AT 1/26 PMPS112, .5u, +1/109, +2/73 LOW #s Pls Help!

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Martha and Lolly (GA)

Martha and Lolly (GA)

Member Since 2015
Hi, my Vet called today to review Lolly's numbers. She thinks that the numbers are low enough that I should try lowering dose from .75 to .5u Dr. K says I want to be in the range of bg= 60 - 180 (AT) but go to .5 with the following caveats:

1) If Lolly's bg goes higher than 220 to call her
2) If Lolly's bg is less than 120 no shot

Lolly has been going down quickly, and just today her bg hit 59. I've been home since last Thurs, and will be tomorrow (the great storm), but I don't want to leave the house for work day knowing that she might go down to 59, or lower if she keeps going lower.

Could the experts please look at her spread sheet and give me your opinion? :):):)


Thanks!!!
 
Your vet is pretty on targe with what I'd be doing. The 59 today would mean a reduction in her previous dose of 0.75u, so her new dose with the next shot would be 0.5u. We would encourage you to continue giving insulin as you continue to go down the dosing scale. Many vets use 0.5u as their smallest dose, but the experience on FDMB has been that giving a little insulin as long as the cat's pancreas seems to need some seems to give cats the strongest possible remission:

btw - the BG numbers below are all in human glucometer numbers:

From the TR Protocol page:
  • Since 2006 we've encouraged those practicing Tight Regulation to attempt reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission.
Remission:
  • From Tilly's Diabetes Homepage:
    Phase 5: Remission

    "14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible. Test the cat's BGs once per month.

    Approximately 25% cats that achieved remission using this protocol relapsed and required insulin again (frequent causes are hyperthyroidism or bouts of pancreatitis). Therefore, it is important to keep your diabetes kit up-to-date. Then you can react immediately by giving insulin and home testing. Importantly, the sooner you react to a relapse (i.e. preventing hyperglycemia and initiating other necessary veterinary treatment), the more likely a second remission will become.

    The longer a cat has had diabetes, the less likely it will go into remission. Many long-term diabetics get stuck in Phase 3 or 4. Yet there is a benefit of using this method for such a cat as well: keeping the cat's BG levels as normal as possible is much healthier for it long term. Insulin requirements will often decrease to very low levels too."
 
The reduction point on an AlphaTrak is 68, so Lolly definitely earned a reduction to 0.5U today. :D

She may bounce after that 59, so I wouldn't worry if she goes over 220 in the next day or so. She'll get back on track after the bounce. I'm not sure why the no shoot below 120 rule. That's around 90 on a human meter and people here will shoot that once they have experience and data to do so.
 
Looks like Lolly is on a mission...seriously!


I would like to comment that 60 on AT= 39 on human numbers...that is a bit too low...lower than you want her.
You would want to be intervening with food by the time she was 70-77 on your AT.
Was hoping you got a chance to get your 1/2U syringes before the storm, I know they would help as your reductions are coming fast and furious.
..same thing happened to us so I get it.

Ultimately you will want numbers to be below 154AT/100human...as you head down the ladder. Once on small doses they don't tend to have as much of a drop. And I agree I would not recommend NOT shooting under 120. You want to avoid skipping shots and find a dose that can be shot twice a day. That is why the protocol has you dropping dose if you get a BG below (your) 68..
From .50 it may be that she needs .25 in order to be shot twice a day. And yes most of us shoot much lower than that. Like Wendy said you just need the data..I don't know she is going to let you stay around long enough to get long-term experience before having to make these moves.
I understand your concern if you are going to be gone, but if you get a +2 before leaving, feed her several meals and leave LC food down..and if it appears it will be an active cycle, you can also feed HC to slow her down, or leave some out as a precaution so she can eat if she gets low.

I might be a little concerned trying to follow more than one protocol at same time as I think it would be confusing especially if they don't sync.

