Dosing and BG Numbers Confusion

PQTaggart

PQTaggart

Member Since 2024
Hi, I'm posting here after getting a great amount of advice from the main forum, especially from @Suzanne & Darcy. Jake has been on PZI since August 2024 and has just gotten a FreeStyle Libre 3+ applied. It's great to have all of the data, though it's alerted to two hypo events (BG<50) in the past two days (AlphaTrak3 showed BG between 70-80 at the same times). I'm hoping the new data gives some insight on whether the dose needs to go up/stay the same or if he's just bouncing. Would love any advice!
 
Are those Libre numbers from today? The 67/62/68? Or At3 readings?

The Libre can drive you crazy at times telling you the BG is low when it’s not that low. As long as you have a backup meter to check when the Libre does this, it will be okay.
 
If you are following the SLGS dosing method then you would reduce back to 3 units. If you are following MPM then you would not reduce. You have been getting some great numbers!
 
Suzanne & Darcy said:
Are those Libre numbers from today? The 67/62/68? Or At3 readings?

The Libre can drive you crazy at times telling you the BG is low when it’s not that low. As long as you have a backup meter to check when the Libre does this, it will be okay.
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Yes, those are from the Libre and it definitely startled me awake a few times with its low alarm. Each time I tested with the AlphaTrak3 to be safe and it showed 70-80ish. Due to my schedule, my spreadsheet numbers will be all Libre, then if I test with AlphaTrak the number will show as Libre/AlphaTrak. It is so nice to have more data though, and to see the patterns.

BTW, Jake is doing really well and I wanted to thank you and the FDMB for that - he's walking well (Zobaline), his arthritis is better (YuMove), and he's regained all his lost weight and energy. He is getting kind of fat though (probably the least of my worries at the moment!). The vet isn't worried since his condition is good, but I'm thinking about how I might go about getting his weight stabilized. How the animal gains weight on such low carb food is beyond me!

Do you have recommendations for the dosing method? I know it's dependent on the cat, but are there any hints/numbers that might give you an idea of what might work for Jake?
 
Well, what we know right now is that you definitely don’t want to increase his dose because of the lower green nadirs that you have been seeing. He does bounce after seeing low numbers (so when you fill in the Libre numbers from last night, I am expecting them to be high. I will look at them later today (if hopefully you will have time to fill in the spreadsheet.) How do you capture the data from the Libre? You obviously can’t be around to scan him every hour. You just go back and review the readings/times?

How many hours of the day is Jake usually by himself? Do you have an automatic feeder to dispense his small meals at the recommended +2 and +4 and in Jake’s case, I think I would recommend a +6 mini meal based on what I am seeing. Some of his nadirs are a little late when he’s breaking a bounce (which is not unusual.)

Sorry for asking so many questions. I would like to get a few more days of the Libre data on Jake. As I recall, you work very long hours and unpredictable hours. Who gives Jakes his shots and feeds him at AMPS and PMPS? Or are you home at that time? For right now, I would reduce Jake’s dose to 3 units and gather the Libre data.

I am so glad you got the Libre. With your schedule, it’s really a good tool. I am also happy that you posted. I was just wondering how you and Jake were doing. :) I feel very optimistic for Jake because he’s getting some good numbers.
 
You were right - the numbers from last night are high :( I'll drop the dose down to 3u this evening. There are two ways I can get the data - LibreLinkUp allows me to see exact readings from the last 12 hours (1 reading every 5 minutes) so I do that if I can. Otherwise, there is a graph in the Libre app that provides a max and min reading for each hour and shows that data forever. I use the average of the max/min to get the number for the hour (e.g., max=160, min=130, my number would be 145). I haven't yet got a dedicated phone (it's been a rough few days) but the Libre stores 8 hours of readings and I've been able to grab them by just having my phone in range.

Jake is at home with his brother for anywhere from 8.5-12 hours a day, 2-4 hours on weekends. I try to have food always available to him, in a bowl with ice pack when I'm at work. A lot of the time he and his brother won't finish the food, but 1-2x a week they will. I'll see if I can get an autofeeder for wet food (I checked with my folks but didn't hear back about it) and set it for the +2/+4/+6.

Feel free to ask questions! The more information to work with, the better. The Libre seems to be staying on okay (crossing fingers) so we'll get data from that or from my backup Libre if the current one fails. I do work crazy hours, and I'm on call again for at least two weeks, but that should ease up as we've hired new staff to help out. I give Jake his shots, and I've been able to give them both each day so far, except for a few emergencies (1-2/month) that fall on his shot time.

I'm glad I got the Libre too! It's taking quite a lot off my shoulders. My hope is that we can get him at least regulated, since going up and down so much can't be easy on him.
 
Do you have any suggestions when not to shoot? I usually don't shoot or give a token amount under 200 - should I stick to this for now? Jake's currently trending down, so looks like he may have a low pre-shot BG again.
 
Well last night, when you shot only .25 with those blue preshots, we can see that it wasn’t enough insulin and allowed him to go up into the pink and red. So next time you have a similar preshot number you can try a little more. Remember he’s at 3.25 units. So if you cut the dose in half or a little less than half it would be closer to 1.5 units. If that is too frightening at first, try 1 unit with a similar mid-blue preshots and collect data to see how it goes. Then you can work your way up as you gather spreadsheet data. I would recommend this plan as long as you will be home and can monitor the cycle a bit by scanning the Libre a few times.
 
Okay. Good. That must make you feel better. He’s very flat now and should be fine with the regular dose. Check at +2 and make sure he’s at a similar number to PMPS or only a little lower.
 
The Libre failed after 8 days while we were travelling :/ Abbott is sending a replacement, which is nice. I put on his backup Libre last night (thanks to the Facebook group, I can do it myself), but we lost a bit of data. Still not sure what his pattern is, but his pre-shot numbers are still high most days.
 
Hello. Sorry about the Libre! I hope you can get the full 14 days this time. It’s a shame we have a few blank days. He has earned a reduction it looks like from dropping below 50, but we don’t have a backup number from a human meter which I would prefer before making that decision. I can tell you have already had the experience of the Libre alerting you to low glucose and finding out that it (the Libre) was reading much lower than a handheld glucometer.
 
I checked with his AlphaTrak when the Libre alerted to low BG (<50) and the AlphaTrak came in higher, often much higher - one point where Libre said 49, AlphaTrak said 125. Should I start using the Relion as well? Is the AlphaTrak more accurate or simply reads higher (I've heard both)?
 
PQTaggart said:
I checked with his AlphaTrak when the Libre alerted to low BG (<50) and the AlphaTrak came in higher, often much higher - one point where Libre said 49, AlphaTrak said 125. Should I start using the Relion as well? Is the AlphaTrak more accurate or simply reads higher (I've heard both)?
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I noticed that huge difference at the 49/125 on the spreadsheet. It definitely caught my attention. I have to admit that I was thinking…. I wish the backup readings were ReliOn because the Libre is a human glucose monitor and the ReliOn is a human glucose meter so I thought the comparison would be better. It’s not really that the Alpha Trak is necessarily more “accurate” it’s just that the two use different algorithms to give us a BG value so the AT generally reads higher than the ReliOn. The AT also is allowed to have that “variance” just like the human glucometers.
 
I actually have a ReliOn, did you want me to take readings just to back up the Libre, or should I switch it with the AlphaTrak for regular readings?
 
Suzanne & Darcy said:
I noticed that huge difference at the 49/125 on the spreadsheet. It definitely caught my attention. I have to admit that I was thinking…. I wish the backup readings were ReliOn because the Libre is a human glucose monitor and the ReliOn is a human glucose meter so I thought the comparison would be better. It’s not really that the Alpha Trak is necessarily more “accurate” it’s just that the two use different algorithms to give us a BG value so the AT generally reads higher than the ReliOn. The AT also is allowed to have that “variance” just like the human glucometers.
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The Libre alarmed early this morning, reading 53. I tested with both handheld meters - the ReliOn read 67 and the AlphaTrak read 77. So definitely low numbers! Should we decrease the dose or stay at 3u?
 
Suzanne & Darcy said:
Can you update the spreadsheet? Which dosing method are you following? SLGS or MPM. Remind me, does he eat dry food.
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Just updated. I'm not really following one, I suppose SLGS is similar to what we've been doing since we joined the forum. He's on wet food, FF Classic or Weruva, with plain chicken or beef, 1 minnow, 1/2 chicken heart, 1/2 quail egg, and a few duck liver treats.
 
