? Do I reduce again?? 3 times in a week? And when to feed on TR?

[Butters & Lyla]

Hi all,

I need some advice, please. Butters was switched to Lantus nine days ago. Vet started her with 1 U BID then called me on day one to switch to 1.5 U BID. In hindsight, that was too high. I did not know what I was doing. A few days in, I decided to do SLGS. She since earned two reductions, and then I decided to switch to TR. It says feed multiple small meals...but at what times should I do that?

She technically earned a third reduction last night when she ventured into light green territory again. But she still gets yellow and blue numbers.

I shaved her dose a bit this morning but I am more wondering if i need to adjust her feeding rather than reduce her by another .25, as it would be her third reduction in a week? I have been feeding her snacks around +3 and +6 during the day, and +2 and +4 at night. I know I am supposed to feed small meals but I am struggling with interpreting my nine days of spreadsheet data figure out the best feeding times.

I am kind of at a loss at this point and kinda tired from our late nights in the light greens. Would you mind having a look at her data, I need some advice on whether to do the full reduction to .75, and when to feed?
Thank you!

 

[Si am cat mom]

Sometimes it's not just the times of the feedings, but what you are feeding. Slightly higher carb contents earlier in the cycle before the insulin onset starts can help slow down those drops. It just takes some experimenting with different food and times really..

Sometimes I offer food at +1,+3,+5 and sometimes it's +2,+4,+6 ...it just depends on the preshot and that +1 number. I have zero carb, low carb(2-3%), med carb (7-8%) med/hi carb(12-14%) and high carb food to use if I need. I had to start feeding a slightly higher carb content with his PM shot to hold onto a good dose and stop taking reductions...sometimes using med carbs.

It takes time, but you will figure out what your cat needs since ECID
No real dosing advice, but I'd try and use food to bump those numbers if you stay at 1 unit. Otherwise, after that BG in the 30s- I'd take the reduction to .75 and try different feeding times/ foods.

 

[Sienne and Gabby (GA)]

I think dropping the dose back to 0.25u was OK. You may need to drain the depot a bit given the cycles were Butter was in the 20s and 30s. If the reduction fails, then you can always raise the dose.

Ideally, you don't want to be feeding your cat after nadir. Past nadir, there's less insulin available to offset the effect of food on the BG numbers. It looks like Butter's numbers tend to drop relatively early in the cycle. That being the case, what Ari was suggesting is that you front load the cycle with food. My kitty liked to drop fast and early. I would feed her at pre-shot, +1 and +2 on a regular basis. You might want to feed Butters earlier than the +9 snack.

Also, how you use food is more of an art than a science. There's no one "right" way. Much of what you do is based on your observation of your cat.

 

[Butters & Lyla]

Never considered that I would need to use food as well as insulin to manage her numbers. I have been so hyper-focused on feeding her only low carb and using high carb if she gets dangerously low.

I do not recognize her nadir since the switch to Lantus. Some days it seems obvious but other times it looks like she just slides down for the entire cycle, or goes down, up and then down again. Do I need to stop looking at individual days and figure out the big picture? Are there hours where I should focus on collecting BG data? I have been trying to change it up, but then her BG numbers look so different from day-to-day. Could I be doing something wrong?

I don’t want to risk a third night of her dropping into the 30s. I am going to reduce to .75 for now, buy some different carb foods, move snacks to +1, +3 and +5, and see how that goes. Looking at some days BG numbers, I think snacks may need to be earlier than that, like Sienne what you did for Gabby.

 

[Sienne and Gabby (GA)]

With TR, numbers below 50 warrant a dose reduction. Numbers in the 30 really, really mean a dose reduction. I thought your SS read that you shot lower than a 0.9u this AM. In any event, the dose needs to be dropped to at very most, 0.75u. (I may have read 0.75 and typed 0.25 -- sorry.)

Looking at what Butters has been doing, I'd get a +2 just to be sure that you're not going to get surprised and you can intervene with food if need be.

As for nadir, it's not a fixed point. Don't expect it to be the same every cycle. My read is that in general, Butters has a nadir that's on the early side. You've seen nadirs as early as +2 and +3. (Welcome to my world!) Front loading the cycle with food may help so you're not having panic attacks given Butters like to drop low and early.

 

[LindyNova]

In My experience with a late nadir kitty......when I get and get a # in the great greens after, say +4, I feed as needed. Usually I feed every 6 hours. BUT, when I see my Noves is going into the lower-mid greens, I feed a "token" meal.....meaning I give her 1/2 of her usual serving. She usually does really good on the 4x day feeding, and she is sensitive to even low carbs, so....do what works at the time! Seriously anything to prevent the super low numbers, and the dreaded bounce that happens after that. I have not mastered this, but I do what I can when I see it.

 

[Butters & Lyla]

With TR, numbers below 50 warrant a dose reduction. Numbers in the 30 really, really mean a dose reduction. I thought your SS read that you shot lower than a 0.9u this AM. In any event, the dose needs to be dropped to at very most, 0.75u. (I may have read 0.75 and typed 0.25 -- sorry.)

Looking at what Butters has been doing, I'd get a +2 just to be sure that you're not going to get surprised and you can intervene with food if need be.

As for nadir, it's not a fixed point. Don't expect it to be the same every cycle. My read is that in general, Butters has a nadir that's on the early side. You've seen nadirs as early as +2 and +3. (Welcome to my world!) Front loading the cycle with food may help so you're not having panic attacks given Butters like to drop low and early.

Thanks Sienne, the nadir is starting to make more sense, and now I see what you are saying that her nadir looks on the early side. No wonder you front loaded Gabby with food. I have been having a lot of panic attacks lately and they are not fun.

I dropped her to .75u yesterday PM. I did a +1 and +3 yesterday and she was fine, firmly in the blue range. I missed the +2 today, got a +3 and have been front loading her food since yesterday PM. If she goes below 50 again, I will immediately decrease by .25u.