? Thoughts on reducing dose?

[Amy and Owl]

Relevant prior thread.

It was suggested to me by my vet and also by the feline diabetes Facebook group that reducing Owl's dose down to .25u might help with the rapid drop and then the sharp rise we are seeing during his cycle.

Today his AMPS bg was around 175 and, as usual, he nosedived swiftly after his .5u injection. His numbers went low enough they were no longer readable by the Libre. I had to test him with the Relion multiple times to assure myself he was not hypo. The lowest number I got was 88.

I know that Owl is not going low enough by TR standards to warrant a reduction, but the extreme lows recorded by the libre are honestly frustrating to deal with. Our vet consulted with an internal medicine specialist and they both wanted to see what would happen on a lower dose.

Initially my vet wanted me to only give Owl insulin in the AM and skip the PM shot to see what he'd do. We've done that before and I did not like the outcome (very high numbers for several days, vomiting.) I said no to skipping and asked if we could try instead a lower dose to see if that helped even out his curve.

We did .25u this evening and are going to see what happens. His numbers on the Libre at +1 were 375, significantly higher than his PS of 194.

What should we look for going forward to gauge if this reduction is working and how long should we wait before returning to the .5u dose? Our goal is really just to even out his curve a bit so we don't spend hours in the alarm zone on the Libre. I can't turn the alarm off and it's been rough. Using food, even mixing in higher carb food, didn't do much at all to slow the drop post shot.

Please feel free to tell me I am making a mistake and need to return to the .5u shot in the morning. I'm not currently home to update his spreadsheet but this is a screenshot of his Libre from today.

 

[CORKY]

By the spreadsheet is enough, for a member to give you dosing advice the graph is not necessary, I will tag aa couple of members that can give you that advice
@Wendy&Neko
@Sienne and Gabby (GA)

 

[Sienne and Gabby (GA)]

You might want to think about using SLGS as your dosing method. The point at where you reduce with SLGS is 90.

I realize that it's unnerving to see Owl's numbers bounce around. But that's what's happening. Your kitty is bouncing. It's really hard to wait the process out. Owl's system hasn't reacclimated to what are normal numbers. When the numbers drop fast, drop low, or simply drop into a range his system doesn't recognizes as safe, his liver and pancreas overreact by releasing a stored form of glucose along with counterregulatory hormones. These cause the spike in numbers. As Owl spends more time in normal numbers, the bounces will slow down.

Some of the issue is the caregiver getting comfortable with managing lower numbers and not wanting to start cursing when you see the high numbers. I'd also give some thought to making dose adjustments in 0.25u increments. I think it's fine to reduce. Just keep in mind that if you stick with TR, you need to evaluate the effectiveness of the dose every 3 days unless a dose reduction is indicated.

 

[Amy and Owl]

You might want to think about using SLGS as your dosing method. The point at where you reduce with SLGS is 90.

I realize that it's unnerving to see Owl's numbers bounce around. But that's what's happening. Your kitty is bouncing. It's really hard to wait the process out. Owl's system hasn't reacclimated to what are normal numbers. When the numbers drop fast, drop low, or simply drop into a range his system doesn't recognizes as safe, his liver and pancreas overreact by releasing a stored form of glucose along with counterregulatory hormones. These cause the spike in numbers. As Owl spends more time in normal numbers, the bounces will slow down.

Some of the issue is the caregiver getting comfortable with managing lower numbers and not wanting to start cursing when you see the high numbers. I'd also give some thought to making dose adjustments in 0.25u increments. I think it's fine to reduce. Just keep in mind that if you stick with TR, you need to evaluate the effectiveness of the dose every 3 days unless a dose reduction is indicated.

Thank you for the reply!
I think the real issue here is the Libre cgm. Every time I have tested his numbers with the Relion he has been very normal. I'm not really concerned about low numbers. But since he likes to be in those numbers, the Libre is just not able to read him accurately and we spend hours every day with the urgent low glucose alarm going off. I mean hours. And all night. The thought was that if we reduced his dose to .25 it might slow his drop immediately post shot and give him a gentler curve that reduced those Libre lows. I'm testing every time he drops into alarm range because I don't want to get complacent and miss an actual hypo.

Owl is also a bit underweight. His healthy weight should be around 10lbs but he was 7lbs at his last vet appointment a week and a half ago. Could this impact the way insulin affects him?

I'm wondering if the Libre is the right tool for us. If Owl likes to sit in lower numbers than it can accurately measure and if those lows are causing basically a continuous alarm, then it just might not be the best way to monitor him. It's not saving us from having to poke him because I'm testing frequently to make sure he's not actually low. I think I will speak to my vet at our appointment next week about not continuing the Libre. She doesn't seem to really trust that my Relion readings are accurate but I am picking up a second glucometer today so I can maybe use that to demonstrate that the Relion is accurate and we should use that going forward.

If I were to use the SLGS method then I would need to reduce Owl again today. His BG was 85 at +2. I dont know how much lower we can feasibly go. Would it be reasonable to stick to this .25u dose a few more days to see how it affects him and if he starts to clear that bounce?

 

[Wendy&Neko]

We have many members who use the Relion meters successfully. And a lot of the Libre users find that the Libre tests lower than the human BG meter, though I can think of a couple exceptions - not Relion. I've seen research papers recommend double testing Libre lows, so you are doing the right thing there.

You are seeing huge drops, which cause bounces. Have you read this post: Using Food to Manipulate the Curve

Would it be possible to keep the spreadsheet up to date? We'll better able to answers questions about the 0.25 unit dose if we see that data.

