? 2/1/2016 Conan AMPS 359, +8 385, +10 343, +12 452, PMPS 501, +2 465, +4 487 Bouncing, switch to TR

[Jessica & Conan]

Yesterday

So in light of Conan's bounciness and my confusion, I am considering attempting to adhere to TR, but I have questions.

First, is the "nadir" used to determine dose changes the single lowest measurement during the relevant period, or an average, or the most recent one, or something else?

And second, how does the fact that he might be in a bounce cycle affect whether or when to increase?

*****

Comment from yesterday's thread:

Looks like you have an IBD/diabetic combo as well!!!

One option to maybe discuss with your vet is switching the pred for budesonide.....Skooter is also a steriod induced diabetic and one of the first things we did was ween him off the pred and switch him to budesonide. The switch doesn't help all cats but it has done wonders for Skoots, with his BG numbers as well as IBD.....sure he still vomits occasionally but that is it.....

I see Conan is on it for two reasons so not sure if its an option but maybe worth a discussion at least?

Thanks Molly! My vet and I have discussed this and have decided to stick with Pred. Mostly it's because he's on it for another condition as well as the IBD, and so switching wouldn't change the need for a steroid (though I might be able to lower the dose), but also, we have evidence from repeat biopsies that the Pred is not only controlling his IBD but improving it, and I don't want to mess with that. There are plenty of stories of cats for whom the switch has not worked. So I am going to just have to deal with the diabetes.

 

[Andy & Pimp]

First, is the "nadir" used to determine dose changes the single lowest measurement during the relevant period, or an average, or the most recent one, or something else?

My understanding is: the lowest number that has been recorded since the last dose change.

how does the fact that he might be in a bounce cycle affect whether or when to increase?

It's not generally recommended to increase during a bounce. We like to wait for a bounce to clear (up to 3 days), and see where a dose is really taking them before increasing.

Hope that helps. Keep asking questions!

 

[Sienne and Gabby (GA)]

My understanding is: the lowest number that has been recorded since the last dose change.

This statement is incorrect. Every cycle has a nadir. The nadir is the lowest point in the cycle.

It's not generally recommended to increase during a bounce. We like to wait for a bounce to clear (up to 3 days), and see where a dose is really taking them before increasing.

This is not entirely correct. You don't want to increase the dose when a bounce is breaking. Of course, that also means that you have to know how long a bounce is lasting and where your kitty's numbers are, in general. A cat who's numbers are in the 200s at nadir is very different than a cat who's nadir is in the 70s. For a kitty who's numbers are, on average, in the higher ranges, increasing during a bounce is unlikely to be problematic. You don't want to increase the dose when a bounce is breaking because there can be a fair amount of momentum behind the bounce clearing and if you couple that with a dose increase, it could make for a very late night or long day of closely monitoring your cat's numbers.

Jessica: When you're seeing some of those ghastly high numbers, could you re-test immediately? Looking at your PMPS from last night vs your +2, that's a HUGE drop. It makes me wonder whether you had a bad test or bad strip at the PMPS test. I tend to encourage people to re-test if they get a high or low number that seems out of sync.

 

[Andy & Pimp]

Thanks Sienne, I saw this question sitting since last night and wanted to get the ball rolling on it.

This statement is incorrect. Every cycle has a nadir. The nadir is the lowest point in the cycle.

I understood Jessica's question as which nadir to look at for dosing. A better answer probably would have been "all of them" - but it is ultimately how low our kitties go that determine dosing, no?
Yes every cycle has it's own nadir.

 

[Jessica & Conan]

Sienne, I understand there is a nadir every cycle. But in TR, whether to change the dose depend on the value of the nadir after 3 (or 5 or whatever) days/cycles. My question is, which nadir? Is it, as Andy says, the lowest nadir of those 3 cycles? Or an average? Or some other way? Look at all of them and use judgment?

With regard to bouncing, what exactly does "when a bounce is breaking" mean? I keep seeing that phrase but I'm not quite sure how to identify when it's happening!

If I were to start TR now, how would you recommend I do it, in light of Conan's ss? (Keeping in mind I use AlphaTrak - I've actually ordered a Relion, even though I like the AT, but I won't have it until later in the week).