Hope you are feeling better. Glad you get to stay home for another couple days. Stay safe and warm.
 
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Thanks- I'm so happy this seems to be working. I wish I could convince my vet to use the human meter-- I'm so confused by the range differences, it doesn't seem like human to AT is a straight ratio. Is 60 - 180 AT the right range to aim for in TR then? I want to know how her numbers line up with FDMB experts, and I can't translate human to AT.

I think the 120 might have been her responding to my fear of not being home to monitor. Her original instructions were not below 100. I hate to mess up with a NS and a big bounce.

My big fear now is, if she "runs down the numbers" quickly, does that mean she could test fine one day then hypo the next on same dose?? I can only get one approx nadir test.

Thank you, thank you!! :bighug:
 
"normal" on the AT is 68-160 (human meter 50-120)

The "general" rule is to take the AT number times .66 and you'll get close to the equivalent human number, but the higher the numbers go, the less that applies....Of course if your cat is in yellow, pink, red or black numbers, it really doesn't matter what the exact number is...they're too high
 
70-77 on your AT.
Was hoping you got a chance to get your 1/2U syringes before the storm, I know they would help as your reductions are coming fast and furious.
..same thing happened to us so I get it.

ultimately you will want numbers to be below 154AT/100human..
bettyandhank said:
Looks like Lolly is on a mission...seriously!


I would like to comment that 60 on AT= 39 on human numbers...that is a bit too low...lower than you want her.
You would want to be intervening with food by the time she was 70-77 on your AT.
Was hoping you got a chance to get your 1/2U syringes before the storm, I know they would help as your reductions are coming fast and furious.
..same thing happened to us so I get it.

ultimately you will want numbers to be below 154AT/100human...as you head down the ladder. Once on small doses don't tend to have as much of a drop anyway. And I agree I would not recommend NOT shooting under 120. You want to avoid skipping shot and find a dose that can be shot twice a day. That is why the protocol has you dropping dose if you get a BG below (your) 68..
From .50 it may be that she needs .25 in order to be shot twice a day. And yes most of us shoot much lower than that. Like Wendy said you just need the data..I don't know she is going to let you stay around long enough to get long-term experience before having to make these moves.
I understand your concern if you are going to be gone, but if you get a +2 before leaving, feed her several meals and leave LC food down..and if it appears it will be an active cycle, you can also feed HC to slow her down, or leave some out as a precaution so she can eat if she gets low.

I might be a little concerned trying to follow more than one protocol at same time as I think it would be confusing especially if they don't sync.

Hope you are feeling better. Glad you get to stay home for another couple days. Stay safe and warm.
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Thanks! I am feeling better. Tough I'm glad Lolly's going down, I wish it weren't quite this fast. Or I could take a month of off work.

Dr. K told me she was using same protocol but simplifying it. I also know that she's never used it in practice. Therefore, I trust FDMB's guidance in using this protocol over hers. No reflection on Dr. K, she told me she hasn't been able to use it in practice, because no on would agree to it before me. But you have the experience. So is it safe to say that I want Lolly in range of 80-154AT? What is the safe bottom number in your opinion?

I couldn't get the .50 syringes- problems with them phoning in the Rx. Hopefully Thursday or Fri. I can probably only get a +1 before leaving.

The leaving HC food doesn't work so well with her-- for some reason she doesn't want to eat as her numbers go low (remember our first encounter...) Should I start reducing dose if she is at 100?

Thanks
 
My signature link Glucometer Notes has some feline reference ranges for the different meters.
 
Her PMPS was 110. I went ahead and shot the .5u I used calipers to measure. I'll get +1 and a +2. Do you think I should also do a +5? What kind of numbers (AT) would you want to see in the +1 and +2 to feel safe about the rest of the night?
 
I've looked at them before, I printed them out and have them in my hands-- :) thanks-I don't know why the AT/human thing has become such a bugaboo for me.

