07/16 Small Kitty amps 374 +6 266 +9 182 pmps 166 +1 205 +5 148 +6 88 +7 108 Green night

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Photorecon

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Good morning,

So it sounds the haft shot strategy was not that bad after all. After a skipped shot
the day before, Small Kitty was in the light green last pmps. The numbers were saying
to skip but other option were to be evaluated. Keeping the depot afloat, the
haft shot kept numbers in the blue and I like what I see this morning.

This up and down (more down) ride would better be slowed down now..

Not sure of how much less Small Kitty need... (?)

There's been lots of reduction lately, maybe too many in a row for a SLGL strategy
like some members said.

Will keep reduction on hold for this amps, if some would like to share their
opinion one reduction or not, it would be greatly welcomed.

Have a good one, all.

Sébastien


Yesterday :

http://www.felinediabetes.com/FDMB/...aft-dose-pmps-1-115-2-131-3-146-5-203.161351/
 
Good Morning Sebastien ~ I see you did shoot the 2.25 instead of 2 units so, just monitor him well today since that dose took him too low after a skipped shot. I think it was Julie who suggested 2 units for today. Let's see how this cycle plays out.

Bet you are tired this morning??
 
I just remember, got to shoot later this morning as the shot was at +1 yesterday.

No shot so far, and Yes Bobbie, kind of tired, will go back to sleep soon.
 
The reductions that SK have earned are not too many or too fast. According to the SLGS approach:

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

You are not shooting what the preshot number is you are shooting how low the dose is taking SK. That low last night would have been a reduction even with the TR ptotocol. Please monitor closely today
 
To get back on track with your time you can move the time back either 15 minutes for each shot today or 30 minutes for one of the shots today and the same again tomorrow.
 
Sebastien, reminder: to help you get back to your schedule you can shoot 30 minutes earlier today and 30 minutes earlier tomorrow and you will be back on schedule for Monday morning. Or you can shoot 15 minutes earlier each cycle today and tomorrow. Same thing.

ETA to add word earlier
 
To get back on track with your time you can move the time back either 15 minutes for each shot today or 30 minutes for one of the shots today and the same again tomorrow.

Small Kitty got host 30 min late this amps, pmps will be 15 then normal next day.

Hope I got it right ?
 
Winner at 2.0, Small Kitty just got his reduction.

Congratulation Small Kitty, you're the owner of this new dose for ???? days ! :bighug::bighug::bighug:


I think that was a good decision. Keep an eye on SK's numbers today. Just look at how far SK came down yesterday.I was actually surprised he did not bounce higher this morning after those low greens last night. :D
 
Small Kitty got host 30 min late this amps, pmps will be 15 then normal next day.

Hope I got it right ?


If you shot 30 minutes earlier for the AM shot then you would do the same again tomorrow morning. 30 minutes in total in one day. Either 15 minutes for each shot or 30 minutes once for the day.
 
Small Kitty got host 30 min late this amps, pmps will be 15 then normal next day.

Hope I got it right ?
If you gave insulin 30 minutes early today then give the insulin tonight 12 hours later, so at 6:30PM EST. Tomorrow morning you can shoot 30 minutes earlier too. Then you are back on track.

ETA I meant shoot at 6:30 PM EST tonight.
 
This week-end will be the last time for some time to do a curve, I'm out of the country for
one week starting next Friday.

Could tomorrow be the most representative day to attest this new dose ?

Got to keep one day for my second job.
 
If you gave insulin 30 minutes early today then give the insulin tonight 12 hours later, so at 6:30PM EST. Tomorrow morning you can shoot 30 minutes earlier too. Then you are back on track.

ETA I meant shoot at 6:30 PM EST tonight.

Didn't shoot early, shot was given 30 past normal shot time.

Objective is to keep 12h in between. Why shooting ''early'' ? Shout be delayed ?
 
This week-end will be the last time for some time to do a curve, I'm out of the country for
one week starting next Friday.

Could tomorrow be the most representative day to attest this new dose ?

Got to keep one day for my second job.