Sienne, retesting when numbers are out of whack is a good idea, and I will do it in the future.But as far as yesterday, +8 was 600, +9 was 595 (I didn't put that in the title), and +11 (PMPS) was 705 (I hate those numbers!). It's possible one or more of those was off - but isn't it unlikely I had 3 bad tests? Of course, I suppose it's possible the early lower numbers were bad tests - but again +2 and +4 were reasonably consistent.

 

[Wendy&Neko]

Another way to ask the question on nadirs is "who low can this dose take my kitty?" You want to look at the lowest nadir you've seen for the dose. On TR, you don't want that to be below 50 on that Relion, or 68 when you are using the AT. So it doesn't have to be the nadir for every cycle, but rather what the dose potential is.

As for increasing on a bounce, Libby wrote a good post on some TR myths. She talks specifically about the issue of increasing during a bounce.

A bounce breaking means that the extra blood sugar dumped into the system to start the bounce goes away. The numbers during a bounce can wobble around a bit, but when the higher numbers go away and you see the lower numbers again, that's likely the bounce going away.

 

[Melanie and Smokey]

You can see some examples on increasing during a bounce in Lincoln's spreadsheet and how it can be problematic. On 1/13 I increasing during what was probably the end of a bounce. Drove him to 51 in 2 cycles when that bounce broke. That low created another bounce and threw us right back up into those high numbers.
As you follow his spreadsheet you see his bounces getting shorter, creating better curve action in each cycle despite the high numbers.
Yesterday I was considering increasing, but because we could have been in a bounce yet off of the 50s on 1/29 despite is shorting bounces these days, I was holding another day to see how it broke. He broke into a nice cycle and stayed flatter coming out of it, no pinks. Had I increased I could have bounced him back to the pinks and reds.
Bounces suck. They are not logical and its hard to hold the dose through those high numbers for long even for me and I've been at this a while through a few cats (none as bouncy as this boy though).

 

[Sienne and Gabby (GA)]

Sienne, I understand there is a nadir every cycle. But in TR, whether to change the dose depend on the value of the nadir after 3 (or 5 or whatever) days/cycles. My question is, which nadir? Is it, as Andy says, the lowest nadir of those 3 cycles? Or an average? Or some other way? Look at all of them and use judgment?

So here's the really unhelpful answer -- it depends. If you have not reduced the dose within the past couple of days, then whenever you see a reduction-worthy number, you reduce. It doesn't matter if it's the first nadir after an increase or the 6th nadir. However, if you reduced the dose a few cycles prior to seeing another reduction-worthy number, then you may need to hold off on reducing. It can take the depot a few cycles to get caught up with a newly reduced dose. In other words, the depot is still working off of the insulin from the previously higher dose. I know it's confusing. At this point in your learning curve, if you're not sure what to do, ask. We'll do our best to give you an answer and explain the rationale so you have a reasonable idea of why we're suggesting a particular way of looking at Conan's numbers.

As for the re-testing, I was looking at your pre-shot vs the +2. Ordinarily, seeing a drop like that by +2 would suggest you were going to be doing some additional testing last evening. That you didn't, may simply be Conan or it may have been a wonky test. Like I said, any time I saw a number that didn't fit, I retested.

 

[Jessica & Conan]

Thanks Sienne. I was thinking more about when to increase, but your answer still holds: at this point I need to ask.

So if I wanted to start TR now, do you have suggestions, based on the current state of Conan's ss?

Re re-testing: I see what you were saying! I did actually do a +4 last night. It was 476, consistent with the +2. Is that a breaking bounce, even though those numbers really are by no means low? Though this morning's AMPS suggests the trend continued. (I haven't been able to do any more testing today but will in an hour or so).

 

[Jessica & Conan]

So now having had a chance to do another test today, with two tests last night in 400s and two today in 300s, would I consider the bounce to be breaking, even though none of those numbers are particularly low?

