? 3/14 TILICA PMPS 250|261 +12.5| 244 +13|231 +13.5

Status
Not open for further replies.
Choose a dose that doesn't scare you like 2 u or even a tiny bit over the 2 u mark (this is called a "fat" 2 u) and hold it steady for 3 days at strict 12 hour intervals. Try not the move the shot time and don't reduce the dose unless it's 90 or lower on your human meter (SLGS). I think Tilica is a bouncy kitty and for these guys, too many changes makes it worse. They need consistency.

I think you said you're following SLGS protocol. That means the low greens on March 09 called for a reduction of 0.25 u, which you did. Since then you've moved shot times and that can act like little dose increases or decreases. You also stalled then dropped the dose last night to 1.5 u even though the yellow PS was high enough to give 2 u.

If his nadir is late you're OK to shoot 12/12 because he'll have food in him by the time the insulin takes effect. Try to let the SLGS protocol be your guide instead or trying to guess what might happen. The high numbers right now are from bouncing or possibly a dose that's a bit too low or both. Step back and keep everything as consistent as you can so you can see what the dose can do on its own.
 
Sorry, I don't understand. Why did you delay tonight? 250 was a perfectly safe number to shoot. It's OK to shoot a number that is coming down, especially when it's so high. The insulin onset is not until two to three hours after the shot. Which means you are getting close to 12 hours duration from Lantus, which is perfect.

Also, without a mid cycle test today, there is no way to know if the end of the cycle was his nadir, or he was doing a Lantus "double dip", where they do a small dip down at the end of the cycle. In either case, 250 is a perfectly safe number to shoot.

However, now it sounds like you can't do a shot 12 hours after PMPS tomorrow. How long after tonight's shot do you have to leave to go to work? I'm just wondering how late the schedule is now.
 
I also see you are doing a different dose in the AM and PM. Using the methods we use here, we suggest giving the same dose in the AM and the PM. I would stick with 2.0 units in the AM and PM, as per the SLGS you are now following. Then you can do a curve on the weekend when you aren't working, to evaluate the dose.
 
Kris & Teasel said:
Choose a dose that doesn't scare you like 2 u or even a tiny bit over the 2 u mark (this is called a "fat" 2 u) and hold it steady for 3 days at strict 12 hour intervals. Try not the move the shot time and don't reduce the dose unless it's 90 or lower on your human meter (SLGS). I think Tilica is a bouncy kitty and for these guys, too many changes makes it worse. They need consistency.

I think you said you're following SLGS protocol. That means the low greens on March 09 called for a reduction of 0.25 u, which you did. Since then you've moved shot times and that can act like little dose increases or decreases. You also stalled then dropped the dose last night to 1.5 u even though the yellow PS was high enough to give 2 u.

If his nadir is late you're OK to shoot 12/12 because he'll have food in him by the time the insulin takes effect. Try to let the SLGS protocol be your guide instead or trying to guess what might happen. The high numbers right now are from bouncing or possibly a dose that's a bit too low or both. Step back and keep everything as consistent as you can so you can see what the dose can do on its own.
Click to expand...

Kris, I choose to wait because his BG was dropping after 12 hours and I was afraid that the doses might overlap and dramatic drop could happen. The SLGS protocol says that if the preshot number is lower I can shoot a lower dose.
 
Wendy&Neko said:
I also see you are doing a different dose in the AM and PM. Using the methods we use here, we suggest giving the same dose in the AM and the PM. I would stick with 2.0 units in the AM and PM, as per the SLGS you are now following. Then you can do a curve on the weekend when you aren't working, to evaluate the dose.
Click to expand...

Hi Wendy, because of his sharp drops through which he has gone lately I prefered to shoto a reduced dose at +14 in order to avoid an overlap. I think that happens when a sharp drop occurs. His numbers were greater than 200 but lower than usually at PMPS, as it happened yesterday.
 
Andreea said:
Kris, I choose to wait because his BG was dropping after 12 hours and I was afraid that the doses might overlap and dramatic drop could happen. The SLGS protocol says that if the preshot number is lower I can shoot a lower dose.
Click to expand...
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
I copied/pasted the part of SLGS that you're referring to. Notice it says as a reduced dose might be wise. I think you would have to look at the whole picture for that day and the days before to judge properly. I don't think only one yellow pre shot is enough to go on when all the other numbers that day and the days just before were high. I think this is a guideline you might use when you see a definite downward trend in BGs that starts well before the lower pre shot happens. Another point: reductions are generally 0.25 u, not 0.5 u unless the whole dose is fairly high.
 
