? Dosing advice for Terry

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Fabiënne

Fabiënne

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Hi all!!

Now I am back from vacation I think it's time to take al close look at Terry's numbers.

He shows me some nice numbers at times. But after that the sheet is a big mess. No dropping during the day, no smiley curve. It might be bouncing from the blue morning numbers but because of that he never shows a nice +6.
What do you think? Maybe adjust the dose and use the U100 strings I got from @Ruby&Baco . And what about the non-shootable numbers? If I don't shoot at numbers round 140-150 he ends up real high. Today I shot a skinny 2IU but he got up and stayed there without dropping at all. And that happens a lot. His amps and pmps are often lower than thr midcycle numbers.
 
I wonder if the 2.75 units may be a bit much of a dose, whilst it is nice to see lower pre shots what you are looking for is to get the AMPS and PMPS numbers evened up a bit which means shooting a little lower even on higher numbers until that happens. For those low pre shots maybe go with a smaller dose than 2 units so he gets some insulin but not too much. What is your no shoot number? You were getting nice numbers on the 2.5 unit dose. The yellow pre shots are nice.
 
Hey Alexi, the yellow preshot numbers are great indeed but Fabiënne did stick with that dose for a long time (up untill now) and Terry doesn't show nice low mid cycle numbers.

Terry seems to tend to stick and adjust to a dose and plateau a little on it... maybe a small increase will help him don't you think?
If you look at the ss you can see that the step back (the reduced dose of 2 and 2.25) were more pink numbers.
Fabiënne has 2 different doses for number ranges:
Pink numbers 2.75
Yellow numbers 2.50

So I would suggest trying a little increase... pink 2.80 (u100 it is 7) and yellows 2.60 (u100 it is 6.50)

@Sue and Oliver (GA) @Rachel @Kris & Teasel
What do you think?
 
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I think I agree with Ruby that Terry gets a bit stuck at a dose. He has a really nice array of yellow and blue pre-shots but stays stuck there through the cycle. It can either be bouncing from too high a dose as Alexi has suggested or he might need a little boost. It's hard to know which until some experimenting is done. I vote for a small increase to see what happens. At least he's not dipping and shooting sky high.
 
Okay. so, it could be bouncing from a too high dose or he just could get stuck at this those.

This is a difficult one because before the last increase we had the same dilemma. The increase worked for a little while and than he got stucked again.
I think Alexi could be right. And what if we now increase and he gets stuck again? Keep increasing? ... I mean at what point it would be clear that a decrease could be required?
 
I do also think Alexi got a point, but i'm still thinking a little u100 increase can get Terry up and running again to let you see those nice numbers again.
If the increase was 0.25 i would say definetely no! But this would be a tiny increase, it wouldn't even be a fat 2.50 if you know what i'm talking about;)

@Kris & Teasel maybe you can tell Fabiënne a little bit more about the u100 syringes and those increases. They worked for Teasel a lot right?
 
I am only basing on my own experience, I was on sliding scale for a while but now on a fixed dose and once I hit a no shot situation the dose comes down - my regime is a little different as sometimes I can shoot at +1 if the number is high enough. Of course I am on quite a different kind of protocol to the standard we follow here and under strict vet supervision so not to be copied which is why I don't want to give specific advice but just suggestions for what might be going on.
 
It is always hardest when the numbers suggest either a small increase OR a small decrease, and only trying one of those will really tell you. I think I'd try a small increase. He has room to drop and his preshots - while nice and yellow - can still drop a little too. As always, on a cycle you can monitor.
 
Hi Fabienne,
I agree with Ruby that you'd find the U100 syringes along with the conversion chart would give you a lot more options for creating dose fractions, eg., 0.2, 0.4, 0.6 etc. units using the marks as well as 0.1, 0.3, 0.5 etc. units going between marks. I couldn't give the small dose changes Teasel needs without these syringes.
 
Okay, I will try a small increase.
If I read the chart right, I will shoot 6,5 u100 ( 2.60 u40) for the yellows and 7 u 100 (2.80 u4o) for the pinks.

Am I right? Dosing was 2.50 and 2.75 u40
 
Fabiënne said:
Okay. so, it could be bouncing from a too high dose or he just could get stuck at this those.

