2/6 Elise/Max AMPS311Vets says hold+5=346PM+PS318+4=291
- Thread starter tiffmaxee
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Angela & Blackie & 3 Others
Member Since 2010
Re: 2/6 Elise/Max AMPS311
I would think that the test results should be marked at the time that you actually did the test (for instance the +11). Then, retest at PS time. Chances are... Max may or may not have gone down by then, and you wouldn't really know what the exact # would be to shoot. Sometimes they may be the same, but then, you don't know for a fact. Better to be safe than sorry.
Hoping for a nice surf for you both today. Have a great day, and please stay safe and warm.
I would think that the test results should be marked at the time that you actually did the test (for instance the +11). Then, retest at PS time. Chances are... Max may or may not have gone down by then, and you wouldn't really know what the exact # would be to shoot. Sometimes they may be the same, but then, you don't know for a fact. Better to be safe than sorry.
Hoping for a nice surf for you both today. Have a great day, and please stay safe and warm.
tiffmaxee
Member Since 2013
Re: 2/6 Elise/Max AMPS311Vets says hold
I guess I need to post again to get answers to my latest dilemma. My vet just called after reviewing the spreadsheet and said to keep Max at l unit for another week. I increased to 1.25 yesterday. He said we are in between and wants to see what l unit does for another week.
I guess I need to post again to get answers to my latest dilemma. My vet just called after reviewing the spreadsheet and said to keep Max at l unit for another week. I increased to 1.25 yesterday. He said we are in between and wants to see what l unit does for another week.
Amy&TrixieCat
Member Since 2011
Re: 2/6 Elise/Max AMPS311Vets says hold
You did have one good cycle on 1.00, but aside from that, the data says to me that you were good to increase...just my opinion, though. Many vets aren't used to numbers as low as we follow here in LL, so maybe that's why he told you to hold it at 1.00. But you test frequently enough and are on top of the numbers - something else most vets aren't used to.
I'm sure others will chime in, but those are my thoughts....
You did have one good cycle on 1.00, but aside from that, the data says to me that you were good to increase...just my opinion, though. Many vets aren't used to numbers as low as we follow here in LL, so maybe that's why he told you to hold it at 1.00. But you test frequently enough and are on top of the numbers - something else most vets aren't used to.
I'm sure others will chime in, but those are my thoughts....
Chris & China (GA)
Member Since 2013
Re: 2/6 Elise/Max AMPS311Vets says hold
I agree you were right to increase
Vets don't usually understand that you're checking at home and so they like the numbers to be higher
I'd just tell the vet that you've been doing a lot of research into treatments for feline diabetes and you're following the TR Protocol developed by Roomp/Rand and offer to send him/her the information if they'd like to read up on it.
I know it can sometimes be hard to "buck the system", but Max is your cat, and it's your responsibility to make decisions for him. If your vet gets upset with you because you're not following his/her lead, it might be best to find another vet who will work with you instead of dictate to you.
I agree you were right to increase
Vets don't usually understand that you're checking at home and so they like the numbers to be higher
I'd just tell the vet that you've been doing a lot of research into treatments for feline diabetes and you're following the TR Protocol developed by Roomp/Rand and offer to send him/her the information if they'd like to read up on it.
I know it can sometimes be hard to "buck the system", but Max is your cat, and it's your responsibility to make decisions for him. If your vet gets upset with you because you're not following his/her lead, it might be best to find another vet who will work with you instead of dictate to you.
tiffmaxee
Member Since 2013
Re: 2/6 Elise/Max AMPS311Vets says hold+5=346or287
My vet does work with me which is why I briefly left him because he is conservative but quickly went back. If respects my opinion as well. This time I'm not feeling like I know what is best. I just tested at +5. The first reading was 346 so I poked him again and got 287. I wish these meters were more consistent.
My vet does work with me which is why I briefly left him because he is conservative but quickly went back. If respects my opinion as well. This time I'm not feeling like I know what is best. I just tested at +5. The first reading was 346 so I poked him again and got 287. I wish these meters were more consistent.
