Gandalf dosing advice, 2.3 mmol/l +10. Decrease dose?

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Helena and Gandalf

Helena and Gandalf

Member Since 2016
Hi!
Since 10/12 we have been trying to follow the TR protocol, though looking back at the first weeks the dose was not very consistent. That was because we did not feel comfortable shooting the full dose at low PS numbers, some dosing-decisions were probably also made while severely sleep deprived. :coffee::rolleyes:
Anyhow, we eventually landed on 1.4U and seemed to get ok readings on this dose, mainly blues and the occasional greens. For some reason (I really don't know why since that was not supported by the TR protocol) we lowered to 1.3U and felt we lost the ok response, and moved him back to 1.4u. The last 3 days on 1.4U he stopped responding (despite the opening of a new vial) so we bumped him up to 1.5U. He has now had a few cycles on 1.5U and it has been a rollercoaster, especially today with a huuuge drop.

We are completely lost now and don't now what dose to keep him on. 1.5U seem to much (or not?) and on 1.4U it seem like the response could be improved. He is also a master bouncer which is not making this any easier... We could not bring ourselves to give the full 1.5 U last night when he was only 4mmol/l, since he dropped so much from the 9.6 mmol/l AMPS. Do you think it would be safe to give the full dose with such a PS if we can monitor the cycle? Should we keep him on 1.5U or move him back down to 1.4U?
Thanks!

Edit: Just tested 2.3 mmol/l (just above 40) at +10. Gave him som gravy food.
 
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Per TR, since he went below the action number, he would earn a .25 reduction, so his new dose would be 1.25 units. Because you've had 3 different doses in the span of 3 days, it's hard to say what will happen. Lantus, being a depot insulin, needs time to build up to see the full impact of a given dose. I also notice you've been doing smaller increases (i.e. 1.4 to 1.5), is there a specific reason for that? Is he very sensitive to minor adjustments? If you wanted to try to just follow TR as written, his new dose would be 1.25 until such time as he got another neon green (another reduction) or if his numbers kept trending up and it's been several cycles so you know it isn't a bounce, you would increase again to 1.50. If you try following TR and have another instance where you are not comfortable shooting the full dose based on the preshot, post here and get some help, I've been in that situation too, and people here have been so helpful. :)

Hopefully more experienced people will chime in.
 
Helena and Gandalf said:
Hi!
Since 10/12 we have been trying to follow the TR protocol, though looking back at the first weeks the dose was not very consistent. That was because we did not feel comfortable shooting the full dose at low PS numbers, some dosing-decisions were probably also made while severely sleep deprived. :coffee::rolleyes:
Anyhow, we eventually landed on 1.4U and seemed to get ok readings on this dose, mainly blues and the occasional greens. For some reason (I really don't know why since that was not supported by the TR protocol) we lowered to 1.3U and felt we lost the ok response, and moved him back to 1.4u. The last 3 days on 1.4U he stopped responding (despite the opening of a new vial) so we bumped him up to 1.5U. He has now had a few cycles on 1.5U and it has been a rollercoaster, especially today with a huuuge drop.

We are completely lost now and don't now what dose to keep him on. 1.5U seem to much (or not?) and on 1.4U it seem like the response could be improved. He is also a master bouncer which is not making this any easier... We could not bring ourselves to give the full 1.5 U last night when he was only 4mmol/l, since he dropped so much from the 9.6 mmol/l AMPS. Do you think it would be safe to give the full dose with such a PS if we can monitor the cycle? Should we keep him on 1.5U or move him back down to 1.4U?
Thanks!

Edit: Just tested 2.3 mmol/l (just above 40) at +10. Gave him som gravy food.
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Bumpy ride, handsome Maine Coon you have in your hands...Toro's had been on the same bumpy ride until we decided to push him and have him under 2.8 three times (in three different days with constant dose - as per Roomp & Rand protocol )....and his BG numbers magically regulated. He actually got as low as 2.9 on FT2 (the equivalent of 1.6 on Freestyle Lite) at one time but I don't suggest you go there. :)
I guess your two choices are to stay with 1.5U and watch him closely, be prepared for low numbers - or get back to 1.25U, play safe and see what will happen.
 
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Toebeans said:
Per TR, since he went below the action number, he would earn a .25 reduction, so his new dose would be 1.25 units. Because you've had 3 different doses in the span of 3 days, it's hard to say what will happen. Lantus, being a depot insulin, needs time to build up to see the full impact of a given dose. I also notice you've been doing smaller increases (i.e. 1.4 to 1.5), is there a specific reason for that? Is he very sensitive to minor adjustments? If you wanted to try to just follow TR as written, his new dose would be 1.25 until such time as he got another neon green (another reduction) or if his numbers kept trending up and it's been several cycles so you know it isn't a bounce, you would increase again to 1.50. If you try following TR and have another instance where you are not comfortable shooting the full dose based on the preshot, post here and get some help, I've been in that situation too, and people here have been so helpful. :)

Hopefully more experienced people will chime in.
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He is indeed sensitive to changes in dose, and reducing by 0.25 has not been sticking well in the past (although this is mainly based on his Prozinc journey), but shaving the dose has been the way to go with Gandalf. My gut feeling is telling me a 0.25 U reduction is too much.
TR has always confused me since there seem to be soo many different interpretations. According to the TR protocol on Tilly's page (http://www.tillydiabetes.net/en_6_protocol2.htm) he earns an immidiate reduction when he goes below 40, technically he never was below 40 but really close, else he earns the reduction when he goes below 2.8 three times, like @Toro & Ovi says.

We still have 40 minutes to go until shot time and he was up to 4.0 mmol/l at +11. I will chat with my partner when he gets home but I think we will have to lower him again. Since he did not do so well on 1.3U I think 0.25U is to much of a decrease, I think we will probably go with 1.4U again and hold that for 6 cycles. There are busy times at the universoty and we really need to get some sleep. :)
 
Gandalf is a long term diabetic, so on Lantus TR, he earns a reduction by dropping 3 times below 50 (on separate days), or once below 40. It's very important to take a single drop into the 30's seriously and take a full reduction.

At the moment you've been reducing dose when he hasn't really earned a reduction (even if he were newly diagnosed), that's the reason he's not holding them.

If this were my cat I would, for now, especially as he is new to Lantus, take the full reductions when they are earned.

I have to dash out to a yoga class now I'll write some more when I'm back.

Here's a post by Jill on earning reductions
http://www.felinediabetes.com/FDMB/...ng-reductions-and-starting-otj-trials.150160/
 
Gill & George said:
Gandalf is a long term diabetic, so on Lantus TR, he earns a reduction by dropping 3 times below 50 (on separate days), or once below 40. It's very important to take a single drop into the 30's seriously and take a full reduction.

At the moment you've been reducing dose when he hasn't really earned a reduction (even if he were newly diagnosed), that's the reason he's not holding them.

If this were my cat I would, for now, especially as he is new to Lantus, take the full reductions when they are earned.

I have to dash out to a yoga class now I'll write some more when I'm back.

Here's a post by Jill on earning reductions
http://www.felinediabetes.com/FDMB/...ng-reductions-and-starting-otj-trials.150160/
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Thanks for your input! We reduce to 1.25U then, as he was basically at 40 and we can't be up steering all night, and will hold the reduction for 6 cycles. He just tested 3.7 mmol/l for PMPS (2 hours after his gravy food). I really hope you are right about the reason he is not holding his reductions, but as I said he has a history of being fuzzy with dose changes in general.
Gosh I really hate this, never knowing what to do, always second guessing and whatever decision you make still turn out bad! :banghead::oops:
 
Even though you shot a reduced dose, be aware that the first half of the cycle, because of the depot, will likely still play out the same.

If this were me, I would get a +1 and +2 tonight.

That should give you an idea of where he's heading.

A +1 that is the same or lower, than ps indicates an active cycle. If +1 is rising, get a +2, same applies if that is lower or about the same, as your Pmps, you need may need to test more.

