12/04/2019 Blackie AMPS 368

Sue and Luci said:
I agree with the dose reduction - but I wouldn't have been comfortable shooting last night either - so I guess it was up to Sherry - after all she has to weigh how long she would have been able to stay up and after the run to the ER 6 nights ago for a glucose drip I can understand her reluctance to shoot when he was in the 60's.

It's always good to learn from our experiences and next time weigh all the factors - but with so many IF's at play it's still challenging to know the right thing to do. I didn't want to discount what Christie and Nan were saying - and we all felt that to be conservative last night might be a better option. So just for clarification - how long is a kitty 'sensitive' to insulin after an event like Blackie had the other night?
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Nan & Amber (GA) said:
Yes, it's true that the no-shoot-under 90 is a guideline for beginners rather than a hard-and-fast rule under SLGS. But, also for clarification for anyone reading this, we do always want to consider the specific situation. In this case, we had the following:

PMPS: 60
(meal)
PMPS+0.5: 64
PMPS+1: 75

With a meal on board, the numbers were staying flat, so there was a possibility that Blackie was still heading down but was getting propped by food a bit (it's hard to say for sure with the food on-board, without the hindsight of seeing numbers later in the night as we do now). In addition, Sherry has never shot a number under 165, so this would not be a gradual working down to shooting under 90.

I agree that it might have been possible to shoot when she got the 113 at +2, although I don't think I would have done it, either. That's definitely a situational call, balancing the caregiver's tolerance for schedule disruption and a possible late night with the disadvantages of a skip.

I would also like to know the answer to this question, so that I can give more correct advice in the future.
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@Sherry and Blackie Just so you see this response. And thank you for making changes to your user ID and signature.

I tagged both Sue and Nan specifically regarding the insulin sensitivity comments. Looking at the SS, he’s not exhibited any insulin sensitivity since his low numbers episode. It’s important to be “cautious” for a couple of cycles to see how the insulin is affecting them but it’s also important to pay attention to the BG. If he’s showing no sensitivity in the couple of cycles after the low numbers, he’s not going to.

I’m also not criticizing the decision to not shoot the 60s last night or even, for this specific kitty at 75. I didn’t suggest that the shooting advice be any different than what was given; I would have advised the same thing that Sue and Nan advised; everyone who’s been here when Gracie was with me knows I tend to be on the more aggressive side of safe. You’ll note I didn’t tag @Christie & Maverick; I had no issue with not shooting 64 or 75.

I just wanted everyone to be aware that SLGS does not mean “never shoot below 90”. It’s important to go back and read what I wrote about CGs who might reasonably shoot below 90. I don’t believe Sherry is there “yet”. And, perhaps, she might not ever feel comfortable shooting below 90 with SLGS and that’s fine. The goal of SLGS is to keep numbers flat above 90.

Good luck with the reduction!
 
I certainly read Marje's note as she indicated. Frankly, I was surprised at the suggestion that Blackie may be hypersensitive to insulin almost a week past his trip to the ED. Even immediately after the event, there was no indication of Blackie being sensitive to insulin.

Personally, I find the entire notion of "no shot" numbers to be problematic. Essentially, these are points where members should simply be posting and asking for help. If someone won't shoot below 90, I tend to think it reduces the chances of remission or it reinforces a belief that "low" numbers are bad. I understand the apprehension but there are so many factors that need to be considered that I don't want to see someone who is able to monitor, knows how their kitty responds to insulin. can steer a curve with food, etc. throw the proverbial baby out with the bath water.
 
Congrats on Blackie's reduction, I'm so glad he came through those lows safely out the otherside.

I know this was touched on in the thread when you got those lo's, but reading through I wasn't sure if with all that went on whether you took on board a few things that lead to the event, so from a learning perspective I just wanted to go over those again. Now the dust has settled I hope that you can see it as a learning experience.
  • He was on 3u and a reduction was not taken when he dropped below 90
  • You had a petsitter dose him, and didn't take a vacation dose. (as you were shooting 3u, I would have taken him down to 2.5u for a couple of cycles before I was going, I would have left the sitter with an on the line dose of 2.5u, then I would have shot his regular dose as soon as I got back)
  • I don't believe you left the sitter with a sample syringe.(I think it's quite possible that your sitters 3u was more than your 3u)
I feel that's what created the perfect storm that led to those lows.

