6/29 Esse AMPS 176

[Lauren & Esse]

Previous thread!

We chickened out on the 2u dose--the second day was equally alarm-filled and he got down to 56 on the handheld meter after being given some snacks (and a reduced dose the night before), so we are giving him a few more days on 1.75u. We may very well go back to 2 but want to see if his cycles flatten out any more first vs. the sudden steep dives. I know it's not TR-approved technically but we're trying to keep all 3 of us comfortable and sane.

I do have a question: I have seen folks mention that kitties can feel kinda puny when they first start seeing lower numbers. How long is this phase expected to last, or is it very dependent on the cat? He's been pretty low energy the past couple days. He'll eat if it's put in front of him but doesn't seek out snacks. I know it's possible that his appetite will be lower permanently once he's regulated, but seeing him sleep all day the same way he does when he's super high and his ketones are elevated is a bummer.

 

[Sienne & Gabby (GA)]

Lauren -

I need some help understanding how you're annotating Esse's numbers on your spreadsheet. From yesterday (6/29), your comments state, "AM+2.5 steep drop LC." Your AMPS was 189 and your +2 was 171 and +3 was 143. That's not a steep drop. In your AM +5 cell, you entered 147, 59 (+2.5). What does the +2.5 refer to? Also, which is the reading from the Libre? To confuse me further, the comment reads, "+5.5 alarm LC meter 110." Those numbers are not reflected in the +5 cell. There's the same issue with your reading at PM +6.5.

It would be very helpful if you could indicate whether the readings are from the Libre or your Contour and if the comments were consistent with the numbers you're entering on the spreadsheet. Given that the Libre gives false low reading if your cat is in numbers under 100, you need to test on a glucometer and decide whether to intervene with food based on the glucometer reading.

Cats can feel "off" with lower then usual readings as well as when they experience bounces. When this improves is dependent on the cat. The more time your cat spends in more normal blood glucose range, the more she'll get used to those numbers.

I would also encourage you to stick with the dosing guidelines in SLGS. It will be much easier for us to help you if we know which meter you're using otherwise, we are either not going to make suggestions or ask you to clarify before doing so (which will get very old very fast).

@Staci & Ivy is a long time user of the Libre. She can likely offer you some ideas on how to structure your spreadsheet so we have a better idea of what's happening with Esse's numbers.

 

[Lauren & Esse]

I'm so sorry, I promise I'm not trying to be confusing. It does not feel good to be told repeatedly that my record-keeping is bad or misleading, so I really am apologetic. It feels at times that the learning curve to correctly keep the spreadsheet for everyone else to understand without asking questions--especially now, as a Libre user--is a little tough. I am trying.

As with the last time I was asked, all Contour meter numbers are in the remarks section, but I have bolded/color-coded them since then to make them easier to spot since it seemed folks had a hard time seeing them. I have updated my signature and spreadsheet to indicate this.

To me it's more confusing to have both types of numbers in the main portion of the spreadsheet since then the 'curve' is not one data set, and they measure two different things (serum vs. blood glucose). For me the point of using the Contour meter on top of the Libre is as a verification system, not to still have the Contour meter be the primary data source as we did before we began using the Libre. But if that's the only acceptable way to do things and still participate on the board successfully then I will adjust. If I do move the numbers to the main portion of the spreadsheet I could use an asterisk like others do. I would not just leave them unmarked as, again, I prefer not to mix serum glucose (Libre) and BG (Contour) data.

In your AM +5 cell, you entered 147, 59 (+2.5). What does the +2.5 refer to?

At the top of the +2 hour, he was 147 on the Libre. At the middle of the +2 hour, which I thought is typically written as +2.5, he was 59 on the Libre. If there is a better way to add multiple numbers from the same hour please correct me, I thought I was doing what I had seen others do.

When I mention "sharp drops" in the remarks, I mean sharp drops I have been seeing on the Libre graph that prompt me to give him a snack--I had been doing that to try to 'feed the curve' and try to slow his roll a bit. Perhaps I am misunderstanding this article. Sometimes these drops end up not 'sticking' on the Libre graph later, possibly because his numbers are changing rapidly in a short amount of time. This is a known issue with the Libre, and in those cases I do not add the numbers to the spreadsheet. When the drops do 'stick' to the graph, I indicate multiple numbers in the same cell, like in the +2/+2.5 example above. I have the comments in my the remarks for my personal reference but if they are confusing I will remove them to a separate tab that you don't review.