I think it's fine that you reduced to 1.25, with the dose changes it's hard to figure bout what's been going on. On TR if he is trending up, you can call a fail reduction and take him up to the last good dose. As you are new to lantus I would ask on the forum, get someone experienced to look at the numbers and give you their opinion.

Yoga about to start, off line now for a couple of hours.
 
+2 looks like he is going up. Possibly a bounce starting.

Paws crossed he holds the reduction.

If you get worried/confused by his numbers and what to do next, post up for guidance.
 
Looks like he is heading down already. With +2 being quite low in comparison to PS.

If you are home and are able to, I would try and get a test in at +5 / +6.

Just wondering what your feeding schedule is like with Gandalf?
If you are just feeding at amps and pmps, you might want to consider, splitting his meals up during the course of the day, on Lantus, this works better than feeding just twice a day. Splitting his daily allowance up into small portions and trying to feed that in the first half of the cycle (feeding in the latter half of the cycle, can have the undesired effect of bumping the numbers up for the next PS).
If you are not already feeding small regular meals, You could try feeding 25% of his allowance at PS, then 12.5% @+2 or +3; 12.5%@+5 or +6.

What I found worked best for George was feeding at +2 +4 +6, (that's if I didn't have to steer to keep him from the sharks)
I made notes, of what I fed(carb %) when, kept that on the ss, so I could look back regularly and see what worked and what didn't, it also allowed those that were helping me have some extra info and they could suggest better strategies.

ECID, so if you decide to experiment, keeping notes can really help you figure what will work best for Gandalf.


If when you next test him he is dropping, like he did yesterday, and he's back to blue you might want to try giving a couple of teaspoons of his regular LC food, that come help slow them down and surf, instead of continuing to drop like he did yesterday, since the bounces can be triggered by them dropping low or dropping fast, using food to slow them down can result in them spending more time in better numbers. By using food to manipulate his curve you might be able to slowly, over time get his body used to lower numbers and hopefully flatten out his BG.

It would be good if you could hold on to this dose, allow the depot to settle, at the moment numbers are likely wonky due to the frequent dose changes in the last few days. This makes it hard to decide what would be a good dose.
 
Gill & George said:
Looks like he is heading down already. With +2 being quite low in comparison to PS.

If you are home and are able to, I would try and get a test in at +5 / +6.

Just wondering what your feeding schedule is like with Gandalf?
If you are just feeding at amps and pmps, you might want to consider, splitting his meals up during the course of the day, on Lantus, this works better than feeding just twice a day. Splitting his daily allowance up into small portions and trying to feed that in the first half of the cycle (feeding in the latter half of the cycle, can have the undesired effect of bumping the numbers up for the next PS).
If you are not already feeding small regular meals, You could try feeding 25% of his allowance at PS, then 12.5% @+2 or +3; 12.5%@+5 or +6.

What I found worked best for George was feeding at +2 +4 +6, (that's if I didn't have to steer to keep him from the sharks)
I made notes, of what I fed(carb %) when, kept that on the ss, so I could look back regularly and see what worked and what didn't, it also allowed those that were helping me have some extra info and they could suggest better strategies.

ECID, so if you decide to experiment, keeping notes can really help you figure what will work best for Gandalf.


If when you next test him he is dropping, like he did yesterday, and he's back to blue you might want to try giving a couple of teaspoons of his regular LC food, that come help slow them down and surf, instead of continuing to drop like he did yesterday, since the bounces can be triggered by them dropping low or dropping fast, using food to slow them down can result in them spending more time in better numbers. By using food to manipulate his curve you might be able to slowly, over time get his body used to lower numbers and hopefully flatten out his BG.

