12/26/2011 Marilyn...THANKS TO ALL

[Barn Cats R Us]

Marilyn's Yesterday 12/25/2011: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=59350

Marilyn's Today 12/26/2011:
AMPS = 600
1.5u Lantus (Day 1, Cycle 1: Earned 0.25 Dose Decrease = 1.5u Total Dose)
1/2 Can Friskies Pate Tuna (usual feeding; decreased appetite)
AM+1 = 450

 

[Sienne and Gabby (GA)]

Re: 12/26/2011 Marilyn AMPS:600 +1:450

If I may make a suggestions... The 37 is coded as red on your SS. You might want to find a shade of green to use so it's obviously a below 100 number and not misinterpreted. For those of us who look at everyone's SS, we are often looking at the colors to spot trends.

There is also an option of "shooting through the bounce" that you can take advantage of for the future. When a cat is due for a dose reduction but there is a bounce the next cycle, you can shoot the old dose. This helps to bring the numbers down a little more quickly. Marilyn's AMPS is clearly a bounce and shooting her old dose could have been feasible. It does, however, look like her numbers are coming down relatively quickly if your +1 is any indication. Having information on how quickly she clears a bounce can guide your decision making for the future.

To answer your question from yesterday about stalling, if you stall, you can if at all possible, shoot your regular dose. In Marilyn's case last night, that would have most likely been the reduced dose (unless it was very clear she was going to bounce to the moon). With a stall, the first "rule" is to not feed. You don't want to be giving insulin based on the influence of food on your PS number. Once you see that numbers are rising or in some cases, where they are flat but in a safe to shoot range, it's fine to go ahead and shoot. If this is the lowest number you've shot, you then want to get a +1 and a +2. Stalling, especially if you are stalling beyond an hour, begins to function as a dose reduction and this is why stalling AND reducing the dose is a big hit on the shed. Libby's post on handling low pre-shot numbers has a good explanation of your options.

A thought -- when you are seeing high numbers with Marilyn, I don't think it's necessary to test every hour unless you are suspecting there's going to be a big drop. You can give yourself a break and get some sleep. I'm pretty much of a testaholic and I think you've got me beat!

 

[Barn Cats R Us]

Re: 12/26/2011 Marilyn AMPS:600 +1:450

Happy Holidays Sienne:

If I may make a suggestions... The 37 is coded as red on your SS. You might want to find a shade of green to use so it's obviously a below 100 number and not misinterpreted. For those of us who look at everyone's SS, we are often looking at the colors to spot trends.

The SS came "pre-coded" to show green below 100, and a deep red below 40. I always thought the bright-red high, and the deep-red "hypo", were a little too close in color. Has everyone changed their SS to show a different color, other than deep red, when heading hypo? I believe the SS has "conditional formats", and is locked by its' creator...but I can look into it. I definitely don't want to change it to something that might not be recognized as a below 40 emergency. Is this not the color you folks are used to seeing in this range? This is not the number range I want to mess with without further clarification.

Stalling, especially if you are stalling beyond an hour, begins to function as a dose reduction and this is why stalling AND reducing the dose is a big hit on the shed. Libby's post on handling low pre-shot numbers has a good explanation of your options.

Here's the problem I had with the sticky yesterday...Libby states:

"Beyond the general guidelines, there are other factors we consider when we are helping someone with a low preshot.
If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative."

I'm not sure what "more conservative" is...but I was definitely thinking something was "wrong". I still don't understand how she came up with a pre-shot number like 37. I would like to hear more thoughts on this.

A thought -- when you are seeing high numbers with Marilyn, I don't think it's necessary to test every hour unless you are suspecting there's going to be a big drop.

I know you guys have told me not to test so much during high numbers...but when high, she needs ketone tests anyway. Also, I have little to "suspect" so far...unless I can understand what happened yesterday.

You can give yourself a break and get some sleep. I'm pretty much of a testaholic and I think you've got me beat!

Pre-shot of 37? Less testing? Sleep? I have no idea where to fit "sleep" in after that "little number". I'm mostly sleepwalking right about now. Is there a trophy, or prizes/gifts, for winning testaholic of the year? Should I make time to start a gift registry at Neiman Marcus? That might take my mind off of testing...but not for long.

