11/15 Gryphon AMPS 457 Requesting Advice re: PMPS 121

Hi Cindie from another Canuck in Ontario. I see this isn't the first time Gryphon has thrown you low pre-shots but this is the lowest. I think the question is how long are you willing to monitor tonight? Can you stall another 30 minutes to see if he's on his way up without throwing your schedule to the wind. No matter what you shoot, I'd definitely get another BG at least +2 or +3 and then decide from there. You've shot very reduced doses at 137 and 149 before but then Gryphon was really high by next pre-shot.
 
MrWorfMen's Mom said:
Hi Cindie from another Canuck in Ontario. I see this isn't the first time Gryphon has thrown you low pre-shots but this is the lowest. I think the question is how long are you willing to monitor tonight? Can you stall another 30 minutes to see if he's on his way up without throwing your schedule to the wind. No matter what you shoot, I'd definitely get another BG at least +2 or +3 and then decide from there. You've shot very reduced doses at 137 and 149 before but then Gryphon was really high by next pre-shot.
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It's now 1.5 hours past his usual shot time. I can stall a bit longer, though. If the numbers start to come up, should I give the full dose? Also, if I give insulin, and test at +2 or +3, what BG would I need to see before it's safe to stop monitoring?
 
If the numbers start coming up a lot, you could give the full dose. If he's not coming up much, I think you could try 3 or 4u.
 
When you retest at +2 or +3, it would depend on what his numbers are doing. If he is holding in the same range or dropping, you'll need to keep monitoring until he's rising. If he is rising, you should be fine to get some sleep and if you are concerned set an alarm for +7 or +8 and check then. It's hard to just give you a number. It's really about the activity (holding, dropping or rising) for the cycle that would dictate how much testing is needed.
 
MrWorfMen's Mom said:
If the numbers start coming up a lot, you could give the full dose. If he's not coming up much, I think you could try 3 or 4u.
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I just tested again and he's at 140 now. So, I think I'll give him 4U and set the alarm to test him +2. Thanks very much for your help with this!
 
Sorry I wasn’t on earlier.

A couple things for the next time you see a low number at preshot and are able to monitor. First, if you stall try stalling just 20-30 minutes before testing again, you want to get insulin in before he starts shooting up, as there is still a couple hours after the shot before onset for the numbers to rise. Second, if he’s flat or rising after that stall, SHOOOT! He shouldn’t be going down after that unless you stall too much. Lack of food from the delay can lower the BG’s. Third, a stall acts like a reduction. Tonight you both stalled and reduced the dose. You don’t need to do both. Lesson learned and an opportunity to gather data. And lastly, I am not a huge fan of the reduced dose as a safety measure anyway, as the depot will usually make the first part of the cycle play out like you had shot the full dose anyway, but with the reduced dose you just end up with higher numbers to start the next cycle.

I really liked blue preshots. Shooting lower means much flatter cycles and more predictable cycles. Cycles starting pink or worse can go anywhere.

One thing to remember with an acrocat, there is no one good dose, only the dose that is good at the moment. Don’t get attached to any given dose. Have you thought about what dosing methodology you want to use?
 
Wendy&Neko said:
Sorry I wasn’t on earlier.

A couple things for the next time you see a low number at preshot and are able to monitor. First, if you stall try stalling just 20-30 minutes before testing again, you want to get insulin in before he starts shooting up, as there is still a couple hours after the shot before onset for the numbers to rise. Second, if he’s flat or rising after that stall, SHOOOT! He shouldn’t be going down after that unless you stall too much. Lack of food from the delay can lower the BG’s. Third, a stall acts like a reduction. Tonight you both stalled and reduced the dose. You don’t need to do both. Lesson learned and an opportunity to gather data. And lastly, I am not a huge fan of the reduced dose as a safety measure anyway, as the depot will usually make the first part of the cycle play out like you had shot the full dose anyway, but with the reduced dose you just end up with higher numbers to start the next cycle.

I really liked blue preshots. Shooting lower means much flatter cycles and more predictable cycles. Cycles starting pink or worse can go anywhere.

One thing to remember with an acrocat, there is no one good dose, only the dose that is good at the moment. Don’t get attached to any given dose. Have you thought about what dosing methodology you want to use?
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Thanks for this information, Wendy! I haven't yet had an opportunity to talk with my vet re: possibly mixing with Toronto insulin. I will also ask him if it is the same as Humulin R. I have read some of the information on the Tight Regulation Protocol and SLGS to try to get an understanding of how they work, and how they are different. If I am understanding correctly, Tight Regulation involves more testing and adjusting the dose based on the nadir. Is that correct?
 
Both SLGS and TR base dosing on the nadir. TR has faster increases and a lower reduction point, and also requires feeding low carb wet or raw food only. TR requires a bit more testing, to make sure you are dosing safely with the more aggressive dosing. IMHO, you do need to be a bit more aggressive with an acrocat. Tumour changes can mean steadily increasing doses to keep in good numbers, or else you get caught with glucose toxicity. However it’s also about work/life balances and not everyone can do TR.
 
Wendy&Neko said:
Both SLGS and TR base dosing on the nadir. TR has faster increases and a lower reduction point, and also requires feeding low carb wet or raw food only. TR requires a bit more testing, to make sure you are dosing safely with the more aggressive dosing. IMHO, you do need to be a bit more aggressive with an acrocat. Tumour changes can mean steadily increasing doses to keep in good numbers, or else you get caught with glucose toxicity. However it’s also about work/life balances and not everyone can do TR.
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Wendy, to answer your question, I want to work toward TR, although there will be times when I'm not able to do it due to other responsibilities in my life. At this point, I don't feel I have enough data. Gryphon's BGs seem to be erratic and unpredictable. I'll try to do more frequent testing and, hopefully, gain a better understanding of how he works. Today I shot the full dose after a pre-shot # of 155. He dropped to 59 at +4, which was really a surprise to me! His lowest numbers are usually much later in the cycle. I fed some HC food and he's back up to 128.
 
I was just looking at Gryphon's SS. Good catch today! :eek: Looks like he wants to go back to 5.5 units.:)

I am glad you shot the full dose so you could monitor and see what this dose has really been doing. When Neko was looking at a reduction, she usually dropped earlier in the cycle. Good to know if you are leaving food out for him, to make sure there is a little extra earlier in the cycle for him.
 
Wendy&Neko said:
I was just looking at Gryphon's SS. Good catch today! :eek: Looks like he wants to go back to 5.5 units.:)

I am glad you shot the full dose so you could monitor and see what this dose has really been doing. When Neko was looking at a reduction, she usually dropped earlier in the cycle. Good to know if you are leaving food out for him, to make sure there is a little extra earlier in the cycle for him.
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He has an automatic feeder and gets 6 meals per day. I could set it up to feed more frequently if that would be helpful. I'll reduce to 5.5. Thanks for your support!!
 
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