07/23 Herman amps 171 stall, +30min 234 and shot, pmps 434, +6 117+7 60…trying to stay calm

Amy & Herman

Amy & Herman

Member Since 2022
Yesterday: https://www.felinediabetes.com/FDMB...15-skip-dose-4-124-6-220.266163/#post-2979554
Hello,
Shooting 171 would be my lowest pre shot yet. The previous lowest pre shot was 221 (2 units, we reduced since then), and we had some (scary to me) lows (and he had a bad day - maybe unrelated to lows).

Given his last few days and skipped am dose yesterday I am stalling until I get some input. I can work around a disrupt in my shooting time. First though….do I feed? Below say feed as usual but I thought I read somewhere I should wait with food.

The SLGS protocol states:
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
 
Bandit's Mom said:
When stalling you withhold food and test in 20 mins. 171 is a compfortable number to shoot if you can monitor. How is his appetite?
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I have not fed yet. But he seems hungry. Will test again now and see where we are at. I can be around to monitor, I bit nervous though given the other days events. Testing now I’ll post number ina min.
 
And at +7 we are at 380 o_O I guess this is a bounce. My Herman is all over the map! From early low to late high. Curious if he will continue to rise or go low. He’s steadily risen all day and I’m positive I didn’t do a fur shot.
 
I'm glad you shot. Typically shooting lower means flatter cycles. But the other thing happening today could be the result of yesterday's skip. Skips or fur shots can impact later cycles.

A couple clarifications. First, SLGS is not a protocol, it is a dosing method developed here over time. Unlike the TR protocol which was subject to a formal research study and published in veterinary journals. Second, there are two parts to the shooting lower numbers in the dosing methods sticky note under the SLGS method. The first one, which you quoted, is for when you are new and have little data on your cat. If you read a little further down, there is a section starting "with experience". Given how much you test, which is way more than even most people on TR (definitely more than I did), you are collecting a lot of data on Herman's reaction to Lantus than most people have at this point. I personally would have stopped testing at +5 today, once they start going up like that, they aren't going down the rest of the cycle.
 
Answering yesterday's question:
Amy & Herman said:
Is it correct that I want some in the 15-20% range to bump him up if he gets to the greens steeply?
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Unfortunately this is one of those "know thy cat" situations and ECID, every cat is different. You are recording some good data on how much he eats and when and of what food. Soon you should be able to figure out how carb sensitive Herman is. If a kitty is low (below 50), the goal is to give enough HC to bump them up about 30-40 points. I started out with a tsp of the higher carb% Weruva and found it gave Neko too much of a boost, so settled on 17-18% carb food. Note, when she was below 40, she got a drop of corn syrup on her food right away. Thankfully that wasn't too often. You can play around with both carb % and amount of food to get the effect you want.

If you want to just slow the steep drops, then I'd try some MC (11-15%) first, to see if you can slow him down. With Neko, something around 8% was good enough to do that job.

Another time you can use food to effect is when they first hit that high greens is he's approached them slowly, and that's to give a tsp or two of regular low carb food. That can help them surf, or hang out in those safe and healing high green numbers.

The other thing to consider is what point you are in the Lantus cycle. After onset and before nadir, the insulin action is the strongest and you may need a higher carb% than later in the cycle after his typical nadir.
 
Wendy&Neko said:
Answering yesterday's question:
Unfortunately this is one of those "know thy cat" situations and ECID, every cat is different. You are recording some good data on how much he eats and when and of what food. Soon you should be able to figure out how carb sensitive Herman is. If a kitty is low (below 50), the goal is to give enough HC to bump them up about 30-40 points. I started out with a tsp of the higher carb% Weruva and found it gave Neko too much of a boost, so settled on 17-18% carb food. Note, when she was below 40, she got a drop of corn syrup on her food right away. Thankfully that wasn't too often. You can play around with both carb % and amount of food to get the effect you want.

If you want to just slow the steep drops, then I'd try some MC (11-15%) first, to see if you can slow him down. With Neko, something around 8% was good enough to do that job.

Another time you can use food to effect is when they first hit that high greens is he's approached them slowly, and that's to give a tsp or two of regular low carb food. That can help them surf, or hang out in those safe and healing high green numbers.

