1/31/18 - Luci AMPS 407! Why from 53 to 407 since last night???

[Sue and Luci]

Why does Luci have to keep me on this roller coaster? I see her numbers going down so low at night - I get worried...and then soaring so high this morning. Why isn't she settling down? I was starting to feel more comfortable in the yellows...at least they were all about the same...but this is all over the map...

Please advise. Is it time to contact the vet about changing the dose - I know what he'll say - increase the dosage - but with those lower numbers last night I keep looking at the SLGS method and saying, no, it'll only make the lower numbers lower...and then we'll have a hypo cat on our hands....will we be able to ride this out with consistent dosage and feeding? She's eating the same food and same amount that she's used to having - no change there at all...Fancy Feast pate' - various flavors but anything with gravy or modest carbs have been moved to the 'emergency drawer' - not for daily consumption. No kibble in weeks. She's playful and relaxed...

If she could talk she'd tell me this is all in my head (but I have the numbers Luci! - I can prove it )...crazy cat lady...

 

[Amy&TrixieCat]

Luci is bouncing from those pretty greens last night...her body still isn't used to being in normal, lower numbers so her liver overreacts to try and protect her, and that results in these highs.

You are absolutely correct that you do not want to increase Luci's dose right now. With Lantus, dose adjustments are primarily made based on the nadir, not preshot values. Her current dose got her to the low 50s; more insulin will most likely push her lower.

Bouncing is stressful to observe, but it is unfortunately part of the sugar dance for many kitties. Some kitties eventually do settle down; some just bounce on and on. Some people do steer the numbers with strategically-timed food; that's not something I ever did, though, so if others think that will be useful with Luci, I'm sure they will chime in.

The good news is Luci is feeling good - remember that a kitty is more than her numbers! Hang in there...many folks here have been in the same bouncy boat!

 

[Sue and Luci]

Luci is bouncing from those pretty greens last night...her body still isn't used to being in normal, lower numbers so her liver overreacts to try and protect her, and that results in these highs.

You are absolutely correct that you do not want to increase Luci's dose right now. With Lantus, dose adjustments are primarily made based on the nadir, not preshot values. Her current dose got her to the low 50s; more insulin will most likely push her lower.

Bouncing is stressful to observe, but it is unfortunately part of the sugar dance for many kitties. Some kitties eventually do settle down; some just bounce on and on. Some people do steer the numbers with strategically-timed food; that's not something I ever did, though, so if others think that will be useful with Luci, I'm sure they will chime in.

The good news is Luci is feeling good - remember that a kitty is more than her numbers! Hang in there...many folks here have been in the same bouncy boat!

Thanks so much for the confirmation of what I suspected...I'm going in to take my seasickness medication now...whew!

 

[Amy&TrixieCat]

It can be a rollercoaster, but it's important to watch the big picture....that Luci is feeling good, and the numbers will follow !

 

[Mandy & Rex (GA)]

Good morning! You had an exciting night, along with a few other CG's!

I didn't realize you are following SLGS. Please add that to your signature.

Anytime you see a number below 90, the next dose given needs to be cut by 0.25u. That means tonight, you give 1.0u. By giving 1.25u this morning, you shot through the bounce, which was a good thing. But please start giving 1.0u tonight.

Can you remind me why you are following SLGS? Is dry food in the picture? You do test enough for TR.

 

[Amy&TrixieCat]

Good morning! You had an exciting night, along with a few other CG's!

I didn't realize you are following SLGS. Please add that to your signature.

Anytime you see a number below 90, the next dose given needs to be cut by 0.25u. That means tonight, you give 1.0u. By giving 1.25u this morning, you shot through the bounce, which was a good thing. But please start giving 1.0u tonight.

Can you remind me why you are following SLGS? Is dry food in the picture? You do test enough for TR.

Thanks for that catch, Mandy!

 

[Sue and Luci]

Good morning! You had an exciting night, along with a few other CG's!

I didn't realize you are following SLGS. Please add that to your signature.

Anytime you see a number below 90, the next dose given needs to be cut by 0.25u. That means tonight, you give 1.0u. By giving 1.25u this morning, you shot through the bounce, which was a good thing. But please start giving 1.0u tonight.

Can you remind me why you are following SLGS? Is dry food in the picture? You do test enough for TR.

I really don't know...she does not eat dry food. I don't think I can test enough for TR.
So with her numbers so high this morning over 400 and now 386, her next dose should be lower???

 

[Stacy & Asia]

I really don't know...she does not eat dry food. I don't think I can test enough for TR.
So with her numbers so high this morning over 400 and now 386, her next dose should be lower???