Looking at the TR, trying to understand it and figure it out for myself:
- He started (and currently is) on the correct starting dose. He weighs approx. 3.9kg (underweight, but that's his actual weight) x .25/kg = .96U, and we started him on 1U.
- So I'll pretend for the sake of the protocol that I started 5-7 days ago (though I'm not sure I need to do that). Looking back over 5 days, not including today, his lowest nadir - the lowest this dose got him to - was 149. That was 5 days ago. Looking back over 7 days, the lowest nadir was 95. That was 7 days ago. And even looking back over the entire almost-3-weeks he's been on insulin and on this dose, that 95 from 7 days ago is the lowest he's achieved.
- None of these nadirs are low enough to earn a reduction, even using the AlphaTrak threshold of 68. So under the rules for "Increasing the Dose": "If your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles (4-5 days) before increasing." And, "when your cat starts to see nadirs under 100," hold for at least 10 cycles. I am not sure what this means - hold for 10 cycles after seeing the nadir under 100, or hold the dose for 10 cycles total? I'm thinking it's the latter. He's been on this dose for more than 10 cycles, and more than 10 cycles since the 95 nadir.

So, am I understanding the TR correctly that Conan is ready for a .25 increase? Even if his bounce is clearing right now, given that he's never shown a number less than 95?

And a more general question: is there a point at which, under TR, you just hold steady and don't do anything, or are you constantly adjusting the dose every three (or five or whatever) days? As I read the TR, if after 3 days the nadir is above 40 but less than 200, then you increase by .25. If it's less than 40, you reduce by .25. But there's never a situation in which the BG levels are "ideal" and you just stay where you are, unless I'm missing it. So it seems like for cats that aren't going to go into remission, you'd constantly be bouncing back and forth between a dose that has the nadir in the blue or dark green range, and a dose that has them in the hypo/bright green range.

I'm sorry if these questions are simple or have been asked before. I've tried to search for threads that are relevant to help me understand, and I've found many, but there are just so many threads and so much information - it's so difficult to assimilate it all at once. And then, a thread will seem irrelevant when I read it, but later, when I finally have enough understanding to appreciate what it was talking about and that it was actually quite useful, I've lost it!

 

[Gill & George]

I think this may answer your question.

Taken from the Tilly Diabetes site same protocol written differently

Phase 3: Holding the dose
Try to keep the cat at a dose where the BGs are in the 50 to 200 mg/dl range for as much of the day as possible. The majority of cats are actually able to achieve consistent BGs in the 50 to <100 mg/dl range with consistent dosing. A well regulated cat looks like this.

Don't let the cat go below 50 mg/dl (N.B. there are some cats that do well with BGs >=40 mg/dl and are difficult to regulate unless the dose is held at BGs in this range, but a cautious approach should be used until you are sure your cat reacts this way). 200 to 220 mg/dl is approximately the renal threshold for glucose and important for renal health and general recovery. This phase may last a long time (many months). Periodic slight adjustments are necessary in many cases.

If your cat remains in this range, testing for ketones is no longer necessary. But if your cat should, for example, develop an infection and suddenly have higher BGs as a result, start testing for ketones immediately and adjust the dose appropriately.

 

[Jessica & Conan]

I'm not sure that does resolve my confusion. "Try to keep the cat at a dose where BGs are in the 50 to 200" is not inconsistent with the idea that you increase the dose if the nadir is less than 200. And it doesn't mean anything to say to "try." Of course BGs in the 50 to 200 range the goal - isn't the protocol supposed to tell me how to go about getting there, rather than telling me to "try"? I.e., what are the standards/criteria at which the TP says, stay at this dose, don't increase or decrease? What am I missing? As I read it, if the cat is having nadirs below 200 (but above 50), you're supposed to increase.

But that is a longer-term question - my immediate one is whether Conan is ready for an increase. I don't trust myself that I understand or am correctly interpreting the TP at this point. And looking at Melanie's Lincoln spreadsheet (sorry Melanie - I completely missed your post, but thanks for that, it's very helpful to look at another ss!), now I'm wondering if I need to wait in case Conan is clearing a bounce - -even though he's shown absolutely no signs that this dose could take him that low, and his high numbers have been way, way higher than Lincoln's?

