8/31 Ludwig - General dosing advice

[jennaboden]

Hello everyone,

I'm just so confused about Ludwig's sugars, they vary so much day to day and I don't understand why. We are still figuring out the correct dose, we've been doing 2 units Lantus which wasn't enough, but then we transitioned him to ONLY wet food, so we've stayed on 2 units for now. He had a bad low one day last week, so I've been hesitant to up his dose. However, based on his numbers, I suspect we should try 2.5 units again.

My main issue right now is how different he is from day to day. Yesterday his AMPS was 338 (18.8 mmol/L), and his nadir was 196 (10.9), which is a pretty decent number for him right now. But then today, his AMPS was 207 (11.5) and his nadir went up to 275 (15.3). How can it go way down one day, and then way up the next? Same amount of food, same amount of insulin, literally nothing was different today. I know there will be fluctuations, I am diabetic myself so I understand that better than most. But still, it's really hard to adjust his dose when his nadirs are all over the place!! Help!

 

[Marje and Gracie]

Hello everyone,

I'm just so confused about Ludwig's sugars, they vary so much day to day and I don't understand why. We are still figuring out the correct dose, we've been doing 2 units Lantus which wasn't enough, but then we transitioned him to ONLY wet food, so we've stayed on 2 units for now. He had a bad low one day last week, so I've been hesitant to up his dose. However, based on his numbers, I suspect we should try 2.5 units again.

My main issue right now is how different he is from day to day. Yesterday his AMPS was 338 (18.8 mmol/L), and his nadir was 196 (10.9), which is a pretty decent number for him right now. But then today, his AMPS was 207 (11.5) and his nadir went up to 275 (15.3). How can it go way down one day, and then way up the next? Same amount of food, same amount of insulin, literally nothing was different today. I know there will be fluctuations, I am diabetic myself so I understand that better than most. But still, it's really hard to adjust his dose when his nadirs are all over the place!! Help!

I want to be clear whether he is eating any dry food because it’s listed in your signature but your post says he is only getting wet food. It makes a big difference so if you could please confirm, that would be great. If he is eating absolutely no dry food at all, please update your signature.

Whether his dose is increased or not depends on whether you are doing tight regulation or start low go slow. If he is getting any dry food, you must do SLGS and will hold the current dose a total of seven days and then reassess his BGs.

If you are doing TR because he’s only eating wet food, you would hold a dose six cycles. I’d he’s seeing blue or green nadirs, you would hold the dose ten consecutive cycles and reassess. He has been on 2u ten cycles but you shot 2.5u once in there (unless that’s a typo). Theoretically, you would hold the dose four more cycles but he’s really shown he needs an increase so, if you want to do TR, you can increase his dose to 2.25u.

Please note: we do increases/decreases in 0.25u unless the BGs are above 300 so when he earned a reduction with the 40, you should have decreased him to 2.25u.

His BG seems erratic because he’s bouncing which is very common. When his BG goes lower than his liver is used to, it releases counterregulatory hormones to bring the BG back to what it deems as safe. It can take up to six cycles to clear a bounce but he’s clearing them faster.

Please let us know which method of regulation you are going to use and add it to your signature and his SS.

Thank you.

 

[jennaboden]

I want to be clear whether he is eating any dry food because it’s listed in your signature but your post says he is only getting wet food. It makes a big difference so if you could please confirm, that would be great. If he is eating absolutely no dry food at all, please update your signature.

Whether his dose is increased or not depends on whether you are doing tight regulation or start low go slow. If he is getting any dry food, you must do SLGS and will hold the current dose a total of seven days and then reassess his BGs.

If you are doing TR because he’s only eating wet food, you would hold a dose six cycles. I’d he’s seeing blue or green nadirs, you would hold the dose ten consecutive cycles and reassess. He has been on 2u ten cycles but you shot 2.5u once in there (unless that’s a typo). Theoretically, you would hold the dose four more cycles but he’s really shown he needs an increase so, if you want to do TR, you can increase his dose to 2.25u.

Please note: we do increases/decreases in 0.25u unless the BGs are above 300 so when he earned a reduction with the 40, you should have decreased him to 2.25u.

His BG seems erratic because he’s bouncing which is very common. When his BG goes lower than his liver is used to, it releases counterregulatory hormones to bring the BG back to what it deems as safe. It can take up to six cycles to clear a bounce but he’s clearing them faster.

Please let us know which method of regulation you are going to use and add it to your signature and his SS.

Thank you.

Thanks so much for the information! He is no longer eating any dry food (except when he was low that one day, it was all I had to give him). I will try the TR method, my vet didn't specify any method either way. I updated my signature, sorry about that!

Yes I know I did too much of a reduction that one time, I was paranoid about him going low again. I know better now!

I figured he was bouncing after that one day with the lows, but since then I didn't know if he could be bouncing from like a 125-150 number. That's low for him but not actually low - can that still cause a bounce?

I can try 2.25, but the syringes are so tiny, I think it would be hard to consistently dose a .25 increment.

 

[Marje and Gracie]

You’re welcome.

Yes, he can bounce from numbers in the 100s.

Most vets just kind of “wing it” when it comes to dosing but having a specific method is best. You can read through the TR protocol and then ask questions for what you don’t understand.

Most members use calipers to dose because syringes are so inaccurate and the calipers let you dose more accurately…..even in between or smaller doses.

This graphic below shows you about what 0.25u looks like so you can estimate how it would be for 2.25u. It doesn’t have to be exact but you do want to try and be consistent.

 

[jennaboden]

You’re welcome.

Yes, he can bounce from numbers in the 100s.

Most vets just kind of “wing it” when it comes to dosing but having a specific method is best. You can read through the TR protocol and then ask questions for what you don’t understand.

Most members use calipers to dose because syringes are so inaccurate and the calipers let you dose more accurately…..even in between or smaller doses.

This graphic below shows you about what 0.25u looks like so you can estimate how it would be for 2.25u. It doesn’t have to be exact but you do want to try and be consistent.

Okay thank you so much for the help! Will the bouncing happen less often once he is more regulated and his body becomes used to the lower numbers?

I will try 2.25 tomorrow then, thanks so much!

 

[Marje and Gracie]

Okay thank you so much for the help! Will the bouncing happen less often once he is more regulated and his body becomes used to the lower numbers?

I will try 2.25 tomorrow then, thanks so much!

Some cats do quit bouncing but some don’t. In 5.5 years, my girl had some times of limited bouncing but she still would bounce on occasion. It just depends on the cat.

Good luck drawing the dose!