? 1-22-20 PMPS 260 increase dose? Please help

[Ori (and Erica)]

I can’t figure out what to do - should I increase to 3 units? I think I need to change to TR. i gave less today and she did well but I’m wondering if she needs 3 units?

I changed spreadsheets before this current one. Vetsulin was a nightmare and then she was on 2 units of Lantus for a while. Can’t break thru the yellows and pinks. If she was a human I’d up her dose.
Advice appreciated!

 

[Si am cat mom]

HI
Was something going on this morning with Ori that made you give a reduced dose?

Typically with SLGS, you hold a dose for a week and then do a curve to see how low the dose is taking them so you can adjust. It does look like sometimes you held a dose for 9-10 days. I do see a blue PMPS recently, so you have broken though the yellows and pinks, which is great.

Just for reference: SLGS
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. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• 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

I am not sure what the testing parameter are for TR...if it's 6 per day or not. Hopefully someone with more experience with TR vs SLGS comes by. This comment should bump your post back up to the top if it's not close to it already so someone should see it.

 

[Sienne and Gabby (GA)]

Welcome Erica!!

It looks like you're planning on following SLGS. With that approach, you want to hold the dose for a week, get a curve, evaluate the numbers and then decide whether to increase. I'm not sure why you shot 2.5u this morning after having been at 2.75u. In any event, it looks like you increased to 3.0u this evening. It was technically a couple of days early for an increase but I'd stick with the 3.0u dose for a week.

What were your reservations about TR? In response to Ari (@Si am cat mom), the minimum number of tests with TR is 4 -- your pre-shot tests and at least one additional test during each cycle. Most people using TR often test more than that but pre-shot tests and a test in the vicinity of nadir during was cycle is recommended.

 

[Ori (and Erica)]

HI
Was something going on this morning with Ori that made you give a reduced dose?

Typically with SLGS, you hold a dose for a week and then do a curve to see how low the dose is taking them so you can adjust. It does look like sometimes you held a dose for 9-10 days. I do see a blue PMPS recently, so you have broken though the yellows and pinks, which is great.

Just for reference: SLGS
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. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• 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

I am not sure what the testing parameter are for TR...if it's 6 per day or not. Hopefully someone with more experience with TR vs SLGS comes by. This comment should bump your post back up to the top if it's not close to it already so someone should see it.

I want to try TR - I think SLGS may not be working well --- I was listening to some other comments that maybe she was bouncing - but I really don't think that is the case. I tried a lower dose and she did well, but I also eliminated the Fancy Feast because she does better, it seems on Dr. Elsey's only.

 

[Ori (and Erica)]

Welcome Erica!!

It looks like you're planning on following SLGS. With that approach, you want to hold the dose for a week, get a curve, evaluate the numbers and then decide whether to increase. I'm not sure why you shot 2.5u this morning after having been at 2.75u. In any event, it looks like you increased to 3.0u this evening. It was technically a couple of days early for an increase but I'd stick with the 3.0u dose for a week.

What were your reservations about TR? In response to Ari (@Si am cat mom), the minimum number of tests with TR is 4 -- your pre-shot tests and at least one additional test during each cycle. Most people using TR often test more than that but pre-shot tests and a test in the vicinity of nadir during was cycle is recommended.

I am not sure what my reservations are about TR - I can do 4 tests a day and as you can see, I do collect pretty good data. I was kind of hoping to do "almost TR" because I am a little scared of it? I cannot commit to testing more often than that, however, so if it's best that I stay on "slightly accelerated" SLGS, I will. Ori is AWAYS higher in the AM - I am guessing that is dawn phenomenon. I am not inexperienced with diabetes as I have a type 1 family member and some things are very much the same it seems. I just always hesitate to increase the dose. Is 3 units a lot?

 

[Crista & Ming]

Is 3 units a lot?

They need what they need. And you've been increasing safely. It might also be glucose toxicity settling in and the only way to break through that, is more insulin.

I was kind of hoping to do "almost TR" because I am a little scared of it? I cannot commit to testing more often than that, however, so if it's best that I stay on "slightly accelerated" SLGS,

I think you test enough to do TR. Even on SLGS, cats will go low and you'll need to test more during those cycles. The difference really is how fast you're increasing and the reduction point. Some on SLGS don't test in between cycles all the time but you do.

You also need to rule out dry. Sorry, are you saying Ori wasn't doing well on FF but is better on Dr. Elsey's dry? What was Ori like on FF?

 

[Ori (and Erica)]

They need what they need. And you've been increasing safely. It might also be glucose toxicity settling in and the only way to break through that, is more insulin.


I think you test enough to do TR. Even on SLGS, cats will go low and you'll need to test more during those cycles. The difference really is how fast you're increasing and the reduction point. Some on SLGS don't test in between cycles all the time but you do.

You also need to rule out dry. Sorry, are you saying Ori wasn't doing well on FF but is better on Dr. Elsey's dry? What was Ori like on FF?

No dry at all. I was mixing in a little wet Fancy Feast to augment the $$$ Dr. Elseys wet, but her numbers seemed worse on it, and I think the Dr. Elseys wet is a better food. I think I want to react faster than 10 days when I see a trend...like 2.75 was not working and that is why I decided to step up to 3 and also get on this board in earnest.

 

[Crista & Ming]

Oh cool! I didn't know Dr. Elsey's made wet food too. As long as it's LC, then you're good to switch to TR.

You can always go back to SLGS. And I doubt there will be immediate overnight changes if you switched to TR.

