https://felinediabetes.com/FDMB/thr...-375-9-325-10-294-11-252.290069/#post-3179838 Hello Everyone, Last night, she woke me up at 3am wanting to eat. That's when I noticed that she had come down just a bit from the over 400 the libre2 goes to. It didn't go under 300 last night. So hopefully we will see what happens with this bounce and keeping it at 2 units. I am confused and frustrated. My vet wants to increase Teja's insulin dose to 3 units. We haven't even been at 2 units that long. On Tuesday, she changed us to 2.5 units, then the next day, 2 units and now 3 units? I don't feel comfortable with this and I am going to tell her. I am seeing good numbers with 2 and I would rather give her a week at that dose to see how she responds and then make adjustments, but nothing crazy. This is the first week we have had a super low dose of steroid, and we have changed her dose twice and now looking at 3 times. I am afraid to tell my vet I am not comfortable with making changes, but I am going to. Making changes just before the weekend is also something I am not a fan of. It isn't like I have her office to contact with questions, only the ER. I just feel there are too many changes. Also, she isn't eating as much as usual. I know that this is something that will happen with insulin. She ate this morning at 3am, which was her usual amount. And also before her shot, but not her usual amount (1/4 can of d/d or PR), she ate about half of what she usually eats. Could this just be her and this bounce?
I wonder if your vet is not used to depot insulins. With nadirs in the 100’s even with our TR more aggressive method you would hold the dose for at least 10 cycles and if an increase was then needed it would be .25. You can’t rush the process. Increasing too fast or on whole units can not only miss a good dose but also cause a symptomatic hypo. We will be here for you weekends and nights so don’t worry about that.
Thank you for replying. Teja's vet is an internal medicine specialist, but she is super busy. Here in AZ, she is one of a few, so she is in high demand. And I've mentioned this group to her and bouncing and so on, but I am not sure what her methods are. She looks at the libre data and makes the calls. I don't know if she is taking into account how she is eating or what she is eating, and most.of our conversations are done via text. So when I give my concerns, she just thinks I'm letting my fear get the best of me. I just don't want to change anything just yet. I mean, we had some blues yesterday, which takes some getting used to. So here we are, in a bounce from those numbers. I hate these high numbers now, but this is going to be a first for us to see what happens after a bounce at a sustained dose. We are doing the start low and go slow method. And I just want to follow it to give Teja her best chance. This is her third cycle at this dose. In your opinion, should we go a week at this dose, then do a curve? Then go every week? I think my vet is going to be upset with me not following her suggestions on insulin. Teja isn't happy today in her bounce. ☹️
I’m glad you are going to follow SLGS. I only mentioned TR so you know that not even if following a more aggressive method you would not do as your vet suggested and why.
I read in on of the stickies that what happens current day is from previous days/cycles and the insulin depot. In looking at my previous dosing/cycles, could the nice blues that Teja got on 05/16 be because of the 3 units of insulin and that depot that we had been doing in the previous cycles? And now with the 2 units that we are doing, that we aren't getting enough in the depot? I probably have no idea what I am talking about. I am just worried that this bounce is never going to end because of the reduced amount of insulin.
When on 3 units he earned a reduction which means that was too much insulin for him at that point. That depot disappeared a long ago. It usually lasts for about 4 cycles or less. Stick with 2 units for 7 days starting with 5/15. Don’t worry about the 2.25 you gave that night. So 4 more days as is unless the bg drops under 90 and a reduction is earned.
Thank you so much! I feel better about sticking with this dose. I just hate that Teja is in a bounce. This is the first week where she is at the lowest dose of her steroid, before that, the dose was fluctuating and causing issues. We were going to taper Teja off of the steroid next week, but my vet said that we would stop and hold the dose. I thought she meant hold the dose for insulin too. But that is obviously not the case. What is the difference between the Start Low, Go Slow and Tight Regulation? When I read the both of them, it seems that the dosing protocols are pretty much the same. It seems to me the Tight Regulation requires more testing. Would I be able to switch to the tight regulation? Also, I am a bit worried. Teja hasn't been too interested in eating today. Lots of sleeping, and some eating, but not like she normally eats. These high numbers are making her feel like poop.
IF you are feeding dry you need to follow SLGS. TR is more aggressive. Reductions under 50 rather than 90 and the dose is changed after 6-10 cycles depending upon nadirs. You do need to test every amps and pmps and at least one other test every cycle. That’s the cliff note version
Oh, wow I completely missed reductions under 50. Wow. So may I ask, when watching the BG, what if the numbers change due.to eating? Yesterday's numbers for Teja would have gotten lower, but she ate and that made her numbers go up and down. She doesn't eat dry food, but some of her food is higher carb, which I did give her to eat since she was dropping so quickly. I just didn't want her.to drop too much while I was in meetings and wouldn't be able to tend to her.
We do feed them to keep the bg from dropping too low. I fed the curve and fed small mini meals until nadir and stopped if Max was heading up or remaining flat. He was used to that because he had chronic pancreatitis and was fed mini meals for a few years before becoming diabetic. If I had to leave him and he was dropping I fed more carbs and left food out. The longer they surf in normal numbers the more healing of the pancreas happens and most dint bounce nearly as much. Some do bounce all the way to otj!
So much to learn. I'm pretty sure Teja would have gone lower yesterday had I not fed her all the way through her cycle. Plus the meetings I had and giving her higher carb food for that. Would have loved to have her hang out in better numbers longer. I wish her bounces weren't so extreme. She's my old girl and I know all of this doesn't feel good for her. I just gave her some cerenia. Thinking about talking to my vet about doing subcutaneous fluids again, to help the kidneys through all of this. I have hope, but this is hard. The first 3 weeks don't really count. She was on a steroid that was screwing everything up. She is still on the steroid, but the dose is so much less. The three units were fighting the steroid. When we dropped the dose last Friday, that's when the 3 units became.too much. So it feels like I am starting over and that I have wasted time. I just want my Teja to feel better. I get sad when the bounce happens. I know it's all a part of the marathon. But she's the light of my life, and I hate to see this.dim her light. Thank you for your help today. I am so grateful for this group. I don't know what we would do without it. ❤️
You did the right thing in feeding higher carbs. That’s what to do if dropping and you can’t monitor. That will keep her safe.