If she goes below 83, I'll need to give HC. And if I can't get her over 83, I should monitor for the nadir.

But since I lowered the dose, and todays PMPS is about the same as yesterdays, hopefully things will go well. Also, calipers worked well on the .5
 
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A +2 may give you a heads up if she's planning to dive.

Other than that +5ish, at the beginning of the likely nadir period could be helpful.

If you want to nap, make it in multiples of 45 minutes (ex 1.5 hours, 3 hours, 4.5 hours). That's the average length of a sleep cycle and waking up at the end of a cycle is much easier than waking up in the middle of one.
 
We use 68 as our take action and feed HC numbers. You can feed a little low carb food at numbers above that to see if you can get her to surf.

Hard to say what'll be safe "go to bed" numbers. I'll keep an eye on her +1 and +2 and we can figure it out from there.
 
Her +1 is 109.

Weird, her ears all of a sudden got a lot harder to test. When I prick her instead of forming a drop, it's more like a small scrape that won't bleed. I'm using the heated sock and a lancet pen. She's also starting to resist, which she hasn't done at all until now. I thought maybe I should shave part as suggested in the ear tips, but I don't have a new razor, and no hope of getting one for a while now. I'm so frazzled.
 
I wish I could convince my vet to use the human meter-- I'm so confused by the range differences,
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She can use the AT, you don't need to convince her to switch for herself, but there is no reason for YOU to use AT if you prefer a human meter which most here use, not only for the less expensive strips but to take the conversion and that part of the confusion out of the equation. Most here do 'speak' in human meter by default..and follow the protocol ranges specified in those terms. Why not just try it out and see...I think you will save yourself some grief AND $$.

the leaving HC food doesn't work so well with her-- for some reason she doesn't want to eat as her numbers go low (remember our first encounter...)
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YES, I remember!!!! That was one week ago today...and she is down 1U in dose!!! This is why i was asking and hoping you have gotten some HC cans of food to try out on her. We were finagling everything...she may not like dry gravy flour with karo in it ;)
But why not try to open a couple cans of FF gravy and give her just a TEENSIE teensie bit (it WILL bump her numbers up for a bit but wears off quickly)...maybe just a 1/4 t or so..to see what she likes so you will have something reliable should you need it. For all we know she'll go gaga over it like most kitties...maybe we just haven't found her version of kitty crack yet?
It would be good to know BEFORE you need it so we don't get in a pinch again.

you are in the same dilemma as many once their kitties start racing down the ladder. You are fortunate to have hubby home in times you cannot be, now that he is learning to test/shoot. It can be chaotic and exhausting when they are flying like that. but the PAYOFF is great!

Have you tried milking the ear a bit to get the blood bead, use some neosporin or vaseline (tiny bit) to help it bead up, switch ears? I also alternate the warm rice sock with rubbing the ear between my thumb and forefinger, one on inside and one on outside edge. He always liked that part anyway and it helps with the blood flow.

I would try to stick with the protocol here if you can, there are so many here fluent not just because they practice it 24/7 with their own kitties, but also helping each others. It is designed for safety first and we will help you work with your schedule. In the end, Lolly is really the one leading...making it impossible to totally control how it goes.
 
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wait!! ljust seeing this...let me catch up. DOnt give any more for a sec. you do not want to overfeed hold tight BRB
 
how much did you give her...she is not too low yet, and normally you would give HC if she is below 60-65..you are still ok. When we DO give HC...we start with ONLY a teaspoon of the gravy....you don't want them to get too full. So for now hold off. what time was that last test?
the HC will bump her...but it may not be a bad thing to slow the cycle down since it is so early.
Let me also get some more eyes...be back
 
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Can you please edit your subject line....and add your numbers and times? Also please add- something like Help with low numbers! whatver you have room for of that essence
 
If she drops below 68 on the AT, you'd want to give her a teaspoon of the "gravy" from the Gravy Lovers....The gravy is where all the carbs are, so if you pop open a can, put the lid back down onto it and "push" all the gravy out into a bowl or something.