 

[Sienne and Gabby (GA)]

Re: 12/26/2011 Marilyn AMPS:600 +1:450

My SS isn't coded for a red below 40. In fact, your SS is the only one where I've seen this. When Gabby is in the 30s, the color comes up green on my SS. You are also able to manually change the colors. I don't believe the colors are locked, or they shouldn't be. I've changed the font color on mine using the conditional format scheme. If your color coding is locked, I haven't a clue who locked it since people mess with the colors all the time.

What Libby is referring to might be a cat that isn't eating well -- limited food on-board may cause a low pre-shot as may a cat that has vomited, certain medications, or other extraneous factors (e.g., a bad test). What the pattern looks like to me is that Marilyn's numbers have been coming down. She was in the blues on 12/21 (and then bounced), the greens on 12/23 (and then bounced), and then the bounce broke and she dropped to the 37 at PMPS (and then bounced). Marilyn was angling for a decrease.

Testing for ketones is a good thing. While ketones can develop quickly, it's unlikely that they will get to a dangerous level within a couple of hours. If you are testing for urinary ketones, this is especially the case. It takes longer for the body to process waste, the bladder to fill, and then for the urine to be excreted. It won't happen in an hour. If you are testing for blood ketones, the results are immediate but it would take several hours for levels to be worrisome. I also don't see any note regarding Marilyn having an episode of DKA or being prone to developing ketones. A reading of 3.0 on a Precision Xtra meter is equivalent to "trace" ketones on a Ketostix and from what I can tell on Marilyn's SS, it looks like you've never seen a level above 0.7.

 

[Dyana]

Re: 12/26/2011 Marilyn AMPS:600 +1:450

My SS isn't coded for a red below 40. In fact, your SS is the only one where I've seen this. When Gabby is in the 30s, the color comes up green on my SS. You are also able to manually change the colors. I don't believe the colors are locked, or they shouldn't be. I've changed the font color on mine using the conditional format scheme. If your color coding is locked, I haven't a clue who locked it since people mess with the colors all the time.

Munchie's Spreadsheet is the same way. There is a 33 on 10/16/11 that shows up as a darker red color.

 

[Vyktors Mum]

Re: 12/26/2011 Marilyn AMPS:600 +1:450

My SS isn't coded for a red below 40. In fact, your SS is the only one where I've seen this. When Gabby is in the 30s, the color comes up green on my SS. You are also able to manually change the colors. I don't believe the colors are locked, or they shouldn't be. I've changed the font color on mine using the conditional format scheme. If your color coding is locked, I haven't a clue who locked it since people mess with the colors all the time.

Munchie's Spreadsheet is the same way. There is a 33 on 10/16/11 that shows up as a darker red color.

Vyktor's is dark red below 2.2 as well (not that we've had numbers that low, I just checked) and I think the green that comes up for between 2.2 and 5.5 is the bright green that most people seem to have for below 2.2??

 

[Barn Cats R Us]

Re: 12/26/2011 Marilyn AMPS:600 +1:450

Hi Sienne: Sorry I couldn’t get to this yesterday.

My SS isn't coded for a red below 40.

Mine is conditionally formatted for a deep-red. I made three attempts, after your last post, to change the SS for BGs 1 thru 39, everything went fine...at first. Then, the spreadsheet's head exploded and screwed up all of my past data. Thank goodness the undo actually worked. Google Docs isn't the brightest star in the sky.

You are also able to manually change the colors.

The next time Marilyn is "hypo", I will try to remember to manually change the background color for those particular cells. I don't know that it will be the foremost thing on my mind though. I changed the 37, from Christmas afternoon, shortly after your reply. I hope that helps. As suspected, it does look like this problem exists beyond my SS though.

If your color coding is locked, I haven't a clue who locked it since people mess with the colors all the time.

I was certain I had noticed this before, so I did look into it. All of the cells are checked as "locked", however, it is strictly the Excel version on the PC, as opposed to the uploaded version on Google Docs. This is most likely the default setting, as opposed to the author's, and only takes effect once the SS is protected. However, it's a moot point, since it doesn't follow through to Google Docs.

What Libby is referring to might be a cat that isn't eating well -- limited food on-board may cause a low pre-shot as may a cat that has vomited, certain medications, or other extraneous factors (e.g., a bad test).

