We were over 600 this am, I did not retest because he was eating and I did not have the heart to take his food away, he was ravenous. I will not be able to do a curve for 2 more days due to work but I need to up his dose now, I have held since 10/23 at 1u ,as you can see. We haven't seen these high numbers for a while. I was hoping we were on the way to reduction. So... 1.25 or 1.5? anyone? SLGS.
There are two possible explanations for that Hi. The first, your guess, is that he needs more insulin. The second possibility is that he went low last night, and this morning is a bounce, meaning he is on too much insulin. With that 59 and 65 on 1.25 units a little over a week ago, and zero tests in the night time cycle, too much insulin is a real possibility. Is there any way you can get a test before bed on this dose? Even a +2 or +3 would be helpful in figuring out what is happening at night. Many cats go lower at night, we determine the dose based on the lows, not the high preshots.
I'm going to tag some who may be more familiar with SLGS - I'd increase but that's just me - poor Zeke is too high... Are you testing for ketones? @Wendy&Neko @Marje and Gracie @Gill & George @Bron and Sheba (GA)
I work third shift. He has been high since I lowered his dose . He hasn’t been this hi since we started. I cannot get doses at night I am at work . I Know we determine based on nadir. His numbers at nadir are now in the 300s. According to what slugs rules say shouldn’t I raise? I keep getting told to lower, I am trying to follow the rules.
Do you work the 12 hour between shots? Just wondering if a +2 or +10 is possible at night? Do you leave lots of food out while you are gone?
Y es, I am gone 12 hrs. No other checks possible. Yes lots of food out for him and sister, many times there are leftovers. Do you see his 7+? That should tell you he is not going down lower than 300s.
I have tested twice. Negative. Not flooding the box either. He is active when awake except for this am when HI. So. I am going to raise . Should it be by .25 or .5?
That HI looks like a bounce from low numbers to me. If you look at my cat's SS, you'll see that he hits blacks now only when he goes low!
We typically raise by .25 increments...getting some tests on the weekends or when you're around - even if it's at 1+ or the minute you get home from work will be great! I know it's hard when you work...but that's the only way you'll know how low this dose is taking Zeke.
That +7 just tells me he is bouncing. Numbers wobble around a lot during a bounce. I wouldn’t used today’s bounce data to determine a dose change. I would hold the dose and get more data. Neko often would go low, earn a reduction at night, then bounce during the day. Did that for three straight months! Based on daytime data I would have increased, but she was telling me the dose needed to go the other way. Hopefully you will have a work break from night time shift and able to get some data then,
If we were goi I will be doing a curve on Thur night when I am off. I was trying to hold the 1u until then but when we hit high this AM I lost it. I don’t think we should wait 2 more days do you? I test him immediately when I get in the door, I have to go to bed afterwards. I can’t do anymore when working. If you were me would you hold until curve day, just to show he is not bouncing? I feel like I’m hurting him just to show that he needs help!
I would love to offer advice but you are using a SS from a FB group that pirated our SS and whenever I try to go through it all, it blows up and shuts down on me...every time. This is an ongoing issue and we ask members to please use our SS. If you’d like me to do a SS for you and transfer your data, I’d be happy to do so. Please just send me a PM. Thank you.
The fact he's not flooding the box may suggest he is spending more time in 'better numbers' than you might think. George's pee rate went right down once we started seeing some better numbers. It's possible with your schedule that his pattern has changed and you are just not seeing them. That is the concern.
I had to up him last night, he was 501 for PM shot. Now doing 1.25u, This AM was 375, +7 was 285. Much better! He feels better too. I'm doing a curve Thur or Fri night. Stay tuned!
Do you think you could update those numbers and dose increase on the SS when you get a chance. Thx I know seeing those high ps is hard, with lantus we need to largely ignore those and look to the nadirs to help us decide what to do with the dose. It's great that he has access to food all day, when you get home from work do you know if he's eaten in the two hours prior to shot time? With a depot insulin we often don't see an effect on the numbers straight away, it usually takes a few cycles,, it's likely that he would have had a similar cycle if you'd held the dose. Some cats do react sooner to dose increases, but we can't say that for sure with your guy given the data we have available. Sometimes when we are not able to get that midcycle data too much insulin can look like not enough. When do you have your next day off?
