? Need advice after reduction/frequent bouncing & high preshots

[hellen_maggie]

14/02 Maggie AMPS 345 +3 172, +5 75, +5.5 88, 6.4 102 /Reduction earned

Hi everyone,
I really need your advice. Since we reduced the dose from 1.0U to 0.75U (after she dropped below 90), her numbers haven’t been very good, with only a few exceptions.
Yesterday:

• PMPS: 323
• +2: 315
• +5: 313

Today:

• AMPS: 392
• +2.45: 226
• +6: 209
• PMPS: 377

I understand that last night’s cycle could have been a bounce. However, every time she drops into nicer numbers, a bounce follows. She was doing the same thing on Caninsulin for about two months. Will this cycle of bouncing ever break? I adjusted her feeding schedule to +1, +2, +3, and +4.5 to try to prevent early steep drops in the cycle, but it doesn’t seem to be helping. (Her food transition to LC is currently at about 18%. I’m moving very slowly and carefully with the change).

What I don’t understand is why she’s having such big fluctuations. I can’t really see a pattern. My biggest concern is that her preshots are always high, is there anything I can do to help bring them down safely? Should I hold the dose longer, go back up, or just give her more time to adjust? And is this frequent bouncing something that typically improves with time?


Thank you so much for your help, I truly appreciate all the guidance

 

[Allie & Gen]

This is something I hated about being on SLGS (which is designed to be such a cautious approach, with such a relatively high threshold for reductions) - Gen would have one dive and earn a reduction, but then his numbers on the reduced dose wouldn't be good, and after the requisite 10 days he'd go right back up to that earlier dose. Once you've finished transitioning Maggie to LC, if you're then able to switch to the TR method, that may help a lot (it has for Gen). I imagine that the higher-carb food isn't doing her BG any favors, either, though of course I understand why you're being so careful!

That said, I'm also dealing with frustratingly high preshot numbers right now (even though I've gotten Gen's cycles down quite a bit overall in recent days). The suggestion I was given was based on his eating habits; he likes to graze his food all day long, and the suggestion was that I remove his leftovers after nadir, to prevent boosting his numbers up higher as the insulin starts to wear off. (I'm waiting on delivery of an autofeeder to put this into practice and see if it helps.) I don't know how long you leave Maggie's food out for her (since you feed her at intervals, while Gen gets one meal each cycle to eat at his leisure), so this may not be of any help to you, however.

Sorry if none of this is useful (at least for now re: dosing methods), and my sympathies on the frustration! Best to both you and sweet Maggie.

 

[hellen_maggie]

This is something I hated about being on SLGS (which is designed to be such a cautious approach, with such a relatively high threshold for reductions) - Gen would have one dive and earn a reduction, but then his numbers on the reduced dose wouldn't be good, and after the requisite 10 days he'd go right back up to that earlier dose. Once you've finished transitioning Maggie to LC, if you're then able to switch to the TR method, that may help a lot (it has for Gen). I imagine that the higher-carb food isn't doing her BG any favors, either, though of course I understand why you're being so careful!

That said, I'm also dealing with frustratingly high preshot numbers right now (even though I've gotten Gen's cycles down quite a bit overall in recent days). The suggestion I was given was based on his eating habits; he likes to graze his food all day long, and the suggestion was that I remove his leftovers after nadir, to prevent boosting his numbers up higher as the insulin starts to wear off. (I'm waiting on delivery of an autofeeder to put this into practice and see if it helps.) I don't know how long you leave Maggie's food out for her (since you feed her at intervals, while Gen gets one meal each cycle to eat at his leisure), so this may not be of any help to you, however.

Sorry if none of this is useful (at least for now re: dosing methods), and my sympathies on the frustration! Best to both you and sweet Maggie.

Hi Allie,
Thank you so much for always trying to help us, you’re consistently so sweet and supportive, and I truly appreciate it. Maggie doesn’t have food available after +6, that was suggested to me here as well, so I remove it during the second half of the cycle. Even so, our preshots are still frustratingly high!
I’ve thought many times about switching to TR. Of course, the priority is completing the full transition to LC (ugh… it’s so exhausting reducing 2 grams at a time every two days, the waiting feels endless!).
What I’m considering now is something I’ve seen on other spreadsheets here, modifying SLGS slightly by reducing at a lower number, not at 90 but maybe at 70 instead. I’m just not sure if that’s something I can safely do without enough data, especially since we’ve only been on Lantus for 11 days.
Yes, I’ve been following Gen’s progress over the past few days, and I truly hope you keep moving in this direction and achieve the same success as last time!!

