Hello again
EllieKozak said:
I have no idea why it's as low as it is, his dose hadn't changed in a week.
It's quite possible he has been going low on the overnights.
Todays +10 is a heads up that the picture is changing for the better, and also that it's time to re-evaluate and to plan next steps.
It's also time to step up your game
A very important part of the picture is missing -
you don't have any data on where Charlie goes from PM +6 through and including PM+11
EllieKozak said:
If he's in the 400s in the am still skip the r
My $0.02 is that as long as the most recent ketone tests are negative, Charlie is eating well and all Ps are in place hold off on the R for a few cycles so you can see what the Lantus is or is not doing.
Guiding Charlie
safely out of the grasp of ketone development that could potentially progress quite rapidly into DKA is a balancing act.
One of the key elements is safely arriving the right insulin dose; one that is enough to take care of the short term goal of getting the ketones behind you . .
and the long term goal of keeping them behind you, ultimately without R.
You are walking a tightrope - fall on one side and Charlie can end up in DKA again, fall on the other side and his numbers could bottom out.
I see Julie linked the Shooting Low information, which explains
the importance of being 'Data Ready' and the part the +10s and +11s play in becoming so.
From the sticky:
Why the +10s and +11s? These spot checks will help keep you out of trouble. Again, let’s say that you have a lower than usual preshot. If your preshot is higher than +10 or +11, you know the insulin from that cycle is waning, the cat is on his way up, and the number is probably shootable. If you have a preshot that is much lower than your +10 or +11, knowing why will help you decide whether or not to shoot. Some Lantus and Levemir users notice a dip at the end of the cycle, meaning that the preshot is always a bit lower than +10 or +11 (but usually still higher than the nadir – the cat dips to a nadir at mid-cycle, then rises, then dips again). If this is your cat’s pattern, then this type of dip is not a reason to delay a shot. On the other hand, if your cat has a bounce clearing and is still careening downhill at shot time (usually characterized by numbers that drop for the whole cycle, without a clear nadir), then you will want to take that into consideration as you make a decision about shooting. Know thy cat.
Knowing whether your cat is one that dips at the end of the cycle can also help you with dose increases. If your nadirs are not that great and you are considering an increase, but then he dips again at the end of the cycle, you might be tempted to delay the increase. If you know that this is a usual pattern for your cat, you will know that you can ignore that dip and go ahead with the increase.
Do not forget the “neglected spot checks.” They are more useful than most realize.
Know thy cat. Be data ready to handle the situation.
if there are circumstances preventing you from getting any PM +10s and +11s please let us know.
It helps those who are willing to help make appropriate recommendations.
No one knows if it's in the cards but when it comes to regulation or remission potential, being newly diagnosed (less than a year) is an advantage.
Following the TR protocol is also an advantage. Since 2008,
299 kitties, mine included, have gone into remission thanks to the knowledge, camaraderie and generosity of this community.
You have those advantages with Charlie. Make the most of them.
its worth every effort.
