10/24 Bocephus AMPS 81after 20 min stall (was 80) just some thoughts PMPS 83 NS and +3 61

10/22/2020 Bocephus PMPS 86 20 minutes later 89 Dose Help

Here we are again with a pre-shot under 90 despite barely getting started on the .5 dose we just dropped to. I planned on doing a curve today. I couldn't stall anymore he was starving so I fed him and gave .25 rather than skip completely (I'm home today and can watch him close)

• Should I do a curve before making another dose reduction since he just dropped to the .5
• Looking at the progress and considering if he takes another reduction he'll be at .25 and then another reduction would be no insulin am I understanding that right.
• Just worried it's moving so fast and if I'd chose TR instead of SLGS he wouldn't have earned any reduction yet because he hasn't been under 50 it's scary for me as I very much want a remission but I don't want to go to fast and cause him to relapse or something worse

 

Hi Wendy! The link to your previous post is not working. I am linking it again for other folks.
https://www.felinediabetes.com/FDMB...pmps-86-20-minutes-later-89-dose-help.237339/

With SLGS, the no-shoot number is 90! But you have shot an 89 on 22/10 and shot again today. This is not criticism. Just wondering why you aren't following TR. Is that something you can do going forward?

 

I just edited my post. I'm not sure if my internet crashed or what but it posted before I was done so what you read may be different and thank you for the link I was trying to fix it when I saw the alert.

 

Could you edit your thread title - it sounds like you are stalling and waiting for advice

 

I questioned if I should switch methods a few days ago but I thought maybe I was overreacting because I was just afraid to keep reducing.
I haven't discussed any reduction with his vet. She is familiar with the FDMB and didn't seem to have any issues with my participation/use for guidance but I guess I should put a call in on Monday.

 

Got that edited and as much as I hate doing things from my phone it appears our home internet is crashing so I apologise for my responses being all over the place. Can you see where I (think I edited my original post)

 

I don't really know why I didn't go with TR but yes going forward I can follow TR if that would be best for him.
I shot the 89 since it was so close to 90 and I've been told there is some variation with readings and I read somewhere in the stickys that you can skip dose or give reduced dose and I hated to skip another one. (Probably not best line of thinking)

 

TR allows you shoot lower numbers than SLGS - reduces skips and also reductions. You could consider it since Bocephus seems to be doing so well.

 

Bocephus is in normal bg numbers the last 5 days. You need to get some mid cycle tests now to see how low he is going. Can you get a +2 today? If lower than the amps he is likely to have an active cycle. Then a +3 or +4 would be suggested depending on how much lower. If higher get a +4. Please read the TR guidelines because you need a minimum of 3 tests each cycle as Lantus is based upon how low it takes the cat. You will want a test around +5-6 to find the nadir, At night a +2 or if possible also a before bed test is needed as many cats drop at night. Is this possible ?

 

I'm going to run a curve today last one was 10/14 and I think that was 7 days after starting the Lantus and then we had the PJ party on the 17th and since then I've only been able to get a few mid-cycle numbers because of work schedule adjustment so since I'm home today I might as well use the opportunity to get some good data. As for TR testing needs I should be able to get 3 per cycle but can't guarantee the exact +hours so one day it may be +1 another may be +8 during the day cycle but at night sometimes the +2 would be the same as before bed but other days especially weekends the bedtime would be more like +4. So basically I can guarantee a AMPS, a random +hr? before the PMPS, the PMPS and at least one +hr? (which most of the time would be +2) and on weekends I could grab an extra +hr? like a +3 or +4 (could even stay up like a mini pj party to grab anything past a +4 on a weekend). Is that acceptable or do I need to stay on the SLGS since I can't get more tests?
Disclaimer: If ever his readings or behavior suggested a possible Hypo situation I would stay up all night or miss work if required regardless of which method used and even when I can't be home I do have my Mom come up and check on all of my animals periodically during the day and she feeds him his mid cycle snacks for me she just can't do the tests because she shakes to bad due to medical reasons.

I almost think it would be easier if there wasn't a choice.. like it is only TR or only SLGS and I always seem to focus on irrelevant details. In either protocol is the goal the same.. and are OTJ trials the same for both protocols. I bring that up because since you don't earn a reduction on TR until below 50 but earn them at below 80 on SLGS it would seem different or I'm probably over thinking again.

 

I'm going ahead with the curve today so I will have some better data since I've only done one curve and it was 10/14 and hopefully it will help give a clearer picture of what is best but it is looking like maybe TR just to ensure I don't jump the gun with reducing or worse a trial otj that he wasn't ready for and cause him a set back.

