? 6/5 99 on Libre, dropping fast again, what do I do to stop drop again???

Staci & Ivy

Staci & Ivy

Member Since 2022
https://felinediabetes.com/FDMB/thr...s-do-i-give-pain-meds-now-if-nauseous.278225/
* +2 edit, just gave tsp MC food 72 bg now, dropping fast (reading on Libre 3). What to do to slow drop?
Ivy has decided to finally start working the dose. She’s currently on 3.25 units Lantus. This is day 3 of dose as we are returning to increasing dose from reduced doses last week when she broke her leg and had surgery.
The first day of this dose she was in pink range. Yesterday became yellow 200s and overnight. *This am she’s been dropping and in Blue range.
** she’s finally decided to work this dose. This morning her pre-shot was 157
30 minutes ago, and dropping fast. She dropped to 117 at +.25 on her Libre 3 device.
It’s not uncommon for her to have these very late nadirs in her cycle and do a very fast drop within the first hour right after her dose.
(She was already dropping. Here’s hoping she doesn’t continue to drop like a rock I plan to give her +1+2+3 small low carb snacks.
Any ideas why she tends to have these intense drops either day two or three into a new dose to her, (even though she has been at the stairs a few weeks ago), please see spreadsheet for details.
Please advise dosing suggestions for Ivy, trying to follow TR as she recovers from surgery and on lots of meds. I want to keep her safe with meds but still bring her bgs down to a better range.

Surgery update:
She still on buprenorphine and gabapentin for her pain. And clindamyacin which dues mess with her and we’ve had some nausea. **Need to keep her eating so we can dose the insulin!
However, she’s definitely starting to feel a lot better and trying to walk around a bit on the leg and wants to be out of her confined space and, she still hates wearing the cone on her head when I’m not watching her so she won’t disturb her surgery site.
@Wendy&Neko @Bandit's Mom @Bron and Sheba (GA) @Sienne and Gabby (GA)
Thank you.
Here’s what her overnight looked like:
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Angela & Cleo said:
Sorry no one responded sooner. It's good you gave the shot. When was her last BG reading? Did/can you cross check with an ear prick?
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Hi Angela, I just crossed checked with 2 meters. Look at the wild differences from Alpha Track & Contour Next.
My Libre flaked out so I used ear prick.
(I think it was dropping so rapidly that the Libre sort of crashes when there’s a very fast drop, Libre had said 72 then I did ear prick) after feeding a 1/2 tsp/lick of med carb food. She shot right up.
Right now Libre says 182 (mc food influenced)
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Sorry I had to answer a work call:

Libre is great for trends but does get wonky :rolleyes:.
Discrepancies in meters is a much talked about topic. What you experienced today is the reason experienced members say pick a meter and stick with it. I myself use the freestyle lite handheld meter which tends to read lower in low numbers. I cross check lows with the alpha Trak for safety.
Looks like she's not in any dangerous low territory and you can officially relax for the rest of this cycle.
 
When did you start Ivy on clindamycin? While she's had some runs of better numbers, I'm wondering if she had some sort of infection/inflammation going on. Even something like gingivitis can cause numbers to be high. Also, the trauma from the injury and surgery can have an influence on her numbers. As she's getting comfortable and in less pain, her numbers may improve. It's also likely that you'll see a bounce off of the drop in numbers.
 
Angela & Cleo said:
Sorry I had to answer a work call:

Libre is great for trends but does get wonky :rolleyes:.
Discrepancies in meters is a much talked about topic. What you experienced today is the reason experienced members say pick a meter and stick with it. I myself use the freestyle lite handheld meter which tends to read lower in low numbers. I cross check lows with the alpha Trak for safety.
Looks like she's not in any dangerous low territory and you can officially relax for the rest of this cycle.
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Hi Angela, thanks for checking back. I agree on meter variance obviously. (I just wanted to cross check for sanity)
Unfortunately, I only got the food influenced meter read from ear prick.
Ivy really likes her late cycle nadir and early cycle drops :banghead:
Seems she takes a few solid days to settle into a dose and then shows me what she can actually do with it. It makes me wonder how quickly I should move her to the next increased dose before I let her show how a dose can take her.
 
Sienne and Gabby (GA) said:
When did you start Ivy on clindamycin? While she's had some runs of better numbers, I'm wondering if she had some sort of infection/inflammation going on. Even something like gingivitis can cause numbers to be high. Also, the trauma from the injury and surgery can have an influence on her numbers. As she's getting comfortable and in less pain, her numbers may improve. It's also likely that you'll see a bounce off of the drop in numbers.
Click to expand...
She started clindamyacin last Wednesday when she came home from hospital post surgery (broke her leg on 5/27, surgery was 5/30). she has a few more days in the antibiotics.
(She actually had a dental done in February where she had some teeth removed so I really doubt it has anything to do with gingivitis at this point.)
What would you recommend I do in terms of dosing and increases? Should I leave her at this does 3.25 for a few more days to see what she can do with it? @Sienne and Gabby (GA)
Thank you!
 
