7/7/2015 NORMAN AMPS 325 +5 52 + 5.50 62 +6 65 +8 65 fed and surfing beautiful

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Cindywith4cutecats

Cindywith4cutecats

Member Since 2014
Good afternoon everyone, I really hope Julie and punkin( anyones help will be appreciated ) see this thread as from yesterdays condo she helped get a grip on this Lantus insulin and how it works... Ok if you look at Normans SS you can see I made a major GOOF. I was given 2 units and Norman finally some greener pastures and then I freaked out decreased his dose...his numbers trended up to blue land but where I really goofed was the evening of July 6th when I shot him 1 3/4 units LATE by 2 1/2 hours cause I was freaking out about shooting a 90. SO this morning I went back to the last working dose and look where we landed. I am under the assumption that on Lantus you earn a a small .25 reduction if you dip below 50, well I am starting the coasting , I am not freaking out cause he is acting wonderful, he came to me while I was blow drying my hair to demand food, he was biting my foot so I checked his BG ASAP and got the 52. I am feeding him small amounts of his regular LC Wellness, I don't want to have use HC if I can coast him this thru this and not do more damage. I am home, wanted a nap but oh well........I am going to need help tonight when it comes to shot time in about 6 1 /2 hours ...will anyone be able to talk then and guide me ???? I AM SHOCKED RIGHT NOW

yesterdays Condo http://www.felinediabetes.com/FDMB/...-pmps-103-3-164-going-back-to-2-units.140633/
 
Ok. what time was the 52?..... it is now 11:52CST here..you are 1 hour later I think.
This is manageable, we just need to steer the cycle with some food...

At 52 you were fine to give a little LC. How much did you give? You don't want to feed too much at once as you don't want to overfill him and chance he won't eat lter if you need him to. I would test him again about 20-30 minutes from the last test...if numbers fall into the 40's....then give JUST A teaspoon or 2 of the gravy only from the HC food. Let's cross that bridge when/if we get there. Test 30 minutes from the last test, then report back here with the number and we'll go from there. k?
 
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its currently 12:58 pm here now. I got the BG of 52 at 12:00 NOON my time, approx one hour ago. Getting ready to test again as I let him have LC wellness twice since this happened,,he ate at LC at both sittings 2o min apart about 2 teaspoons each time
 
PS: from what you wrote above and yesterday, I agree you have some things better understood but still some confusion with others. for right now, lets NOT try to worry about all that...let's get this cycle dealt with then come back to that later.

But on a couple of notes, just for perspective, ...you did not make MAJOR goofs. some of these things that feel catastrophic to you are simply normal little blips here and there that happen to everyone. You just process then as if hey are huge and bad. Same with his numbers being a little low or high. I say this only to give you a perspective. There will never be a time you put X amount into even the same cat and always get an X outcome. You just have to take it as it comes and get your toolbox well stocked so you learn how to deal with whatever comes up when it comes up. That's how you gain control and help Norman the most.

..now back to the cycle at hand....
 
re reading everything now..I will say this Betty he is having a good time with his new numbers, the goofball just chased down my more aggressive cat ...so he is not staggering at 62 or anything and I had been afraid of that number...52 little uncomfortable as he did come screaming at me for food, thats what prompted me to test. So he was feeling it at the number
 
Cindywith4cutecats said:
BG 25 minutes since last full 2 teaspoons of food (LC) he is at 62
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Great!...he is surfing. I say stick with the LC..... 62 is a perfectly safe number. THIS IS WHAT YOU WANT! you want Norman spending as much time in normal green numbers as possible to allow his pancreas the break and healing time it needs. You are just giving him some outside assistance. So at this point i think you can wait at least 30-45 minutes before testing again. Just keep checking...and if you want give him only a teaspoon or so of food in 1/2 hour or so to keep him on his surfboard. And remember do not overfeed. If his number drop you want to keep him hungry.

Since you have some time, I'd check the HC cans you have on hand...find one in the 20% or so range. That way if you need any later it would be ready and easy to grab for. For right now the LC is doing the trick . You are doing great!
 