Re: 2/6 Elise/Max AMPS311Vets says hold+5=346or287
I agree with the others that the increase to 1.25 was the right thing to do. The goal of the TR protocol is to safely increase the dose to get to the point where kitty spends as much time as possible in normal numbers so the pancreas can heal and make remission possible. Often vets will have a goal of keeping kitty regulated which is numbers mostly below renal threshold. The majority of folks here have a goal of remission which means getting those numbers into normal numbers as much as possible. You have to decide what your goal is, we'll support you whether your goal is remission or regulation.
Meters can make you crazy. They are allowed to have a 20% variance and 346 and 287 are within that variance. I usually opt to save a strip and just test once unless the numbers are wonky (really low or really high).
I agree with the others that the increase to 1.25 was the right thing to do. The goal of the TR protocol is to safely increase the dose to get to the point where kitty spends as much time as possible in normal numbers so the pancreas can heal and make remission possible. Often vets will have a goal of keeping kitty regulated which is numbers mostly below renal threshold. The majority of folks here have a goal of remission which means getting those numbers into normal numbers as much as possible. You have to decide what your goal is, we'll support you whether your goal is remission or regulation.
Meters can make you crazy. They are allowed to have a 20% variance and 346 and 287 are within that variance. I usually opt to save a strip and just test once unless the numbers are wonky (really low or really high).
tiffmaxee
Member Since 2013
Re: 2/6 Elise/Max AMPS311Vets says hold+5=346or287
I definitely would love remission. I'm just struggling with how to deal with my vet wanting to go slower.I'll figure it out. I won't test twice in a session again. I was just curious. I know Max wasn't happy about it. Thanks for voicing you opinions.
I definitely would love remission. I'm just struggling with how to deal with my vet wanting to go slower.I'll figure it out. I won't test twice in a session again. I was just curious. I know Max wasn't happy about it. Thanks for voicing you opinions.
julie & punkin (ga)
Member Since 2011
Re: 2/6 Elise/Max AMPS311Vets says hold+5=346or287
i think wendy's given you a good commentary on why your vet would want you to hold the dose. most haven't had the experience of cats going into remission and off of insulin.
another possibility is that most vets change doses by 0.5u or even 1.0u increments. the 1.0u was getting Max in the ballpark and a larger increase might've been too much. i think the 0.25u increase was absolutely appropriate - and needed. i don't have any doubt about it at all. if we saw it was too much, we'd be the first people suggesting you reduce the dose. None of us wants to be responsible for a cat being overdosed, so those of us willing to give advice are going to be cautious. The TR Protocol provides a good balance of moving the cat into better numbers while monitoring so that it's done safely.
usually we can see what a dose is going to do within the 6-10 cycles and if it hasn't brought a cat into good numbers consistently by 10 cycles, it probably isn't going to.
Take a look at Davidson's spreadsheet, just today and yesterday, and notice how flat the numbers are and how they are primarily under 120. That's what you want to get to in order to head towards remission. He's at 2.75u right now. The size of the dose is far less important than the BGs that the dose produces. of course, not every cat goes into remission, even with a good spreadsheet. our first goal is to get the cat into numbers that prevent organ damage, under about 200ish. but the next goal is to get them under 120 and give the pancreas an opportunity to heal.
When you get to a good dose, the cycle will flatten out like davidson's is doing, bringing the preshot numbers down. we haven't gotten Max to a good dose yet, but he'll get there. Going back to 1.0u is counterproductive, in my mind, if you are wanting to try for remission. if you were a person who couldn't monitor, then just keeping Max safe and in decent numbers is a good goal. but you do monitor enough to follow the TR protocol and try to get him off.