I would hold her dose unless she drops below 50.

Going back to your original question, you asked why it takes a while for her to adjust to a dose. That is typical of glargine. You are waiting for the depot to catch up to any change in dose. In addition, not all cats have their nadirs at mid-cycle. Some cats lean toward an early or late nadir. My cat had early nadirs (except for those times when she didn't). Nadirs can and do shift around which I assume is because cats hate to be predictable!
 
Sienne and Gabby (GA) said:
I would hold her dose unless she drops below 50.

Going back to your original question, you asked why it takes a while for her to adjust to a dose. That is typical of glargine. You are waiting for the depot to catch up to any change in dose. In addition, not all cats have their nadirs at mid-cycle. Some cats lean toward an early or late nadir. My cat had early nadirs (except for those times when she didn't). Nadirs can and do shift around which I assume is because cats hate to be predictable!
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Ok I just want to confirm, I should hold her at 3.25 units (unless she goes below 50?)

Here's her recent history:
About a week to 1.5 weeks ago we were trying to increase her doses (she was up to 3.75 the day before 5/26/23 she broke her leg and all hell broke loose 5/27/23. (Don't know what that dose would have rendered- the overnight on 5/26, she was sharply dropping and at 5:50 am broke the leg (it was literally just about time for me to feed and give insulin!)
She then spiraled down to 40/50s (on Libre 3 device on the ride to the hospital less than an hour later), then while in surgery 5/30, it APPEARED she went under 50 on Libre device (I could follow her device on the app, while in surgery, but they said she didn't drop that low, they monitored her during surgery in whatever means they use).

We have been conservative since the leg surgery as she recovers, keeping her at 3.0, until I increased to 3.25 on 6/3/23 to try to bring her numbers back down again. As usual for her, as I mentioned, she takes her time settling into a dose and usually gives a fast drop with late nadir.
I appreciate the guidance @Sienne and Gabby (GA) :bighug:
 
Staci & Ivy said:
However, she’s definitely starting to feel a lot better and trying to walk around a bit on the leg and wants to be out of her confined space and, she still hates wearing the cone on her head when I’m not watching her so she won’t disturb her surgery site.
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Hi Staci I'm glad Ivy's starting to feel a lot better and trying to walk around some. continued prayers :bighug::cat:
 
Her numbers at 3.0u were not great. If you're following TR and using a human meter, the point at which you decrease the dose is 50. Doses are held at least 3 cycles/6 days. Since you increased the dose on 6/3, you've been at this dose (3.25u) for 5 cycles. You would hold the dose for the PM cycle this evening.

At the moment, Ivy is bouncing. The drop to 72 is lower than what she's used to and triggered a bounce back into the 300s. What this means is that her liver and pancreas have released a stored form of glucose along with counterregulatory hormones that cause numbers to spike upward. Bounces can take up to 3 cycles to clear. Given that you've skipped shots due to her injury and surgery, it's hard to know if the bounces are clearing sooner. At the very least, I would hold the dose tonight and see how her numbers look. Ordinarily, she would be due for a dose increase tomorrow at AMPS. When a cat starts to see better numbers, with TR, you can hold the dose up to 5 days before increasing which is something you may want to factor in to your decision making.
 
Sienne and Gabby (GA) said:
Her numbers at 3.0u were not great. If you're following TR and using a human meter, the point at which you decrease the dose is 50. Doses are held at least 3 cycles/6 days. Since you increased the dose on 6/3, you've been at this dose (3.25u) for 5 cycles. You would hold the dose for the PM cycle this evening.

At the moment, Ivy is bouncing. The drop to 72 is lower than what she's used to and triggered a bounce back into the 300s. What this means is that her liver and pancreas have released a stored form of glucose along with counterregulatory hormones that cause numbers to spike upward. Bounces can take up to 3 cycles to clear. Given that you've skipped shots due to her injury and surgery, it's hard to know if the bounces are clearing sooner. At the very least, I would hold the dose tonight and see how her numbers look. Ordinarily, she would be due for a dose increase tomorrow at AMPS. When a cat starts to see better numbers, with TR, you can hold the dose up to 5 days before increasing which is something you may want to factor in to your decision making.
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I think what you were saying is to hold this dose for up to five days right now due to all of the traumas she’s had and we can’t be sure what is actually causing the bouncing. She’s actually bouncing again right now do I understand you correctly? Please confirm. @Sienne and Gabby (GA)
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I’m
 

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Glad Ivy is feeling better… Not glad all the meds and irregular circumstances are making your dosing decisions harder to make. Like you’re being pulled in every direction. I hope things calm down soon and you and Ivy get a …. Hiatus from all the madness.
 