Cindywith4cutecats said:
re reading everything now..I will say this Betty he is having a good time with his new numbers, the goofball just chased down my more aggressive cat ...so he is not staggering at 62 or anything and I had been afraid of that number...52 little uncomfortable as he did come screaming at me for food, thats what prompted me to test. So he was feeling it at the number
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There would be no reason to stagger at 62..that's a perfectly normal number. Normal numbers are 50-120. (some would say 40-120) Many non-diabetic cats run normally in the 40's & 50's. You're biggest challenge is not freaking out.
I am proud of Norman for coming and telling you he was hungry, which prompted you to test. But it's just like if you were late for lunch or skipped it, you're tummy might be growling, you are hungry and want to eat...but you are not about to starve to death.
 
I have a couple questions. When exactly was Norman diagnosed...your SS began in September of last year, was that right when he was first DX?

The reason I ask..is the protocol uses a BG number to earn a reduction of 50 or below for a newly diagnosed diabetic (1 year or less)....but 40 or below for longer term diabetics. And there are some modified versions where beans are waiting for 3 consecutive drops below 40 to warrant/earn a dose reduction.
I had been telling you 50 or below....but notice Julie mentioned 40 or below.

There may be some nuance regarding cats coming out of remission that I am not recalling though..that could default you to the more conservative of the 2 even kitty has been diabetic < 1 yr. That would be something to clarify.
 
Yes I bought some gravy lovers FF which is a highest carb and I still have some cans in the pantry also of the Hills M/D which is like 14% carb. Kept the M/D for a time he may need a carb boost but not require a high hard hit of CARBS like in the gravy lovers. I am in waiting mode to retest and he is sitting on the porch lol...I am just glad I was home and listened to his complaining , well I really had no choice, he nipped the top of my foot and he has never been that aggressive with me before..
 
bettyandhank said:
I have a couple questions. When exactly was Norman diagnosed...your SS began in September of last year, was that right when he was first DX?
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what is answer to ^



..one more favor. It is not clear to me looking at your SS how the delayed shot time, etc.. played out on 7/6. I see some notes on the right, but for those doing only a quick glance in the future, i think it would help to note in the U given box (or next to it) that the shot time was +14.5 OR to note in U box * *shot delayed- see +14.5 ...and then note it in the +14.5 box that 1.75 U was given. Also need to correspondingly note the test before shooting were +12(vs pmps) +13, +14, etc... else it skews things.

as it stands, you glance and the numbers make no sense as it appears you shot at +12, with numbers coming after that make no sense. I knew form having read your condos what happened...but anyone just glancing quickly at your SS in the future will not.....
 
He was diagnosed last September. I found you guys shortly after his diagnosis and back filled the SS. When he was fist diagnosed the Vet said 3 units which you can see we did do and then he dropped pretty low on us ona AT2 meter. We were told to skip shot and then resume following morning at 2 units. I found FDMB sometime after all that happened cause I was not feeling the love with the VET as far what he was telling me to and what would I do over a weekend.....
 
How i understand Julie was that in one of the condos she did 40 to earn a reduction more so on Lev and that Lantus usually earns a reduction below 50....this is my understanding NOrman is on LANTUS.......

JUST RETESTED and his BG is 65 since the last test 45 min ag0

holding off on feeding at all since he is safe right now. Will retest in 45 min to 1 hour . Need to keep the bugger hungry if we drop at his normal nadir time
 
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There is no difference between Lantus and Lev with regard to when a dose reduction is earned. For a longer term diabetic (i.e., more than a year post-diagnosis) or for cats that fall out of remission, we make it tougher for them to get a dose reduction. Either numbers need to drop below 40 OR their numbers need to drop below 50 three times regardless of which of the "L" insulin they are getting.

Please consider that when you see a 52 that you would want to re-test sooner than an hour. Until you have a better handle on Norman's patterns and are getting less upset at lower numbers, re-testing after 30 min. is a much safer strategy than waiting an hour.
 
