George 5/3/26 AMPS 246 - +1 148 +2 158 +6 95 +7 100 +9 106 +11 135 - PMPS 161

[borg the gorb]

George had a bit of a bounce but seems to be doing okay!

 

[Staci & Ivy]

George is looking really good. Even with his bounce.
He’s seeing some nice green numbers.
Great job Zach, hope you and George have a nice Sunday

 

[Marje and Gracie]

George had a bit of a bounce but seems to be doing okay!

Are all these BGs from a handheld or from the Libre? If they are from the Libre, are you seeing any other BGs below 100 other than what you’ve listed?

The reason I’m asking is the Libre tends to read a little bit low and, honestly, even with the little bit of green you have, I think he could use a dose increase to 0.5u bid. If your goal is remission, we need to see a bit more green in his cycles so he might just need a little oomph from a cycle or two at a higher dose. If you are not wanting to potentially get him into remission but you are ok with where he’s at (well regulated), then you wouldn’t need to raise the dose.

However, you’ve come a long way and there is good potential to get him into remission since it’s early. No promises but potential. What do you think?

 

[borg the gorb]

Are all these BGs from a handheld or from the Libre? If they are from the Libre, are you seeing any other BGs below 100 other than what you’ve listed?

The reason I’m asking is the Libre tends to read a little bit low and, honestly, even with the little bit of green you have, I think he could use a dose increase to 0.5u bid. If your goal is remission, we need to see a bit more green in his cycles so he might just need a little oomph from a cycle or two at a higher dose. If you are not wanting to potentially get him into remission but you are ok with where he’s at (well regulated), then you wouldn’t need to raise the dose.

However, you’ve come a long way and there is good potential to get him into remission since it’s early. No promises but potential. What do you think?

Its a mix of both, ive been using the handheld mostly though and putting that in my logs rather than the libre since I was made aware it can be in innacurate at times, so ive been using the libre just as a proof of concept and baseline and the handheld as the more accurate one. Remission is my goal, but my vet did give me problems when I changed his dose, so i am a bit hesitant to do so without their knowledge (theyre closed today, but open tomorrow, so i could call them tomorrow regarding it). If moving him up to 0.50u is what will get him into remission I would gladly do so, however im nervous whenever he dips below 100 at any given time since im still getting used to this and dont want him to go into hypo. Could you remind me what reading would be considered hypo under TR? Its below 50, correct me if im wrong

Edit: the libre has been reading relatively low and has given me two alerts so far regarding him going below 69mg/dL, and at each alert I tested with the handheld to double check and he was above 70

 

[Mary & Jude]

Glad to see he brought things back down from that lemon!

 

[Staci & Ivy]

Its a mix of both, ive been using the handheld mostly though and putting that in my logs rather than the libre since I was made aware it can be in innacurate at times, so ive been using the libre just as a proof of concept and baseline and the handheld as the more accurate one. Remission is my goal, but my vet did give me problems when I changed his dose, so i am a bit hesitant to do so without their knowledge (theyre closed today, but open tomorrow, so i could call them tomorrow regarding it). If moving him up to 0.50u is what will get him into remission I would gladly do so, however im nervous whenever he dips below 100 at any given time since im still getting used to this and dont want him to go into hypo. Could you remind me what reading would be considered hypo under TR? Its below 50, correct me if im wrong

Edit: the libre has been reading relatively low and has given me two alerts so far regarding him going below 69mg/dL, and at each alert I tested with the handheld to double check and he was above 70

I’m so glad you checked those lower Libre numbers.
Some members find the comparison as you do, similar numbers between both meters.

Hypo isn’t necessarily 50ish. But you don’t want him going lower.
If he does go under 50, please reduce ask for help to determine what to do about a dose!

 

[Marje and Gracie]

Its a mix of both, ive been using the handheld mostly though and putting that in my logs rather than the libre since I was made aware it can be in innacurate at times, so ive been using the libre just as a proof of concept and baseline and the handheld as the more accurate one. Remission is my goal, but my vet did give me problems when I changed his dose, so i am a bit hesitant to do so without their knowledge (theyre closed today, but open tomorrow, so i could call them tomorrow regarding it). If moving him up to 0.50u is what will get him into remission I would gladly do so, however im nervous whenever he dips below 100 at any given time since im still getting used to this and dont want him to go into hypo. Could you remind me what reading would be considered hypo under TR? Its below 50, correct me if im wrong

Edit: the libre has been reading relatively low and has given me two alerts so far regarding him going below 69mg/dL, and at each alert I tested with the handheld to double check and he was above 70

I’m glad to see the handheld numbers on the SS. That gives me a better picture on his cycles.

I think most members here will tell you they don’t discuss dosing with their vets because vets are often a lot more cautious than we are (they can’t be here 24/7 to help you) and often don’t like numbers to go below 200. I once had a vet (not my current one) tell me after six months of Gracie being diabetic she wasn’t because her BG was around 200. She wanted me to stop the insulin and this group helped me understand that was not going to help Gracie. BUT I did drop her dose in half and her BG shot way up. She was diabetic almost 6 years.

