PMPS 6.0 DJOKO - Question

Sorry no one got back to you earlier. Looks like you went with the 1.25U, I think that's good. 1.5U brought him all the way down to 86 on the AlphaTrak, which is safe but low. I'd like to see how he does on the lower dose.

I like that he was blue at pre-shot, and still blue late in the day today!
 
Nan & Amber (GA) said:
Sorry no one got back to you earlier. Looks like you went with the 1.25U, I think that's good. 1.5U brought him all the way down to 86 on the AlphaTrak, which is safe but low. I'd like to see how he does on the lower dose.

I like that he was blue at pre-shot, and still blue late in the day today!
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Nan & Amber (GA) said:
Sorry no one got back to you earlier. Looks like you went with the 1.25U, I think that's good. 1.5U brought him all the way down to 86 on the AlphaTrak, which is safe but low. I'd like to see how he does on the lower dose.

I like that he was blue at pre-shot, and still blue late in the day today!
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I guess this means between shot and +8, he was in the pink. Isn'tthe goal to have him in the blue and higher green?
Please let me know.
 
We don't really have any way of knowing where he was between the two readings. There are (at least) three common possibilities:

1) He followed a "normal" Lantus curve, with the insulin starting to work around +2, bringing him a little lower than the pre-shot number, then started to rise back up by +6

2) He was breaking a bounce from yesterday's red numbers last night, and he continued downward steeply from the pre-shot, going quite a bit lower before rising back up

3) He's just flat in blues today, no movement at all.

There's really no way to tell which of these happened without having a few more tests during the day. I'd guess that #3 is the least likely-- maybe when Djoko has had more time to settle on a good dose for him, he'll have some flat days, but all signs point to him still liking to bounce a little. The good news is that he doesn't seem to be bouncing for very long, he's already back to blue after only a day in high numbers!
Marj & Djoko said:
Isn'tthe goal to have him in the blue and higher green?
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You're right, eventually we want him to be in blues and greens overall. It's a matter of both finding the right insulin dose for him, and also his body getting used to nice numbers like today's. He'll get there!
 
Nan & Amber (GA) said:
We don't really have any way of knowing where he was between the two readings. There are (at least) three common possibilities:

1) He followed a "normal" Lantus curve, with the insulin starting to work around +2, bringing him a little lower than the pre-shot number, then started to rise back up by +6

2) He was breaking a bounce from yesterday's red numbers last night, and he continued downward steeply from the pre-shot, going quite a bit lower before rising back up

3) He's just flat in blues today, no movement at all.

There's really no way to tell which of these happened without having a few more tests during the day. I'd guess that #3 is the least likely-- maybe when Djoko has had more time to settle on a good dose for him, he'll have some flat days, but all signs point to him still liking to bounce a little. The good news is that he doesn't seem to be bouncing for very long, he's already back to blue after only a day in high numbers!


You're right, eventually we want him to be in blues and greens overall. It's a matter of both finding the right insulin dose for him, and also his body getting used to nice numbers like today's. He'll get there!
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Was he really bouncing or was it the outcome of skipping a shot?
 
Mark -

A bit of housekeeping. ..
  • Can you please include which dosing method you're following -- SLGS or TR in your signature? This link provides guidance on what information you need to have in your signature. (I think most of it's there but the dosing method is critical.)
  • Please remember to put Djoko's name in your subject line.
  • Please decide where you want to post. You mentioned that no one replied on the Lantus forum (i.e., here). No one responded on Health, either. While this forum is typically busy, at the moment, we are in extraordinary times. People do their best to respond but sometimes, things get busy in everyone's life or someone on the board is having an emergency. You can always bump your post up.
We do have a few more "rules" here compared to Health but this board gets busy. For example, we also do not have threads that are over a hundred posts long. We encourage people to post on a daily basis if possible. Please read the sticky notes -- they will help guide you as to how this board works.
 
Marj & Djoko said:
Was he really bouncing or was it the outcome of skipping a shot?
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There's no way to tell 100%, of course, but it's unlikely that you'd see that extreme a reaction to a single missed shot of Lantus. You've probably read about the "depot" in the yellow stickies, this is one of the consequences of having a depot. If you miss a shot, there's still the "saved" insulin from previous shots available.

So, it likely wasn't a lack of outside insulin that caused him to go so high, it was the reaction of his body to that good, but unfamiliar, green number.
 
Sienne and Gabby (GA) said:
Mark -

A bit of housekeeping. ..
  • Can you please include which dosing method you're following -- SLGS or TR in your signature? This link provides guidance on what information you need to have in your signature. (I think most of it's there but the dosing method is critical.)
  • Please remember to put Djoko's name in your subject line.
  • Please decide where you want to post. You mentioned that no one replied on the Lantus forum (i.e., here). No one responded on Health, either. While this forum is typically busy, at the moment, we are in extraordinary times. People do their best to respond but sometimes, things get busy in everyone's life or someone on the board is having an emergency. You can always bump your post up.
We do have a few more "rules" here compared to Health but this board gets busy. For example, we also do not have threads that are over a hundred posts long. We encourage people to post on a daily basis if possible. Please read the sticky notes -- they will help guide you as to how this board works.
Click to expand...
I am trying to follow your rules the best I can.
 
