and make the necessary insulin adjustments when he reacts to it. He's somewhere around .5 - .75 units right now; it would go up nearer to 1 unit with slightly higher carbs. This would make it easier for me to read the syringe, too (especially with the recent vitreous detachments intermittently warping my vision!)

Since PM+12 (edited to add: yesterday's PM+12, what would have been AMPS) was low, I fed him and waited an hour before giving a slightly reduced insulin dose of .5, rather than .75.
Yes, I could have re-tested before giving the insulin. I know from experience, though, that his glucose was going up because 1) the previous night's insulin was wearing off, 2) he scarfed when I put down fresh food right after testing and thus had a good meal on board to use the insulin given, and 3) it has never, ever, dropped after eating that much.
 
Re: 01/01/2011 Spitzer PM+12=99

Happy New Year to you and Spitzer!!

Will you link your old SS also? I was thinking of starting a new SS today also and linking both in my signature..
 
Re: 01/01/2011 Spitzer PM+12=99

BJ -

I honestly don't mean to be harsh, but I suspect my comments will come across that way. I don't know what I have to offer you. I don't know if you want me/us to offer you anything. If you don't, that's OK. Let me explain my reaction.

  • We need data in order to understand what's going on with Spitzer. The limited information you have provided in the past and the almost nonexistent information from today basically says you want no input from anyone here.
  • Without spot checks, there is no information upon which to base dosing decisions. Jill posted this message some time ago on this topic. All of the long-acting types of insulin (i.e, Lantus and Lev) base dose adjustments on the nadir and not on pre-shot numbers. Spot checks are essential.
  • You provide an eloquent rationalization for not getting a PMPS test this evening. It is a rationalization nonetheless. You shot on a food spike rather than on a BG value that was not influenced by food. That is your decision; you are holding the syringe. If this were me, it's not something I would do to my cat. I've seen too many spreadsheets where a great deal changes within the space of an hour. Shooting blind has the potential to be quite dangerous.
  • It so happens I was looking at your SS earlier this week. If I'm remembering correctly, it looked like there were times when you were split dosing. There is a great deal of feedback provided to you in your thread in Think Tank as to why this is not a strategy that typically works well with Lantus. There are one or two people I can think of who have done this successfully. I hope you contacted them for information.

From some of your earliest posts, you mentioned you were a scientist -- an epidemiologist. The idea of having data upon which to base your decisions should be enormously appealing. You study trends. You know the effectiveness and efficacy of protocol based clinical trials. You should understand the value of a peer group that can help you refine your thinking and help examine your data to catch any oversights or missteps or outliers. That's what we're here for. Like I said, you're holding the syringe and will make decisions on Spitzer's behalf. If you want help, we're here. What we can't do is help if you tie our hands.
 
PMPS = 249; shifted .5 hr earlier

Dose kept @ .5 because earlier dose acts like an increase. (Shifting because I need to get to 9 AM/PM schedule)

Refreshed the food that was out. Spitzer appreciated it and had a bite.
 
Re: 01/01/2011 Spitzer PM+12=99

Inconsistent data, due to schedule disruptions, my housemate skipping a dose, and then OD-ing Spitzer are an inadequate foundation for interpretation. Looking back over the past 3 months does little good other than inviting people to slam me for not being perfect. I already know that and don't need it rubbed in my face further.

I'm starting with a clean spreadsheet for the year because I need a fresh start. I want to get consistent scheduling for testing and dosing, if my @#$%$^ life would just cooperate. Every time I think I'm on track, some @#$% happens to screw up the schedule. You did not see split dosing; you saw me rolling the time later in blocks of a few hours rather than skipping an entire dose to get back on schedule ... again ... because he had a low morning glucose I couldn't shoot and I had to go to work.

I wish I could get up in the middle of the night without it affecting my ability to work and to drive safely. I wish I had someone who lived with me who could help out with all 11 of the cats.
I wish the last asthma flare hadn't cause vitreous detachment in both eyes, further impairing my vision; I was going to schedule the cataract surgery until that happened. Now I have to wait 4 - 6 weeks to see if the retinas are going to detach, too.
 
BJ, no one is perfect, and you will see evidence of that on every spreadsheet you look at...including mine. Life happens! I'm sorry that you feel that people are rubbing your errors in your face or slamming you for it, because that is not the intent. The intent is to help you by pointing out what needs to be done and/or explaining why you should do it that way. Having a perfect SS is not the goal here....helping Spitzer get regulated and OTJ if possible is the goal. It's not about you, it's about Spitzer.

In addition to that, there is a responsibility to point out the errors, because there are more eyes here than just yours and mine and anyone else that posts in your condo. There are other people who look at these threads, newbies, lurkers, etc who don't necessarily ask questions and might assume that it's ok to do things the way you are if no one says differently. You might not think about that, but I do....and so do others who try to help here!

What Sienne has laid out to you are facts....the dosing guidelines we use here are based on nadirs, not preshots. If you can't get spot checks, there's no way to know how any particular dose is working for Spitzer. If you won't share your data, no one here can help you....we are a data driven group. If you can't do the testing necessary, I don't see how you can follow the TR protocol that we use here. Dose is adjusted by nadir. Without nadir checks, you can't adjust dose. I know I'm saying the same thing over and over, but you don't seem to understand the importance of the spot checks.

While it is true that Lantus and Levemir doses are adjusted by nadir, so those checks are crucial, no matter what insulin you choose to use, you will need to do spot checks. Even PZI....although some people adjust the dose based on preshot, you still need the nadir checks to assess the dose. I don't know how to explain any more simply than to say you need to know how low Spitzer is going to assess how an insulin dose is working....any insulin, any dose. The preshots will NOT tell you that. Period.

Do you give the shot and then go to bed? Isn't there some time to get a before bed test? Can you start thinking about ways you can get some spot checks....it's rare that someone cannot find a way to get some spot checks. Can you get nadir checks on the weekends? Keep in mind that one curve is not a good way to adjust dose, because if Spitzer happens to be bouncing when you do the curve, it won't give you useful information. It's much better to get a few nadir checks in different cycles....or do a curve and get some nadir checks in addition.

I'm sorry about your vision issues getting worse, I know that doesn't help. I hope you will have a good outcome from the most recent problem.
 
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