? 12/19 Silver AMPS 436 PMPS 265 - shoot/no shoot vs bouncing question
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Bronx's dad (GA)
Member Since 2016
Well, the red is not a big surprise after a NS. Hopefully Silver gets back to some blues today...
I probably should have shot any aye but I was going out and not back for a couple hrs. Was trying to follow the SLGS protocol and not to shoot. Should have me thinks.
Bronx's dad (GA)
Member Since 2016
Better to always be safe. One saying here that I always remember: "better a day too high, than an hour too low".
Yes I know. But I would have been safe shooting a blue. I will next time.
Stacy & Asia
Member Since 2017
Besides just being really interesting, this little gem discusses the what and why of SLGS. Mainly that it isn't so much about hard and fast rules, but that it is very much meant to be tailored to your cat and situation, not followed rigidly like a protocol.
This thread is tucked away over in think tank, so I don't think it gets the eyes it should from people on this forum. Well worth the read:
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tr-vs-slgs-how-to-choose.161504/
This thread is tucked away over in think tank, so I don't think it gets the eyes it should from people on this forum. Well worth the read:
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tr-vs-slgs-how-to-choose.161504/
Tracey&Jones (GA)
Member Since 2016
There is always do overs with FD. The don't shoot under 150 is for the owner's new to the treatment plan. You should be comfortable at shooting that low as well as able to monitor so you know how your kitty will react. It is scary the first blue, then even scarier on the first green!
You can always stall, don't feed for 20 minutes and post here for advice. I know for me, that it was nice having someone with knowledge handy when you shoot those first lows. Guiding you through testing and what the results mean - so you don't panic and give HC when not needed or to give the HC as the cycle is more active then it should be. It gets easier and you get to know your kitty.
You can always stall, don't feed for 20 minutes and post here for advice. I know for me, that it was nice having someone with knowledge handy when you shoot those first lows. Guiding you through testing and what the results mean - so you don't panic and give HC when not needed or to give the HC as the cycle is more active then it should be. It gets easier and you get to know your kitty.
I’d never shoot a blue or green and then head out. At 5.7 I made a judgement call that it was too low as I was going straight out again. I have to weigh the risks. If I was home I’d shoot. So much easier if I worked close to home. Monitoring isn’t easy
Tracey&Jones (GA)
Member Since 2016
Never said you would. That is why I typed what I typed. You need to be comfortable and able to monitor. You need to get to know your cat. SLGS protocol does not state that you absolutely can not shot below 150. Only after experience and time getting to know your cat then you can start to. I was trying to be encouraging.
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Oh you were! Typed word is so hard to tell tone. I hope I didn’t sound like you weren’t being encouraging. I’m looking forward to seeing what he might give me tonight. Hoping it’s low again as I am home.
On my way home to see what number Silver will give me tonight. Question re shot/no shot and bouncing. I looked at his spreadsheet from 12/12. He gave a low blue and I shot anyways and monitored. Bounced sky high into the reds the next AMPS. Last night low blue PMPS and I couldn’t shoot and monitor as I had to head out. This morning at AMPS? High red due to no shot. Feel like whatever I do he’s going to be high next AMPS. Thoughts? Did I do wrong to skip shot last night given by today's numbers?
@Chris & China @Wendy&Neko @Tracey&Jones @Stacy & Asia
@Chris & China @Wendy&Neko @Tracey&Jones @Stacy & Asia
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Stacy & Asia
Member Since 2017
Since you couldn't monitor, I think it was wise to skip the shot last night, it could have turned into a bounce anyway, but if it were an active cycle, you could easily have had a situation on your hands. High AMPS is a thing many people contend with, there's something called dawn phenomenon that might explain it. I'm not sure what you do about it though, I've heard about giving a snack at +9, but I don't know why that helps. For the most part Asia rapidly tries to pull down from high preshot numbers, so my focus hasn't been on preshots as much as keeping her in good numbers without going too low. When I get to that point, if I make any amazing discoveries, I will share them with you.