I went on a few vacations, I have a very experienced friend that cares for George when I am away, she would test him ambg and pmbg as well as midcycle, and I still reduced the dose.

As far as the numbers yesterday, I read the post as Cheryl did, and as I believe Marje intended it, what she was trying to do is to give Sherry more information around the subject so that she can make a more informed decision next time, once she has more experience under her belt and more data to back up the decision.

I also don't see any insulin sensitivity in the days following the lo's, as for how long it takes to no longer be an issue, it's an ECID, looking at the numbers will tell you. A bit like when a bouncy kitty just stops bouncing, how long does that take? well for George he started insulin in Nov 2015 and January 31st 2016 he gave up bouncing. We all know it can take some kitties longer, others less, some never stop at all, we just have to look to the numbers to let them guide us.
And although it is important to realise that, insulin sensitivity, could be an issue and watch for it, but if it didn't/ isn't happening there is no need to live under that fear.
 
Marje and Gracie said:
@Sherry and Blackie Just so you see this response. And thank you for making changes to your user ID and signature.

I tagged both Sue and Nan specifically regarding the insulin sensitivity comments. Looking at the SS, he’s not exhibited any insulin sensitivity since his low numbers episode. It’s important to be “cautious” for a couple of cycles to see how the insulin is affecting them but it’s also important to pay attention to the BG. If he’s showing no sensitivity in the couple of cycles after the low numbers, he’s not going to.

I’m also not criticizing the decision to not shoot the 60s last night or even, for this specific kitty at 75. I didn’t suggest that the shooting advice be any different than what was given; I would have advised the same thing that Sue and Nan advised; everyone who’s been here when Gracie was with me knows I tend to be on the more aggressive side of safe. You’ll note I didn’t tag @Christie & Maverick; I had no issue with not shooting 64 or 75.

I just wanted everyone to be aware that SLGS does not mean “never shoot below 90”. It’s important to go back and read what I wrote about CGs who might reasonably shoot below 90. I don’t believe Sherry is there “yet”. And, perhaps, she might not ever feel comfortable shooting below 90 with SLGS and that’s fine. The goal of SLGS is to keep numbers flat above 90.

Good luck with the reduction!
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Hi! Thank you I have read all comments and I am working on absorbing it all. Blackie seems to be presenting me with plenty of learning opportunities. I don't feel comfortable shooting under 90. With more data and experience I hope too. I'm not paralyzed with fear but I'd be lying if I said the other night didn't scare me to death. However I am prepared to move on and I certainly don't want to do anything to jeopardize a possible remission for Blackie or even regulation and a great quality of life for him. I am most grateful for all the knowledge you all are sharing with me .
 
Gill & George said:
Congrats on Blackie's reduction, I'm so glad he came through those lows safely out the otherside.

I know this was touched on in the thread when you got those lo's, but reading through I wasn't sure if with all that went on whether you took on board a few things that lead to the event, so from a learning perspective I just wanted to go over those again. Now the dust has settled I hope that you can see it as a learning experience.
  • He was on 3u and a reduction was not taken when he dropped below 90
  • You had a petsitter dose him, and didn't take a vacation dose. (as you were shooting 3u, I would have taken him down to 2.5u for a couple of cycles before I was going, I would have left the sitter with an on the line dose of 2.5u, then I would have shot his regular dose as soon as I got back)
  • I don't believe you left the sitter with a sample syringe.(I think it's quite possible that your sitters 3u was more than your 3u)
I feel that's what created the perfect storm that led to those lows.

I went on a few vacations, I have a very experienced friend that cares for George when I am away, she would test him ambg and pmbg as well as midcycle, and I still reduced the dose.

As far as the numbers yesterday, I read the post as Cheryl did, and as I believe Marje intended it, what she was trying to do is to give Sherry more information around the subject so that she can make a more informed decision next time, once she has more experience under her belt and more data to back up the decision.

