09/08 Ivana AMPS=128 No shot, +3=216, +6=245, +9=308, PMPS=290, +4=257

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Hi. You don't have much data. Will you be home and able to test frequently should she drop under 50? Do you have a hypo kit with plenty of test strips and high carb food or karo should she drop under 50? Are you following TR or SLGS?
 
Yes I will be home to test her. Have got lots of test strips and wet carb food and honey. I'm not sure if I'm doing TR or SLGS?
 
Found them, thanks. Given that it's not always possible for us to test as often as tight regulation needs, we'd be looking at SLGS, so we don't shoot as it's under 150. Does that mean we just skip her shot altogether and her next one is this evening at the usual time?
 
Found them, thanks. Given that it's not always possible for us to test as often as tight regulation needs, we'd be looking at SLGS, so we don't shoot as it's under 150. Does that mean we just skip her shot altogether and her next one is this evening at the usual time?

That is correct. You can start with SLGS and see how it goes. You can always switch if it seems right. She will likely be a lot higher with a skipped shot. If you stick with this you will want to find a dose that lets you shoot every 12 hours. See how she handles the skipped shot. You might want to read the sticky on can I follow TR if I work full time as well.
 
Thanks for your help!! I think SLGS would be a better fit until we're more comfortable with how she's reacting (and she's more comfortable with all the extra poking). Definitely happy to look at TR further on though. How often do you suggest I test her during her AM cycle after a skipped dose?
 
I'd get a test somewhere around mid-cycle.

Personally, if you were OK with shooting a 164 last night, I would shoot the 124 if you're around to test. Ultimately, regardless of which approach you use, you're going to need to get used to shooting lower numbers at some point. What I'd suggest is waiting 20- 30 min and re-testing. See if numbers are heading up or staying flat. If they are, then shoot. (I just hope you haven't fed Ivana yet)
 
Yeah she's already had breakfast when we decided to skip the shot. Hopefully it happens again and we can try that different approach then :-)
 
Remember Tara....when you get a PS that you're concerned with, stall, don't feed and test again in about 20 minutes....a lot of times that original PS number will come up on it's own, so that tells you that the last shot is wearing off and it's usually going to be safe to shoot.

Also, remember that the number you're shooting isn't the number you're shooting (that makes sense, doesn't it?....LOL) Lantus generally doesn't "kick in" for a few hours, so the number you're getting at PS might be lower, but then you're going to be feeding (which adds carbs which will naturally bring up the blood glucose) and then later the new shot will have it's "onset of action" (will "kick in")

You're still in the very early stages though, and you're doing GREAT so far! Every "experiment" (whether you shoot, don't shoot, feed, don't feed) will add to your data and help to make better decisions in the future

One final thought...Ivana seems to be doing really well since you're getting lower and lower Preshots....what you might want to consider doing is lowering her dose so you can make sure you can always get shots in every 12 hours without getting a PS that makes you worry about shooting

You're testing more than enough during the day to be doing TR ...and as long as you can get at least a "before bed" test at night, TR is (in my opinion) the way to go..It will give Ivana the best chance at remission!! Of course it's a decision that only you can make :)
 
I don't suppose it's possible to switch between TR and SLGS on a day-to-day basis, is it? I wouldn't think so.

I've been able to do testing a few times per day because I've been home to do it, but unfortunately it's not always the case. Darn work and having to make money :mad: I talked to hubby about the two methods this morning and we think we will start with the SLSG and then move onto TR, it sounds like it suits us all better at the moment.

Question #1: Ivana is eating mince or human tuna for her meals. Given that there's no carbs in either of those, would that still affect her numbers? If, for example, I did decide to shoot her this morning (ack I don't like typing that haha!), could I have given her a little bit of carbs with her meal to offset the lower-than-usual AMPS?

Question #2: WRT lowering her dose, how many low AMPS/PMPS should she have before I do that? I've arranged a day to stay at home to do her curve on Tuesday, so perhaps that will give more info?
 
Hi Tara!
Ivana is doing really well! What a clever girl!
I just wanted to say I agree with everything Chris said.
You are doing really well with the testing too....how did Darryn go?
You are doing enough testing to do the TR. You can't really swap between the two on a day to day basis because the criteria for each is different. You could swap after a period of time from one to the other but not back and forth. Having said all that....it is entirely up to you what you decide.