Here's a couple of articles that you could read and if you think they would be helpful, pass on to your vet. They support getting a cat tightly regulated in order to achieve remission:
http://www.ncbi.nlm.nih.gov/pubmed/19592286
http://www.uq.edu.au/news/article/2009/05/new-management-treatment-diabetic-dogs-and-cats
There are others on the yellow starred sticky for Tight Regulation Protocol at the top of this forum.
that's my 2 cents worth! if i were you, i'd either stop sending the vet his ss and follow the TR protocol, stop asking him about dosing advice, or tell him that you're committed to following the dosing protocol of the Tight Regulation Protocol, because that's what is best for Max.
i think wendy's given you a good commentary on why your vet would want you to hold the dose. most haven't had the experience of cats going into remission and off of insulin.
another possibility is that most vets change doses by 0.5u or even 1.0u increments. the 1.0u was getting Max in the ballpark and a larger increase might've been too much. i think the 0.25u increase was absolutely appropriate - and needed. i don't have any doubt about it at all. if we saw it was too much, we'd be the first people suggesting you reduce the dose. None of us wants to be responsible for a cat being overdosed, so those of us willing to give advice are going to be cautious. The TR Protocol provides a good balance of moving the cat into better numbers while monitoring so that it's done safely.
usually we can see what a dose is going to do within the 6-10 cycles and if it hasn't brought a cat into good numbers consistently by 10 cycles, it probably isn't going to.
Take a look at Davidson's spreadsheet, just today and yesterday, and notice how flat the numbers are and how they are primarily under 120. That's what you want to get to in order to head towards remission. He's at 2.75u right now. The size of the dose is far less important than the BGs that the dose produces. of course, not every cat goes into remission, even with a good spreadsheet. our first goal is to get the cat into numbers that prevent organ damage, under about 200ish. but the next goal is to get them under 120 and give the pancreas an opportunity to heal.
When you get to a good dose, the cycle will flatten out like davidson's is doing, bringing the preshot numbers down. we haven't gotten Max to a good dose yet, but he'll get there. Going back to 1.0u is counterproductive, in my mind, if you are wanting to try for remission. if you were a person who couldn't monitor, then just keeping Max safe and in decent numbers is a good goal. but you do monitor enough to follow the TR protocol and try to get him off.
Here's a couple of articles that you could read and if you think they would be helpful, pass on to your vet. They support getting a cat tightly regulated in order to achieve remission:
http://www.ncbi.nlm.nih.gov/pubmed/19592286
http://www.uq.edu.au/news/article/2009/05/new-management-treatment-diabetic-dogs-and-cats
There are others on the yellow starred sticky for Tight Regulation Protocol at the top of this forum.
that's my 2 cents worth! if i were you, i'd either stop sending the vet his ss and follow the TR protocol, stop asking him about dosing advice, or tell him that you're committed to following the dosing protocol of the Tight Regulation Protocol, because that's what is best for Max.
julie & punkin (ga)
Member Since 2011
Re: 2/6 Elise/Max AMPS311Vets says hold+5=346or287
None of the above look likely to me. It doesn't look like a bounce. New Dose Wonkiness usually only accounts for the first day after a dose increase. I don't even think about meter variance, honestly. it could make a person crazy. However, if you had taken the 287 from your second test, you'd see a yellow in the +5 today, which is what it has been most mid-cycle tests for the past little while. If you saw a yellow there, you might not be wondering as much about what he's doing.
i just think it looks like he hasn't gotten to the right dose and he still needs more insulin. i'd give it 6-10 cycles total at 1.25u, look at his nadirs from that time and compare to the protocol guidelines, and adjust his dose again. Waiting longer just gives glucose toxicity a chance to grab hold and then it takes even more insulin to bring down the blood sugar.
There are links on both New Dose Wonkiness (and bounces) and Glucose Toxicity that explain them more on the "New to the Group" sticky, down near the bottom of the page.
and i completely agree with you - seems odd that meters aren't more consistent.
None of the above look likely to me. It doesn't look like a bounce. New Dose Wonkiness usually only accounts for the first day after a dose increase. I don't even think about meter variance, honestly. it could make a person crazy. However, if you had taken the 287 from your second test, you'd see a yellow in the +5 today, which is what it has been most mid-cycle tests for the past little while. If you saw a yellow there, you might not be wondering as much about what he's doing.
i just think it looks like he hasn't gotten to the right dose and he still needs more insulin. i'd give it 6-10 cycles total at 1.25u, look at his nadirs from that time and compare to the protocol guidelines, and adjust his dose again. Waiting longer just gives glucose toxicity a chance to grab hold and then it takes even more insulin to bring down the blood sugar.