The other thing to consider is what point you are in the Lantus cycle. After onset and before nadir, the insulin action is the strongest and you may need a higher carb% than later in the cycle after his typical nadir.
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Thanks for this, I will experiment and document. I test so often because I am really trying to get data-confident while I can (working mostly from home), but my goodness, I feel like no pattern is emerging and that he has had some scary drops at unpredictable moments. I really need to wrap my head around the fact that the shot doesn't affect just 12 hours but can be days. So I need to looks at big picture.
 
Wendy&Neko said:
I'm glad you shot. Typically shooting lower means flatter cycles. But the other thing happening today could be the result of yesterday's skip. Skips or fur shots can impact later cycles.

A couple clarifications. First, SLGS is not a protocol, it is a dosing method developed here over time. Unlike the TR protocol which was subject to a formal research study and published in veterinary journals. Second, there are two parts to the shooting lower numbers in the dosing methods sticky note under the SLGS method. The first one, which you quoted, is for when you are new and have little data on your cat. If you read a little further down, there is a section starting "with experience". Given how much you test, which is way more than even most people on TR (definitely more than I did), you are collecting a lot of data on Herman's reaction to Lantus than most people have at this point. I personally would have stopped testing at +5 today, once they start going up like that, they aren't going down the rest of the cycle.
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I will look closer at the dosing method, I should likely bump back to TR. I more or less have the testing down but you know it’s always the ‘scary” days where tests don’t go as planned. I test too often I know… it’s mostly out of fear, but mostly the desire to learn what Herman is likely to do in various situations so I can plan and stop panicking at every unexpected or low number. but also, we struggled SO much at first that I took it on as a must succeed challenge (he HATED THE LIBRE) …it was literally a matter of life or death in my mind!. Herman has more or less gotten to the point where he “presents” himself for testing almost hourly during the day. He goes outside, does cat stuff. I call him (or he just shows up at my desk) and I make much production of ear rubs and “poke poke” time. Sometimes he gets a mouthful of lc wet. Sometimes not. He always gets praised and now I see him look forward to our little chore. But I plan to start skipping tests for sure.
 
OK. So the 116 at +6 was enough of a dive from the 266 at +4 to merit MC. When they drop so fast, you want to feed higher carbs to slow them down.
You might be able to switch to low carbs now since it is late in the cycle. Let's see the +8?

He has earned a reduction tonight to 1.5U. Congrats. He is on a mission down the dosing ladder and the ride can be a little hairy. :-)
 
Bandit's Mom said:
I think it's about 30 mins to +8? And he was 75 at the last test? Let's hold back on the carbs and see where he is at +8? Is he asking for food?
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It is now 30 minutes to +8. I did not give anything between +7.25 and 7.5 and it rose from 76 to 99 in those 15 min. I will test again in 15 minutes (+7.75) without feeding more and see if still rising. He is interested in food (will eat if offered but not out looking for it he is in his bed).
 
Bandit's Mom said:
OK. So the 116 at +6 was enough of a dive from the 266 at +4 to merit MC. When they drop so fast, you want to feed higher carbs to slow them down.
You might be able to switch to low carbs now since it is late in the cycle. Let's see the +8?

He has earned a reduction tonight to 1.5U. Congrats. He is on a mission down the dosing ladder and the ride can be a little hairy. :)
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No kidding it can be a little hairy! My boy is on a roller coaster these days. Will reduce next dose. Thanks for helping me out again tonight. Heading out to get a +7.75
 
Bandit's Mom said:
OK. So the 116 at +6 was enough of a dive from the 266 at +4 to merit MC. When they drop so fast, you want to feed higher carbs to slow them down.
You might be able to switch to low carbs now since it is late in the cycle. Let's see the +8?

He has earned a reduction tonight to 1.5U. Congrats. He is on a mission down the dosing ladder and the ride can be a little hairy. :)
Click to expand...
If I was following TR would I not reduce after tonight’s adventure? Someone today mentioned I might consider switching to TR since I test so much. Want to do what’s best for him. Weighing safety with what gives him best chance of getting healthy and possibly remission.
 
With TR, the reductions are at 50 vs 90 for SLGS (on a human meter). Right now he seems to be zooming down the dosing ladder so you are okay to reduce.
 
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