6/6 Egon AMPS 66 | Feline Diabetes Management Board

6/6 Egon AMPS 66

mady and egon

mady and egon

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I skinnied up Egon's AM shot from 7u to 6.75u on a gut feeling. We just had such a sharp decline coming off the kibble accident and this is the first time I've had the Libre low glucose alarm go off which kind of freaked me out.

I know per the protocol it would have been fine for me to shoot the 66. What would you have done? Should I have kept with the 7u? I guess I can see what his nadir looks like in the day today and make an adjustment based on that.
 
I'm not at all qualified to give dosing advice, but whoa! Congrats on shooting that 66, even if skinnied up a bit. 😵 The aim with TR is to shoot low to stay low, so hopefully he just has a nice flat green surf for you. 🤞🏻🌊
 
mady and egon said:
Last Post

I skinnied up Egon's AM shot from 7u to 6.75u on a gut feeling. We just had such a sharp decline coming off the kibble accident and this is the first time I've had the Libre low glucose alarm go off which kind of freaked me out.

I know per the protocol it would have been fine for me to shoot the 66. What would you have done? Should I have kept with the 7u? I guess I can see what his nadir looks like in the day today and make an adjustment based on that.
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I would get a +1 to make sure he’s not dropping too low early in the cycle before insulin kicks in and go from there. Safe surfin’
 
Maybe not protocol, but I would likely have done the same, Mady. 66 is a new low PS. It would make me VERY nervy. Brava to you for shooting it!

Other options? Looking back at his data, perhaps you could have waited and retested; he was going down at the end of his PM cycle; you might have looked to see if he was headed up, and if he was (and it looks like he was), gone ahead and shot the full dose knowing that he was on an upward trajectory? Also, as you said earlier, his history shows him going up with those green preshot doses, so if history is a predictor of the future, that might happen again. The good news is that this cycle will teach you something--give you some good data.

Also, I don't think a .25 reduction is going to have that much of an impact given that Egon is receiving higher doses of insulin, do you?

I'm just talking it through with you. You're doing a fantastic job taking care of him, and you're clearly only interested in his well-being! I'm hoping he'll have a nice, safe surf for you today!
 
Thank you for the support Mary! I get nervous about waiting because the few times I've done that, he's continued heading down not up. Also I'm not sure I actually trust these Libre numbers 100%

I'm not sure. Maybe 6.5 would be better. He was trucking along well on 6.75u before my trip so I was hoping that skinny-ing back to that amount would be ok for him. Like you said, we shall find out soon. I am thankful to still have the Libre on while navigating these new lows to keep an eye on the general picture. Luckily I am home and can keep a close eye on him today!
 
When you are on a 7 unit dose (and corresponding 7 unit depot), just skinnying the dose will do hardly anything. The depot pretty much controls the first half of the cycle. With those larger sized doses, you'd need to do a half or 2/3 dose to see any impact, and even then the depot still might be driving the first part of the cycle.

The first time you see those lower preshots than you are used to, try stalling. That means waiting 15-20 minutes WITHOUT FEEDING, then check again to see if he's on his way up. If he's rising, that'll make you feel better about shooting cause it'll be another couple of hours after that before he onsets (the insulin starts to work again). Plus, that's a good time to double check with the Relion as the Libre could be showing quite a bit lower.
 
mady and egon said:
Thank you for the support Mary! I get nervous about waiting because the few times I've done that, he's continued heading down not up. Also I'm not sure I actually trust these Libre numbers 100%

I'm not sure. Maybe 6.5 would be better. He was trucking along well on 6.75u before my trip so I was hoping that skinny-ing back to that amount would be ok for him. Like you said, we shall find out soon. I am thankful to still have the Libre on while navigating these new lows to keep an eye on the general picture. Luckily I am home and can keep a close eye on him today!
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What I meant about .25 that you shaved today is that I don't think it's gong to have that great of an impact in terms of throwing things off right away.
 
Wendy&Neko said:
When you are on a 7 unit dose (and corresponding 7 unit depot), just skinnying the dose will do hardly anything. The depot pretty much controls the first half of the cycle. With those larger sized doses, you'd need to do a half or 2/3 dose to see any impact, and even then the depot still might be driving the first part of the cycle.