With the low numbers yesterday, and not bouncing as high as I would have expected this morning, I would try to do a curve this morning and plan on doing regular monitoring this evening. Monitoring well again tomorrow would also be a good idea since this is the last chance you have to do numbers in between shots before you go away.


Didn't shoot early, shot was given 30 past normal shot time.


You shot "early" in relation to the last shot you did last night which was 1 hour late. So you are counting back from last nights time.
 
Didn't shoot early, shot was given 30 past normal shot time.

Objective is to keep 12h in between. Why shooting ''early'' ? Shout be delayed ?
The reason to shoot a bit early is to get you back on your schedule of 6 AM and 6 PM since you shot one hour late last night. So if you shot this AM at 6:30, you can give the shot tonight at 6 PM ( that is if SK is in a safe number) and then tomorrow you will be back on track.
 
From yesterday :
Oh Sebastien, I did a boo boo saying "1/2 hour later" . I should have said "1/2 hour earlier". It's okay, no harm done. Just shoot 1/2 earlier tonight or at 6PM to get you back on your schedule of 6 AM and 6 PM. I am so sorry for the typo, guess I was tired last night and not thinking straight. :confused:

Forget shooting at 6Pm tonight, shoot at 6:30 PM and then like Maryanne said, tomorrow you can shoot a 6 AM then be back on schedule. I am still tired and not thinking straight. Sorry ofr any confusion.
 
If you shot at 7PM last night and your normal shot time would have been 6PM then you were an hour late shooting from your normal time. If you shot at 6:30AM this morning you are 1/2 hour early for doing a 12 hour cycle, but still 1/2 hour later than your normal schedule. Tomorrow you can shoot at 6 AM to get back on schedule.
 
Oh Sebastien, I did a boo boo saying "1/2 hour later" . I should have said "1/2 hour earlier". It's okay, no harm done. Just shoot 1/2 earlier tonight or at 6PM to get you back on your schedule of 6 AM and 6 PM. I am so sorry for the typo, guess I was tired last night and not thinking straight. :confused:

Too much action yesterday :)
 
Tired too.

Thanks for this early ''meeting'', gave Small Kitty and Big Brother little treats
and will head for the bed.

Got it all, stay tuned (if you wish), probably more surprises to come :)

That seems to be the Small Kitty specialty !
 
Tired too.

Thanks for this early ''meeting'', gave Small Kitty and Big Brother little treats
and will head for the bed.

Got it all, stay tuned (if you wish), probably more surprises to come :)

That seems to be the Small Kitty specialty !
Enjoy your nap, I am off to an appointment and maybe I will get a nap today too. :)
 
Well what a night!!
Now the dust has settled some and after having read through last nights condo, I would like to recap.
Last night you shot 1u to 61 on your AT, I agree with @Tuxedo Mom , that is not usually a number that we would consider shootable, regardless of which method you are following, @Bobbie And Bubba the 61 would be equivalent to a number in the 40's on a human meter, guess in all the confusion last night the AT being in play slipped through the net, I think that's the point that Mary Ann was trying to make. In that situation, you need to wait and see if his numbers bump up.

Here's the relevant section on handling a low PS, it is taken from the TR protcol (the numbers quoted are for a human meter) though not from SLGS, but it may give you an idea of how to handle those lower PS numbers 68 AT= 50Human, therefore the 61 was below 50 (ie in the 40's)
I think I would have waited till at least he got over 68, (though strictly on SLGS you wouldn't shoot below 90)

** 40s or lower – you have a couple of choices.

  • When 40s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
  • If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
    • --- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

I like @julie & punkin (ga) suggestion of going to 2u, with DKA in SK's history I would be more worried of the return of high numbers and SK not having enough insulin on board. It will be interesting to see how this cycle plays out given the 1/2 dose last night. 2u might still be quite an active dose for SK, so don't get complacent with those higher numbers you are seeing early on in the cycle.

 
Actually, Small Kitty is handling perfectly, 266 in mid cycle. With the cut off dose
it's better to have a constant go down. Would be nice to have right on target shootable
numbers at when it will come.
 