I am doing a curve Thur or fri. He responds very quickly to skipped doses. I realize nadirs are the indicator... his nadirs were in the 300s with 1u, I know he needed a little more, trust me, he did not respond well to the decrease at all. We have not had nadirs that high for a long time. I will put new numbers in when I do the curve for you guys. Marjorie is transferring my SS to FDMB format so you’ll all have easier access to it. I’ll keep you posted. Thanks. Also, for the most part I wake him and get a test before I even get my shoes off! I am quite sure he hasn’t eaten. I’ve thought about a timed feeder but I don’t think it’s feasible or necessary at this time with 2 kitties.
One way I used the feeder was to have it rotate to 'hide the food' two hours shot time. If Zeke were to eat let's say an hour before the end of the cycle, it could really impact his BG. A LC snack at the end of the cycle will bump numbers up much more than the same snack in the early part of the cycle. They may well be, but you are making the assumption that he always nadirs at +6/+7, a nadir is the lowest BG in the cycle, although it is true that a well regulated cat will tend to nadir at around the same time, they can and do nadir at anytime in the cycle. I've taken a screen shot of George's SS, I was home and able to test a lot and also I did TR. But the data will help me illustrate a couple of points. I'm sorry it's small, you can look in his ss linked on my signature if you want a closer look 12/14/2015 to 12/20/2015 Starting at the top 1st line am cycle bouncing lowest number +6/ pm cycle nadired at +12/amps 2nd line am cycle nadired +5 / pm cycle nadired +2/ started to bounce 3rd line am cycle nadired at +12pmps (bounce breaking)/ pm cycle nadired +2.25 4th line was bouncing, numbers largely flat but lowest number recorded was at +6 / pm cycle nadired at +8 So the lowest BG's in just in those 4 days were +6 +12 +5 +2 +12 +2.25 +6 +8 Here's another example, again these are actual cycles George had, but I have deleted a lot of data so it simulates the data you have been able to get. So in the first line on TR, he earns a reduction, by the fourth line his nadirs are in the pinks, they 'appear' to be trending up, one might be tempted to say that the reduction had failed (on TR we are able to call a failed reduction/ not with SLGS), he's not showing any green on the SS. In fact 8 cycles on the dose and still no green. Why then do I take the dose down on the 6th and final line?? Surely I should have gone up in dose, as nadirs were trending up?? So below is the same 6days, Tells a different story, we can see that George has been generally having low green cycles at night the dose reduction is holding and in fact he earns another reduction on the 5th line. The above examples are perhaps not as helpful to you as they could be as the overall range is lower, I followed TR, and George was not a bouncy kitty, he did bounce a bit at first, but settled very quickly but it does illustrate the point that when we are lacking data it is harder to know with certainty what is going on. If I had taken the dose up instead of reducing it, there could have been two possible outcomes, the preferable of which would be that George's liver would have kicked in to 'keep George safe mode' and would have dumped glucose into his bloodstream causing one heck of a bounce after I basically overdosed him. I hope you find the above helpful, I thought that visualising it might help you see how it is possible for low numbers to 'hide' in the periods when you can't test. I know that with work, it is how it is, hence SLGS, but there are safegaurds built in to SLGS to allow for you situation, but if you make the method more risky, by taking the dose up before the 7days, (14 cycles) before running the curve, you run the risk of getting into a sticky situation. I look forward to seeing the new SS, I hope you and Zeke are keeping well, I can empathise with how horrible it is to see those ugly numbers, and how you just want your guy to be feeling better.
Wow, thanks for so much info, it's rather mindboggling, really.We have a long way to go, I fear. Today's AM at 730a was 566 (!), so I guess it really didn't need to be raised after all. I will be doing a curve tomorrow night, (even when I'm off I am up until 5a or so. He was back down just now to 354 at 430p. As far as the feeder, I do think it's a good idea, however, I just can't do it with 2 cats. I put his food on a table, her's on the floor, she is arthritic and can't jump, so he can eat hers too. Even if I got 2 feeders, he would eat hers after he was finished with his and she would not be able to get any (?). Thanks again for the help. Please stay in touch. I need you guys! BTW, my last boy was named George, I loved him dearly!
