Hitting low numbers but still quite variable - guidance?

[kayoodlemom]

Hi wonderful kitty parents,
My Kayoodle is hitting some low numbers, and I was hesitant to shoot when she was at 75, so skipped that shot, but she went to 300 right after, so at the next low AMPS, I shot 1/2 dose and then returned to a normal 1 unit of Lantus when her numbers were up for the PMPS. Are my numbers looking like I should just stay skinny on the 1 unit and maybe go to .75? I am not able to monitor the nadirs much except on the weekends, but she hit 40 at +2 tonight and was happy and playing with string. I fed her and she ate happily and will recheck the numbers soon, but she seems to be handling numbers in 60's without problems, so I am not freaking on 40 except to feed her and recheck. (chart link is below). compared to the vet's IDEX, my meter runs about 20% high based on a curve we did a couple weeks ago.
Any additional advice?
thank you,
Mary and Kayoodle

 

[Larry and Kitties]

I myself would go to 3/4 unit

 

[Deb & Wink]

Any BG reading <50 mg/dL on a human meter is an earned dose reduction. Those 40 readings you got, earn Kayoodle an automatic dose reduction of a quarter unit (0.25U).

That 49 reading you got back on 2/15 also earned Kayoodle an automatic dose reduction. It doesn't matter if you are following the TR protocol which is an aggressive dosing protocol or the SLGS (start low, go slow) protocol or "Relaxed Lantus" protocol, you need to take those reductions in the insulin dose.

So, it's definitely time to go down on the dose, to 0.75U.

Here's the part of the TR (tight regulation) protocol that talks about dose reductions. I've bolded the section on the part that talks about a newly diagnosed diabetic, which Kayoodle is since you have been at this less than 1 year.

Reducing the dose:
•If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

Please do not let yourself become complacent or blasé about drops into the 20s or 30s. ◦If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
◦If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
◦Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
Please ask for advice.


If anyone suggests otherwise, they are putting your cat at risk! Our kitties are not just numbers. They are living beings who trust us to look out for them. The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive.

Keeping YOUR cat safe is the #1 priority of the FDMB.
Let's keep all our kitties in the Lantus Tight Regulation ISG safe by suggesting and taking appropriate reductions.
•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. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.

Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose.
•Try to go from 0.25u to 0.1u before stopping insulin completely.

 

[kayoodlemom]

thank you all!
:mrgreen: