? 05/15 Lisa AMPS 391 +2.25 392

My next week schedule is here
Monday 17.30-21.30
Tuesday 16.30-21.30
Wednesday17.30-21.30
Thursday 9.00-14.00
Tuesday 9.00-14.00
Weekend day off
Also next weekend I may start my old work too, and be away in the morning or evening or both
 
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Looks like she's ready for an increase. I'm not seeing much in the way of bounce...more like generally numbers that are high and require more insulin.

Hopefully the schedule can accommodate an increase and subsequent testing.
 
dionysia ke said:
My next week schedule is here
Monday 17.30-21.30
Tuesday 16.30-21.30
Wednesday17.30-21.30
Thursday 9.00-14.00
Tuesday 9.00-14.00
Weekend day off
Also next weekend I may start my old work too, and be away in the morning or evening or both
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Lisa, looks like you can test till Wednesday. If you increase tonight, that would give you 9 cycles to test the new dose.
 
I thought I was told to wait for the bounce to break or for 7 days on this dose before I increase. Can you see my program and tell me what you think?
 
dionysia ke said:
I thought I was told to wait for the bounce to break or for 7 days on this dose before I increase. Can you see my program and tell me what you think?
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Technically that’s correct. We just feel that with your schedule and since you can monitor closely a little early increase just this one time would be good. If you were following our TR method you could for sure. I’m sorry we are confusing you. As you will see those of us giving advice don’t always agree. Perhaps the bounce is breaking today. Let’s see the next pre test before insulin.
 
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Here is your last post for continuity

https://www.felinediabetes.com/FDMB/threads/05-14-lisa-amps-418-5-5-424.247341/#post-2790254

Being that this is a peer review board, sometimes you will get differing opinions.

There have been some caregivers here who have experienced elevated BG when giving topical ointments with steroids in them. There also have been some who do not. Usually with SLGS we hold the dose for 7 days, however, if you feel based on the data you are getting that the Suralan is contributing in part to the higher numbers, then you can choose to increase earlier than what the guidelines suggest, to try and mitigate some of the possible effects of the ointment.

The ability to monitor and intervene with higher carbs if required is also a factor, particularly when you choose to go outside of the typical guidelines with only some data to determine how your cat is responding to insulin and carbs, and in Lisa's case, to the topical ointment. Again, just my 2 Canadian cents, for what they are worth.
 
I don't know if surolan affects bg, although I have thought ear infection itself to have triggered the relapse in the first place...
So according to the slgs protocol I should increase on Sunday evening? I feel nervous about increase, so I want to be conservative. Is there any pm value she could have today that would help towards the decision?
 
Ok. Get a +6. If she continues to come down the bounce had definitely cleared. You have one more day after today at this dose since you want to follow SLGS.

Was the diabetes diagnosed originally after being on that medication or before she ever was on it. Steroids often cause cats to become diabetic. IF she never had any type of steroid before being diabetic then it wasn’t the original cause. If she was diagnosed for thefirst time after the steroid it’s very likely why she became diabetic in the first place.
 
I just want to be as safe as I can. It is way beyond +6 now, I will do pmps in less than an hour. Is there a pmps value that would make the decision to increase sooner stronger?

The diabetes was initially caused by cortisone injections to treat asthma, however she had managed remission. I was talking about the time she relapsed and came out of remission, which was when she again had an ear infection, so I thought maybe it was related.
 
By my calculation, I think you are either at +10 or +11. Please don't feel nervous about an increase, you are doing very well at testing, much more than what would be required with SLGS. You do have a good idea of how the cycles are going, much more so than if you were only getting preshots and an occasional spot check.

As I said, there are times when a factor like perhaps an infection may require some extra thought in adjusting things.
 
dionysia ke said:
Is there a pmps value that would make the decision to increase sooner stronger?
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If the preshot is higher than the rest of her cycle today, I'd be more comfortable with saying that it's fine to increase a little earlier this time vs. waiting the full 7 days, again, provided that you are fine with continuing to monitor if required.
 
All you are saying points to steroid induced diabetes and the infection also is an influence. A topical steroid is still a steroid. Lisa has shown that steroids increase her BG. I had a cat on prednisolone, a steroid l, whose bg never increased from it. If a cat becomes diabetic after steroids you know they are prone to it. When they are needed we deal with the BG. I am glad it’s helping her ears.
 
tiffmaxee said:
All you are saying points to steroid induced diabetes and the infection also is an influence. A topical steroid is still a steroid. Lisa has shown that steroids increase her BG. I had a cat on prednisolone, a steroid l, whose bg never increased from it. If a cat becomes diabetic after steroids you know they are prone to it. When they are needed we deal with the BG. I am glad it’s helping her ears.
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I agree. It may also be somewhat of a cumulative effect perhaps, since upon starting the Surolan, there didn't seem to be much influence, with low blues being achieved a couple of cycles later, but continued application is now affecting BG. I too have had a cat on prednisolone, without any effects to BG. I've used Surolan with a previous dog, with no issues, but for a cat who may be sensitive to steroids, the Surolan does seem to have a good amount of steroid (5 mg/ml) to where it can be a factor.
 
I got a 402 pmps! what should I do??

PS.
Lisa initially got diabetes due to cortisone pills to treat her asthma, however she then was in remission for many months. At the time she relapsed, she had an ear infection again, that was treated with surolan, so I thought relapse was related to ear infection or to surolan.
 
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As I said, if numbers are going up to preshot, it would be acceptable to consider an increase tonight to 0.75u, provided you can at least get one test tonight to see how she is doing after the increase. She's gone up :)
 
She's still pretty high, and came up a little today from pinks. I always found +2 to be a good indication of how the cycle will go. If it is higher than preshot, she's not going to get up to much, if it is flat, the BG will likely come down although not very sharply. If the +2 is lower, that would mean additional testing. Not all cats react to an increase immediately, particularly those who may or may not be influenced by topical steroids. We'll just have to wait and see. I'd keep following the timing of your snacks in the pm like you've been doing before.
 
Yeaaaaa! Good luck with the increase. Try to relax a little, Di. Lisa may pick up on all your tension. You will be fine and so will your pretty girl.
 
I’m glad you increased. Max often reacted on the second or even third cycle. You will be home to feed and monitor so this was a good time to increase. Some cats react on the first cycle and then just settle in. I often suggest a +2 because that’s when many cats onset. Max got a food bump at +1 and onset at +2.5 or +3. That’s when Lantus started working for him. Once you learn that you will know which test will indicate what will happen for that cycle.
 
dionysia ke said:
I got 472 at +2!!!why?should I continue to feed and monitor? how often?
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Please put the 472 in your spreadsheet. I assume you fed Lisa at PMPS. I don't think you need to feed again. Remember, an increase will not always show up right away. It may take several cycles. I think you are okay to sleep tonight with her high number but I will let the others advise. She is high. No reason to be worried about low numbers. Take care of yourself and you and Lisa get some sleep tonight unless someone else comes in and advises differently and I don't think they will.
 
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