Cindy-

I have followed you almost since the beginning. The truth is you went mostly by the seat of your pants before... sometimes sort of following protocol, sometimes not..it was random..yet luck had it that Norman did well and responded and down you came. I kept encouraging you to post daily threads for a reason...you keep everything chronologically in one place, people get to know Norman and his patterns, they know his story. On FB there are fragments and pieces all over the place that disappear by the next day...and while there are some old timers posting there, there are also lots of transient posters that may be their first day or week, may be inexperience, etc.. and its hard to discern the difference. Here your SS is attached to your signature, the board is peer reviewed so you get enough input on matters to get different points of view...and be able to learn better.

I will tell you that when Hank was on insulin i had almost no idea at all how it all worked or what was going on often. I simply had to rely on the fact that those with more experience could see things I could not.. I just didn't have my arms around it all yet so early on. I ultimately figured things out more and more over time but in truth it was more in the rear view mirror..we were already in remission having followed the guidance from others. After hanging around long enough, reading others threads, observing advice being given, seeing other SS..it all begins to click. So don't worry about knowing everything at once. It is a lot to know and will come in time.
My concern is more that until you have it all down, that you make a point to get advice and confirmation before making random moves...so you do keep him on track and give him the best chance for another remission. You are truly hands on and a great 'bean'....you just get a little ahead of yourself sometimes.

Cindywith4cutecats said:
How i understand Julie was that in one of the condos she did 40 to earn a reduction more so on Lev and that Lantus usually earns a reduction below 50....this is my understanding NOrman is on LANTUS.......
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NO...this is not correct. it is not a Lantus vs Lev thing. it is a newly diagnosed cat vs a longer term diabetic thing. For cats who are diagnosed less than 1 year...you 'earn' a dose reduction when a given dose drops them below 50 at any point in a cycle. You do not base dosing on pre-shot numbers but on nadirs. (with only some consideration given PS# in case where # may be super low- ie: for safety purpose)

Once a cat has been diabetic a year or more, then the number for warranting a dose reduction becomes 40 or below. And some more conservative will wait for hitting 40 in at least 3 cycles before taking the reduction.
It may be that because Norman is coming back after remission that using 40 (to earn reduction) was used. WE need to get some other feedback on this as it may be that may be some nuance I was not aware of.

The reason for this is you want the earned reductions to 'take'. And a reminder..you won't know in a single cycle or even 2 if something 'took' or not...as with it being a depot insulin, it takes a few cycles for the dose you gave to catch up and reflect in his BG's.
There are many variables that will affect his numbers on a given day..it's never just that he will always respond the same on a particular dose of Lantus.
That is why we test. But as long as you are testing...you will be able to respond to whatever he throws at you. Your goal is to keep in in healing numbers as much of the time as possible. You WANT green. So yes, that means shooting lower....which i know can feel uncomfortable at times. But once you do it more, you will learn how he responds and it will be less scary. If you delay, reduce, skip every time he has a lower PS, you will never get him regulated or off insulin again.
And as a reminder, you shot low plenty before, you just didn't realize it because you were on AT back then and not understanding the conversion. So look back at you SS and add 35% to the numbers and you will see you have already been there done that.

Keep posting every day, post his numbers in the subject line as you get them, read other condos, ask lots of questions..it will all continue to click. Glad he is having such a great surfing green day!!:D:D
 
Sienne and Gabby said:
There is no difference between Lantus and Lev with regard to when a dose reduction is earned. For a longer term diabetic (i.e., more than a year post-diagnosis) or for cats that fall out of remission, we make it tougher for them to get a dose reduction. Either numbers need to drop below 40 OR their numbers need to drop below 50 three times regardless of which of the "L" insulin they are getting.
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OK, Sienne...I figured there may be that nuance since he is back from remission...thanks for confirming!
She is coming up on a year anyway, but this makes sense...that you'd lean more aggressive after relapse.


Cindy, trust Sienne she is quite experienced & wise. So going forward, you do NOT reduce his dose unless he drops below 40 on a given dose in a cycle.
Also note correction she made that the other scenario earning a dose reduction is 3 cycles of dropping below 50 on a given dose (vs the 3x 40 i said)

You want him to earn his reductions, not lower him prematurely or randomly. You want to give his pancreas a chance to be in green numbers and heal. If If after taking and earned reduction, numbers trend upwards for several cycles THEN you might consider taking it back up as a possible failed reduction. But again I would post for advisement before doing so if I were you.
 