It would be good if you could hold on to this dose, allow the depot to settle, at the moment numbers are likely wonky due to the frequent dose changes in the last few days. This makes it hard to decide what would be a good dose.
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Gandalf is raw fed and very conveniently the food comes in frozen balls. He eats 5 balls/24h, he gets 2 at AMPS and PMPS respectively and 1/2 ball at approx. +5 each cycle. This varies a lot since both me and my partner go to the university and cannot be home the right time every AM-cycle to feed. Today we both had to leave at +2 (so he was fed his 1/2 ball then) and I could not get home to test until after +8. (A few times we have had to bike home during lunch to test and feed due to a suspected midday drop, that is a 1 hour round trip. By bike... :p) So I think experimenting with the feeding pattern to draw any conclusions from it might be hard since it is always going to vary from week to week or even day to day. Or do you think he would still benefit from just splitting the meals more those days we are home and can do so?
We did try what we called "mini-meals" (split food to 6 servings/24h) when we were on Prozinc to see if it would keep him surfing the greens, instead of diving then jumping. It was somewhat successful, but eventually his body always fought back and he would bounce right up to pinks or sometimes reds.

It was looking really good at AM +8.5 (8.9 mmol/l), really curios to see what PMPS he will bring and if he can keep it up on 1.25! :cat:
 
Helena and Gandalf said:
(A few times we have had to bike home during lunch to test and feed due to a suspected midday drop, that is a 1 hour round trip. By bike... :p)
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:eek:No need to go to the gym then:p

Seriously though, I got an automatic feeder, so I could leave it set to dispense mini meals when I went out. If I thought it looked like he was going for a dive, then I'd leave higher LC or even MC in the snacks, just depended on where his numbers were. And even better I could eave snacks for him at night, helped with being able to catch some extra zzzz's

Helena and Gandalf said:
Or do you think he would still benefit from just splitting the meals more those days we are home and can do so?
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I think that if you start to see really active cycles, ie if you are testing at +2 +3 and catch a large drop it might be worth trying to slow him up.
Helena and Gandalf said:
Today we both had to leave at +2 (so he was fed his 1/2 ball then)
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I would have suggested feeding a little at +2 today since he had a big drop from amps.:)
Though when in a similar situation myself with George I would have also left the autofeeder set to give him a snack at +4 and then +6. I measured everything in teaspoons, so as an example, he'd have got 4 teaspoons amps, 1tsp at +2+4+6 .

With your schedules being variable I do think an automatic feeder would be a great tool in helping you manage his meals, especially if Mr Gandalf starts to have more cycles like today.

It will indeed be interesting to see pmps, I am excited to see it too.:nailbiting:
If he is flat blue or if he numbers are falling, then that may signal his intention to party tonight.

Nice numbers the last couple of days, he's been spending a lot of time in good numbers.:)
 
Gill & George said:
:eek:No need to go to the gym then:p

Seriously though, I got an automatic feeder, so I could leave it set to dispense mini meals when I went out. If I thought it looked like he was going for a dive, then I'd leave higher LC or even MC in the snacks, just depended on where his numbers were. And even better I could eave snacks for him at night, helped with being able to catch some extra zzzz's


I think that if you start to see really active cycles, ie if you are testing at +2 +3 and catch a large drop it might be worth trying to slow him up.

I would have suggested feeding a little at +2 today since he had a big drop from amps.:)
Though when in a similar situation myself with George I would have also left the autofeeder set to give him a snack at +4 and then +6. I measured everything in teaspoons, so as an example, he'd have got 4 teaspoons amps, 1tsp at +2+4+6 .

With your schedules being variable I do think an automatic feeder would be a great tool in helping you manage his meals, especially if Mr Gandalf starts to have more cycles like today.

It will indeed be interesting to see pmps, I am excited to see it too.:nailbiting:
If he is flat blue or if he numbers are falling, then that may signal his intention to party tonight.

Nice numbers the last couple of days, he's been spending a lot of time in good numbers.:)
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Heh definitely no need for the gym! All in all a day like that results in about 30 km of cycling. :cool:

We did think about buying a feeder, several others also suggested it over at the Prozinc forum. We are just worried it would be wasted money. He is like a tiny grizzly, soo strong, and also stubborn as hell. He is notorious for breaking out through the locked cat door. Once he broke out by moving 20 kg of weights (home gym equippment) plus a bench that we put there to block the cat door so he would not get out. :rolleyes: His determination is very impressive! So, since he is also very food driven we worry he would absolutely trash an automatic feeder to get to the goodies inside.