Nan & Amber (GA) said:
There's no way to tell 100%, of course, but it's unlikely that you'd see that extreme a reaction to a single missed shot of Lantus. You've probably read about the "depot" in the yellow stickies, this is one of the consequences of having a depot. If you miss a shot, there's still the "saved" insulin from previous shots available.

So, it likely wasn't a lack of outside insulin that caused him to go so high, it was the reaction of his body to that good, but unfamiliar, green number.
Click to expand...
Djoko is at 6 now and does not want to eat. Is it possible that he went into hypo ? He is always hungry normally, especially before his shot. I am worried.
 
Sienne and Gabby (GA) said:
Mark -

A bit of housekeeping. ..
  • Can you please include which dosing method you're following -- SLGS or TR in your signature? This link provides guidance on what information you need to have in your signature. (I think most of it's there but the dosing method is critical.)
  • Please remember to put Djoko's name in your subject line.
  • Please decide where you want to post. You mentioned that no one replied on the Lantus forum (i.e., here). No one responded on Health, either. While this forum is typically busy, at the moment, we are in extraordinary times. People do their best to respond but sometimes, things get busy in everyone's life or someone on the board is having an emergency. You can always bump your post up.
We do have a few more "rules" here compared to Health but this board gets busy. For example, we also do not have threads that are over a hundred posts long. We encourage people to post on a daily basis if possible. Please read the sticky notes -- they will help guide you as to how this board works.
Click to expand...
The link you referred me to does not explain what Dosing: TR or SLGS or Custom stand for.
 
Here's the sticky for dosing methods: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

Marj & Djoko said:
Djoko is at 6 now and does not want to eat. Is it possible that he went into hypo ? He is always hungry normally, especially before his shot. I am worried.
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That is your pre-shot number, 6 (108 in US numbers)?

First: don't give tonight's shot yet, let's do a stall. Don't feed (doesn't sound like that's a problem at the moment), and test again in 30 minutes.

Second: how does he seem otherwise? Is he bright, or is he lethargic? He may not be as hungry after spending most of the day in non-diabetic numbers, but there could be something else going on (let's hope not).
 
Sienne and Gabby (GA) said:
Mark -

A bit of housekeeping. ..
  • Can you please include which dosing method you're following -- SLGS or TR in your signature? This link provides guidance on what information you need to have in your signature. (I think most of it's there but the dosing method is critical.)
  • Please remember to put Djoko's name in your subject line.
  • Please decide where you want to post. You mentioned that no one replied on the Lantus forum (i.e., here). No one responded on Health, either. While this forum is typically busy, at the moment, we are in extraordinary times. People do their best to respond but sometimes, things get busy in everyone's life or someone on the board is having an emergency. You can always bump your post up.
We do have a few more "rules" here compared to Health but this board gets busy. For example, we also do not have threads that are over a hundred posts long. We encourage people to post on a daily basis if possible. Please read the sticky notes -- they will help guide you as to how this board works.
Click to expand...

As per your third point, I have just started posting on Lantus and I am not the best at technology. Let's be indulgent. I thought I had not received a response because I had not posted at the right place. It is true. Difficult times for everyone.
Merci
 
Nan & Amber (GA) said:
Here's the sticky for dosing methods: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)



That is your pre-shot number, 6 (108 in US numbers)?

First: don't give tonight's shot yet, let's do a stall. Don't feed (doesn't sound like that's a problem at the moment), and test again in 30 minutes.

Second: how does he seem otherwise? Is he bright, or is he lethargic? He may not be as hungry after spending most of the day in non-diabetic numbers, but there could be something else going on (let's hope not).
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He just ate a bit (sorry). He seemed lethargic. We played earlier and he had lots of energye and I thought he was off throughout the end of the cycle. I was checking on him but thought he was napping.
Should I not feed him and retest? Or feed him (since I have already started) and test him in 2 hours. Merci
 
Hmmm.... if he only ate a little bit, you could try testing in 30mins and see if he is higher.

My concern is that, while his current BG is shootable with experience, it's a much lower number than you have shot before. We like to work our way down to shooting these kinds of numbers, so that we have a good idea of what will happen.

Stalling will give us a chance to "cheat" a bit to look in the future by 30 mins, to see if he's moving up or down. All we know right now is that he's lower than he was at +8, but he could be on the way up again.
 
Nan & Amber (GA) said:
Hmmm.... if he only ate a little bit, you could try testing in 30mins and see if he is higher.

My concern is that, while his current BG is shootable with experience, it's a much lower number than you have shot before. We like to work our way down to shooting these kinds of numbers, so that we have a good idea of what will happen.

Stalling will give us a chance to "cheat" a bit to look in the future by 30 mins, to see if he's moving up or down. All we know right now is that he's lower than he was at +8, but he could be on the way up again.
Click to expand...
Do you think he went into hypo and that explains his lethargy? I was next to him this is bad on my part.
 
