? 11/5 Lilly AMPS = 82, stalled, reduced dose; PMPS = 381, +3 = 429; Question!

[Kelsey & Lilly]

So, I'm trying this whole TR thing, based on some advice I've gotten (here http://www.felinediabetes.com/FDMB/...s-387-questions-about-tr.220892/#post-2466853). I'm struggling to understand it, and I was told to come to the board when I needed help. So, here I am.

This morning, Lilly gave us a surprise green number. (She likely may have sneakily dipped even lower while we were sleeping.) One of my concerns with TR is my work schedule -- I'm away 12.5 hours most days. So I had to wake up my poor fiance so that he could stall and re-test 30 mins, then an hour later, so we could safely give her at least something, but I had to leave for work. He/We ended up going with a reduced dose, since she was staying kind of stagnant. Obviously I may have messed up, because we're up in the reds again. But honestly I'm sure it would've happened anyway because she bounces to the moon any time she sees green.

So I guess I have two questions:
1) In as nice of a way as you can put it (I get discouraged about this so easily and hate feeling like I've done something wrong for my baby girl), what should I have done differently? Or what should I do next time, when I get a PS number under 100? In your opinion, Do I have the data to go ahead and shoot, really regardless of what her PS numbers are? I have a hard time interpreting all the data I have.

2) What should I do with her dose? These high numbers I've been getting on 2u are clearly bounce numbers to me. Should I hold this dose a while longer, since I've gotten two nadirs around 74-28 (and possibly lower)?

 

[Sienne and Gabby (GA)]

I don't think you did anything wrong. What I would suggest is if you get a lower than expected pre-shot number is to post and ask for help. When this situation occurs again, and it will, you have a few options.

• You can shoot your regular dose if numbers are above 50 and you're comfortable doing so. You need to be there to monitor and have extra strips and high carb food on hand. With Lantus, the mantra is, "Shoot low to stay low."
• You can stall. If you so stall, do NOT feed your cat! You want to re-test in 15 - 30 min. to see if numbers are rising on their own.
• You can shoot a reduced dose like you did today.
• You can skip the shot entirely.

While you have plenty of data, what you don't yet have is much experience with lower pre-shot numbers. Most people are reticent to shoot low numbers if their cat has been mostly in much higher numbers. Start considering what the lowest number you'd be comfortable shooting would be.

One think I don't think you know is that if you stall, your next shot is due 12 hours after you shot. Since you shot at 7:00 this AM, Lilly's PM shot would have been at 7:00. With Lantus, you need to walk the time back in smaller increments since an early shot is like a dose increase and a late shot is like a dose reduction. Given that Lilly bounced, you'r likely fine with the early shot. Just keep in mind the two time changes today may cause some wonky numbers.

TR takes a bit of getting used to. Generally, you evaluate the dose every 3 days/6 cycles. However, any time a dose is changed, you have to wait another 6 cycles for the depot to restabilize. With the reduced dose this morning, you need to wait for 3 days before an increase. Doses are reduced only if numbers drop below 50.

 

[Kelsey & Lilly]

Okay, so I hold 2 units for a full consecutive 6 cycles. got it.

With the low pre shot numbers... in the mornings unfortunately I don't really have an opportunity to post and wait for a reply. I literally shoot and feed and walk out the door. Likewise with stalling. I just kind of panicked yesterday and woke my fiance up, but he's not on my same schedule and cant routinely wake up that early. And, I'm not home to monitor when we shoot low. He happened to be home yesterday, but that's not always the case.

Which kind of leads me in the circle I was in before starting to try TR. I commend folks that do this with no help and with a full time job. I've read the thread about TR with a job and it blows.my mind.