Give Gen a big kiss, keep going strong!

 

[Allie & Gen]

Hi Allie,
Thank you so much for always trying to help us, you’re consistently so sweet and supportive, and I truly appreciate it. Maggie doesn’t have food available after +6, that was suggested to me here as well, so I remove it during the second half of the cycle. Even so, our preshots are still frustratingly high!
I’ve thought many times about switching to TR. Of course, the priority is completing the full transition to LC (ugh… it’s so exhausting reducing 2 grams at a time every two days, the waiting feels endless!).
What I’m considering now is something I’ve seen on other spreadsheets here, modifying SLGS slightly by reducing at a lower number, not at 90 but maybe at 70 instead. I’m just not sure if that’s something I can safely do without enough data, especially since we’ve only been on Lantus for 11 days.
Yes, I’ve been following Gen’s progress over the past few days, and I truly hope you keep moving in this direction and achieve the same success as last time!!

Give Gen a big kiss, keep going strong!

Thank you. Hellen, you're very sweet. I think Gen's other health challenges will have to be addressed before we have any chance of him going back into remission, but I'm hopeful that I'll finally have the opportunity to do more for them soon (once my vet gets back to me re: various diagnostics). I appreciate your support!

I will offer a note of caution about the SLGS modifications you're referring to - I think that's almost always being done by people who use the Freestyle Libre glucose monitors, because the Libre often gives exaggerated low numbers (so a 90 on the Libre might "really" be a significantly higher number, as shown with a comparative blood test). I was using 70 as my reduction threshold on SLGS, but that was an attempt to compensate for the Libre.

I am impressed by your diligence - I've tried to be careful with Gen's food transitions, etc, but I don't think I could pull off anything as precise and gradual as you are. Best of luck with all of it!

 

[hellen_maggie]

Thank you. Hellen, you're very sweet. I think Gen's other health challenges will have to be addressed before we have any chance of him going back into remission, but I'm hopeful that I'll finally have the opportunity to do more for them soon (once my vet gets back to me re: various diagnostics). I appreciate your support!

I will offer a note of caution about the SLGS modifications you're referring to - I think that's almost always being done by people who use the Freestyle Libre glucose monitors, because the Libre often gives exaggerated low numbers (so a 90 on the Libre might "really" be a significantly higher number, as shown with a comparative blood test). I was using 70 as my reduction threshold on SLGS, but that was an attempt to compensate for the Libre.

I am impressed by your diligence - I've tried to be careful with Gen's food transitions, etc, but I don't think I could pull off anything as precise and gradual as you are. Best of luck with all of it!

Thank you for pointing that out about the SLGS modifications, honestly didn’t know that! So we’ll scratch that scenario and wait until the food transition is fully complete, hopefully then we’ll be able to move to TR.
I pretty much have to keep the scale in one hand and my notes in the other when it comes to her food transition, because I’ve been trying for 2.5 months now and I’ve failed so many times (no matter how slowly I go) due to vomiting and diarrhea along the way. Thankfully, the people here on the forum have helped me a lot in different ways. Right now I’m trying a single-protein food with a novel protein and eliminating as many ingredients as possible, hoping we’ll have better luck this time.
Every time I add just 2 grams of the new food, I’m filled with anxiety waiting to see if she’ll tolerate it. Thankfully, so far her stomach seems to be handling it well!!It just makes me sad that we can’t move faster, I want so badly to see her healthy and happy again.

I truly hope your test results come back as good as possible. I’ve been following your previous posts, you have all my positive energy. With a mom like you, I honestly think Gen is destined to make it through this.

 

[Staci & Ivy]

Thank you. Hellen, you're very sweet. I think Gen's other health challenges will have to be addressed before we have any chance of him going back into remission, but I'm hopeful that I'll finally have the opportunity to do more for them soon (once my vet gets back to me re: various diagnostics). I appreciate your support!

I will offer a note of caution about the SLGS modifications you're referring to - I think that's almost always being done by people who use the Freestyle Libre glucose monitors, because the Libre often gives exaggerated low numbers (so a 90 on the Libre might "really" be a significantly higher number, as shown with a comparative blood test). I was using 70 as my reduction threshold on SLGS, but that was an attempt to compensate for the Libre.

