Taishi 10/15 AMPS 204, +3 62, +4 60, PMPS 204, +2 46, +2.5 64

[Taishi_Ci]

Taishi surprised us tonight with his first very low number. We've had mostly green and blue numbers on his sheet recently, so I expected this was coming.

I panicked a bit and fed probably too much HC (we were out of MC - ugh) at PM+2. He threw it up almost immediately. I let him have a couple bites of his leftovers from dinner (LC) and he immediately threw that up as well. I waited a few minutes then gave him a different kind of HC but only a tiny bit. I retested about 20 minutes after +2 and got 64. We're going to continue to keep testing and feeding until we're sure he's all good.

Am I understanding correctly that we still need to give him his whole 2.5U in the morning? It's scary to think about giving him the full dose in the AM after this, but according to the TR protocol you only give a reduction after a solid week+ of greens or a BG under 40, right?

 

[Bron and Sheba (GA)]

Hi Jessie, that must have been scary for you getting the 46 then having Taishi vomit twice.
Looks like you have it under control now though.
Keep testing at least every hour, or half hour if the BG drops again, and give a small snack of low carb food if the BG is over 50. If it drops under 50, give a HC snack.

Taishi has earned a reduction in dose down to 2.25 units, starting in the morning.

Can you please update the SS and let us know what the BG is now please?

 

[Taishi_Ci]

Hi Jessie, that must have been scary for you getting the 46 then having Taishi vomit twice.
Looks like you have it under control now though.
Keep testing at least every hour, or half hour if the BG drops again, and give a small snack of low carb food if the BG is over 50. If it drops under 50, give a HC snack.

Taishi has earned a reduction in dose down to 2.25 units, starting in the morning.

Can you please update the SS and let us know what the BG is now please?

Thank you for your reply. It looks like I went to bed about 10 minutes before you replied last night, so I apologize for leaving everyone in the dark. I tried to stay on the forum but it didn't look like anyone was around at that hour.

My only concern regarding a reduction is that it seems to go against TR protocol at this point:

"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! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further."

We've still been seeing preshot numbers in the high 100s pretty regularly, so I'm worried reducing the dose will turn those 100s into 200s. After last night I'm not keen to give him the full dose, so we'll do 2.25U this morning and hope it works out @Bandit's Mom any thoughts, when you get a sec? <3

 

[Bandit's Mom]

Hi Jessie, Lantus dosing is based on nadirs and not preshots. Taishi is newly diagnosed (less than a year from DX) so the criteria for reduction is:

Newly diagnosed diabetics - less than one year since diagnosis

• reduction *earned* after a single drop below 50 mg/dL and following TR, or
• reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
• reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.

Reminder: *earning* reductions and starting OTJ trials

The criteria you quoted were for long term diabetics.

You are seeing the higher preshots because he is diving leading to further bouncing. For eg 204 at AMPS to 60s at +3. Does he get snacks at +1 and +2? That may flatten him out a little.

Congrats on the reduction!

 

[Christie & Maverick]

"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! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further."

I believe you are quoting what is from the TR protocol established by the german forum. We have here on the Lantus Basalgar Levemir subforum made some modifications based on experiences over time, one of which is to suggest taking reductions under 50 for newly diagnosed (within a year) diabetic cats.

 

[Taishi_Ci]

Hi Jessie, Lantus dosing is based on nadirs and not preshots. Taishi is newly diagnosed (less than a year from DX) so the criteria for reduction is:

Newly diagnosed diabetics - less than one year since diagnosis

• reduction *earned* after a single drop below 50 mg/dL and following TR, or
• reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
• reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.

Reminder: *earning* reductions and starting OTJ trials

The criteria you quoted were for long term diabetics.

You are seeing the higher preshots because he is diving leading to further bouncing. For eg 204 at AMPS to 60s at +3. Does he get snacks at +1 and +2? That may flatten him out a little.

Congrats on the reduction!

Thank you for this and the link. I thought I'd read everything but a lot of info here (like this part of the the TR protocol) is spread out in so many different threads/links. The link I've been following doesn't mention anything about it only being for cats with long term diabetes (in fact it even says things like "on the first 3 days of Lantus..." etc as if the kitty is just starting out) and the difference between that guidance for reduction and the thread you linked are so similar (only difference being the 40 vs 50 single drop part). Thank goodness for people like you who help us wade through it all, because I totally would have missed that.

Re: snacks: Taishi doesn't usually eat a bunch at breakfast/dinner, but he typically goes back at +1 and +2 to finish it (so it basically takes him 2 or 3 hours to finish his preshot meals). We do let him snack throughout the day on top of that (moreso lately with the lower numbers) and he has an autofeeder at night.

I'm sure he'll be doing some bouncing today (preshot this morning was 231), but here's hoping he adjusts well to the reduction and we get back to the greens soon. Thank you again for your help!

 

[Sienne and Gabby (GA)]

Jessie:

It looks like you've been following the directions for TR that's found on Tilly's Diabetes Homepage. That iteration of TR was developed on the German Lantus/Lev forum. One of the people who was involved in the development of those directions was Kirsten Roomp (one of the authors of the original TR protocol). When those changes were published, the moderators here opted to do a slight modification of TR but we opted to be less aggressive. To be honest, I was here when those changes were published. I find the instructions on Tilly's Homepage to be a bit confusing! Bhooma did a good job of getting to the point of when to reduce.