Taco, questions, answered. Thank you :)

Cindy&Taco

Cindy&Taco

Member Since 2017
At this for almost 2 years :(
As you can see I haven't been actively participating in the forum.

My reason is I can't decide if I want to do SLGS or TR.

The reason for that is really, I don't understand them and the more I read over each one the more I get confused.

There's things in each protocol I like and some I don't.

I've been encouraged over and over again to do TR because I am a test aholic and continue to be :)

But I get scared with TR, most likely because I can't get the hang of NADIR.

Should Taco be having 2 similar nadirs per 24 hours?

He does well for 1/2 of the day , most days, then the other 1/2 is completely different. That's the part I can't understand, no matter what or how many times I read something.

The other thing is, is that Taco shows a great result after an increase (sometimes) and other times it takes him forever.
And then there's the part where, I don't feel he "deserves" a reduce just because he went below 90 and the rest of the day he's in the 300s. So, I wait it out, trying to get him in better numbers on that dose.

And I don't mind shooting lower than 90. I don't want NOT to shoot, because I feel confidant that I can get his numbers up with feeding higher carb.Yes, it's exhausting, but, we've done it every time.

Now, as far as TR, I can't get myself NOT to feed, and stall, because Taco has shown every time that he will not rise without food and he does NOT seek food out at all. He never has. He shows NO signs of being low, the only way we know he is low is because of the amount of testing we do, and it's always a surprise.

This last round on 2 units I held for 9 days, because he seemed to do well,and had earned a couple reductions, but, ONLY in his first cycle of the day, the rest of that day he went downhill. So I waited it out.

Did I wait too long? Am I doing more harm than good waiting it out?
Why am I waiting, I'm waiting for him to get better numbers throughout the WHOLE day. Am I wrong doing this?

I know it's all up to me what I do, but, if I don't understand what I'm doing none of it makes sense.
So, can I get anyone to explain to me in a 2nd grade level :) of what the heck I'm doing and what I can do to make this journey a little better.

I have read over and over the protocols and the more I read them the more confused I get.
If you've read all this , then you have more patience than I'll ever have. ;)
Thank you in advance for any help with this. :bighug:
 
Hi Cindy, great new avatar of Taco.

First off, nadirs are ECID. Some cats have regular nadirs. Neko did not. On Levemir it was anywhere for +5 to as late as +15, though most often from +9 to +12. Her onset was +5. Her AM cycles and PM cycles were often very different. I spent a lot of time pouring over her SS trying to find patterns, which typically go over several cycles. I did not test as much as you. I cross border shopped for strips, so played a lot of “guess the BG” when testing to hone my knowledge and save strips.

If you post here and ask questions, perhaps we can help you understand the two different dosing methods. I know it took me a while of asking questions before I got it. And it will be a lot easier if you pick one dosing method and stick with it for a while. The amount you test does not have to be a factor in your decision, though for some people it is.
 
Wendy&Neko said:
Hi Cindy, great new avatar of Taco.

First off, nadirs are ECID. Some cats have regular nadirs. Neko did not. On Levemir it was anywhere for +5 to as late as +15, though most often from +9 to +12. Her onset was +5. Her AM cycles and PM cycles were often very different. I spent a lot of time pouring over her SS trying to find patterns, which typically go over several cycles. I did not test as much as you. I cross border shopped for strips, so played a lot of “guess the BG” when testing to hone my knowledge and save strips.

If you post here and ask questions, perhaps we can help you understand the two different dosing methods. I know it took me a while of asking questions before I got it. And it will be a lot easier if you pick one dosing method and stick with it for a while. The amount you test does not have to be a factor in your decision, though for some people it is.
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so, only 1 nadir in 24 hours ? Not 1 for AM and 1 for PM? Thanks for the compliment on Tacos pic, he's such a handsome ,gentle cat.
 
It may help to think in terms of # of shots = # of nadirs. Every time you give a dose of insulin, that is a cycle. Every cycle has a low point/nadir. So, if you are shooting twice a day, Taco has a nadir for each cycle or two nadirs per day. You were correct -- an AM and PM nadir. (Sorry if Wendy confused you.)

I think what is challenging for all of us is that we talk about the nadir as if it's a fixed point and once you figure out where it falls, that's where it is forever. Unfortunately, our kitties refuse to follow the rules! Nadirs can and do change. Gabby had an early nadir -- usually around +3 or +4 except for those times when that's not where her nadir fell. It's also why I tested early since her numbers could drop fast and early in the cycle. It looks like Taco's nadir is somewhere after +6 much of the time (except for a day like Jan. 2).

