7/23 - Mačka AMPS 463, +4 345, +6 194, +7 161 / welcome purples and blues!

Penelope and Mačka

Penelope and Mačka

Member Since 2019
http://www.felinediabetes.com/FDMB/...se-to-1-5-and-calorie-intake-question.217173/

It might look like not much to you, but Macka hasn't been in the purples (300s) during the day for almost three weeks. Not sure if he was bouncing like crazy or if there's such a huge difference between 1.25 and 1.5 units, but clearly, he's doing a little better.
=> How long should I keep the current dose? 5 days? 1 week?

His stools were firm today thankfully. Not a lot of appetite, but he's purring normally.

Today was also his first take of Budesonide for his presumably IBD. I am so scared because one of the side effects is heart related, and the vet asked me to count his breaths for 2 weeks. This is absolutely not what one should ask me to do, because of course, I count and count again and I trip (but he looks fine, 20 breaths/minute asleep, 28 awake).

He's had asthma for the last two days, not sure what's causing it right now.
Also, going to the store now to buy kitten food for higher calories.
 
Hooray! A pink for Macka! This is the direction we want to see! :cat:

Remember that the SLGS method specifies a week at least at the same dose and then a curve before another increase, for safety. His depot may be building now, and then you also want to make sure any bouncing settles. Of course I know you have read and re-read the SLGS protocol just like me! But when it's your cat and the numbers are so high, it can feel like an eternity waiting... believe me I know (it's all over my own posts!). It may feel like you're not doing enough since the dose may be too low, but that is not true. Waiting is a safeguard and helps to avoid a crisis situation. I keep reminding myself of this :)

Are you planning a curve after a week at this dose, maybe this weekend?
 
Penelope and Mačka said:
How long should I keep the current dose? 5 days? 1 week?
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I still think you should move to Tight Regulation....you're already testing enough to do TR and it would be better for Mačka

If you stick with SLGS, you have to hold this dose for 7 days.....If you change to TR, you can increase as often as every 3 days (it doesn't mean you HAVE to increase every 3 days...it just gives you that option if the dose isn't getting the results you want)
 
Thank you @Figaro's Liz for reminding me to be patient! It does feel like an eternity and he is so weak from all the high numbers.
I will stick to a full week. Vet asked me to do a curve after 1 week of steroids (1st day was yesterday), so I might have to stick to this dose for a little longer too. Not sure what to do. I don't want to bias the numbers. I feel like the depot is building.
He definitely did not have glucose in his urine when I tested him yesterday afternoon, meaning he was possibly somewhere in the 200s during the day... So he's been curving during the day, which is new to him!
 
Chris & China (GA) said:
I still think you should move to Tight Regulation....you're already testing enough to do TR and it would be better for Mačka

If you stick with SLGS, you have to hold this dose for 7 days.....If you change to TR, you can increase as often as every 3 days (it doesn't mean you HAVE to increase every 3 days...it just gives you that option if the dose isn't getting the results you want)
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The two methods are still a little confusing to me: I tend to mix them both in my head, and went from one to the other if I have to be honest with myself. I read a lot on this forum, and learn from it more than from the stickies, and it's hard to see the difference between the two. That being said, I don't want to be aggressive with dosing because I am prone to high anxiety. And having to test more when I try to test less, waking up in the middle of the night to test etc... I am SO scared of hypo that I don't have a normal life anymore. I can easily lose it (I mentioned it many other times, apologies to the people who are going to read this again!).
 
Looking at his SS, when Macka was at 1.75, he had nicer curves during the night, but crazy bouncing during the day (in the 500-600s).
Wouldn't it be better to stay for a while on 1.5 so that his body gets used gently to the 300s, and then increase?
 
Penelope and Mačka said:
Do you think it's okay to increase the dose while we're in the middle of the 1st week of steroids?
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Yes, I think it's safe....if anything, steroids usually make the blood glucose go higher.

