1/5 - Leo 115 @ +11 Need advice ASAP

Susan Shropshire

Susan Shropshire

Member Since 2021
I have been seeing good numbers from Leo. We had a 170 @ PMPS the other night and I reduced by 1/2 unit from 9.5 to 9. He still stayed relatively good overnight. I then went back to 9.5 the next morning and I think we go a little bump from the night before.

Tonight he wanted to eat so I went ahead and did a +11 test so the food wouldn't interfere. He ate a couple of hours ago so it wasn't a big fasted number. He is only at 115 on the Relion and I checked with the AlphaTrak 2 and it was 146. I don't think I need to do the 9.5 tonight. Should I go back down to 9 or lower? Today is cycle 9-10 of this new dose.
@Wendy&Neko
 
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Why did you reduce down to 9 the other night when he was in a high blue? He went pink the next day perhaps as a result. You should have been safe to shoot 9.5. Was he eating okay?
 
Suzanne & Darcy said:
Why did you reduce down to 9 the other night when he was in a high blue? He went pink the next day perhaps as a result. You should have been safe to shoot 9.5. Was he eating okay?
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Since he is new to these lower numbers and I am on a roller coaster with him I would rather go on the lower side of a dose than to risk him going too low especially overnight. I usually see an increase in his numbers that 2nd day of a new dose and he went the other way.
Now tonight he is the lowest I think he has ever been at the time for an injection. I know he needs an injection (even though my vet says not to give an injection if he is under 150). I worry that the 9.5 units will be too much and again it will be overnight.
 
So the 115 was before eating and then you fed him?

What’s your reduction point? I don’t think you should change the dose every few days, unless you are in a situation where you need to do a big chicken shot of 1/2 or 2/3 of your regular dose to drain the depot. I think if you need to reduce then go ahead and reduce and stick with that and see if it holds or if you need to go back up. But it doesn’t look like you are at the point where he’s earned a reduction.
 
So you are not able to monitor him tonight? Or leave food out for him in an auto feeder? Or set alarms to wake up and test?
 
Lantus is dosed based on nadirs and not on preshots. With TR, you can shoot any number over 68 (on the AT) if you can monitor. He earns a reduction whe he drops below 68 (for long term diabetics the reduction point is lower - not sure what is the equivalent on a pet meter).

He seems to be seeing low blue nadirs on this dose, so there is no reason why you cannot give the full dose.
 
I totally understand your anxiety! I don’t have a lot of faith that reducing by only half a unit is going to do much to keep him up tonight- if the concern is that he will drop tonight. He has a pretty good depot at this dose.
 
Suzanne & Darcy said:
So the 115 was before eating and then you fed him?

What’s your reduction point? I don’t think you should change the dose every few days, unless you are in a situation where you need to do a big chicken shot of 1/2 or 2/3 of your regular dose to drain the depot. I think if you need to reduce then go ahead and reduce and stick with that and see if it holds or if you need to go back up. But it doesn’t look like you are at the point where he’s earned a reduction.
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I don’t usually change the shot unless it’s time for an increase. The other night was the first reduction. Again I would rather do a reduction than for him to have a crisis situation overnight. That is why I was asking for advice on what dose to do tonight.

He did eat just 2 hours before and the food he is on is only 1% carbs so it won’t raise it a lot.

I suspect he has has some type of insulin resistance and I am wondering if we are breaking through some of it.
 
Susan Shropshire said:
I don’t usually change the shot unless it’s time for an increase. The other night was the first reduction. Again I would rather do a reduction than for him to have a crisis situation overnight. That is why I was asking for advice on what dose to do tonight.
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Like Suzanne pointed out, a 0.5U decrease at 9.5U dose wil not really make a difference. The depot will continue to influence his numbers. Also, the size of dose does not make a difference in a decision about shooting. A cat needs however much insulin he needs. The size of dose will not impact how the cycle will play out, if it's a good dose for that cat.
 
Bandit's Mom said:
Lantus is dosed based on nadirs and not on preshots. With TR, you can shoot any number over 68 (on the AT) if you can monitor. He earns a reduction whe he drops below 68 (for long term diabetics the reduction point is lower - not sure what is the equivalent on a pet meter).