Wohoo we have a blue PMPS! :joyful: Really hoping for some action tonight! He usually is the most active during his night cycles, as I have understood a lot of kitties are.
 
:cool::cool::cool: Go Gandalf. Looking promising.

OMG on Gandalf the destroyer!! How big is he?

Funnily I thought George would destroy his feeder, he broke into a neighbours house to get at their kitties food:oops: totally trashed their kitties cat flap. He too is very motivated by food.

But amazingly he seemed happy to wait for his snacks, has never tried to break in to the feeder. (Anti jinx)
 
Gill & George said:
:cool::cool::cool: Go Gandalf. Looking promising.

OMG on Gandalf the destroyer!! How big is he?

Funnily I thought George would destroy his feeder, he broke into a neighbours house to get at their kitties food:oops: totally trashed their kitties cat flap. He too is very motivated by food.

But amazingly he seemed happy to wait for his snacks, has never tried to break in to the feeder. (Anti jinx)
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He is a bit more 5 kg, so not a very big cat.
Hahaha hilarious, but embarrasing! :D That is interesting, we might actually give the feeder a go then and hope for the best.
 
@Gill & George Need some advice. We are 40 min away from his PM shot. He got in our other cats food so we decided to test him right away since the PMPS would otherwise be food influenced. To our suprise it is only 7.7 mmol/l, when we were just about to call it a failed reduction. Should we keep the 1.25U for, at least, one more cycle?
 
With the +11.5 showing blue like that it looks as though he might be clearing a bounce.
I think I would stick with the 1.25u tonight and see where that takes you.

Still get an pmps and see what that number is.

What sort of food do the other cats get? Is it LC?
George got into my other cats food today too, I think Gandalf and George may have been plotting together
 
Phew good that they get the same fuds, George used to seek out food when his BG's dropped. His falling BG might have prompted him to seek out his civies food.

Tonight will be cycle 7 on this dose, if you don't see any green tonight you might want to think about taking him back up to 1.5u. If it's a little easier for you to monitor at the weekend, it might be good timing.

Have you seen this thread by Libby and Lucy? http://www.felinediabetes.com/FDMB/...combining-merging-protocols-good-idea.111088/, post number 6, talks a bout shooting a dropping number. Mindset is a little different to Prozinc.
 
Another factor that may be contributing to the numbers is if you're not shooting in 12-hour intervals. Given the long-acting nature of Lantus and the way the depot acts, a late shot acts like a dose reduction and an early shot acts like a dose increase. If you are shooting at +2 some days, then your next shot should be 12 hours later. If instead, you shoot at your usual shot, the late shot followed by the "early" shot don't cancel each other out. Rather, those changes cause wonky numbers since the depot doesn't have a chance to stabilize. Gill's suggestion regarding a timed feeder may be very useful so you are able to shoot at 12-hour intervals if, in fact, your schedule willl permit.
 
He always comes running when he hears that we are about to feed Frodo (Frodo does not want to eat on set times so we just need to suck it up and feed him when he tells us he is hungry... Sigh!). So he was lurking around waiting for Frodo to be done. You look away for one second and then the food Frodo left is gone. :banghead:
Great post, will definitely keep this in mind! Would be really nice to see some lower numbers again, and a nice surf tonight. He just tested 7.4 mmol/l som we shoot the 1.25U know!
 
Sienne and Gabby (GA) said:
Another factor that may be contributing to the numbers is if you're not shooting in 12-hour intervals. Given the long-acting nature of Lantus and the way the depot acts, a late shot acts like a dose reduction and an early shot acts like a dose increase. If you are shooting at +2 some days, then your next shot should be 12 hours later. If instead, you shoot at your usual shot, the late shot followed by the "early" shot don't cancel each other out. Rather, those changes cause wonky numbers since the depot doesn't have a chance to stabilize. Gill's suggestion regarding a timed feeder may be very useful so you are able to shoot at 12-hour intervals if, in fact, your schedule willl permit.
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Good point! We shoot a a 12/12 schedule. We try to be as consistent as possible, the shot times only vary about +/- 10 mins.
 