I've started my curve, just checking, take up food 1 hr before next q2hr test, right? then ok to free feed again for next 1 hr?
Sorry I was in bed, I'm at the other side of the big pond. You only need to take food up 2 hrs before amps/pmps, not for any midcycle tests. How did that curve pan out? can't see the numbers on the ss
Thanks for responding I got my answer in another forum, Zeke’s curve numbers now posted. Looks like a dosage increase to me what do you think?
Great job getting the curve. On SLGS you need to hold the dose for 7 days before taking it up. Are you home today? If you are do grab some spot checks where you can, it will help with the overall picture From the sticky on SLGS Requisites when following the Start Low, Go Slow Method: Learn the signs of and how to treat Hypoglycemia and prepare a Hypo Toolbox. Test regularly for ketones and know about Diabetic Ketoacidosis (DKA). Use a meter calibrated for humans, not a pet-specific meter. Reference numbers given are for measuring blood glucose with a human meter. Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing. Most kitties are easier to regulate when fed small meals throughout each cycle. Others adapt well to free feeding. Starting Dose: 1u BID if kitty is not on a wet/canned low carb diet 0.5u BID if kitty has been switched to a wet/canned low carb diet If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration Generally, shots are to be given 12 hours apart. Hold the dose for at least a week: Unless your cat won’t eat or you suspect hypoglycemia Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately. After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments. If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Can someone tell me why I am suppose to be holding for additional 3 days with numbers this high? What is the point, he's shown with the curve last PM he is not bouncing, I am going to raise him to 1.5 tonight and hold that for 7 days, I should have never lowered him to 1.0, we held there for 6 days with high numbers, that seems like enough. He is obviously regressing.
For safety. Because of your predicament with work there are a lot of blanks, it's what I tried to demonstrate in my examples above. Lets take 10/30 pm cycle, not one single test that evening, so we/you have no idea what went on. It's entirely possible that he dropped to blue or green and that triggered a god almighty bounce that resulted in the black amps on 10/31. Might he have been high all cycle, sure, but he might have equally been low. The truth of the matter is that we/you do not know. SLGS makes allowances for a CG inability to monitor cycles and keep your cat safe, this involves waiting the prescribed time between increases. The problem with going up to soon is that there is increased potential for Zeke to end up in a hypo event and you coming home to a very sick kitty at best. From the slgs guidelines Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose. Did you shoot on 10/29? there's nothing in the box. I don't recall you saying you skipped a shot??
No problem it's 10pm here so I might not be awake when you right back, but I'll look you up in the morning.
Bonnie -- TR and SLGS are fundamentally and philosophically very different. They are not meant to be a mix and match of options or interchangeable on different days of the week. TR is much more aggressive and as such, requires more monitoring. If that is not feasible with your work schedule, then your option is SLGS. Both approaches have been successful at getting cats into remission. Gill has given you a wealth of information as to why switching back and forth between dosing methods isn't a good decision. Ultimately, though, you're the person holding the syringe and you can do whatever you choose. Please understand that not knowing how you're making your dosing decisions also makes it very difficult for us to lend a hand when you have questions.
Bounces can take six cycles or three days to resolve. In that time period, numbers will be higher and also wobble around. Data taken during a bounce are not good data for deciding to increase. SLGS has safety guidelines built into it, including waiting enough time so you can get data to make good dosing decisions.
I will hold for the 7 days. This is difficult but I will follow all of your advice. 367 tonight, maybe he’s coming down. 1.25 u it is. Thanks for your patience.
Why do you think this? That sharp rise into the pinks would make me suspect at least the start of the bounce. If he is bouncing then if you could test what you will see is relatively high flat numbers during this and upto 6 following cycles. He doesn't have to be in the black for it to be a bounce.
