Martini 12/12 TR problem

[SMM]

http://www.felinediabetes.com/FDMB/threads/martini-12-02-bounce-bounce-bounce.187490/#post-2080724
http://www.felinediabetes.com/FDMB/threads/martini-12-02-bounce-bounce-bounce.187490/#post-2080724
Yes, I am a chicken sh*t. I don't feel comfortable when Martini goes below 4. I reduced her to 1.75 for 6 cycles and then went back to 2.00 as I was not getting any dark greens. Last night she hit a 45. I am so very worried/panicky that I will get called into work (could be anytime) and not have a chance to test to see how low she is and then try to raise her. I put her back to 1.75 after only 2 cycles of 2.00 due to this.
I cannot leave out food as Penny, my other kitty, will eat it all. Martini shows no signs of being low - she just sleeps in her princess bed. Husband is useless in this journey.
Am I screwing up TR? I don't see any other option than what I'm trying to do, does anyone else? I am trying so hard to help her, but running into roadblocks. Am I dosing correctly?

 

[Mandy & Rex (GA)]

You did correct by giving 1.75u after that 45 last night. I think the SS has an error because it shows 2u given this morning.

You are doing good by Martini!!

 

[SMM]

Yes thank you Mandy, I did screw up on the 2u. Any other ideas on dosing/holding or options?

 

[Stacy & Asia]

I don't know! I'm sort of there myself with Asia waffling between a dose that's not good enough and one that is too good! Trying to do a little bit of food manipulation, but I'm still figuring that all out.

I would have taken the reduction last night too, there wasn't even a big drop ahead of time to warn you that was coming!

 

[Mandy & Rex (GA)]

Yes thank you Mandy, I did screw up on the 2u. Any other ideas on dosing/holding or options?

I would stay with 1.75u for a few cycles. I saw you did get a 62 on the 2nd cycle last time. After the 6th cycle, ask if you should increase or wait.

 

[tiffmaxee]

You might want to try smaller increases and decreases. I used calipers and made tony dosing changes which worked for Max.

 

[SMM]

I don't know! I'm sort of there myself with Asia waffling between a dose that's not good enough and one that is too good! Trying to do a little bit of food manipulation, but I'm still figuring that all out.

I would have taken the reduction last night too, there wasn't even a big drop ahead of time to warn you that was coming!

Looks like besides ping pong, our two are doing 'the dance' together hehehehe!

 

[SMM]

I would stay with 1.75u for a few cycles. I saw you did get a 62 on the 2nd cycle last time. After the 6th cycle, ask if you should increase or wait.

Will do thanks Mandy!

 

[SMM]

You might want to try smaller increases and decreases. I used calipers and made tony dosing changes which worked for Max.

I do use calipers and I'm finding it difficult to see the difference in the smaller increase/decrease esp because of the darn BD needles that are not consistent in their measurements/plunger levels. I will try tho, thank you!

 

[tiffmaxee]

What I did with the frustrating lines I had even my wonderful terumo syringes was to ignore them and just use the calipers. I first used monojects with the hub that could hold extra insulin which was very frustrating. It’s a shame that the syringes, even when made for animals, are so inconsistent. I feel your pain.

 

[Marje and Gracie]

Being constant in giving the same dose is very important.
If you can't control the food intake, I personally wouldn't go for TR.
I strongly believe a cat will not go into hypo (when follow the TR protocol) as long as has enough food around the clock to fuel the liver when feels is necessary - but without food, I wouldn't bet on it.

There are several points here that I disagree with. I do agree that it’s important to give a dose enough of a chance to work unless a reduction is earned.

But I’ve seen cats that have been fed regularly, my own included, drop into the 20s. I think it is important to really understand how insulin works before making such a broad statement so that others, especially new members like yourself, will think it’s not possible to hypo as long as there is food on board.

It’s also untrue that she shouldn’t do TR if she can’t control the food intake. It is very important to learn to feed the curve but there are and have been a lot of members who don’t have to do that, they do TR, and the cat goes into remission. Remember...ECID.

