? 2-16-20 AMPS 348 switching to TR; searching for correct dose (still high)

[Ori (and Erica)]

Hello all - I guess I am officially switching to TR since I am more or less doing it anyhow, except I think I've been holding the dose too long. Ori has been on Lantus, and I am very familiar with the action of this insulin and how diabetes works. However, I seem to be chasing her up, and not down.

Someone suggested insulin resistance at this point, and I think that if I follow the protocol, I would increase her to 3.75 tomorrow. To me, it looks like she needs more insulin, not less.

She did do better when she was first on insulin at lower amounts, but I can't bring myself to give her less (some have said the dose is too high - but that would be from bouncing, and I've seen no evidence of that).

She might have had a little cold - she does get them on and off, but this morning her eyes are clear and she just has her usual Ori stuffy nose.

She is peeing and pooping twice a day, and not flooding the litterbox. I would still like to see the volume of urine decrease. I do add some water to her food but other than that, I do not see her at the water bowl. Ever. She has gained weight nicely since dx and eats small wet meals about 5-6 times a day (Dr. Elsey's chicken.)

So - what do I do from here? My vet is happy that I am monitoring her, but they know less than I do, so I am making all of the dosing decisions.

Thank you - so I increase tomorrow to 3.75?

 

[Ori (and Erica)]

Hello! I have basically been doing TR except we may have been holding the dose too long. Other boards have encouraged me to let the dose "settle" but I am continuing to chase an upward spiral of glucose.

I understand the action of Lantus and I very much understand how diabetes works in humans - and I have read the entire internet about Feline Diabetes, it feels like.

That said, I need help. I feel like Ori needs more insulin support right now, and I would appreciate some guidance. She has her food on a timer so she can eat twice during the day during the workweek.

She is peeing and pooping twice a day, drinks no outside water except for what I add to her food at every meal. I would like to see the volume of urine decrease, but she is otherwise not flooding the litter box and her energy is Ok (for her - she is pretty sedentary).

Do I surge ahead with 3.75 tomorrow? It seems like I need to find a breakthrough dose. I am discouraged, a little because she was doing well on 2.5, but it did not hold.

Advice appreciated. I don't necessarily need to achieve remission, but I know she needs lower numbers. Thank in advance for everyone's help. We need it.

Erica and Ori

 

[Darcy and Jonesy]

Hello! I have basically been doing TR except we may have been holding the dose too long. Other boards have encouraged me to let the dose "settle" but I am continuing to chase an upward spiral of glucose.

I understand the action of Lantus and I very much understand how diabetes works in humans - and I have read the entire internet about Feline Diabetes, it feels like.

That said, I need help. I feel like Ori needs more insulin support right now, and I would appreciate some guidance. She has her food on a timer so she can eat twice during the day during the workweek.

She is peeing and pooping twice a day, drinks no outside water except for what I add to her food at every meal. I would like to see the volume of urine decrease, but she is otherwise not flooding the litter box and her energy is Ok (for her - she is pretty sedentary).

Do I surge ahead with 3.75 tomorrow? It seems like I need to find a breakthrough dose. I am discouraged, a little because she was doing well on 2.5, but it did not hold.

Advice appreciated. I don't necessarily need to achieve remission, but I know she needs lower numbers. Thank in advance for everyone's help. We need it.

Erica and Ori

Hi Erica,

I'm NOT able to advice you, I'm sure someone brilliant will come along very soon, but I want to ask, your spreadsheet has four different AMPS shots given for the past four days, is that correct? 2.5 yesterday? Also, can you enter what you shot for the PMPS dosage? (I'm only asking as I anticipate someone "in the know" may ask it)

Hang tough hon, advice will be coming!

Darcy

 

[Nan & Amber (GA)]

On your spreadsheet, you have 2.5 in the morning of 2/15, and nothing in the evening (a skip?). Either one of those will re-set the clock on number of cycles to hold a dose. I agree that it looks like Ori is going to need more insulin, but I'm afraid you're going to have to wait out the six cycles before the next increase.

Hang in there!

 

[Nan & Amber (GA)]

Whoops! Just found your other post for today here:
2-16-20 AMPS 348 switching to TR; searching for correct dose (still high)

We like to keep things to one post per day on the L+L+B forum, just to keep all the info easily findable; maybe one of the moderators can merge it in to this thread, as it gives a bit more detail.

 

[Sienne and Gabby (GA)]

I just merged the threads. Please post here: Ori's thread

If you shot a reduced dose yesterday (and it's not a typo) and/or you skipped a shot at PMPS (and it's not an oversight), then your cycle count started over. Any time you adjust or skip a dose, the cycle count restarts. If those were incorrect entries on your spreadsheet, you're 6th cycle at 3.5u would be tonight. You could increase Ori's dose at AMPS tomorrow as long as he doesn't earn a dose reduction today.

