New here and could use some help with TR dose

Jenny & Cashmere

Jenny & Cashmere

Member Since 2020
I adopted Cashmere because he was in foster care/rescue for 2 years and nobody would adopt him, I’ve officially had him for almost a year and trying to get his numbers down, I’m getting discouraged!
I’m testing often and increasing insulin every 6 cycles as best I can. His BG’s are still high and it’s like playing tug of war, he has no other health issues other than Diabetes but his numbers were so high for so long before I got him, that I’m doing TR and currently have him in 4.25 units of Lantus. I just didn’t think he would need 4 -5 units of insulin, no matter the increase, he’s still in the high 300’s and preshot numbers sometimes in the 400’s!
I would be so grateful for any help, suggestions and feedback, I just want to know what to expect, And when I can expect to see lower numbers? And at what point will I know to hold the dose at? Thank You in advance for any help!
 
Hello and welcome. And thank you for adopting such a special sweet kitty.

First of all, a cat needs however much insulin they need and ECID, each cat is different. That just means it’s really hard to predict when you will see better numbers. You just have to keep increasing as per the protocol, until you reach a dose that moves him. Since he’s been in high numbers for a while, you are also up against glucose toxicity, where their bodies get used to high numbers. Again, increasing per protocol will help you get there. If you should need to go the five units at a time, increases go to 0.5 units, maybe 0.25 units if you are seeing some green or under 100.

My girl had a couple secondary endocrine conditions, that meant she got up to 8.75 units before turning the corner. But at around 3.5 units I saw my first green, then it kept disappearing. The feline diabetes dance really teaches you patience.

On your first post in Health, Deb asked how old your insulin is. Here is the link to that post: http://www.felinediabetes.com/FDMB/...tter-what-i-increase-decrease-dose-to.227296/
 
Wendy&Neko said:
Hello and welcome. And thank you for adopting such a special sweet kitty.

First of all, a cat needs however much insulin they need and ECID, each cat is different. That just means it’s really hard to predict when you will see better numbers. You just have to keep increasing as per the protocol, until you reach a dose that moves him. Since he’s been in high numbers for a while, you are also up against glucose toxicity, where their bodies get used to high numbers. Again, increasing per protocol will help you get there. If you should need to go the five units at a time, increases go to 0.5 units, maybe 0.25 units if you are seeing some green or under 100.

My girl had a couple secondary endocrine conditions, that meant she got up to 8.75 units before turning the corner. But at around 3.5 units I saw my first green, then it kept disappearing. The feline diabetes dance really teaches you patience.

On your first post in Health, Deb asked how old your insulin is. Here is the link to that post: http://www.felinediabetes.com/FDMB/...tter-what-i-increase-decrease-dose-to.227296/
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Thank You for the sharing your wisdom!
And yes, the insulin pen is fresh, it’s only been opened a week and I keep it in the frig
 
Hi and Welcome to the forum! And thanks for adopting Cashmere !

you are on the right track by doing TR to help get him into better numbers. As Wendy said, you could be up against some glucose toxicity which will take diligence on increasing until you break through.

If it’s any consolation, Bubba’s breakthrough was around 5.25 units and then he started racing down the dosing ladder.

Hang in there and keep posting !
 
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Hi Jenny, just touching base with how you are doing. Since you are following TR now, if a dose doesn't give you anything lower than 300, you can increase by 0.5 units at a time. It'll help you get where you need to be faster. And over 5 units total dose, you can also increase by 0.5 units even with lower nadirs. We think of the dose increase size as a percent of total dose, so the increase gets bigger as the dose overall gets bigger.

Most important, how is Cashmere feeling these days?
 
Wendy&Neko said:
Hi Jenny, just touching base with how you are doing. Since you are following TR now, if a dose doesn't give you anything lower than 300, you can increase by 0.5 units at a time. It'll help you get where you need to be faster. And over 5 units total dose, you can also increase by 0.5 units even with lower nadirs. We think of the dose increase size as a percent of total dose, so the increase gets bigger as the dose overall gets bigger.