The first time you see those lower preshots than you are used to, try stalling. That means waiting 15-20 minutes WITHOUT FEEDING, then check again to see if he's on his way up. If he's rising, that'll make you feel better about shooting cause it'll be another couple of hours after that before he onsets (the insulin starts to work again). Plus, that's a good time to double check with the Relion as the Libre could be showing quite a bit lower.
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Ok. I was just thinking the 7u gave me a nadir a little lower than I'd like so maybe a little lower dose would give me a slightly higher nadir next time? Or is that not how it works? I am still trying to decide what dose to give tonight.

And in future, if I were to stall on the 66 (which was a ReliOn number) and historically he goes down on stalling so say in 20 minutes without feeding I got a 60, would you recommend I have given 3.5 or 4 units? Just trying to formulate a game plan for next time. Ideally the stalling would cause him to rise a bit and I could shoot the 7units.
 
Would it be possible to do something on the spreadsheet cell to make it easier to see what was tested with the Relion? Either bold/italic the number of put at R by it.

When you are following TR, ideal nadirs are in the 50-88 range. He wasn't even seeing greens on 6.5 units. You have to decide whether you want to shoot 6.75 units for a while, or stick with 7.0 units. The answer may depend on your ability to monitor the next while.
mady and egon said:
And in future, if I were to stall on the 66 (which was a ReliOn number) and historically he goes down on stalling so say in 20 minutes without feeding I got a 60, would you recommend I have given 3.5 or 4 units?
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The Sticky Note on Getting Data Ready to Shoot Low Numbers is a good read. It's a good idea, with those +1's, to figure out about how much of a numbers bump he gets from his meal. That will also lift the numbers until onset. 66 and 60 are essentially the same number with meter variance. When they are flat, you can give the full dose too. But for you that may be over time and data that you feel comfortable with that full dose shot. If you don't feel comfortable shooting the full dose, shoot less and see what happens. Your job is to learn how Egon reacts to food, different carb% and the insulin.

Another thing to consider, it looks like Egon often likes to nadir towards the end of the cycle (when not bouncing). That means you'll have to be comfy with shooting lower numbers more often, as he is seeing better numbers overall.
 
Wendy&Neko said:
Would it be possible to do something on the spreadsheet cell to make it easier to see what was tested with the Relion? Either bold/italic the number of put at R by it.

When you are following TR, ideal nadirs are in the 50-88 range. He wasn't even seeing greens on 6.5 units. You have to decide whether you want to shoot 6.75 units for a while, or stick with 7.0 units. The answer may depend on your ability to monitor the next while.

The Sticky Note on Getting Data Ready to Shoot Low Numbers is a good read. It's a good idea, with those +1's, to figure out about how much of a numbers bump he gets from his meal. That will also lift the numbers until onset. 66 and 60 are essentially the same number with meter variance. When they are flat, you can give the full dose too. But for you that may be over time and data that you feel comfortable with that full dose shot. If you don't feel comfortable shooting the full dose, shoot less and see what happens. Your job is to learn how Egon reacts to food, different carb% and the insulin.

Another thing to consider, it looks like Egon often likes to nadir towards the end of the cycle (when not bouncing). That means you'll have to be comfy with shooting lower numbers more often, as he is seeing better numbers overall.
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Thank you so much Wendy. Just reread it. Good refresher! I'll see where the nadir takes us today on 6.75 and see if I want to keep it or go back to 7. 66 really isnt that bad of a number... It's just the lowest I've seen so I got a little cold feet. I should tell @Mary & Jude I misplaced my balls of steel somewhere :ROFLMAO:

Last question for today!! Unfortunately I have to shoot an hour and a half early tonight at 6pm instead of his usual 7:30pm. Should I reduce his dose to 6.5u tonight for the early shot? I just reread this getting back on 12/12 sticky and it says I should talk it out with someone on here.
 
Right now he’s at 103 with the ReliOn and id be shooting in about 40 minutes if I’m going with the early route. Or I can stall and do two hours later than normal.
 
Wendy&Neko said:
Sounds like the best choice, and safest choice.
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Seemed to work perfect. He had a slight rise from 52 (LIBRE number) to 70 (ReliOn number) @ +1.5 when I fed and shot.
I am happier shooting a 70 than a 52 anyways and I learned that if I do wait long enough he will rise. Good learning lesson!!
Thank you for the guidance 😸
 
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