 

[Ori (and Erica)]

Hi Erica,

I'm NOT able to advice you, I'm sure someone brilliant will come along very soon, but I want to ask, your spreadsheet has four different AMPS shots given for the past four days, is that correct? 2.5 yesterday? Also, can you enter what you shot for the PMPS dosage? (I'm only asking as I anticipate someone "in the know" may ask it)

Hang tough hon, advice will be coming!

Darcy

My recording keeping error. It’s been 3.5 for last 3 days. I edited. So sorry!!

 

[Ori (and Erica)]

I just merged the threads. Please post here: Ori's thread

If you shot a reduced dose yesterday (and it's not a typo) and/or you skipped a shot at PMPS (and it's not an oversight), then your cycle count started over. Any time you adjust or skip a dose, the cycle count restarts. If those were incorrect entries on your spreadsheet, you're 6th cycle at 3.5u would be tonight. You could increase Ori's dose at AMPS tomorrow as long as he doesn't earn a dose reduction today.

It is a typo. So sorry. I’ve held at 3.5. I’ve fixed it.

 

[Si am cat mom]

Good luck with the dosing method change!
Just remember TR requires 2 tests per cycle- so preshot and one other daily. I would also read up on the sticky for lower than usual preshot numbers, so you can refresh on how to handle them and decide if you are comfortable shooting anything over (50) ? Sometimes grabbing the +10/+11 shot will let you see where they are before the insulin is due and plan to intervene/ post for help.

 

[Ori (and Erica)]

Whoops! Just found your other post for today here:
2-16-20 AMPS 348 switching to TR; searching for correct dose (still high)

We like to keep things to one post per day on the L+L+B forum, just to keep all the info easily findable; maybe one of the moderators can merge it in to this thread, as it gives a bit more detail.

Thanks - I would appreciate that. I posted and got an error message so I don't think it went thru. I would appreciate it if a moderator can help please. I've had a few problems getting the board structure correct. Sorry, but I could use help with that and insulin today.

 

[Ori (and Erica)]

Good luck with the dosing method change!
Just remember TR requires 2 tests per cycle- so preshot and one other daily. I would also read up on the sticky for lower than usual preshot numbers, so you can refresh on how to handle them and decide if you are comfortable shooting anything over (50) ? Sometimes grabbing the +10/+11 shot will let you see where they are before the insulin is due and plan to intervene/ post for help.

If you see my sheet - I test a minimum of 3 times a day and often more. I also have read all of the stickies. When I was using SLGS I never got low enough to need a dose increase and I was told I was holding the doses too long and should do TR. I have grabbed several +10 and +11 numnbers.

 

[Ori (and Erica)]

....alright. Sorry.
It just looked like during the day in the past week the 15th was the only day you got midday test- possibly because the numbers were consistently higher which makes sense. I just wasn't sure if there were days you were gone and couldn't test -maybe working or something.
We can't overnight some nights at all here and didn't know the testing requirements for each when TR was recommended.
It also seems like people new to TR will get the random green preshot number and it can be stressful 15 minutes before the insulin is due. That random +11 seemed to take the guess work out of things when folks start to see preshots in the more "normal " range- or at least gives plenty of time to post and get help if needed.

Well - that is correct - I cannot test midday except for weekends in general now. So, if that boots me from TR, then I guess I am on SLGS. This is confusing. The truth is, I test often enough that I don't feel like I need to wait a whole week before making a decision. But even if I did wait a week, it still seems like she is needing more insulin. That is what I can't get a handle on. I have been told I was waiting TOO long to make an adjustment.

 

[Sienne and Gabby (GA)]

If you are able to get at least 4 tests -- your AM and PM pre-shot tests and one test per cycle, that's fine for TR. Most of us would test more than that.

 

[Ori (and Erica)]

If you are able to get at least 4 tests -- your AM and PM pre-shot tests and one test per cycle, that's fine for TR. Most of us would test more than that.

But let's say that I can do an adjustment every weekend - do I go up to 3.75. I am trying to get an idea of what to do now.

 

[Chris & China (GA)]

Erica....what's your usual daily schedule? What time do you get up and what time do you have to leave for work? When do you get home?

 

[Ori (and Erica)]

Erica....what's your usual daily schedule? What time do you get up and what time do you have to leave for work? When do you get home?

Test and feed and shoot around 7:15 AM and 7:15 PM. Leave for work about 8:45 AM. Can occasionally get a midday test during the week and on some days husband is home with her. Sometimes I can get a +2 check in during the week. Her food is on a timer during the day so she always gets a meal at noon and about 3. No lack of food at all - she eats 5-6 small meals a day.