I think looking back at his first time around, I did get lucky but I also feel that his pancreas may not have healed to the best it could because I didn't follow the protocol really at all (thought I understood it but really didn't at all ). My vet certainly has not helped at all considering his belief was that getting Norman into a range of 250 to 350 was what he was aiming for lol...then once my vet found I was not following his RULES he kept warning me to never take Norman below 60 at all. That has been ingrained into my head. Today seeing Norman at 52 with what ever variance is in the relion meter, Norman was talkative, playful and down right funny as all could be...am I scared as hell, YES, I would be lying if I said oh yeah I got this..But for Normans sake I have to get this so that he can heal up nice. I have court Wednesday coming up July 15th during the critical time of testing him lol so I have got to get my nerve up and do this so he can earn a reduction by then lol and be left with plenty of kitty food for that 2 hours I won't be home lol....I am so happy he is in the green, he feels better...I will let you know where I am at at shot time. I think if I have any of this figured out I am shooting the NADIR not so much the Pre Shot Number, the nadir is where my attention should be focused on although shooting a 50 would probably not be recommended at all especially someone new like me lol.....so if I shoot low and concentrate on the NADIR this is when I should see so nice flat lines of green that I love so much and dont' freak out over...I think many of us freak when we see a AMPS 325 and hours later down to 52 , we automatically think OMG if I shoot him at PMPS of like 80 he will plummet and die on me.....I have to concentrate on the NADIR...
 
bettyandhank said:
Cindy, trust Sienne she is quite experienced & wise. So going forward, you do NOT reduce his dose unless he drops below 40 on a given dose in a cycle.
Also note correction she made that the other scenario earning a dose reduction is 3 cycles of dropping below 50 on a given dose (vs the 3x 40 i said)
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Not understanding the second part (correction she made ) are you saying do not reduce unless he drops below 40 on a given dose cycle or he drop below 50 3 times during 3 cycles ...so in other words tomorrow he drops below 40 that would earn a .25 reduction ASAP....otherwise I am looking for him for drop below 50 3 times during 3 cycles ...Monday morning NADIR 48 Monday night Nadir 45 and then Tuesday morning Nadir 47 that would earn him a .25 reduction, CORRECT ??? By George I think I may have this.....
 
But if you don't shoot lower, find his optimum dose, etc..then he is forever in high/low numbers and on the roller coaster none of us want.

MANY CATS NOT ON INSULIN AND NOT DIABETIC RUN NATURALLY IN THE 5o's..some in the 40's.

I agree you are not ready to shoot a 50 now either..but that is a non issue at the moment...and if it ever happens come here for communal advice in figuring out what to do.
We've had this discussion, your vet sounds great in many other ways...and tires to learn at least, but like so many is not up to date in day to day management of FD. Remember many/most of their patients may not test, they are trying to avoid hypo and liability. But as a result they just dont have the chance at remission or sometimes even regulation that our cats do. 250-350 is over renal threshold...how is that good for any cat?

Being gone for 2 hours one day is not a big deal..and certainly not something for you to worry about. yes you just leave out food, maybe make some catsicles between now and then. And be sure its one of his favorites you know he will eat.
 
OMG Betty I just tested Normans +8 and he is holding at 65..he is holding flat beautiful greens..OMG I am so stinking proud of myself right now, yes I freaked a little but I didn't go overboard like I usually do. He has not eaten since the +5 and +5.50 mark at all. SO he is holding this on his own without a food influence at all...WOW..can you tell me the question I had regarding the holding for 3 cycles of lower than 50 and a lower than 40 would earn ASAP reduction
 
You don't need to test every 45 minutes in the 60's BTW.

I see that, I just glanced at his SS.
Suggestion: if you use +6.15- (#) ... +6.30- (#) in each square it gives you more room and reads cleaner than spelling out 'plus' . I also use to reduce the font size in my squares to be able to get more in easily.