@Gill & George Sorry to bother you again. We really don't know how to handle Gandalfs reaction to 1.5U. He has gone from 17.3 mmol/l this morning to 6.6 mmol/l now, with only 10 min until shot time. We shot 1.5U at 9.6 mmol/l once (11/20) and then he almost dropped below the take action number. We can monitor all night if necessary but I do believe 1.5U is to much for him. What do you think?
 
It looks like he is clearing a bounce. Although some kitties do have a strong initial reaction to a dose increase.

If you are stalling without food, check again in 20min-30min, and see if he is staying flat or dropping.

It might help you decide.

If it were me I would shoot, but I would be prepared to monitor, especially the early part of the cycle, in case you need to manage the numbers with food.
Remember the post that I linked the other day about shooting a dropping number?
 
Gill & George said:
It looks like he is clearing a bounce. Although some kitties do have a strong initial reaction to a dose increase.

If you are stalling without food, check again in 20min-30min, and see if he is staying flat or dropping.

It might help you decide.

If it were me I would shoot, but I would be prepared to monitor, especially the early part of the cycle, in case you need to manage the numbers with food.
Remember the post that I linked the other day about shooting a dropping number?
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Just tested 7.1 mmol/l after 25 min. We were just about to go ahaead and shoot, feels like the right decision now with some support, thank you so much! :bighug:
 
Helena and Gandalf said:
Retested after 25 min and got 7.1 mmol/l. We decided to take the sleepless night


Just tested 7.1 mmol/l after 25 min. We were just about to go ahaead and shoot, feels like the right decision now with some support, thank you so much! :bighug:
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I was just typing some other options, glad you decided to shoot, I do believe it is the right choice. Looks like he is flattish coming into PS then.

Definitely start by grabbing a +1 and +2 tonight.

If at +1, if you find he is dropping/ or if his numbers are flat, I would suggest you give him a small snack (I am going to be his best buddy), depending on what his numbers are doing you might want to consider what carb% you want to give.
Do you know if he is carb sensitive?
George wasn't so I would need to be quite heavy handed with the carbs if he dropped fast and low into +1, if I didn't get the big guns out he would have me feeding him snacks for hours fighting to keep his numbers up.
Some cats are much more sensitive, and need less carbs to bump them up, even LC will do it for some. The only way to find out is to keep notes, and experiment.

BTW no worries about tagging me I was online, glad I could be around.
 
Gill & George said:
I was just typing some other options, glad you decided to shoot, I do believe it is the right choice. Looks like he is flattish coming into PS then.

Definitely start by grabbing a +1 and +2 tonight.

If at +1, if you find he is dropping/ or if his numbers are flat, I would suggest you give him a small snack (I am going to be his best buddy), depending on what his numbers are doing you might want to consider what carb% you want to give.
Do you know if he is carb sensitive?
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Haha yes! He is going to be a happy camper tonight, suspect he will fed above his normal amount.
He is carb sensitive, he usually only need a moderate amount of LC gravy food to steer.

Will post the +1 in a while!
 
Gill & George said:
Quite Flat, the absence of a food bump, makes me think this could be an active cycle.

At this stage as he is not dropping a teaspoon or two of LC so that he has some extra food on board for when he onsets may aid a surf.
See you at +2
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Sure glad we decided to shoot full dose, +2 is 10.9 mmol/l. He was given some raw food at +1 (not LC gravy food) so very low carb.
Last one to bed will do a test and someone will get up if that turn out to be necessary. After tonight I think we feel confident enough to shoot 1.5U tomorrow as well, even if he would be lower for AMPS.
 
Just seen his +2, looks like he may be starting a bounce. Unless it's a food spike.
What food did you give him at +1?

I think you can give him a break and just get a test before you head to bed.
 
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