Leaving him on a dose that's not working just gives his body time to learn to live at those higher numbers even with the insulin....usually you end up having to go a lot higher in dose to get his "attention" again.
 
The difference with SLGS and TR is the frequency of increase, the BG in which you decide when to change the dose, and the amount of testing you need to do.

With TR:
- you decrease doses when you go under 50.
- you can change the dose as quickly as 3 days if you are not seeing good numbers
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
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- you need to test more (I can't remember how much you need to test right now and I can't seem to find it in the sticky) but you're testing enough imo.

With SLGS:
- you start at a lower dose (1 or 0.5 unit usually)
- you decrease doses when you go under 90
- you hold doses for 7 days
- do a curve at the end of 7 days.

The benefit of doing SLGS is you don't need to do as much spot checking as TR because you are starting low enough that it's unlikely there will be a hypo but ECID and even cats on SLGS method still drop and dive - that's why it doesn't really matter IMO. You test Macka enough to be able to catch him diving.

And the anxiety of Macka going hypo is okay. It's healthy and going hypo is a scary thing. But Macka being high is also detrimental to his health. Just remember, you're testing, you're increasing doses safely, and you are ready if there is a hypo threat.
 
Penelope and Mačka said:
+6 194!!! He has NEVER done that before during the day. I think I'll stay to this this dose for a little longer :) It's working
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That's awesome! The depot is filling. If you were following TR, this would be the 5th cycle. The 6th cycle and the cycles that follow, usually tell us what the current dose is doing. And by then, bounces may have cleared.

However, you might see Macka bounce tonight because he is not used to blues.
 
Penelope and Mačka said:
But looks like I can't help it :)
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Don't feel bad about testing a lot. I test a lot too and got shamed by my vet for doing it. If Macka doesn't mind and it gives you ease knowing his number atm, I think it's more beneficial than anything. But I also understand the anxiety it will cause if you get a bad result. I've been there. We've all been there. So it's okay!

Penelope and Mačka said:
Oh nooooo not again!!!! :facepalm:
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You should check out Ming's SS. He is the Bounce King. I'm perpetually disappointed by him lol
 
:woot::woot::woot::woot: Yes, I’ve died a few times but I keep coming back!

It helps to know thy cat. It’s been long enough that I am comfortable with him pulling shenanigans at me but I still have questions and I still have scary moments. Just not as scary as in October of 2018. I would cry almost every time I needed to give insulin and he was “low” and I cried when I saw numbers in the black. There was a lot of crying but also lots of hand holding from the amazing folks here at FDMB.

You’re in good hands here. :)
 
Great news Penelope! Progress!! Macka you look better in pink than red... and I have a feeling you'd be a stunner in Yellow ;)

RE: SLGS vs TR, I agree with you that at this point, even though you test enough for TR that your comfort level just isn't there for the lower BG levels that would come with TR. For now, until you build more of a comfort level I think you should continue with SLGS. With SLGS you can test less which is a mental break that I think you need. You have only been on 1.5u for 5 cycles and already Macka is showing progress, I think I would wait to do the increase until the weekend so that you can see exactly what the dose can do after a full depot build. Then you can do the curve on the weekend to see if he needs an increase / decrease. Of course, if you want to test more, then test more, but... if it is stressing you out SLGS has the safety guards in place so that you dont have to test as much, the purpose of this protocol is for people who aren't able to monitor as much as those who follow TR :)

Penelope and Mačka said:
Looking at his SS, when Macka was at 1.75, he had nicer curves during the night, but crazy bouncing during the day (in the 500-600s).
Wouldn't it be better to stay for a while on 1.5 so that his body gets used gently to the 300s, and then increase?
Click to expand...

Don't focus too much on Macka's responses to doses in the past. He actually might react differently to 1.75u if you ever have that dose again, it could be too much or too little :). I think if you choose a protocol and stick with it, that you will relieve some of the anxiety that has been building. You will have a direct set of guidelines to follow and ask questions about... it should take out a lot of the guess work. This is true whether you choose TR or SLGS. One thing that is important is that you do choose one of them and stick to it... don't pick and choose from both because it will be too hard to get any feedback and there will be no consistency to Mackas treatment. Both are honestly great options, but I worry about how stressed you might get if you jump into TR.

