? 11/12 Ivy amps 400, +3.25 296, +5 240, +7 228, + 10 234, PMPS 246, + 4 117 Dose Question

Staci & Ivy

Staci & Ivy

Member Since 2022
https://www.felinediabetes.com/FDMB...5-3-99-4-53-5-53-6-125-libre-dose-inc.283462/
Good morning,
AMPS 400
We saw some good action in both cycles yesterday and nadirs in the under 149 range.

I’m contemplating an increase up to 3 units, however yesterday was very active so I held her dose today at 2.75 units.

My question is this: how many nadirs in a 7 day SLGS cycle on a dose should there be under 149 in order to either hold or increase a dose?
(**Part of what complicates this question is that when Ivy gets into that desired range, she then bounces high. Some cycles are bounces where she’s never going to be in that nadir range)

Hope to get some clarity here and maybe this will help others with similar questions.
Have a great Sunday everyone :cat:
 
I think the "under 149" is implied to be on a meter, so I am not sure how the Libre compares. Could you try to get a few tests when you think she might be approching her nadir, to help you decide?
She will "bounce" less and less as she gets used to those lower numbers.
 
cecile & bella said:
I think the "under 149" is implied to be on a meter, so I am not sure how the Libre compares. Could you try to get a few tests when you think she might be approching her nadir, to help you decide?
She will "bounce" less and less as she gets used to those lower numbers.
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Hi Cecile, yes it is definitely implied on a human meter. I ear prick her when she’s in the low ranges to confirm the bg number and I only give reductions based on an actual blood test, not the libre reading.
 
I understood that. What I mean here is that when you say she had a very active cycle yesterday and so you decided to wait, why not test her when you see her get lower. If the Libre says 58 but your handheld meter shows 155, then you will have a better idea of where she is and what dose she needs.
 
cecile & bella said:
I understood that. What I mean here is that when you say she had a very active cycle yesterday and so you decided to wait, why not test her when you see her get lower. If the Libre says 58 but your handheld meter shows 155, then you will have a better idea of where she is and what dose she needs.
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Yes I agree. I have an understanding of how the Libre reads and what the corresponding numbers mean between the 2 meters.
I’m trying to determine how often those nadirs need to be in the desired range in order to hold/increase a dose.
Since she bounces from being in lower numbers, she spends part of those 7 days in bounce cycles. That makes it confusing to me to know if she has spent enough time in the desired nadir range to hold or increase a dose?
(I.e. should she have 3,5, 7, 10 nadirs in desired range in a week to hold or increase ?? In the past week I would say she has had 3 or 4 nadirs in the desired range.
Is that enough to hold a dose given all the bouncing, or does that mean I should increase the dose?)
Does that make sense? Perhaps I am not being clear and what I’m trying to figure out. :banghead:
 
From what I remember from when I started with Bella and SLGS, you hold the dose for a week, then you do a curve and decide to increase or not. You decrease if the BG is under 90. You should adapt as you go. You can try ti read the sticky again: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
The curve is meant for a handheld meter. I think I would start with that, test her several time on your meter during a day, to see where she is. Since you would use the handheld meter to decide a decrease, it seems reasonable to check those lower numbers that prevent you from increasing, too. But I don't have any experience with the Libre. I tried to double check the AT and the Relion and stopped very soon, there was absolutely no logic in the way the numbers were compared to each other.
I'm editing to add, maybe try not to see the higher numbers as bounces for now. She seems to be mostly in higher numbers. If you increase and she does not need it, she will let you know.
 
cecile & bella said:
From what I remember from when I started with Bella and SLGS, you hold the dose for a week, then you do a curve and decide to increase or not. You decrease if the BG is under 90. You should adapt as you go. You can try ti read the sticky again: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
The curve is meant for a handheld meter. I think I would start with that, test her several time on your meter during a day, to see where she is. Since you would use the handheld meter to decide a decrease, it seems reasonable to check those lower numbers that prevent you from increasing, too. But I don't have any experience with the Libre. I tried to double check the AT and the Relion and stopped very soon, there was absolutely no logic in the way the numbers were compared to each other.
I'm editing to add, maybe try not to see the higher numbers as bounces for now. She seems to be mostly in higher numbers. If you increase and she does not need it, she will let you know.
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Thanks for those detailed thoughts, Cecile. It’s helpful to try to figure this all out. :bighug:
 
I'm not an expert as you know, but I would increase because she isn't stable and isn't seeing consistent blues/greens. She's gotta get used to consistency before she can keep reducing. I'm sure the CKD is throwing wrenches in her stabilization too. It's so tricky. :facepalm:
 
allicatmeow said:
I'm not an expert as you know, but I would increase because she isn't stable and isn't seeing consistent blues/greens. She's gotta get used to consistency before she can keep reducing. I'm sure the CKD is throwing wrenches in her stabilization too. It's so tricky. :facepalm:
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It is tricky!! Thanks for weighing in, Alli!! Muchhhhh appreciated! :bighug:
 
tiffmaxee said:
I would not increase because she’s getting into lower green on this dose on the Libre which has to be at minimum blue on a human one.
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Yes Elise, the low Libre greens tend to be near or under 150 on a handheld device.

When the Libre reads “Lo” then the handheld is usually under 100.