I also don't see any insulin sensitivity in the days following the lo's, as for how long it takes to no longer be an issue, it's an ECID, looking at the numbers will tell you. A bit like when a bouncy kitty just stops bouncing, how long does that take? well for George he started insulin in Nov 2015 and January 31st 2016 he gave up bouncing. We all know it can take some kitties longer, others less, some never stop at all, we just have to look to the numbers to let them guide us.
And although it is important to realise that, insulin sensitivity, could be an issue and watch for it, but if it didn't/ isn't happening there is no need to live under that fear.
Click to expand...
Hi! I am definitely sorting through all that has happened and will utilize what I have learned to make better decisions . I have printed the SLGS guidelines and I am studying those. I was not aware of a vacation dose or the idea for the syringes. My next trip will be planned much better. Thank you again for taking your time to help.
 
Sienne and Gabby (GA) said:
I certainly read Marje's note as she indicated. Frankly, I was surprised at the suggestion that Blackie may be hypersensitive to insulin almost a week past his trip to the ED. Even immediately after the event, there was no indication of Blackie being sensitive to insulin.

Personally, I find the entire notion of "no shot" numbers to be problematic. Essentially, these are points where members should simply be posting and asking for help. If someone won't shoot below 90, I tend to think it reduces the chances of remission or it reinforces a belief that "low" numbers are bad. I understand the apprehension but there are so many factors that need to be considered that I don't want to see someone who is able to monitor, knows how their kitty responds to insulin. can steer a curve with food, etc. throw the proverbial baby out with the bath water.
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Hi! Can you explain idea of not shooting under 90 may reduce chances of remission. Trying to learn all I can here. Thank you !
 
Sherry and Blackie said:
Hi! Can you explain idea of not shooting under 90 may reduce chances of remission. Trying to learn all I can here. Thank you !
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I will explain.

The longer a cat’s BG stays in the range of 50-90, the more healing the beta cells in the pancreas do. Quite often with SLGS, as soon as the kitty starts seeing “some” green, numbers fall below 90 and the dose is reduced and, thus, healing time reduced. With TR, the dose that is working can be held much longer. Does that make sense?

While we do see an occasional cat on SLGS go into remission, the rates are much lower that those on TR and it seems they often come back from remission sooner.
 
Nice to see Blackie wasn't all that phased by the no - shot!

Marje and Gracie said:
One other clarification for all involved. While SLGS states we usually don’t suggest shooting below 90, remember that for experienced CGs who have data; know their cat’s onset, nadir, duration, and response to food; and are available to monitor, they can determine what preshot is a safe number to shoot, even if it is below 90.
QUOTE]
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Thank you Marje @Marje and Gracie for providing this - I had intended to come back and provide those details after walking the drooler, and once the immediate issue of shoot/no shoot had been tackled, but didn't get the opportunity.

Just as a few people have commented today that they read no criticism in your post (I certainly for one also didn't take it that way), I would also like to note that when I read Nan's @Nan & Amber (GA) comment this morning, it was clear to me that she was addressing the comments to those who either may come along (quite a bit after the fact) and not understand the circumstances and basis for what we suggested, or those lurkers who read but don't post for help for their own particular cat.

@Sherry and Blackie keep absorbing and asking questions, as I told you yesterday, many of us here continue to learn something new every day :)
 
Marje and Gracie said:
I will explain.

The longer a cat’s BG stays in the range of 50-90, the more healing the beta cells in the pancreas do. Quite often with SLGS, as soon as the kitty starts seeing “some” green, numbers fall below 90 and the dose is reduced and, thus, healing time reduced. With TR, the dose that is working can be held much longer. Does that make sense?

While we do see an occasional cat on SLGS go into remission, the rates are much lower that those on TR and it seems they often come back from remission sooner.
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Hi,
It does make sense. I have noticed that cats on TR seem to go into remission more than SLGS. Maybe I should consider changing. I have thought about it. I'll read more and see what's involved. With working though my daytime testing is limited to lunch time only .
 
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