This week-end will be the last time for some time to do a curve, I'm out of the country for
one week starting next Friday.

Could tomorrow be the most representative day to attest this new dose ?
If you could do a curve tomorrow, I think that would be great. Anytime you can't do a curve, then I would just hold doses a little longer. I wouldn't increase his dose without either a curve or enough nadir checks that you can feel very confident about how low a dose is taking his blood sugar. You do a great job of getting extra tests in when you can - those are very helpful!

One more thought - would you mind taking out all the extra color from the ss that aren't test colors? I'm finding it hard to read his spreadsheet because I'm used to the only color being test results. My little brain is having a hard time not seeing the oranges and only focusing on the test results! Maybe it's just me, but I'm used to looking at the flow of the colors to help me see what's happening with blood sugar. I hope I'm not being too picky, :bighug: but it really is challenging to my little brain to have all the extra color in there that isn't for tests. o_O If you absolutely love the colored cells and want to keep them, I'll just try harder to not see them.:)

Hope you have a good weekend!
 
Just another word about shooting low numbers. Both Marje and I would shoot any number above a 50 on a human meter. We had TONS of data on our cats -- literally years of data and lots and lots of tests. I am a big proponent of helping people get comfortable shooting low numbers.

With a 61 on an AlphaTrack meter, I would not shoot. A 61 on an AT meter is below 50 on a human meter. In other words, this is not a safe number to shoot. You have no margin for error. I think there was some confusion about SLGS and the dose reduction threshold of 90 (on a human meter) and whether you should shoot low. The difficulty with the AT meter is that other than using a 68 as the threshold for a dose reduction if following Tight Regulation, there aren't reliable conversions with SLGS between human and AT meters. The SLGS instructions for someone who is just starting out is that you do not shoot numbers below 150. Given how hard you've been working to get SK in better numbers and coupling that with the history of DKA, I'd be reticent to suggest skipping with numbers below 150. My point is, though, you need to consider where the safe range is for shooting. It's clear with TR -- you do not shoot numbers below 50 if using a human meter. I want to reinforce that you should not shoot below 68 with an AT meter regardless of which approach to dosing you're using.

As for SK being on too high of a dose, I don't think so. You have been systematically working at increasing the dose. Your efforts are beginning to pay off with better numbers. I would not rush into lowering the dose. This is especially the case in a kitty that has a history of DKA. While SK may be past any immediate danger, some cats are just prone to developing ketones. None of us want to see SK go that route again.

 
One more thought - would you mind taking out all the extra color from the ss that aren't test colors?

I'd prefer keeping the color for food. At one time or another dental will be needed for Small Kitty.
There is a competent vet out of Montreal that knows about FD that would be ok working with
''unstable'' numbers. Global picture with punch might be helpful for her but just for you, Julie,
I'll think about a very light color :)
 
With a 61 on an AlphaTrack meter, I would not shoot.
Agree, thing is the price to pay, just don't like red at the morning, doesn't start my day very well ;) This morning was a good color not to be angry :D. Particularly good for a week-end :bighug:.. spend sleeping haft of the day.

There was just too many tests yesterday, I could have let him go past +3, a go sleep, I guess.

.
 
Look at how far low a skip shot brought Small Kitty 24h later on the 14th.
ECID, this one, at this period, seems to be very responsive to insulin.
Nadir is all messed up...

Not sure if this is making sens.
 
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Was about to run for my second job but it takes 4h door to door... Small Kitty will be
green at pmps..

Think that's going to be for tonight... Hope the grocery (next door to where I work) will be
open, almost out of right type of food just sold there...
 
I think there was some confusion about SLGS and the dose reduction threshold of 90 (on a human meter) and whether you should shoot low. The difficulty with the AT meter is that other than using a 68 as the threshold for a dose reduction if following Tight Regulation, there aren't reliable conversions

Yes, I think that is exactly what happened. After Julie posted the guidelines for TR and shooting low numbers. I posted the following after Sebastien mentined doing two 18 cycles.

