07/11 Mowgli AMPS 362 +0.75 364 PMPS 254 +1 187, +3 76, +4 72, +5 65 +8 223

AmandaE

AmandaE

Member Since 2019
http://www.felinediabetes.com/FDMB/threads/07-10-mowgli-amps-301-pmps-284-2-236.216630/

Morning all!

I gave Mowgli his increase early this week, these high numbers aren’t working for me and I want this new dose to take hold before I do my next curve on the weekend. I took a +0.75 to see if I had any big concerns of a drop and left some extra food out. I hope it works well for him, last time we kind of skipped 1.25u with a back to back reduction (a rookie mistake on my part) so maybe this could be his perfect dose... fingers crossed :)

I wanted to revisit a question that I had informally asked in post 5 of my June 22, 2019 Condo HERE. I’m going to tag @Jill & Alex (GA) (the big guns;)) since I feel like there has been quite a bit of interest in the ‘how’ of executing SLGS modifications by members who use this dosing method lately (@learjetta @Armish & Roo, and myself )

The question is related to my SLGS modification of reductions at 70 rather than 90. SLGS states that increases should be made when nadirs are more than 150 and doses should be held with nadirs between 90 and 149.

Since SLGS can be modified with time and data, do you think it would be acceptable to also adjust the BG levels for dose holds and increases? For example: since I lowered my reduction point to 70, would it be acceptable to change the protocol for myself and Mowgli to do the following:
  • Increase dosage when nadirs are more than 130
  • Hold doses when nadirs are between 70 and 129
If this modification is acceptable, I personally would probably still use 90 as my no shoot / reduced dose number since I don't have experience shooting greens yet. Does this make sense, or am I off the mark on the types of modifications that can be applied to SLGS?

Looking forward to any informed insight :)

Have a great Thursday folks!! We’re rounding the bend towards the weekend :D
 
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Good luck with the new dose. I'm not sure about your SLGS question. I think since you monitor a lot, you would be okay to make those changes. I'll be curious to see what others say.
 
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carfurby said:
Good luck with the new dose. I'm not sure about your SLGS question. I think since you monitor a lot, you would be okay to make those changes. I'll be curious to see what others say.
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Thanks Carla! I am expecting better things from Mowgli on this dose... let's see :)

I thought it might be ok too but I did want to see what more experienced members like yourself thought about it, as well as call in Jill since she is very much an experienced lay person on the subject. I don't want to make any assumptions and put Mowgli at risk or even worse have another member look at my experience and apply it to their cat and put their cat at risk :) Potentially we will all learn something new about SLGS today :cat:
 
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AmandaE said:
The question is related to my SLGS modification of reductions at 70 rather than 90. SLGS states that increases should be made when nadirs are more than 150 and doses should be held with nadirs between 90 and 149.

Since SLGS can be modified with time and data, do you think it would be acceptable to also adjust the BG levels for dose holds and increases? For example: since I lowered my reduction point to 70, would it be acceptable to change the protocol for myself and Mowgli to do the following:
  • Increase dosage when nadirs are more than 130
  • Hold doses when nadirs are between 70 and 129
If this modification is acceptable, I personally would probably still use 90 as my no shoot / reduced dose number since I don't have experience shooting greens yet. Does this make sense, or am I off the mark on the types of modifications that can be applied to SLGS?
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I'm not sure how to say this in a way that will be helpful, but I'll try. No, you're definitely not off the mark when it comes to those kinds of modifications. But it's not the modifications themselves that can always be addressed in groups like this. Instead, it's up to the caregiver to ask themselves questions along the lines of what I've written below.

Before modifying any dosing method, one should be pretty darn sure of their cat's response to the combination of food and insulin.
  • How much of a food spike does kitty get after feeding a typical meal at shot time? Those 'forgotten' spot checks that no one thinks are valuable at +1 and +2 provide a huge clue.
  • How easy is it to bump kitty's numbers up with food when running low? What does it take? Remember, in most cases you're only looking for a 10 - 20 point rise.
  • Would a technique like manipulating the curve with food (not to be confused with feeding low numbers) help? Propping up the curve with food will raise the curve... which allows for more insulin to be given... which will help flatten out the entire curve/cycle.
  • If I asked when the insulin onsets, when is nadir, and what kind of duration is kitty getting on any given dose the answers should immediately roll off the caregiver's tongue.
    • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
    • Peak/Nadir - the lowest point in the cycle
    • Duration - the length of time insulin continues to lower blood glucose
  • What's the reason for the modification? In other words, is kitty repeatedly failing reductions or why do you think it's necessary to adjust guidelines in order to pull the entire range down in a given cycle?
The TR Protocol and SLGS have some safeguards built into them. Any time a caregiver strays from the usual guidelines, they do so with an increased risk and in turn, responsibility to keep their cat safe... no matter what it takes. That begs the question... are you able to and more importantly, available to monitor as much as necessary to keep your cat safe after making modifications? Are you willing to take kitty to your vet or an ER if necessary?