 

[Gill & George]

I'm not sure that does resolve my confusion. "Try to keep the cat at a dose where BGs are in the 50 to 200" is not inconsistent with the idea that you increase the dose if the nadir is less than 200. And it doesn't mean anything to say to "try." Of course BGs in the 50 to 200 range the goal - isn't the protocol supposed to tell me how to go about getting there, rather than telling me to "try"? I.e., what are the standards/criteria at which the TP says, stay at this dose, don't increase or decrease? What am I missing? As I read it, if the cat is having nadirs below 200 (but above 50), you're supposed to increase.

But that is a longer-term question - my immediate one is whether Conan is ready for an increase. I don't trust myself that I understand or am correctly interpreting the TP at this point. And looking at Melanie's Lincoln spreadsheet (sorry Melanie - I completely missed your post, but thanks for that, it's very helpful to look at another ss!), now I'm wondering if I need to wait in case Conan is clearing a bounce - -even though he's shown absolutely no signs that this dose could take him that low, and his high numbers have been way, way higher than Lincoln's?

I am sorry if I added to your confusion.

Have you followed the link to Tillys site? The bit I cut and pasted for you is phase 3, follow the link, phase 1 and phase 2 tell you how to get there, it may make more sense taken in context. It is the same protocol written differently I thought perhaps you would find it easier to interpret.

Phase 3 regulation, is where you are initially aiming for, some cat's will stick at that others go on to phase 4 reducing dose and phase 5 remission.

 

[Andy & Pimp]

isn't the protocol supposed to tell me how to go about getting there, rather than telling me to "try"?

You'll get there by following the methodical increases and decreases of the protocol.

@Sienne and Gabby (GA) please correct me if this is worded badly!

When you get to a dose where the cat spends most of the day between 50-200 (preferably under 150 overall), you want to hold that dose until kitty either goes too low (under 50, exceptions for long-term diabetics- decrease dose) or isn't spending enough time in good numbers any longer (increase dose). Periodic dose adjustments will be needed as insulin requirements fluctuate.
Edit to add: By the way...None of this accounts for bouncing. You just have to wait out the bounces to see what the dose is really doing for them.

 

[Sienne and Gabby (GA)]

First, you need to consider whether a cat is within the first year of diagnosis or beyond a year. With the modifications we use here, the approach differs a little if your kitty is considered a "long term" diabetic. Since Conan is newly diagnosed, let's apply the use ot TR to him. Also, we use a slightly modified version of what can be found on the Tilly site. I think the language here is a bit clearer.

With TR, the dose is reduced if your cat's numbers fall below 50 (or 68 on an AT meter). That's easy.

For most of us, we consider increasing the dose if the nadir is generally falling outside of the normal BG range (i.e., above approx. 120 on a human meter):

• If the nadirs are mostly over 200, you increase after 3 days/6 cycles.
• Once numbers are in the blues and greens (below 200), you hold the dose for 5 days/10 cycles prior to evaluating and potentially increasing. Where this becomes more "art" than science is based on how low the nadir is and how well you know your cat -- it's where ECID applies. I believe that Dyana mentioned earlier that you need to ask yourself how low is the current dose bringing your numbers. For example, if your nadirs are at approx. 60, it;s probably unwise to increase the dose.
• You can also decrease the dose if your cat has been in normal numbers (mostly green) for a week.

If you scroll through Gabby's SS, you'll see that I was following TR very closely when she was first diagnosed. The last year or two, I held doses much longer. Some of this was strategic -- it was a way to get her to stop bouncing quite as much -- and some was because I knew Gabby and had a pretty good feel for when she needed a dose increase. (Don't look at her data from after October -- she was getting sick and none of the rules applied.)

If Conan were my cat, I'd be increasing the dose. Even with the most recent nadir of 162, you still have plenty of room to increase.

As for telling you to "try," that's the escape clause. We all try our best to manage our cat's FD. The problem is that our kitties are notoriously unpredictable and no matter how well you understand your cat or how religiously you follow TR, Conan will throw you a curve for no other reason than he's a cat. It can be completely crazy-making if you think in terms of trying to get your cat to follow the rules. It helps to remember that insulin is a hormone so how it's absorbed and utilized depends on a lot of factors, especially your cat's stress (and by extension, your stress since that can influence Conan's stress levels). It also helps to remember that one of the big lessons that Lantus will teach you is patience. I know you want to understand all of this in order to do the right thing(s) for Conan. It takes time to understand how he responds to insulin and how to interpret his SS. We'll do our best to guide you but you may find that even among the most experienced members here, we disagree. Keep asking questions. The more questions you ask, the more we need to think about our answers.

