9/27 Diago - Dosing Method Questions

[JennC & Diago]

Hi All, (Sorry for the long post but I need some guidance)

I've been trying to figure out which direction of dosing I should go with. My goal is to safely regulate my cat, remission would be a bonus. We had remission for 2.5 years and yes it was nice but right now I'm concerned with regulation.

I've read the stickys on both methods but still unsure which method to choose mainly because we're seeing some successful mid-100's throughout the day. Yesterday and today we got to see some greens. He did give me a scare yesterday with a 44 so we decreased by 0.25u since yesterday was day 5 of the change to all wet food and he went from 500's down to the 100's. He was on low carb food since original diagnoses of 2018. Dr. Elsey's Clean Protein Chicken and FF chicken pate. We cut out the Dr.E CP dry. I worry that he's still on too high of a dose now that we cut out the dry food and given the decrease we've seen so far.

With SLGS I see that if your cat's nadir is below 90 to decrease by 0.25 on one sticky and 0.5 on another sticky. When is the right time to decrease, is it the first time you see a number below 90, is it after a few days? Also, if you decrease and the nadir's start to creep back up, do you hold that dose for 5-7 days before you go back to the last 'good' dose?

With TR, it scares me to hold a dose until you see three instances of dropping below 50. Seeing those numbers when his normal without insulin was around 80-90 and I can visibly see he feels terrible sucks. What I do like about TR is that it allows you to increase within 2-3 days if needed based on the readings. Right now, I'm working from home so I can grab mid-cycle tests but I'm not sure for how much longer.

I'm also still very nervous about shooting lower pre-shot numbers, for instance tomorrow I have jury duty so I can't be home to test him through the cycle which is scary but I'm a little glad to give us both a break after yesterday. He's super tired of me right now. I definitely don't want to lose our progress so even though I'm nervous about shooting pre-shot numbers I don't want to start skipping shots and lose everything we've gained so far.

I know this is a personal preference as long as you are feeding all wet food and honestly I made the switch to all wet food to follow TR but with the drop yesterday to 44 and that fact that he is super growly with me since yesterday has me upset and trying to figure out what direction to go. I've literally broke down today with everything with him. The fact that he is upset with me got to me. If you've read all the way to here, thank you. I need some guidance and appreciate you reviewing.

 

[Chris & China (GA)]

When is the right time to decrease, is it the first time you see a number below 90, is it after a few days?

On SLGS, you reduce the dose by .25 on the next shot after the drop below 90....so if he dropped below 90 on the morning cycle, on the PM cycle you'd shoot the reduced dose.

Also, if you decrease and the nadir's start to creep back up, do you hold that dose for 5-7 days before you go back to the last 'good' dose?

Yes, you'd hold the dose for a full 7 days

With TR, it scares me to hold a dose until you see three instances of dropping below 50. Seeing those numbers when his normal without insulin was around 80-90 and I can visibly see he feels terrible sucks

Yes, it can be scary but getting a 2nd remission is always much harder than the first one, so being more aggressive the 2nd time gives him the best chance to go into remission a 2nd time. Just to be clear....it's 3 under 50 OR 1 under 40

I'm also still very nervous about shooting lower pre-shot numbers, for instance tomorrow I have jury duty so I can't be home to test him through the cycle which is scary

Well you could wait to start TR until after you're sure you're not on a jury. There are also some great tips on Doing TR with a full time job that has lots of ideas

I totally understand how scary it can seem to shoot those lower numbers. I mean you see your cat go from 225 to 75 and your brain says "that dose dropped my cat 150 points so if I shoot the same dose when he's only 150, he'll drop to zero!!"....but it doesn't work that way.
Take a look at China's spreadsheets. She's a good example of how "shooting low to stay low" can work.

 

[JennC & Diago]

Thank you so much @Chris & China (GA) for reading through (I know it was a long post) and answering my questions and concerns. With the TR what is the time frame of three drops below 50, ie. 3 times in a week or two weeks? Or is there a time frame? And you are so right about looking at a preshot of 225 and a decrease to 75 that getting a preshot of 130 would drop him to zero. It's so hard not to think that way. I see from China's spreadsheet you had a lot of tests overnight. This is really tough for me to do frequently. I feel selfish saying that but it really is. I see some really low numbers with China, does it ever get easier?

We just decreased to 2.25u with the PM shot last night but his nadir today was at 77, may have been a bit lower. I didn't grab the +6. Should we keep the same dose or reduce another .25 since he was under 90 today.

 

[Chris & China (GA)]

Should we keep the same dose or reduce another .25 since he was under 90 today.

I'd keep the same dose because you just reduced today. Back to back reductions usually fail. Remember, with Lantus there's a depot which is still releasing a higher amount for up to 6 cycles.

With the TR what is the time frame of three drops below 50, ie. 3 times in a week or two weeks? Or is there a time frame?

Again, due to the depot still releasing the higher amount of insulin, we usually don't count consecutive drops below 50. If there's been at least several cycles between drops, then we'll count them. It's not a static thing though. It takes experience to learn to read spreadsheets, understand the cat/caretaker and recommend when to change the dose. No one answer fits for every cat/caretaker.