A little board history: when the board was first created by Rebecca, a doctor, because her cat had acro, the only method early on was SLGS; TR didn’t yet exist. Cats did go into remission with SLGS and still do. Lantus started being used and that was followed by TR. More cats started going in to remission with Lantus and TR. When we got here in 2010, the
only SLGS users were ones who absolutely could not get their cats off dry. We had alot of OTJ parties in those days. Then a group came in and they all wanted to do SLGS so a separate board in FDMB was created for them called “Relaxed Lantus” and they all used SLGS. Usually the people advising on the TR board didn’t advise on the Relaxed Lantus board and vice versa, except Jill and Libby, of course. But some of those people had their own ideas about how Lantus worked and when we started seeing more and more of those cats there with DKA, Jill closed that board. Those people left and I’ll leave the rest of it at that.
Yes, SLGS can get cats into remission but TR is a much better option for those who can do it and whose cats don’t eat dry food. But, most of us that are big TR proponents are so because we don’t like seeing cats at higher BGs than they need to be if the cat is not on dry food or if the CG doesn’t have a health issue or a family member with a health issue, etc. We’ve had many, many people over the years hold down full-time jobs and do TR.
Some cats will be slow responders to a dose change and my Gracie was one. I learned that if she dropped into the 100-199 range in the first six cycles, it was going to take a full
11 cycles before she would start turning out green BGs. One thing we all do as CGs is sometimes get lost in the dance and don’t take an objective look at the SS. So I looked at her 2023 SS when she was on TR. Here’s what I see starting on 5/2 when you began TR:
5/10: low numbers at AMPS; I couldn’t really sort out the exact way it all played out but she evidently vomited at some time which will cause the BG to drop. I also couldn’t tell what you fed her but she came up at +1 and stayed.
5/27: low numbers but it was the day she broke her leg (poor sweetheart) but she came right up.
5/30: surgery; anesthesia almost always causes low BGs but she came right up
6/9: those numbers were on the Libre but then one on the contour was 86. Great number; but it didn’t look like you had to fight to get her up. She didn’t even “wobble” which means you think you have her up and then the next test, she’s way down again.
6/12: PM....she did wobble here but you only used MC.
Then you went back to SLGS; so, in my eyes, I’m not seeing an issue with her dropping low and continuing to drop low enough to be worrisome. Yes, you had to work at it the night of 6/12 but that could have been the dose was done or a little extra absorption. And as you know, bounce clearing cycles are always active cycles. Here’s the other thing, you are using 70 as a reduction point but you still had the evening of 1/4 where she dropped down and you had to work to get her back up. It’s going to happen whether you are doing SLGS or TR or custom dosing when the depot gets overfull unless you catch it early.
I’m not trying to push you to TR but it’s easier for me to be objective about it.
I’m so sorry. Yes, for some cats, and Gracie was one, too, it takes some food experimentation. However, you’ve now seen the information on how a higher LC might work better for some cats. But, 12% is not higher LC. It’s MC and if it raised her BG, she’s more carb sensitive than you think. I’ve seen members feed their cat 18% with gravy and a drop of syrup and the BG barely budge. I’ve also seen cats whose BG has bumped up with almost zero carb freeze dried food.
As I mentioned yesterday, at some point in time when a CG has alot of data and experience (as you do) and knows their cat’s pattern, we would expect to veer off a method of regulation to what works for the cat as determined by all that data and feeding. I don’t know when you were advised to drop the reduction point to 70 but if it was early on, it shouldn’t have been done. Also, holding the dose longer without back-to-back reductions is not SLGS; it’s also custom dosing. It’s ok for you to do custom dosing, but I’d just like to ask that you change the SS and your signature to reflect you are doing custom dosing. Usually with custom dosing in the signature, we would add “do not follow”.