I think you want to get him before he gets too high to take advantage of the overlap that is mentioned in the above post by Julie. How comfortable are you with shooting a lower number? @@julie & punkin (ga) , with 90 being a reduction number for SLGL, does Sebastien need to wait till SK gets to that number? Post #15

It was decided that if he were to wait till SK came up to 90, he would be too far off his shot schedule and with the DKA history maybe shooting a reduced dose of 1 unit would be a better decision for him.

I wish there were better guidelines for SLGS and I admit, I am not real fluent in the guidelines that are in place, but I did question him shooting below 90.
 
Just a general reminder...

Lately, there appears to be a whole lot of confusion in the group on how to handle lower numbers depending on what method of regulation is used.

The suggestions found in the Tight Regulation: Shooting & Handling Low Numbers sticky were written for those following the TR Protocol only.

The How to Treat Hypos sticky contains the suggested low numbers guidelines for those following SLGS.

With a 61 on an AlphaTrack meter, I would not shoot. A 61 on an AT meter is below 50 on a human meter. In other words, this is not a safe number to shoot. You have no margin for error. I think there was some confusion about SLGS and the dose reduction threshold of 90 (on a human meter) and whether you should shoot low. The difficulty with the AT meter is that other than using a 68 as the threshold for a dose reduction if following Tight Regulation, there aren't reliable conversions with SLGS between human and AT meters. The SLGS instructions for someone who is just starting out is that you do not shoot numbers below 150. Given how hard you've been working to get SK in better numbers and coupling that with the history of DKA, I'd be reticent to suggest skipping with numbers below 150. My point is, though, you need to consider where the safe range is for shooting. It's clear with TR -- you do not shoot numbers below 50 if using a human meter. I want to reinforce that you should not shoot below 68 with an AT meter regardless of which approach to dosing you're using.
Well said. Thank you, @Sienne and Gabby (GA) .



 
I’ve been working on SK’s SS this morning so it should be in good form now, Sebastien. And so.....that also caused me to go back and see all the excitement I missed.

Here’s an easy way to tell if you should shoot a number whether it is rising or not. If it’s in bright green on the SS, don’t shoot it. That’s the first tip.

For a 52 on an AT, I would have followed directions for numbers on a human meter that are in the 40s. So I would have retested in 15-20 mins and if numbers were not rising, I would have fed 1 tsp of low carb food and retested in 30 mins but I would have then waited until numbers were above 90 to shoot.

I know it gets scary and posts are flying, but just remember that for SLGS, your cut off for shooting is 90. Because it is very easy for people to miss or forget what meter you are using or what method you are following, then you are the one that would be responsible for knowing that you aren’t going to shoot below 90. You just have to be patient and keep testing to see if numbers come up above 90 and when they do if it is still within a two hour window and you can afford to make up time slowly over the next few cycles, then you could shoot. The only thing “magical" about shooting no more than two hours late is that any more than that and it can take a while to make up the time and get you back on your regular shot time.

And the other thing I would like to add is that when we stall, we do not usually shoot a BCS unless there is some really some glaring reason (e.g. kitty not eating) to do so and there wasn’t last night. I read through the condo and I do not agree that there was any reason to shoot 1u. Did he earn a reduction with the 52? Yes. Therefore, considering his history (DKA), considering that you had just reduced and you could have been looking still at depot, and considering that you stalled an hour, if he were my kitty, I would have shot 2u once he had risen above 90 provided it was within the amount of time I could afford to stall. If, within two hours, he had not risen above 90, I would have skipped but ETA: that would have made me nervous with the DKA in the history.
 