He seems to be seeing low blue nadirs on this dose, so there is no reason why you cannot give the full dose.
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His Nadir is usually around +6 or +7 and since we went to 9.5 units he’s been up and down but I’ve seen a 115 & 150.
So with 115 now a 9.5 dose won’t cause him to go too low before the previous dose gets out of his system? I know there is an overlap with Lantus. I know keeping him as low as possible is the best but having him at 68 would make me worry.
Isn’t 120 and under considered normal? So are you saying If I am seeing 120 and under Nadirs to keep the dose and if the nadir goes to 68 reduce?

I switched to the Relion meter at the first of the year. That is why I rechecked with the Alphatrak to get a 2nd #.
 
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Bandit's Mom said:
Like Suzanne pointed out, a 0.5U decrease at 9.5U dose wil not really make a difference. The depot will continue to influence his numbers. Also, the size of dose does not make a difference in a decision about shooting. A cat needs however much insulin he needs. The size of dose will not impact how the cycle will play out, if it's a good dose for that cat.
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This makes me a nervous wreck. So I will do the the 9.5 tonight and I’ll get up and check him a couple of times tonight. I usually get up 1-2x and check.
 
Susan Shropshire said:
His Nadir is usually around +6 or +7 and since we went to 9.5 units he’s been up and down but I’ve seen a 115 & 150.
So with 115 now a 9.5 dose won’t cause him to go too low before the previous dose gets out of his system? I know there is an overlap with Lantus. I know keeping him as low as possible is the best but having him at 68 would make me worry.
Isn’t 120 and under considered normal? So are you saying If I am seeing 120 and under Nadirs to keep the dose and if the nadir goes to 68 reduce?

I switched to the Relion meter at the first of the year. That is why I rechecked with the Alphatrak to get a 2nd #.
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Lantus is good at keeping numbers flat. Just because he drops from 200 to 110, it does not mean that he will drop as hard when you shoot at 120.

Your Signature still says AT2 and your SS is the format for a pet meter. I can help you change that to a human meter.
 
Susan Shropshire said:
This makes me a nervous wreck. So I will do the the 9.5 tonight and I’ll get up and check him a couple of times tonight. I usually get up 1-2x and check.
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We will be around to help, so go for it! How long till PMPS?

Susan Shropshire said:
Isn’t 120 and under considered normal?
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The normal range is 50-100 mg/dl on a human meter. You want him to spend as much time as posssible in that range. In fact, per TR, you have scope for a dose increase. His nadirs are over 100 on this dose and today is Day 5 on the dose.
 
Bandit's Mom said:
We will be around to help, so go for it! How long till PMPS?


The normal range is 50-100 mg/dl on a human meter. You want him to spend as much time as posssible in that range. In fact, per TR, you have scope for a dose increase. His nadirs are over 100 on this dose and today is Day 5 on the dose.
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I had actually considered increasing to 10 tomorrow and then had the low # tonight. I have been trying to break through either IAA or glucose toxicity or something that has been holding him back. I hope we are starting to see a change. I’m hoping he will come down and need a reduction soon.

I did recheck before his injection after he ate. It was 155 Relion and 188 on Alphatrak. I gave him the 9.5 units.

thank you all for the support. It’s so stressful!!!!
 
Anyway, if it were my kitty I would shoot 9.5 and monitor tonight. Do you have medium or high carb food and karo syrup/honey/pure maple syrup on hand (not that I think you will need it tonight.). I only ask because you mentioned that his regular food was 1 percent.
 
I’ll let y’all know how it goes tonight
Suzanne & Darcy said:
Anyway, if it were my kitty I would shoot 9.5 and monitor tonight. Do you have medium or high carb food and karo syrup/honey/pure maple syrup on hand (not that I think you will need it tonight.). I only ask because you mentioned that his regular food was 1 percent.
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I have Karo syrup as well as a 2% carb food and if needed high carb dry food and treats. I feel better after the advice that he will be ok. Hoping for some green tonight!!!
 
Bandit's Mom said:
This could be part food bump since he had a snack at +11(?). Let's see the +2. If he will eat again, feed a little now and again at +1.