This is a difficult one because before the last increase we had the same dilemma. The increase worked for a little while and than he got stucked again.
I think Alexi could be right. And what if we now increase and he gets stuck again? Keep increasing? ... I mean at what point it would be clear that a decrease could be required?
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Hi Fabienne,

Terry and Teasel are exactly alike in this. Often a tiny increase in dose will move Teasel's BG numbers but it only lasts a cycle or so then he gets stuck. I'm coming to the conclusion that I'll always be changing Teasel's doses a tiny bit to keep him in better numbers, at least while he's in the middle range of good numbers - blues and yellows. I also think that if I get him to doses that drop him into low numbers like green and blue and maybe a few scary lime greens he's more likely to stay there because he'd lose some of his reserves that his liver draws on to make glucose to deal with near hypo numbers (or when it "thinks" a number is just too low). This is what contributes to the increased insulin sensitivity after a hypo event.

If you look at Teasel's first SS entries, the numbers look quite good. That was after three full weeks on a much higher dose of 3.6 u - before I was testing the way I do now. Thinking back to some things I noticed then, he might have had a few near hypos overnight during that time. He had no compensating liver reserves and so his numbers stayed low and he wasn't bouncing. Do I know this for sure? No. But it does explain things. There are people who dose more aggressively to force the BGs down to these levels in an attempt to teach the cat's body to accept them. I think that can be risky unless you're prepared to monitor often every day and intervene with food, etc. It could be a full time job and there'd always be the threat of a hypo over your head. I don't think i'm brave enough for that.

As far as when is a decrease needed: if you keep having too low to shoot PSs, then maybe a small decrease; if nadir drops too low, I'd decrease a little then too.
 
I think you might be right Kris! That sounds as a good explanation. So by taking real small steps in increasing the dose he could drop slowly without the liver needing to compensate.

I'm really not that brave either. And I can not monitor all day and to be honest I don't want to. Terry would start hating me when I did. If I knew it was just for a period of time and after that he was regulated or better in remission:smuggrin:, I would deal with it immediately. But there is no garantee, and with kitties like Terry and Teasel it might never happen. We could test for weeks every hour but still they manage to surprise us ;)
 
Fabiënne said:
I think you might be right Kris! That sounds as a good explanation. So by taking real small steps in increasing the dose he could drop slowly without the liver needing to compensate.

I'm really not that brave either. And I can not monitor all day and to be honest I don't want to. Terry would start hating me when I did. If I knew it was just for a period of time and after that he was regulated or better in remission:smuggrin:, I would deal with it immediately. But there is no garantee, and with kitties like Terry and Teasel it might never happen. We could test for weeks every hour but still they manage to surprise us ;)
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Yes, Fabienne, we have to accept that Teasel and Terry don't follow the rules. This gives us some peace of mind and helps us to be patient when things don't go as planned. We need to find a balance between what we can do in a practical way and what is realistic for cats like Teasel and Terry. We want humans and kitties to be as stress free as possible. Sometimes good enough is good enough. :)
 
Hopefully there is someone online now to help you with the issue!

Terry has a 7.3 (131) before dinner, Terry just ate almost an hour ago and Fabienne is now doubting what to do.
He will show a higher number for sure when she will test (in a moment) but should she give him a dose with the max of testing him at +3/+4 or should she do a no shot?
I believe it is wise to give a shot but a reduced one of course. She normally gives him at yellow preshot numbers 2.60 and with the purple ones 2.80.
She gave Terry 2.40 on 11/05 on a preshot number 10.8 (194) and this was before his meal that number.
He ate after but as you can see his +6 that day came out higher than the preshot (which is a pattern what Terry does most likely)
So my theory is to give him 2.40 with this pre shot which will be higher probably in a minute when Fabienne tests him again, and hopefully he will drop this time on that 2.40 dose.

What would you all do?

@Kris & Teasel @Alexi @Sue and Oliver (GA) @Rachel
 
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Tricky to judge as we don't usually have a +1 to check his normal response to food, its one number so a tiny bit of insulin should be fine, it may throw his numbers off a bit the next few cycles though.
 
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