I don't have an expert opinion on this, but my own experience is: before they regularly spend time in blues and greens, I'm personally not a fan of skipping shots. It was frustrating enough to try to find the right dose and a couple of times when I was really close, a fur shot happened. It seemed like a major setback at the time. I think when they are in better numbers, consistently, it's not as big of a deal, but when you're in a sea of pinks, skipping a shot is just going to take a few cycles to recover from (in my experience, ECID). I try really hard not to skip, I'd rather delay and shoot late or give a smaller dose (although my experience there is didn't make much of a difference for that cycle anyway). But again, that's just me, I don't require as much sleep as many people do and I also have a decent amount of flexibility in my schedule.
Thanks for that. It’s so hard to figure this all out and try to make the right decision. I’m trying to follow SLGS not I didn’t realize it is supposed to be tweaked and tailored to the cat. I’m so good and following instructions bit not so much when I’ve to make a judgement call.
Stacy & Asia
Member Since 2017
I completely understand! I get analysis paralysis sometimes. Especially when your decisions can seriously harm your cat. It's pretty intense. I think I'd have trouble with SLGS after reading that post where you have to know your cat more. I've known Asia for 21 years and FD has taught me just how much I still don't know about her! Aye!
But just know you're doing an amazing job!
FD cats are not unlike human infants, they are so dependent on you and you think any little wrong move will break them, but at the end of the day, I think they are a little more resilient than we give them credit for. And I also think we are all doing a better job of dealing with all this FD stuff than we give ourselves credit for. 
Oh I hope so. I really want to do TR but I’m very rarely home for nadir and can’t lose sleep as my health isn’t good. I know dosing decisions are based on nadir so TR and being gone 12 hrs a day wouldn’t work. There’s also no way I’d ever want to shoot 50. I can manage 90 but I wouldn’t shoot lower. Too much of a chicken for that.I completely understand! I get analysis paralysis sometimes. Especially when your decisions can seriously harm your cat. It's pretty intense. I think I'd have trouble with SLGS after reading that post where you have to know your cat more. I've known Asia for 21 years and FD has taught me just how much I still don't know about her! Aye!
But just know you're doing an amazing job!
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Tracey&Jones (GA)
Member Since 2016
The high red was more likely due to the blue number then the fact you skipped the shot. Silver may run higher for a cycle or two as that skipped shot drained the depot. It will take a cycle or two or three to build that back up again. That said you see where that 1.75u can take him - within 4 cycles he was just hovering above green! That is exciting.
Silver's body may just need some more time in blues to figure out it is ok to be in the lagoon!
Next time you have a lower PS that you are feeling edgy about - you can skip - which if you can't monitor may be a good option or you can stall-do-not feed and ask for dosing advice. If you wait 20 mins and Silver is going up without food - that tells you the cycle is ending and you maybe good to shoot a small dose (BCS) or a full dose.
As Stacy has indicated with Lantus when you skip a shot, you upset the momentum of the depot.
Lots of factors to take into account. Just post with the ? and indicate you are stalling and looking for dosing advice.
Oh so the red today could be bouncing? Man I wish these kitties could talk and tell us what is going on. So stressed out getting my brain round this. Tonight he’s in yellows so not toooo bad. Not blues yet tho.
Tracey&Jones (GA)
Member Since 2016
Yep, and the good news is that he is clearing them fairly quickly. See, you are honing into the right dose and his body is slowly getting with program. Looks to be around 3 cycles. If you can grab a mid-cycle test tonight that would be great. I wouldn't be surprised to see a blue tonight.
Tracey&Jones (GA)
Member Since 2016
That is too bad. Any chance you can get a +11 and post vs. waiting for the +12?
Thanks so much. A little encouragement goes a long way. So if his dose works and brings him into greens - following SLGS I’m supposed to reduce if he goes below 5 - but then he’ll be back in yellows and pinks if I reduce no? Confused.
Tracey&Jones (GA)
Member Since 2016
Yes, you reduce. And yes, he will bounce. And then he will come back down and he will go to green again. Trust me. Jones would go 4 cycles and I was reducing again. He spent a fair bit in blues and greens. Of course then we changed his meds and I am now battling yellows and pinks.
ETA - if Silver doesn't come down, we go back up.
What constitutes a failed reduction?
Tracey&Jones (GA)
Member Since 2016
The same guideline as in the SLGS protocol.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.
- If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
Stacy & Asia
Member Since 2017
[/QUOTE]
It's happened to me several times as well, and I have learned a lot by having to make those decisions on my own (and reading the guidelines of course). But that's when my analysis paralysis gets a kick in the pants and I have to make an educated guess what to do. I'll admit it hasn't always been the right decision, but I've learned from them all, and it still feels good to make one, especially when I do get it right!