Here's what I notice on your SS:

  • Yes, the drops are often earlier in the cycle. Maybe Tilica has an early nadir rather than a late nadir.
  • Almost all the greens called for a reduction of 0.25 u because they were below 90 (SLGS).
  • None of the greens were near the hypo number of 50 on a human meter. That's when you should start to react.
 
Kris & Teasel said:
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
I copied/pasted the part of SLGS that you're referring to. Notice it says as a reduced dose might be wise. I think you would have to look at the whole picture for that day and the days before to judge properly. I don't think only one yellow pre shot is enough to go on when all the other numbers that day and the days just before were high. I think this is a guideline you might use when you see a definite downward trend in BGs that starts well before the lower pre shot happens. Another point: reductions are generally 0.25 u, not 0.5 u unless the whole dose is fairly high.
Click to expand...

I can't monitor him during the morning cycle and indeed I don't have a clear picture of the BG trend. I 'll try to sort thingd out starting tomorrow but I have to take into account dose overlaping.
 
Kris & Teasel said:
Here's what I notice on your SS:

  • Yes, the drops are often earlier in the cycle. Maybe Tilica has an early nadir rather than a late nadir.
  • Almost all the greens called for a reduction of 0.25 u because they were below 90 (SLGS).
  • None of the greens were near the hypo number of 50 on a human meter. That's when you should start to react.
Click to expand...
Kris, when I saw the drops more than 200 mg/dl in only 2 hours I was thinking it might drop down to 50 and whrn he was around 60-65 I stteped in. I think that if I didn't step in he could drop under 50.
 
Andreea said:
I can't monitor him during the morning cycle and indeed I don't have a clear picture of the BG trend. I 'll try to sort thingd out starting tomorrow but I have to take into account dose overlaping.
Click to expand...
If there is some overlap it would be the last bit of one dose overlapping with the beginning of the next dose. The two amounts together would probably add up to less than the total amount of active insulin at nadir.
 
Andreea said:
Kris, when I saw the drops more than 200 mg/dl in only 2 hours I was thinking it might drop down to 50 and whrn he was around 60-65 I stteped in. I think that if I didn't step in he could drop under 50.
Click to expand...
Teasel sometimes drops a lot in the first 2 hours but the amount of drop decreases as the cycle goes on. It's not a linear rate of dropping, especially with Lantus.
 
Kris & Teasel said:
Teasel sometimes drops a lot in the first 2 hours but the amount of drop decreases as the cycle goes on. It's not a linear rate of dropping, especially with Lantus.
Click to expand...
Sometimes he drops and it's difficut to stop it and sometimes the BG increases in the first 2 hours and decreases afterwards. There is no rule yo that, it's unpredictible..
 
@Kris & Teasel The part you quoted from the SLGS Sticky is in the section labelled "In the beginning". Andreea has been at this a while and I wouldn't say she is new anymore.

Andreea, you have shot full dose in the 270's before. 250 is not much lower. You have to think about gradually lowering the number you are comfortable shooting, especially if you are home to monitor. Lantus is great at keeping lower numbers flat. When you shoot a low number, the cycle is much flatter than when you shoot a high number. You don't get as big a drop when you start with a lower preshot number. Experienced people following SLGS will shoot anything above 90. I am not saying you should do that now, but over time and as you gather data, you can shoot lower and lower numbers. Especially when you are home to monitor and see what happens when Tilica gives you a lower number to work with.

I always liked shooting lower numbers, because it was much easier to predict what might happen. When you start with a high preshot number, you could have a dropping cycle or a flat cycle.

Andreea said:
I have to go to work 12.5 hours later after the shot.
Click to expand...
For adjusting your schedule, you can move the shot time forward by 1/2 hour once a day, or 15 minutes each cycle. So do tomorrow morning's shot 11.5 hours after the one tonight, and the night time shot at the same time. The next morning, you can shoot again 1/2 hour earlier than the night before.
 
Wendy&Neko said:
@Kris & Teasel The part you quoted from the SLGS Sticky is in the section labelled "In the beginning". Andreea has been at this a while and I wouldn't say she is new anymore.

Andreea, you have shot full dose in the 270's before. 250 is not much lower. You have to think about gradually lowering the number you are comfortable shooting, especially if you are home to monitor. Lantus is great at keeping lower numbers flat. When you shoot a low number, the cycle is much flatter than when you shoot a high number. You don't get as big a drop when you start with a lower preshot number. Experienced people following SLGS will shoot anything above 90. I am not saying you should do that now, but over time and as you gather data, you can shoot lower and lower numbers. Especially when you are home to monitor and see what happens when Tilica gives you a lower number to work with.

I always liked shooting lower numbers, because it was much easier to predict what might happen. When you start with a high preshot number, you could have a dropping cycle or a flat cycle.