We have a saying around here, "KNOW THY CAT". Honestly, caregivers who really KNOW their kitty's response to the combo of food and insulin won't ask permission to make modifications. They make them and then tell you about the modifications they've made and why. :cool:
 
AmandaE said:
I thought it might be ok too but I did want to see what more experienced members like yourself thought about it, as well as call in Jill since she is very much an expert on the subject.
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No, I am not an expert. There are not ANY experts on the FDMB. Some have more experience than others, but it's very important to know we're all lay persons... not experts.
 
@Jill & Alex (GA) this is very helpful, thank you :) I will suffice it to say you are very experienced as a layperson, rather than an expert, as, like you have pointed out, there are no experts on the FDMB. I value your insight and just having a conversation around this type of question provides a deeper confidence, comfort, and understanding of the SLGS methodology for me.

"KNOW THY CAT". Honestly, caregivers who really KNOW their kitty's response to the combo of food and insulin won't ask permission to make modifications. They make them and then tell you about the modifications they've made and why. :cool:
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This statement especially is really useful for me. I believe Wendy had lead me to come to the same conclusion very early on in my journey with Mowgli (it's still early for us, I know) - when I was trying to decide whether or not to shoot a lower number, at that time I didn't have the data on how Mowgli would react so my conclusion was to shoot a reduced dose. If I have that much uncertainty that I am, in a relatively stressed manner, asking whether or not I should shoot, I realized I definitely ought not to shoot the full dose.

I have asked myself the questions you have provided above, which are great brainstorming tools on how well I understand Mowgli's cycle. As the days go on (especially with the new dose) I will consider these questions even more to ensure I am making the right decision to modify Mowgli's treatment if we approach a situation where I am considering an increase. I believe based on what I know about Mowgli so far that I am going to try the modified version of SLGS I mentioned above, I personally thought it would make the most sense based on how Mowgli's cycles typically progress when I initially lowered his reduction point (this was due to failed reductions and a lack of lower numbers).

Again, thanks for taking the time to respond to this, your experience has a lot of weight around here especially when it comes to LB&L. I know you have a lot going on, basically at all times on the board so I appreciate you stopping by Mowg's condo.

@Armish & Roo / @learjetta: Jill has given some great food for thought here, lets do some heavy consideration on how well we know our cats before any of us proceed with modifications ;) Additionally I think Marje gave some good info on Boris' condo as well. So many things to consider :D
 
How do you like that......from PINK to GREEN!!:D:D:D Aunt Lyane is there watching you sweet little boy and she's sooo proud of you!! Keep safe Mowgli! Mamma is there for you, figuring out a magical recipe! You're doing great Amanda! That post from Jill was very interesting! :)
 
Ti-Mousse said:
How do you like that......from PINK to GREEN!!:D:D:D Aunt Lyane is there watching you sweet little boy and she's sooo proud of you!! Keep safe Mowgli! Mamma is there for you, figuring out a magical recipe! You're doing great Amanda! That post from Jill was very interesting! :)
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+4 is 72! I’m feeding him some LC to try and get him on the way up. I’ll be so annoyed if he gets a reduction lol We want to see you spending more time in blues and greens melly moo!!

Yes definitely really great content from Jill, it’s awesome to have someone with experience help put things in perspective :)
 
AmandaE said:
+4 is 72! I’m feeding him some LC to try and get him on the way up. I’ll be so annoyed if he gets a reduction lol We want to see you spending more time in blues and greens melly moo!!

Yes definitely really great content from Jill, it’s awesome to have someone with experience help put things in perspective :)
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He seems to start going up after +4, so he should be OK, but keep testing! We always have to be careful with them !:rolleyes:
 
Ti-Mousse said:
He seems to start going up after +4, so he should be OK, but keep testing! We always have to be careful with them !:rolleyes:
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Definitely! I gave him a tsp of MC since I don’t really want him to go back to 1u yet ... he’s so close to a reduction, Little scamp!
 
+5 is 65. He had a couple tsps MC. I guess Mowgli was really missing his 1u dose. He just really wasn’t doing very well on the 1u. I’m frustrated that I have to go back to it.

Maybe I will do a fat 1u dose instead of a normal 1u using the bottom of the 1u line as the measurement market for the next dose and see how he does.

It’s so remarkable what 0.25u can do.
 
AmandaE said:
I know! I’m a little nervous of them like I won’t be able to use them right. I even recommended them to someone else the other day when really I should use them myself :p
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So easy! If you're using BD Ultrafine II, I have the conversion units!
Hope you won't be too tired today at work after your testing night !! :) but it's Friday !! :joyful:
 
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