? TUT AMPS 70

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ppp

ppp

Member Since 2017
http://www.felinediabetes.com/FDMB/...s-guidelines-see-post-12.188113/#post-2089584

12 hours after last night's .25 U, Tut's at 70? (!)

And, this is the only insulin he's had since .75 12/15 a.m. (Has otherwise earned skips.)

As a reminder, we are post-steriod, so he may be lucky enough not to have this illness in his genes to the extent so many other kitties do.

Of course, per SLGS, I should not shoot this a.m.

I hear him shouting 'I want to get OTJ' (or, is that me?)

I see that many go down to .1, or even a drop (for a long period) before trying to do without.

Can anyone suggest what an attempt at transitioning out would reasonably look like for this guy?



p.s. want to thank Gracie for her response in the attached link. I did realize after I sent my last message that there may be other protocols out there [the article quoted was part of this forum, but as an attachment]. And, in regard to the reduction last night...the way I figured it -- maybe incorrect -- was that he had earned a reduction for yesterday a.m. (by going below 90 during the last cycle), then I just missed the shot, but he went under 90 again, anyway, so he earned another reduction for last night.
 
I agree you should have skipped the shot this morning with the 70. However, I think it looks like Tut still needs a little bit of insulin. His numbers are going over 120, which is the highest we like to see for a cat not on insulin. It is better to see higher greens and lower blues. I think you should try the 0.1 unit dose tonight. The longer he is on insulin and in normal numbers, the better chance he has for a strong remission. I'd suggest getting a +1o or +11 and post here asking for advice on tonight's shot. Then when you test at PMPS, you'll have a better idea of if he's going to go up or keep surfing.
 
Thanks very much for the reply.

I wonder if, in general, shooting 0.1 would commonly be done even if he is below 90 at shot time.

I will check back in.
 
According to SLGS, you would not give the shot if he is below 90. He may let you know he is ready for no insulin by giving you numbers below 90. It is possible those numbers higher than 120 are from bouncing from the lower numbers and he will bring his numbers back down on his own. But you don't want to rush the process and stop insulin until he gives you the numbers where you need to. I don't think it will be much longer.
 
Thanks again.

(knocking on wood)

I did feed him quite a bit in the second part of the cycle, too -- which I know is not generally recommended -- but I do get so nervous about hypoing.
 
Actually, the person (not the cat) who responded in your previous condo is Marje. If you read carefully, the information in the table is encouraging some of the dosing to be based on the pre-shot ("pre-insulin") number. With TR in particular but also with SLGS, Lantus dosing should be based on the nadir with the understanding that shooting low makes sense only when safety is taken into consideration. The guidelines in the article are generic -- they are not specific to the insulin they are referring to. The section on diet is also a bit "iffy." I'd encourage you to look at the journal articles specific to Lantus -- although they are focused on tight regulation.

Feeding during the latter half of the cycle can be fine. If your cat's pancreas decided to wake up, feeding prior to +8 or +9 may cause Tut's numbers to stay flat and low since the pancreas will produce it's own insulin.

With regard to pre-shot numbers below 90, this becomes a challenge. If you compare TR and SLGS, there is a vast difference in this issue. With TR, most of us would shoot any number above 50. I would look at the SLGS information from the perspective of what the outcomes may be. If you skip a shot and numbers are not so good, it tells you that you're getting highs and lows and insulin is still needed. Seeing a flat AM cycle yesterday and a rise to 148 by +11 (and please do not skip your pre-shot test because numbers really can change in an hour), tells you that skipping may not be such a great idea. With SLGS, you have several options when faced with a lower than expected pre-shot number:
  • skip the shot
  • shoot a one time reduced dose (also called a BCS - "big chicken sh*t" dose)
  • do NOT feed and stall for 15 min or so and retest; repeat until you see numbers rising
  • shoot
With the exception of shooting, all of the other options have an effect on the depot. Stalling beyond approximately an hour will act like a dose reduction. You have to weigh whether your schedule can manage a late shot since the next shot time will need to be adjusted and if the potential for losing the potential for flat, green cycles is OK. What I often encourage people to do is to decide how comfortable you are with shooting lower numbers even if you're following SLGS. Decide on what number you would be comfortable with and work your way down so you don't end up with the numbers acting like a yo-yo due to skipped shots. If you look at the SS of kitties that have gone into remission, they eventually end up on microdoses of insulin and they have gotten shots despite green pre-shot numbers.

It's up to you how you proceed since what I've outlined isn't entirely within keeping of SLGS.
 
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