There are certainly days when Taco is spending a good amount of time in numbers under 100. What seems to be happening is that he's in yellow numbers at pre-shot, drops into greens, and then bounces by evening. This is not unusual -- it's a bounce. Bounces are hugely annoying to us but a part of the process. If you scroll through Taco's SS, you can see that overall, his numbers have dropped into a lower range. The more time Taco spends in closer to normal numbers, the less he may bounce.

Maybe I missed something re. stalling. You can (and I stress "can") stall if numbers are too low for you to shoot comfortably. Depending on where the numbers are, as long as they are not dropping, it is likely safe to shoot. I would shoot anything above 50. Take a look at Gabby's SS, or Marje's Gracie's or any of the other long term members who were using TR. We would shoot low numbers. You don't want food to give you "artificial" confidence if you have a low pre-shot. That's more the issue with not feeding and stalling. You might want to look over the Shooting & Handling Low Numbers sticky and let us know if you have questions.

Fundamentally, there are a couple of differences between TR and SLGS
  • How long you hold the dose (3 - 5 days depending on where the low point is over the majority of the time for TR; a week for SLGS) unless a dose reduction is earned
  • The cut off for a dose reduction (below 50 for TR; below 90 for SLGS)
  • The amount of testing needed (more for TR)
  • You MUST be feeding a low carb, canned food diet with TR
I hope this helps to clarify.
 
At the risk of adding more confusion to what's already been said about nadirs...

When using data to determine a dose adjustment, the only nadir that "counts" when making dosing decisions is a single nadir: the lowest nadir/low point at that given dose at that particular time in the sugar dance. That's the nadir that determines whether one increases or decreases the dose... not the nadir from every cycle at that dose, a nadir last week, 3 weeks ago, last month, etc.

This is why I like to emphasize/suggest looking at kitty's spreadsheet in "waves of action" and I rarely go back much more than a couple of weeks rather than trying to analyze each and every cycle for months on end because it's the current data that yields the most information. Initially these "waves" of action may appear to be nonexistent. Soon they often appear to run in waves lasting 6 cycles/3 days. As kitty becomes better regulated then tightly regulated, the waves of action become flatter until there's very little "wave" action seen at all.


Caveat: Not every cat has read the manual so an individual kitty's mileage may vary (ECID)



PS - More info/discussion you *may* find helpful on "bounces":
 
Sorry to do it this way, but, it's the only way I know how, so my replies are in blue @Sienne and Gabby (GA) see post #4 for original.

It may help to think in terms of # of shots = # of nadirs. Every time you give a dose of insulin, that is a cycle. Every cycle has a low point/nadir. So, if you are shooting twice a day, Taco has a nadir for each cycle or two nadirs per day. You were correct -- an AM and PM nadir. (Sorry if Wendy confused you.)
That I understand, except Tacos nadirs are SO different between his AM & PM. So frustrating, is that normal?

I think what is challenging for all of us is that we talk about the nadir as if it's a fixed point and once you figure out where it falls, that's where it is forever. Unfortunately, our kitties refuse to follow the rules! Nadirs can and do change. Gabby had an early nadir -- usually around +3 or +4 except for those times when that's not where her nadir fell. It's also why I tested early since her numbers could drop fast and early in the cycle. It looks like Taco's nadir is somewhere after +6 much of the time (except for a day like Jan. 2).
Yes, mostly after +6 or close to shot time, going into second cycle.

There are certainly days when Taco is spending a good amount of time in numbers under 100. What seems to be happening is that he's in yellow numbers at pre-shot, drops into greens, and then bounces by evening. This is not unusual -- it's a bounce. Bounces are hugely annoying to us but a part of the process. If you scroll through Taco's SS, you can see that overall, his numbers have dropped into a lower range. The more time Taco spends in closer to normal numbers, the less he may bounce.

I can see that somewhat, BUT, he still manages to stick those pinks in when I least expect it.And has gotten close to those reds lately. Not many, but, still there.

Maybe I missed something re. stalling. You can (and I stress "can") stall if numbers are too low for you to shoot comfortably. Depending on where the numbers are, as long as they are not dropping, it is likely safe to shoot. I would shoot anything above 50. Take a look at Gabby's SS, or Marje's Gracie's or any of the other long term members who were using TR. We would shoot low numbers. You don't want food to give you "artificial" confidence if you have a low pre-shot. That's more the issue with not feeding and stalling. You might want to look over the Shooting & Handling Low Numbers sticky and let us know if you have questions.

Now , this section I could go on all day about. :( Like I said , I cannot stall him, I have tried, he just keeps dropping,unless I feed him and keep testing until his number comes up and he has been doing this for close to 2 years. There's only been maybe 3 times I have had to do that pre-shot and I had time to feed him because I test at +11.

When I didn't test at +11, I hated the fact that I was encouraged to stall and not to feed, and I would feed anyways ,because I knew that was not an option with Taco.