Like Crista said above though, you can always switch if one method doesn't work out for you. If you want to try living a life with less testing for now, I recommend SLGS until you have more data on Macka when he is in lower numbers :)

also: DAMN! just saw Macka's blue :cool: :cool: :cool: congrats! 1.5 is working better than you thought :D

FWIW I think you're doing a really great job with Macka
 
AmandaE said:
also: DAMN! just saw Macka's blue :cool: :cool: :cool: congrats! 1.5 is working better than you thought :D

FWIW I think you're doing a really great job with Macka
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Thank you <3 Yes, that's hard to believe but he is in the blues right now. I will test at +7 to see if he's going up or down and get an idea of how he's reacting overall with the depot being built. I am not going to change the dose any time soon, as it is already very scary to let him in the blues without feeding him, and waiting...
You're right, I don't have the nerves and mental strength to go into TR right now. I am just not ready.
We have other struggles here besides his diabetes: his asthma coming back (freaks me out), his IBD (not very hungry, diarrhea here and there), his relationship with Chou-Fleur (the other cat) which is at its absolute worst. This is just too much :)

I know I'm dreaming right now, but... have we ever seen a cat go into remission with SLGS?
 
Penelope and Mačka said:
Thank you <3 Yes, that's hard to believe but he is in the blues right now. I will test at +7 to see if he's going up or down and get an idea of how he's reacting overall with the depot being built. I am not going to change the dose any time soon, as it is already very scary to let him in the blues without feeding him, and waiting...
You're right, I don't have the nerves and mental strength to go into TR right now. I am just not ready.
We have other struggles here besides his diabetes: his asthma coming back (freaks me out), his IBD (not very hungry, diarrhea here and there), his relationship with Chou-Fleur (the other cat) which is at its absolute worst. This is just too much :)

I know I'm dreaming right now, but... have we ever seen a cat go into remission with SLGS?
Click to expand...
YES! cat's go into remission on SLGS!! I think TR has the better reputation for cases of remission but SLGS is the original protocol of this site before TR was developed. Many cats have gone into remission with SLGS :D

I think if you start with SLGS for now you can do some strategic exercises for testing that will help you test a little less, for example, if you feel compelled to test, try testing every 3 hours. You could think about staggering your test times so that through the days you fill in your spreadsheet and get a good idea of how Macka is progressing and what his reactions to insulin are, ex:

Day 1: AMPS, +1, +4, +7, +10, PMPS
Day 2: AMPS, +2, +5, +8 +11, PMPS
Day 3: AMPS, +3, +6, +9, PMPS
Day 4: AMPS, +1, +4, +7, +10, PMPS

You could try playing around with rotating schedules of testing every 2 hours, every 3 hours and every 4 hours. If you can do that you will be able to eventually define Macka's insulin onset, nadir, and typical duration of a dose. You will also learn if Macka has somewhat of a consistent or floating onset, nadir, or duration. I think this strategy could relieve some of the testing that you have been doing. This is a suggestion for day time testing only, I think for night time you should use the +2/ +3 value to predict if you need to stay up longer or not. If you are unsure then post, someone will give you feedback :) I drew kind of a cartoon (all hypothetical) of what this could look like - starting with 4 days of testing every three hours, 2 days testing every 2 hours, and 1 day testing at 4 hours. You can choose what frequency you would want to test based on what you have going on that day. From switching up the test schedule you start to get a really good idea of what is going on in your cat's day, without poking them incessantly :p



upload_2019-7-23_15-0-1.png


Does this make sense? hopefully it is helpful as really I should be working :p (shh our secret ok?)

