2/15 Buzzy AMPS 356 = 0.75U; +2 434; +4 364; +6.5 345; +8 367; PMPS 420 = 1U; +2 363; +4 318

Well, at least we're pink again...even if still above pre-shot numbers.

Headed to the store to get a zillion ingredients; going to spend my child-free day cooking freezer meals & muffins for post-baby-birth. Gotta rush to get back ASAP for testing
 
367 at +8
I think I'm done poking him til pre-shot at this point since he's clearly not going anywhere.
He got a little LC wet as a treat this time for putting up with all this, so I imagine he'll go back up.

I would like to increase dose back to 1u. Should I increase 1u tonight or tomorrow? Does it matter?
 
Does Buzzy get to eat during the day and overnight?
Feeding small, frequent meals can help the ride out the early part of the cycle sometimes without large drops/ spikes in numbers?

I don't know about a dose...Buzzy has had 3 doses in the last week and you've skipped shots with Preshot numbers around 100 so....if you do go back up and get numbers that low again- will you skip doses or do you feel comfortable shooting? Can you consistently grab night test before bed?

if it were me, I'd try to hold a dose for 1 week, do a BG curve and see what his is actually doing on the insulin. I'd also offer snack at +1,+3 and/or +5 to help him surf through the onset of his insulin without dropping so low that you have to reduce a dose.
 
The answer really depends on whether you follow SLGS or TR. Your SS says SLGS? You would need to hold for 1 week, do a curve, and then re evaluate.
toomanycats said:
Yeah my plan is to go back to 1u literally tonight if today looks like yesterday. And then to do a sort of modified TR/SLGS in that I'm not going to decrease him for a number in the 80s.
Click to expand...
Doing a mix and match TR/SLGS is not recommended. Each one has its own safety measures, please pick one or the other.

Please read this older post on why we don't mix and match the methods. http://www.felinediabetes.com/FDMB/threads/tight-regulation-slgs-myths-debunked.111088/#post-1554089
 
Si am cat mom said:
Does Buzzy get to eat during the day and overnight?
Feeding small, frequent meals can help the ride out the early part of the cycle sometimes without large drops/ spikes in numbers?

I don't know about a dose...Buzzy has had 3 doses in the last week and you've skipped shots with Preshot numbers around 100 so....if you do go back up and get numbers that low again- will you skip doses or do you feel comfortable shooting? Can you consistently grab night test before bed?

if it were me, I'd try to hold a dose for 1 week, do a BG curve and see what his is actually doing on the insulin. I'd also offer snack at +1,+3 and/or +5 to help him surf through the onset of his insulin without dropping so low that you have to reduce a dose.
Click to expand...

The next day I will be able to do a real curve is next Friday.

I am kicking myself for reducing to 0.75u because of being in the 80s. I just don't think it was necessary even though I know it was technical SLGS protocol; I think it was a sign the 1u was working for him & I should've stuck with it. I would not reduce for a drop into the 80s again. I would not reduce unless he dropped below 50 to be honest.

Buzzy does not eat throughout the day, but he does get a second meal at night at +2 every single night. I can test consistently in the evening. I am only here during the day on Saturday, Sunday, Monday, and Friday (thus, I would like to do increases around the times when I can be around to monitor). I cannot currently afford a timed feeder to offer a second meal during the day Tues-Thurs.

I am comfortable shooting, at a minimum, anything above 150. I'm not sure about lower mostly bc I have zero data for what that would look like for him...I would probably feel comfortable shooting anything above 120 though bc at some point you have to just take the risk, I imagine...
 
Christie & Maverick said:
The answer really depends on whether you follow SLGS or TR. Your SS says SLGS? You would need to hold for 1 week, do a curve, and then re evaluate.

Doing a mix and match TR/SLGS is not recommended. Each one has its own safety measures, please pick one or the other.

Please read this older post on why we don't mix and match the methods. http://www.felinediabetes.com/FDMB/threads/tight-regulation-slgs-myths-debunked.111088/#post-1554089
Click to expand...

I'm afraid he's going to develop ketones. If he does & goes into KTA, our only option will be to put him to sleep as we do not have the money to treat it. So, I'm frustrated with SLGS; I'm scared to see him in these high numbers -- staying high, going higher. So I guess this would mean I'm switching to TR but at the same time, there will simply HAVE to be some adjustments made for the fact that I work full-time, HAVE to leave the house, and HAVE to sleep because I'm pregnant & have a 3-year-old, and all that stuff has got to take priority. And also I am the ONLY one in this house who can test or shoot.

I've read the thread about TR while working full-time multiple times, and I will do my best to do similar - except that it will be impossible for me to grab even a +1 on Tuesday, Wednesday, and Thursday AMs as I am out the door by 5:30am those days. I will be able to grab a +2, +3, +4 every evening (barring some sort of emergency coming up, I guess).

