? - Mimi 102 @ +12.5/AMPS, surfing in lagoon until +10 247. PMPS REDUCIE 246 | Page 2 | Feline Diabetes Message Board - FDMB

? Mimi 102 @ +12.5/AMPS, surfing in lagoon until +10 247. PMPS REDUCIE 246

Mimis mom said:
Ya sorry I really am- I passed out waiting for her +7... she also was laying on me and purring which always puts me to sleep. I have a lot of sleep issues and can fall asleep or need to sleep a lot during the day (if it’s my day off and I’m home)
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Wait so do I give her a reduction tonight or not?
Sue and Luci said:
Sorry to hear that! I too need to get some sleep now. Hopefully if needed, @Bron and Sheba (GA) will be available to help you later this evening if necessary. I suspect that there will be a bounce into higher numbers this evening as Mimi went really low today...and her body isn't used to that and will respond with some higher numbers.

Have a good night :)
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thanks for all of your help and you do as well!
 
I need some help with understanding when to drop or increase a dose. If you look back to my SS- there were a few cycles that looked similar to this one and I was advised against a dose decrease. Just wondering why that might have been?

is it because I have collected more consistent data since then?
 
Probably because of the relatively recent DKA. Having sufficient insulin is a really important part of the initial DKA recovery period, so some of the normal rules about taking reductions don't apply. But we're now a month and a half out, so if Mimi is doing well in general, you can take the recommended reduction to 0.75U.
 
done!
I have a question quick and I know I've asked before but how important is it to get a digital caliper? I know where to get one and how they are used but ive also felt pretty confident I measure good- but is it possible one little drop could make a difference- like say when she was at 1 unit- could I have been a hair closer to the line at bedtime and a hair further at am- does that make sense?
if its reduced to .75 and I gave .76 or in the morning did more like .73 is that making a difference? does everyone on here use a caliper? (just wondering if that small detail could be affecting her numbers even though Im pretty neurotic about getting to the same spot every time. at least I think I am - but what if it was the angle I held the needle to the light to see where the plunger was- slightly off the night before.
THANKS! hah- I'm a nut job
 
Mimis mom said:
I need some help with understanding when to drop or increase a dose. If you look back to my SS- there were a few cycles that looked similar to this one and I was advised against a dose decrease. Just wondering why that might have been?
is it because I have collected more consistent data since then?
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With TR, because Mimi has had FD for under a year, you reduce the dose when the BG drops under 50 by 0.25 units.

If you look at the SS you will see that each time she has dropped under 50, she has had her dose reduced by 0.25 units....with the exception of the cycles on 9/30 when she had a preshot of 48 and you skipped and a couple of days later she was hospitalized with DKA....I don't think you were a member then. And again on the 11/10 when she was 1 day out of hospital following DKA and she dropped to 39 at +6 and the reduction wasn't taken. You had joined the day before and I don't know if you had begun posting or were being helped then or not. I cant find any posts relating to it.

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
 
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Bron and Sheba (GA) said:
With TR, because Mimi has had FD for under a year, you reduce the dose when the BG drops under 50.

If you look at the SS you will see that each time she has dropped under 50, she has had her dose reduced by 0.25 units....with the exception of the cycles on 9/30 when she had a preshot of 48 and you skipped and a couple of days later she was hospitalized with DKA....I don't think you were a member then. And again on the 11/10 when she was 1 day out of hospital following DKA and she dropped to 39 at +6 and the reduction wasn't taken. You had joined the day before and I don't know if you had begun posting then or were being helped then or not. I cant find any posts relating to it.

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
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so well see how she does on this new dose then and if she has nadirs under 200?
there were a couple of times she was at 53, and 56 which i thought was basically the same as say, 46. its close enough, but the below 50 is pretty strict I take it?
 
Mimis mom said:
so well see how she does on this new dose then and if she has nadirs under 200?
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The nadirs under 200 is for increases in dose

Mimis mom said:
there were a couple of times she was at 53, and 56 which i thought was basically the same as say, 46. its close enough, but the below 50 is pretty strict I take it?
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The rule is strictly you reduce the dose if the BG drops below 50

53 and 56 are much the same if you take in meter variance of 20% but when a reduction is taken we do not say 56 is basically the same as 50 or close enough.
 
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Mimis mom said:
but the below 50 is pretty strict I take it?
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Yes it is.

Let's see how she does on the new dose.

  • Because of the way that Lantus works, with the depot, the next few cycles may be influenced by the depot of the 1u, it takes a few cycles for the depot to reduce in size and re stabilise, upto 6 cycles.
  • So reducing tonight doesn't mean that you will necessarily see the numbers jump up straight away.
  • the larger dose may still drive the numbers down.
  • so do not become complacen
  • keep checking those ketones, especially as we have reduced the dose and let us know asap if they become an issue

Thanks @Bron and Sheba (GA) and @Sue and Luci for stopping by.
 
Rosa asked if I would weigh in on whether Mimi needs a dose reduction.

A drop to 43 indicates a dose reduction is warranted. Both Gill and Bron provided a cogent rationale for reducing the dose.
 
Gill & George said:
Yes it is.

Let's see how she does on the new dose.

  • Because of the way that Lantus works, with the depot, the next few cycles may be influenced by the depot of the 1u, it takes a few cycles for the depot to reduce in size and re stabilise, upto 6 cycles.
  • So reducing tonight doesn't mean that you will necessarily see the numbers jump up straight away.
  • the larger dose may still drive the numbers down.
  • so do not become complacen
  • keep checking those ketones, especially as we have reduced the dose and let us know asap if they become an issue

Thanks @Bron and Sheba (GA) and @Sue and Luci for stopping by.
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Her last few readings have been yellow and purple.
Sienne and Gabby (GA) said:
Rosa asked if I would weigh in on whether Mimi needs a dose reduction.

A drop to 43 indicates a dose reduction is warranted. Both Gill and Bron provided a cogent rationale for reducing the dose.
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Sienne and Gabby (GA) said:
Rosa asked if I would weigh in on whether Mimi needs a dose reduction.

A drop to 43 indicates a dose reduction is warranted. Both Gill and Bron provided a cogent rationale for reducing the dose.
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Sienne and Gabby (GA) said:
Rosa asked if I would weigh in on whether Mimi needs a dose reduction.

A drop to 43 indicates a dose reduction is warranted. Both Gill and Bron provided a cogent rationale for reducing the dose.
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I need to get a digital caliper so I’m for sure giving 1 unit, or .75 because I could be giving 1.1 units and not realizing it
 
Sienne and Gabby (GA) said:
Rosa asked if I would weigh in on whether Mimi needs a dose reduction.

A drop to 43 indicates a dose reduction is warranted. Both Gill and Bron provided a cogent rationale for reducing the dose.
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@Sienne and Gabby (GA) and @Bron and Sheba (GA)

I'm still confused - referring to the TR protocol:

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!

So with that in mind, why reduce at a drop under 50 rather than a drop under 40? Unless I'm missing something about three drops on three separate days.
 
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