Don & Xena said:
Glad Ivy is feeling better… Not glad all the meds and irregular circumstances are making your dosing decisions harder to make. Like you’re being pulled in every direction. I hope things calm down soon and you and Ivy get a …. Hiatus from all the madness.
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Thank you Don! Totally agree, she (and I ) need a hiatus (not the other word) for sure!! :bighug:
 
She is bouncing again. It's very clear (at least to me) what's causing the bounce. Cat's bounce because:
  • their numbers drop into a very low range
  • their numbers drop into a lower range that they are no longer used to spending time in
  • their numbers drop fast
This is the information on dose increases:
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...
Ivy is new to seeing numbers that are in the blues and greens. As such, you hold the dose a bit longer.
 
Sienne and Gabby (GA) said:
She is bouncing again. It's very clear (at least to me) what's causing the bounce. Cat's bounce because:
  • their numbers drop into a very low range
  • their numbers drop into a lower range that they are no longer used to spending time in
  • their numbers drop fast
This is the information on dose increases:
Ivy is new to seeing numbers that are in the blues and greens. As such, you hold the dose a bit longer.
Click to expand...
Ok, thanks SO much for confirming, I will HOLD this dose to see where it takes her :):bighug::)
 
Sienne and Gabby (GA) said:
She is bouncing again. It's very clear (at least to me) what's causing the bounce. Cat's bounce because:
  • their numbers drop into a very low range
  • their numbers drop into a lower range that they are no longer used to spending time in
  • their numbers drop fast
This is the information on dose increases:
Ivy is new to seeing numbers that are in the blues and greens. As such, you hold the dose a bit longer.
Click to expand...
We are having a very similar PM cycle, see photo of how her numbers sharply drop after the bounce earlier. How do we get past all of these extreme late nadir and extreme bounces? @Sienne and Gabby (GA)
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https://felinediabetes.com/FDMB/thr...133-5-153-1-72-2-177-3-177-4-pmps-207.278265/
Ivy glucose dropping very fast at +3 suggestions on what to do, I have fed 6% low carb snacks at +1+2+3
Reading was 99 10 minutes ago on Libre 3.
Cross checked with Contour next meter read 237 (bounced?)
This pattern keep happening over and over. Am I doing something wrong to avoid these steep drops??
Help please.

Same thing happened this am too!!
@Bandit's Mom @Wendy&Neko @Sienne and Gabby (GA)
@Bron and Sheba (GA)
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A teaspoon or 2 and keep good notes in the "remarks" part of your spreadsheet. Since you have a Libre on, it shouldn't take too long to see what kind of reaction she has and you can use that information to make decisions the "next time".

12-13% sounds like a good place to start. We're just wanting to level her out a little
 
Chris & China (GA) said:
A teaspoon or 2 and keep good notes in the "remarks" part of your spreadsheet. Since you have a Libre on, it shouldn't take too long to see what kind of reaction she has and you can use that information to make decisions the "next time".

12-13% sounds like a good place to start. We're just wanting to level her out a little
Click to expand...
Got it. I’ll try the mc early on. I’m sure it will shoit her up higher.
Unfortunately the “next time” is a constant battle. Today it was both cycles same pattern! I’m on day 3 of this dose 3.25 units Lantus.
I feel like I’m missing something since I can’t get her to stop these steep drops. And she starts to go low right before food and shot time each cycle. I can see the drop begin on thr Libre.
 
We ask that you do just one post per day, as this is a busy enough forum with just one post per day.

If you haven't read it already, you might want to check out this post on: Using Food to Manipulate the Curve You know she starts to drop (onset) at +2. Feed her a little something about 20-30 minutes before that so she has some fresh carbs on board to cushion the drop. What exactly you feed will depend on what works for Ivy. Cats differ in how carb sensitive they are, so it's time to experiment and learn what works for Ivy.
 
Wendy&Neko said:
We ask that you do just one post per day, as this is a busy enough forum with just one post per day.

If you haven't read it already, you might want to check out this post on: Using Food to Manipulate the Curve You know she starts to drop (onset) at +2. Feed her a little something about 20-30 minutes before that so she has some fresh carbs on board to cushion the drop. What exactly you feed will depend on what works for Ivy. Cats differ in how carb sensitive they are, so it's time to experiment and learn what works for Ivy.
Click to expand...
Hi Wendy, she’s been dropping even before +2 onset, she’s dropping before amps or pmps, then within
Wendy&Neko said:
We ask that you do just one post per day, as this is a busy enough forum with just one post per day.

If you haven't read it already, you might want to check out this post on: Using Food to Manipulate the Curve You know she starts to drop (onset) at +2. Feed her a little something about 20-30 minutes before that so she has some fresh carbs on board to cushion the drop. What exactly you feed will depend on what works for Ivy. Cats differ in how carb sensitive they are, so it's time to experiment and learn what works for Ivy.
Click to expand...
Hi Wendy, I only posted 2X because I needed some guidance at that time as it was happening again. I’m sorry to have posted 2X.
I’m about to feed again for AMPS & she’s repeating that drop yet again. I have read the Feeding the Curve information.
She drops immediate after feeding, not just at +2 onset.
I’m really not sure how to handle.
If anyone has alternate ideas, PLEASE advise.
Is this dose too high for her?
Here is her Libre picture now
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