 

[Sarah and Blaze]

I work Monday through Thursday and am doing TR. I get up between 5:00-5:20am and test/feed/shoot at 5:30 am and 5:30pm. I can’t always make it home on my lunch to get a midday test in, if I have enough time in my lunch I’ll come home to get a test, but it doesn’t always work out. So I always get a test before I leave for work, usually a +1-+1.5. Im off work at 5:00pm so I usually am not able to get a test before PMPS so PMPS is at 5:30 and then I test a couple times in the evenings, depending on what his BG is and then I get more tests in on the weekends.

 

[Chris & China (GA)]

Any chance you could move to 6:30am/6:30pm? That way you could get a +2 every day before you left for work.

Can you get hubby to get a mid-cycle test some time during the AM cycle? (I know a lot of men seem to be kind of squeamish when it comes to testing, but with a little encouragement ...and maybe a little bribery....most learn to do it!)

 

[Sarah and Blaze]

Any chance you could move to 6:30am/6:30pm? That way you could get a +2 every day before you left for work.

Can you get hubby to get a mid-cycle test some time during the AM cycle? (I know a lot of men seem to be kind of squeamish when it comes to testing, but with a little encouragement ...and maybe a little bribery....most learn to do it!)

It took me some time but my DH is finally comfortable testing and giving insulin. I usually go to the gym after work and my DH is in charge of PMPS almost every Monday through Thursday, such a life saver! Hopefully your DH is willing to help like Chris suggested, makes life so much easier!

 

[Ori (and Erica)]

Any chance you could move to 6:30am/6:30pm? That way you could get a +2 every day before you left for work.

Can you get hubby to get a mid-cycle test some time during the AM cycle? (I know a lot of men seem to be kind of squeamish when it comes to testing, but with a little encouragement ...and maybe a little bribery....most learn to do it!)

He can - yes. He knows how to check and inject.

 

[Ori (and Erica)]

Any chance you could move to 6:30am/6:30pm? That way you could get a +2 every day before you left for work.

Can you get hubby to get a mid-cycle test some time during the AM cycle? (I know a lot of men seem to be kind of squeamish when it comes to testing, but with a little encouragement ...and maybe a little bribery....most learn to do it!)

And I like to do 7 because she demands food at 5 and then I can get a no-food check 2 hours later. 6:30 does not work.

 

[Chris & China (GA)]

she demands food at 5

might consider getting an auto feeder that you can set to open at like 4:00-4:30...that way she wouldn't expect food at 5 and you'd still get your 2 hours without food. Just throwing idea's out there

 

[Ori (and Erica)]

might consider getting an auto feeder that you can set to open at like 4:00-4:30...that way she wouldn't expect food at 5 and you'd still get your 2 hours without food. Just throwing idea's out there

I do have a feeder - but I'd really like to stay with the 7 AM and 7 PM. Sometimes we are not home until then and I really need to be able to sleep until 7. I can get a few midday tests in. But the bigger question is - don't you think she is not bouncing and just needs more?

 

[Chris & China (GA)]

But the bigger question is - don't you think she is not bouncing and just needs more?

No, I don't think she's bouncing and I wish that other group would have never put that idea into your head.

I think she needs more insulin...whether that's tonight or in 4 more days is the question (TR versus SLGS)

Either way, you don't want to hold a dose that's not getting the results you want any longer than 7 days (unless there's a specific reason to....like on day 7 kitty all the sudden drops into low blues/greens)

 

[Ori (and Erica)]

What if I give her 3.75 tonight and then re-evaluate on Friday night? I can tell she is more thirsty than before because she keeps messing with her tongue and her sinuses are dry. Yeah? Thank you Chris. I know she has better number early on, but she does not now, so I have to look at now.

 

[Chris & China (GA)]

Sounds like a plan! Hopefully it will work and get her attention!

 

[Ori (and Erica)]

PMPS was 245 and I am going to take the leap and do 3.75 and hold until Friday night.

 

[Sue and Luci]

I'm happy to see that you'll be increasing...I think I just posted a similar comment on FB on your thread there.

Please be aware though that IF you see a nice drop into some much lower numbers as the depot fills there may be an unexpected decrease in the dosage - just throwing that out there so you're aware.

Best of luck this week with seeing some lower numbers on that new dose

 

[Ori (and Erica)]

I'm happy to see that you'll be increasing...I think I just posted a similar comment on FB on your thread there.

Please be aware though that IF you see a nice drop into some much lower numbers as the depot fills there may be an unexpected decrease in the dosage - just throwing that out there so you're aware.

Best of luck this week with seeing some lower numbers on that new dose

Thank you! I will try to grab a couple midday tests and enlist husband help (she is a good girl and let's everybody test and shoot as long as she gets her (food) payout!)