Not being snarky, just asking, what is wrong in Tacos case for me to do "artificial" confidence ,if I know he will be able to get his insulin on time? I've thought a lot about that one for a long time and maybe I'm missing something? I know what skip shots or reduced shots do, so I try and stay away from them. Am I not thinking right?

Fundamentally, there are a couple of differences between TR and SLGS
With the info below, I can live with the SLGS amount of days for dose holding, but, I don't like the below 90 SLGS reduction and I don't like the below 50 TR. I feel more like a below 80 , 2 times(2 different days) on a particular dose for a reduction makes more sense for Taco. Not mentioned is the do not shoot at below 90. I'm more than willing to shoot at 90, but not anything under 80 unless I'm feeding to bring his BG up some , which is what I would do anyways. So, there's my dalema :( I'm not trying to negotiate anything, or the protocols that you like people to follow. What I'm trying to do is understand all this better and the why's of it. I am a WHY person :) I'm sure you can tell :) So when I get an answer that I understand, then I have a aha moment that makes me want to do it the way suggested.But I need to know what I'm doing wrong or harmful first :) Does that make sense ? :)
What to do?
  • How long you hold the dose (3 - 5 days depending on where the low point is over the majority of the time for TR; a week for SLGS) unless a dose reduction is earned
  • The cut off for a dose reduction (below 50 for TR; below 90 for SLGS)
  • The amount of testing needed (more for TR)
  • You MUST be feeding a low carb, canned food diet with TR
I hope this helps to clarify.
 
@Sienne and Gabby (GA) or anyone else, so after I wrote all that in post 6, we have exactly what I was talking about with him dropping, right now @ +8 he is at BG 100, he dropped all night, and my gut tells me that at AMPS or +11 he will be quite lower. Hope he proves me wrong but I'm not counting on it. ;)
If he's below 90, then if I'm doing SLGS, I would not shoot, but stall, that to me makes no sense. He really just started on the 2.25, a reduction to me would most likely fail, right?
If I say I'm doing TR, what are my options? I can't stall him, I'm so confused :arghh:
 
Cindy&Taco said:
@Sienne and Gabby (GA) or anyone else, so after I wrote all that in post 6, we have exactly what I was talking about with him dropping, right now @ +8 he is at BG 100, he dropped all night, and my gut tells me that at AMPS or +11 he will be quite lower. Hope he proves me wrong but I'm not counting on it. ;)
If he's below 90, then if I'm doing SLGS, I would not shoot, but stall, that to me makes no sense. He really just started on the 2.25, a reduction to me would most likely fail, right?
If I say I'm doing TR, what are my options? I can't stall him, I'm so confused :arghh:
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I'm not saying this to ruffle any feathers here but if you need to modify the methods to suit Taco or give yourself peace of mind then that's what you need to do. The clear guidelines work very well for many kitties but some are less inclined to follow the rules. We are also different as humans in our ability to tolerate the stresses of low numbers, late nadirs, atypical responses and so on. As is often said here, ECID and it's also true that EBID (Every Bean Is Different). Ask yourself what you can comfortably live with and do that. :)
 
Kris & Teasel said:
I'm not saying this to ruffle any feathers here but if you need to modify the methods to suit Taco or give yourself peace of mind then that's what you need to do. The clear guidelines work very well for many kitties but some are less inclined to follow the rules. We are also different as humans in our ability to tolerate the stresses of low numbers, late nadirs, atypical responses and so on. As is often said here, ECID and it's also true that EBID (Every Bean Is Different). Ask yourself what you can comfortably live with and do that. :)
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I like your answer :) But, if I need help or reassurance with dosing or how long to keep him on a certain dose, will I still be able to get some feedback here if I'm not following one protocol or the other ?
I enjoy the forum a lot and get a lot of good info from some members, I like some of the ideas I get here and sometimes the light bulb DOES turns on , other times I have felt because I wasn't doing the protocol exactly as written,because like I said some I don't understand and some I know don't work with Taco , so I didn't follow everything exact and felt like I didn't belong and could sense discord. So, I'll stick around for now and see what happens. I am grateful that some people are willing to help me with this journey. So thank you very much :bighug:
 
Cindy&Taco said:
I like your answer :) But, if I need help or reassurance with dosing or how long to keep him on a certain dose, will I still be able to get some feedback here if I'm not following one protocol or the other ?
I enjoy the forum a lot and get a lot of good info from some members, I like some of the ideas I get here and sometimes the light bulb DOES turns on , other times I have felt because I wasn't doing the protocol exactly as written,because like I said some I don't understand and some I know don't work with Taco , so I didn't follow everything exact and felt like I didn't belong and could sense discord. So, I'll stick around for now and see what happens. I am grateful that some people are willing to help me with this journey. So thank you very much :bighug:
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All I can tell you is, being in a similar position as yours, I learned through trial and error (carefully!) what works for Teasel and I now trust my own judgment. Yes, I make mistakes but that's how I've learned as much as I have. So - in a nutshell: trust yourself. :)
 
