? 1/8/17 OSCAR's 2ND CURVE - Dosage advice please!

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Oscar & Mom Sheila

Member Since 2015
1/6/17 OSCAR's BGs - Some questions

Please check the boy's SS. Hubby and I worked together at building Oscar's curve. He had one hypo today. I need to know what do do dosage-wise in the morning. Is this the way Lantus usually reacts whilst finding our way? Hoping to get a bit more help in this posting than I did in the last one. Thanks.
 
I don't see that he was hypo by the numbers. Normal on a human meter is 50-120. What do you mean by hypo? I am guessing that you mean he dropped under 90 which means you drop the insulin by .25? That isn't a hypo.
 
I forgot to mention that Oscar had the runs at +4. I had to adjust the spreadsheet as I do the numbers in Canadian, then only a few American numbers show up so I have to fill them in by hand. Now it's complete - that's why you didn't see the hypo.
Would appreciate some dosing advise for the week. Oscar is presently getting .10.
@Tuxedo Mom @Marje and Gracie @Critter Mom @Kris & Teasel @Bobbie And Bubba

Hi Sheila,
I don't have any experience micro dosing at this level or with Lantus. I'm sure there are others here on L&L to help.
 
Since Oscar is a long time diabetic it is sometimes advised to allow them to drop to 40 or below 3 times before trying another reduction
Hmmm, I don't think there is a provision in the slgs guidelines for that technique. With the limited midcycle tests on the ss, I would be concerned that in this particular case that would be a risky approach.
 
One thought on the lower green. Since Oscar is a long time diabetic it is sometimes advised to allow them to drop to 40 or below 3 times before trying another reduction. Whether you would be comfortable with this would be your decision based on how much monitoring you are able to do during the work week. Other than that trying a further reduction would involve fine micro dosing which I have no experience with. Hopefully one of the other members who has used very fine tuning for dosing can give you more information on that.


ETA The provision for dropping to 40 or below 3 times is only used with the TR protocol. Sorry for the incorrect information since you are following SLGS. Further fine tuning of the microdose would be the best and safest approach,

It's actually 3 times under 50. With TR. Any test under 40 requires a reduction.
 
I think it's 3 drops below 50 for long time diabetics, and a single drop into the 30's.

I haven't seen anything about 3drops below 40.

From the TR guidelines
  • 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 blasĂ© 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
 
And from Tilly's diabeteshttp://www.tillydiabetes.net/en_6_protocol2.htm

When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose. Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. If the cat drops below 40 mg/dl once, reduce the dose immediately! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further.

If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose. Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet. Try to go from 0.25 IU to a drop before stopping the insulin completely. Reducing the dose too quickly generally does not work: most cats do not go into remission with fast reductions
 
OK
There were a couple of posts where it had been suggested as an alternative to failed reductions, but I can't find them at this point. However it certainly doesn't apply in this situation because Shelia is following SLGS.
If you find them would be interested to see, I wonder if it's been one of those things that's been miss written???

But absolutely either way does not apply in this case.:bighug:
 
  • I need to confirm that Oscar is SLGS. I'm finding myself very confused by all this. Is it possible for someone behind the scenes to delete the info that is not relevant to SLGS? Bottom line - do I continue on with a one drop per dose of insulin? Relevant advice needed BIG TIME. :banghead:
 
I would reduce the dose down to 1 drop of insulin. Meaning, press the plunger in firmly, insert into the Lantus and let go which should create a vacuum "drop dose".


From her posting above Karen had suggested trying to drop the dose down to 1 drop.

I will remove all my posts from this thread that relate to TR approaches so as not to confuse the issue
 
  • do I continue on with a one drop per dose of insulin? Relevant advice needed BIG TIME. :banghead:

I would try pressing in the plunger firmly, inserting it into Lantus and releasing. With that 42 yesterday it does appear the dose needs to be reduced. Practice the "drop" I mentioned and see if anything comes out of the syringe and try that dose.

Although you're not following TR the issue is it does not look like Oscar is ready to be off insulin. See if the drop dose will work. Has anything else changed with Oscar recently?
 
I would try pressing in the plunger firmly, inserting it into Lantus and releasing. With that 42 yesterday it does appear the dose needs to be reduced. Practice the "drop" I mentioned and see if anything comes out of the syringe and try that dose.

Although you're not following TR the issue is it does not look like Oscar is ready to be off insulin. See if the drop dose will work. Has anything else changed with Oscar recently?
Shortly after the hypo (no visible symptoms other than the number) Oscar had diarrhea. I haven't been able to observe any stools today - yet.
 
Shortly after the hypo (no visible symptoms other than the number)
If there were no symptoms, it's not considered a hypo but rather just low numbers and a reduction earned. There are kitties during an OTJ trial that give BG's in the 40's.

Hopefully there won't be any more diarrhea. What do you think about trying the "drop"?
 
Sorry Sheila, we got off subject.

I agree that you should drop the dose, though I would probably aim for 0.1, I'll post a link for how to do that in a minute, for me that worked out at between 2-3drops, (0.25 for me was between 4-5drops) it's worth experimenting with a little water and a used syringe, perhaps first seeing how many drops in 0.25, and taking it from their.

As Karen has mentioned above, it doesn't look like Oscar could manage without any insulin, we are saying that because typically when a kitty is approaching that we would see a SS that was all green, take a look at when George went otj, tab 2016 march April.

With TR you have the option of being a little more aggressive with dosing with a long term diabetic as it's often harder to achieve regulation and get them to hold reductions, which if I'm reading your Sig block Oscar has been diabetic for 7 years?

However, as pointed out with slgs you haven't really got that option, it's a more cautious approach which takes into account a reduced ability to monitor.
So for you a reduction is in order, but be aware that he may fail to hold the reduction and you will have to take him up again, but you'll cross that bridge when/if you get to it.

Sorry for the confusion, but as there are loads of folk that lurk and read threads, it's important to have these discussions out in the open.
Apologies for going of subject.:bighug::bighug::bighug:

ETA I've had a brain fsrt, please go with Karen's suggestion of 1 drop. So sorry. You are already on 0.1 so a reduction to 1 drop is the way to go
 
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Shortly after the hypo (no visible symptoms other than the number) Oscar had diarrhea. I haven't been able to observe any stools today - yet.
George would often have loose stools after I fed him gravy foods, never lasted long. +Only one soft poo then back to normal) Some kitties are sensitive to the sugars in the gravy. If you gave him gravy, next time you might want to try adding honey to his regular food to bump up the carbs.
 
George would often have loose stools after I fed him gravy foods, never lasted long. +Only one soft poo then back to normal) Some kitties are sensitive to the sugars in the gravy. If you gave him gravy, next time you might want to try adding honey to his regular food to bump up the carbs.
DH fed him Boreal with honey - no gravy but who knows. Cats are a mystery. thanks for the advice though.
 
BTW, his PM +2 last night was a huge drop. I wouldn't be surprised if he didn't drop down low again after that and is bouncing this morning. Hope the new dose works.
 
How long does it take for this bouncing business to level out a bit more? It's making me bounce too (to the ceiling at times) LOL.
Some bounce all the way off the juice. Lowering his dose might help as it was clearly too much insulin. Looking at your SS there are a few big drops at PM +2 which would indicate an active cycle and leaves me to think he was going lower and bouncing which has caused those higher preshot numbers.

Considering he went from 268 to 42 in 4 hours yesterday tells me it's likely not the first time it's happened.
 
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