01/24 Ivana AMPS=362, +2=315, +5=304, +6.5=263, PMPS=203, +2=151, +3=137, +5=95, +7=85

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Tara & Ivana (GA)

Tara & Ivana (GA)

Member Since 2015
Yesterday's diving post

Well, taking the skinny of her dose last night was good in theory, but those extra few drops did a lot more than we bargained for! She dropped down to 2.0 / 36 at +4, was hovering in the light greens for a little while before surfing the dark greens for a good few hours. Then, of course, her customary bounce followed. Hubby did a fabulous job at his first pyjama party while I attempted to sleep, and apparently Ivana was a compliant patient which is always helpful.

Technically she should take a reduction down to 1.25u, but for this morning's shot I just took her back to 1.50s which is where she was immediately before last night's shot and was going relatively well (lots of nice blues, but not many greens). I hope that was ok, am open to suggestions to take the full reduction if people think that's better. I suppose this means she really is recovering from her health issues from the last few weeks, which is great!
 
Exciting night last night! :eek::D What a difference a little drop makes for Ivana. And so lovely to have a DH who takes on the PJ party duties. What a keeper!

Continuing on the discussion from yesterday, when I see a number in the 30's (or heaven forbid lower), Neko gets a drop of syrup on her HC. 40's just gets HC. So lower number = bigger guns.
 
Wendy I've asked Sienne on yesterday's post and I'll ask you here too, do you think going from 1.50 to 1.50 skinny is ok, rather than a full reduction to 1.25? She was doing ok on that 1.25 dose up until last night (as in, we got a fair amount of blues), I'm reluctant to drop her all the way to 1.25 as I have a feeling we're just going to end up with her being high for days again. What do you think?
 
Here's a quote from the TR sticky. I've highlighted a couple of sections.

REDUCING THE DOSE:
The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus & Levemir ISG safe by suggesting and taking appropriate reductions.
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
  • Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
Ivana seems to fit the description of a kitty that isn't holding reductions well. However, she did get into the 30's. I think if you'd seen the 40's, a shave would have been fine. However, if she bounces, you can shoot through the bounce for one cycle, which means you could have shot 1.5 for today, then reduced tonight. Shooting through the bounce can help them get over those high numbers sooner.
 
Wendy&Neko said:
Ivana seems to fit the description of a kitty that isn't holding reductions well. However, she did get into the 30's. I think if you'd seen the 40's, a shave would have been fine. However, if she bounces, you can shoot through the bounce for one cycle, which means you could have shot 1.5 for today, then reduced tonight. Shooting through the bounce can help them get over those high numbers sooner.
Click to expand...
Yes I agree. She seems very sensitive to small dose changes, and often appears to need a dose that's inbetween the quarter doses. In this respect, the fats and skinnies seem to fill that gap.

I will count this morning's shot as shooting through the bounce, even though it was slightly less. I think this little trick could be really useful for her, she is a very bouncy girl!

Replying here so it's together with Wendy's post:
Sienne and Gabby (GA) said:
Shooting through the bounce seemed like a good idea. With the drop into the 30s, it would be safest if you took a full 0.25u reduction although it looks to me like you've been shaving the dose when you reduce.

I'd like to propose you think about two slightly different options regarding managing Ivana's numbers. One option is to hold the dose if she drops into the 40 - 50 range on three separate days. After three drops, you reduce the dose. The other alternative is to use food to prevent her from earning a reduction. You already test a good deal so it is unlikely you would need to do much more than you're already doing. The idea behind preventing a reduction is to try your best to keep Ivana in a lower range of numbers so the curve flattens out. Ideally, you'd want blue pre-shots and as much green in the middle as you can get. Today, for example, I would have gotten a test at PM +3 (because with perfect hindsight, her numbers were dropping fast) since given her pre-shot number and your +2, her numbers were dropping and you would have started giving HC at +3. This might have avoided the dose reduction. Jill had suggested this strategy with Gabby and it was very helpful in getting her numbers in a lower range overall.
Click to expand...

Yes we've been trying the shaving approach lately, both going up the dose ladder and going down, because it seems that even the quarter unit doses make a huge difference to her. Uncertain if it's the best approach or not, but the quarter unit changes have had her up and down the ladder so many times that I thought it was worth trying.

Questions (of course!):

With the 'three drops then reduce' approach, is the purpose of waiting for three drops to be absolutely certain that kitty is done with that dose? If they drop to <40 is that an immediate reduction regardless?

With the reduction prevention approach, I think I understand the idea of it, but am still unsure - if the food 'cancels out' the insulin in order to keep kitty in the dark greens, I'm not sure how that is different to just using less insulin? I actually think I've done this before without realising it was a legitimate approach, so that makes me feel good!

Re getting a +3 last night - as it happens, it looks like the same thing is happening tonight based on her PMPS vs +2. Please please please don't dive Ivana, we need sleep! Will see what +3 is and give food then if needed (she still has some uneaten dinner left in her bowl).

Thankyou both @Wendy&Neko and @Sienne and Gabby (GA) for your help :cat:
 
Just got a +3 and it looks like Ivana is not in a diving mood, thank goodness! We're heading to bed now due to last night's shenanigans, but will set the alarm for +5 to see where she's at and decide then what food to give her for her midnight snack and if we get to sleep the rest of the night through or not. Paws crossed!
 
In response to your questions, a drop below 40 warrants an immediate reduction. Numbers below 40 give you absolutely no margin for error and indicate the doses too high in a dramatic way.

By maximizing the insulin dose and maintaining it with food, there's a good chance you'll stay at the dose longer in order to get your kitty's pancreas used to being in better/normal numbers. If you reduce the dose, there's always the chance that it won't be enough insulin and the numbers will creep back up, thereby defeating the purpose of keeping your cat in normal numbers so her pancreas can get used to those greens.

 
Thanks for those explanations @Sienne and Gabby (GA). Are both of those options of the three drops before reducing, and the reduction prevention, are they used separately or should they be used together? Is one way better for the cat than the other? I'm leaning towards the three drops before reducing, purely because it makes more sense in my brain. But honestly, we're willing to try both (at different times if we need to) because what we've been doing hasn't been working so it can't hurt to try other options.
 
If you're more comfortable with the 3-drops method, try that first. I wouldn't do both together only because you won't really know what's working.
 
Good point about not knowing what's working. I will talk to hubby about which one to try first and see what he thinks (since he is very involved in her management as well), then go from there. Thanks for your help :-)
 
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