Sandy...IMHO, I think the issue is that you are missing the clues that Martini is giving you. She likes to drop around +3/+4. That would be the time I’d be sure to test and feed her. In a perfect world, you could test at +2 every cycle because then you would have a pretty good idea if she was going to drop. If the +2 is similar to or less than the PS, you are most likely going to have an active cycle.

Knowing that, you could be sure there is food on board before that +3/+4 timeframe and test then as well so you can control the drop with food and keep her out of reduction numbers. Being able to hold a good dose longer will help her get into green and give her pancreas some healing time.

Besides the ECID saying we have here, the other one that is equally important is “know thy cat”. Study her SS and notice the patterns. It’s always great to ask for help if you can’t figure the pattern out or if you do but don’t know how to handle it.

In this case, I don’t think it’s a situation of one dose is too much and one is too little and I wouldn’t shoot in between doses on Martini at this time, if she were mine. Instead, I’d work at testing at the appropriate times and feeding accordingly.

 

[SMM]

Thank you so very much Marje for your thoughts, I have a tough time sometimes getting replies to my posts, I don't know why.
I do try my best and test at +3/+4 (mornings are difficult +3 -work), evenings when I'm home I do try +3 at least, see what the # is and go from there. At +2 she is pretty much high from eating still for the most part - tho you are definitely spot on with the +3/+4 remarks. Martini has been fed twice a day all her life. She eats until she is full (she gets her shot while eating) and isn't really hungry after that, although if I do see her going lower I try to give a tbsp of food.
I do try to see patterns but I'm obviously not very good at it.
I will keep the 1.75 for at least 6-8 cycles unless something goes wacky, I hope that's what you are saying. I'm just paranoid about not being around when she goes low, thankfully that has not happened (yet).
Again, thank you so much for your guidance!!!

 

[Marje and Gracie]

Thank you so very much Marje for your thoughts, I have a tough time sometimes getting replies to my posts, I don't know why.
I do try my best and test at +3/+4 (mornings are difficult +3 -work), evenings when I'm home I do try +3 at least, see what the # is and go from there. At +2 she is pretty much high from eating still for the most part - tho you are definitely spot on with the +3/+4 remarks. Martini has been fed twice a day all her life. She eats until she is full (she gets her shot while eating) and isn't really hungry after that, although if I do see her going lower I try to give a tbsp of food.
I do try to see patterns but I'm obviously not very good at it.
I will keep the 1.75 for at least 6-8 cycles unless something goes wacky, I hope that's what you are saying. I'm just paranoid about not being around when she goes low, thankfully that has not happened (yet).
Again, thank you so much for your guidance!!!

I’m sorry if you aren’t getting responses to your posts. If you use the “?” mark in the dropdown box to the left of the subject line, that might help. The other thing that helps is to put something in your subject line that catches the eye that you have a specific question. Today is a great example of a good subject line that caught my eye.

If you don’t get a response even if you’ve done the above, it often means that no one experienced enough to answer the question is on the board and others just don’t feel comfortable answering something that might be out of their realm of experience (which is good....we all need to understand our limits so other members’ cats stay safe).

I didn’t plain it well but I think it is great value for you to get a +2 test every single cycle that you can. The +2 is a great tool to tell you if she’s going to come down or not. If she’s higher at +2, she’s typically not going to have a busy cycle. But if she’s the same or lower, she isn’t. I see a couple cycles where she was up at +2 and then came down but more times than not, she’s done nothing when she was up at +2.

What if you try to spread her food out a bit? You’d be surprised at how flexible cats can be with their feeding. It might be worth a try.

Since you reduced the dose, you don’t have to hold it six cycles if it isn’t working for her. When you increase, you want to hold it at least six cycles unless she earns a reduction. But when you reduce, you just need to let any bounce clear and see if she comes back down to green. If it takes her only three cycles to clear any bounce and she’s doesn’t come down to green, you can increase the dose. If she doesn’t bounce but doesn’t come down to green on the reduced dose within a couple cycles, you want to take the dose back up to the last good dose.

 

[SMM]

Will try to get +2 ( in the evenings is best for me) more, and try spreading out her food a bit. She's bouncing now so I'll go from there. Thank you!