So it looks like he has earned a reduction on several occasions … the 19th and 21st … with greens under 90. His new dose would be 2.75 if you are following SLGS. If you would like to switch to MPM then you would not need to reduce. His numbers have been excellent in those safe greens (that you verified were safe with the ReliOn and AT meters). Did you give him any high or medium carb food when he had those numbers? Or did you give any food at all or just low carb wet food?
 
Suzanne & Darcy said:
So it looks like he has earned a reduction on several occasions … the 19th and 21st … with greens under 90. His new dose would be 2.75 if you are following SLGS. If you would like to switch to MPM then you would not need to reduce. His numbers have been excellent in those safe greens (that you verified were safe with the ReliOn and AT meters). Did you give him any high or medium carb food when he had those numbers? Or did you give any food at all or just low carb wet food?
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I'll decrease to 2.75, yay! I didn't feed him high/medium carb food with those numbers, he had a mid-cycle snack (plain chicken) and/or ate some of his regular food from earlier. He always acts very hungry during low numbers, though not panicky hungry, if that makes sense.
 
Okay. That is fine if you want to stay with SLGS. reduce if he falls below 90. It depends on your goals for him (remission vs. regulation) You are not home a lot, so maybe it’s better to reduce now. Perhaps at some point we may consider a custom reduction point to keep him in the greens where his pancreas will be able to heal.
 
I also feel very good about how he is self regulating on this dose and not dropping too low. You didn’t give HC so that is a good sign.
 
I would love to get him into remission, but I'm not sure how the MPM would work with my schedule. I'd love to hear what you think will work best for dosing/method, and what might be required on top of what I'm doing. For example, if I decrease now do I lower the chance of remission or regulation? Should I go to the MPM now since he's been on the SLGS for a while? I've been reading up on the MPM and it looks like it lets us adapt to the number by changing the shot dose and/or delaying the shot, is that right? I'm sorry for all the questions!
 
I saw this advice from one of your other posts, would MPM for us look like this too (with custom doses)?

190 or above — give full dose
150-190 — give 1.75 - 2 units
100 - 149 — give 1.25 units
Below 100 skip shot.
 
PQTaggart said:
I saw this advice from one of your other posts, would MPM for us look like this too (with custom doses)?

190 or above — give full dose
150-190 — give 1.75 - 2 units
100 - 149 — give 1.25 units
Below 100 skip shot.
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Oh no. Not necessarily. This was only for Charly and was based on data from her spreadsheet— a lot of things will differ per cat depending upon theor tendency to drop quickly and when the insulin onsets, etc. Also, a lot depends upon how much data we have amassed on the cat at the time. If we don’t have too much data or the cat is new to low numbers, etc. there are a lot of variables.
 
PQTaggart said:
I've been reading up on the MPM and it looks like it lets us adapt to the number by changing the shot dose and/or delaying the shot, is that right? I'm sorry for all the questions!
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The main differences between SLGS and MPM is that we can let the BG drop to 50 before reducing. It also allows us to change the dose more frequently if needed. I am slightly uncomfortable doing this with your schedule. However, we can customize it for Jake.

I think you should go ahead and take the .25 unit reduction for now and we will see how it goes. If, after 6 cycles, it looks like he needs to go back up, we will do that. Does that sound okay? We will customize things for Jake as it goes along.
 
Suzanne & Darcy said:
The main differences between SLGS and MPM is that we can let the BG drop to 50 before reducing. It also allows us to change the dose more frequently if needed. I am slightly uncomfortable doing this with your schedule. However, we can customize it for Jake.

I think you should go ahead and take the .25 unit reduction for now and we will see how it goes. If, after 6 cycles, it looks like he needs to go back up, we will do that. Does that sound okay? We will customize things for Jake as it goes along.
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That sounds good! Thank you for all your help!
 
Suzanne & Darcy said:
The main differences between SLGS and MPM is that we can let the BG drop to 50 before reducing. It also allows us to change the dose more frequently if needed. I am slightly uncomfortable doing this with your schedule. However, we can customize it for Jake.

I think you should go ahead and take the .25 unit reduction for now and we will see how it goes. If, after 6 cycles, it looks like he needs to go back up, we will do that. Does that sound okay? We will customize things for Jake as it goes along.
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At first the numbers looked pretty good after lowering the dose, but for the last few days he's only had one true nadir per day (the rest of the day is flat 300s). I'm not seeing much of a drop at all. Have you seen a pattern like this before?
 
