Need SS analysis and dosing advice. New Member.

BonnieZeke

BonnieZeke

Member Since 2019
I test Zeke before I go to work at 8PM, am gone for 11 hrs. and his AMPS is before I go to sleep at 8AM. He is quite high is AM when I get home. I never know if he is just waking up, or has been up waiting for me and has been grazing. He does eat well in AM, doesn't usually finish a full 1 can, and we play a little, then he sleeps when I do until approx. 3p. Then he gets 1/2 can and is up with me until time for me to go to work and gets another can and shot. He has a sister who is approx. 13, and she shares this schedule, as well. She is not diabetic. I am aware of bouncing and am trying to deal with it. when I try to lower dose, he doesn't do well, when I raise it, he bounces. I did a curve last week. He is much more relaxed on curve days because I am home and he gets to play outside, and gets lots of love and attention, so I don't know if he is lower than usual due to this then. Any suggestions to get these numbers down? Thanks. I don't know which protocol I am on, just trying to get in a groove somehow. Feeling frustrated and sorry for him.
 
Hi Bonnie,
I think one of the best things you could do is decide which method you are going to follow.
If you are gone for 11 hours each day, you might like to start on the Start Low Go Slow method.
It will give you more structure and direction if you are following a method and take the guesswork out of it all.
Read about it here
http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

You have been on the 2.1 dose for a week now so you are ready to do a curve. Do that when you can, post the results and ask for dosing advice.

Until Zeke gets used to lower numbers again, he is going to bounce when you raise the dose and his numbers drop into lower numbers. This is perfectly normal and there is nothing you can do about it but to persevere with following the method, increasing when indicated, and wait for him to get used to lower numbers. Some cats do this quickly and some cats take a lot longer.
All you can do is put on your patience pants and wait it out:joyful:

One thing to remember is that the AMPS is often the last of the numbers to come down, so if you see higher AMPS just remember this.
Keep asking questions. You are doing well.
 
Thank you, I will read it, it'll be nice to know what I'm shooting for...ha! ha!. I'll try another curve and take it easy the best I can. It's hard when I know he doesn't feel well.:blackeye:
 
BonnieZeke said:
Thank you, I will read it, it'll be nice to know what I'm shooting for...ha! ha!. I'll try another curve and take it easy the best I can. It's hard when I know he doesn't feel well.:blackeye:
Click to expand...
I completely understand how you are feeling. We like our kitties to be happy. But the best way to help him is to get started with a method.
 
Welcome to the group!!

In looking over Zeke's spreadsheet (SS), what do you mean by "ggt"? Are you using this to mean drops?

You also noted that any test below normal (80- 150) is considered "hypo." That's not accurate. If you look at the parameters for the Tight Regulation Protocol, for a cat beyond the first year since diagnosis, numbers have to drop below 40 for a dose reduction. We don't want our kitties to spend a lot of time below 40, but it's unlikely that a brief time that low will result in hypoglycemia. Normal range on a human meter is 50 - 120.

Would Zeke do better with a timed feeder? There are models where the food tray rotates and that way you can insure that he isn't getting any food for the 2 hours prior to his shot. At least you would know if he's having a food spike around shot time. A feeder will also allow you to spread out his meals which may help to offset any lower numbers since he can eat when he's hungry or if his numbers are dropping.

Bouncing is normal. If you are attempting to adjust Zeke's dose to compensate for his bouncing, chances are you will make yourself crazy. Whatever you can do to get tests, particularly around mid-cycle will help you to know if Zeke is bouncing and how low numbers are going.

This post on using Tight Regulation with a Full Time Job may give you some ideas on managing Zeke's FD given your schedule.
 
Tha
Sienne and Gabby (GA) said:
Welcome to the group!!

In looking over Zeke's spreadsheet (SS), what do you mean by "ggt"? Are you using this to mean drops?

You also noted that any test below normal (80- 150) is considered "hypo." That's not accurate. If you look at the parameters for the Tight Regulation Protocol, for a cat beyond the first year since diagnosis, numbers have to drop below 40 for a dose reduction. We don't want our kitties to spend a lot of time below 40, but it's unlikely that a brief time that low will result in hypoglycemia. Normal range on a human meter is 50 - 120.

Would Zeke do better with a timed feeder? There are models where the food tray rotates and that way you can insure that he isn't getting any food for the 2 hours prior to his shot. At least you would know if he's having a food spike around shot time. A feeder will also allow you to spread out his meals which may help to offset any lower numbers since he can eat when he's hungry or if his numbers are dropping.

Bouncing is normal. If you are attempting to adjust Zeke's dose to compensate for his bouncing, chances are you will make yourself crazy. Whatever you can do to get tests, particularly around mid-cycle will help you to know if Zeke is bouncing and how low numbers are going.