Honestly, this is the kind of explanation that gets really confusing for me. What Libby "is" referring to "might be"? The "might be" isn't in the sticky. I read your "Holiday PSA" to refer to the stickies. So I did, and what was clear was, "If the low preshot is not part of that cat’s normal pattern"...well, it wasn't..."or there is reason to think something might be wrong, we will be more conservative." Well, since it wasn't part of a "normal" pattern, I automatically thought something was wrong. Everything you added above, such as vomiting, I suppose could fall into the "or" part of Libby's statement, but it isn't stated, and wouldn't have mattered much in this particular situation. It wasn't part of her normal pattern, she had her usual food intake, she didn't vomit, she is not on medication, and it wasn't a "bad test". Also, the "we will be more conservative" sounds to me that decisions must be made, at that point, that might have nothing to do with everyday procedures for the handling of low pre-shots, and stalling. Which turns out fine, since you will never catch me "stalling", for more time than it takes to get food in her, on a number like 37. My only regret was over-carbing.

A thought -- when you are seeing high numbers with Marilyn, I don't think it's necessary to test every hour unless you are suspecting there's going to be a big drop. You can give yourself a break and get some sleep.

It is touching that you are worried about my lack of sleep. All of you folks are so kind here. That said, I suppose I was using the ketone testing as a polite response, since I do not test for ketones every couple hours. As far as the BG testing, this insulin has me pretty much scared to death. I honestly haven't been able to "suspect" anything so far. I only changed Marilyn to Lantus because I thought it was the best thing for her after searching these forums. I intend on hanging in there as long as possible...and then I am crying uncle. In the meantime, if you tell me how many BG tests you would like to see, that is how many I will post to Google Docs.

While ketones can develop quickly, it's unlikely that they will get to a dangerous level within a couple of hours.

If you are testing for blood ketones, the results are immediate but it would take several hours for levels to be worrisome.

As stated above, I do not test her for ketones bi-hourly...but talk about opening a can of worms. I see words like "unlikely" to get dangerous in a couple hours...would take "several hours" to be "worrisome". If I didn't already feel I had a handle on ketone testing, there would be more testing in Marilyn's future. :shock:

I also don't see any note regarding Marilyn having an episode of DKA or being prone to developing ketones.

No, there's no DKA to date.

 

[Sienne and Gabby (GA)]

Re: 12/26/2011 Marilyn AMPS:600 PMPS:397 Late w/Reply Sienne

Thanks for the info on the SS template. I'm trying to track down who set this up so we can fix the color coding. I wasn't aware of an Excel version. My SS was a Google doc and as far as I know, originated as a Google doc.

As far as interpreting Libby's comments, I do not and will not write in terms of absolutes. First, you are not the only person who is reading any given condo -- even your own. To make an absolute statement implies that the comment is "truth" for every cat in every situation. I'm not comfortable doing that. There are too many variables in play at any given time. I'm also not Libby and I can't do anything more than intuit what she was thinking. If you would like clarification, please send her a PM. I'm sure she will be happy to offer clarification.

You can test as much as you like. It's your call. Testing is a matter of your comfort, what your cat will tolerate, and how much data you need to make dosing decisions.

 

[Barn Cats R Us]

Re: 12/26/2011 Marilyn AMPS:600 PMPS:397 Late w/Reply Sienne

Hi Sienne:

I wasn't aware of an Excel version. My SS was a Google doc and as far as I know, originated as a Google doc

Oh, then I could be wrong; it was over a month ago that I started my SS...and I can barely remember past yesterday, at this point. I thought it had to be downloaded to the PC, which "lands" as an Excel SS, and is then uploaded to a Google account. All I know is, I have copies on my PC, which is where I noticed the "locked" cells...but again, moot point.

As far as interpreting Libby's comments, I do not and will not write in terms of absolutes. First, you are not the only person who is reading any given condo -- even your own. To make an absolute statement implies that the comment is "truth" for every cat in every situation. I'm not comfortable doing that. There are too many variables in play at any given time.

:shock: :shock: :shock: Wow, I really don't get this. I didn't ask for an interpretation of Libby's comments. You offered an interpretation...which I found confusing. That confusion is tenfold now. This started when you directed me to Libby's post on handling low pre-shot numbers. You also referred to stalling. I pointed out that I followed the directions to go to the stickies over the holiday. I read Libby's post the day prior, and my eyes landed on the section that most closely related to the situation at hand..."If the low preshot is not part of that cat’s normal pattern". I was merely pointing out that this negates everything else in the sticky, since decisions at that point, "will be more conservative". Well, I suppose the more conservative decision I made was not to shoot...since it was Christmas day, and everyone was busy with the holiday, and unable to offer suggestions. I can't imagine that anyone had the time to walk me through a "stall", and if not feeding is part of a stall, it wasn't going to happen anyway, since she was fed immediately at the 37 reading. Holy cow, I have apparently lost the ability to communicate my thoughts...but I figured I would give it one last try just now.