If she's having a low day and surfing well past nadir, I try to ask the question in advance just to gather advice so I'm not waiting at shot time for a response. It also helps to stall, just a little (15-20 mins) without feeding, and then it's easier to decide based if she's going up or down.What if he’s in the middle of a bounce? Increase anyways?
Ok I’ll try. Silver won’t like it much tho. I basically am out all day not free feeding. When I come home he wants his FOOD and makes noise about it. We are used to this the past 11 years. I come in and food is priority. Stalling 20 mins = one unhappy Silver but he will survive. This would be so much easier if I was home during the day. It’s soooo hard being at work and not able to test.
Tracey&Jones (GA)
Member Since 2016
I know! I work a full time job. I am unlucky/lucky. My DH had a really bad motorcycle accident in August of 2016 and he has been home since. He has learnt how to test - will only do the one test a day but that is all I need. My DS will also test if needed.
Yes, the key is how low did he go? If it not below 8.3 then yes. You may only get a cycle or two in and come back down again. Silver is leading this dance...so we go where he is taking us. Hopefully you will find over time he will bounce less often and less dramatically. His liver and pancreas need to figure things out and we keep changing the game on them. Remember you are shooting a hormone not administering a pill, so things are just a wee bit more complicated.
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Going to test now at + 4. Too tired to stay awake another hour. Have a feeling it may still be yellow.I know! I work a full time job. I am unlucky/lucky. My DH had a really bad motorcycle accident in August of 2016 and he has been home sense. He has learnt how to test - will only do the one test a day but that is all I need. My DS will also test if needed.
Yes, the key is how low did he go? If it not below 8.3 then yes. You may only get a cycle or two in and come back down again. Silver is leading this dance...so we go where he is taking us. Hopefully you will find over time he will bounce less often and less dramatically. His liver and pancreas need to figure things out and we keep changing the game on them. Remember you are shooting a hormone not administering a pill, so things are just a wee bit more complicated.
Stacy & Asia
Member Since 2017
Yeah, he probably won't be thrilled about it, but hopefully it won't happen very often and once you shoot lower numbers a few times, you will get a good idea what happens when you do and can better make decisions with that data and experience. I think you could maybe give him a piece of boiled chicken or freeze dried chicken to tide him over, I think that is okay, but I'm not sure. Asia is on no carb food, but it does make a difference when I feed her after nadir vs not even though no carbs in the mix.
Tracey&Jones (GA)
Member Since 2016
Come on blue!
Nope - a horrible RED - 423 - and I always check to see I'm not giving a fur shot - no insulin smell. WHAT on earth is going on....going to bed upset. His ss looks like a skittles factory!
Tracey&Jones (GA)
Member Since 2016
Have you thought about an automatic feeder? Giving him a +3,+6 snack? That can help them coast good numbers and maybe even kick the pancreas in to help out a little?
Jones free feeds as that is how he rolls and there is no changing that about him. And with 3 other kitties (some which are horrible food hogs) it is just easier to fill his sure flap feeder and let him eat.
Jones free feeds as that is how he rolls and there is no changing that about him. And with 3 other kitties (some which are horrible food hogs) it is just easier to fill his sure flap feeder and let him eat.
Stacy & Asia
Member Since 2017
Bummer, that red, but it's a free pass for a good night's sleep!
No, I dont want to do that. I have two cats, one of who is on a strict diet. They have been used to just two feedings a day all their lives. I watch them both eat until they are finished as Silver is the food hog and always tries to steal Sasha's food.
Tracey&Jones (GA)
Member Since 2016
Don't do that. Go cuddle with your kitty. Tomorrow is another day.
Was going to have a good night's sleep no matter what the number. My health does not allow me to lose sleep when I have to be up at 5:30am. Staying up til 10:30 is pushing it for me. Wish I understood the red though.Bummer, that red, but it's a free pass for a good night's sleep!
Stacy & Asia
Member Since 2017
Could be several things, a bounce, lack of depot from skipped shot, not quite at the right dose. You'll get there, try hard not to be discouraged.
I really wish I hadnt skipped that shot but SLGS said skip - should have adjusted. GrrrrrCould be several things, a bounce, lack of depot from skipped shot, not quite at the right dose. You'll get there, try hard not to be discouraged.