I will hold the dose for now and see what happens. I will post if she stops seeing low Libre greens. Thank you. :bighug:
 
Wow, it's really complicated Staci!
Sounds like you are trying to figure this out. So tricky.
A lot of people with SLSG also seem to get their own thresholds for changing the dose.
Hope you find approaches that give you confidence.
Hope you and Ivy are having a great day! :bighug:
 
Mikanmama said:
Wow, it's really complicated Staci!
Sounds like you are trying to figure this out. So tricky.
A lot of people with SLSG also seem to get their own thresholds for changing the dose.
Hope you find approaches that give you confidence.
Hope you and Ivy are having a great day! :bighug:
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It’s so complicated and to me, confusing. I keep hoping to crack the code for Ivy and what will work best for her. But she’s still mystery to me even with as much time as I spend on this. I just keep asking questions keep reading, keep delving I don’t know what else to do.
Hope you and Mikan are having a great day as well, Kit.:bighug::bighug:
 
Staci & Ivy said:
It’s so complicated and to me, confusing. I keep hoping to crack the code for Ivy and what will work best for her. But she’s still mystery to me even with as much time as I spend on this. I just keep asking questions keep reading, keep delving I don’t know what else to do.
Hope you and Mikan are having a great day as well, Kit.:bighug::bighug:
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It's a good thing you are asking and searching the answer!
I'm sure you'll get the hang of it and figure out the best approach for Ivy!
 
I'm glad to see that Ivy has been seeing some lower numbers, even if it then brings about the bounce. It feels like forever since I've had a minute to check in! I'm looking forward to catching up (although maybe not today, I'm feeling much a pj's and reading trashy novels and ignoring as much of the world day as possible).
 
Staci & Ivy said:
My question is this: how many nadirs in a 7 day SLGS cycle on a dose should there be under 149 in order to either hold or increase a dose?
Click to expand...
There is no specific number that answers this question. You want the cycles that are normal Lantus cycles, not the bounce cycles, to have nadirs under 150. Depending on how many cycles she bounces, the number of normal Lantus cycles in 7 days can vary from 3 (assuming bouncing 6 cycles) and up.

Part of the problem is you aren't using the Contour to test if she went under 150 when she might have. We have no way of knowing if yesterday or last night were times she went under 150 on a BG meter.

Out of curiosity, when was the last time you used the Contour? I think the strips are only good for so long once the package has been opened.
 
Alicia & Kit cat said:
I'm glad to see that Ivy has been seeing some lower numbers, even if it then brings about the bounce. It feels like forever since I've had a minute to check in! I'm looking forward to catching up (although maybe not today, I'm feeling much a pj's and reading trashy novels and ignoring as much of the world day as possible).
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Thanks Alicia. Do it! Just try to relax and enjoy the day :bighug:
 
Wendy&Neko said:
There is no specific number that answers this question. You want the cycles that are normal Lantus cycles, not the bounce cycles, to have nadirs under 150. Depending on how many cycles she bounces, the number of normal Lantus cycles in 7 days can vary from 3 (assuming bouncing 6 cycles) and up.

Part of the problem is you aren't using the Contour to test if she went under 150 when she might have. We have no way of knowing if yesterday or last night were times she went under 150 on a BG meter.

Out of curiosity, when was the last time you used the Contour? I think the strips are only good for so long once the package has been opened.
Click to expand...
I used that Contour this week and the strips are not close to being expired. The package insert only says “do not use expired strips”. The packs aren’t that large, so I do go through them pretty regularly.

I know I didn’t test the Libre 50s & 60s numbers yesterday as they are usually around 120s-150s or so on handheld meter.
I’m usually most concerned about when she’s dropping very low and that’s when I make sure to test to see how low she’s going, and if she needs to earn a reduction.
I try to limit my pokes as you know because she’s so fractious.

I know it’s not a perfect system I’m using. I’m doing the best I can with a difficult cat.
 
Staci & Ivy said:
I try to limit my pokes as you know because she’s so fractious.
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I wasn't here when you started, so I may not know just how fractious she can be ;) but do you think if you do it more often she could be better about it? Maybe even go through the motions like you're going to a couple times a day, with lots of treats, then don't even do it. Just pretend you did and give praise, rub her ear, etc. Do this for a few days and then sneak one in. Repeat. Would this kind of "training" help?
 
allicatmeow said:
I wasn't here when you started, so I may not know just how fractious she can be ;) but do you think if you do it more often she could be better about it? Maybe even go through the motions like you're going to a couple times a day, with lots of treats, then don't even do it. Just pretend you did and give praise, rub her ear, etc. Do this for a few days and then sneak one in. Repeat. Would this kind of "training" help?
Click to expand...
Great suggestions Alli. I am able to get tests in when it’s essential. I just try to keep it to when I must, so she will allow it.

She doesn’t like being handled and will bite & scratch. I have to sedate her for any vet visits. She won’t allow them to handle her.
All that being said, I’ve learned to handle her when I must. (not new since FD).

If I do something to agitate her before feed & shot time, I risk her not allowing me to give her insulin. (So I make sure to not engage & try to keep all things very calm leading up to that time of day). It’s like psychological warfare. Lol.
Ivy leads the pace. I follow. I have to pay close attention to her cues and mood.
But all great suggestions. And thank you so much. I really do appreciate it :bighug::bighug::bighug:
 
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