10/16/2019 Buddy AMPS 205 +4 130 UPDATE! Vet wants to cut dose in half! Protocol guidance

Sandra And Buddy (GA)

Sandra And Buddy (GA)

Member Since 2019
Previous post
http://www.felinediabetes.com/FDMB/threads/10-13-buddy-amps-230-pmps-258-im-new.220420/#post-2459698

UPDATE!
So I just heard back from the vet based on the Alpha Trak number that I did just for her she wants to reduce him from 1u to .5 and recheck in a week. Yeah that's not happening I think.
Alpha trak tests were
10/14 7am 205 - 11am 131 - 7pm 198
10/15 7am 242 - 1pm 108 - 7pm 189

I have been reading up on the protocols and I think they make sense to me but I am unsure which way to go. What will be the benefits of one over the other? I am home pretty much most of the time and can monitor him.

His numbers at this point seem to be trending down so I am not sure if I would increase his dose a bit to bring them down more or hold and see where they go.

I will be calling his pre shot numbers into the Vet today and she will let me know where SHE would go from there. But I will more than likely follow the advice given here.

Thank you!
 
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In the end it is always up to you but here are the differences between the two methods as I see it:

Start Low Go Slow is a more cautious method, it requires less testing and dose changes are done once a week after a blood glucose curve is completed. The exception to this is if the kitty goes below 90 during the week which would earn an automatic reduction. Members who work strict schedules and can’t get tests during the week day are typically the members who choose this method.

Tight Regulation is a scientifically backed protocol with a more aggressive dosing strategy. In TR you take tests throughout the day in order to get an overall idea of how kitty is responding to the dose through the cycles. Dose changes in TR happen More frequently (around every 3-5days) and the dose reduction point is lower than on SLGS ( TR Reduction = 50, SLGS reduction =90). Members who are able to test during the day typically choose TR

there is a more likely chance that cats go into remission on TR than SLGS, but many cats do go into remission following SLGS.

My two cents? If I were mostly able to test during the day I would choose TR. :)

remember. Whatever you do decide to go with, if you don’t like it, you can always switch :)
 
Thank you for your response. I do think I would like to do TR. So what I am seeing is that if he holds his Nadirs between 80 - 100 for a few more days then I should increase the dose by .25 (because he is not holding between 50 - 80 ) Is this correct?
 
Honestly, I’m new to this protocol myself so I’m not quite confident in when to increase. I understood that if you are seeing nadir between 80-100 you would hold the dose. If you increase you could get into some hot water.

I see @Bobbie And Bubba is online, who has a lot of experience, she’s gotten Bubba into remission 4 times!!!

Bobbie, would you be able to advise in this situation?
 
Another big difference between the two dosing methods (SLGS is not a protocol), is that TR requires that you feed a low carb wet or raw food diet. Kitties eating dry food or other high carb food cannot do TR.

Nadirs between 80 and 100 give you room to increase, however, you got a 56 a few days ago.
 
Yes he is eating low carb wet. No kibble. Yeah the 56 makes me want to hold for a while. I will give it a few more days and see where he is . I am sure I will be back asking :)
 
So I just heard back from the vet based on the Alpha Trak number that I did just for her she wants to reduce him from 1u to .5 and recheck in a week. Yeah that's not happening I think.

Alpha trak tests were
10/14 7am 205 - 11am 131 - 7pm 198
10/15 7am 242 - 1pm 108 - 7pm 189

@Wendy&Neko Taging you because you sort of know the situation
 
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If you could add your last post url to the top of your condo for today? It would help with a little background/history.

We only change the dose by .25 increments unless you're in a high dose situation...

Again, the focus is on the lowest numbers you're getting, don't focus too much on the pre-shot numbers (unless of course it's too low to shoot)...

He did earn a reduction the other day with that 56, however that's come and gone...so for now I'd leave the dose alone. Keep testing as often as you can so we can see what kind of numbers he's getting during the hours where you don't have any tests...

As far as what the vet wants...I've been there and done that...and I'm sure she's well meaning...but you'll need to make a decision which advice you want to go with...I've had two vets who wanted to advise me of increases/decreases, etc. I was very nice about it...but just didn't follow up with them (one asked me to 'call next week and we'll discuss dose changes)...I said 'ok, thanks'...last time I talked to her about that....

I figured out early on that I'd take my dosing advice from the people here on this forum...not the vet...the vet has since moved on to other patients...but I continue to see the them for other things...
 
@Sue and Luci thank you an I have updated with the previous thread. I will definitely be going with the advice here I just wanted to see what she had to say. So would I do a dose decrease as soon as he hits that low number or do I hold for a few days to see which way he is going? This is so much to learn, but I will get there. Just an information overload.

Please forgive typo and Grammer as I can not phone! Ha!
 
Sandra And Buddy said:
@Sue and Luci thank you an I have updated with the previous thread. I will definitely be going with the advice here I just wanted to see what she had to say. So would I do a dose decrease as soon as he hits that low number or do I hold for a few days to see which way he is going? This is so much to learn, but I will get there. Just an information overload.

Please forgive typo and Grammer as I can not phone! Ha!
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No worries on the typos...:)

If you're doing TR - here's the stickie in case you want it handy/refresher, etc. http://www.felinediabetes.com/FDMB/threads/tight-regulation-protocol-tr.1581/

You shouldn't change the dose unless he drops below 50 and definitely below 40 - however after you've had some time to collect more tests (gathering data) and you find that if you've reduced and he doesn't do as well, you may want to adopt the three times under 50 or one time under 40 - and add that to the top of your SS so everyone can see that you're doing that. In the beginning though I think it's recommended that you reduce anytime he goes under 50.

The important thing about TR is getting enough tests throughout the day to establish a really good idea of when Buddy likes to go low...a pattern will emerge in a few weeks and you'll start to see trends of when he likes to go low...that's called the nadir. Unfortunately these cats don't read well and can't tell time - so they can't get that nadir down to an exact time of day. One day it could happen early on, another day a bit later..Typically you'll see a 'curve' - higher on the ends at AM and PM test times...with a dip during the middle of the day - to the nadir - the lowest point they reach...and then we do it all over again with the next shot.:D

Every cat reacts differently to the insulin...so this is why we ask everyone to test as often as possible, within reason of course - but frequent testing is your window to what's going on with Buddy...and will help you as you get a feel for all of this.

I know it's a ton of information - but it's lifesaving and life altering! For you and Buddy! Try each day to read and re-read the stickies...you can only absorb so much new information in a day - but each day a new piece of information will 'adhere' and you'll say...oh, yes, now I know why they're saying that...and what it means! After a while you'll be giving support and suggestions to others to help them!:D

So for now, just focus on getting Buddy to eat his low carb foodies; stay with your dose and get as many tests as you can. At least every other hour initially is great...but if you run into bumps with that, do the best you can. Night time testing is often the hardest of tests - because we're all tired...and that is often when these darn cats think it's time to 'pawtay' with the sharkies:eek:...and many head right down through those dark greens and right into the light greens (the danger zone)...so it's really good to know when Buddy hits that 'low' dose during his 12 hour cycles.

If you miss the lowest number of the day, and it happens...he'll show you the next day by throwing out a big ole horrible red or black number on you.:arghh: Typical indicator of a kitty who's gone low - they're not used to being in those low places and it's the body defense - sending out all that stored up sugar into the blood stream to 'save them'...looks bad to us...but it's a normal process...just move on and hope that you can catch those lower numbers next time.

I hope this isn't too much info...I remember in the beginning...it was like drinking water from a firehose...I was simply overwhelmed with it all...and sick about her diagnosis...thought it was going to be the end of her (and that's what the vet recommended)...needless to say I won't go back to him!

Keep posting and asking questions - others will chime in - you are not alone!!:bighug::bighug:
 
@Sue and Luci

Thank you so much for taking the time to write all that Whew! It is all sinking in a bit at a time. In the beginning I was testing a lot! I have taken the past few days to try to give his ears a rest and they are doing better. I have also been poking his paws here and there when he lets me. I think I am also getting better at not going into panic mode haha! I think that will help a lot when I can stay calm when he throws me a curveball.

Thank you again! I really feel like I should fill up this page talking back to you to make up for the book that you wrote to me :D I am just short on words most of the time but do know that I appreciate the time that you and everyone else here takes to help everyone.

:kiss::kiss::kiss::bighug::bighug::bighug:
 
Sandra And Buddy said:
Taging you because you sort of know the situation
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What are your goals for Buddy? Your first goal should be regulation, but do you want to stay with that or go for more?

