1-31 Howie Hold Lower Dose?

Howiesmom

Howiesmom

Member Since 2020
@Wendy&Neko
I just got Howie from his weekend visit at the vet lodge while I was out of town. They only tested him for pre-shot #s and nothing else. But the dose reduction to 50 units from his normal 55 units didn’t seem to raise his BGs very high (in efforts to drain his depot before his stay at the lodge.) I realize we have basically no data for the last couple of days except PS #s on his SS, but I’m wondering about holding him at 50 instead of bringing him back up to 55? I know we also need to keep hammering on the antibodies too.

Previous Post:https://felinediabetes.com/FDMB/threads/going-away-for-the-weekend-what-to-know.242089/
 
Yes, hold the dose, and gather some mid cycle data. We need to figure out if this is what the dose does, or he's lower due to stress and/or not eating at the vet.

Hope you had a good time.
 
Wendy&Neko said:
Yes, hold the dose, and gather some mid cycle data. We need to figure out if this is what the dose does, or he's lower due to stress and/or not eating at the vet.

Hope you had a good time.
This is interesting...he’s been in greens since Jan. 30. I had to do some testing overnight as I’m working from home today and he was getting quite low. His cabergoline should be here tomorrow or Wednesday and am nervous that I’m going to start him on it when I’m back working in the office. With how high dose he is, would there ever be a chance I could decrease him down to 46 units again and see how he reacts even if his BG doesn’t get down to 40? I certainly would love to save on some insulin with this new medication expense. I know Larry does a much bigger R dose to offset how much Levemir he gives. Thanks, Wendy!
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Your spreadsheet says you shot 55 this morning?

Reductions with TR for you are below 50, not 40. Once he starts cabergoline, I'd suggest reductions below 70, to give you some room. I've seen the odd really wild ride down with cabergoline and a buffer is a good idea. ECID of course. Also ECID on R dosing - Larry uses N, not R. But if you nervous, no harm going back to a dose where you were shooting a combination of Levemir and R. That way if he earns a reduction, you have less of a large Lev depot to be wary of.
 
Wendy&Neko said:
Your spreadsheet says you shot 55 this morning?

Reductions with TR for you are below 50, not 40. Once he starts cabergoline, I'd suggest reductions below 70, to give you some room. I've seen the odd really wild ride down with cabergoline and a buffer is a good idea. ECID of course. Also ECID on R dosing - Larry uses N, not R. But if you nervous, no harm going back to a dose where you were shooting a combination of Levemir and R. That way if he earns a reduction, you have less of a large Lev depot to be wary of.
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Ohh...good catch on that mistake. I definitely only gave him 50 this AM! I’ll hold this dose until I start the cabergoline and then decide what to do on doses. I’m shocked the 50 units is reacting this way compared to when he was on that dose earlier! And I didn’t realize Larry was on a different type. Thanks for that clarification!
 
It's possible Howie had some glucose toxicity and all that time in green land broke through it so he needs a bit less insulin. You might want to experiment a bit before starting cabergoline, to get him to a good range with a lower Lev dose plus some R.

Cabergoline effect can take a while, I've seen it as soon as a week, up to much longer.
 
Wendy&Neko said:
It's possible Howie had some glucose toxicity and all that time in green land broke through it so he needs a bit less insulin. You might want to experiment a bit before starting cabergoline, to get him to a good range with a lower Lev dose plus some R.

Cabergoline effect can take a while, I've seen it as soon as a week, up to much longer.
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The interesting thing is that the last doses of R he had was when he was in mostly yellows at 50 units in mid-January! But I definitely was not at an R dose that had any major impact (besides holding him so he didn’t go much higher). Just so I understand, you are suggesting I consider lowering his L dosage so he goes back to at least 175 and then keep trying to find an R dosage that would drop him? Is there any ideas of a sweet spot where I want to keep him so we can see if/what effect the cabergoline has? Try for a nadir of XX? I know ECID!
 
I would try to find an L dose that brings his nadirs up maybe around 100, with an R dose that takes him down in to greens. Start with that, to see if you can figure out the effect or R. Then after that you can try lowering the L and see if you can compensate with R. The goal is to get a better handle on what R dosing can do. I have seen some really dramatic dose reductions when cabergoline kicks in. Ideally you'd be shooting enough R that you'd have more of a cushion so the Lev depot isn't a major pain when/if you have to start reductions with cabergoline.
 
Wendy&Neko said:
I would try to find an L dose that brings his nadirs up maybe around 100, with an R dose that takes him down in to greens. Start with that, to see if you can figure out the effect or R. Then after that you can try lowering the L and see if you can compensate with R. The goal is to get a better handle on what R dosing can do. I have seen some really dramatic dose reductions when cabergoline kicks in. Ideally you'd be shooting enough R that you'd have more of a cushion so the Lev depot isn't a major pain when/if you have to start reductions with cabergoline.
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I brought him down to 46 units today as I started back at the office and I wanted to see what it would do. So far, he’s had a pretty low day. I’m assuming I should follow TR and keep him on this for 6 cycles to see if I can get his L nadir to stay steadier around 100? When trying to find the correct L dose to start bringing R back into the picture, should I decrease him the 10% that I had increased him (so basically following my dosing backwards on the SS)? Or decrease him in smaller (2-3 units) increments? I dropped him 4units today. I wish we knew if this was his depot or he actually just needs less insulin! Still no word from the vet that the cabergoline is in.
 
The 50 units depot is helping you out today. With TR, you don't necessarily hold the dose any particular set length of time after a reduction. If his numbers trend up, you can increase. But it also takes around 6 cycles for the higher depot to deplete and show you what 46 units can do on it's own without the higher depot.

And for the moment, same rules going down as up. Until you find it doesn't work. I ended up doing smaller reductions than increases. However, with cabergoline in the picture, I'd do full decreases to start.
 
Wendy&Neko said:
The 50 units depot is helping you out today. With TR, you don't necessarily hold the dose any particular set length of time after a reduction. If his numbers trend up, you can increase. But it also takes around 6 cycles for the higher depot to deplete and show you what 46 units can do on it's own without the higher depot.

And for the moment, same rules going down as up. Until you find it doesn't work. I ended up doing smaller reductions than increases. However, with cabergoline in the picture, I'd do full decreases to start.
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You are so wise! Thank you for all the guidance. I’ll chime back in once the cabergoline shows up!
 
Wendy&Neko said:
Maybe start a new post next time. Good luck on this dose.
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I will start a new thread ASAP. However, just one more thought...his cabergoline came in today so I will pick it up tonight. He is still hanging out in the 70s-80s for the most part (am on 3rd cycle of decrease to 46 units). Is there any reason to delay starting the cabergoline until I can find a better dosage that keeps him higher as recommended above? Or keep experimenting with his dosage while I start it? I know you said it could take effect in a week or a lot longer. THANKS, WENDY!!!
 
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