It looks like the only times Henry has been above 100 was when he had dental extractions -- an understandable amount of stress -- and. he dropped back down very quickly.The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.
- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
- Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
Robert --
Could you remember to included Henry's actual AMPS test result in your subject line. It let's us have an idea if there may be an issue with a kitty's numbers.
Also, I think you've been missing dose reductions. Henry's spreadsheet is about the greenest I've ever seen. He looks like a cat that's in remission. With TR, if your cat is in normal numbers for a week, you reduce the dose by 0.25u. From the dosing methods sticky note:
It looks like the only times Henry has been above 100 was when he had dental extractions -- an understandable amount of stress -- and. he dropped back down very quickly.
Ideally, you try to keep the numbers like you're seeing them and reduce the dose. Waiting a week with green numbers is a slow, stable way of reducing. If the numbers start going out of normal range, you increase the dose. It can often be a few steps forward and a few steps back. Looking at Henry's numbers in September, his nadirs were good. His pre-shot numbers were largely below 120. FWIW, the pre-shot numbers are usually the last to fall into the green range. It looks like you were feeding Henry at +5.5. Sometimes giving a snack later in the cycle (e.g., +9) may help to bring the pre-shot numbers down. The snack stimulates the pancreas to produce its own insulin and it drops the numbers, much like what you're seeing during the cycle.
Regardless of what the numbers look like, once a diabetic, always a diabetic. However, cats that are in remission are diet controlled diabetics. If your cat starts sneaking carbs, numbers will increase. If there's stress on your cat's system from inflammation or infection or illness, numbers will rise.
You may also find that Henry is a cat that is a tightly controlled diabetic -- not in remission but just needs a small amount of insulin to keep him in good numbers. Tight regulation is a good thing. It keeps the BG numbers below renal threshold.
Sienne is more experienced than I am, but I've been following your journey with Henry and I know you have tried to reduce many times. However, given his recent dental, you may try what Sienne is suggesting regarding reducing after 7 days of green. Dental inflammation can highly impact BGs, and perhaps with the alleviation of any discomfort, the reductions might work this time. This is not the same scenario you were facing last September. It cannot hurt to try.I guess the cat owner will have to decide the answer to the question of "So how many failed reduction attempts could one finally conclude their cat is always going to be a tightly controlled diabetic?"
Sienne is more experienced than I am, but I've been following your journey with Henry and I know you have tried to reduce many times. However, given his recent dental, you may try what Sienne is suggesting regarding reducing after 7 days of green. Dental inflammation can highly impact BGs, and perhaps with the alleviation of any discomfort, the reductions might work this time. This is not the same scenario you were facing last September. It cannot hurt to try.
If it doesn't work, you can keep doing what you've been doing. Henry's a long term diabetic. The reality is that he may need insulin for the rest of his days. You are taking great care of him and giving him excellent quality of life.
I love your big, ole', fat cat, Robert. Merry Christmas!