We don’t change doses based on preshots, but rather nadirs. Ideal flat cycles with lots of green give more time for the pancreas to heal, if remission is your ultimate goal. One option is to smile and nod your head at the vet. I printed off the TR protocol article and told my vet that was what I was going, and gave her the first few weeks of copies of the spreadsheet.

For now, I suggest sticking to once under 50, or a week in green numbers as your reduction criteria. It is too early in Buddy’s diabetes journey to consider anything else.

You do not need to test hourly, unless he is in green numbers, or dropping fast and you think he’s going low.
 
Hey Sandra ! Sue and Wendy have both given you some really good advice. Remember, we base dosing on the lowest (nadir ) Buddy goes, not the pre-shot number.

Since you are mostly home , I would go with the TR protocol. It has the highest Rate of remission.

If you post each day with a new thread , Date, Buddy’s name , and the AMPS , peeps here can help you with dosing.
 
Wendy&Neko said:
What are your goals for Buddy? Your first goal should be regulation, but do you want to stay with that or go for more?
Click to expand...

Yes Regulation first, I really don't know what that looks like. I would like to see him in remission.


Bobbie And Bubba said:
If you post each day with a new thread , Date, Buddy’s name , and the AMPS , peeps here can help you with dosing.
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I can do that. I don't really ever have much to say but I am sure I can come up with something so that It's not just a blank post! Haha!
 
@AmandaE

Hey! On your SS you have a few cells that are split, like on 10/05/2019 I have looked but can't figure out how to do that. Would you mind telling? It would be helpful for rechecks in the same hour. (which is looks like what you are doing) :)
 
Sandra And Buddy said:
It would be helpful for rechecks in the same hour.
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What most of us do is put both numbers in the same cell instead of putting them on different lines which makes it harder to see.

Like if you tested at +4 and got a 110 and at +4.5 you got a 90, you could put 110 @ +4, 90 @ +4.5 in the same cell (in this case, the +4 cell)….You have to color code the cell yourself though with the appropriate color for the lowest number (in this case, the dark green for the 90, not the blue for the 110)

To color code it yourself you just click on the icon along the top of your spreadsheet that looks like a little can of paint tipping over.

I made an example on China's spreadsheet on 7/1 at +4 if you want to see
 
Sandra And Buddy said:
@AmandaE

Hey! On your SS you have a few cells that are split, like on 10/05/2019 I have looked but can't figure out how to do that. Would you mind telling? It would be helpful for rechecks in the same hour. (which is looks like what you are doing) :)
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Yes I insert rows so that if I take multiple tests in one hour I can see them properly with their coded colors. I plot a lot of Mowgli's data so I don't personally like to put multiple values in one cell because it makes it harder to plot. I also work with Excel in my day to day life so for me this method jives more with my personal thought processes

I will say, it isn't a convenient method, and I would never do it on my phone I always do it on my laptop. I am not splitting cells, rather I am inserting rows and then merging various cells together. I will give you an example below, let's say that today I needed to get 2 samples within the +3 window and the +4 window. I would do it like this:

Step 1: Insert a row below the date I am interested in, you do this by right clicking on the number of the row you're working in and choose 'Insert 1 below'
upload_2019-10-16_20-33-16.png


Turns into:
upload_2019-10-16_20-38-41.png


Step 2: Input my test data... wishful thinking obviously ;)
upload_2019-10-16_20-41-49.png


Step 3: Merge any cells that only have one value for the testing hour. This includes the date, the AMPS, the AM Dose, the PMPS and the PM dose as well as any hours that have no tests or only one tests

Before:
upload_2019-10-16_20-52-49.png


After:
upload_2019-10-16_20-51-23.png


For my additional tests within the test hour I try to remember to insert a note that says the time of the test, in this example the 4.5 result and 6 result would have a note inserted that said +3.5 and +4.5 respectively so if anyone is looking in they can hover over the cell and see the note.

As you can see... not convenient, but for me I prefer this method so I can keep the data straight as per my personal preference :)

Also, apologies because I used the Canadian numbers haha. If you ever decide to pursue this type of cell layout and you're having issues definitely feel free to reach out to me and I wouldn't mind helping at all :)
 
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