Hypoglicemic throwback control.

Vivaldi

Vivaldi

Member Since 2018
I suppose Vivaldi situation is common, but any advise will be welcome. Whenever we have achieved control and green and blue numbers for a couple of days he will come with a low hypoglicemic number, will reduce dose and control will be lost for 2 or 3 days. Will reach control again and the cycle will repeat itself. On tight regulation now for 6 months, was hoping for control by now, but maybe we are not to have control ever. Thanks for reading.
 
It takes time. I'm not sure how to read your ss. Are you putting in averages or are the number actual test results your getting?
 
Hi Paula. Readings are actual. Last 3 columns on the right are a summary for the day (nadir, highest number, average). Also every 7 days there is a row (tan color) for the average of the week. Thanks again.
 
Here are my thoughts....

I'm not sure which dosing method you're following -- either Tight Regulation (TR) or Start Low Go Slow (SLGS). It "looks" to me like you may have adapted the method you were using for Caninsulin to Lantus. With Lantus, dose changes are made in 0.25u increments. By "shaving" the dose in 0.1u amounts, you are giving Vivaldi too much insulin, especially when you see a drop below 40. Dosing is also based on the nadir, not the pre-shot numbers. It looks like there were times when you changed the dose after only a few cycles. With a depot-type insulin like Lantus, frequent dose changes generally results in wonky numbers.

I'd also encourage you to get at the minimum, a before bed test every night. Many cats experience lower numbers at night. If you can, I'd also get more random spot checks. Nadirs can and do move around. Always testing at +6 may mean you've missed a lower point in the cycle.

Picking a method to guide your dosing strategy is important. The reduction points differ with TR and SLGS. In addition, TR while being the most formally research method, is more aggressive. Neither method relies on an average BG level. We look to see where the nadirs are and base reduction on the nadir (e.g., if below 90 on SLGS or below 50 on TR a dose reduction is indicated). The methods also differ with regard to how long you hold a dose before increasing.

Just to be sure -- you are using U100 syringes? You didn't continue to use the U40 Caninsulin syringes, correct?
 
Sienne and Gabby (GA) said:
Here are my thoughts....

I'm not sure which dosing method you're following -- either Tight Regulation (TR) or Start Low Go Slow (SLGS). It "looks" to me like you may have adapted the method you were using for Caninsulin to Lantus. With Lantus, dose changes are made in 0.25u increments. By "shaving" the dose in 0.1u amounts, you are giving Vivaldi too much insulin, especially when you see a drop below 40. Dosing is also based on the nadir, not the pre-shot numbers. It looks like there were times when you changed the dose after only a few cycles. With a depot-type insulin like Lantus, frequent dose changes generally results in wonky numbers.

I'd also encourage you to get at the minimum, a before bed test every night. Many cats experience lower numbers at night. If you can, I'd also get more random spot checks. Nadirs can and do move around. Always testing at +6 may mean you've missed a lower point in the cycle.

Picking a method to guide your dosing strategy is important. The reduction points differ with TR and SLGS. In addition, TR while being the most formally research method, is more aggressive. Neither method relies on an average BG level. We look to see where the nadirs are and base reduction on the nadir (e.g., if below 90 on SLGS or below 50 on TR a dose reduction is indicated). The methods also differ with regard to how long you hold a dose before increasing.

Just to be sure -- you are using U100 syringes? You didn't continue to use the U40 Caninsulin syringes, correct?
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Thanks for your reply. To answer your questions:

1. I am using the "tr" method. But lately saw no point of so many testing with same results and went to 3 test per day. I am going back to a minimum of 4 test. If you check Vivaldi ss you will notice plenty of spot checks at different hours.

2. I was not testing when using caninsulin. Started home testing at the same time as the change to Lantus and the beginning of the "tr" method.

3. Yes. I use the nadir for dose adjustment. The summary and averages you see in the extreme columns on the right on the ss are for my reference to track his overall progress. If you check the ss again, you will notice that only hypoglicemic numbers have resulted in dose reductions.

4. I have only use the Lantus pen at the beginning and u100 syringes for many months now.

What is interesting is that Vivaldi's system try to protect himself when hypoglicemic by going hyper hi on glucose immediately after a low number.

Thanks again. Will look into your suggestion of 1/4 change in dose always vs. sometimes trying to fine tune dose with 1/10 adjustments.
 
I believe going high after a low number is called a bounce and can take around three days or six cycles sometimes before the body adjusts back to a more even keel. If I'm incorrect, some of the more experienced members can correct what I've said.
 
@Beck and Grandpa - You are correct. Very low numbers, numbers that are lower than what a kitty's body is used to, or a fast drop can all trigger a bounce. The bounce is the result of the cat's system "panicking" over the drop in numbers and releasing a stored form of glucose along with counterregulatory hormones.
 
I am glad you reduced. Vivaldi has many times shown you that 1.5 units is too much.

As for how long it takes to get over bouncing, it's ECID. After almost five years, Neko still liked to bounce, but for the most part they were little bounces.
 
Vivaldi's nadir was very low today (58), even after the reduced dose. My guess is that at some point in the cycle he went hypo. As usual he bounced real high (378). Am I correct to reduce another 1/4 unit?. I just shot a reduced 1 unit on his PM dose. Inputs welcome. Thanks.
 
We usually don’t decrease unless we see an under 50. If he were my cat I’d hold provided you can watch, test, and have enough supplies.
 
Since you are following TR, we only reduce if you see a number under 50. I don't see that on the spreadsheet. Never assume. I would go back to 1.25 units. This cycle was also only 4 cycles after your last reduction, somthe depot of the previous dose could have been influencing the numbers today.
 
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