11/24 Henry AMPS 378 +5.5 376 PMBG 141 PMPS 166 +1 158 PMPS + 2 122 PMPS + 3 154 PMPS + 5 256
- Thread starter Golf2015
- Start date
Golf2015
Member Since 2020
Too late I already fed him
Now if this is any consolation the meal is 25% of his daily calories
He is fed (4) times daily
(2) just before preshot
(2) @ + 5.5 after preshot
So only 1/4 of his daily requirements was fed to Henry at the PMPS + 0 (141)
JaxBenji
Member Since 2020
no worries - generally if you see a lower than normal preshot, don't feed and retest in 20 minutes to see if he's rising or not.
I don't give dosing advice but I'll tag some people who have helped before - @Marje and Gracie @Wendy&Neko @tiffmaxee
Per your SS, you're following SLGS, is that right? It's a good idea to add to your signature when you get a minute.
Golf2015
Member Since 2020
Yes SLGS is correct
JaxBenji
Member Since 2020
@Golf2015 how long can you be off schedule from your shot time?
If you do end up shooting tonight, you can adjust your shot times back by 30 minutes in a 24 hour period.
If the more experienced folks don't stop by with input then these are the options from the dosing method sticky...Henry was close to 150...If you do shoot, even a reduced dose you'd need to get a +2 - similar to how you did when you shot 177 on 11/20...
If you do end up shooting tonight, you can adjust your shot times back by 30 minutes in a 24 hour period.
If the more experienced folks don't stop by with input then these are the options from the dosing method sticky...Henry was close to 150...If you do shoot, even a reduced dose you'd need to get a +2 - similar to how you did when you shot 177 on 11/20...
- Below 150 mg/dl (8.3 mmol/L), don't give insulin.
- Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
- a.) give nothing
- b.) give a token dose (10-25% of the usual dose)
- c.) feed as usual, test in a couple of hours, and make a decision based on that value
Golf2015
Member Since 2020
I have one serious question very important with respect to those numbers
Henry's numbers are from a pet meter (ALPHATRAK2) not a human meter
So what would be the guidelines for a pet meter since this protocol is human meter numbers????
So I'm thinking if you were to convert Henry's number to human his 141 would convert ~= 100 Human?
JaxBenji
Member Since 2020
On SLGS, the numbers mentioned are safe for AT2 and Human meter. Reductions are taken at <90 on both meters.
edited to clarify: I should clarify that <68 on AT2 or <50 on Human is always a take action no matter the dosing method. On TR, the "take action numbers" are when reductions are taken too.
Maybe @carfurby can stop by - she follows SLGS and has been for awhile.
Golf2015
Member Since 2020
Here how I converted his pet meter 141 to ~= 100 Human
68 to 50
68 is Pet meter
50 is for Human meter
141 divide 68 = 2.07
So 50 (Human Meter #) times 2.07 = 103.5
So converting 141 to Human is 103.5
So this is why I question this protocol based on Human Numbers
So what I'm saying Henry is just not below 150 being 141
He's 103.5 Human meter so He's quite away from the 150 to 200 protocol
I need some guidance
Thank You
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First...we don’t ever convert numbers from the AT to a human meter.
There is absolutely no equivalent.If you fed him, unless you can shoot in two hours, you should just skip because you don’t have enough data to know if he gets food spikes. Can you be two hours off? The good thing is, he does bounce and so if he does, you can shoot early which I’ll explain later. I want to post this so you’ll see it now and then I’ll post another post with info.
JaxBenji
Member Since 2020
Thanks for stopping by @Marje and Gracie - I was getting to the end of my own knowledge
Golf2015
Member Since 2020
First...we don’t ever convert numbers from the AT to a human meter.
If you fed him, unless you can shoot in two hours, you should just skip because you don’t have enough data to know if he gets food spikes. Can you be two hours off? The good thing is, he does bounce and so if he does, you can shoot early which I’ll explain later. I want to post this so you’ll see it now and then I’ll post another post with info.
OK my guess and it's a guess I think his food spike is about 30 points - just a thought
I can shoot in two hours you need a BG reading prior to preshot to determine the dose if needs to be change???
I just want to be sure this does not confuse anyone. The 68 on the AT and the 50 on the human meter are the reduction numbers under tight regulation. For SLGS, the reduction number is below 90 regardless of the meter.
I do understand what you are saying here but I don’t want anyone to get reduction numbers on TR confused with when you need to test more, etc. the main reason is because an experienced caregiver might not need to take action at 50 or 68 on the AT because they might know their cat well enough to know they can surf in the high 40s or low 50s (human meter) with no issue. But, the point is well taken that if you get one of those numbers, you need to be sure you are testing and, depending on when it is in the cycle, possibly feeding.
Robert..I know, intuitively, there is the tendency to want to use the 68 and the 50 as equivalents and then adjust numbers from there. But it doesn’t work that way. When the TR protocol was written, the 68 on the TR and 50 on a human meter were not meant to be equivalents. Those were just the BGs set for reductions. If you look on Gracie’s SS, there’s a tab comparing my human meter and the AT and you’ll see there is not an equivalency and you can’t extrapolate numbers using math.
We never, ever shoot without a preshot so if you want to shoot in two hours, test first. I doubt you’ll see a number that will require the dose to be changed because that would mean that after two hours, and no additional insulin, he’d have to be below 90 to reduce the dose. Impossible? No but it’s unlikely.
In the subject line, the PMPS would need to be PMBG so we know you didn’t shoot. If you do shoot at +14, you would put PMPS in at that time.