There are links on both New Dose Wonkiness (and bounces) and Glucose Toxicity that explain them more on the "New to the Group" sticky, down near the bottom of the page.
and i completely agree with you - seems odd that meters aren't more consistent.
tiffmaxee
Member Since 2013
Re: 2/6 Elise/Max AMPS311Vets says hold+5=346PMPS318
I've been reading as you suggested and I copied the studies to discuss with my vet. Max weighs 14lbs 6oz so 1.25u is still lower than many would start I see. In November we started with 1u but he responded so well he kept decreasing his dose and then we stopped. I wasn't testing at home at the time so we were just going with the +6-7.5 at his office. Now Max doesn't really seem to Nadir. Well let's see where this takes us. I was also reading about where to shoot. I've been shooting more on his side but varying sides and locations. Since he doesn't seem to nadir would the scruff be a better choice after all? I was advised by the vet that told me what to do (not mine) not to use the scruff. Thanks.
I've been reading as you suggested and I copied the studies to discuss with my vet. Max weighs 14lbs 6oz so 1.25u is still lower than many would start I see. In November we started with 1u but he responded so well he kept decreasing his dose and then we stopped. I wasn't testing at home at the time so we were just going with the +6-7.5 at his office. Now Max doesn't really seem to Nadir. Well let's see where this takes us. I was also reading about where to shoot. I've been shooting more on his side but varying sides and locations. Since he doesn't seem to nadir would the scruff be a better choice after all? I was advised by the vet that told me what to do (not mine) not to use the scruff. Thanks.
julie & punkin (ga)
Member Since 2011
Re: 2/6 Elise/Max AMPS311Vets says hold+5=346PMPS318
i've seen both recommended. both of the vets i took punkin to suggested the scruff. We shot most of the time just back from the scruff, varying the location, although punkin had a strong preference for us to shoot over his right shoulder/scruff area, so that's where we did.
i've also seen the suggestion to vary shot locations around the body.
it might be that if you're thinking it's a factor, keep notes on the spreadsheet and see if it makes a difference.
i think the consistent recommendation i've seen is to not shoot in the exact same location every time. one suggestion was to have a quarter-size area shaved on the body, then think of it as a clock face and move the needle around the clock face so that you aren't poking the same spot all the time.
i wouldn't say he's not having a nadir. the nadir is simply the low point of the cycle. if you tested every 2-3 hours for several days, i suspect we'd see a clear nadir for each cycle.
i've seen both recommended. both of the vets i took punkin to suggested the scruff. We shot most of the time just back from the scruff, varying the location, although punkin had a strong preference for us to shoot over his right shoulder/scruff area, so that's where we did.
i've also seen the suggestion to vary shot locations around the body.
it might be that if you're thinking it's a factor, keep notes on the spreadsheet and see if it makes a difference.
i think the consistent recommendation i've seen is to not shoot in the exact same location every time. one suggestion was to have a quarter-size area shaved on the body, then think of it as a clock face and move the needle around the clock face so that you aren't poking the same spot all the time.
i wouldn't say he's not having a nadir. the nadir is simply the low point of the cycle. if you tested every 2-3 hours for several days, i suspect we'd see a clear nadir for each cycle.
tiffmaxee
Member Since 2013
Re: 2/6 Elise/Max AMPS311Vets says hold+5=346PMPS318
Okay. A friend who looked at my ss said it didn't look like I have a nadir.Some days it seems I do but others like today not so much. I don't shoot in the same spot but I think I will experiment to see what happens if I try the scruff or maybe under the shoulders. It might not change anything. Thanks.
Okay. A friend who looked at my ss said it didn't look like I have a nadir.Some days it seems I do but others like today not so much. I don't shoot in the same spot but I think I will experiment to see what happens if I try the scruff or maybe under the shoulders. It might not change anything. Thanks.
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