 

[Gill & George]

Jessica I think that the answer you are looking for has got lost in your thread, we have got sidetracked, correct me if I am wrong, sorry if you are finding this frustrating.

to put it succinctly

You want to swap from SLGS to TR and you want to know if you need to hold Conans dose or if you need to increase?

As Sienne said above, whenever someone gives you advice they will explain rationale.

I cannot help you with that, I haven't got the experience, what with conans other health issues. But if you change your thread title to reflect the question something like changing to TR need doscrease advice, that might help get folk here that can help you.

eta cross posted with sienne, I hope that her response answers your question

 

[Jessica & Conan]

First of all, thank you everyone for your patience and your generous efforts to help - I truly am very, very grateful!

Yes, I got a little sidetracked. I always want to understand everything immediately, even when I know it's impossible, and I gather information like a fiend but don't have the experience to process it, so I get myself very tangled up. I really, really appreciate your willingness to wade through the tangles and attempt to clear my confusion and answer my questions. I am absorbing all of this and storing it somewhere...

George, as you say, I think I should focus on my main issue here, which is what to do for Conan. Figuring out how TR works on a global level is a bit more than I can do right now - I can ask questions when the issues arise, and I'll be able to understand the answers better as I gather more experience. Sienne, you answered my question, and your answer is consistent with what I was already thinking myself: it's time to increase Conan's dose, which adds a whole new set of issues - namely, measuring .25 units! I'd like to do my best to follow TR, being a bit more conservative in light of some of my schedule limitations, and I'll start with this.

But I should add one additional question: my vet mentioned nothing about, and one thing I know nothing about, is testing for ketones. Should I be doing this? How important is it? If so I'll need to go read up on it, because I've just kind of been ignoring it... :sigh:

ETA: I think Conan's relatively stable, and slightly lower if not ideal, numbers today mean...something? He's done bouncing for the moment? Or he's on his way toward breaking the bounce? I feel better at least when the swings aren't so wild .

 

[Andy & Pimp]

But I should add one additional question: my vet mentioned nothing about, and one thing I know nothing about, is testing for ketones. Should I be doing this? How important is it? If so I'll need to go read up on it, because I've just kind of been ignoring it... :sigh:

It's a good idea! It's easy, cheap and good insurance, because DKA can be prevented if caught early enough. By the time you see symptoms it will be too late and they will have to be hospitalized.
You can get ketone test strips at almost any pharmacy, usually under $10 for a vial of 50. Just pass them through the urine stream. Hardest part is stalking the litterbox to get a sample. Some people replace the litter with aquarium gravel or a similar non-absorbant material, some place plastic over the litter, you'll have to find what works for you.

http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

 

[Gill & George]

I'm not sure what I am capable of deciphering his numbers, sorry.

As Andy says above the hardest bit is doing the litter box stalk

George says hi, he's my kitty my fault really I should have used my name on the user name rather than my initials, but I faffed and now I have to wait 90 days to change it to something that makes sense, which should be roughly about now

Gill

 

[Andy & Pimp]

Or he's on his way toward breaking the bounce?

This, more than likely. Keep your eyes open for yellow numbers tonight

 

[Jessica & Conan]

So far no yellow - back to the red and (barely) black for PMPS.... I'll see what happens after tonight's shot, as I am not going to increase dose tonight.

 

[Andy & Pimp]

Some kitties like to climb back up high before they actually come off the bounce. Let's see what he does tonight.

 

[Sienne and Gabby (GA)]

Many of us purchase 4" digital calipers from Harbor Freight instruments as a means of more accurately measuring doses. If you line up several syringes, you'll see that the marks on the barrel are not consistent. Marie and another member who's not around much these days did some investigative work with pipettes and all sorts of measuring. The calipers work great! If you go that route, there's also a video describing how to use them.

 

[Jessica & Conan]

Yes, my calipers currently are en route to me - I ordered them over the weekend! Meanwhile I made myself my own little "ruler" for 1 unit, based on a syringe that seemed accurate, and have been measuring it against every syringe I use to make sure the 1 unit line matches up. I am about to switched to the BD syringes with half-unit markings, and then I can use the online ruler template (I've been using BD syringes, but with whole-unit markings, which hasn't been an issue since my dose has been 1 unit).

One thing that confuses me about any of these measuring methods is whether I measure from the top of the plunger or the middle. In other words, for one unit, do I line up the top of the plunger with my measuring device, whether it's the top (needle-side) of the 1-unit line on the syringe, or the top of the bottom caliper jaw, or the line on my ruler? Or is it the middle of the plunger that lines up with the measuring device? The BD ruler says to line up the with the middle of the plunger, and if you line up with the top you'll be .1 off, but that seems so unintuitive to me. I know it ultimately doesn't matter so much as long as I'm consistent, but I'm still interested to know if there's a convention.

Conan had one and only one entire cycle of blue (and one green) numbers, and I still wonder if it could have been attributable to a measuring error...

 

[Andy & Pimp]

I think with the BD rulers you would follow the instructions? It does seem counter intuitive, though.

With calipers I measure the space between the needle side of the plunger and the bottom of the syringe hub. This is required by the way I calculated my measurements:
-I measured 10 units on as many near-perfect syringes as I could find, and averaged the readings (they were all within .03 mm). The measurement was from the needle side of the zero line to the needle side of the 10u line.
-From that average measurement of 10u I did that appropriate math to find measurements for 1u, .75u, etc.

I'm sure you've seen Marje's dosing with calipers thread and video?

 

[Jessica & Conan]

Yes, it's in the small print on the bottom of the BD ruler page...

Yes, I have seen the Dosing with Calipers thread. And your way seems very sensible Andy, and I like the idea of measuring 10u to find the smaller measurements, instead of trying to measure 1u.

Re: Conan...not climbing anymore, but still in the red at +2. One more test tonight. I would like to increase asap - but trying to decide which day. On W and F I can't test until +8. In light of his high numbers, I don't know how risky that would be. If I increase tomorrow, I can test fairly frequently, but I'll be limited in testing on Day 2 of the increase (Wed), but will be able to test Day 3. Or I could increase on Wed, with the idea that it wouldn't affect his first cycle, and be able to test from +8 on and then all day on Day 2,Thurs, but limited on Fri, Day 3. Or I could increase Fri and be limited for the first cycle but able to test from then on through Sat and Sun - but will have to stay at this dose for longer.

Wow, I really didn't imagine this would be so confusing. Once I've done an increase I'm hoping I'll have more data, but now I have no idea.

 

[julie & punkin (ga)]

Take a look at the pictures on the New to the Group? sticky for how to measure the dose. I found it really helpful to notice where the plunger top line is and to use that as my line. It doesn't really matter where on the syringe you line up the plunger, just be consistent. If you put it in the middle of the line (til your calipers get there) then do that consistently. The important thing is to be able to replicate your dose, increase or decrease it. Once you have calipers you'll probably feel a lot more control of the dose - i've seen some significant improvement in different cat's blood sugar when their person began using calipers.

Regarding the word "try" - one way that one "tries" to maintain a cat in a range is to prop up the lower number by using food. You don't need to do this at this point, but let's say a cat isn't getting good enough numbers on 1.0u, but 1.25u sends them under 50. One isn't enough, the other is too much. Usually the first strategy would be to try to hit a dose in between those 2 doses. But if that still isn't working, another strategy is to go to the larger dose but use food to keep the cat over 50 for a few cycles. Sometimes doing that even for a few days is enough to flatten out the higher numbers (because you have a larger dose) and then the dose can be reduced and the high numbers might remain gone.

That's more like Feline Diabetes 250 though, and you're still in the FD 101 class. When kitties come in new, we teach people the standard beginning techniques. For many cats, that's all it takes. For some, those don't quite meet the need, so then we start looking at what the issues are and what might help. That's more of the "art" that Sienne mentioned.

