Still somewhat new to Tight Regulation with Trinity, Help?

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JoeyB

JoeyB

Member Since 2013
Trinity has been doing great, her BG levels are beginning to come back into the normal range, but I'm unsure whether to give shot or not.

AMPS was 53, best levels yet. Last time she was this low in the morning, she blew up into the 300's only 3 hours later.

Holding shot for now and will re-test in a couple hours.

Advice?
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Hi Joey, welcome to LantusLand! You're doing a fantastic job with Trinity!

I think 53 is too low for you to shoot. Do not feed. You have 3 options:
1. Stall, do not feed, wait 30 mins and test again. Keep doing this until her numbers rise above 150 then shoot. This becomes the new shot time.
2. Shoot a reduced dose, not the best option now because she is still too low to shoot
3. Skip the shot, not a great option because she will likely zoom up, as you saw before

Are you going to be around to test, have plenty of strips, and have medium carb and high carb food or karo or honey to bring up BGs if needed?
Liz, Zener's other mom
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Hi guys .. no dosing advice from me but wanted to say Welcome to lantus land!!
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Yowzah Wowzah! nailbite_smile

Actually a great number, but you did the right thing to stall and seek guidance at this stage of the game.

(why does this always happen on Wed. when Marje is at work?)

But that's the beauty of this place. Nearly always someone here to help.
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

I agree with Liz. You're not quite data ready to shoot this low.

Hopefully, you've not yet fed Trinity. Can you re-test to see what direction her numbers are going? You might also want to take a look at the section of this sticky on dealing with low pre-shot numbers and becoming data ready.
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Anne & Zener said:
Hi Joey, welcome to LantusLand! You're doing a fantastic job with Trinity!

I think 53 is too low for you to shoot. Do not feed. You have 3 options:
1. Stall, do not feed, wait 30 mins and test again. Keep doing this until her numbers rise above 150 then shoot. This becomes the new shot time.
2. Shoot a reduced dose, not the best option now because she is still too low to shoot
3. Skip the shot, not a great option because she will likely zoom up, as you saw before

Are you going to be around to test, have plenty of strips, and have medium carb and high carb food or karo or honey to bring up BGs if needed?
Liz, Zener's other mom
Click to expand...

My schedule is pretty hectic at the moment, just got back from work. I fed the normal amount of Fancy Feast at 10:00 and went to work.

When I returned I tested and she was at only 147. A HUGE difference from her last NO SHOT +3 on 8/28 where she went up almost 290 points!

I'm thinking the best thing I can do now is hold the shot till her normal time tonight. It's very hard for me to change her shot schedule due to my own work schedule.

With the way her numbers are trending downwards, perhaps she is ready for a reduction?
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Sienne and Gabby said:
I agree with Liz. You're not quite data ready to shoot this low.

Hopefully, you've not yet fed Trinity. Can you re-test to see what direction her numbers are going? You might also want to take a look at the section of this sticky on dealing with low pre-shot numbers and becoming data ready.
Click to expand...

Had to go to work and couldn't do any of the above but not shoot. Trinity's +3 was only 147 so I am putting off her shot until PM.

As stated above, am considering a reduction taking into account her downward trend.
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

PeterDevonMocha said:
Hi guys .. no dosing advice from me but wanted to say Welcome to lantus land!!
Click to expand...

Thanks for the welcome! I'll probably be settling in here eventually since I seem to be doing TR already!
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Sienne and Gabby said:
I agree with Liz. You're not quite data ready to shoot this low.

Hopefully, you've not yet fed Trinity. Can you re-test to see what direction her numbers are going? You might also want to take a look at the section of this sticky on dealing with low pre-shot numbers and becoming data ready.
Click to expand...

Have the sticky now bookmarked. Had to leave and go to work, so didn't have any other option other then no shot but am reasonably happy with her +3 at only 147. That was a rise of only 94 points compared to a 290 point rise on 8/28.

Napping for a couple hours now, then testing before work again, and will return at 10 tonight to see where this is all going.
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

There are two basic protocols that people follow for dosing. One is Tight Regulation (TR) and the other is Start Low Go Slow (SLGS). This forum is technically the TR forum and the "relaxed" Lantus forum is the SLGS. You are welcome to post here and follow the SLGS as this forum is the most active and you are likely to get help more quickly here. Here is a reference for the SLGS protocol. The TR protocol is in the starred stickies at the top of this forum.

According to the SLGS protocol, you should reduce the dose by 0.5u, since Trinity went below 90 mg/dL. I am not very familiar with that protocol though so I suggest that you get someone else's input to be sure.
Liz
ETA: You would not reduce if following TR, since Trinity did not go below 50.
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Stayed up before nap an extra hour to get a new test. It came in at 382!!!

Up 250 points in ONE hour? Talk about a roller coaster ride!

Went ahead and gave 1.5u shot at +4 because I didn't want to see her go much higher then what she already has.
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Yes, it's rather distressing to see what happens without the jooce. :-x We recommend that the lantus be given every 12 hours. So when you delay the shot, that becomes the new shot time in the pm. You can adjust the shot by 30 minutes per day, either 30 minutes at 1 shot or 15 minutes at both shots.
Liz
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

As you have heard, the idea is to get a stable depot going. That's why you want to shoot the same dose every 12 hours for the prescribed number of cycles dictated by the numbers.

I don't like to stall more than 2 hours so it's easier to get back on schedule. Of course I don't think I've ever intentionally skipped a shot with Chip.

While shooting at the regular time tonight would be 4 hours early and *behave* somewhat like an increase, the reverse isn't true as you saw the other night.

It's more likely to generate instability. That all *should* improve once you get settled to shooting the same dose every 12 hours.

Because she's having such a promising response, I'd stick with TR and work through these intricacy's with the gurus here and see what that looks like. Getting her into healing normal numbers improves her chance for remission.
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Just a correction to Liz's note about the SLGS approach to dosing. You reduce the dose by 0.25u. There's a caveat in the instructions that the dose change amount is dependent on the insulin. With Lantus, you change doses by 0.25u.
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Congratulations Joey and Trinity! That 40 today is a mandatory reduction to 1.25U.

Great job handling those numbers. :thumbup
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

Dale 'n' Chip said:
Congratulations Joey and Trinity! That 40 today is a mandatory reduction to 1.25U.

Great job handling those numbers. :thumbup
Click to expand...

Due to the recent off time shots and the reduction to 1.5u, I wanted to hold this dosage another couple cycles to see where Trinity ends up since her 9/5 PMPS was 385 after all those great results of the last couple days.

I've got the ability over the next couple days to be around alot during the +3 to +6 range of both AM and PM, so if she drops low again I can quickly deal with it.

Hooray for a healing pancreas and returning insulin production! :-D :-D :-D

I'm thinking the complete lack of dry food since approx 5 days ago may be contributing to it as well. We'll see!!!

Thanks for all the support! Every little bit helps through this complicated process!
 
Re: Still somewhat new to Tight Regulation with Trinity, Hel

The depot likely is "confused" from the recent variations in dose and time.

On the other hand, anything below 50 is considered a mandatory reduction for a newly diagnosed cat.

You can "shoot through the bounce" one more time with the old dose when the numbers are high at the next shot time. But I would still want to monitor as she clears the bounce.

I'd be a little nervous about not taking the reduction in the morning since she seems to be having such a response. I've certainly done that before, but only with plenty of data to support it. And of course a lot of testing. :smile:

You're doing a terrific job, but keep a close eye on things at this important point in the process. And of course post and ask if you have any questions.
 
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