Yes, if you think Ivana could do with a few carbs, that is fine to give her some to bring up the numbers a bit. I do that sometimes with Sheba. She has no carbs in her current diet, so if she is low I give her some to bring her up a bit. You would need to get some low carb food to do that. Have a look at the Weruva range I told you about for some food with carbs below 10%. The higher carb food ......over 10% ...is usually for when they drop down low and need to be brought up higher for safety.
Most people give their cats a diet with about 4 to 8 or 9% carbs in it as a routine thing.
I have just dropped to no carbs for Sheba as I am fiddling about with Sheba's diet trying to stop the big drops and bouncing.
Ivana might do well if she has a few carbs in her diet as a routine thing.........whatever you decide, you really need to stay with the same amount of carbs for each meal as this effects the insulin needs.
I will let Chris answer the dose question.

ETA. Lots of people work and can't get tests during the day and still do TR. On the days you work, try and get a before you leave test and maybe one when you get home and then do a couple of tests in the evening. That is fine.
 
Question #1
Yes...you can always add carbs to help control the BG, but one thing we do recommend is that if she'll eat other foods, that you don't feed fish more than about once a week due to the problems with mercury and it's high in phosphorus too (hard on the kidneys)....As long as the food is about the same carb percentage (within a few percentage points) it shouldn't matter on her numbers (unless she's VERY carb sensitive) If you can find a food that's around 4-6%, that's usually a good point to start at. A lot of cats do better with low carb instead of zero carb

Question #2
There's no set answer for that...if you're doing SLGS, she actually earned a reduction by dropping below 90 on 9/5, so she could have dropped back to 1.25 then. The problem now is that you've "stopped the momentum" by skipping today, so we're kind of back at the beginning. Each time you skip or change dose, it effects the depot, so she'll be draining her depot today and will probably be higher tonight

On a good note, IF you want to change your shooting schedule, tonight's the night to do it since you skipped this morning!

@Bron and Sheba ...do you guys have access to syringes with .5 unit markings or do you have to just eyeball it?
 
If you can't get syringes with half units, you might want to get digital calipers. That will help with being consistent.

You don't hold the dose for a specific number of times. If you're using SLGS, a drop below 90 is the cut-off for a dose reduction. There are some other contingencies with TR, but I wouldn't focus on that for the time being.

Are you feeding only human food? Cats need certain nutrients in their food -- like taurine. You need to be sure you're feeding a nutritionally complete diet.

 
Sienne: The mince is pet mince, the tuna is human tuna. Unfortunately she is an extremely fussy eater and those are the two things she likes. We're trying to get her be a bit more varied now, seeing that we've removed the dry food from her diet.

Chris and Bron: Goodness I think I need to read through both protocols again more closely, there is so much involved. We still stay at 1.5u for now, yes?
 
Has she been getting Lantus since diagnosis? The ss just starts a few days ago, but it looks like she was diagnosed 2 weeks ago. It might help if you insert a row(s) above the 1st row in the spreadsheet and add any data you have from August 20th til September 5th.

I would hold the 1.5u for now. She's looking really good on it. Let's assume you're starting with the Start Low Go Slow dosing method - although you are testing more than enough to follow the Tight Regulation Protocol developed by Dr. Rand at the Univ of Queensland.

The main differences between the 2:

- If a cat is eating any dry food, SLGS is the only dosing method available. Canned low carb or raw food is a requisite for following Tight Reg.

- How often you test matters - with Tight Reg you need to test at least 3 times each day (both preshots and at least one mid-cycle). With SLGS you adjust dosing by doing a curve once a week. SLGS is best for people who can't test at least 3 times per day.

- There's a difference in how often you adjust the dose. SLGS evalutates and possibly increases the dose once a week. Tight Reg allows for evaluating and increasing the dose as often as every 3 days, depending on the tests.

If a person can test enough and if the cat is eating low carb, then the Tight Reg Protocol offers the huge advantage of being able to adjust the dose frequently. Holding a dose for a week can seem like an eternity if you can see the dose isn't getting the cat into normal numbers. Watching your cat sit in high numbers isn't fun. The Tight Reg protocol is also the only dosing protocol for treating a cat with Lantus/Levemir that has been published in a professional veterinary journal. The study determined that getting a newly diagnosed cat's blood sugar into normal range as quickly as possible after diagnosis increases that cat's chances of having their pancreas heal and become diet-controlled. So . . . it's completely up to you, but if you can manage the testing, then it can be a plus to follow Tight Reg.

Assuming you're going with SLGS, stick with this dose for one week, then do a curve per the directions below. Then compare the tests you get on the curve with the info below and decide if you should hold or increase the dose.

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.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note
: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
  • As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Lather, Rinse, and Repeat!
 
Hi Julie, Ivana has been on 1.5u of Lantus since 25th August. Her spreadsheet only starts a few days ago because we weren't home testing before that.

Thanks for outlining the differences between the two methods so succintly! I did have a discussion with hubby about both methods this morning, but I think I might have him read the sticky's I've printed out and we can discuss again in more detail. You're right, TR does sound better - I admit though that I'm worried I won't be able to monitor her as well on the days that I'm not home, and hubby does not have the testing 100% under his belt at the moment.
 
Ok I've re-read the two sticky notes about SLGS and TR, and as usual I have questions, mainly about TR.

Question #1: The info you guys have told me in here sounds completely doable for us. Between all your responses it seems that the minimum amount of testing is AMPS, +1, PMPS, before we go to bed. Have I got that right? We can do that! However the document says at least +3, +6, +9 - that's not so doable. Do we need to be as strict as what the document says, and still not put Ivana in danger? If doing just a +1 and that number is ok, given Lantus doesn't kick in for a couple of hours will she be able to be left alone without monitoring after the +1?

Question #2: I've read varying info about shooting early or late - someone the other day said 30mins either side of the scheduled 12 hrs is fine, and I saw a FAQ on here somewhere that said 1hr either side is fine. Which one should I go by?

Question #3: I think what's making me nervous about starting TR right now is that we don't have much data for Ivana. I'm doing her curve on Tuesday, so can we go by the SLGS 'rules' til then and re-evaluate with that extra data? I'm also more than happy to stay up for a night to get a PM curve as well (though probably not the same day as I get the AM curve as I'll need to sleep sometime!

So many questions, sorry! I'm going to re-discuss this with hubby tonight but I want to be able to address any reservation he has about TR (if I just give him those docs to read he will freak out I think...)

Thankyou so much fellow sugarcat slaves ;-)
 
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Hello, I don't think I've stopped in to see you and your pretty girl yet. I'll do my best to answer the questions.
Question #1: The info you guys have told me in here sounds completely doable for us. Between all your responses it seems that the minimum amount of testing is AMPS, +1, PMPS, before we go to bed. Have I got that right? We can do that! However the document says at least +3, +6, +9 - that's not so doable. Do we need to be as strict as what the document says, and still not put Ivana in danger? If doing just a +1 and that number is ok, given Lantus doesn't kick in for a couple of hours will she be able to be left alone without monitoring after the +1?
The +3, +6 and +9 is when you are first starting out with Lantus but you've been on it a while now. The goal is to really mix up the testing times and try to get a better picture of how Ivana is handling the insulin. If you read the New to the Group Sticky, you'll see about onset, duration, overlap, nadir. Understanding these in your cat gives you a better idea of what to expect. Many people here work during the day and can't get day times tests. The Sticky Note on Doing TR with a Full Time Job may have some ideas for you.
Question #2: I've read varying info about shooting early or late - someone the other day said 30mins either side of the scheduled 12 hrs is fine, and I saw a FAQ on here somewhere that said 1hr either side is fine. Which one should I go by?
Here is a more detailed post on Getting Back on Schedule.
Question #3: I think what's making me nervous about starting TR right now is that we don't have much data for Ivana. I'm doing her curve on Tuesday, so can we go by the SLGS 'rules' til then and re-evaluate with that extra data? I'm also more than happy to stay up for a night to get a PM curve as well (though probably not the same day as I get the AM curve as I'll need to sleep sometime!
Do what makes the most sense for you and your life. Between now and starting TR, get a few spot checks in addition to the preshots. That'll help prepare you. Curves are testing every two hours for a 12 hour period or every 3 hours for an 18 hour period.
 
Here is a thread that you might want to bookmark, called "Where Can I Find?" When you're reading and reading, it's not uncommon to know you've read something about some topic, but you have no idea where it was. Hopefully this semi-index will help you.

Wendy's answered your questions - there is a difference between the suggestions for the first week on Lantus and after that. I think it's helpful to think of the spreadsheet as a jigsaw puzzle. Think about how well you can "see" the image in a puzzle if you have a sprinkling of pieces throughout the puzzle. That's your goal with the spreadsheet. You don't need to test every hour of every day, just sprinkle your tests around throughout the time you are home. You'll see some people do a lot of testing because it's become easy for them and they like to see the data, but that's not necessary. As the days go by, with some tests here and there, the image will become very clear as to what his blood sugar is doing.

Keep asking questions. We've all been in your shoes and we get it.

and i have to say, her picture is adorable! Sitting there so pretty looking straight at the camera.
 
If doing just a +1 and that number is ok, given Lantus doesn't kick in for a couple of hours will she be able to be left alone without monitoring after the +1?