This post on using Tight Regulation with a Full Time Job may give you some ideas on managing Zeke's FD given your schedule.
Click to expand...
That ‘hypo’ is part of the SS I used, I didn’ t write that in. I wish I could take that out, I’ve been asked about it. I’m thinking of the timed feeder. How much are they? I’ll investigate.
Even though I am holding for 5-7 days I guess I am adjusting for bouncing, that’s why I am here., you are right It’s making me a little frustrated and discouraged, but I’m feeling better already, I think I may use the ‘go slow ‘protocol.
I can get mid cycle tests when I am off, that will have to do.
He was 111 this AM when I got home from work!
There was no food left, I didn’t shoot, of course.
I’m going to get a test now, just waking up, I bet he’s high. I just wait until PMPS to shoot.
Yes I used get for drop it’s a medical abbreviation, (I’m a nurse).
I’m wondering how to use the feeder with 2 cats, I don’t know if I want to buy 2.
Thanks for all the feedback, I really appreciate it!
 
[QUOTE="BonnieZeke, post: 2439121, member: 28083"

That ‘hypo’ is part of the SS I used, I didn’ t write that in. I wish I could take that out, I’ve been asked about it. I’m thinking of the timed feeder. How much are they? I’ll investigate.
Even though I am holding for 5-7 days I guess I am adjusting for bouncing, that’s why I am here., you are right It’s making me a little frustrated and discouraged, but I’m feeling better already, I think I may use the ‘go slow ‘protocol.
I can get mid cycle tests when I am off, that will have to do.
He was 111 this AM when I got home from work!
There was no food left, I didn’t shoot, of course.
I’m going to get a test now, just waking up, I bet he’s high. I just wait until PMPS to shoot.
Yes I used get for drop it’s a medical abbreviation, (I’m a nurse).
I’m wondering how to use the feeder with 2 cats, I don’t know if I want to buy 2.
Thanks for all the feedback, I really appreciate it![/QUOTE]gtt not ‘get’ (auto correct)
 
I kinda figured you were a nurse! Medical charts are the only place I see the gtt abbreviation.

This is the timed feeder that many people here use. PetSafe also makes a less complicated model with 2 food bins. I thought about the issue with 2 cats. I. used the 2 bin feeder and when I was using it, I had 2 kitties. My diabetic, Gabby, was far more food motivated than Gizmo. I did leave enough for 2 cats in each of the bins - which Gabby probably hovered up. The alternative is to separate them when you're working. You could always observe them on your days off and see how they use the feeder.

Hmmmm.... That's not our usual spreadsheet template. I'm surprised you can't edit that information out once you copy over the template.

Lest those of us who are veteran Tight Regulation Protocol users make this a point of contention, Start Low Go Slow (SLGS) is not a "protocol." TR has been researched and published in a leading veterinary journal. SLGS was a dosing method developed here and was used prior to and since the publication of TR. It's a more generic method that can be used with any type of insulin. TR was developed specifically for Lantus and Lev. Both are effective and have gotten any number of cats into remission. We have a couple of members who are very exacting and take issue with SLGS being referred to as a protocol.

 
BonnieZeke said:
Tha

That ‘hypo’ is part of the SS I used, I didn’ t write that in. I wish I could take that out, I’ve been asked about it. I’m thinking of the timed feeder. How much are they? I’ll investigate.
Even though I am holding for 5-7 days I guess I am adjusting for bouncing, that’s why I am here., you are right It’s making me a little frustrated and discouraged, but I’m feeling better already, I think I may use the ‘go slow ‘protocol.
I can get mid cycle tests when I am off, that will have to do.
He was 111 this AM when I got home from work!
There was no food left, I didn’t shoot, of course.
I’m going to get a test now, just waking up, I bet he’s high. I just wait until PMPS to shoot.
Yes I used get for drop it’s a medical abbreviation, (I’m a nurse).
I’m wondering how to use the feeder with 2 cats, I don’t know if I want to buy 2.
Thanks for all the feedback, I really appreciate it!
Click to expand...
Sienne and Gabby (GA) said:
I kinda figured you were a nurse! Medical charts are the only place I see the gtt abbreviation.

This is the timed feeder that many people here use. PetSafe also makes a less complicated model with 2 food bins. I thought about the issue with 2 cats. I. used the 2 bin feeder and when I was using it, I had 2 kitties. My diabetic, Gabby, was far more food motivated than Gizmo. I did leave enough for 2 cats in each of the bins - which Gabby probably hovered up. The alternative is to separate them when you're working. You could always observe them on your days off and see how they use the feeder.

Hmmmm.... That's not our usual spreadsheet template. I'm surprised you can't edit that information out once you copy over the template.

Lest those of us who are veteran Tight Regulation Protocol users make this a point of contention, Start Low Go Slow (SLGS) is not a "protocol." TR has been researched and published in a leading veterinary journal. SLGS was a dosing method developed here and was used prior to and since the publication of TR. It's a more generic method that can be used with any type of insulin. TR was developed specifically for Lantus and Lev. Both are effective and have gotten any number of cats into remission. We have a couple of members who are very exacting and take issue with SLGS being referred to as a protocol.
Click to expand...
Ok, I'll do whichever will do the trick. Right now I have a concern... his BG this AM was 111! I have no idea why, nothing was different. All the food was gone this morning when I came home. I tested 3 times, 111, 117, 113! So I skipped shot, of course, and 463 when we got up at 3p. How long will it take for him to get over the missed dose?
Should I wait to try a curve? Should I hold at the 2.1?
 