I would also encourage you to stick with the dosing guidelines in SLGS. It will be much easier for us to help you if we know which meter you're using otherwise, we are either not going to make suggestions or ask you to clarify before doing so (which will get very old very fast).

So you think we should go back to SLGS and end our TR trial? Happy to do it if you think it's more appropriate. We felt a little pushed on here to try TR now that we had consistent Libre data, but since the Libre data doesn't give the helpers here what they need to answer questions, then maybe it's not right for us. Honestly I found SLGS a lot less stressful and required less assistance on here. So maybe that's better.

My question today was about his energy levels, not our dosing, but it is helpful to know that I have problems I need to correct before asking for dosing help again. Thank you for the feedback, and thank you for answering my question about his energy levels.

 

[Sienne & Gabby (GA)]

I know there are a lot of details to stay on top of and it can be mind boggling especially when you're starting out. It is for those of us who are trying to lend a hand, as well. There's really not one best method to do thing but I will say that it was much easier when all we had were human meters. Now there are pet meters, human meters and CGMs and the CGMs need a human meter back up. Any information that you can provide to help those of us who are truly not trying to pester you will be helpful.

TR vs SLGS: I missed the information about your switching to TR. I could have sworn it wasn't on your spreadsheet. (I don't think I'd finished my coffee yet and the cats had me awake at 5:30.) I don't think you need to switch back to SLGS. I just missed that you'd switched. It's entirely up to you which method you use. I "grew up" with TR and once I became familiar with it, it was easy. It does take some getting used to, though. I'm not a big fan of SLGS mostly because TR has published research regarding its effectiveness and that I used TR exclusively. You should do what works for you and Essie. You might want to consider giving TR a bit more of a chance before deciding which you like the best.

As far as the dosing, it looks like you increased Esse's dose to 2.0u on 6/26 then dropped the dose at PMPS due to a lower than expected number. That's fine but at some point, you're going to want to start shooting lower numbers. Maybe not a number in the 50s yet but it's a topic for discussion. The next morning you shot 2.0u but I'm not clear why you shot 1.5u that evening and why you're now shooting 1.75u. With TR, if you have to make a dose adjustment because of a lower than expected pre-shot or some other reason, you go back to your usual dose -- in this case 2.0u. If you're not clear on the nuances of TR, please ask for input. And remember, if you make a one time change in dose, the count for the number of cycles at the original dose starts over. Dose reductions with TR occur if you have a reading below 50 on a human meter (or if you use SLGS, below 90 on a human meter). This is where the Libre is a pain in the neck. The readings that are below 100 are likely inaccurate from what we've been seeing with most cats. I do think it would be helpful if you routinely tested with the Contour when see a number that's under 100 from the Libre.

Feeding the curve is great! Remember, though -- we're not seeing the Libre graphs. What may appear a sharp drop to you may not appear to be so on your spreadsheet.

Spreadsheet: What had me confused is your +5 cell from yesterday morning. In the +5 column, you referenced a +2.5 test with the result as 59. Should the time have been +5.5? If you look at your reading from today, it looks like the time is entered correctly.

 

[Lauren & Esse]

The next morning you shot 2.0u but I'm not clear why you shot 1.5u that evening and why you're now shooting 1.75u. With TR, if you have to make a dose adjustment because of a lower than expected pre-shot or some other reason, you go back to your usual dose -- in this case 2.0u.

This is what I was referencing in my original post on this thread--I know the reduction to 1.75u was not earned, but we just weren't comfortable shooting 2u overnight when that day he had hit 56 on the Contour meter that day after we'd already been hearing alarms and giving him snacks for a couple hours. I think 2u probably will be a better dose for him overall and know we'll probably need to go back to it but we just need a little time to get comfortable seeing him in those lower numbers.

Feeding the curve is great! Remember, though -- we're not seeing the Libre graphs. What may appear a sharp drop to you may not appear to be so on your spreadsheet.

Yes, of course. It almost seems like it would make more sense for me to just say when we fed, and not why, unless we have a handheld number to back it up. To reduce confusion.

Spreadsheet: What had me confused is your +5 cell from yesterday morning. In the +5 column, you referenced a +2.5 test with the result as 59. Should the time have been +5.5? If you look at your reading from today, it looks like the time is entered correctly.

Just a typo. Fixed.