My goal is remission, so SLGS is not ideal
 
I'm extremely frustrated. This CANNOT be my life. I have GOT to take care of my family, I have GOT to function well at work, and I have my own mental health issues that require I sleep, period - I have literally been hospitalized for this in the past. There has got to be some sort of compromise where my life gets to continue. I am doing my absolute best, but it feels like never enough. Never enough testing, never enough money thrown at this for supplies, never enough patience when I'm sitting here watching his numbers be high -- I KNEW I shouldn't have dropped his dose, and I'm angry that I listened to SLGS protocol.
 
I can hold the 0.75u for tonight if we MUST have the 6 consecutive cycles. I'm sorry I'm clearly unloading everything here. I'm not handling this well.
 
I know it can be frustrating at times, we all completely understand. The only thing I can say to try and reassure you is that you are so very new to this process, and have just started insulin, it has only been 8 days :bighug:. It really does take some time to start seeing the results, and numbers do go up and down.

Part of this process is to learn how the particular insulin we use works for our cat, (every cat is different) which means understanding concepts of onset (length of time the insulin reaches bloodstream and begins to lower blood glucose), nadir (lowest point in the cycle) and duration (how long does the dose continue to lower BG). It is also important to understand how food affects your kitty. You can modify SLGS to have a lower reduction number, but IMHO for safety's sake, you aren't quite there yet, because you don't have enough data to be able to assess.

Staying in somewhat higher numbers doesn't cause DKA. The recipe is not enough insulin + inappetance + an infection or other systemic stress. Was Buzzy previously diagnosed with ketones or DKA?
 
Stop kicking yourself....we all did what we thought was right when we first started. If we all kicked ourselves as much as you are, we'd all have a lot of bruised butts.

As hard as it is, take a few deep breaths and try to relax. Buzzy didn't become diabetic overnight and he's not going to be cured overnight either.

There's no reason you can't do TR, especially since you're able and willing to test more in the evenings and on days you can. Just plan your increases on days when you know you'll be available for the next few days to get more tests in and make sure you always get a few tests on the PM cycle.

The high numbers look scary, but cats actually tolerate them a lot better than dogs (or humans). It takes time to do damage from high numbers....it's the low ones that can kill quickly. As long as Buzzy is eating well and acting normally (not hiding or acting like he truly feels awful), just stick with it and give yourself some time.
 
Christie & Maverick said:
I know it can be frustrating at times, we all completely understand. The only thing I can say to try and reassure you is that you are so very new to this process, and have just started insulin, it has only been 8 days :bighug:. It really does take some time to start seeing the results, and numbers do go up and down.

Part of this process is to learn how the particular insulin we use works for our cat, (every cat is different) which means understanding concepts of onset (length of time the insulin reaches bloodstream and begins to lower blood glucose), nadir (lowest point in the cycle) and duration (how long does the dose continue to lower BG). It is also important to understand how food affects your kitty. You can modify SLGS to have a lower reduction number, but IMHO for safety's sake, you aren't quite there yet, because you don't have enough data to be able to assess.

Staying in somewhat higher numbers doesn't cause DKA. The recipe is not enough insulin + inappetance + an infection or other systemic stress. Was Buzzy previously diagnosed with ketones or DKA?
Click to expand...

I think I'm making the full-on decision to switch to TR; I see now that while remission is possible with SLGS, it's less the goal, and it's very much my goal if it's possible to achieve. I think I can do it. I'll just have to keep my butt awake in the evenings to always get a +2 and +4. Maybe I can manage a +1 on Wednesdays if I don't head into the office quite as early as Tues/Thurs. And I can grab other hours' data on all the other days.

Buzzy was not, as far as I know, diagnosed with ketones. The vet said he was not in a diabetic crisis. He has no neuropathy either. He does have a UTI that did not respond to the 2 antibiotics we already tried; I'm waiting for urine culture to come back & we'll try again -- this is another reason I'm eager to get him into the blue NOW though -- bc I think it improves our chances of actually killing the UTI. He also has chronic upper respiratory issues. Also, I'm pretty sure he threw up a couple of times today although I can't rule out it being my other cat.
 
@Chris & China (GA)
Thank you...I guess I don't really know much about how high is scary high/how long is too long to be high. Buzzy is literally glued to me these days; he's definitely not hiding.

I told my husband - I wish I wasn't pregnant so I could be medicated. I think that's the only thing that would actually get me to relax. But I can't take my normal anxiety/OCD medication while I'm pregnant, so this is all so much harder than it would be otherwise.

I do feel ready for TR now. We've gotten better at testing, and that thread about doing TR while working was helpful.

So, that all being said...I guess if we're really doing TR, that would mean hold 0.75u tonight to get 6 cycles in but increase to 1u tomorrow since he's got this flat/high curve thing going on... which I'm pretty OK with since I'll be around to test during the day tomorrow & Monday.

Does that sound right??
 
toomanycats said:
I guess if we're really doing TR, that would mean hold 0.75u tonight to get 6 cycles in but increase to 1u tomorrow since he's got this flat/high curve thing going on... which I'm pretty OK with since I'll be around to test during the day tomorrow & Monday.

Does that sound right??
Click to expand...

On TR, there's no rule about "holding the dose for 6 cycles" when you're talking about a "failed reduction".....the 6 cycle rule only pertains to dose increases

From the TR protocol:
If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
 
Chris & China (GA) said:
On TR, there's no rule about "holding the dose for 6 cycles" when you're talking about a "failed reduction".....the 6 cycle rule only pertains to dose increases

From the TR protocol:
If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
Click to expand...

Dangit just when I think I've got the whole thing memorized :P

OK! Back to 1u tonight then it sounds like since we don't have enough info to really know if 1u was even "a good dose" or not, but it did at least bring us into SOME blues and greens, so good enough to return to for now!

Thank you!
 
First, take a few deep breaths...

Managing your cat's diabetes is not for the faint of heart. That's the bad news. The good news is that we have your back.

As a matter of perspective, cats go into remission using SLGS. Before TR (approximately 2009), SLGS or some iteration of that method is what was used here. One of the moderators, Jill (GA), was one of the first who actually used TR with her kitty. People were convinced she was going to kill Alex with such an aggressive approach. Both methods work.

I'm not convinced that what you're seeing is a failed reduction. This may be a bounce. You have the cycle where Buzzy earned a dose reduction and the following day, he was in blue numbers. He is likely bouncing into the current, less attractive numbers. It can take 3 days for a bounce to clear. We all hate to see high numbers. Just don't try to rush the process. If you want to switch to TR so you have the option to raise the dose sooner, that's fine. Do what works for you and for Buzzy.
 
Sienne and Gabby (GA) said:
First, take a few deep breaths...

Managing your cat's diabetes is not for the faint of heart. That's the bad news. The good news is that we have your back.

As a matter of perspective, cats go into remission using SLGS. Before TR (approximately 2009), SLGS or some iteration of that method is what was used here. One of the moderators, Jill (GA), was one of the first who actually used TR with her kitty. People were convinced she was going to kill Alex with such an aggressive approach. Both methods work.

I'm not convinced that what you're seeing is a failed reduction. This may be a bounce. You have the cycle where Buzzy earned a dose reduction and the following day, he was in blue numbers. He is likely bouncing into the current, less attractive numbers. It can take 3 days for a bounce to clear. We all hate to see high numbers. Just don't try to rush the process. If you want to switch to TR so you have the option to raise the dose sooner, that's fine. Do what works for you and for Buzzy.
Click to expand...

Well, I already went up to the 1u :nailbiting:
I did think of that...that maybe it was just a bounce - I don't have enough data to know much yet, I know. I think what I'm looking at more is how he went into healthy greens (which SLGS dubbed low enough for a reduction and then came back up to yellow by the next morning, which made me think "that 1u might've been just about perfect to keep him in blues/greens most of the day." But, obviously, we don't have enough info to really know that yet. As long as Buzzy doesn't drop below 50, my plan is to hold this 1u dose til next Friday, because I'm not home during the day Tuesday-Thursday to test during the day.

This is hard bc obviously no matter what decision I make, I can't know if making the opposite decision would've been "better." It's tough having to try to be so in control while also not at all being in control. And I am scared. I was scared when he was in those 80s even though that's a healthy, normal bgc level. It's just scary not being in control and not really knowing what to do and just having to make these calls that take his life into my hands.
 
toomanycats said:
I'm extremely frustrated. This CANNOT be my life. I have GOT to take care of my family, I have GOT to function well at work, and I have my own mental health issues that require I sleep, period - I have literally been hospitalized for this in the past. There has got to be some sort of compromise where my life gets to continue. I am doing my absolute best, but it feels like never enough. Never enough testing, never enough money thrown at this for supplies, never enough patience when I'm sitting here watching his numbers be high -- I KNEW I shouldn't have dropped his dose, and I'm angry that I listened to SLGS protocol.
Click to expand...

Not to pile more on ... just wanted to share since I felt pretty frustrated in the beginning too. Almost like no matter what - I was failing my cat who I probably made diabetic by feeding crap food.
My only thought here is that TR since it is a more aggressive protocol ends up - in my opinion- requiring more testing, time and energy... and for you to be able to stay up with your pet when they are in numbers that are too low. It sounds like you already have a lot going on ....
SLGS is a bit more forgiving until you start to see patterns in your pets BGs or are data ready to better intervene with BG numbers. Higher numbers - and we are talking 400s- 500s here are no where near as dangerous as numbers that are too low can be...
We did SLGS in the beginning because I acknowledged that I had no idea how to manage this and that there would be nights that I absolutely would not be able to test or intervene with food. That might have meant a few weeks in the 300s, but I knew he was safer than possibly hitting the low 40s - alone with no food available. I needed a few days to emotionally rest and to try and process what I needed to do to take care of him and to try and take care of myself. SLGS with the 2 test/ day minimum and somewhat predictable numbers (after awhile) let me do that. I guess you ultimately have to do what works for you.

Cats bounce- the numbers don't always make sense- and patience is a requirement. It'll get easier but it does take time - like anything else.
 
Si am cat mom said:
Not to pile more on ... just wanted to share since I felt pretty frustrated in the beginning too. Almost like no matter what - I was failing my cat who I probably made diabetic by feeding crap food.
My only thought here is that TR since it is a more aggressive protocol ends up - in my opinion- requiring more testing, time and energy... and for you to be able to stay up with your pet when they are in numbers that are too low. It sounds like you already have a lot going on ....
SLGS is a bit more forgiving until you start to see patterns in your pets BGs or are data ready to better intervene with BG numbers. Higher numbers - and we are talking 400s- 500s here are no where near as dangerous as numbers that are too low can be...
We did SLGS in the beginning because I acknowledged that I had no idea how to manage this and that there would be nights that I absolutely would not be able to test or intervene with food. That might have meant a few weeks in the 300s, but I knew he was safer than possibly hitting the low 40s - alone with no food available. I needed a few days to emotionally rest and to try and process what I needed to do to take care of him and to try and take care of myself. SLGS with the 2 test/ day minimum and somewhat predictable numbers (after awhile) let me do that. I guess you ultimately have to do what works for you.

Cats bounce- the numbers don't always make sense- and patience is a requirement. It'll get easier but it does take time - like anything else.
Click to expand...

I originally went SLGS because I also can't always stay awake or home.

I'm going to start leaving food out when I go to work. I can't do a timed feeder right now, but I can leave some food mixed w/ water out. I'll never know if he or his sister ate it, but it will be available at least. And if he's too low for my comfort, I'll mix his breakfast with some MC food for safety. And I'll get timed feeders as soon as I can afford them. I can probably afford 1 right now at least - thought of at least doing that (though, again, will have no idea which cat ate). That way I can make it offer food at like +6 but "take it away again" at +10.

I think it's too late for me to waffle on this again - I've already given the 1u dose, so I imagine it's important to go ahead and stay at this dose for now.

Neither SLGS nor TR suit me completely, but I just can't seem to tolerate sitting here watching the numbers climb and NOT acting, and SLGS wants me not to act. And I still don't think it makes sense to have reduced him in the first place just bc he touched the 80s when he came all the way back up to the 200s the next morning.
 
If you want to leave food out, you might want to make "catsicles." You mix Buzzy's regular, LC food with water so it's a bit soupy and then freeze it in ice cube trays. You can leave a couple of "cubes" out and they will defrost over a couple of hours (Although Gabby would lick the frozen cubes.)
 
toomanycats said:
I originally went SLGS because I also can't always stay awake or home.

I'm going to start leaving food out when I go to work. I can't do a timed feeder right now, but I can leave some food mixed w/ water out. I'll never know if he or his sister ate it, but it will be available at least. And if he's too low for my comfort, I'll mix his breakfast with some MC food for safety. And I'll get timed feeders as soon as I can afford them. I can probably afford 1 right now at least - thought of at least doing that (though, again, will have no idea which cat ate). That way I can make it offer food at like +6 but "take it away again" at +10.

I think it's too late for me to waffle on this again - I've already given the 1u dose, so I imagine it's important to go ahead and stay at this dose for now.

Neither SLGS nor TR suit me completely, but I just can't seem to tolerate sitting here watching the numbers climb and NOT acting, and SLGS wants me not to act. And I still don't think it makes sense to have reduced him in the first place just bc he touched the 80s when he came all the way back up to the 200s the next morning.
Click to expand...

Just remembered..the AMPS shot number is often the last one to " fall in line" and sort of resemble the rest of a cat's BGs. It can sometimes be attributed to the " dawn phenomenon" and happens in people also. Another reason why we tend to focus more on the mid cycle numbers and use nadirs for dosing with only some consideration of preshot numbers. I find that my PMPS has been a better representation of where we are with our doses...
So, don't get too hung up on the AM numbers is all

here is post where they discuss this
http://www.felinediabetes.com/FDMB/...-59-4-64-6-71-8-88-10-85.215338/#post-2386180
 
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