We only want to use the gravy so we can get their numbers up without filling them up too much in case we need them to eat later on in the cycle.
 
If she's above 68, what you might try is giving her some of her regular low carb food (about a teaspoon) or if you're concerned she's dropping too quickly, a teaspoon of something "medium carb"...between about 11% to 16%

The "trick" is to get her surfing safely in good numbers without dropping too low or sending her skyrocketing up from all the extra carbs
 
Chris- and Martha- my computer just crashed. I have rebooted firefox 3 times...having trouble and keeps freezing up ...i keep having trouble w/ pages freezing so I cannot type or do anything. loud buzzing ...worried if I can stay connected. we need to get some more eyes here ...

Also can we clarify what time in the cycle it is now? how long ago was the +2?

Martha don't feed any more yet. and when you do it next you ONLY want to feed the gravy part..not the food yet. you want to make sure she doesn't overstuff and will continue eating. ESPECIALLY Lolly. so glad she seems to like the FF gravy though

Depending on numbers, it may be you would give her MC (did you get any?) if none on hand we can mix LC and HC to make MC.

standby
 
Oh dear-- I gave her a teaspoon of the gravy and meat of the Fancy Feast Gravy Lovers- probably bumped her way up. I'm sure she'll eat as much as we need though. She's still sniffing around for it.
 
THAT is how it is supposed to be...your Lolly was unusally apathetic the other night...being low typically triggers hunger in most kitties.
hope you got several flavors. it wears off fast... so not to worry...the point is you just give tiny bits at certain points, not all at once.... you need to be able to keep her eating, and sounds like she will. maybe you had a piggie all along...she was just holding out for stuff she really likes
 
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73 was at 2.5, I fed her 5 min later, it's now +2.75. This is going to be confusing-- I was moving her 15 minutes back, so she's +3 at 11:15 EST. I don't want to get the times/numbers mixed up since they are not on the hour. I have to move her back.
 
3 varieties of FF Gravy Lovers. I didn't buy an MC - I can mix. What should my general strategy be? I know I have to test, but she's really hating it. I guess I have to do the +3 now?
 
As long as she's above 68, she only gets low carb food...if she drops below, that's when you pull out the gravy (yum yum)

You can also give a little higher carb (like MC) if she's dropping fast and it's early in the cycle to help prop up her numbers a little, but generally, we like to stick with low carb unless they drop too low

If she DOES drop below 68, you give a little of the gravy and retest every 30 minutes...as long as she stays above 68, you're good

Yes, you can mix low carb with gravy to make a Medium carb

Go ahead and get the +3 and lets see where she's at
 
See how great the HC works? when she eats?
It gives you comfort to know you can steer her numbers back up

BJ is coming to check on you
 
The steering/low numbers pattern is roughly:

test, feed 1-2 teaspoons, wait 20-30 minutes, repeat

until you are sure you have safe numbers.

- When dropping fast/early, you can use medium carb to slow the drop.
- When below 68, you use high carb to bring the glucose back up; it may wear off quickly.
- When rising steadily, you can either wait until the next time, or give low carb to steer/maintain the numbers.

You can do this; it just bites the sleep big time!!!
 
Ok thanks so much.

People helped me with a similar situation when she was into her 2nd week on insulin. At the end of that I skipped a dose.
She is moving down the dosage not in weeks, but in days now. What is my goal tonight? Keep her above 70 until nadir past? Then what? Do I shoot a lower dose? I can't keep giving her .5 (a .25 reduction from yesterday!), I have to leave the house Wed. So basically, once this is controlled, what next? Thank you this is really too much too fast.
 
She's a gal on a mission - to get off the insulin.
And if she's too low to shoot in the morning, you may have to skip to let the depot drain some more.
We'll see how she's doing then.