I am impressed by your diligence - I've tried to be careful with Gen's food transitions, etc, but I don't think I could pull off anything as precise and gradual as you are. Best of luck with all of it!

HI Hellen and Allie,
One thing I can address here is about the lower reduction point while on SLGS. I've been here long enough to be able to tell you that was in place when I arrived in 2022 (and there were hardly any Libres being used at all at that time).
So, a lower reduction point isn't just for Libre users, but it's very helpful to us Libre users, Allie is correct, many times the Libre exaggerates the "lows".

But, you have to be testing to know how low the dose is taking your cat.

I would guess the more experienced people here may suggest doing that (a lower reduction) once all transitions have been made (from dry to wet food) etc for safety.
Since we don't yet know how low the dose will take Maggie once the dry food is eliminated, I think you're being safe

You're both doing such a good job with your kitties. It's a lot to handle so many factors and make decisions to safely figure out all of these issues

Where did the suggestion come to transition 2 grams at a time in the diet (not saying it's a bad idea, just curious). I do think going slowly with changes is wise.

You could certainly ask those questions for some expert advice, it's a good question.

 

[hellen_maggie]

HI Hellen and Allie,
One thing I can address here is about the lower reduction point while on SLGS. I've been here long enough to be able to tell you that was in place when I arrived in 2022 (and there were hardly any Libres being used at all at that time).
So, a lower reduction point isn't just for Libre users, but it's very helpful to us Libre users, Allie is correct, many times the Libre exaggerates the "lows".

But, you have to be testing to know how low the dose is taking your cat.

I would guess the more experienced people here may suggest doing that (a lower reduction) once all transitions have been made (from dry to wet food) etc for safety.
Since we don't yet know how low the dose will take Maggie once the dry food is eliminated, I think you're being safe

You're both doing such a good job with your kitties. It's a lot to handle so many factors and make decisions to safely figure out all of these issues

Where did the suggestion come to transition 2 grams at a time in the diet (not saying it's a bad idea, just curious). I do think going slowly with changes is wise.

You could certainly ask those questions for some expert advice, it's a good question.

Thank you so much, Staci, I truly appreciate you taking the time to explain all of that.

I’m definitely hoping for guidance from the more experienced members here regarding any possible adjustments to the lower reduction point with SLGS. I want to be sure that whatever I decide to do is safe and supported by enough data.
As for testing, I’ve made a lot of progress compared to when we first started this journey. I really feel like we’re on a good path, and little by little I’m becoming more consistent and confident with it.
This very gradual food transition comes from my experience with our previous failed attempts. The last time, I was adding 5 grams every 3 days, and it didn’t end well. So this time I started with just 1 gram (!) every 3 days, and once I saw she was tolerating it, I moved up to 2 grams every 2 days. Maybe I am being overly cautious, but we went through some very difficult times with IV fluids, medications, and repeated vet visits, and Maggie suffered a lot. I truly never want to see her like that again
That said, I’m receiving so much support and guidance here that it really gives me hope that things will go much better for us moving forward.

Thank you again for your help, it truly means a lot to me.

 

[Staci & Ivy]

Thank you so much, Staci, I truly appreciate you taking the time to explain all of that.

I’m definitely hoping for guidance from the more experienced members here regarding any possible adjustments to the lower reduction point with SLGS. I want to be sure that whatever I decide to do is safe and supported by enough data.
As for testing, I’ve made a lot of progress compared to when we first started this journey. I really feel like we’re on a good path, and little by little I’m becoming more consistent and confident with it.
This very gradual food transition comes from my experience with our previous failed attempts. The last time, I was adding 5 grams every 3 days, and it didn’t end well. So this time I started with just 1 gram (!) every 3 days, and once I saw she was tolerating it, I moved up to 2 grams every 2 days. Maybe I am being overly cautious, but we went through some very difficult times with IV fluids, medications, and repeated vet visits, and Maggie suffered a lot. I truly never want to see her like that again
That said, I’m receiving so much support and guidance here that it really gives me hope that things will go much better for us moving forward.

Thank you again for your help, it truly means a lot to me.

I'm so glad this time the transition is working much better. Slow and steady and knowing your cat means so much!!

There's so much to learn and understand here. I am still learning every single day
But whatever it takes to keep our kitties safe!