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And the other thing I would like to add is that when we stall, we do not usually shoot a BCS unless there is some really some glaring reason (e.g. kitty not eating) to do so and there wasn’t last night. I read through the condo and I do not agree that there was any reason to shoot 1u. Did he earn a reduction with the 52? Yes. Therefore, considering his history (DKA), considering that you had just reduced and you could have been looking still at depot, and considering that you stalled an hour, if he were my kitty, I would have shot 2u once he had risen above 90 provided it was within the amount of time I could afford to stall. If, within two hours, he had not risen above 90, I would have skipped.
Emphasis mine.
I agree with Marje (I would have done the same given the circumstances), but it's also important to point out that her suggestions don't necessarily follow the SLGS guidelines to the letter.

HOWEVER, as I wrote in one of Mocha's threads last year:

"The SLGS Method was written with a whole lot of flexibility in it which seems to have been lost over the past year. SLGS is a thinking man's protocol... not steps to be followed. As written, it's a method designed to allow what you learn and eventually know about your cat to guide you when making decisions. For example, notice phrases like, "In the beginning we suggest following the guidelines..." and "Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide." and "With experience, you may find that lowering these thresholds may work well for your cat." and "Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat." and "We usually...". Get my drift? These are guidelines, not rules. In the beginning, following guidelines is great, but eventually your data and observations are worth their weight in gold."


 
SLGS, your cut off for shooting is 90

That removes all ambiguity, clear cut. Next day might be red but better be too high than too low.

Only thing is, Small Kitty has been hard to get back on track when on the red side so my brain want's
to keep him as close as possible to yellow-green-bleu for days to come.

This era might be gone, insulin seems to be acting promptly.

Vanishing depot ? Just more confusion...
 
Whatever SK has done in the past should not be making the rules for what he is doing now. There was the possibility at one point that the insulin may have been less effective and you changed pens. Then after the vet tech was doing the shots, the suggestion that the shooting technique might need some tweaking was brought up. Whether either/both of these suggestions had any bearing on SK's numbers, the point is that SK has been hitting lower than desired numbers for someone following SLGS. As much as we all want our kitties in good numbers, the first consideration is keeping them safe. Not to be scary but there have been a few kitties that have passed over from serious hypos.
 
Small Kitty is making our job easier this pmps : 166 :bighug::)

Clear and simple without any challenging situation :D
 
Small Kitty is making our job easier this pmps : 166 :bighug::)

Clear and simple without any challenging situation :D


Considering that SK is starting PM with a lower number than through the rest of the earlier cycle, I would plan on doing a +2 and +3 test to make sure he does not do another nose dive. He is obviously clearing the bounce from last night/this morning and it would be good to monitor his numbers/
 
Whatever SK has done in the past should not be making the rules for what he is doing now. There was the possibility at one point that the insulin may have been less effective and you changed pens. Then after the vet tech was doing the shots, the suggestion that the shooting technique might need some tweaking was brought up. Whether either/both of these suggestions had any bearing on SK's numbers, the point is that SK has been hitting lower than desired numbers for someone following SLGS. As much as we all want our kitties in good numbers, the first consideration is keeping them safe. Not to be scary but there have been a few kitties that have passed over from serious hypos.

I think this veterinarian clinic should be brought to justice..

1 : proposing shaving a small part in the fur at the bottom of the neck, in the middle, so I could insert
the needle at 75 degree to shoot (flat skin)

2: Explaining to test using a needle the way a nurse would make an injection (reaching the blood vessel)

3: Letting numbers stay in the red until DKA doing nothing but talking to the cash register clerk
for vet advises.


All this was deadly, for Small Kitty, myself and my credit card. Now I test with just a little punch
to get a blood drop, not the way someone wold proceed to take blood sample, adding stress to
myself and Small Kitty. Who knows for how many weeks/months shot went straight through
the muscles, not under the skin...

These guys are as bad as companies adding rice and corn in cat food, even worst..

God make them pay

.
 
Considering that SK is starting PM with a lower number than through the rest of the earlier cycle, I would plan on doing a +2 and +3 test to make sure he does not do another nose dive. He is obviously clearing the bounce from last night/this morning and it would be good to monitor his numbers/

I've set the feeding with MC food + He's rising at +1, I really need a break tonight, heading to my favorite place for a snack and beer. Dont think Small Kitty is at risk + I need some break time for myself.
 
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