You mentioned looking at spreadsheets - I wanted to give you one more post to confuse you (not really!) - you don't need it yet, but eventually you will. Take a look at this thread about shooting low, ie, shooting the full dose into normal numbers. It's about as counter-intuitive as it could be, but the results when shooting low are not the same as shooting a high number. Take a look at the spreadsheets that are linked so you can see the actual effect of it.

I agree that he could use a dose increase, but I think you're going to feel better starting out to wait until Friday to do it. There's no rush. And yes, there are many cats that sit at a good dose for a while, maybe even weeks, if it's working and the cat's blood sugar is in a good range. I'll look and see if I can grab a couple of spreadsheets for you to see that.

One last thought to leave you with - insulin is a hormone, as she also mentioned. It's not like high blood pressure med where you take the same dose daily and get the same result. It's more like 14 year old girls, tears, slamming doors and laughter all within a day. Also, we know that absorption from a dose of insulin can vary by as much as 50% from one shot to the other. I tried to hold all the variables constant - same dose, same food, same volume of food, same timing of food - and yet you get different results from one cycle to another. So we all just do the best we can and realize the cat's body is in charge. That's why people say the cat is leading the dance - our job is just to follow.

 

[julie & punkin (ga)]

Here's a good one - Asrael's Trouble. Here's his spreadsheet for 2016.

Here is Asrael/Trouble's thread. Feel free to look at other people's threads. We have several new people each week and everyone is facing the same things in the beginning.

Other kitties that have joined recently include Elliott, Rebel, and Callao. There are others but I'm not seeing names at the moment. It's perfectly ok to post and ask questions about what you're reading.

 

[Andy & Pimp]

I agree with Julie about increasing on the weekend when you can monitor the most.

....and everything else she said!

 

[Jessica & Conan]

Thank you Julie! I will study that link and the linked spreadsheets tomorrow. The point about food is interesting. I've already noticed that feeding him mid cycle sometimes actually lowers his numbers (his food is virtually no-carb) - maybe because it spurs him to produce his own insulin? But if he were low, then I'm guessing food would raise the numbers. Maybe it is just an evening influence, as long as it's not high carb.

But yes, this is all theoretical for the moment - I am definitely FD 101!

Part of me looks at his reds and wants to increase right away, but I know I will feel better if I wait until Friday. And by then I should have calipers - and hopefully a Relion meter. I like the AT and would continue using it despite the range difference, which doesn't strike me as an insurmountable problem, but the strip cost difference will definitely add up $.35 each vs $1 each is a pretty big difference.....

(I'll just think of Conan's ss as a 14yo girl...maybe that will help my perspective!)

 

[Chris & China (GA)]

China (until just yesterday) was on 1.5 since 12/30 .....as long as you're getting the numbers you want, you hold the dose!

 

[julie & punkin (ga)]

I've already noticed that feeding him mid cycle sometimes actually lowers his numbers (his food is virtually no-carb) - maybe because it spurs him to produce his own insulin?

yes, that can definitely happen. Most of the kitties here have some sputtering to their pancreas - and cats are unique in their ability to have their pancreas heal and begin putting out insulin again. That's part of the driving force behind using Tight Reg. While we don't know what kitties are able to have their pancreas heal and go off of insulin, it does happen, especially in newly diagnosed kitties before the damage to their pancreas is too great. Newly diagnosed = first year after diagnosis, but sooner is better.

If a pancreas is working, typically you'll see numbers drop 3-4 hours later.

I meant to answer your question about the "hows" of switching to TR - you just have the freedom of increasing more than once a week and you can make that decision. Looking at Conan's spreadsheet, you could increase his dose tomorrow. This is what my mental process would be to decide about his dose:

Basically you look back from wherever you are at the present, so I'd look back 3 days on his ss, and I see the lowest points are in blue numbers. So I'd refer to the Tight Reg guidelines and I'd be thinking "lows in the mid/high-100's, not really new to blues as he's seeing them most days, held the exact same dose 3 days (checkmark that it was done), therefore ready for a 0.25u increase. I'd be having a mental note in my head that these are AT numbers, so on a human glucometer the 150 would be lower, perhaps a low 100's even.

INCREASING THE DOSE:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• 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.