4/27 Penny AMPS 195

Courtnee P

Courtnee P

Member Since 2022
Are we making the right call by reducing to 2U when Penny's preshots are below 200? Any idea what could be causing her nadirs to occur later in her cycle (this morning and 4/25)?

This is the longest we have kept her below 300 since she was diagnosed and we are so happy about that!
 
Courtnee P said:
Are we making the right call by reducing to 2U when Penny's preshots are below 200?

No. Reductions with lantus are not based upon preshots. You reduce if a nadir is under 90. So far she only earned one reduction. So her dose should be 2.25. When the preshot is under 200 you have choices for that cycle to shoot the full dose if close to 200 and shoot a reduced or token dose if much lower. Gradually you lower the no shot or reduced dose. Refer to the dosing methods sticky for your options if under 200. Today I would not have shot a reduced dose as 195 is so close to 200 and within meter variance.

Nadirs do move around which is why spot checks are important at various times in each cycle. Make sense?
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@tiffmaxee With that being said, can you give me an example? What number below 200 would warrant a token dose then, and what would be considered a token dose of 2.25U? I think if I were to go from 2.25U and then give her, say 1U, wouldn't it cause her sugar to spike with that much of a reduction?

I have been using the sticky for guidance as follows:
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
What numbers are considered "much lower" than 200 when the sticky gives the same options for anything between 150 and 200? It seems like there's a grey area.
 
I would suggest a full dose if under 175 at this point as your data shows 187 was fine. Meter variance is 20% so that is less than 20%. It is a gray area when between 150-200. If shooting a full dose below meter variance you need to take into account whether you can monitor and have supplies.

Shooting a slightly reduced dose did not cause her to go low. What is your goal? Are you hoping for remission or okay with Penny being under renal threshold? What is your comfort level? A slightly reduced dose will likely give a similar cycle to a full dose as the depot is in play. The reduction will effect later cycles, not the current one.
 
tiffmaxee said:
I would suggest a full dose if under 175 at this point as your data shows 187 was fine. Meter variance is 20% so that is less than 20%. It is a gray area when between 150-200. If shooting a full dose below meter variance you need to take into account whether you can monitor and have supplies.

Shooting a slightly reduced dose did not cause her to go low. What is your goal? Are you hoping for remission or okay with Penny being under renal threshold? What is your comfort level? A slightly reduced dose will likely give a similar cycle to a full dose as the depot is in play. The reduction will effect later cycles, not the current one.
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Did you mean to say give a full dose if OVER 175? The goal is definitely remission eventually. I work full time and can only check her once during the day between her pre-shot checks. I'll start shooting the full dose if over 175. Thanks.
 
Yes. Full if over 175 working your way to 150 soon. Sorry. Can you get a +2 before work? It might mean waking up earlier but will that mean you won’t get home in time for her pm shot?
 
tiffmaxee said:
Yes. Full if over 175 working your way to 150 soon. Sorry. Can you get a +2 before work? It might mean waking up earlier but will that mean you won’t get home in time for her pm shot?
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Yes, unfortunately. I work 8 to 5. She gets her shots at 6:30 am/pm.
 
If you can move up her shot time a half hour a +2 will likely be onset and help set the feeder appropriately.
 
tiffmaxee said:
If you can move up her shot time a half hour a +2 will likely be onset and help set the feeder appropriately.
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Can you please clarify what you mean by "set the feeder appropriately"? Still relatively new to this site so I might need more detailed explanations. :cat:
 
Courtnee P said:
Can you please clarify what you mean by "set the feeder appropriately"? Still relatively new to this site so I might need more detailed explanations. :cat:
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I will try. As you shoot lower preshots you will learn how carb sensitive Penny is and may need to feed the curve. That means you might need a little higher carbs as points in the cycle so she doesn’t drop under 90 while you are at work. If she has a lower amps you would set the feeder to open at various points in the cycle to keep her bg in the range that’s safe. While dosing is based upon nadir, a lower than usual bg at onset which is when lantus starts working might mean an active cycle so you would set the feeder with higher carbs. Lantus typically onsets around +2 which is why I suggested you change your insulin time to be 30-40 minutes earlier so you can get a +2. That gives you a +2 and time to set the auto feeder. Does this make sense?
 
To add to what I wrote above, some cats onset earlier and some a little later. Getting some tests between +1 and +3 tests when you are home will help figure that out. Max onset around +2.5 unless he started with a lower preshot number. It’s also good to figure out how much of a food bump she typically gets.
 
tiffmaxee said:
I will try. As you shoot lower preshots you will learn how carb sensitive Penny is and may need to feed the curve. That means you might need a little higher carbs as points in the cycle so she doesn’t drop under 90 while you are at work. If she has a lower amps you would set the feeder to open at various points in the cycle to keep her bg in the range that’s safe. While dosing is based upon nadir, a lower than usual bg at onset which is when lantus starts working might mean an active cycle so you would set the feeder with higher carbs. Lantus typically onsets around +2 which is why I suggested you change your insulin time to be 30-40 minutes earlier so you can get a +2. That gives you a +2 and time to set the auto feeder. Does this make sense?
Click to expand...

Yes, makes perfect sense. Thank you for taking the time to explain! I understand that an automatic feeder could be beneficial (I didn't originally understand that that was what you were referring to), but we have another cat, and I would have no way of monitoring/preventing him from eating Penny's food. Beyond that, getting one of those chip sensitive feeders is not an investment we're prepared to make. Penny also has never worn a collar. So doing all of that just sounds like... a lot.

She eats the Tiki Cat Born Carnivore chicken & egg recipe. She has never taken to wet food. The only time we could get her to eat it was when she was a lot less regulated and even more ravenous, but as soon as her appetite started to return to normal, she refused it (and I mean numerous kinds), even mixed in with dry food. It caused much more stress than it was worth when we needed her to eat so we could give her insulin, so we stopped trying wet food. She will only eat dry food reliably, so we've settled on Tiki Cat.
 
I looked the food up on chewy and it’s about 10% carbs so not too bad. Have you tried Epigen or Dr. Elsey which are even lower carbs.
 
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