9/8 Toeby - Is there a protocol for a switch back to SLGS from TR?

[Laurasboyz]

Our last post was August 29th: https://www.felinediabetes.com/FDMB...-3-5-47-4-59-4-5-70-5-77.252182/#post-2845418

Toeby and I didn't have a good day today.
He started off this morning with a 121 preshot, acted normally, but a +3 check showed him at 40.
I gave him some gravy HC food, which normally works to raise his BG level.
Today it didn't - it took me over two hours to get his BG over 50.
I even had to give him some honey because he eventually stopped eating for me, something he'd never done before.

I want to stop following TR guidelines.
I really don't think attempting to give him just a drop of insulin on a TR protocol is going to work for me.
He's gone below 50 three times at this 0.10 unit dose, and had an even 50 a fourth time.

I know I have to indicate a change on my spreadsheet, in the event I need help and someone looks at my SS.

I'm not sure if I should go back to the original SLGS guideline to decide whether to shoot or not, i.e not shooting below 100, and possibly skipping doses at BG's from 150 - 200.
If someone could help me on that, I'd really appreciate it as I'm feeling a bit frazzled on how to proceed.

I did search on previous posts, and read the lengthy convo about some people wanting to modify TR and the establishment of the SLGS protocol, but obviously I'm sure I didn't read all the discussions on how to go BACK to SLGS from TR.

Any input will be considered and appreciated.
Tagging @Wendy&Neko and @tiffmaxee and @Christie & Maverick
Not playing favourites! just some people I know who have given guidance on dosing in our past.
Thanks,
Laura

 

[Katherine&Ruby]

So sorry you're having such a rough time of it, Laura. You just make the decision to do it. There is nothing special about making the switch. You don't shoot anything below 90 or whichever reduction point you choose, since Toeby doesn't have anywhere to go with reductions right now. This might be a good solution for you.

 

[tiffmaxee]

How about going down to a drop abut don’t shoot if he’s lower than 90 or whatever number you choose. He’s earned a reduction to a drop. Would it be possible to count the number of drops in your .10? Everybody gets a different number when that low and with different brands of syringes. There’s a chance he’s already on a drop. If not maybe the difference between your 0.10 and a drop may be bugger than you think and he won’t go low. Does he get a +8-9 snack? Let’s see what Wendy has to say.

 

[Christie & Maverick]

Oh Laura, I'm sorry you are feeling frazzled . You can change to SLGS anytime you want. I know it can be frightening when the usual measures don't seem to bring the numbers up like they have done in the past. Even if you decide to go back to SLGS, I would try a drop dose for a while. Generally with SLGS you do not shoot if he is under 90. And, you would be taking reductions under 90, but it is a general guideline which may be personalized if you feel you have a good sense of how Toeby responds to insulin. That may mean perhaps reducing the threshold when you take a reduction. I see you've tried front loading the cycles a little with carbs, was that something you did today or is that just occasionally?

 

[Chris & China (GA)]

If someone could help me on that, I'd really appreciate it as I'm feeling a bit frazzled on how to proceed.

I have to wonder if you got a wonky syringe this morning that gave him a bigger dose than the .1 you were trying for because he's been doing well on that dose for some time.

But anyway, if you want to go back to SLGS, just do it. Change it in your signature and on your spreadsheet....but NO, you don't go back to the "original" directions since you now have a lot of testing data and experience. At first we say not to shoot below 200 but you gradually reduce that even on SLGS. The main difference is on SLGS, we don't shoot below 90 where on TR we shoot anything over 50.

You might want to consider trying to use calipers for dosing....that way you ignore the wonky lines on the syringes completely and your dosing can be a lot more accurate.

 

[Laurasboyz]

Thanks for the prompt responses... I've just been feeling quite stupid about how to make the switch - I like having written guidelines to refer to.
Many of his preshots in the last couple weeks were below 150, which is what I thought was the point you would not automatically shoot.
He has seldom been below 90 - so maybe a switch to SLGS is not going to help.