Also, as you add tests, you edit your subject line to include the new numbers... you won't have room for them all when you test as much as today. but it keeps the subject line more current.
Like right now you still have the ? mark up...which was from earlier. You remove that when you got your question answered..that leaves more room for updating numbers, etc.. People will get on and scan the subject lines first.....to get to those needing attention the most first. ..but won't see the comments if thread not opened. So subject line is sort of a summary of the day...or a current status of where things are, etc.. You may have needed help this morning but not now, or vice versa.

Yes the more you understand the protocol the more in control you will feel. But i repeat...we did not understand it really WHILE it was going on with us, because Hank just responded so quickly I couldn't keep up....it was more in hindsight I began to 'get it'.

This is why those of us outside can sometimes see what you cannot. You have freaked when Normans numbers were not really that high, or when he didn't have all greens and blues in the first 5 minutes, and NOW in contrast when he does...LOL! ...or giving to much weight to what a food is or isn't doing after feeding once, or how many bites he ate.... You will never have that kind of control. He is going to do what he is going to do...you will be able to manage by following protocol, adjusting dose accordingly, steering cycles when needed. There are lots of tricks to pull from but right now just focus on the basics and being consistent.
There will come a time when you hit optimum dose and he does start flying down the ladder that you will really have to stay on top, test, test, test, lose sleep, etc... but it is not in the 60's and 70's. That is a price to pay for heading to remission again so its nerve wracking but worth it. If they dont go down the ladder, then they aren't going in remission either. And it may not be a straight line down either..there will be ups and downs. So just learn whatever he teaches you during those so you get more relaxed and less panicky at every turn. Then you'll be an old pro in no time...
 
Cindywith4cutecats said:
Not understanding the second part (correction she made ) are you saying do not reduce unless he drops below 40 on a given dose cycle or he drop below 50 3 times during 3 cycles ...so in other words tomorrow he drops below 40 that would earn a .25 reduction ASAP....otherwise I am looking for him for drop below 50 3 times during 3 cycles ...Monday morning NADIR 48 Monday night Nadir 45 and then Tuesday morning Nadir 47 that would earn him a .25 reduction, CORRECT ??? By George I think I may have this.....
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YES..you got it! Though it can be at any point in the cycle..not necessarily just the nadir.
1) Reduce his dose IF he drops below 40 on a given dose in a cycle.
or
2)Reduce his dose IF he drops below 50 3 x's in 3 different cycles on a given dose.

@Sienne and Gabby .... does it matter if these are consecutive cycles?




The other good thing is playing with foods to see how Norman responds as you are trying to 'feed up' his numbers. I would find the favorite foods you know he loves and will always eat...and also some different carb levels.... lower low <5, 5-10, etc... as you can start playing with steering his lower cycles with food to keep him surfing greens...and see how he responds to different ones. Then you know what to pull from with what he throws you cause you'll know how different ones bump him up.

If a diabetic person, it might be they need juice, vs a candy bar vs some nuts, etc..
 
... and what beautiful numbers!!! :D:D:D Go Norman!!

(great job on the subject line- see how much clearer it makes it for people scanning)

great job today all around!!!
 
I just shot his 2 units pmps was 147 ...so I am hopeful running 6 full cycles his numbers come down for that pre shot.....I am taking a nap now and hubby is watching him and will test so that I can get up later and be on standby if he should drop ..always good to be ready when you are unsure
 
Cindywith4cutecats said:
OMG Betty I just tested Normans +8 and he is holding at 65..he is holding flat beautiful greens..OMG I am so stinking proud of myself right now, yes I freaked a little but I didn't go overboard like I usually do.
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Well YOU GO GIRL! Way to grab the bull by the horns and take control!

Yay for Betty & Sienne helping clarify things too - I think you're getting the hang of it.

Today was exactly what you want - those nice long green surfs are hours that have the potential for his pancreas to heal. Well done! And shooting the 147 tonight gives the potential to reduce his entire range of numbers - another huge AWESOME thing!

It's fine to dole out a bite of low carb every hour or so when you've got a green surf going - sometimes it can really encourage a cat to surf. You don't want to feed in the couple of hours before the shot, but other than that, it's just up to you. If you see it helps him, go for it. If it doesn't then don't worry about doing it.
 
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