Suzanne & Darcy said:
Did he drop down last night according to the recent pattern? I can only see the first few hours of the cycle.
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Sorry for the delay, I didn't have a chance to update this weekend. He did follow the same pattern all weekend, so pattern has lasted for 5 days.
 
I think you should go back up to 3 units. You may see the occasional lower green, but in general he was doing better on 3 units (although he’s seen some good solid blue on 2.75.) Even during the day he’s had some green on 3 units. He definitely likes to drop lower at night though.
 
Suzanne & Darcy said:
I think you should go back up to 3 units. You may see the occasional lower green, but in general he was doing better on 3 units (although he’s seen some good solid blue on 2.75.) Even during the day he’s had some green on 3 units. He definitely likes to drop lower at night though.
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Jake's numbers seem to be getting significantly lower on average, which is good. I've been able to do a full dose even when he's close to 140, but would love some advice on what to do with even lower numbers. I always seem to give too little when he's low and then he jumps back up into the 300s for a day afterwards (e.g., PMPS on 3/25). Is there a dose you might suggest when this happens?
 
@Suzanne & Darcy So far giving full 3 units down to 130, then 2.5u (only have a few times, usually PSBG is 120-130). I'd love to keep the good numbers coming, but am worried about the dose below 120 (see 3/25 PMPS). I really appreciate any advice, thanks!
 
Hello! I am happy to see Jake doing so well! The 3 units dose seems to be a very good dose for him. I t looks like on the night of 3/25 when you skipped the shot that he could have used a token dose of maybe 1 unit instead of skipping entirely — to keep him from climbing so high. The Libre sensors are known for giving wacky numbers when you first apply them and when they are about to fail. It would be good if (when you can when you’re at home) you check the Libre’s low numbers (like anything 70 and under) with a handheld meter. Without that information, it is hard for me to say if you should reduce the dose when his preshot numbers are a little low. He’s come awfully close to 50 a few times the last few days. He’s seems to surf right along really well, but I would feel more comfortable if I knew what a human handheld glucometer said when the Libre says 50s. The thing is, he’s gone into the 50s with AMPS in the 170s, 120s and 140s. I think that, until I got more reliable data about the Libre /handheld meter comparison, I would shoot a slightly smaller dose when Jake is in the 120-140 range. I would try a 2.75 unit dose to start and see what kind of difference it makes.
 
PQTaggart said:
Jake's numbers seem to be getting significantly lower on average, which is good. I've been able to do a full dose even when he's close to 140, but would love some advice on what to do with even lower numbers. I always seem to give too little when he's low and then he jumps back up into the 300s for a day afterwards (e.g., PMPS on 3/25). Is there a dose you might suggest when this happens?
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And by the way, I think you are doing an amazing job. When he has the green preshot I would give just 1 unit to start and then collect data. The next time you could try a little more depending on the numbers you get 1.25 or 1.5 … collect data and see if it’s enough to keep him from going too high… etc. … adjusting the dose each time if necessary and using the information you get each time to inform your decision the next time.
With those lower blue preshots — as I said above— try just a slightly reduced dose. Jake has an automatic feeder to give food while you’re away, right?
 
Suzanne & Darcy said:
And by the way, I think you are doing an amazing job. When he has the green preshot I would give just 1 unit to start and then collect data. The next time you could try a little more depending on the numbers you get 1.25 or 1.5 … collect data and see if it’s enough to keep him from going too high… etc. … adjusting the dose each time if necessary and using the information you get each time to inform your decision the next time.
With those lower blue preshots — as I said above— try just a slightly reduced dose. Jake has an automatic feeder to give food while you’re away, right?
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Thank you so much for the advice! I'm happy that he's doing better - in fact, he's the happiest and healthiest he's been in a year, thanks to you and the forum's advice. I usually check low numbers with the AlphaTrak, but realize that in a way it's comparing apples to oranges, rather than using the ReliOn and comparing apples to apples. During low events, I'll start getting data on both meters so we can see if the Libre is being weird (like when it said 54 and AT said 130) or if it really is a low number. For doses, I'll start with 3u at 130+, 2.75u at 120-140, and a token shot (~1u) when <120. We do have an auto-feeder available during the week. Sometimes they finish every bite and sometimes they won't touch it at all. I've tried to correlate the amount eaten to his BG, but there doesn't seem to be a pattern, but that could be due to his brother sharing the food too.
 
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