For adjusting your schedule, you can move the shot time forward by 1/2 hour once a day, or 15 minutes each cycle. So do tomorrow morning's shot 11.5 hours after the one tonight, and the night time shot at the same time. The next morning, you can shoot again 1/2 hour earlier than the night before.
Click to expand...
 
Wendy&Neko said:
@Kris & Teasel The part you quoted from the SLGS Sticky is in the section labelled "In the beginning". Andreea has been at this a while and I wouldn't say she is new anymore.

Andreea, you have shot full dose in the 270's before. 250 is not much lower. You have to think about gradually lowering the number you are comfortable shooting, especially if you are home to monitor. Lantus is great at keeping lower numbers flat. When you shoot a low number, the cycle is much flatter than when you shoot a high number. You don't get as big a drop when you start with a lower preshot number. Experienced people following SLGS will shoot anything above 90. I am not saying you should do that now, but over time and as you gather data, you can shoot lower and lower numbers. Especially when you are home to monitor and see what happens when Tilica gives you a lower number to work with.

I always liked shooting lower numbers, because it was much easier to predict what might happen. When you start with a high preshot number, you could have a dropping cycle or a flat cycle.


For adjusting your schedule, you can move the shot time forward by 1/2 hour once a day, or 15 minutes each cycle. So do tomorrow morning's shot 11.5 hours after the one tonight, and the night time shot at the same time. The next morning, you can shoot again 1/2 hour earlier than the night before.
Click to expand...

Thank you Wendy.
Honestly, for now I'm afraid to shoot when the preshot numbers are lower. Now at +1.5 he is at 215, and I wonder what the dropping pace will be.
I'll move the shot time half an hour later once a day.
 
Wendy&Neko said:
@Kris & Teasel The part you quoted from the SLGS Sticky is in the section labelled "In the beginning". Andreea has been at this a while and I wouldn't say she is new anymore.

Andreea, you have shot full dose in the 270's before. 250 is not much lower. You have to think about gradually lowering the number you are comfortable shooting, especially if you are home to monitor. Lantus is great at keeping lower numbers flat. When you shoot a low number, the cycle is much flatter than when you shoot a high number. You don't get as big a drop when you start with a lower preshot number. Experienced people following SLGS will shoot anything above 90. I am not saying you should do that now, but over time and as you gather data, you can shoot lower and lower numbers. Especially when you are home to monitor and see what happens when Tilica gives you a lower number to work with.

I always liked shooting lower numbers, because it was much easier to predict what might happen. When you start with a high preshot number, you could have a dropping cycle or a flat cycle.


For adjusting your schedule, you can move the shot time forward by 1/2 hour once a day, or 15 minutes each cycle. So do tomorrow morning's shot 11.5 hours after the one tonight, and the night time shot at the same time. The next morning, you can shoot again 1/2 hour earlier than the night before.
Click to expand...
Thanks for pointing that out, Wendy. I missed the "in the beginning" part.
 
Kris & Teasel said:
If there is some overlap it would be the last bit of one dose overlapping with the beginning of the next dose. The two amounts together would probably add up to less than the total amount of active insulin at nadir.
Click to expand...

Thank you Kris. I have to make sure what happens when he drops very fast, maybe his pancreas is working and could be like an overdose?
 
Andreea said:
I'll move the shot time half an hour later once a day.
Click to expand...
No, you move the shot time a half hour earlier than you shot tonight. Sorry if I was confusing you.
Andreea said:
Honestly, for now I'm afraid to shoot when the preshot numbers are lower.
Click to expand...
And only by experience will you get over that fear. That's why I suggest gradually lowering the preshot numbers you are willing to shoot, if you are home and able to monitor. You have shot full dose into the 270's, next time try the 250's. There isn't much difference between the two, well within meter variance. Once you have data on how he rsponds to the 250's, you move the safe preshot number down again. I admit I was very nervous the first times I shot lower numbers. We probably all were.:bighug:
 
Wendy&Neko said:
No, you move the shot time a half hour earlier than you shot tonight. Sorry if I was confusing you.

And only by experience will you get over that fear. That's why I suggest gradually lowering the preshot numbers you are willing to shoot, if you are home and able to monitor. You have shot full dose into the 270's, next time try the 250's. There isn't much difference between the two, well within meter variance. Once you have data on how he rsponds to the 250's, you move the safe preshot number down again. I admit I was very nervous the first times I shot lower numbers. We probably all were.:bighug:
Click to expand...
Wendy, now at 2.5 he is at 186, I see that this small dose is efficient. I have enough experience to shot at lower numbers and during the night I'll get scared :nailbiting:
 
Maybe you try shooting a lower dose during the weekend when you can monitor. 186 is a very nice number. I see that an hour later he's higher so no where near a low number.
 
Status
Not open for further replies.
Back
Top