hi sara!
in response to your pm - the shed size seems to correspond to the size of the dose. having gone OTJ for 9 days, however, his shed would be gone so it would be like starting over. you hold the dose for 5-7 days while the shed rebuilds.
here's the part of the protocol that will be helpful to you:
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581
Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.
"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.
Random Notes:
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.
A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.
Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
yes, i think reducing from .25 to .1 when he's overall lower would be a good tactic. overall, though, just fyi a lot of cats who've done a trial OTJ end up going back above the dose they ended with. for whatever reason you have to go up sometimes to come down. so be watching for that possibility and don't be afraid to increase the dose by .25 after a week if you need to.
in regards to your question about low numbers - it probably would help your perspective to know that a non-diabetic cat's normal BG falls in the range of 40's-120's, with most of the numbers under 100. so when you see a 60, that's a mighty nice number, not anything to be afraid of. the protocol calls for reducing by .25 when a cat that is newly diagnosed goes under 50, so you can see there is what i think of as a "safety zone" of the 40's. 40's are normal numbers, but we don't want them staying there because we don't really want them going in the 30's or lower. so we try to keep them surfing above 50.
you don't have to be afraid of low numbers though. as long as you are monitoring with tests, you can feel comfortable that you can deal with lower numbers. the Lantus Land saying is that one must "shoot low to stay low." it kinda goes against logic, cuz you'd look at Duncan's ss on 12/6 - he was 395 at preshot, you gave him 1u and at +6 he was 119. that's a mighty drop of 276 points!
a week later on 12/14 he was 104 and was still getting a fat 1unit dose. using logic, seems like he'd be at zero in 6 hours, but he was 93 at +4 and 111 at +6. the giant drops only happen when they start out high. this is one of the good things about lantus - it's what people mean when they say the curve flattens out as the cat gets regulated.
sorry this is so long, i just want to make sure you kinda get an idea of the "why" of all of this. personally, i think it helps.
anyway, if i were you, i'd continue with the .25unit for the 5-7 days, always monitoring so you catch his lowest point. looks to me like it's around +4-+6.
if he goes below 50, no need to freak out. just pop open a can of high carb kitty food (anything with gravy in the name will work) and squeeze only the gravy into a spoon and give him about a teaspoonful. recheck him in about 20 minutes when it's had a chance to get into his system, and if he's still below 50, repeat the process. we call it wash, rinse, repeat. you just want to keep him above 50 until he's past his nadir and you think he won't wobble back down again. sometimes they will wobble with food/carbs/karo.
alternatively, if you don't have gravy kitty food, add about 1 drop of karo syrup to duncan's regular food and do the same thing.
it would be good if you had the Low Numbers post printed out for reference, just in case no one is on.
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147
trial and error will tell you what works best for duncan and how well he holds the carbs - like if it wears off quickly.
the first time i had to do that punkin popped up with a number in the 30's - i posted on the Tight Reg forum and someone held my hand through it. you can always post there if you need help and anyone would help you. most of us face this early on, and while it's unnerving the first time, you soon realize that with carbs you are in complete control and can steer your cat's BG. just like you've steered it already by removing the high carb foods when he became diabetic.
as far as your question about what's too low to shoot - people with experience shoot with preshot BG's in the 60's. as long as you are able to monitor, it's ok. the "don't shoot low" advice is for newbies. you have done a super job of getting tests and have quite a bit of data collected. for example, as you said to me, you know that duncan doesn't dive, doesn't bounce much and that he's held reductions very well. you've learned all that from your testing, so at this point, if i were you and headed for OTJ like duncan is, as long as i was going to be home, i'd shoot fairly low.
what you're looking for on an OTJ trial is a majority of the numbers being below 100 and pretty much all of them being below 120. continuing til you're just giving .1u gives the pancreas the most support while it's healing and gives duncan the best chance at succeeding at staying OTJ.
feel free to post over in the TR forum as well. there's a lot more traffic there and folks can help you make it through this last phase. i haven't done this part, so am just explaining as best as i understand it. :YMHUG:
