Help with micro-dose adjustment

[cilohen]

Hi everyone,

Cilo had a hypo episode for the second time and we reduced the dosage by 0.25u. She was on 0.75u for around 20 days before reduction and now she has been on 0.5u for 10 days.
Looking at her BG level lately, her nadir mostly fall between 200-300 and her overall trend seems flat.

Could I increase the dose by just 0.1-0.15u instead of full 0.25u?

Going from 0.5u to 0.75u is a 50% jump which might have been too much all at once especially since she already been on 0.75u twice before the reduction. I could be wrong, though - I'm a bit lost on how to micro-dose safely.

Oh and I'm using digital calipers. I find myself remeasuring the 0.51mm gap for every single shot because I'm worried the base zero-point differs from syringe to syringe. am I overcomplicating this?

I'm very happy to hear some advice and thank you for letting me get this off my chest!

 

[CORKY]

@Wendy&Neko
Cilo needs dose adjustment advice

 

[Wendy&Neko]

Cilo is a relatively new diabetic. In your signature you have Dx (diagnosis) in July of 2016, but according to the spreadsheet is says May 2026 - so I'm going with that and calling her a new diabetic. Anyway, for recently diagnosed cats, we have found that changes by 0.25 units is best. You should go back up to 0.75 units. If you are following TR, you would have done the increase several days ago, as she hadn't seen numbers under 100 for a week.

 

[cilohen]

Cilo is a relatively new diabetic. In your signature you have Dx (diagnosis) in July of 2016, but according to the spreadsheet is says May 2026 - so I'm going with that and calling her a new diabetic. Anyway, for recently diagnosed cats, we have found that changes by 0.25 units is best. You should go back up to 0.75 units. If you are following TR, you would have done the increase several days ago, as she hadn't seen numbers under 100 for a week.

Hii, I'm so sorry for the mix-up between DX date and DoB , I've updated that!

I ended up increasing the dose to 0.62 (0.63mm on the caliper), which felt like a safe middle ground between 0.5u and 0.75u. Does that sounds like a reasonable approach?
Today was her 3rd shot using 0.62u and her BG dropped very fast:

• PMPS : 271
• +3 : 102
• +4 : 67

To be safe and prevent another hypo episode, I give her 1 teaspoon of FF gravy . I 'm really trying my best to follow TR protocol, but I agree with you, I should have increase the dose earlier. The main issue is that increasing the dose requires monitoring curves over at least 3 cycles, and finding a time when I can safely do that has been really tough. Given these scheduling constraints, should I go ahead and remove TR from my signature so it doesn't give false information?

Thank you so much for the advice and support

 

[Wendy&Neko]

Can you get another test tonight? I'm worried she'll keep dropping and tell you to go back to the old dose.

Cat's don't always take 3 cycles to tell you what the new dose will do. Do you have an automatic pet feeder? That can really help keep your cat safe for those cycles when you can't be around as much as you'd like to be.

 

[cilohen]

Can you get another test tonight? I'm worried she'll keep dropping and tell you to go back to the old dose.

Cat's don't always take 3 cycles to tell you what the new dose will do. Do you have an automatic pet feeder? That can really help keep your cat safe for those cycles when you can't be around as much as you'd like to be.

Yes now at +4.5 her BG increased to 72 and I give her 1 teaspoon of LC wet food. I will do another test at +6.

Aaah I see, thanks for clarifying! Just to double-check: as long as I’m monitoring her nadir (and checking pre-shot levels), is that enough visibility on the dose?
Regarding the feeder: I do have an automatic feeder, but since I have other cats who quickly swarm the bowls, I can't guarantee she'll actually get the food unless I'm there to supervise . So usually I will feed her small amount LC after every blood check outside her meal time.

 

[Wendy&Neko]

Good you are testing again. The HC gravy numbers boost can wear off in a couple hours.

As far as TR goes, yes, testing the two preshot numbers plus at least one other test per cycle is sufficient. It doesn't always have to be a nadir test. If you get a test 2-3 hours after the preshot and it's higher than preshot, it'll likely be a quiet cycle not needing a nadir test.

There are automated feeders that work off a microchip.

If you want to, you could start posting over on the Lantus forum. It's a busier forum and you are more likely to get help throughout the day (and night) over there.

 

[cilohen]

Good you are testing again. The HC gravy numbers boost can wear off in a couple hours.

As far as TR goes, yes, testing the two preshot numbers plus at least one other test per cycle is sufficient. It doesn't always have to be a nadir test. If you get a test 2-3 hours after the preshot and it's higher than preshot, it'll likely be a quiet cycle not needing a nadir test.

There are automated feeders that work off a microchip.

If you want to, you could start posting over on the Lantus forum. It's a busier forum and you are more likely to get help throughout the day (and night) over there.

+6 : 115
+9 : 207
It seems the insulin already start to wear off.

I thought we needed to run curves for those cycles , thanks for clarifying!

Yeah I saw lots of thread with BG level on its title, if I were to start posting there, should I start from with today's reading or I have to post all previous reading as well?

 

[Wendy&Neko]

Once the blood sugar numbers are headed up during the cycle, with no higher carb given, you are good to stop testing until the next preshot time.

 

[CORKY]

As Wendy suggested to perhaps use a feeder with microchip, here are a couple of examples