Most important, how is Cashmere feeling these days?
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Hi Wendy! Thank You for checking in on us! I did increase this time by 0.5 and got some yellow numbers yay! Im now testing throughout the day today to see if we get a number in the 100’s but, after taking a +2 this morning I’m puzzled as to why PS was 213 and at +2 it’s 315 and trying to determine wether to hold this dose longer than just 6 cycles? Or to increase again?
I don’t want to get any scary low numbers,
 
That's a nice low yellow start.

I think that you should hold on to this dose for 6 cycles at least, unless you see blue, in which case you may need to hold a little longer.

Given that he is seeing yellows, and low ones at that, I think that it would be sensible to hold on to the dose for the full six cycles, unless he were to drop below 50 of course. You may still see some further downward trend as the depot fills, and we consider it can take up to six cycles for that to happen.
 
Gill & George said:
That's a nice low yellow start.

I think that you should hold on to this dose for 6 cycles at least, unless you see blue, in which case you may need to hold a little longer.

Given that he is seeing yellows, and low ones at that, I think that it would be sensible to hold on to the dose for the full six cycles, unless he were to drop below 50 of course. You may still see some further downward trend as the depot fills, and we consider it can take up to six cycles for that to happen.
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Thank You! and yes indeed I fully planned on waiting the full 6 cycles before changing or deciding to hold dose
 
@Wendy&Neko can you take a look at his SS, after some good yellow numbers yesterday, he’s back to the 300’s, and this morning was the 6th cycle on the current dose, so I’m thinking I need to increase? (Up 0.5) Uhg! Just when I thought the tug of war was over! Any thoughts on why numbers are back up?
 
@Wendy&Neko , ugh! I’m so discouraged! I thought I’d see better numbers but, they are either bouncing or just still being stubborn, this morning was the 6th cycle on this dose, can I safely increase .50 this evening??
 
Yes, you can increase to 5,5 units tonight. I know it's tough to see the dose rise, but he's been in high numbers for a while. His body has gotten used to high numbers. That means glucose toxicity and you'll just have to keep increasing to get over it. On the up side, if you look from a distance and squint at the spreadsheet, there is more yellow showing up now. That's progress.
 
@Wendy&Neko his PSBG was 117, so to keep him on schedule, I went ahead and gave him 1 unit, not sure if I did the right thing but, I thought that was better than skipping and risking a bounce, it’s taken so long to see these beautiful numbers! I don’t want to go through bouncing ;) I hope I didn’t mess it up!
Do I need to monitor him closely tonight?
And tomorrow? Can you tell me what to do if morning Preshot is below 100, what dose do I give?
 
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Hi Jenny. It’s best to start a new post per day if you have a new question. I was out of the house kayaking for while today. :) Easy to physical distance and unwind p, but no phone.

Cashmere will likely be high tomorrow morning, you can continue with the 6 unit dose. It was gr at to see that green today! That’s huge progress. In future, when you get a lower preshot than you are used to shooting, you have a couple options. One is a lower dose like you did, though next time maybe half a dose, as long as you can get a later test that cycle. Option 2 is to stall, which means do not feed, and test again 20-30:minutes later to see if he has come up enough to where you feel comfortable shooting. You can get back on schedule by 15 minutes a shot, or 30 minutes once a day. Option 3, for later, and you have more data to do so, is to shoot lower numbers. Lantus is a gentle insulin and typically when you shoot low, you get a very flat cycle.
 
Thank you again Wendy! I’m so nervous about getting a number under 50 and then having to worry about a hypo episode! I’m not sure I’m comfortable with teetering on the edge like that! Can I do a decrease in dose if I get a number under 80? And is the process the same as increasing? Like every six cycles I would decrease when we get there of course! I’m just wondering how long he will need to be on these high doses, so I can plan ahead and not run out of insulin. When he was on 3 units for so long, I knew exactly how long the pen would last and could plan ahead when to refill
 
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