11/20 Eddie AMPS 148 +4 362 PMPS 488 +6 383

[Jodey&Eddie&Blue]

Good morning,
Here is yesterday:

https://felinediabetes.com/FDMB/thr...0-3-5-410-6-376-8-412-pmps-448-6-5-95.270960/

Eddie is temporarily on SLSG and I did a curve on him yesterday that appeared to suggest an increase but then following @Wendy&Neko 's advice did a PM + 6.5 and he was at 95.

I'm a little unclear regarding how many times to test with the SLSG in contrast to TR. I took Wendy's advice and did a night test and am glad I did but then heard I should have tested again. The reason I had to put TR on pause is that I've got a ramped up working schedule and am not home much during the day. It's quite labour intensive and requires mental acuity and the night testing in addition to the day was really wearing on me. The question is: beyond AMPS and PMPS, which are givens, how often during the day or night is the standard for this method. I'm wanting the best for Eddie and Blue and am doing the best I can given the circumstances (I have no one else to test either Eddie or Blue beyond myself) but am not sure what frequency I should be following other than doing a curve every 7 days and re-evaluating. I hope this makes sense.

Anyway, PM + 6.5 95 and maybe he did go lower but I'm doing what I can.

 

[Little Man's mom (GA)]

Dont be hard on yourself you are doing an excellent job caring for your fur babies

 

[carfurby (GA)]

The idea with SLGS is that you don't need to test as much unless you think Eddie will keep dropping. I think the idea of getting another test last night was because he had gone down so much from PMPS and it would be a good idea to make sure he didn't keep dropping. When I am able to with Furball I get at least one mid cycle test and more if I think she will keep going down. Hang in there. It's not easy to be the only one testing while working. Just do the best you can. You're doing great taking care of two sugar cats.

 

[JL and Chip]

I think the idea of getting another test last night was because he had gone down so much from PMPS and it would be a good idea to make sure he didn't keep dropping.

Exactly.
It was a suggestion based on the specific situation.

Levemir typically has later onset and nadir than Lantus, so with the steep drop from PMPS to the 95, and knowing he could still be dropping and still had plenty of time to go before likely nadir (and was near reduction point), grabbing another test under those circumstances could have been helpful.

You don’t know whether he went to 40 or 70 or headed steadily back up from that 95. And given that you’re using an AT meter, 90 doesn’t give you as much cushion as it would were that number on a human meter. The data could have helped you keep him safe as well as decide whether a dose reduction is warranted. (Personally, I would take a reduction given your schedule and the likelihood that he went lower, but I don’t give dosing advice)

The rule of thumb I use is to throw in extra texts when the numbers are lower, especially after a rapid drop. It’s a caution/safety thing. It’s like driving a car — one is more careful and diligent when driving on snow or hairpin curves because of the circumstances.

 

[Wendy&Neko]

I'm a little unclear regarding how many times to test with the SLSG in contrast to TR. I took Wendy's advice and did a night test and am glad I did but then heard I should have tested again.

As others said, the suggestion to test again was not specific to dosing method, but rather to the idea of keeping him safe. Did he go under 90 and earn a reduction under SLGS? We don't know, and typically if we don't see it, we don't act. Eddie tends to nadir on the early side of what is typical for a Lev kitty (much like he did on Lantus). Except when he doesn't. You don't have any Levemir data showing what happens when he dives from on high, so this was a tricky situation to figure out. As usual, the cat likes to keep us guessing. Waiting 20-30 minutes and retesting would have helped answer "and what happened next?", and wouldn't have disrupted sleep that much.

On the up side, Eddie doesn't need an increase and you did a great job catching that green last night! As far as how often to test, the absolute minimum with SLGS is as you stated, but you still need to be able to answer the question "how low is this dose taking my cat?". If you can't answer that, more testing is needed. You don't want to base an increase on data from a curve during a bounce cycle. Spot checks, when you are home and awake, are a fantastic way to fill in data.

 

[Jodey&Eddie&Blue]

I do understand the issue of later onset and nadir. I also get it that extra testing works to ensure there's no dangerous dive. But I'm also challenged by the fact I'm dealing with peaks and valleys following his SRT and the possibility that growth hormone (GH) is not being released to the same extent it was before we left for Victoria when he was on 27u of insulin. I mean, he's now on 1/2 the therapeutic dose of Prednisolone, too, so there's a lot going on and I keep thinking that while insulin and BG and safety are issues that there are so many unknowns here that it's hard to look at the situation as if he has only DM and nothing else going on.

Also, I should say that whenever I test Eddie, it's always before a snack and if I test him anywhere post PM, he gets a snack. Always.

Now we're at PMPS 488. I mean, really...