 

Random tests are fine and mixing up the times when tested is really good. TR gives the best chance of remission which from what I see on your ss is definitely probable. Cats do also go into remission with SLGS too. Your are already shooting numbers that make me nervous without getting a few extra tests. People do follow TR working full time. There’s a sticky on that. In your case I believe it will work even better than for many working because your mom can put out food if it looks like a active cycle on a work day. Is there any chance she would be willing to learn to test? I ask only because just looking at a cat you can’t tell if they are in danger if a hypo. My cat hit the 30’s and I never would have known without testing. You would only need to ask her to test if he were low when you leave for work. If not possible you can just ask to make sure he eats if he’s low when you leave.

 

One other thought. You can tweak TR to work for you.

https://www.felinediabetes.com/FDMB...ion-possible-with-a-full-time-job-yes.129378/

 

Yikes.. as excited as I was to earn those two reductions.. I almost wish I had chose the TR then and kept trucking at the 1U but I guess I just live to learn these days and lately all that living seems to be a trail of should of .. could of.. would of.. well you get the point. I just constantly feel like no matter what I choose its wrong but I can't always stall and wait for help. He was 95 +2 hour mark and its 15 min till +4 test and I keep updating his SS (also he got a snack after the +2 which is about how we do it everyday).
I so wish she could test and even give his shots but she shakes so bad some days she can't hold a fork or spoon so she for sure can't do the poking. Don't worry if he was ever low low I wouldn't shoot and I wouldn't leave for work or go to bed if I thought he may be at risk for hypo .. with that said I know that could happen even with normal range numbers at preshot. Its all about more than I can handle.

 

Don’t worry about this. I remember you saying this now. As long as mom can make sure he eats it will be fine. When I worry is when I see a green being shot and no tears after and a person goes off to work without food being out. I suggest labeling or making a list of carb % of each food. Have a hypo kit ready and leave out honey or karro for when you are at work.

I bet I have asked you this before but is an auto feeder possible? That’s another way to put food in to open at various times and you could base the carb amount on the last test before you leave.

 

Gotcha! I use to do pre-test and then shoot at 6 and 6 but after multiple times of stalling it is now pre-test and shoot at 7 and 7 which works out good with time change coming up so what we do is:

• pre-test for AM/feed/shoot (usually while he's still eating) (that is as long as everything is normal lol)
• Snack at 9 am but no later than 10 am
• Snack at 1 pm but no later than 2 pm
• Pre-test for PM/feed/shoot (usually while he's still eating)
• Snack at 9 pm but no later than 10 pm

I just ordered a auto feeder and it came this morning so I will have it set up and ready to use (ordered it because if I end up having to board him over Thanksgiving holiday at the end of Nov its the only way I can guarantee he gets mid cycle meals because the Vet office only has someone come in twice daily to give meds and feed. They will use the auto feeder with either wet or dry food.) I also thought it would help in the event Mom ever got sick or something and I absolutely couldn't be here. I tend to always prepare for the absolute worse because I'm so use to being the exception to all rules when it comes to my animals .

Hypo kit is ready and I've gone over it with her and my husband (I also have a back up meter that is off by 3 compared to the one I always use but I have it and know about the point difference it is labeled back up meter only)
I have the Hypo sticky notes printed out and a copy with the hypo kit, one I keep with me even when I'm not home, and one where I keep his food just incase
I don't have the food labeled or a list printed up but that is a great idea and I will do that because in a panic I would have to find the list and determine which to give or tell her to give him.

Mom and Dad live next door to us and luckily for all of us someone is always either here or at their house so we can pitch in and help with each others animals. There are just limits to what they are able to help do sometimes but I'm beyond blessed they are able to watch over things.
So AMPS 80 after 20 min stall 81 fed shot .25 at +2 95 (fed snack) and at +4 he was 85 (+6 will be at 1:30) we're off by 30 min today because I stalled out this morning

 

I’m impressed with how prepared you are! You can make up the time by shooting 15 minutes early tonight and tomorrow morning if he complies and us at a shootable number. A lot can happen between now and Thanksgiving.

 

Right. She dropped to .25 today. I didn’t want to jinx things but see my comments about Thanksgiving being a long way off. Implication there.

 

Hi after .25 there is a smaller dose, 0.10 that would be right under the zero line, the middle pic





Pictorial guide using a U-100 syringe marked with half units:

 

The .50 depot is in play. When did you last feed him?

 

I think this is were I get confused or even nervous. Shooting the .25 I wasn't considering it a dose reduction like just drop down to it reduction but more I was afraid to shoot full dose but afraid to skip dose and mess up his depot or risk losing ground.

 

He’s so new to Lantus that it’s too low to shoot. I think if you stall he may drop more. When did he last eat? I do think you should stick with .25 as his dose. You can always go back up if necessary.

 

He’s all in normal bg and even dropped at PMPS. I feel he’s too low to shoot any tonight unless he’s come up from the 83.