Well, lethargy is one of the symptoms of a mild hypo, problem is it's so hard to tell the difference between "lethargy" and "nap time" with cats :D.

There's no way to tell, really, without having the numbers and without any more diagnostic external symptoms. I will say, though, that most cats respond to really low numbers by getting hungrier, so either Djoko is one of the exceptions, or he didn't actually go that low.

I'm thinking that, unless he's a lot higher on the next test, you will probably end up skipping tonight again. How do you feel about that?

Whether or not you skip, I would definitely maintain the lower dose going forward. Seems like Djoko does better with a little less insulin.
 
Nan & Amber (GA) said:
There's no way to tell, really, without having the numbers and without any more diagnostic external symptoms. I will say, though, that most cats respond to really low numbers by getting hungrier, so either Djoko is one of the exceptions, or he didn't actually go that low.
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Yes when he got at his lowest, 4.8, he was very hungry and running around to get food. He seems well today I don't get it.


Nan & Amber (GA) said:
I'm thinking that, unless he's a lot higher on the next test, you will probably end up skipping tonight again. How do you feel about that?
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Last time I slipped he went back in the red zone but safety first!
Nan & Amber (GA) said:
Whether or not you skip, I would definitely maintain the lower dose going forward. Seems like Djoko does better with a little less insulin.
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Today I gave him 1.25U. When I did the curve on Sunday, I fed him more (more than what the vet says he needs for a shot). I fed him the entire day throughout the day. Given that I reduced the dose, I did not feed him the entire day as I did last Sunday. I gave him snacks but less. So from now on is it 1U or 1.25U? How much should I feed him?
 
Nan & Amber (GA) said:
Well, lethargy is one of the symptoms of a mild hypo, problem is it's so hard to tell the difference between "lethargy" and "nap time" with cats :D.

There's no way to tell, really, without having the numbers and without any more diagnostic external symptoms. I will say, though, that most cats respond to really low numbers by getting hungrier, so either Djoko is one of the exceptions, or he didn't actually go that low.

I'm thinking that, unless he's a lot higher on the next test, you will probably end up skipping tonight again. How do you feel about that?

Whether or not you skip, I would definitely maintain the lower dose going forward. Seems like Djoko does better with a little less insulin.
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Is reducing the dose a possibility?
 
Marj & Djoko said:
So from now on is it 1U or 1.25U? How much should I feed him?
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As of right now, 1.25U, unless he gives you a lower number on the re-test. If he does that, you'll skip tonight and the new dose tomorrow will be 1.0U.

Marj & Djoko said:
Is reducing the dose a possibility?
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Do you mean as a one-time reduction tonight? Yes, depending on what number he gives you next, it might be an option to do a half-dose tonight instead of skipping or shooting the full dose.
 
Have you re-tested, or did you decide to skip tonight? Even if you skip, you should get another test to make sure Djoko is staying out of trouble-- we don't know where he was headed from that 6 (108).
 
Nan & Amber (GA) said:
Have you re-tested, or did you decide to skip tonight? Even if you skip, you should get another test to make sure Djoko is staying out of trouble-- we don't know where he was headed from that 6 (108).
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Hello, I just retested (it was difficult as his ears are in a rough state). He is at 8 now.
 
Nan & Amber (GA) said:
As of right now, 1.25U, unless he gives you a lower number on the re-test. If he does that, you'll skip tonight and the new dose tomorrow will be 1.0U.



Do you mean as a one-time reduction tonight? Yes, depending on what number he gives you next, it might be an option to do a half-dose tonight instead of skipping or shooting the full dose.
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Yes I meant a one-time dose reduction for tonight.
 
OK, from here it is your call. Feed him now, see how he eats. The number is high enough to shoot, but if you're worried he still doesn't have a good appetite, or if you don't want to get off-schedule on shots, you can skip. Or you could shoot a reduced dose, maybe 0.5U. A full dose (1.25U-- he has not earned another reduction yet) is also possible, but only if you are prepared to monitor as long as necessary tonight. Once again, I won't be able to stay up with you if you shoot and he goes low, so I really hesitate to recommend that option. As Sienne mentioned, we are especially short-handed around here as everyone is dealing with off-line issues, so I don't know who else might be here tonight.
 
Nan & Amber (GA) said:
OK, from here it is your call. Feed him now, see how he eats. The number is high enough to shoot, but if you're worried he still doesn't have a good appetite, or if you don't want to get off-schedule on shots, you can skip. Or you could shoot a reduced dose, maybe 0.5U. A full dose (1.25U-- he has not earned another reduction yet) is also possible, but only if you are prepared to monitor as long as necessary tonight. Once again, I won't be able to stay up with you if you shoot and he goes low, so I really hesitate to recommend that option. As Sienne mentioned, we are especially short-handed around here as everyone is dealing with off-line issues, so I don't know who else might be here tonight.
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I would only give him 0.5U but he has not eaten enough. Merci.
 
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