At that point where you are doing custom dosing, then we have to ask, “when do we increase”? Well, first, we never increase unless we know how low the current dose is taking her and that’s the great thing about the Libre because you get alot of data. But which meter do you use to make dosing decisions? It’s like using an Alpha Trak. Members who start using them have a hard time switching and they always want to compare the human vs pet meter numbers. But you can’t. So you have to pick one and go with what it’s telling you. If the Libre is telling you she got down to 68 but she’s been on this dose a long time and that was the first green in four days, how aggressive can you be? We were pretty aggressive but either my husband or I were always here with Gracie and we tested alot. If you want to get more insulin into her, then you need to get more
low carbs into her (i.e. 9%) to see if that will raise the overall curve. See where I’m going?
Look at 12/12. She lost duration by +7, went way up (no duration) but then came back down again when she got her next shot. If she was going to bounce, she would have just kept going up; same for the PM cycle; she lost duration, went up early but came back down the next cycle. A cycle where they don’t lose duration should see the BG steadily coming up towards the next PS and will most likely have a second dip but she didn’t do that. When they lose duration and then bounce, the BG goes way up.
When the BG stays pretty flat until +10, but then shoots up alot more than the 20% meter variance, it’s loss of duration although not as bad as when they lose it at +7. Don’t beat yourself up over this because there are only three of us here that can tell loss of duration. It’s tricky and you have to look at hundreds of SS to learn it.....and not your own cat’s
If a cat is dropping fast and
especially towards the 50s, slow it down with the lowest carbs you know will do the job. If that’s 15%, do it. If it’s 10%, great. If she’s dropping very slowly in a “normal” curve, then feeding the curve with your regular LC and seeing what she does is fine. If she drops below 50, then so be it. But we shouldn’t be feeding HC to prevent a reduction. I’m not saying you’ve done that but I’m just putting it out there for readers. And, again, as I said before, you have to look at where she is in the cycle. If she’s dropped 100 in an hour early on and is headed towards 50 in a bounce clearing cycle, I’m going to slow that down because the reduction she earns will not hold. Guaranteed. And she will bounce hard again. The goal is to flatten it out so there aren’t any fast drops that you have to control so the cycle can play out with LC and she earns her reductions that way. Does that make sense?
I’d say if she’s getting into nadirs 90-149 and then bouncing, then clearing the bounce and going back down, it’s worth holding the dose. But if you are going days without a decent nadir, then you have to ask yourself how aggressive do YOU want to be with IVY.
(This part of the advice pertains only to Ivy because of Staci’s experience and data). Only you can decide that and you must consider how low she’s going when she does come back down as well as how long she stays there if you are feeding LC.
Giving more insulin
without feeding higher LC just to get rid of the bounces is too aggressive. If she’s in that area where you aren’t sure whether to increase or not and she’s bouncy, then you can feed 9% and see if it helps to flatten the curve but the BGs will overall be higher. They won’t magically come down at least not right away. When the depot gets full and she earns a reduction, they will but then she might start bouncing again...or not.
Look at
Gracie’s 2012 Levemir SS around April 27. I tried an experiment, very briefly, where I raised her dose when she went above 200 (dose increases are in orange). She quit bouncing and started churning out green but boy did she hit some low numbers and I had to call that one off. This is not to suggest anyone should ever do this but you can see what happens if you don’t feed a higher LC food when you increase a dose. When I let off, she started bouncing again...not high but she did. I was very, very experienced at this time and knew her very well. And I told Jill what I wanted to do so she was looking out as well.
I’m not sure I should say, “you’re welcome” because I’ve only given you info to mull over. The strategy comes after you think and absorb some of this and maybe look at some of the things I learned with Gracie who could drop fast, who loved to bounce, etc etc. All those things, I had to learn to live with because we were at it a long, long time. As it evolved, I started using R insulin with her as a bolus and that helped. That takes alot of time, attention, and someone who can be with you to teach it. It is, very sadly, a lost technique here because it can be quite effective under some circumstances as long as a CG can monitor alot.