You also always have a choice of when you want to increase. Of course, it's always safer to increase when you can monitor. As time goes on and you understand Ori better and gather data, you'll start to notice his patterns. For example, when I increase Ming's dose, I know the first couple of cycles won't be too dramatic as the depot is still building. The 3rd or 6th cycle is when he starts to show action. He also does this thing called the high before the low. Where he'll go high for a cycle and then come back down. It's only taken me almost 2 years to figure him out and I'm STILL learning lol

 

[Ori (and Erica)]

Oh cool! I didn't know Dr. Elsey's made wet food too. As long as it's LC, then you're good to switch to TR.

You can always go back to SLGS. And I doubt there will be immediate overnight changes if you switched to TR.

You also always have a choice of when you want to increase. Of course, it's always safer to increase when you can monitor. As time goes on and you understand Ori better and gather data, you'll start to notice his patterns. For example, when I increase Ming's dose, I know the first couple of cycles won't be too dramatic as the depot is still building. The 3rd or 6th cycle is when he starts to show action. He also does this thing called the high before the low. Where he'll go high for a cycle and then come back down. It's only taken me almost 2 years to figure him out and I'm STILL learning lol

It's fantastic wet food - low carb, yes. And it smells (almost) good enough to eat on a cracker with some wine and cheese. Almost.
Yeah - that is what I see too - it's just not quite kicking in at 2.75 and I feel like she needs more juice to give her pancreas a fighting chance here. I don't know why I am so scared to give 3 units - probably because she had some lows and I freaked a tiny bit. I did not double-check the numbers and over-treated, etc. Thank you for the input!

 

[Sienne and Gabby (GA)]

I think I want to react faster than 10 days when I see a trend

With SLGS, you increase after 7 days. With TR, you evaluate the dose and potentially increase every 3 days if numbers are above 300 and every 5 days if below (on a human meter).

 

[Sue and Luci]

Hi Erica, Could you please update your title to show the correct date? I've been off sick for a day and just saw your post from 1/28/20 - thought I'd been away longer than I thought... Looks like you may have posted this yesterday? If so, that date would be 1/22/20, right? Otherwise, I'd better go back to bed...LOL!

 

[Ori (and Erica)]

I’m at 3 units - I’m so confused because the one night I checked her she had lovely blues but she is so high in the morning. Seems happy - eating and grooming. I’m very frustrated. Stay the course at 3 - ok I will do it.

I need a pep talk because the dawn phenomenon is making me nuts.

 

[Sienne and Gabby (GA)]

Erica -

A housekeeping note...

The Lantus forum is a bit different than Health.You want to start a new thread every day you post. You copy and paste the link to your previous thread into the new so it's easy to back track. Given how busy this forum is, it's challenging to read a thread if it gets as long as the posts can get over in Health -- hence the request to start a new thread. It also means that given the date on this thread is 1/22, there's a good chance people like me who skims the subject lines to see who may need help would overlook the thread since it isn't from today.

Did you shoot last night? There's no dose noted which typically implies a skipped shot. Also, did you get any PM tests? Without the information about numbers during the PM cycle, you don't know if Ori bounced off of lower numbers or if the cycle was flat and he stayed in the 300s. Without more context for the AMPS numbers, I wouldn't necessarily conclude this is dawn phenomenon. This is why those PM tests are so important!

 

[Ori (and Erica)]

Erica -

A housekeeping note...

The Lantus forum is a bit different than Health.You want to start a new thread every day you post. You copy and paste the link to your previous thread into the new so it's easy to back track. Given how busy this forum is, it's challenging to read a thread if it gets as long as the posts can get over in Health -- hence the request to start a new thread. It also means that given the date on this thread is 1/22, there's a good chance people like me who skims the subject lines to see who may need help would overlook the thread since it isn't from today.

Did you shoot last night? There's no dose noted which typically implies a skipped shot. Also, did you get any PM tests? Without the information about numbers during the PM cycle, you don't know if Ori bounced off of lower numbers or if the cycle was flat and he stayed in the 300s. Without more context for the AMPS numbers, I wouldn't necessarily conclude this is dawn phenomenon. This is why those PM tests are so important!

No - I did not skip. I gave her 3 units. I did test before bedtime but not in the middle of the night. I am not going to be able to get up twice a night to test her. I could back down to a lower dose and reset.

 

[Sienne and Gabby (GA)]

You don't need to always get more than one PM test. If you can get a "before bed" test every night, hopefully that will give you enough information to know if numbers are dropping. It's those PM cycles where numbers may be dropping where you need to insure that Ori is in safe numbers before you go to sleep. As you saw with those blue numbers, some cats like to drop into lower numbers during the PM cycle. Likewise, if you don't get any tests at night, you're missing half of your data and it becomes difficult to make decisions about dosing.

If you did get a test last PM cycle, the test info isn't on your spreadsheet.

 

[Ori (and Erica)]

You don't need to always get more than one PM test. If you can get a "before bed" test every night, hopefully that will give you enough information to know if numbers are dropping. It's those PM cycles where numbers may be dropping where you need to insure that Ori is in safe numbers before you go to sleep. As you saw with those blue numbers, some cats like to drop into lower numbers during the PM cycle. Likewise, if you don't get any tests at night, you're missing half of your data and it becomes difficult to make decisions about dosing.

If you did get a test last PM cycle, the test info isn't on your spreadsheet.

Ah - I guess I failed to enter the data - I both shot and got a reading. I will try to get a few early AM.