Now for my majorly gigantic epiphany: I didn't realize that you've been advising, in general, for all FD cats, and not specifically with Marilyn in mind. So that could be the culprit of ALL of my confusion here, so I apologize for asking so many questions pertaining specifically to Marilyn...and then pestering you when I didn't understand why the replies didn't pertain to my specific questions. Apparently, I have no idea of how advice giving works...so I apologize that my questions, and subsequent endless confusion, caused you discomfort.

I'm also not Libby and I can't do anything more than intuit what she was thinking.

I never asked you to discern Libby's thoughts. I never asked you to assume she was talking about vomiting and/or medications. I simply said I don't know what "more conservative" is...so I chose something I thought to be more conservative, since I was basically on my own that day. Actually, on the bright side, it was good practice for all of the upcoming days.

If you would like clarification, please send her a PM. I'm sure she will be happy to offer clarification.

Hopefully she would be happy to offer clarification...if I only wanted it. I think I misspoke when I said, "Here's the problem I had with the sticky yesterday". The problem wasn't actually with the sticky; the sticky clearly stated Marilyn's precise dilemma. It was the "we will be more conservative" that was a problem at the time...assuming the "we" are the advice givers...and there weren't too many of those around on Christmas. So I made a decision...and it wasn't really a problem until now. Wow, I'm just going in circles here. Kind of a familiar feeling lately.

You can test as much as you like. It's your call. Testing is a matter of your comfort, what your cat will tolerate, and how much data you need to make dosing decisions.

Thank you. This is what I thought all along.


Thanks to everyone for all of your time, and kindness.

 

[Marje and Gracie]

Beyond the general guidelines, there are other factors we consider when we are helping someone with a low preshot.

If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative.
If the cat is not a food spiker or tends to have an early onset/early nadir then they may not want to shoot as low. If the cat has a late nadir, then they will HAVE to learn to shoot low.
We will also be more conservative in some cases because of the person – if you are not able to monitor then you want to be more careful, or if you are not sure that you can get back to the board to keep us updated throughout the cycle. Trust me, if you shoot low, we will be watching for your updates and we will worry if we don’t see them.
We have to be a lot more careful with the cats who eat only dry food, because they don’t have access to the tools the rest of us use to keep our cats safe.
Also, when it comes to very low preshots, there is an unwritten rule that whoever helps that person shoot low should expect to sit with them through any low parts of the cycle. There have been times when I knew a cat’s number was likely shootable, but I also knew that I could not be around to help if the shot resulted in low numbers later in the cycle. For safety’s sake, if I could not find someone else who would be available to support for the next several hours, I would most likely suggest that the shot be reduced or skipped. I will not encourage someone to shoot low and then abandon them.
There are a lot of other scenarios, and you always want to keep your cat in mind.

My two cents worth in this discussion for whatever it is or isn't worth

I quoted the above from the sticky because it lists the things that are considered by those assisting a caregiver when that person gets a low PS. The statement

If the low preshot is not part of that cat’s normal pattern

indicates to me if the kitty has been running in higher numbers and now throws a low PS, then it's important to be conservative in dealing with the number. For example, if a kitty typically had PSs above 200 and then had a 100, we need to deal with it more cautiously then if it's a kitty who routinely has low to mid blue PSs and then has one that is, say ,,in the 80s. The goal is to teach caregivers how to progressively become more comfortable in shooting low.

I also think there are two kinds of suggestions: general ones and ones that are aimed specifically at your kitty. The problem that has occurred in the past at times is that someone reading your condo might decide that the information meant specifically for your kitty is something they might want to try with theirs even though the situations might be quite different. That's why we are typically careful with the way we word things.

An example of this (because examples always help me learn ) is that about the time we first came to FDMB, Libby or Jill one suggested on a condo of a cat about to go OTJ that the caregiver feed a late cycle (+8 or +9) meal to help the pancreas. That was taken out of context and before long, alot of people (including us) were feeding +8/+9 meals and wondering why we were getting higher PSs. So then Jill/Libby had to clarify again that the suggestion was only for almost-OTJ kitties. Thankfully, this was a suggestion taken out of context that only resulted in higher PSs and was not putting any kitty's safety in jeopardy. But....you can imagine if we aren't really careful with wording, what could happen if something is taken out of context.

I hope this helps to clarify things a little and didn't further muddy the waters.