Shall I go ahead and switch your SS to a human meter if you are using a ReliOn now?
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I usually feed him right before bed. He eats at 8:30 and I do test & injection and then I feed him around 10-10:30 before we go to bed. I usually check at +4-5 and +6-7. I usually don’t see a big difference at +3

yes, please change my info. I forgot to change it on my signature. I just added it at the top of the spreadsheet.
 
Suzanne & Darcy said:
So you are not able to monitor him tonight? Or leave food out for him in an auto feeder? Or set alarms to wake up and test?
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I usually get up and do a +5 or +6 test. I see his lowest usually around +6 or +7.

I just don’t like not being able to keep and eye on him like I would during the day. I usually feed him right before bed which is around the +2 mark.
 
Susan Shropshire said:
Again I would rather do a reduction than for him to have a crisis situation overnight.
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The thing is, reducing for a cycle, unless you do a really big reduction, is unlikely to change how the cycle plays out, because of the depot effect. The others have said the same thing.

As Bhooma suggested, start with a +2 or +3. Based on it, you may or may not need that +6 or +7. First few times I shot lower blue, Neko bounced to the moon right afterwards. And same with shooting green. Eventually she learned to flatten out. I loved shooting low blues or greens after that, cause it meant a flat cycle. With a higher preshot, you have not idea what is going to happen next. Paws crossed for Leo being flat tonight.
 
Susan Shropshire said:
The old vet drilled to me that under 250 was scary! This new vet says low 100s are good. I think she understands it better.
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Vets operate on the premise that we don't test our cats. Which is why they prefer that cats run higher when on insulin than too low. But when you are testing enough and can keep them safe, there is no need to keep them in high numbers. The whole idea behind TR is tight regulation i.e. try to get them to spend as much time in normal numbers - safely.

Since you have shot a blue, let's see the +2 and then decide on futher tests?
 
Wendy&Neko said:
The thing is, reducing for a cycle, unless you do a really big reduction, is unlikely to change how the cycle plays out, because of the depot effect. The others have said the same thing.

As Bhooma suggested, start with a +2 or +3. Based on it, you may or may not need that +6 or +7. First few times I shot lower blue, Neko bounced to the moon right afterwards. And same with shooting green. Eventually she learned to flatten out. I loved shooting low blues or greens after that, cause it meant a flat cycle. With a higher preshot, you have not idea what is going to happen next. Paws crossed for Leo being flat tonight.
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Yeah, Leo is a very bouncy cat. He has been all over the place. I have seen at 9.5 that we didn't have the higher 2nd day bounce we usually do with the NDW. I have started to see a more leveling out of his numbers. I hope we are finally breaking through whatever has been going on with him.

I usually don't see a big difference at +3 it's usually +4 before I see a drop then +6 and +7 is the lowest and at times I see a little more decline at the end which I know some cats do. Tonight I might do a +2 and a +4 and see where we are and go from there. Since I feed him before bed that is at +2 but it's a really low card food so it doesn't move it much. I will do a test when I feed him at 10:30 (that's in an hour +2) and then if it's still around the same I'll do one at +4.
 
Bandit's Mom said:
Vets operate on the premise that we don't test our cats. Which is why they prefer that cats run higher when on insulin than too low. But when you are testing enough and can keep them safe, there is no need to keep them in high numbers. The whole idea behind TR is tight regulation i.e. try to get them to spend as much time in normal numbers - safely.

Since you have shot a blue, let's see the +2 and then decide on futher tests?
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I had one vet that told me he didn't want me to home test! UGH! I am lucky that I work from home so I can test during the day and night and keep a close eye on him.
 
Bandit's Mom said:
Nice and flat! If he is flat or higher at +4, you should be good for the night.

You want to think about an increase at some point. Get him into greens.
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If we stay in blues tonight should I increase to 10 tomorrow? Tonight was the 10th cycle. Should I give it one more day?
I usually see a bigger drop around +6 with him, so I’ll probably do that one too unless for some reason we go up at +4.
Who needs sleep lol
 
Susan Shropshire said:
If we stay in blues tonight should I increase to 10 tomorrow? Tonight was the 10th cycle. Should I give it one more day?
I usually see a bigger drop around +6 with him, so I’ll probably do that one too unless for some reason we go up at +4.
Who needs sleep lol
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I would go to 10U tomorrow if you don't see green tonight. Let's see what he has in store for us at +4.
 
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