If you really, really need to crash tonight, there is the option of aborting the cycle and loading her up with a mixture of the low (for sustained calories) and high carb (to pop up the glucose quickly). That is completely up to you; if you can steer for a few hours, that'd be better for her and won't shoot her glucose up as high.

ps Please update the spreadsheet if possible.
 
One thing you cannot do is predict cycles in advance. As exhausting as it seems, it is because she is seriously wanting off insulin. BTW that last event was only 1 week ago. But that was different in that she was so over dose at that point AND not eating. One thing you can do is play with timing of food to level her out more...I am not as versed at this as some, but ask Julie, Wendy, and some of the others. I will say though her timing for this run down is actually good.. if she does drop below 68 again (which she hasn't) ie: earning another reduction then you will be at .25 before you go back to work. SO then on a very tiny amount where you won't have to worry as much.
AND if she is going to have action it is great that it is while you are off these days.
Your feeding HC tonight stopped her (so far) from dropping low enough to earn a reduction. That is a strategy some may use sometime if there have been too many reductions close together and they worry it will 'stick'. So we won't know where this cycle goes til you are through it, but either way the numbers will be your guide. If you ever do take a reduction and numbers rise too much in subsequent cycles, then you consider it failed and go back up to the last good dose. All this is referenced in the protocol. But it's too early for you to worry about every possible hypothetical and nuance right now. See where you are and get some advice when needed for your upcoming cycles. There are others better at dose advising than me, lets get some more opinions.
But already you can see tonight the big difference from last time is you have HC/gravy food she will eat, you are on 1/3 the dose you were then, and also you didn't shoot into nearly as low a number. You got this Martha.

Lolly means business though. She is dancing her toes off. Very exciting!
 
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All Numbers ALPHATRACK

PMPS 112
.50 U shot at 8:15est
+1- 109
+2.5- 73
teaspoon HC food/gravy mix
+3- 96


was the 73 at + 2 or 2.5 Martha?
Can you add AT to your subject line
(take out the .50U if you need more room)
 
The tricky part is the depot....since tonight's the first dose at .5, the .75 dose can still be effecting tonight's cycle

Since Lolly's so new to the dance, it's impossible to say that "tomorrow it'll be safe to give XX"

The depot can be in play for several more cycles...One thing that will help to know what to do next will be "how hard is it to keep Lolly above 68 tonight?"

If you have to keep giving HC to keep in safe numbers, then it's more important to consider skipping the next dose and letting the depot drain some, but if it's not that hard to keep her above 68, then you'd probably be fine to continue with the .5 tomorrow too
 
the 73 was actually at 2.25 (10:30 EST) I was trying to move her 15 minutes back to 8:15 est dosing time. I actually wondered about starting .5 and whether the .75 would still have the depot effect. This is very complicated, understatement of the year. I'm going to try to get the +4. Her poor poor ears...
 
Still going up 108 at +4 Guess I overdid it on the HC. I know now not to include the meat, just the gravy, and go slower-- I was nervous -- but what I really hope is that I don't have to do this again....
 
Have you got some Neosporin ointment with pain relief? That helps the blood bead up.

Remember that high carb wears off fast; adding in the meat part will actually help sustain the later glucose numbers, so you're fine.
 
Yes, I use the Neo with pain relief. I also wonder if the pen I use Accu check soft clix is accurate; the depths keep changing. I can do it with a plain lancet, it's more accurate, but I always pierce the ear. She's also starting to pull away.

Chris said if I can keep her up easily without more HC, than it's probably ok to dose her in the AM. but I don't understand why wouldn't I then have the same problems? Is the dose too high now? Or do we not know about the previous .75 dose's effect, so I should try the .5 again?

I don't know if I'm making sense. I've been up almost two straight nights with her. I need to get some sleep tomorrow day and I have to sleep tomorrow night, go back to work. Can you guys help me work this while keeping her safe, and not messing up the protocol? How do you all do this?:coffee:
 
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