? 3/29 Scooter AMPS 107 - failed reduction?

Jill & Scooter

Jill & Scooter

Member Since 2018
http://www.felinediabetes.com/FDMB/threads/3-20-scooter-pmps-54-reducie.212176/#post-2351809

Hi all!
Scooter got a reduction from 3u to 2.75u on 3/21 and his numbers have looked good until yesterday AMPS. I wasn’t to worried yesterday as he sometimes gives me a wonky number here and there, but his were mostly higher yesterday and again this AMPS. I’m thinking I need to take him back up, but I’m wondering if I should try a skinny 3u. He did have a 65 at +7 yesterday and on 3u he was having lots of low 50s. Anyone have some advice?

Prayers for all kitties and beans in need!
 
Hi Jill, I think I would hold this dose for right now. You are still in mostly green numbers with exception for the +1's which are food spikes. Any chance he is constipated? That always raises Bubba's BGs. Yesterday you got a nice 65 @ +7. And on 2/24 you had a nice run in the 50's for the AM cycle.

Back on 2/28 and 3/1 you had higher blue starts than today and yesterday. If it starts to look like a trend upwards in the next cycle or two then maybe think of raising him back up. But, for now, I think he looks good.
 
LOVELY DAY.jpg
 
I think his numbers look good! From the guidelines for TR:

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.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
Personally, I would be worried about nadirs dropping too low if I increased the dose. Since his numbers are all well below the renal threshold where high BG can start to cause problems, it doesn't seem like there's any rush to change anything. Lots of lovely greens on that spreadsheet.
 
@Jill & Scooter
Jill & Scooter said:
I’m thinking I need to take him back up, but I’m wondering if I should try a skinny 3u. He did have a 65 at +7 yesterday and on 3u he was having lots of low 50s. Anyone have some advice?
Click to expand...
You could give it another day or two to see if this is just a bump in the road, but I wouldn't let it go any longer than that if nothing has changed. You don't want glucose toxicity setting in. I could have missed it, but I don't think he dropped below 50 when on 3u bid? If I were in your shoes and could continue monitoring as carefully as you have been... I think I'd go back to 3u bid since he remained above 50 (unless I missed it). If it makes you nervous, go ahead and try a skinny 3 units.

Possible tip worth trying: Alex would get food spikes after eating. I'd have to feed her prior to nadir in order to keep her from bottoming out. That allowed me to get more insulin in her which in turn, helped to flatten out those food spikes and/or dawn phenomenon.

@Erin & Scott
Erin & Scott said:
From the guidelines for TR:

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.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
Click to expand...
I know it can be confusing, but those are guidelines from the 'Increasing the dose' section of the TR Protocol. The section of the protocol which applies in these circumstances is found in the 'Reducing the dose' section:
  • 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 an in-between the dose.
 
Bobbie And Bubba said:
Hi Jill, I think I would hold this dose for right now. You are still in mostly green numbers with exception for the +1's which are food spikes. Any chance he is constipated? That always raises Bubba's BGs. Yesterday you got a nice 65 @ +7. And on 2/24 you had a nice run in the 50's for the AM cycle.

Back on 2/28 and 3/1 you had higher blue starts than today and yesterday. If it starts to look like a trend upwards in the next cycle or two then maybe think of raising him back up. But, for now, I think he looks good.
Click to expand...

I will stay with 2.75 a little longer. His nadir has been earlier in the cycle than it used to be, so I could be missing a lower number. The 24th was an interesting cycle. Those 50’s are fine when I’m home, but I always worry he’ll drop lower when I’m at work. He’s not constipated, all 5 P’s are in place, his PMPS is still about the same, so I really have no idea why he might be creeping up. I was thinking another possible reducie until yesterday. :( Thanks for helping us!
 
Jill & Alex (GA) said:
@Jill & Scooter

You could give it another day or two to see if this is just a bump in the road, but I wouldn't let it go any longer than that if nothing has changed. You don't want glucose toxicity setting in. I could have missed it, but I don't think he dropped below 50 when on 3u bid? If I were in your shoes and could continue monitoring as carefully as you have been... I think I'd go back to 3u bid since he remained above 50 (unless I missed it). If it makes you nervous, go ahead and try a skinny 3 units.

Possible tip worth trying: Alex would get food spikes after eating. I'd have to feed her prior to nadir in order to keep her from bottoming out. That allowed me to get more insulin in her which in turn, helped to flatten out those food spikes and/or dawn phenomenon.

@Erin & Scott

I know it can be confusing, but those are guidelines from the 'Increasing the dose' section of the TR Protocol. The section of the protocol which applies in these circumstances is found in the 'Reducing the dose' section:
  • 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 an in-between the dose.
Click to expand...
I’m going to stick with the 2.75 just a bit longer. I worry about glucose toxicity. When he was first diagnosed he had something going on and it took a good bit of time and insulin before we broke through whatever it was. I don’t want to hold a dose to long and wind up there again! If I have to go back up, I may try the skinny 3. Those 50’s when I’m at work make me very nervous!
As for feeding, Scooter gets a snack at shot time, +2, +4, and +6. His nadir used to be around +7-8. I’ve been wondering if should cut out at least the +6 since his nadir is earlier now. It just seems a long time without food, especially when I’m at work and can’t monitor. Do you have a recommendation for snack times? I sure would like to bring that +1 down. That spike drives me crazy! Thanks for your help!
 
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