? Question about reducing the dose

[Karen and Chispa (GA)]

Most recent thread: https://www.felinediabetes.com/FDMB/threads/09-07-22-chispa-379-amps-358-2.268097/#post-2997591

Hi all,

As many times as I've consulted the TR/SLGS sticky, I realize that I am still unclear on this guideline:

"When your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing."
​

Chispa saw nadirs under 100 on 09/03/22, after twelve days of holding at 3 units because I was out of town and DBF was in charge. She might have had nadirs under 100 before that, but since there is no way to know, let's assume 09/03/22 was her first time in the greens. Should I have continued to hold the dose for 10 cycles AFTER she fell below 100?

I hope this question makes sense.

Thank you!

 

[Diane Tyler's Mom GA]

@Bandit's Mom

@tiffmaxee

@Karen and Chispa
Can you add TR to your signature also since that's the first thing members look at
Edit just tap on your name then signature and add TR and tap Save

 

[Bandit's Mom]

Yes, when you see a green on a dose you hold that dose for 10 cycles. Like you said, it's possible that she saw greens before that as well. It's 10 cycles in total on a dose where you start seeing green. After that you want to get tp a dose where you see lower green and longer stretches of green. A dose where she drops briefly to the 80s or 90s and then heads back up is not a good enough dose.

It's good you increased to 3.5U. It does look like she needs more insulin.

 

[Karen and Chispa (GA)]

TR added; thanks, Diane. And thank you, Bhooma, for clarifying that it's ten cycles in total.

I'm encouraged that she's starting to dip her toes into the blues and greens. Hopefully she will wade in a little further on the new dose.

 

[Karen and Chispa (GA)]

@Bandit's Mom
Hi Bhooma -- may I ask you a follow-up question about holding the dose for 10 cycles in total? I just saw on another member's thread that she was advised to hold the dose for ten cycles from the LAST green that she saw (https://felinediabetes.com/FDMB/thr...133-3-140-8-194-pmps-383.268261/#post-2998717). If I'm interpreting that correctly, she could be holding the dose for quite a long time (at least as long as the cat continues to bounce in and out of greens) -- whereas I had understood your advice to mean that I should move on to the next dose after 10 cycles if there was green anywhere within those 10 cycles. I know ECID, so perhaps there is a cat-specific reason for this. Sorry for my confusion ... I just want to be sure I'm clear on the protocol. Thank you!!

 

[Bandit's Mom]

It depends on whether the cat is new to to greens or not. If you've just started seeing green on a dose, you want to hold it to see if the greens come back after any bounce is cleared. But like you rightly pointed out, if you hold a dose 10 days from the last green, you will be holding the dose a very long time. Too long. The only time you hold a dose is if the nadirs are in the range you want them to be - lower green. Then you just keep an eye on the numbers and increase if they start trending up.

 

[Karen and Chispa (GA)]

The only time you hold a dose is if the nadirs are in the range you want them to be - lower green. Then you just keep an eye on the numbers and increase if they start trending up.

Thanks so much -- this is very helpful.
I know all of the information is supposed to be in the sticky, but I keep reading it over and feeling like I mostly understand. So at the risk of making things even more complicated, I tried to simplify all of the information into a "cheat sheet" that I could print out for quick reference. I'm attaching it as a PDF. Would you mind looking it over to see if it makes sense?

 

[Bandit's Mom]

Thanks so much -- this is very helpful.
I know all of the information is supposed to be in the sticky, but I keep reading it over and feeling like I mostly understand. So at the risk of making things even more complicated, I tried to simplify all of the information into a "cheat sheet" that I could print out for quick reference. I'm attaching it as a PDF. Would you mind looking it over to see if it makes sense?

Looks good with these caveats:
- Once the cat starts seeing green nadirs, you would not hold doses with blue nadirs for more than 6-8 cycles.
- Nadirs 80 to 100 (if new to cat) - you would hold the dose 10 cycles in all, but if the green shows up towards the end of the 10 cycles, you might want to hold it longer to see if the greens return after any bounce clears.

The rules for reduction in the PDF are for newly diagnosed cats. For long term diabetics, it's a drop below 40 and not 50. For cats that go between doses (due to failed reductions), you can either choose to follow the 3 drops rule (3 drops between 40 and 50 on 3 separate days) or you can choose to skinny/fatten the dose.

 

[Karen and Chispa (GA)]

Looks good with these caveats:
- Once the cat starts seeing green nadirs, you would not hold doses with blue nadirs for more than 6-8 cycles.

Thanks so much, Bhooma. I should have mentioned that I edited out everything that didn't pertain to Chispa (long-term diabetic, high-dose conditions, etc.)

About not holding the doses with blue nadirs (above) -- does that mean that if the nadirs have been consistently green, but then the cat goes BACK to blue, you would increase the dose 6-8 cycles after that? Or does it mean that you should increase after 6-8 cycles if the dose is producing BOTH green and blue nadirs? I'm sorry to be dense ... As you can see, I am easily confused; therefore I appreciate your help (and your patience!) all the more.