Getting a +2 tells us more than the +1 does because usually, by +1 we're still looking at a food spike...by +2, the Lantus can be "kicking in" (but as you get more data on Ivana, you'll learn more about her food spikes ...how much she usually spikes and how long)

We've seen it often enough that a lot of us use the +2 as a kind of "crystal ball"

If the +2 is about the same as the PS, it's usually a pretty normal cycle...gradually down to nadir, then gradually back up

If the +2 is lower than the PS, that's your clue that it's important to plan on getting more tests in later in the cycle because Ivana might be planning something dramatic

If the +2 is higher than the PS, that usually means they're starting a bounce...and those are the cycles you can generally take a pokey break and get some sleep!

All that being said, if all you can get is a +1, then it's just important to learn when it's important to leave out some higher carb food for her to eat later in the cycle. A lot of us use auto-feeders so there's food out in case kitty needs it.

Another option is to make "food-sicles" by freezing some food (add water and put into an ice cube tray or muffin tin) and then as it defrosts, it offers "fresh" food later in the cycle....but you have to try this first...some kitties will eat it frozen or not!
 
Wendy, Julie and Chris - you guys are awesome! Thanks for bearing with my million questions, and that Where Can I Find It doc is great! Just when I thought I'd navigated the whole FDMB site, something else pops up :-)

So let me just confirm I'm understanding this correctly, I'm so scared to do it wrong - if we do TR, it would be ideal to time her AM shot so that I can get a +2, and then after that I can leave for the day. If not, then +1 is still ok as long as there is carb food out. (I think I like the idea of a +2 better!). So our day, if we both had to work all day, could look like this:

6.30am - AMPS, food, shot
8.30am - +2
6.30pm - PMPS, food, shot
8.30pm - +2
Bedtime - +whatever (varies)

We'd follow the 'rules' of when to shoot and not to shoot in the TR document, and this schedule would allow us to pick up on any potential hypos at the +2 points, to take action with carb food. Am I getting this?? I'm feeling a bit dumb.
 
Forgot to add: This will sound really selfish but I'm going to ask it anyway - What if we want to go out to dinner or movies or something? What would we do then? I don't want to never go out at night again. What do you guys do?
 
Well, you have the basic idea, but it's hard to lay out specific rules and times because every cat is different. I think you've got a super plan for starting out though! A lot of this you have to take a day at a time.

Don't worry about feeling dumb - as questions come up then things will make more sense.
 
You can shoot a little early or a little late, probably up to about 1/2 hour without her blood sugar even noticing it. Kinda depends on the situation. Sometimes people just skip a shot if they need to.
 
Ok good, a starting point is all I need! I also relayed to Ivana that you think she is pretty, and she just snored in reply. No wait, there was an ear flick. I think she approves :-)
 
The other thing you can do (depending on when you get home from work) is to grab a test as you come in the door (before the PMPS) Since I don't know you work schedules, it's hard to say, but if either of you can get a test as you walk in, that'll add to your understanding of Ivana

Do either of you work close enough to home to get an occasional lunch test? Again, just something that some people who are really lucky and can leave for lunch do when they can.

Dinner and a movie??? Now you're pushing it.....LOL
 
Having a life and a diabetic cat is important. I must admit that when I was thinking about a good schedule for preshot times, I did consider movie times! We mostly go to matinees, but the odd late movie too. Just don't buy tickets in advance. If you have an autofeeder, it does open up more options for going out. If I think there is any chance Neko will go low, I load up the autofeeder with higher carb food. Once you build up data on Ivana's cycles, you'll get more confidence about when it's safe to go out and play.
 
Thanks Wendy. I feel bad for thinking that, and I'm glad I'm not the only one. Obviously we don't go out every night or anything, but I don't want to give up the option. I'm just lucky Ivana got this diagnosis now, and not a few years ago when we actually did go out nearly every night!

Chris, no we can't duck back for lunch. If at all possible I will schedule my appointments so that I'm only out in the middle of the day, but it's not always possible and I need to earn money of course. We are both out all day only once a week generally, so most other days I'll be able to have a bit more leeway with Ivana and testing etc, I just wanted to run a schedule past you guys to make sure it would be safe. I'm still leaning towards getting more data before we actually officially start TR. Assuming hubby is on board with it, which I'm sure he will be once I tell him it's her best chance of remission.

Also, can I please have a clap for hubby who managed to successfully test her tonight!!! Only took him two goes too! :woot: So given that she didn't have her shot this morning, how do her numbers look?
 
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