Mandy & Rex said:
Of course!! It would be easier if you could put in your signature something like: TR (or SLGS) modified to 80 not 50. Then people won't keep asking why you aren't shooting below 80.
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I appreciate what you're saying, but, I'm still not sure of which one I am following and need time. :)
 
Sorry I confused you Cindy. What I meant to say is that there is a nadir following each insulin shot, but sometimes with cats that nadir late (like some on Levemir) that nadir can be pushed into the cycle or time after the next shot. Neko even did that on Lantus, occasionally her AM nadir was at PM+1. I knew her onset for the PM shot was later, so I could see it was the nadir of the previous shot.
Cindy&Taco said:
That I understand, except Tacos nadirs are SO different between his AM & PM. So frustrating, is that normal?
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I have seen that happen. Neko once did a three month stretch of going low and earning reductions at night, and bouncing and going up during the day. Her bounce breaking cycle nadirs were later than her "regular" cycles. It was very tiring for me, and one of the reaons I always stress those PM test - which Team Taco is great at getting.
Cindy&Taco said:
what is wrong in Tacos case for me to do "artificial" confidence ,if I know he will be able to get his insulin on time?
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If you are confident shooting low, just do it. The only time I stalled is when Neko gave me a number under 50 at shot time. We typically suggest stalling for newbie's, but you aren't that anymore. Besides which, now you know it doesn't work for Taco.

As for reduction numbers, there were times I raised Neko's reduction number to 70, I have seen others do the same with TR. My reason for it was that the times I changed the reduction point were post radiation therapy on her pituitary tumour. I knew it could result in sudden drops in amount of insulin needed. Raising the reduction point gave me a little margin of safety. No it's not standard TR, and I did lower the reduction point for safety. If you want to tweak the dosing method you are following for your reasons, whatever they are, just put it in your signature. For example "following TR but reductions on 2 days below 80", or something like that.
 
Hi Cindy, I am sorry for being off topic here (please let me know if you want me to delete it) - but I looked at your spreadsheet and was surprised to se how much are you testing. I wish I had this much data! I just wanted to ask you how are Taco's ears? I just test 4 times a day (that often means more than 4 pricks, as sometimes the blood doesn't flow, sometimes Bacardi manages to shake his head and lose the drop), and sometimes I have to look for a healthy spot to let those little wounds heal. I hope you figure out which protocol to follow. Sending a stroke to your little purrer :)
 
@BacardiTheGreat - Kate, I was a testaholic. Look at Gabby's spreadsheet. I tested on one ear only. Her ears were fine. If you're using a wide gauge lancet, (e.g., 28 gauge), once the capillary bed in Bacardi's ear(s) develop, it will be easy to get blood with a thinner lancet (e.g., a 30 gauge).

FYI - if you have an off topic question, it's best to put it in your/Bacardi's thread and change the subject line to reflect your question. Otherwise, Taco's condo could get hijacked with people responding to your question.
 
BacardiTheGreat said:
Hi Cindy, I am sorry for being off topic here (please let me know if you want me to delete it) - but I looked at your spreadsheet and was surprised to se how much are you testing. I wish I had this much data! I just wanted to ask you how are Taco's ears? I just test 4 times a day (that often means more than 4 pricks, as sometimes the blood doesn't flow, sometimes Bacardi manages to shake his head and lose the drop), and sometimes I have to look for a healthy spot to let those little wounds heal. I hope you figure out which protocol to follow. Sending a stroke to your little purrer :)
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I have gotten comments about how much we (my daughter Moriah & I) test and I don't mind them at all. Taco's ears are fine. We switch ears about every 4-5 days. I rub them down good with a very wet paper towel of whitch hazel at swich time.

We are also down to a very thin lancet, so that helps some.

Sure , they've gotten little bumps around the edges, but , when that starts, we leave that ear alone for a while.
We also put pressure with a clean tissue on the poke everytime.

The reason, we test so much, is because, Taco is so unpredictable, he'll go from 300 to 70 in a couple hours :(

We also have the luxury of someone being awake in our home 24/7. So, really no ones sleep gets disturbed.

I am also a person that JUST has to know and am horrified of lows, so I want to take care of them as soon as I can.

Taco is 13 years old and feel we need to help him any way we can to keep him out of danger, not saying , anyone doesnt want to do that, but like I said, we can :)
Sometimes we do give him a few hours break, as we get to know his antics better, but that's no guarantee :)
You can also use the whole outer edge of the ear, from midway to the top at the point, it gives you a wider range. That is what we do. Hope that helps :)
 
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