? 02/02 - Bandit - Dosing advice please???

Bandit's Mom

Bandit's Mom

Member Since 2019
Previous Thread - http://www.felinediabetes.com/FDMB/threads/1-18-bandit-amps-342-3-277-5-271-failed-reduction.224451/

So after the last failed reduction (2 back-to-back from 1.75 to 1.25), we have upped the dose every week and are back to 1.75. Bandit fell below 90 on the 5th cycle (Jan 29th) of the increase to 1.75, but we didn't take a reduction since we had only just increased from 1.5 which was doing nothing for her except keep her in near flat yellows.

As per SLGS one is required to hold the dose "longer" if the kitty is seeing nadirs around 100 and pre-shots around or below 300. Which is where Bandit is.

We have been on 1.75 for a week now and I am wondering if we should take an increase to 2 starting tomorrow.

Bandit is one bouncy kitty and she seems to spend more time in high numbers thanks to bouncing. I am now beginning to wonder if it is a case of too much insulin - could really use some expert advice!
 
You're mixing up TR and SLGS. TR says to hold the dose longer if you see nadirs below 100. With SLGS you reduce the dose immediately when you see a number below 90. You should have reduced on Jan. 29 when you got that 59. Besides those greens you are seeing nadirs in the hold the dose range for SLGS (between 90 and 149). If you don't want to reduce since the green was days ago, I'd at least hold the dose. I would not increase.
 
I got this from the TR/SLGS sticky under SLGS:

"As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases."

It doesn't say how long to wait between dose increases.
 
As long as the nadirs are in the desired range, hold the dose. Have you decided to lower the reduction point for Bandit, or are you staying with the standard 90? I see two drops below 90 on this dose.
 
Wendy&Neko said:
As long as the nadirs are in the desired range, hold the dose. Have you decided to lower the reduction point for Bandit, or are you staying with the standard 90? I see two drops below 90 on this dose.
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I know one is is required to reduce the dose below 90, but coming so soon on the back of a failed reduction, I didn't want to reduce the dose again too soon. Wanted to see more greens. The 1.25 and 1.5 were not taking her there.

She is bouncing so much (as always) that she doesn't even spend too much time in blues. I read on one of the threads that too much insulin also looks like too little insulin on account of the body going into self-defense mode. So I wonder if her dose is between 1.5 and 1.75. How does one know whether it's too little or too much insulin?

I can hold this dose. I understand that more drops below 90 would trigger a reduction. If that doesn't happen, how long do I hold this dose?
 
The failed reduction was long enough ago that it's ancient history. You had 2 drops well below 90 which is telling you that the depot was too full. At this point, I'm not even sure what make sense given that you didn't take the reduction. Please take reductions when the numbers drop below 90.

You quoted the SLGS guidelines: "As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases." This states when your cat's BG begins to fall mostly in the desired range... The important point here is that the numbers are mostly in the desired range. I don't think Bandit's numbers are there.

With SLGS, you evaluate the dose on a weekly basis unless numbers drop below 90. I also want to suggest that some of what I think you are viewing as a bounce is simply the insulin wearing off at the end of a cycle. In all likelihood, Bandit is going to need more insulin in order for the overall range for the cycle to be lower.
 
Sienne and Gabby (GA) said:
The failed reduction was long enough ago that it's ancient history. You had 2 drops well below 90 which is telling you that the depot was too full. At this point, I'm not even sure what make sense given that you didn't take the reduction. Please take reductions when the numbers drop below 90.

You quoted the SLGS guidelines: "As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases." This states when your cat's BG begins to fall mostly in the desired range... The important point here is that the numbers are mostly in the desired range. I don't think Bandit's numbers are there.

With SLGS, you evaluate the dose on a weekly basis unless numbers drop below 90. I also want to suggest that some of what I think you are viewing as a bounce is simply the insulin wearing off at the end of a cycle. In all likelihood, Bandit is going to need more insulin in order for the overall range for the cycle to be lower.
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So I can increase the dose to 2? I needn't worry that she is on a higher dose than she needs?

Could you explain why she isn't seeing better values on 1.75 if I had to reduce to 1.5? I am really confused. I find that she reacts well to a dose increase soon after but that peters out and she goes back up to higher BG levels.
 
The only time we are concerned about a dose is if the dose wasn't raised systematically. You've been making small, consistent changes in dose.

Insulin needs can change. There are any number of factors that can influence a dose such as activity, stress, a batch of food that was a little lower or higher in carbs, the phase of the moon (I'm not kidding --m some cats have predictably higher or lower numbers with a full moon) and more that I'm not thinking of. Insulin is also a hormone -- it doesn't function like an antibiotic or pain medication. A dose may be a bit too high one week and you have to reduce and then that dose doesn't seem to be working so you need to increase and you may end up having to increase (or decrease) again. It's the nature of how insulin works and why testing is so important. If you look at other people's spreadsheets you'll see there's a good deal of variation with respect to the dose-response numbers. You just having found the "good" dose that has the desired effect on Bandit's numbers. It's not something you can rush. Bandit is directing the show.
 
Sienne and Gabby (GA) said:
The only time we are concerned about a dose is if the dose wasn't raised systematically. You've been making small, consistent changes in dose.

Insulin needs can change. There are any number of factors that can influence a dose such as activity, stress, a batch of food that was a little lower or higher in carbs, the phase of the moon (I'm not kidding --m some cats have predictably higher or lower numbers with a full moon) and more that I'm not thinking of. Insulin is also a hormone -- it doesn't function like an antibiotic or pain medication. A dose may be a bit too high one week and you have to reduce and then that dose doesn't seem to be working so you need to increase and you may end up having to increase (or decrease) again. It's the nature of how insulin works and why testing is so important. If you look at other people's spreadsheets you'll see there's a good deal of variation with respect to the dose-response numbers. You just having found the "good" dose that has the desired effect on Bandit's numbers. It's not something you can rush. Bandit is directing the show.
Click to expand...

Thank you for that detailed explanation! So I should increase her by 0.25 in the next cycle?
 
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