Sienne and Gabby (GA) said:
I kinda figured you were a nurse! Medical charts are the only place I see the gtt abbreviation.

This is the timed feeder that many people here use. PetSafe also makes a less complicated model with 2 food bins. I thought about the issue with 2 cats. I. used the 2 bin feeder and when I was using it, I had 2 kitties. My diabetic, Gabby, was far more food motivated than Gizmo. I did leave enough for 2 cats in each of the bins - which Gabby probably hovered up. The alternative is to separate them when you're working. You could always observe them on your days off and see how they use the feeder.

Hmmmm.... That's not our usual spreadsheet template. I'm surprised you can't edit that information out once you copy over the template.

Lest those of us who are veteran Tight Regulation Protocol users make this a point of contention, Start Low Go Slow (SLGS) is not a "protocol." TR has been researched and published in a leading veterinary journal. SLGS was a dosing method developed here and was used prior to and since the publication of TR. It's a more generic method that can be used with any type of insulin. TR was developed specifically for Lantus and Lev. Both are effective and have gotten any number of cats into remission. We have a couple of members who are very exacting and take issue with SLGS being referred to as a protocol.
Click to expand...
I love your beautiful signature statement. I'll try to edit the SS.
 
I have a sneaky suspicion he went lower t Han expected when you were at work. I'm not sure how you're going to fit in a curve since it would mean testing every 2 hrs.

With TR, if you skip a shot, the rule of thumb is that the shot "clock" starts over. Since with TR, you evaluate the dose every 3 days/6 cycles, the cycle count re-starts. (The same is true for any change in dose.) The issue is that the depot needs time to re-stabiize if you do anything that changes the dose. With SLGS, there's more flexibility and the guidelines don't specifically state how long to stay at a dose if you skip or reduce. I'm tagging @Jill & Alex (GA) who knows the ins and outs of SLGS better than I do.

Thank you regarding the quote. I came across it shortly after Gabby crossed the Bridge. I touched me and helped to ease the grief.
 
I can do curves when I am off occasionally. I need to give him his shot now so will stay with 2.1.Thanks. No curves this weekend. I'm off next weekend.
 
Sienne and Gabby (GA) said:
Lest those of us who are veteran Tight Regulation Protocol users make this a point of contention, Start Low Go Slow (SLGS) is not a "protocol." TR has been researched and published in a leading veterinary journal. SLGS was a dosing method developed here and was used prior to and since the publication of TR. It's a more generic method that can be used with any type of insulin. TR was developed specifically for Lantus and Lev. Both are effective and have gotten any number of cats into remission. We have a couple of members who are very exacting and take issue with SLGS being referred to as a protocol.
Click to expand...
I strongly suspect a 'point of contention' has simply been made due to a lack of knowledge and/or misunderstanding of how each dosing method came about.

The original SLGS method was created by laypersons/members of the FDMB in our '5 Steps to Regulating Your Diabetic Cat' document (circa 1996 or so)... a document which could be applied for use with all insulins known at the time. However, adaptations were necessary and were eventually made to specifically accommodate the action, nuances, and exceptions to the newer Lantus, Basaglar, and Levemir insulins (2014). The adapted version was called, "The Start Low, Go Slow Method (SLGS) with Lantus, Basaglar, or Levemir for Diabetic Cats." To my knowledge, no one from the FDMB has attempted to have the dosing method published.

The original "Protocol: Tight Regulation with Lantus®or Levemir® for Diabetic Cats" was created by laypersons/members of the German Diabetes-Katzen Forum (circa 2002-3 or so). The 'research' was put together by the cat parents themselves... much like any research was done here on the FDMB. Dr. Rand was not even associated with the German TR Protocol until many years later. A move I suspect had more to do with the ability to publish easily, than much else.
Sienne and Gabby (GA) said:
With TR, if you skip a shot, the rule of thumb is that the shot "clock" starts over. Since with TR, you evaluate the dose every 3 days/6 cycles, the cycle count re-starts. (The same is true for any change in dose.) The issue is that the depot needs time to re-stabiize if you do anything that changes the dose. With SLGS, there's more flexibility and the guidelines don't specifically state how long to stay at a dose if you skip or reduce.
Click to expand...
(emphasis mine)
When following the dosing methods presented on the FDMB, and given the very nature of the depot, the depot will always require time to re-stabilize if you do anything to change the dose.

With SLGS, the guidelines do not specifically say how long to stay at a dose after skipping or reducing. Instead, the method relies on those offering assistance to draw upon their knowledge and experience of the insulin in use and combine that knowledge with data you've accumulated in an effort to assist you. Eventually, you'll have that knowledge and even experience at your fingertips. That's when you'll feel comfortable making your own dosing decisions. :)
Sienne and Gabby (GA) said:
I'm tagging @Jill & Alex (GA) who knows the ins and outs of SLGS better than I do.
Click to expand...
Assisting members with SLGS has less to do with 'ins and outs' of the dosing method itself and more to do with understanding and recognition of the action and nuances of glargine or detemir.
 
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