Sometimes when Macka's BG decreases quickly, you will have to test more. If Macka is bouncing, or if he is staying relatively flat (something like day 6 in the cartoon) you can test a little less. Again, the +2 can be a good indicator. As you get more comfortable maybe you could test even less than that graph. BTW you would definitely NEVER have to test this much during a normal cycle on SLGS, I just know you're prone to testing so a 3 hour gap seems a good place to start :p

When I am thinking about if the +2 shows whether or not I need to test more or not in that cycle I personally kind of use the spreadsheet colors as a strategy. If I have a pink AMPS and my +2 is blue, it means that a whole "color" has been skipped and a +2.5 / +3 would be needed so that I am comfortable. I will even get a +3 if I have a large drop say from High yellow AMPS to mid blue +2, just in case. If I have a yellow AMPS and a Yellow +2 I am less worried about the rest of the cycle, since there hasn't been a lot of action. Of course ECID, that is why it is important to learn Macka's onset, nadir and duration.

Sorry if this causes confusion... anyone with more experience can agree or disagree with me, these have kind of been my strategies, although I definitely test less ;) :p
 
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Crista & Ming said:
Don't feel bad about testing a lot. I test a lot too and got shamed by my vet for doing it. If Macka doesn't mind and it gives you ease knowing his number atm, I think it's more beneficial than anything. But I also understand the anxiety it will cause if you get a bad result. I've been there. We've all been there. So it's okay!


You should check out Ming's SS. He is the Bounce King. I'm perpetually disappointed by him lol
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And Bella’s ss, I test a lot, I figure testing a lot is better than not enough hooooorah for blue!
 
Guys, I had to go to my physical therapy session and Macka was going lower and lower (was at 141 at +8) and I panicked because I wasn't gonna be home, so I gave him a good spoonful of MC food. I feel so bad now. He's at 245 @+9. I guess it's not just because of the food but still, I was so scared of finding him dead when I get home.
I understand that 141 is still safe, but he got there from 189 even after eating 1/2 can of LC. I was worried :(
 
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AmandaE said:
Day 1: AMPS, +1, +4, +7, +10, PMPS
Day 2: AMPS, +2, +5, +8 +11, PMPS
Day 3: AMPS, +3, +6, +9, PMPS
Day 4: AMPS, +1, +4, +7, +10, PMPS
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You are so well organized Amanda! Thanks so much for the tip, I'm gonna do that from tomorrow on :)

EDIT: Actually, don't you want to create a sticky for that method???
 
Penelope and Mačka said:
Guys, I had to go to my physical therapy session and Macka was going lower and lower (was at 141 at +8) and I panicked because I wasn't gonna be home, so I gave him a good spoonful of MC food. I feel so bad now. He's at 245 @+9. I guess it's not just because of the food but still, I was so scared of finding him dead when I get home.
I understand that 141 is still safe, but he got there from 189 even after eating 1/2 can of LC. I was worried :(
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It’s okay. You’ll know for next time what to do :) if you need to ever leave, you can always put down LC.
 
Penelope and Mačka said:
You are so well organized Amanda! Thanks so much for the tip, I'm gonna do that from tomorrow on :)

EDIT: Actually, don't you want to create a sticky for that method???
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Thanks Penelope!

I actually got the idea from the stickies, advice others have given me, and creeping through other people’s spreadsheets... I recommend creeping because then you’ll see how other members do it. Always remember ECID though ;)

Let me know how it goes!!

Penelope and Mačka said:
BTW are you an expert at creating graphs on spreadsheets lol? Is that your job? ;)
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Lol no. But I do work with excel at my job quite a bit, nothing fancy. I also use Microsoft paint or PowerPoint for some of my “diagrams”

I’m glad you liked my ideas and I hope they can get you to a place where you don’t need to test as much :)
 
Every cat is different! It just means you shouldn’t compare Macka to other cats because his reactions to insulin could be different from other cats :)

An example for you of a time I will get a +2.5 from Mowgli is his current +2. He isn’t behaving differently but he did drop 100points since PMPS. I’m giving him some LC and will test him again at +2.5 to see how he is trending :)
 
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