 

So here's how the Curve went today.
AMPS after stall was 81 and I fed him and gave .25
+2 95 and fed snack
+4 85
+6 92 fed snack
+8 105 the +10 was 104 and the PMPS was 83

 

I didn't shoot tonight

 

Okay. Good. Put NS in the box for dose. Depending on his amps you can either shoot .25 or .1 in the morning. If he stays green I would not shoot or shoot .1 in the morning. Can you test again tonight 3 hours after his dinner?

 

Thank you that will keep me from guessing in the morning.
Yes I can test at +3 tonight. I normally feed a snack at +2 should I hold it till after the +3 check

 

You can test at +2. If his pancreas is working it should come down 2-3 hours after eating. So +2 is fine and post it in your title. I think his pancreas just might be coming alive.

Was he on a steroid by any chance?

 

Yes he was given 3 high dose steroid injections within one month and right behind getting neutered and vaccines. His vet 100% feels his diabetes is caused by the steroids and feels he'll reach remission.

 

That’s why he is doing so well and even more reason to be cautious. I think he is going into remission. I didn’t want to get your hopes up. The same happened with Kyle’s Simon.

What time do you shoot?

 

I'm praying he is but definitely not getting my hopes up. 7 and 7 but today was 7:30 am and no shot tonight

 

If he’s green I would try .1 if you can test. Look at Simon’s spreadsheet. He’s back on a steroid but so far okay. It’s for IBD so he’s on budesonide and doing ok so far.

https://felinediabetes.com/FDMB/thr...al-day-2-ambg-91-pmbg-84.233747/#post-2613340

 

I will definitely thank you for the link. I was trying to search for them.

 

Here’s another one.
https://felinediabetes.com/FDMB/threads/otj-party-for-blaze-today.236398/#post-2651775

 

So I'm feeling less freaked out by the sudden need to skip and reduce doses after seeing these other kitties spreadsheets. I'm getting ready to test him and then feed him his snack. I'll update his SS and reply with results.

 

Good. It really helps to see other spreadsheets.

 

So he's 61 at +3 would you give a MC or HC snack instead of his normal LC one

 

61 is still safe, I'd feed LC and test in 1/2 hour.

Can you please update your title as well, just so we can see the latest with NS at pm and subsequent tests?

 

You didn’t give him insulin so give him LC. The fact that his bg came down after eating and no insulin shows that his pancreas is coming alive.

 

Christie, she didn’t give any insulin. Definitely lc.

 

I think I said LC?

Bowing out now, hope everything goes well tonight, let the numbers guide you Wendy. If you see anything under 50, intervention with either some higher LC or MC.

 

I really don’t expect him to drop lower. I think he dropped because he ate and his pancreas is working.

 

You did. I as surprised about testing in 30 minutes. That’s what I meant to question. Sorry.

 

Thank you and have a good night appreciate every one of y'all taking time to keep me going

 

The depot may continue to affect this cycle, so IMHO check to make sure he is staying flat or rising

 

I fed him his LC snack but had already set a can of mc out just in case and I swear he knows it's the good stuff he keeps pawing the unopened can and there's a stack of LC cans sitting here all the time and he never pays them any attention. I said sorry baby not this time.

 

Lol. They are too smart sometimes.

 

That they are for sure . I really appreciate you taking so much time to help me today. I'm going to grab that other test and as long as he isn't dropping I will call it a night. I'll update the title and as once I get it .. about 20 minutes to wait

 

You should be good for the night.

 

I think so it was 62 at the 30 min mark and just to be sure that back up meter is still calibrated like I said (off by 3) hubby grabbed sample with it at same time it was 59 so still off by 3 from the one we normally use but good to know it's still useable in a pinch just off a hair.
We're going to snuggle up and listen to the purring.
Thanks again and have a great night

 

A point of clarification, you do not need to do three tests per cycle to follow TR. If you read the dosing methods sticky note, you'll see that original study of TR says the people were testing an average of 5 times per day. Some less, some more. Some people here are admitted testaholics. I think think I mostly averaged 5 tests a day, sometimes 4, sometimes more depending on whether Neko was thinking of going low or not. Once you learn your cats onset, nadir and duration, you can be strategic about when you test. Doing curves like you did today go a long way towards figuring those out, and understanding how your cat works on Lantus. Basically you want to test enough to know if you cat is going low and have an idea what the nadirs looks like.

Looks like you've got a great plan for the rest of the night.

 

Thank you it just all seemed to be moving so fast but now I'm feeling more confident that he's heading towards possible remission as the steroids are clearing out and his foot is almost completely healed so that inflammation and infection isn't there. TiffMaxee really worked hard helping me basically the entire day.

 

Just to let you know I was counting the AMPS and PMPS tests when I said 4 tests.