? 9/5 Ivy AMPS 400, +6 236, +10 247, PMPS 198, +1 215, +3 250, Increase Dose?

Staci & Ivy

Staci & Ivy

Member Since 2022
https://www.felinediabetes.com/FDMB...08-pmps-400-2-246-10-172-see-question.281191/
Good morning.
Ivy is finally seeing action and bouncing on this dose.
Today is day 7 on 2.75 u Lantus, SLGS.
(Readings are generally from Libre sensor, cross checked with Contour meter when she goes lower, under 60s or so & noted on SS).

It took until day 4 and 5 to see any action on this dose. And she’s bouncing from the lower numbers (for her) she sees. Clearing bounces fast, sometimes by next cycle.
She is seeing longer stretches of blue #s.

Do I increase dose or hold?

Per @Sienne and Gabby (GA) I am trying to slowly lower her carb % from her 12.5% homemade lamb diet (has IBD issues).
Today at am meal I fed 9.25% lamb (am meal only).
Will repeat that daily and add more of the lower carb into her schedule every few days to try to transition her to lower carbs.
*Ivy is not carb sensitive and lower carbs don’t bring up her BG when she’s dropping fast. Requires mc 13% or 15% to raise bg.

Have a great week. Thanks for your thoughts. :)
@Gill & George
 
Hi Stacy,

She seems to be seeing lower greens on the libre but the times you manage to cross check with the contour she didn't seem that low (eg 58 was a 133 contour)

If we are not to trust the libre at lower numbers, we might be look8ng at nadirs that are over 100, how much over, I don't know. It makes it hard for me to advise you, as I haven't used the libre myself, nor have I closely been following its use o the forum.

So before you take the dose up you need to consider
  • How low did she really get .?
  • As she gets lower nadirs with the libre how are you going to determine if she's gone low enough for you to maintain , refuce or increasethe dose?
  • Perhaps you need to decide what your cut off point for increasing the dose is and test numbers dropping below that with the contour (74 libre was 165contour)
Slgs and TR both rely on us determining the nadir to make the decision to increase, so you need to be able to determine that. From your libre ss and the cross-check you do I'm just not sure I have any idea what her nadir really is with a regular human meter. Perhaps you do.

I'm sorry I know that's not perhaps the answer you are looking for, and I realise you hVe difficulty testing her, I'm not unsympathetic to that
 
Gill & George said:
Hi Stacy,

She seems to be seeing lower greens on the libre but the times you manage to cross check with the contour she didn't seem that low (eg 58 was a 133 contour)

If we are not to trust the libre at lower numbers, we might be look8ng at nadirs that are over 100, how much over, I don't know. It makes it hard for me to advise you, as I haven't used the libre myself, nor have I closely been following its use o the forum.

So before you take the dose up you need to consider
  • How low did she really get .?
  • As she gets lower nadirs with the libre how are you going to determine if she's gone low enough for you to maintain , refuce or increasethe dose?
  • Perhaps you need to decide what your cut off point for increasing the dose is and test numbers dropping below that with the contour (74 libre was 165contour)
Slgs and TR both rely on us determining the nadir to make the decision to increase, so you need to be able to determine that. From your libre ss and the cross-check you do I'm just not sure I have any idea what her nadir really is with a regular human meter. Perhaps you do.

I'm sorry I know that's not perhaps the answer you are looking for, and I realise you hVe difficulty testing her, I'm not unsympathetic to that
Click to expand...
Hi Gill, I know the Libre makes it a challenge, that's why I do cross check when she falls under the 60s or 50s (and lower) for sure just to be certain where she is on the handheld meter.
I take the "greens" on the Libre as a guide only, and then cross check if she's really dropping lower so we have actual verified data to make dosing decisions.
In answer to your questions about how low did she really go:
We can safely say she hasn't gone under 90 on this present dose. And I don't see that she's gone under 100 either.

We do know she hit 133 and 165, verified on the Contour, as the lowest tested values and she's spending stretches in "Libre blue" (likely upper 100s to 200s) with some "Libre green" which is really mid to high 100s on the human meter, can we try to work with that?

Also, she is bouncing high after each of these stretches of lower (for her) numbers. But she's a real bouncer, we also know that.
So with all that said, I know she took her time to settle into this present dose and get some action.
I just need to be able to decide to hold the dose or is an increase warranted.

Sorry for the difficulty of managing Ivy. It's a challenge for all involved and I appreciate the difficulty on your end as well.
 
SLGS GUIDELINES FOR TAKING DOSE UP

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

Staci & Ivy said:
We do know she hit 133 and 165
Click to expand...

In that case it may make sense tonhold the dose, as per the guidelines, I highlighted the section in the guidelines that references that.

I'd be interested to see what others that are more familiar with Ivy think.
If you hold I would watch those nadirs and see if you need to take action.

Thanks for the background on the libre



 
Gill & George said:
SLGS GUIDELINES FOR TAKING DOSE UP

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit



In that case it may make sense tonhold the dose, as per the guidelines, I highlighted the section in the guidelines that references that.

I'd be interested to see what others that are more familiar with Ivy think.
If you hold I would watch those nadirs and see if you need to take action.

Thanks for the background on the libre
Click to expand...
I have read and re-read that information, so thank you for sending it!
When it says to hold the dose based on nadirs (plural), how do we interpret that? She had 1 verified 133 nadir in the "maintain dose" category.
Does that qualify to hold this dose?

And if holding dose, how long would you hold the dose, based on the 1 verified low we see from her values?

Noone else has responded, so not sure how to get other opinions on her current situation. Anyone we should tag?

Glad to clarify the Libre information.
I appreciate your help! :bighug:
 
Gi en you are reducing catbs and you have seen her nadir below 150 a couple of days ago, what do you think would be a good option for you and Ivy?
 
As for how long to wait, you could ask how long is a piece of string?

I think you need to let the data be your guide.

I would be inclined to spot check numbers below 150 with the contour, since is that I your cut off for increasing the dose.

In my mi d you need to know when to reduce, but also when to increase it seems that with the libre you can't say where that point is with certainty.
 
Gill & George said:
As for how long to wait, you could ask how long is a piece of string?

I think you need to let the data be your guide.

I would be inclined to spot check numbers below 150 with the contour, since is that I your cut off for increasing the dose.

In my mi d you need to know when to reduce, but also when to increase it seems that with the libre you can't say where that point is with certainty.
Click to expand...
That's a good point. I will work on getting some tests of other values under 150 to verify on the Contour meter regarding increases.
(Also, The analogy of the piece of string is good).
Of course today she's bouncing a bit it seems from the lower values she's seen the past few days.

Many thanks, Gill!
 
You must log in or register to reply here.
Back
Top