11/05 Misho - AMPS -329 @+8- 211 PMPS- 333

[Di&Misho]

Hi everyone ! I post here for the first time as you have a bit different approach to dosing and I will be glad to read your opinion. Misho's thread in Relaxed Lantus HERE
He earned 2 reductions a few days ago but I think he doesn't respond well to the second one ,this has also happened before. I am planning to go back and shoot skinny 2U tomorrow instead of the 2U that dropped him below 50 . Can you please take a look at his ss and tell me if it is the right decision having in mind his numbers for the last three days after the reduction. Any thoughts are welcome.Thank you !

 

[Wendy&Neko]

Hi Di and welcome to you and Misho over here. This link here is the one to your posting on the Relaxed Forum. For what it's worth, I agree with Mel's advice to you to go to 2 units, as long as he doesn't see green tonight. Bounces can take 6 cycles to clear and he did get pretty low. I believe you are following a somewhat modified Tight Regulation with Misho? I'll give you the reference from the TR protocol on reductions:

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. See additional notes in the next paragraph about drops into the 20s and 30s. 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.

Please do not let yourself become complacent or blasé about drops into the 20s or 30s.
If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.

and

If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.

Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose.

Misho has been diabetic less than a year, so he is considered a newly diagnosed diabetic. He did get into the 20's. How scarey for you!!! But that meant the 2.25 depot was very full and probably influenced the cycle the following night when he got into the 40's again. We consider reductions two cycles apart to be "close together" as the depot can influence 4-6 subsequent cycles, depending on the dose. If that happens again, and I hope not for your sake, you can choose to sneak the dose down. An option for you after he got into the 40's two cycles later would have been to reduce the dose to 1.75F.

 

[Jill & Alex (GA)]

di's thread in the Relaxed group: http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=127477.
scroll down for the latest info. RL hasn't been starting new threads daily so it can get confusing.

hello di,

welcome to the TR group! i don't post much any more, but i was made aware of you looking for more opinions.

see how things go tonight. it's possible misho's bounce might clear (6th cycle after the last low).

if nothing much happens tonight i'd probably take the dose back up to 2u bid tomorrow morning (06/11/14) if i were you. i think those 41s you saw a few days ago were simply the leftover residual effects of the higher dose of 2.25 units.

good luck!



edited to add:
wendy and i must have been typing at the same time. happy to see someone else offer their thoughts...

 

[Di&Misho]

I have already posted here when I read Mel's answer . Your detailed explanations also made things much more clear to me and I will have this info in mind. Thank you both for your input it was very helpful :thumbup

 

[Libby and Lucy]

Di, I noticed a couple of posts in your other thread where you seem to think you did something wrong in reducing the dose the second time. It wasn't wrong - Misho went to the 40s so you needed to do the reduction. Sometimes when cats get 2 more reductions quickly, the second reduction doesn't hold. It's almost like they are trying to get to that lower dose, but they're just not quite ready for it yet. When that happens, you just increase the dose again. But sometimes they DO really need that second reduction and it holds just fine.

The right thing to do is to take reductions when the numbers say you should, but also to recognize when a reduction isn't holding and increase again. You did both of those things.

 

[Di&Misho]

Di, I noticed a couple of posts in your other thread where you seem to think you did something wrong in reducing the dose the second time. It wasn't wrong - Misho went to the 40s so you needed to do the reduction.

I don't know any more if that was right or wrong but this was what my inner conscience told me to do. If you have read Misho's story you know he doesn't live with me at home and taking care of him is supreme effort for me. So it is true I didn't know that the second drop was due to the depot insulin from 2,25 but I also didn't want to put him at risk shooting this dose in the morning as I am not there to monitor him . I only test @ +4 and +8 and only God knows what can happen in the meantime. When I know he will drop low at nights it is not that frustrating as I stay there with him to monitor and even then he dropped twice to 41. The thought it could happen during the day was the reason why I reduced the second time. May be I should only have tried "shaved” dose but I read for this possible option afterwards. Besides English is not my native language and as I said to the folks from Relaxed Lantus I am often lost in translation- which is not an excuse but I just mention it. Due to time difference of about 10 hours I seldom see someone online to help, this is other reason I have to make decisions myself and I don't pretend they are the best possible. Anyway, I am thankful to all experienced members or just concerned caregivers like me from both groups who helped me understand what has happened with Misho the other day , I prefer to take advice rather than learn from my mistakes as it often happens :sad: I shot 2u this morning and hope to see better numbers soon.
Have a happy day, all of you. Hugs from overseas :YMHUG: