04/22 Mowgli: AMPS 212 - Help interpreting Mowgli's BG data overall

[AmandaE]

Hello!

Mowgli's BG curve data seems to have been changing back and forth between a mid cycle nadir and a very late cycle nadir. This weekend he surprised me with an 83 PMPS on the 20th (when I had a dinner engagement to attend of course ) so I reduced his dose by 0.25u for that shot and the next morning's dose. I'm struggling with dosing strategy because I am not confident in the interpretation of his reactions to insulin.

These "dark greens" are kind of throwing me for a loop because they trigger a dosage decrease when you follow SLGS. I personally feel like Mowgli should be staying at a 1.5u dose since the majority of his time on this dosage is being spent in the "yellows" and "blues". I don't want him to go Hypo while I'm at work (obviously) but I also feel like he has room in his patterns before we see any light greens out of him (if we ever see any at all.)

This situation has led me to a few questions / requests:

• Would someone mind having a look at April's data so far and provide a more experienced interpretation of Mowgli's BG data?
• How would you advise I react when Mowgli has a dark green for a pre-shot? Handle it the same way (lower by 0.25)? Lower it by more? Maintain the same dose?
• How do you pronounce "Nadir"? Naid-er? Nadder? Na-deer?

I feel like I keep asking the same questions, but for me - I am having a hard time applying the advice I am being given evenly across Mowgli's day to day data. I also feel fairly confident that 1.5u is the right dose for him right now since I am seeing such a nice downward trend in his BG levels. That being said, I recognize my lack of experience with feline diabetes and Blood glucose patterns / trends so I really would appreciate input from more experienced members so that I am not putting Mowgli in any danger.

Thanks in advance

 

[Wendy&Neko]

Here is the link to your previous post, for continuity: http://www.felinediabetes.com/FDMB/...ps-317-a-change-of-long-weekend-plans.213388/

How would you advise I react when Mowgli has a dark green for a pre-shot? Handle it the same way (lower by 0.25)? Lower it by more? Maintain the same dose?

Another option is to delay 20-30 minutes, without feeding, and see if he is on the rise naturally without food. If he comes up enough, you could shoot either full or part dose, depends on your comfort zone and ability to monitor. You can shoot a dropping number too, but not with SLGS if they are already under 90. One idea is to post here for help with the decision.

How do you pronounce "Nadir"? Naid-er? Nadder? Na-deer?

I do the first one.

Would someone mind having a look at April's data so far and provide a more experienced interpretation of Mowgli's BG data?

This one takes a bit more. It really helps if you chose a dosing method, either follow SLGS or follow TR. Mixing and matching the two is not good. Here is a post that explains why. The whole post is full of good tips in general. Including one on why it's OK to shoot a dropping number. If you are using SLGS, it means holding a dose for a week, unless they drop below 90, in which case you reduce the dose right away. That is in there for safety. If you know a dose will take him below 90, do you want to stay on that dose if you can't monitor at all that day? You did reduce a couple nights ago, but then you increased back up.

Lantus requires a lot of patience. Mowgli was bouncing after those green numbers he's not used to. You don't increase because of a bounce. I would have held the 1.25 units for a week, and see what he did on that dose. Here we find that changing the dose around a lot can also cause wonky numbers because the depot doesn't get time to stabilize.

Mowgli's BG curve data seems to have been changing back and forth between a mid cycle nadir and a very late cycle nadir.

Neko's nadir was reliably between +3.5 and +13 on Lantus. Though most often between +7 and +9, unless she was breaking a bounce and it would be later, or earlier if she was looking to go low. A nadir is simply the lowest point of a particular cycle. Some cats are consistent about when that is, some not so much.

 

[AmandaE]

@Wendy&Neko Thanks so much for your reply, your points are exactly why I feel so redundant when I ask my questions... you've made me aware that I am right! I am asking the same questions over and over :|

Another option is to delay 20-30 minutes, without feeding, and see if he is on the rise naturally without food. If he comes up enough, you could shoot either full or part dose, depends on your comfort zone and ability to monitor. You can shoot a dropping number too, but not with SLGS if they are already under 90. One idea is to post here for help with the decision.

My Biggest problem here is my morning routine. I JUST have enough time with giving Mowgli his shot at 6 am to get ready and catch the bus. Getting up earlier to dose isn't really an option because of regular bus delays on the way home(=regular delayed evening shots). This is also the problem for posting for help with the decision, I definitely wouldn't expect that someone can answer my question within the time frame that I wake up to when I have to catch the bus, even if they did, I may not have time to dose or soak in the advice

This one takes a bit more. It really helps if you chose a dosing method, either follow SLGS or follow TR. Mixing and matching the two is not good. Here is a post that explains why. The whole post is full of good tips in general. Including one on why it's OK to shoot a dropping number. If you are using SLGS, it means holding a dose for a week, unless they drop below 90, in which case you reduce the dose right away. That is in there for safety. If you know a dose will take him below 90, do you want to stay on that dose if you can't monitor at all that day? You did reduce a couple nights ago, but then you increased back up.

