? Looks like we've hit a plateau on BGs?

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Robin&BB

Robin&BB

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Bat's vet wanted me to try withholding insulin after her #s started looking good @ 0.18U (since 4/04). So did full curves of her daytime cycles Sat. (no morning shot) and Sun. (gave her both a Sat. night shot & a Sun. a.m. shot - just 0.10U ea.) ... and there wasn't all that much difference in her daytime curves on either day.

The new ISFM 2015 Consensus Guidelines read: "Primary goal of management to maintain BG between a peak of 10-14 mmol/L (180-252 mg/dl) and a nadir of 4.5-8.0 mmol/l (80-144 mg/dl)" - and I'm assuming they're using pet glucometer BG #s here. She's within normal AlphaTrak #s according to the Glucometer Reference Numbers/ Notes I pulled from BJ's info sheet, too.

Today she's been really flat throughout her cycle: apparent nadir @ 160, not much of a drop at all! (But she also slept most of the day, as I was up to my eyeballs in paperwork.) I considered letting her go a full 24 hrs. without a dose today, but got a PMPS of 186, so caved in & gave her about 0.10-0.12U after her dinner.

I'm a little stymied on how to work this super-low-dose insulin now, as she was still doing the "hang onto the insulin too long" thing at 0.18U. (Which was why vet said maybe we should just try doing without: "Such a low dose," he said.) But I'm haunted by 1.5 yrs. ago: When she went OTJ after TR on Lantus, she had lower BG#s than she's showing me these days. And I notice that a lot of the kitties on your "Remissions" page seem to pop more greens than Bat-Bat does. (Yes, I know that most aren't using an AlphaTrak to monitor, but still ... Bat's numbers aren't as low as they used to be.)

So ... should I be concerned that she didn't go into the green zone at all today? She's great on the 5 P's, btw - she looks great (nice weight), no significant water drinking, etc. But I don't want to rush this, either, regardless of what her vet's saying.

Any thoughts from Ye Wiser Ones here would be greatly appreciated. (Sorry for the long post ... gee, am I hyper-fretting today, or what?!) Thanks! - Robin
 
This is one of those hard places, Robin. You have to decide how comfortable you are being more aggressive. You can monitor carefully so I think I'd be tempted to give tiny doses when she reaches your target (150-180?) and see if she starts to drop lower overall. Check those spreadsheets in the Remission thread to see the different approaches others have used.

Our remission range is 40-120 (without insulin) for 2 weeks. Adjust those numbers for your AlphaTrak.
 
Those are some lovely numbers. I hear you...you don't want to rush OTJ. I'm with Sue here.....if you're there to monitor, why not give a tiny dose when she reaches that target? That way, should she start to drop too low, you can steer with food when necessary. That might push her to those greens and see if she can stay there. :)
 
Thanks, Sue & Rachel! Finally updated her SS; I fattened up Bat's dose a little - starting Monday night- to more like 0.12U. Looks almost like she had bit of a "mini-bounce" after that. (Go figure!) I'll hold her there @ 1.2 for a few more days, & if her #s aren't coming more into greens, will inch her closer toward 0.2U - as I can monitor closely, & feed her if she drops too low. Our biggest problem, though, hasn't been too low a BG at nadir; rather, it's her hanging on to the insulin too long at shot time. But I suppose I can shoot her at lower pre-shot #s now anyway, since I can keep a close watch on her ...

Must say: This super-dinky dosing is not the easiest thing to pull off, even with a U-100 syringe! (Ugh, the markings are soooo hard to see. If this keeps up, will need a stronger eye glasses prescription soon. :rolleyes:)
 
Check Amazon for Carson Clip and Flip clip on magnifiers. Flip down to use, flip up out of the way when not needed.
They come in a few different levels, get the highest number - 3X - if you can.
Makes seeing those tiny marks a h*ll of a lot easier!
 
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