Bouncing? Unsure of dose for TR

Bubba and Melissa

Bubba and Melissa

Member Since 2019
Hello. I switched to Lantus Saturday AM 7/27 and it took a day or two to figure out how to read the tiny lines of the U-100 syringe vs the U-40. I am still not 100% sure I am being accurate as I am getting some bubbles and the clear insulin is harder to see vs the Vetsulin.

My question is regarding dosing. For 7/29-7/31 the highest Bubba got was 228 (AMPS) and had a low of 40 so I reduced from 2.5 to 2.25 (ish because I can't see that tiny of a dose). Yesterday, 7/31/19, his numbers looked awesome with him staying most of the day in the green. This AM he had an AMPS of 143 after the previous night's PMPS of 80...but his +3 was 300 and +6 is 349 today.

Do I need to stay with 2.25 or go back up to 2.5 or just keep watching and wait? I am trying to do TR but I am really new to this so just learning. Thanks!
 
Hi @Bubba and Melissa ,

I am not experienced enough to give you an advice regarding the dose. However, I can definitely help you find good U-100 syringes that will not create any bubbles! I use the Monoject Ultra Comfort U-100 Insulin Syringes 29G 3/10cc 1/2" 100/bx, that I buy online at ADW diabetes. They are the ones that they use at the ER pet hospital. I tried a few others: not as good!

Good luck with the dosing!
 
@Penolope and Macka---I ordered those this weekend! Hopefully they will be here tomorrow. I also ordered calipers that arrived today so I will wait for the right syringes and then start using them for better dosing.

@Dandelion I did read the sticky about TR (like 8 times!!! LOL). It says if nadir >200 consistently then increase by .25, if >300 consistently increase .5 if on a big dose after 2-3 d or 5-7d, but also if <50 for a new dx diabetic to lower dose by .25. I'm just confused as to where to go because he doesn't fit into those categories (except the one low), plus it hasn't been a full 3d at the .25 dose. This whole thing is confusing for sure!
 
his nadir has been in the green for two days? under 100?

not counting today which I'd think is a bounce.
 
you forgot the part about Hold The Dose--- then do what it says below.

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.
then there's more.

Break apart the sections of the sticky.
General Guidelines
Increase dose
Decrease dose
etc

there's a ton of info to digest to be sure.



Bubba and Melissa said:
@Penolope and Macka---I ordered those this weekend! Hopefully they will be here tomorrow. I also ordered calipers that arrived today so I will wait for the right syringes and then start using them for better dosing.

@Dandelion I did read the sticky about TR (like 8 times!!! LOL). It says if nadir >200 consistently then increase by .25, if >300 consistently increase .5 if on a big dose after 2-3 d or 5-7d, but also if <50 for a new dx diabetic to lower dose by .25. I'm just confused as to where to go because he doesn't fit into those categories (except the one low), plus it hasn't been a full 3d at the .25 dose. This whole thing is confusing for sure!
Click to expand...
 
Bubba and Melissa said:
Hello. I switched to Lantus Saturday AM 7/27 and it took a day or two to figure out how to read the tiny lines of the U-100 syringe vs the U-40. I am still not 100% sure I am being accurate as I am getting some bubbles and the clear insulin is harder to see vs the Vetsulin.

My question is regarding dosing. For 7/29-7/31 the highest Bubba got was 228 (AMPS) and had a low of 40 so I reduced from 2.5 to 2.25 (ish because I can't see that tiny of a dose). Yesterday, 7/31/19, his numbers looked awesome with him staying most of the day in the green. This AM he had an AMPS of 143 after the previous night's PMPS of 80...but his +3 was 300 and +6 is 349 today.

Do I need to stay with 2.25 or go back up to 2.5 or just keep watching and wait? I am trying to do TR but I am really new to this so just learning. Thanks!
Click to expand...
Hi Melissa!

