4/21, Sabrina, AMPS=175, +2=166, +3=121. Hold dose after flat curve?

[Jia&Sabrina]

Last thread

Meow everyone!

We increased Sabrina's dose from 1.25 to 1.5 seven days ago but her nadirs are higher in general with some near preshot time. She had nearly flat curve for the last five cycles (Freestyle Libre readings). It seemed that insulin barely worked on her…

I did some digging and understand that flat curve could be a consequence of (1) bouncing, (2) too much insulin, or (3) too little insulin. I am confused and was torn this morning but eventually decided to hold the dose for another day.

Anyone have experience with flat curve? I wonder if I should keep the same dose for a little bit longer? Any advice are very much appreciated! TYTYTY!

 

[Katherine&Ruby]

Hi Jia, I can't seem to get access to your spreadsheet. Would you please make sure that you've turned on sharing in permissions in Google sheets?

 

[Jia&Sabrina]

Hi Jia, I can't seem to get access to your spreadsheet. Would you please make sure that you've turned on sharing in permissions in Google sheets?

Hi Katherine! Thank you for reminding me of that! I just changed the setting for Google Sheets. It should be accessible with the link now.

 

[Katherine&Ruby]

It works!

It's so nice seeing all of those nice blue numbers on her SS. A flat curve is what Lantus is supposed to do. It's a good thing, but we do want to see some more greens. I'm looking at Sabrina's data and since you recently started incorporating some dry food back into her diet, you might want to hold for a few more days to see where that might take her. Here I've pulled a bit from the SLGS description of what to do with dosing (I highlighted in blue what I think might apply to Sabrina), but it looks like she might need an increase to 1.5 units if her numbers do not drop any further, but I'll let @tiffmaxee or @carfurby confirm this:

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.​

• • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

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. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).
​

Hope this helps!

 

[Jia&Sabrina]

Hope this helps!

It really does help!

We have to add 8 pieces (yes! exact 8 pieces) of kibbles as Sabrina requires quite a bit encouragement when it comes to eating low carb wet food. Having some kibbles in the auto feeder eases my mind at night as I am almost certain that, even she chooses to ignore the wet food, she would eat the kibbles.

I took a sneaky peek at Ruby's SS. Aww, it seems that increasing Ruby's dose to 1.75 last November made a huge impact as her numbers have turned blue and then green since then.

BTW, I hope you feel better! Thanks again!

 

[tiffmaxee]

I would increase the dose.

 

[Katherine&Ruby]

It really does help!

We have to add 8 pieces (yes! exact 8 pieces) of kibbles as Sabrina requires quite a bit encouragement when it comes to eating low carb wet food. Having some kibbles in the auto feeder eases my mind at night as I am almost certain that, even she chooses to ignore the wet food, she would eat the kibbles.

I took a sneaky peek at Ruby's SS. Aww, it seems that increasing Ruby's dose to 1.75 last November made a huge impact as her numbers have turned blue and then green since then.

BTW, I hope you feel better! Thanks again!

I understand completely about the kibble. I sprinkled a few kibbles on top of Ruby's food in the early days of her transition to wet food and it definitely encouraged her to eat when I was always freaked out that she would not. Now I don't think she misses it. Yes, we found the right dose that pushed Ruby into the greens and I'm so happy to have her regulated. She's like a new cat with lots of energy and a soft shiny coat. Could never have done it without @tiffmaxee and all of the other moderators and members who advise and cheer us on every single day. Just keep giving Sabrina as much insulin as she needs while still being safe and I am sure she will turn a corner as well. She's doing great right now.

And thank you for the good wishes re: my health!