9/26 Diago AM cycle hypo; PMPS 134, reduce .25, +2: 213, +3, 226

JennC & Diago

JennC & Diago

Member Since 2018
https://felinediabetes.com/FDMB/thr...327-5-237-6-239-pmps-196.235909/#post-2644029

The day started out asking the below question, unfortunately we had a hypo event during the AM cycle. Updating this first post for the PM details as I get them.


Maybe this is too soon to ask since we just started to see some progress after switching to 100% wet food. I'd like to try TR protocol since we were able to switch him to wet and stopped Dr. Elsey's clean protein. Should we hold this 2.5u dose a few more cycles since he bounced after hitting the blues on 9/23?

Also, as we start getting lower preshots, @Wendy&Neko or @Chris & China (GA) I think you mentioned to shoot anything over 150. If we get something lower than 150 and after waiting 20-30 min it doesn't rise to 150 or greater what dose should we give? With Lantus being a depot insulin I'm unsure?
 
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Today is Day 5 on all wet food? I think you can switch to TR and take that 0.25 unit increase. @tiffmaxee or @Sue and Luci should be along soon and confirm that.

The ultimate aim with TR is to shoot any number above 50 on a human meter and 68 on a pet meter. You are already doing well shooting much lower numbers than you were used to till just a week ago! 500+ to 150! WOW!

If you encounter a number you are uncomfortable shooting, you can stall and post here for advice. But if you are comfortable and can monitor him though the cycle, per TR, 50 is the limit!
 
Today is day 5 of all wet food. I can't believe how much better his numbers got after switching to ask wet. That Dr. E kept him in remission but clearly wasn't helping his relapse. I've got to say the first time I shot a lower than 200 I was super nervous but glad I got his tests to back up that he does just fine.

Shooting his full dose at 50 would make me super nervous. Thankfully I'm still working at home due to covid but not sure for how much longer.
 
A second remission is possible and even a third but often a little harder to achieve. I think TR will give you the best chance. You can work your way up or I guess I should say down to shooting a 50. That’s a nice AMPS. You might just see green today. I would increase tomorrow unless today and tonight show lots of green.
 
The diet change is definitely working. It is always amazing to me that just when you think you might need to increase as you get close to either 3 or 5 days, the dosing methods show a reason to follow them. A little low carb, just a teaspoon or two might be a good idea after the next test.
 
I'm not sure if the 911 title is appropriate but I just took a reading at +4.5 and he's 44. I'm giving a little medium carb food right now with the LC.
 
I only have the chicken pate and chicken in gravy. Should I give a little karo or check in 15 min to see if the chicken in gravy brought him up a bit?
 
You can see the next test. Do you know if he’s carb sensitive? With the diet change working so well what you fed might be enough. If a little karro is needed don’t add too much. A teaspoon should do it with the food.
 
I'm not quite sure. Since I've cut out the Dr. Elsey's clean protein we've gotten way better numbers. From 500's to 100's
 
Also, I realized I have light corn syrup not karo. The label says it has real vanilla. Is this ok to rub on his gums if he dips below 40?
 
Vanilla won’t hurt him. Is the carb count high enough? What makes it light? know Do you have any honey?
 
+5 he at 63, should I test again at +5.5 to see if he's holding? He was not happy this time, actually growled at me.
 
tiffmaxee said:
Yes please. Sorry he’s growling. I’d feed a little more lc.
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Will do. I'll post in 26 min. Thanks for hanging in there with me. I've only experienced this once when he was first diagnosed in 2018, he reached 37 and shortly after went into remission. Given he went so darn low, should we decrease to 2u?
 
Because he’s a long term diabetic we reduce with 3 times under 50 with TR but with SLGS you reduce under 90. If you reduce the dose would be 2.25.
 
Okay perfect. Praying this doesn't happen again tonight.

My analytical part of the brain has a question about these numbers...preshot this morning he was 151 and keeping his dose at his normal 2.5u, he decreased all the way down to 44. If let's say his PMPS is around 100 wouldn't that be an even bigger concern of dropping too low around his nadir? I'm sure I'm looking at this the wrong way but I'm struggling to understand with how much a cat can decrease after insulin how giving the normal dose at shot time with low preshot wouldn't always result in a hypo?
 
By the time you tested this morning he had already dropped a lot. A +2 usually lets you know if it will be an active cycle. IF it’s lower than the preshot you will know to feed and get a +3. It means there’s the potential for him to drop a lot lower and you will need to monitor closely. If the same as the preshot I’d grab a +3 also. If higher he likely won’t go into hypo numbers. Some cats onset earlier than others. That’s why a +1 is advised at first. Max used to let me know between +2 and +3. Sometimes a 100 means it will be a flat cycle so that’s where you won’t know until you have more data. See what the PMPS is and if in doubt post for dosing advice. Add the “?” Prefix and put dosing advice in the title. I’d read the two methods again and decide which you want to follow for now.
 
tiffmaxee said:
By the time you tested this morning he had already dropped a lot. A +2 usually lets you know if it will be an active cycle. IF it’s lower than the preshot you will know to feed and get a +3. It means there’s the potential for him to drop a lot lower and you will need to monitor closely. If the same as the preshot I’d grab a +3 also. If higher he likely won’t go into hypo numbers. Some cats onset earlier than others. That’s why a +1 is advised at first. Max used to let me know between +2 and +3. Sometimes a 100 means it will be a flat cycle so that’s where you won’t know until you have more data. See what the PMPS is and if in doubt post for dosing advice. Add the “?” Prefix and put dosing advice in the title. I’d read the two methods again and decide which you want to follow for now.
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This whole post was amazing! Very very informative, i'll be sure to save this in my bullet points. I read the TR this morning and actually made my own bullet points with the data on Tilly's page. I prefer to use this method just to get him regulated as quickly as possible mainly because he was in the 500's for so long.

I'm going to grab a +6 and post an update in about 15 min. I gave him a little more MC.
 
Sorry I wasn't around earlier...Saturday is my 'errands' day! Sounds like you're in good hands!

Congratulations on your first earned reduction! Good catch with the testing!
 
Make note of that and next time feed very small amounts to keep him hungry. Hopefully he’s past nadir.
 
+7.5 back down to 53. Should I try and get him to eat again?

I went back and read both the TR and SLGS, which is recommended? It seems TR is recommended for a potential remission but do people achieve remission with SLGS? I'd love to achieve remission but I'm more looking for regulation at this point. Reason I ask is I'm sure we're going to see a low preshot number tonight and I'm nervous to shoot the 2.5u. What makes me nervous about the SLGS approach is based on guidelines you don't shoot if ps is below 150 and given we're using Lantus what affect does this have on the depot? Is it really advisable not to shoot at all? Sorry for all the questions, trying to wrap my head around the logistics all of this.
 
People do achieve remission following SLGS. One is going through an OTJ trial right now. The no shot number of 150 is when you first start insulin and if you read further you will see that number comes down until shooting 100. That would be you with returning diabetic. You don’t know where he will be at PMPS. He could very well be over 100. You can also choose a higher no shot number with TR. Not shooting will make it necessary for the depot to rebuild. See where he is at PMPS. I suggested getting a +11.5 so that you can see if he’s on his way up by PMPS.
 
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