Welcome to the group! I started with Vetsulin too but didn't stay with it long because of my work schedule... and my nerves :P

I don't follow TR but I know a little about it from hanging around the forum. You were definitely right to reduce the dose after you had the 40 on the 29th. From there, the way I understand TR is that now you move forward holding the reduced dose (2.25u) for at least 3 days (6 cycles). You wouldn't change the dose unless Bubba earned another reduction (goes below 50). So right now you are on cycle 4 of the 2.25u dose. The pinks that you are seeing today are probably Bubba bouncing from all of the great numbers hes been seeing (29/30 look AWESOME). I wouldn't increase the dose yet, just wait until you are finished the 6th cycle and see how Bubba's BG values are then :)

@Chris & China (GA) @Wendy&Neko @Bobbie And Bubba If any of you are around today could you help Melissa with some TR guidance?

Just curious Melissa... its none of my business but what is the marshmallow root for?
 
BTW Melissa, Some of us use calipers when dosing for consistency reasons, If you're having a hard time with the half doses, using calipers might help

I know you've been reading the stickies but this image from fine dosing helped me with visualization of 0.25u changes in dose
Pictorial guide using a U-100 syringe marked with half units:

someinsulin-1.jpg
01unit-1.jpg

025unit-1.jpg


Hope this helps :)
 
@Dandelion "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."

This is the part I was confused about vs holding the dose that you mentioned. Didn't know if I didn't count today because it was potentially bouncing or a "failed reduction" so should stay at 2.25 or go back up to 2.5 because that was the start of his good numbers. I'll just hold at 2.25.


@AmandaE thanks for your help! The marshmallow root is supposed to help with inflammation and/or urinary tract health per my understanding from reading on here and he has been peeing outside the litter box for weeks. We cleared up his UTI with abx and just did a culture and sensitivity and ultrasound when he was still peeing outside the boxes (on the vents and carpet) and it was clear/nothing growing so the vet said it is likely either cystitis or behavioral. I figured I'd try this to see if it helped at all. I got my calipers today...will start using when I get the Monoject syringes tomorrow. :)
 
Hey there Melissa. The failed reduction is a tricky thing to spot because after a number that goes too low, you reduce and then the bouncing begins. It looks like to me that he cleared the bounce on the AM cycle of the 30th and started a new one from that nice streak of greens that went into the PM cycle.

I agree with Elise, and I would hold the dose for now and let's see what he does tonight and tomorrow.
 
I agree, hold the dose. You are still in the initial dose phase of building the depot, plus had some inconsistency of dose as you get used to the syringes. After a reduction, we wait for the bounce to clear before deciding if the reduction has failed. Bounces can take six cycles to clear. If you don’t see green after the bounce has cleared, then the reduction has failed.

This is where our famous patience pants come in handy.;)
 
Bubba and Melissa said:
@AmandaE thanks for your help! The marshmallow root is supposed to help with inflammation and/or urinary tract health per my understanding from reading on here and he has been peeing outside the litter box for weeks. We cleared up his UTI with abx and just did a culture and sensitivity and ultrasound when he was still peeing outside the boxes (on the vents and carpet) and it was clear/nothing growing so the vet said it is likely either cystitis or behavioral. I figured I'd try this to see if it helped at all. I got my calipers today...will start using when I get the Monoject syringes tomorrow. :)
Click to expand...

Thanks for the info on the marshmallow root! that is definitely good to know! I hope Bubba stops peeing outside of the litter box soon! do you think he could just be having a hard time holding it? One of the reasons that we knew something was wrong (diabetes) with Mowgli was because he had started peeing outside of the litterbox, he had a bad case of polyuria and he just couldn't always hold it all the way to the litterbox! Maybe as Bubbas BG levels get lower he will stop peeing outside of his LB... fingers crossed :)

I'm still getting used to the calipers but i love that I know it is a more consistent way to measure dose, there are a few of us that just started using them so we can learn together :)
 
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