You are testing more than the minimum for TR. TR is a published protocol and it has the best odds at getting to a remission, if that is a goal of yours. Not to say remissions can’t or won’t happen with SLGS, but SLGS is slower, there is a time window and the longer your cat is on insulin, the odds are more against remission. You have to go with the method you are most comfortable with, ultimately, but some people cannot do TR because of dry food or other limitations that preclude them from testing or monitoring as much as needed with TR because it is more aggressive.

And yes, with SLGS, you would reduce the dose even with numbers that high, with TR, you wouldn’t reduce the dose if/until she goes below 50.

 

[Mandy & Rex (GA)]

I went back and read the TR protocol and I can see why you feel you don't test enough. It suggests you do PS, +3, +6, and +9. I was told that I needed at least 2 tests per cycle or 4 tests a day. You can see my SS where I was able to test only twice in the AM cycle, then I try to do at least 3 in the PM cycle before going to bed. On the days I didn't work, I grabbed more tests to fill in the gaps.

Think it over and decide what you would like to follow and let us know because our advice does change based on TR or SLGS guidelines.

 

[Sue and Luci]

You are testing more than the minimum for TR. TR is a published protocol and it has the best odds at getting to a remission, if that is a goal of yours. Not to say remissions can’t or won’t happen with SLGS, but SLGS is slower, there is a time window and the longer your cat is on insulin, the odds are more against remission. You have to go with the method you are most comfortable with, ultimately, but some people cannot do TR because of dry food or other limitations that preclude them from testing or monitoring as much as needed with TR because it is more aggressive.

And yes, with SLGS, you would reduce the dose even with numbers that high, with TR, you wouldn’t reduce the dose if/until she goes below 50.

I guess I'm pretty confused as to which method I should follow. Luci does not have to eat dry food - there are no other cats. She eats only what I feed her - and that's been nothing but low carb wet food since I've learned about the impact of high and medium high carb foods. So her diet isn't the issue. If I can continue to test on the PS, +3, +6 and occasionally at night - DH is up much later than I am so he can get at least a couple there; for sure the 3+ but not sure about the 6+...but we can try. I'd like to get Luci into remission - certainly not on insulin for any longer than necessary.

So with that being said, should I reduce the dose tonight or night?

 

[Stacy & Asia]

I went back and read the TR protocol and I can see why you feel you don't test enough. It suggests you do PS, +3, +6, and +9. I was told that I needed at least 2 tests per cycle or 4 tests a day. You can see my SS where I was able to test only twice in the AM cycle, then I try to do at least 3 in the PM cycle before going to bed. On the days I didn't work, I grabbed more tests to fill in the gaps.

Think it over and decide what you would like to follow and let us know because our advice does change based on TR or SLGS guidelines.

I think the P.S., +3, +6, +9 is often misunderstood. As I read it on both our TR and the Tilly’s write up, that applies to monitoring closely on the first 3 days of starting insulin, because the initial dose is a guess and you really have no idea how the cat will react. After that 3 days, it’s not test rigidly at these times, it’s get tests where you can and start filling in the blanks so you can make good guesses about how your cat does. Those 3-5 tests can be anywhere in the cycle you can fit them in.

 

[Sue and Luci]

I think the P.S., +3, +6, +9 is often misunderstood. As I read it on both our TR and the Tilly’s write up, that applies to monitoring closely on the first 3 days of starting insulin, because the initial dose is a guess and you really have no idea how the cat will react. After that 3 days, it’s not test rigidly at these times, it’s get tests where you can and start filling in the blanks so you can make good guesses about how your cat does. Those 3-5 tests can be anywhere in the cycle you can fit them in.

OMG! I'm more confused that ever...so Tight Reg does not mean I have to test on schedule - every 3 hours?
Just 3-5 tests in a cycle? (how long is a cycle? 24 hours? 12 hours?) Please clarify...

 

[Amy&TrixieCat]

You definitely do test often enough for TR, and since Luci eats only LC wet food, you are also good in that department.

Correct - with TR you do not have to test on a schedule per se; you just need a minimum of a pre-shot test and one other test per cycle - so that's a total of 4 tests per day (which is two 12-hour cycles). However, if it is an active cycle, or you see a big drop, of course you will want to test more, for safety purposes. This is where "know thy cat" comes in; once you get used to how Luci generally responds to insulin, you will get a feel for when the most useful time for testing is. For Trix, I tested at +2 to see where things were going, and then decided from there if I needed a +4 or any other tests during the cycle. We also suggest that getting random tests sometimes can really be helpful with filling in the gaps.

A cycle is 12 hours, starting when you give the shot.

As for tonight's dose, if you stay with SLGS, yes - you would reduce, since Luci's nadir was below 90. If you decided to switch to TR, you would hold the dose and not reduce, since Luci's nadir was not below 50.

Both are very good methods, so more than anything it's a matter of what you feel comfortable with.

 

[Myagi (GA) and Heidi]

OMG! I'm more confused that ever...so Tight Reg does not mean I have to test on schedule - every 3 hours?
Just 3-5 tests in a cycle? (how long is a cycle? 24 hours? 12 hours?) Please clarify...

