1/4 Tibby AMPS 291 PMPS 351 +3 251 going low

I'm thinking I'll need to do curves every 3-4 days rather than rely on data collected while working. I could probably do a curve on Wednesday, but that means holding this dose for a while. I'll see how much data I can collect, but I don't see there being enough data for my own peace of mind.


https://felinediabetes.com/FDMB/threads/1-3-tibby-amps-285-overnight-went-blue.240928/#post-2711363

 

Possible for you to get a test every day before you head out the door (assuming you aren't working from home)? And one before bed?

 

Before bed, yes, but not likely before work. Maybe when I get home from work. Are curves not a thing in TR?

 

Daily spot checks might yield more info than a weekly curve. If he happens to be bouncing on the day you pick to do the curve, you would get just high and flat numbers!
I would suggest you get the odd test when you can - even if its a +2 before work or after you come back and see how it goes.

 

I'm going to try for other tests, but they may not always happen, and they'll all be at the beginnings and ends of cycles. Since I need info on the nadir, I'd feel more comfortable if I have a full curve of data to go from. That's why I'm planning on curves. My daily spot checks would be at the same times every day.

 

Getting the info from the beginnings and ends of cycles will be more helpful than you may think . If you add the additional data from days you are able to get it (what you are referring to as curves), that will be provide some more pieces to the puzzle. Try your best to grab what you info you are able to given your schedule!!

The other thing I want to throw out there that you may want to explore given your desire for data to be able to feel more comfortable with dosing is using a CGM-Libre. It may or may not be something you want to try, but it would get you the data you need. My thought is you could even use it for a time limited period in order to become more comfortable with what is happening/trends, know that there aren’t any sudden drops. If the glucose is consistent with dosing, you will see that and that should alleviate some concerns. Just a thought.....

Libre sensor is able to record up to 8 hours of data, so as long as you scan it within the 8 hours you don’t lose any of it. Bonus is that you get even more accurate trend info because of the amount of data a CGM is able to record vs BG alone.

 

I've been thinking of the Libre for when I go out of the country. My mom is going to cat sit, but she can't wrangle him for all the blood tests. He behaves for shots, but the tests take a little restraining. Maybe I'll do a trial of it sooner than planned. But a curve will make me feel better. I've been doing those for months anyway. I just don't see a way to get nadir data other than staying up all night, which I can't do, or doing them on the weekends and Wednesday when I can work from home. Just today I realized I have evening meetings and will barely be able to do his PMPS on time.

 

You’ve got a solid plan. Get the additional info when you are able to do so . Wednesday will be here before you know it and you will be able to grab the additional data points that you want to feel comfortable with dosing decision. It looks like the increase in dose is already helping being those #s down . Outstanding.

 

OK, his evening test seemed like he's on his way to a low number. I'm going to set an alarm...

 

He seems like he will be fine based on trends to this point, but if you can set an alarm to get the info at +8, 9 or 10 that seems to be where he has hit his nadirs....later in the evening cycle .

Those #s are very safe ! It can be anxiety provoking when you start to see lower numbers than you have been used to seeing, but you are not near any concerning low #s at this point if that makes you feel any better! Those 100s are awesome !

 

He should be fine, but I'd like to catch the nadir if I can. That might give me enough data without having to do a curve. We'll see. I might be a zombie tomorrow though.

 

Welcome to the land of Zombies (at least at one point in time or maybe a few more than one point ) !!

Coffee, espresso....my personal favorite Bang !!

The good news is it generally does become easier —the regulation piece...which means eventually not missing sleep! As you become more comfortable, get the BGs you need & see the trends, you are able to pick the times you need to set alarm & know that other times, you can rest without worry.

 

OK, I got very little sleep, but he didn't dip too low, and I got a couple more data points. May not need a curve to determine his dose.

 

If you are still following TR, you'd increase the dose next cycle. If following SLGS, you'd have to wait a few days and if you don't see anything better, then increase.

 

OK, cool. I was wondering if that was enough data. It seemed to me that it was and that he would get a dose increase since I was able to get somewhat a variety of tests in.