Tracey&Jones (GA)
Member Since 2016
I don't know....I am still thinking Silver is going to through you a blue. If not tonight then tomorrow. The skipped dose is a factor but it took only 4 cycles on this dose to get to that 5.7.
That’s good then? He’s purring loudly beside me in my bed and no idea the stress he’s causing me trying to keep him healthy. Did I say I was allergic to cats??
Tracey&Jones (GA)
Member Since 2016
It means you are close to finding a good dose! Enjoy the cuddles.
Stacy & Asia
Member Since 2017
I'm allergic too! You did the right thing to skip the shot, better to have a couple high cycles than to have a hypo when you can't monitor.
Aren’t we crazy?? I pop antihistamines every day and wake up sneezing (probably because Silver decides to share my pillow half way through the night). His sibling, Sasha prefers her tlc in the evening.I'm allergic too! You did the right thing to skip the shot, better to have a couple high cycles than to have a hypo when you can't monitor.
I want to be sure and address this since there is a misunderstanding. The only time we recommend a +9 snack is if the kitty is about to into remission but the preshots, especially the AMPS, are still high. The AMPS is generally the last number to come down. By feeding a +9 snack, a working pancreas (as we should see in a cat near remission) will bring down the AMPS.
It isn’t recommended for cats not about to go into remission, unless the BG is low and food is needed to bring the BG up, because feeding at +9 can put a damper on duration.
Hi Juliet
You are doing the best you can between your work schedule and needing to take care of yourself.
The high number today indicates, to me, the effects of the skipped shot. Often when we stall, shoot a reduced dose, or skip a shot, the depot might keep us from immediately seeing the effects and they become more evident towards the end of the cycle or the next cycle. The dose you gave this morning helped to refill the depot but it might take a couple cycles to get him back on track where he is getting into blue.
I don’t see a high before the break the last couple cycles although the 407 on the night of 12/16 looks like it could have been one.
Under SLGS, you will just hold this dose for seven days and then run a curve to see where his nadirs are. Please fell deee to ask for help if you can’t decide whether to increase or not.
You are doing the best you can between your work schedule and needing to take care of yourself.
The high number today indicates, to me, the effects of the skipped shot. Often when we stall, shoot a reduced dose, or skip a shot, the depot might keep us from immediately seeing the effects and they become more evident towards the end of the cycle or the next cycle. The dose you gave this morning helped to refill the depot but it might take a couple cycles to get him back on track where he is getting into blue.
I don’t see a high before the break the last couple cycles although the 407 on the night of 12/16 looks like it could have been one.
Under SLGS, you will just hold this dose for seven days and then run a curve to see where his nadirs are. Please fell deee to ask for help if you can’t decide whether to increase or not.
Thanks. Let’s hope he comes down for AMPSHi Juliet
You are doing the best you can between your work schedule and needing to take care of yourself.
The high number today indicates, to me, the effects of the skipped shot. Often when we stall, shoot a reduced dose, or skip a shot, the depot might keep us from immediately seeing the effects and they become more evident towards the end of the cycle or the next cycle. The dose you gave this morning helped to refill the depot but it might take a couple cycles to get him back on track where he is getting into blue.
I don’t see a high before the break the last couple cycles although the 407 on the night of 12/16 looks like it could have been one.
Under SLGS, you will just hold this dose for seven days and then run a curve to see where his nadirs are. Please fell deee to ask for help if you can’t decide whether to increase or not.
This is one of those "learn your cat" things. Over time and data, you will find there are times you can shoot lower numbers and head out the door. If I knew Neko was on her way up (and stalling without feeding for 15 minutes and retesting would tell me that), and I left a little higher carb food, I knew Neko was good for several hours, if I needed to go out. Plus I had an autofeeder, and I could load it up with higher carb food for each hour while I was gone. But no way at the beginning would I feel that confident. It took quite a few cycles with low preshots when I could monitor and gather data before I'd feel confident leaving. Each cycle in FD is a do-over. Try something and see what happens. If you don't like it, try something different next time. Now you've learned what happens when you skip. It can take quite a few cycles for the depot to get back, so sleep well tonight.
Follow the guidelines as long as you want. Then if you decide somethings not working, you can change it. And feel free to post questions here and ask if people think about your proposed changes.
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