My choice between TR and SLGS is tied to my comment above: because I am working without the capability to get home during the day, combined with unreliable busing schedules preventing an earlier dosage time (not to mention my great need of sleep) SLGS seems like the only option. I just don't think that I will be able to give TR justice in the am. In my previous post I mentioned my concern about not shooting lower numbers. I am concerned that because every time Mowgli dips into the dark greens I have to decrease his dosage that he will never get to that dark green range. I personally would like to see more dark green values before I lower his dosage. In summary I have an internal conflict of a TR mentality with a SLGS protocol.

I did decrease the dose on Saturday because I had a dinner engagement and wasn't going to be home to watch Mowgli, I thought of it more like the decrease that I made on the 8th and 14th a "token dose" so to speak. My biggest worry here is that Mowgli has had high BG levels for so long and I don't want him to suffer, I think that is what is causing my conflict with SLGS vs TR.

The post you reference actually added to my conflict because experienced members mention that it is more of a guideline not steps to be followed... but I guess one line that really solidified your point is that if I have to ask for advice, I obviously don't have the data or confidence to be straying from those guidelines.

Lantus requires a lot of patience. Mowgli was bouncing after those green numbers he's not used to. You don't increase because of a bounce. I would have held the 1.25 units for a week, and see what he did on that dose. Here we find that changing the dose around a lot can also cause wonky numbers because the depot doesn't get time to stabilize.

Ugh... patience... a virtue I am hardly grasping, I swear it comes from an honest place... I'm really concerned about any glucose toxicity in Mowgli... He went undiagnosed for a really long time. I think upwards of 6 months to a year That's why I hesitate towards a dose that holds him in the yellows historically.

Neko's nadir was reliably between +3.5 and +13 on Lantus. Though most often between +7 and +9, unless she was breaking a bounce and it would be later, or earlier if she was looking to go low. A nadir is simply the lowest point of a particular cycle. Some cats are consistent about when that is, some not so much.

MOWGLI!!! can't you be consistent for MY SAKE!? I was hoping he would be.

In summary: You're right - I need to commit to SLGS - but I'm going to be stubborn with my 1.5u for now, and this week if he dips green again I will lower the dose (rebel with a cause)

Again, thanks so much for your insight, I am going to spend more time looking through the post on the debate between not combining SLGS and TR to gain a better understanding on why it's important and maybe gain some patience in the mean time. (that's a gem of a post)

 

[Marje and Gracie]

Hi Amanda

Here is a great post on working and doing TR which might give you some ideas.

I am concerned that because every time Mowgli dips into the dark greens I have to decrease his dosage that he will never get to that dark green range. I personally would like to see more dark green values before I lower his dosage. In summary I have an internal conflict of a TR mentality with a SLGS protocol.

I really understand this...not because I ever used SLGS but because those of us advising share the concern of caregivers when they should decrease under SLGS to keep kitty safe. However, you should know that SLGS was the method used on the board for some time before the TR protocol was developed and cats went into remission on it...and still do. But, yes, it does take patience.

 

[Wendy&Neko]

It’s OK to keep asking questions. The lovely Marje and Sienne were patient with me, kept answering my repeated questions when I started. I learned a lot about patience here too.

Just remember, learn about Mowgli, how he uses the Lantus, how he responds to food, and you will be able to tweak guidelines safely. Experiment, take good notes.

 

[AmandaE]

Thanks Ladies,

I am so so appreciative for the patience with me on this board. You guys are all so busy, so it means a lot to me when you answer my questions so thoroughly and thoughtfully, then re-answer them later down the line

I’ll try and refocus this week, and I’ll look through the post Marje linked. I definitely feel like I have the TR mindset but little flexibility for the AM so hopefully there will be some ideas on there that I might be able to follow.

Let’s see how it goes!!

 

[Marje and Gracie]

It’s OK to keep asking questions. The lovely Marje and Sienne were patient with me, kept answering my repeated questions when I started. I learned a lot about patience here too.

Just remember, learn about Mowgli, how he uses the Lantus, how he responds to food, and you will be able to tweak guidelines safely. Experiment, take good notes.

We love you, too, Wendy.

Thanks Ladies,

I am so so appreciative for the patience with me on this board. You guys are all so busy, so it means a lot to me when you answer my questions so thoroughly and thoughtfully, then re-answer them later down the line

I’ll try and refocus this week, and I’ll look through the post Marje linked. I definitely feel like I have the TR mindset but little flexibility for the AM so hopefully there will be some ideas on there that I might be able to follow.

Let’s see how it goes!!

We are happy to help and we always love questions. And I was the QUEEN of impatience

 

[AmandaE]

Hopefully I unlock the lifeskill of patience soon!