? Bounce?

Keiko and Sara said:
Keiko finally moved away from reading HI on the libre3 last night. I gave him his morning shot but it doesn't seem to have any effect. Would this be a bounce? Should I dose the 3.5units tonight? Shot time is 730am/pm EST
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Hi Sara, Here is your last post on the forum; we always include these with each new post so that folks can review what has been happening with Keiko: Dka. The switched from prozinc to lantus

If you will, please edit your initial post above, click on the "prefix" located on the left, and then select the drop-down menu + "?" That will flag your post to, hopefully, get some attention to your dosing question.

Today's higher numbers are likely a bounce from last night's lower numbers. It's good that Keiko is starting to see some action on that 3.50 dose.
 
Yes, he's bouncing from the blues last night. Not unexpected. When using SLGS as a dosing method, you stick with the same dose for 7 days, unless he goes under 90. Then evaluate the dose at the end of the week. So that means 3.5 units tonight.
 
Sorry, I'm trying the tight regulation. Would he never go down with a bounce? He's hasn't dropped beyond high on the libre 3 since. Just trying not to panic as he looks worse now since this happened.
 
TR (tightly regulated) allows you to take dose increases at more frequent intervals. Here is the explanation of the two dosing methods; Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR), and here is the specific TR dosing language for increases/reductions:

"General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
  • Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
  • Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
  • Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
  • If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
  • We've found many kitties benefit from 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. Most kitties will be in the range of a healthy cat (50 - 80 mg/dL) overall."
I highlighted the "increasing the dose" section because under TR Keiko is likely ready for an increase. Let's tag some of the more experienced folks to ask about how much of an increase @Bandit's Mom @tiffmaxee
 
If you want to try TR since you had a streak of blue I would increase to 3.75 but you do need to see how low it takes kitty day and night. You need a minimum of two tests every cycle and an occasional test at night between at +3-6. With the Libre you have that covered. I would do it if my cat.
 
Could you change your signature to say TR for the dosing method. It currently says SLGS. Thank you! And good luck with the switch.
 
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