Golf2015
Member Since 2020
Marje
So if his number is not below 90 - 4.75 units for his shot
Do you anticipate it will be rising above 141 at +2 (8:00pm EST)?
Thank You
Right. Even if we skip or stall, we don’t reduce the dose unless they actually earned a reduction which is below 90 for SLGS.
Regarding whether he will be rising at +14 (we count time in hours from the last shot), he should be. But he also has a large depot at 4.75u and with Lantus, the dose can affect up to six subsequent cycles. Also, he finally was clearing his bounce and often in bounce clearing cycles, the BG drops unless food is given (which you’ve done). We will just have to see where he is at +14.
Unless the kitty has earned a reduction, if we stall, we shoot the full dose because stalling acts like a dose reduction.
If his numbers aren’t dropping, I’d just feed him before his +2 for the evening cycle. That means if PMPS is at 8 and +2 is at 10 and he onsets at +2, unless he is headed way up from PMPS, you might want to feed. Otherwise, I would feed on his normal schedule.
Thank you for being there. You did a great job!!!Thanks for stopping by @Marje and Gracie - I was getting to the end of my own knowledge
Golf2015
Member Since 2020
That means if PMPS is at 8 and +2 is at 10 and he onsets at +2, unless he is headed way up from PMPS, you might want to feed. Otherwise, I would feed on his normal schedule.
So feed him +2 (10:00pm EST) if his BG reading is up very little from the BG reading @ (8:00pm EST) - Which is his new PMPS
But if BG reading is significantly up just feed him his normal schedule which would be 11:30pm EST
Next BG reading in 15 minutes
Thank You
So feed him +2 (10:00pm EST) if his BG reading is up very little from the BG reading @ (8:00pm EST) - Which is his new PMPS
But if BG reading is significantly up just feed him his normal schedule which would be 11:30pm EST
Next BG reading in 15 minutes
Thank You
I’d shoot and get a +1 and +2.
Correct.
On his SS, in the +11 column, please put “141 @ +12” and in the PMPS column, put “166 @ +14”.
Golf2015
Member Since 2020
Sounds like he is going to have some lower numbers tonight. It might be good to just give him a tsp or two of low carb food so he doesn’t drop a lot when he onsets. See you at +2.
Golf2015
Member Since 2020
OK just fed Henry (2) teaspoons of his normal LC wet food
(1) teaspoon of Henry's LC wet Food is 11 calories
Henry under his scheduled feedings (4) daily (6) hours between is 80 Calories each feeding for total 320 per 24 hours
Next BG reading +2 @ (10:00pm EST)
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Yes. I would and test at +3 to see if he slows down a bit.
Golf2015
Member Since 2020
DONE
Henry is consuming (1/4 daily Calories - 80) as I'm writing this message
Will perform next BG reading @ +3 (11:00pm EST)
If numbers drop, we often have to feed more.
No. Just letting you know if he continues down, he might need more food at some point.
Good observations. By +5, he will be getting close to nadir.
What I’ve been having you do tonight is to feed him as numbers come down while he’s in very safe numbers so you can get an idea of how he responds to food. The caveat is that in some cats, if numbers drop faster or they are lower, it might take a higher carb food to control it. But this gives you some data.
I suggest you keep track of it on his SS. I’m not saying you have to get as detailed as I did on Gracies SS but it’s good to have a record so you can go back and look at it.
Since he’s headed up and not down, I am probably going to head to bed before his +5 which is when you should test again. If numbers come down, feed. Test as much as you need to. But....he shouldn’t come down too much more as he will be approaching nadir. Post for help if you need to.
Is that ok?
Golf2015
Member Since 2020
OK But I have to be honest I'm nervous
So the NADIR under Vet supervision was around + 6
This is my understanding now is to check at + 5 if the numbers are down (below the + 3 BG reading) feed but if status quo or rising then it is safe to assume Henry is past the peak of the insulin.
If the numbers are in fact dropping at + 5 ==>next BG reading + 6 (Which possibly might be his true NADIR)
Now the AMPS will now be 8:00am EST?
Does Henry qualify for a reduction because of the feedings prevented him from approaching the 90 threshold?
Nadirs can change so try not to get too married to that +6. Yes, check at +5 and feed, if necessary. I think you normally feed at +5.5 so it’s fine to feed him then as long as numbers are headed up. If the BG is coming down, be cautious about feeding at +5.5 if he doesn’t need it because you don’t want him to be too full.
If you are up at his regular shot time and he’s bounced up to pink or higher, you can shoot early at +10.5 (6:30). If he’s still coasting in blue, shoot at 8 and we’ll start getting him backed up tomorrow night.
Golf2015
Member Since 2020
Marje does Henry possibly qualify for a reduction (@ AMPS) assuming his feedings prevented the 90 threshold to occur???
Golf2015
Member Since 2020
Does his feeding schedule align with his new amps?
I’m sorry I forgot to answer that. No. We don’t reduce based on that and I don’t believe he would have gotten close to 90 without feeding. We only reduce when we actually get a number below 90 (SLGS) on the meter or, very occasionally, if the depot gets ahead of us a bit and it takes a ton of food to keep the numbers up above 90.
if you test him a little before 6 and you aren’t able to shoot because he’s in blue, you can feed him as long as it’s by 6 so you can shoot at 8. But you will likely have to feed him at +2 ( from when you shoot) as well so he’s got food on board within two hours of when you shoot.