I do give him snacks of low carb or sometimes MC if he seems on the low side when I test him, but he has free access to food all day except for the couple hours before testing, when we take up his food.
He would eat snacks at +9 if I was here to feed him - for whatever reason, he will leave food in his dish, but eat for me if I deliver it to him and fuss over him.

I have tried to see how many drops are in what I measure to be 0.10, and to be honest, I guess it depends how big your drop is...
I'm not giving him much more than a big fat drop, maybe two.

His vet thinks I should not be running his BG so low, and I guess a morning like this morning just supports her opinion.
She'd be happy if he was running under 200 without insulin.
I'd be happy if he wouldn't keep surprising me with lows.

 

[Laurasboyz]

You might want to consider trying to use calipers for dosing....that way you ignore the wonky lines on the syringes completely and your dosing can be a lot more accurate.

Hi Chris, nice to see you - I am used to seeing you primarily on the FB group.
With regard to calipers: I bought digital calipers last year, (this is a bit of a running refrain from me) but I use BD syringes with the round ring at the bottom and I cannot for the life of me understand how using the calipers is easier or more accurate - I will post photos if that will help show what my issue is, but the best I can describe in words is that - I don't have the wherewithall to print that German scale meant for A4 paper stock on my printer paper to lay the syringe on top of - and eyeballing a dose that's a millimeter or less than a millimeter between the arms of the caliper with that ring in the mix is beyond me.
I just don't understand how people do it with any real accuracy given that tiny space between the arms of the caliper.

 

[Laurasboyz]

How about going down to a drop abut don’t shoot if he’s lower than 90 or whatever number you choose. He’s earned a reduction to a drop. Would it be possible to count the number of drops in your .10? Everybody gets a different number when that low and with different brands of syringes. There’s a chance he’s already on a drop. If not maybe the difference between your 0.10 and a drop may be bugger than you think and he won’t go low. Does he get a +8-9 snack?

Hi, just checking back in tonight - I do read everyone's responses to my posts and wanted to respond to this and to everyone who responded to my original post who will get tagged (I think?) after some fresh data.
He deffo got a nice snack of low carb canned food this afternoon at +9, before we took their food bowls up at +10... he was hungry today, but his BG's were up so that may go hand in hand.
I did give him snacks in the earlier hours of the cycle as well.

I did try again to measure what my 0.10 was, as Elise is absolutely right, it is important to know.
I drew up water in a syringe several times and expressed the water onto a non-absorbent surface, and my 0.10 is probably was somewhere between one fat droplet or two, depending on variables like my eyes and the ease with which the plunger slides (and yes, I move it back and forth several times to distribute the lubricant in the syringe before drawing insulin).

Today I tried to give him what I was fairly sure is just ONE drop...
This morning it didn't have much effect, but tonight he was 187 at supper/shot time and 4 hours later, much to my surprise, he had dropped to 95 - that's a pretty big effect from one drop of insulin, in my humble opinion.

I thought Chris's theory about a wonky syringe might be a good one, but it also appears that he is quite reactive to his insulin.
I would happily use calipers if it would make me more accurate in dosing, and I could use a magnifying glass, but it still comes down to using my eyes.
If one unit of the insulin I use measures 1.5 mm in length in the BD Ultrafine syringes I use, then 0.10 units measures 0.15 mm in length, and that's not very big/long to measure with one's eyes even with metal caliper arms set at an exact distance.
One drop is less than 0.15 mm.
If I'm wrong, and doing the math wrong, please let me know.

I changed my signature and put a line on my SS to indicate SLGS, as I have no inclination to shoot any amount below 90 any more, and I will probably pick a higher number than 90.
That's the hard part now, deciding what is best for him, for me, and to make his vet comfortable.
I got my coveted "balls of steel" award once and will have to admire that on the mantel from now on.

Thanks again for all ideas and input.
Laura