Also, I may be working from home for a bit, so I can keep doing TR more easily. I hate these increases one right after the other, though. I'm so used to the pace of SLGS.

 

Yes, but once you get to a dose where his numbers are better, you'll like that too.

 

True. For a little while, I did see blues and occasional greens. That was much prettier. However, getting up in the night for tests is awful. I set my alarm to get the +8 and never got back to sleep. That's why there is a +10 as well. So now I'm operating on 3 hours of sleep.

 

Morning Amy......

Sending virtual coffee and energy. I am sorry that you couldn’t go back to sleep . Sleep is vital.
I was happy to see @Wendy&Neko, West coast , pick up on the thread (thank you!) I am East coast like you.

Based on what you have shared so far.......

+you would like better regulation than you were getting using SLGS on your own so that is why you wanted to try TR
+you are not very comfortable with dose changes unless you know the nadir...or at least something near the nadir
+daytime mid cycle tests are a challenge or not possible due to work which means you are only able to get mid cycle tests on Wed, & Sat/Sunday OR not sleep because you set an alarm to get the tests but cannot go back to sleep
+you are more comfortable with more time between dose changes

Let me know if I missed anything . Again, it is important to sleep. I am all about the advice you get on a plane “put your mask on first before helping others”. You need to take care of yourself & that means sleeping.

I am going to tag a few people to help problem solve. As I have mentioned before, there is the option of optimizing dosing safely with their help and the use of the SLGS—remember, SLGS is simply guidelines with flexibility if you are getting some help with dosing vs a set protocol like TR.

I do not want to discourage you from continuing your trial of TR if that is what you want to do .
I just want to make that sure you are aware that there are options to get better regulation AND sleep if it continues to be an issue for you. No need for complete misery here .

I also do have some concern given that Tibby is on higher doses of insulin. When Tibbys BGs decrease, they may start to decrease more quickly and require adjustment with dose reductions (for example reduce by 5u vs .25u).

@Sienne and Gabby (GA)
@Marje and Gracie

 

I do like the idea of the modified SLGS once I'm working in-person again full time. I may be working from home a little longer than expected, and if so, I'll give the full TR thing more time. I can do tests between classes. But last night I went to bed late for me, around 10pm, and then woke up at 1am to do a quick test. I never got back to sleep. I'm not a caffeine drinker, but I'm drinking some coffee right now.

 

Sounds like a great plan Amy !

I bet you will find a workable rhythm soon enough....& maybe some help from the ole’ caffeine ! I personally find Bang to be more helpful—B vitamins & feeling alert & focused vs that caffeinated/shaky feel. I just don’t drink the whole can or an entire shot at once! It is not like those Monster/Red Bull drinks. It is definitely one of my vices .

Best with the teaching at home . My sis in law teaches up in PA & the stories she is sharing
belong on a comedy network or a book. Her students have locked her off the computer a few times !!! Jeesh!!

 

Well, I cut caffeine to improve my health, so I'm hoping for some testing pattern that doesn't require coffee or anything else. Otherwise I'll never sleep. The insomnia pre-dates the cat, for sure. I usually have a cup of tea, maybe two, and all before noon. No coffee or soda. I was getting heart palpitations, too, and I was only having a few cups of coffee a day.

Teaching online isn't much fun, though. I'm used to keeping things interactive, and it's tricky to do when they are at home and can easily fall back asleep. Teenagers online first thing in the morning is a groggy bunch.

 

You definitely need to be mindful of your sleep then....& not have to lean on the caffeine !
Too much coffee upsets my stomach & anything carbonated is an issue as well, so that’s why I moved to the Bang shots. I have very low BP, so caffeine and salt are my friends for that issue but not so great for the stomach .

I give it up to you...that is a HARD job! My
sis in law has actually been teaching and she gets a text that her son is not online—he’s late . He’s a teenager. She has to take a quick break and yell into the other room for him to get online! She said her students will actually start using their iPhones or iPads and that when she tells them to stop, they just take themselves off video.....& that is allowed!
Wow....what else is there to say?? Again, tough job you guys have!