 

[Amy and Owl]

We have many members who use the Relion meters successfully. And a lot of the Libre users find that the Libre tests lower than the human BG meter, though I can think of a couple exceptions - not Relion. I've seen research papers recommend double testing Libre lows, so you are doing the right thing there.

You are seeing huge drops, which cause bounces. Have you read this post: Using Food to Manipulate the Curve

Would it be possible to keep the spreadsheet up to date? We'll better able to answers questions about the 0.25 unit dose if we see that data.

I did try using food, both low carb and low carb with a smidgen of higher carb mixed in. I did not see any sort of change in that rapid steep drop when using food. He gets fed one half can of fancy feast at shot time and then one quarter can at +1 +2 +3. It just doesn't seem to matter. That's why I tried lowering the dose.

I will update the spreadsheet this evening. I haven't been home longer than to sleep and test Owl in a day or two

I am going to test more frequently with the Relion to see if I can figure out what his actual curve is throughout the day. I don't think I'm getting the whole picture with the Libre.

I just feel a lot of pressure to get this right and get him regulated swiftly. He has an appointment end of February with Radiocat for an i-131 treatment but they want him "well regulated" by then and I'm so worried I won't be able to do it and they will cancel his appointment. He reacted poorly to methimazole and the iodine is our only bet. His thyroid can't go unregulated forever

 

[Wendy&Neko]

We've had many people take their cats in for i-131 when not perfectly regulated. In fact, hyperthyroidism can cause a form of insulin resistance and getting the cat in normal thyroid numbers can help with regulation.

 

[Amy and Owl]

We've had many people take their cats in for i-131 when not perfectly regulated. In fact, hyperthyroidism can cause a form of insulin resistance and getting the cat in normal thyroid numbers can help with regulation.

I know which is why I am trying so hard to get him into that appointment. Thanks so much for taking the time to reply, I still have a lot to learn and I appreciate everyone who has taken the time to help me.

 

[Amy and Owl]

Well the Libre just gave us an error message saying it has shut its self down for our safety and we should apply a new one. So I think that may be part of the puzzle here

 

[CORKY]

I will say one thing, if you feel more comfortable and relaxed and will be able to sleep better, it’s your decision to test with the ReliOn, is your decision not your vets, and actually we base our numbers mostly and more accurately with the ReliOn, but is your choice , hope all goes well with your appointment

 

[Amy and Owl]

I will say one thing, if you feel more comfortable and relaxed and will be able to sleep better, it’s your decision to test with the ReliOn, is your decision not your vets, and actually we base our numbers mostly and more accurately with the ReliOn, but is your choice , hope all goes well with your appointment

The ReliOn has given me some peace of mind that Owl is not going that low at all. Since the Libre decided to die on us (with 8 days left...) I think that might actually explain the really low numbers, and I'm just going to use the ReliOn going forward. I'm worried now that I based dosing changes on faulty Libre readings and reduced when I shouldn't have. Always something to learn!

 

[CORKY]

Good for you, and one step at a time when reducing or increasing it takes about 3 cycles to really know if changes are needed, I am sure that @Wendy&Neko as well as @Sienne and Gabby (GA) will guide better with dosing advice, but for your sanity and mental health you have made a good decision, now you will see better regulation in the BG readings

 

[Amy and Owl]

We have many members who use the Relion meters successfully. And a lot of the Libre users find that the Libre tests lower than the human BG meter, though I can think of a couple exceptions - not Relion. I've seen research papers recommend double testing Libre lows, so you are doing the right thing there.

You are seeing huge drops, which cause bounces. Have you read this post: Using Food to Manipulate the Curve

Would it be possible to keep the spreadsheet up to date? We'll better able to answers questions about the 0.25 unit dose if we see that data.

The spreadsheet is updated now. The Libre sensor failed this evening and I've made note of it in the margin. I think it's possible that the hours and hours of LO and sub-50 readings today and yesterday are very questionable as a result.

 

[CORKY]

The good thing is that you can manually test, and I used the Libre when Corky was first diagnosed, so I understand your sleepless nights and that alarm going off in the middle of the night, this Forum also taught me about the ReliOn and on his last sensor, i realized the big difference in BG readings, now I sleep like a baby. You’re doing an awesome job and I’m sure Owl knows it! If you scroll the SS to the left you’ll see REMARKS, You can put your notes there, I put an * next to the BG number, use the paint bucket on the top right of the SS there’s a drop-down, choose the color of the BG (example: 70*)

 

[Amy and Owl]

The good thing is that you can manually test, and I used the Libre when Corky was first diagnosed, so I understand your sleepless nights and that alarm going off in the middle of the night, this Forum also taught me about the ReliOn and on his last sensor, i realized the big difference in BG readings, now I sleep like a baby. You’re doing an awesome job and I’m sure Owl knows it! If you scroll the SS to the left you’ll see REMARKS, You can put your notes there, I put an * next to the BG number, use the paint bucket on the top right of the SS there’s a drop-down, choose the color of the BG (example: 70*)

This is what I've been doing, I have made some notes in the remarks column about the libre and feeding at +1 etc. Hopefully it shows on my spreadsheet. I appreciate all the support and encouragement, this is such a nerve-wracking thing to deal with.

 

[CORKY]

This is what I've been doing, I have made some notes in the remarks column about the libre and feeding at +1 etc. Hopefully it shows on my spreadsheet. I appreciate all the support and encouragement, this is such a nerve-wracking thing to deal with.

It gets better trust me, we are here for you, and yes I saw your remarks. I was showing you how I make sure the remarks are seen but you can do it your way, sleep tight tonight! YOU GOT THIS!