There are no guarantees on remission. I’ve seen cats eek down in dose to 0.1u bid and still couldn’t get entirely off the “juice”. But, they were in great numbers (below 100) all the time. I am pretty certain leaving him at the current dose is not going to get him there because he’s seeing way too many BGs above 120. Ideally, you want him 50-120 for most of the cycle. He’s been at this dose 12 cycles and he’s really not getting into those good ranges of 50-120 and staying there.

For a cat like him that doesn’t seem to do alot of bouncing, when they edge down into green, they tend to stay relatively flat but i won’t tell you he will not go below 50 or even 40 if you raise the dose.

Every cat is different (ECID) as to what BG is too low for them. My own Gracie scared me with BGs in the 20s on multiple occasions and she never once hypoed. She was very good at going along normally and then dropping but then she was a bouncer and they tend to be less flat. It’s impossible to say what BG will cause a cat to hypo but i’ve not seen any do it in the 40s or 50s. The TR protocol is designed so newly diagnosed cats like George earn reductions is by going below 50 once. Cats who have been diabetic more than one year, earn the reduction by dropping below 40.

Is it possible the increase will allow him to stay perfectly between 50-120? Sure, it’s possible. But, based on where he is, we often see these cats just need a few cycles of a higher dose to “jump start” them and they earn the reductions fairly soon. For cats who fail reductions and go up and down around a certain dose (which is actually fairly common), we hold onto a dose longer with them and let them go below 50 three times before we reduce (that is the second way a newly diagnosed cat earns a reduction). And some cats don’t drop below 50, but they stay in normal numbers (50-120) for seven days. That is the third way they can earn a reduction. Only George knows where he falls between those three.

You are doing a great job of getting tests and data. One way you can tell what direction he might be headed in is to always get a +2 every cycle. If his +2 is similar to (within 20%) or lower than his PS, he’s likely to decrease throughout the cycle. Based on your notes, he seems to respond well to food but be cautious about feeding to influence the BG too much. Yes, if he’s dropping fast through mid-cycle, feed LC to slow it down. If he’s at 50 at +2, you probably want to give him a snack. If he’s at 50 at +10, unless he’s been barreling down, you might just want to keep testing to see if his duration slows and he comes up for PMPS. But be aware that Lantus often gives a second dip around PS. The second dip is not lower than the nadir. It doesn’t look like, on this dose, that George is a second dipper but that can change.

The decision is up to you. We will support you. If you are at home to monitor him and feed low numbers, that’s great. I can tell you what I see but you hold the needle and there is no pressure from us. Everyone has to learn to deal with those good, lower numbers (above 50) and shoot if the PS is 50. You haven’t shot any green BGs yet so I would encourage you, if you get one at PS, to stall his feeding and post for help. Be sure you have read this important post. Keep asking questions. You got this!

 

[borg the gorb]

I’m glad to see the handheld numbers on the SS. That gives me a better picture on his cycles.

I think most members here will tell you they don’t discuss dosing with their vets because vets are often a lot more cautious than we are (they can’t be here 24/7 to help you) and often don’t like numbers to go below 200. I once had a vet (not my current one) tell me after six months of Gracie being diabetic she wasn’t because her BG was around 200. She wanted me to stop the insulin and this group helped me understand that was not going to help Gracie. BUT I did drop her dose in half and her BG shot way up. She was diabetic almost 6 years.

There are no guarantees on remission. I’ve seen cats eek down in dose to 0.1u bid and still couldn’t get entirely off the “juice”. But, they were in great numbers (below 100) all the time. I am pretty certain leaving him at the current dose is not going to get him there because he’s seeing way too many BGs above 120. Ideally, you want him 50-120 for most of the cycle. He’s been at this dose 12 cycles and he’s really not getting into those good ranges of 50-120 and staying there.

For a cat like him that doesn’t seem to do alot of bouncing, when they edge down into green, they tend to stay relatively flat but i won’t tell you he will not go below 50 or even 40 if you raise the dose.

Every cat is different (ECID) as to what BG is too low for them. My own Gracie scared me with BGs in the 20s on multiple occasions and she never once hypoed. She was very good at going along normally and then dropping but then she was a bouncer and they tend to be less flat. It’s impossible to say what BG will cause a cat to hypo but i’ve not seen any do it in the 40s or 50s. The TR protocol is designed so newly diagnosed cats like George earn reductions is by going below 50 once. Cats who have been diabetic more than one year, earn the reduction by dropping below 40.

Is it possible the increase will allow him to stay perfectly between 50-120? Sure, it’s possible. But, based on where he is, we often see these cats just need a few cycles of a higher dose to “jump start” them and they earn the reductions fairly soon. For cats who fail reductions and go up and down around a certain dose (which is actually fairly common), we hold onto a dose longer with them and let them go below 50 three times before we reduce (that is the second way a newly diagnosed cat earns a reduction). And some cats don’t drop below 50, but they stay in normal numbers (50-120) for seven days. That is the third way they can earn a reduction. Only George knows where he falls between those three.