The cycle is 12 hours. Bounces suck ! They also clear. We just have to wait it out. I was slgs initially and everyone kept asking why not TR as you test enough. I was just scared. The reductions came faster on slgs, but Myagi couldn't hold them. On TR we are holding the dose longer and he's doing much better, staying in better numbers longer. But as is repeatedly told us, ecid and every sugar dance has a different tempo, different music and different partners! So it'll play out however it does and we're just here to follow the lead as best we can. you guys are doing great with Luci! continued success whichever route you go!

 

[Sue and Luci]

You definitely do test often enough for TR, and since Luci eats only LC wet food, you are also good in that department.

Correct - with TR you do not have to test on a schedule per se; you just need a minimum of a pre-shot test and one other test per cycle - so that's a total of 4 tests per day (which is two 12-hour cycles). However, if it is an active cycle, or you see a big drop, of course you will want to test more, for safety purposes. This is where "know thy cat" comes in; once you get used to how Luci generally responds to insulin, you will get a feel for when the most useful time for testing is. For Trix, I tested at +2 to see where things were going, and then decided from there if I needed a +4 or any other tests during the cycle. We also suggest that getting random tests sometimes can really be helpful with filling in the gaps.

A cycle is 12 hours, starting when you give the shot.

As for tonight's dose, if you stay with SLGS, yes - you would reduce, since Luci's nadir was below 90. If you decided to switch to TR, you would hold the dose and not reduce, since Luci's nadir was not below 50.

Both are very good methods, so more than anything it's a matter of what you feel comfortable with.

Thank you so much for clarifying!
Just to confirm I understand - A cycle is 12 hours - the time between shots.
I will test at least PS and at least one other time during the 12 hour cycle - minimally.
It sounds like I can follow TR and will change my sig.
After big drops I will be testing more frequently (like last night)! I was too nervous to sleep with her numbers plunging like that!

On the upswing I'm still waiting to see the number coming down today and will likely test again in a couple of hours if possible (yesterday I got caught up with my boss and was unable to get away for a regular timed test)...things like that happen - completely out of my control...

I will hold the dose at 1.25 tonight - and will test at least two times to watch for that plunge again - if it's down I'll set my alarm and get up at two hour intervals or less until the numbers start to come up again...I'm ready in case it gets too low with gravy style foods (in the emergency drawer). Also have Karo syrup and honey on hand.

 

[Sue and Luci]

The cycle is 12 hours. Bounces suck ! They also clear. We just have to wait it out. I was slgs initially and everyone kept asking why not TR as you test enough. I was just scared. The reductions came faster on slgs, but Myagi couldn't hold them. On TR we are holding the dose longer and he's doing much better, staying in better numbers longer. But as is repeatedly told us, ecid and every sugar dance has a different tempo, different music and different partners! So it'll play out however it does and we're just here to follow the lead as best we can. you guys are doing great with Luci! continued success whichever route you go!

She's certainly doing her own dance! And we just have to hold on for the ride...she's making me a nervous wreck though...all this slamming up and down...sheesh..

That's Luci's way of telling me 'heads up'! I'm in charge around here and don't you forget it!

 

[Wendy&Neko]

I went back and read the TR protocol and I can see why you feel you don't test enough. It suggests you do PS, +3, +6, and +9.

It suggests you do that the first couple of days on Lantus. Some cats react strongly to Lantus initially. You are way past that now. Now you know more about Luci and when are the best times to test. Test at preshot and at least one other as you said you would, and based on those numbers you may have to test more frequently.

Try not to worry about the bouncing - those high numbers aren't what we look at when trying to figure out the dose. My Neko used to hit blacks the first times she hit greens. Over time, and in the cat's own time, the bounces will become lower and eventually become almost nothing.

 

[Mandy & Rex (GA)]

I'm happy we cleared up some questions for you!!

Yes, you would hold the dose at 1.25u until Luci drops below 50 OR if she stays in all greens for a week. I wouldn't worry about the 2nd part because she's new to the diabetes dance so her body isn't used to the "good" numbers yet.

What you did last night was perfect with the way you handled it!!

 

[Amy&TrixieCat]

Sounds good...and we're always here to help answer any questions!!

 

[Sue and Luci]

Luci went back to Blue last night And she's feeling FINE! That crazy girl was out here in the living room playing with her toys and galloping back and forth - this was late in the night - jumping and acting crazy - PLAYING! I couldn't get over the good time she was having...ha ha! Crazy cat! And she's doing it again this morning - jumping up on the sofa and then down upon the poor unsuspecting catnip toy! She's certainly feeling her oats this morning - and I'm glad for her. And now on to a new day - hope she'll stay in the blues and maybe even show me a little green ....on her way? We can only hope