You are doing a great job of getting tests and data. One way you can tell what direction he might be headed in is to always get a +2 every cycle. If his +2 is similar to (within 20%) or lower than his PS, he’s likely to decrease throughout the cycle. Based on your notes, he seems to respond well to food but be cautious about feeding to influence the BG too much. Yes, if he’s dropping fast through mid-cycle, feed LC to slow it down. If he’s at 50 at +2, you probably want to give him a snack. If he’s at 50 at +10, unless he’s been barreling down, you might just want to keep testing to see if his duration slows and he comes up for PMPS. But be aware that Lantus often gives a second dip around PS. The second dip is not lower than the nadir. It doesn’t look like, on this dose, that George is a second dipper but that can change.

The decision is up to you. We will support you. If you are at home to monitor him and feed low numbers, that’s great. I can tell you what I see but you hold the needle and there is no pressure from us. Everyone has to learn to deal with those good, lower numbers (above 50) and shoot if the PS is 50. You haven’t shot any green BGs yet so I would encourage you, if you get one at PS, to stall his feeding and post for help. Be sure you have read this important post. Keep asking questions. You got this!

So, essentially (and correct me if im wrong, I apologise if I am misreading),

- Sometimes a higher dose helps "start up" the pancreas, but then they earn a reduction shortly after that in the next cycle

- if the +2 is similar or less than PS he is going to drop more during the cycle (which isnt neccessarily a bad thing but to monitor closely to be sure he doesnt go below 50) if the +2 is more than the PS he is not going to drop as much

Please let me know if im misunderstanding, i apologise in advance if so

My only questions are, should I start allowing him to go below 100 and stay closer to 70-90? Remission is the goal, and i want him to have the highest chance of it. If hes not prone to bouncing, what would be the best course of action? Reduce dose at <70 and increase dose >200 like ive been doing or is there a seperate protocol? I have read the sticky post and I dont fully understand it, I am sorry

 

[Marje and Gracie]

So, essentially (and correct me if im wrong, I apologise if I am misreading),

- Sometimes a higher dose helps "start up" the pancreas, but then they earn a reduction shortly after that in the next cycle

- if the +2 is similar or less than PS he is going to drop more during the cycle (which isnt neccessarily a bad thing but to monitor closely to be sure he doesnt go below 50) if the +2 is more than the PS he is not going to drop as much

Please let me know if im misunderstanding, i apologise in advance if so

My only questions are, should I start allowing him to go below 100 and stay closer to 70-90? Remission is the goal, and i want him to have the highest chance of it. If hes not prone to bouncing, what would be the best course of action? Reduce dose at <70 and increase dose >200 like ive been doing or is there a seperate protocol? I have read the sticky post and I dont fully understand it, I am sorry

You are correct in the hyphenated paragraphs.

But in the last one, not. He doesn’t appear to be a bouncer right now so let’s not borrow trouble.

The TR protocol is really clear on increases and decreases.

--hold doses 6 cycles and if nadirs are above 200, increase by 0.25u
—if nadirs are below 200, hold the dose ten cycles (which you’ve done)

After ten cycles, if you aren’t seeing nadirs consistently under 100, you can increase the dose by 0.25u because the goal is to see nadirs under 100 pretty much every cycle or at least see a majority of the cycle under 100.

You are suggesting custom dosing which we do not recommend for a newly diagnosed cat. Try to give the TR protocol a chance or your other option is to go back to SLGS where you will hold the dose for a week and reduce when you get a BG below 90.

 

[borg the gorb]

You are correct in the hyphenated paragraphs.

But in the last one, not. He doesn’t appear to be a bouncer right now so let’s not borrow trouble.

The TR protocol is really clear on increases and decreases.

--hold doses 6 cycles and if nadirs are above 200, increase by 0.25u
—if nadirs are below 200, hold the dose ten cycles (which you’ve done)

After ten cycles, if you aren’t seeing nadirs consistently under 100, you can increase the dose by 0.25u because the goal is to see nadirs under 100 pretty much every cycle or at least see a majority of the cycle under 100.

You are suggesting custom dosing which we do not recommend for a newly diagnosed cat. Try to give the TR protocol a chance or your other option is to go back to SLGS where you will hold the dose for a week and reduce when you get a BG below 90.

I understand now, thank you for your assistance! I think im going to continue with TR, his BG seems to be very stable

 

[Marje and Gracie]

I understand now, thank you for your assistance! I think im going to continue with TR, his BG seems to be very stable

You’re welcome. Just remember you are in control with texting and feeding so be sure you have your hypo kit with HC foods and syrup.

If you wake up to a BG that’s 100-120, hold off on the increase, ok?

Good luck and let’s hope this will get him into some better numbers. Please be sure and post. Have a good night.