Low Nadirs - decrease dose?

Marie & Red

Marie & Red

Member
Good Evening! Red has been having some low nadirs but I'm not positive if or when his dose should be reduced. His nadirs seem to be happening about +3 hours. Is that possible?

Do I need to do some more curves before a decision is made to reduce?
 
Per SLGS you'd reduce anytime you get a number below 90, so technically yes you should reduce to 0.25U.

That said, these numbers are perfect. If you can continue to test this often, I would hold this dose for him, and just say you're doing TR.
 
FrostD said:
Per SLGS you'd reduce anytime you get a number below 90, so technically yes you should reduce to 0.25U.

That said, these numbers are perfect. If you can continue to test this often, I would hold this dose for him, and just say you're doing TR.
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Thank you. I know Red is feeling better because he's starting to be playful again. I haven't seen that in a few years.

I've been off from work for a few days so testing more often was easier. Now back to work, I can still test several times per day, but unfortunately not able to do every 2-3 hours daily.

If I hold him at this dose of 0.5U, how low can he go before I reduce it? I get a little nervous when he gets those low 60's or 70's mid cycle.

Should I still shoot 0.5U if pre-shot levels are in the 90's, or lower?

Thank you for your help!
 
What times are you able to test? In the "+ X" format.

Per MPM you'd reduce below 50. You could always just modify SLGS to reduce below say 65 or 70 if that's more comfortable for you. The reason I like his current numbers is I think you've got a darn good chance at remission, and the more he can stay in green and get those preshots down the more his pancreas can heal.

You've shot a 95 before and it went ok. I'd say depends if you can be around to monitor or not, if not you could always try a drop dose or your best estimate of 0.1U (so just baaarely anything drawn up in syringe).
 
FrostD said:
What times are you able to test? In the "+ X" format.

Per MPM you'd reduce below 50. You could always just modify SLGS to reduce below say 65 or 70 if that's more comfortable for you. The reason I like his current numbers is I think you've got a darn good chance at remission, and the more he can stay in green and get those preshots down the more his pancreas can heal.

You've shot a 95 before and it went ok. I'd say depends if you can be around to monitor or not, if not you could always try a drop dose or your best estimate of 0.1U (so just baaarely anything drawn up in syringe).
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Besides the AM and PM tests, I can usually test about 2 more during the day, depending on the day, and one in the evening before bed. Today is tough to test, but I did another one now and his BG is 90.

I like your suggestion of reducing at 65-70. Does that mean keep him at 0.5U unless his preshot is 65-70, then if so, reduce it? Would I reduce to 0.25 or 0.1U? I can't imagine drawing up so little.

Does the pancreas heal when he keeps getting the insulin or when the insulin can stop?

Thank you again!
 
It means keep the dose until you get a number below 65 or 70 at any point in the cycle, usually around nadir.

It goes 0.5U, 0.25U, 0.1U (I can post a pic when you get there), then a drop dose. You just do your best with those smaller measurements; some people use calipers, I can post a link in a bit. Drop dose is just pushing plunger aaall the way down to get all air out, then insert into vial, and release it. Result is one drop in the needle. When giving the shot, hold the plunger down all the way for 10 seconds if you can to let it absorb

The pancreas is healing whenever he's in those green numbers. The ideal scenario is that he eventually sees all green numbers on insulin, and you continue to lower the dose. Then do an OTJ (off the juice) trial - 2 weeks without insulin, and if he stays nearly all green we call it remission
 
FrostD said:
It means keep the dose until you get a number below 65 or 70 at any point in the cycle, usually around nadir.

It goes 0.5U, 0.25U, 0.1U (I can post a pic when you get there), then a drop dose. You just do your best with those smaller measurements; some people use calipers, I can post a link in a bit. Drop dose is just pushing plunger aaall the way down to get all air out, then insert into vial, and release it. Result is one drop in the needle. When giving the shot, hold the plunger down all the way for 10 seconds if you can to let it absorb

The pancreas is healing whenever he's in those green numbers. The ideal scenario is that he eventually sees all green numbers on insulin, and you continue to lower the dose. Then do an OTJ (off the juice) trial - 2 weeks without insulin, and if he stays nearly all green we call it remission
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I truly appreciate all your explanations and help. There is so much to learn. I keep reading the responses over and over so it sinks in.

If I understand correctly, if Red gets to BG of 65-70 anytime in his cycle, I reduce his next dose to 0.25U? He tested at 71 before bed last night, so maybe it's a possibility of getting that low today. How long will I hold that lower dose?
Thank you
 
Marie & Red said:
I truly appreciate all your explanations and help. There is so much to learn. I keep reading the responses over and over so it sinks in.

If I understand correctly, if Red gets to BG of 65-70 anytime in his cycle, I reduce his next dose to 0.25U? He tested at 71 before bed last night, so maybe it's a possibility of getting that low today. How long will I hold that lower dose?
Thank you
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Correct! Hold the dose until he goes below reduction point again, or if his numbers creep up can consider increasing again (only if nadirs aren't really going below 90)
 
@FrostD
Red just hit BG 65 at PMPS +2. Should I now decrease his does to 0.25U for his AM dose tomorrow no matter what his level is, even if high? Normally, his AM levels aren't low. I'm not sure what's better, drop the dose or keep him at 0.5U?
Thank you
 
It depends whether you want your reduction point to be 65 or 70 lol it all depends what #s you're comfortable with. You would go down to 0.25U if you want to reduce
 
FrostD said:
It depends whether you want your reduction point to be 65 or 70 lol it all depends what #s you're comfortable with. You would go down to 0.25U if you want to reduce
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I think I will wait until he goes down to under 65 and then reduce his next dose. I just thought that if he reached the level to reduce the dose, but his AM level was high, say 140, wouldn't it be better to give him the 0.5U instead 0.25U?
 
No if you reduce, hold it for a few days to see how he does. BG pattern will tell you if it.woukd have better better hold. Consistency is key
 
@FrostD
Good Evening, I just wanted to let you know that Red leveled at 63 last night, so this morning I reduced him to 0.25U. I guess we'll see how he does in the next few days.

I'm hoping his numbers don't jump up!
 
@FrostD
Good Morning,
Red was doing very well on the reduced 0.25 dose throughout the day for 4 days, then on day 5 & 6 (today) his AM pre-shot numbers have jumped up. I'm not sure why. Could it be a bounce? I also thought it may be because he is eating food, which I leave out for the night, within the 2 hours prior to me waking and testing.

I usually feed 1 FF can about midnight for 2 cats, which is PMPS +3. They eat about 1/4 each. Then before I go to sleep, within another hour, I leave 1 more FF can out for the night for both of them. I worry about leaving Red without food during the night. The food is usually gone in the morning.

How long should a diabetic cat go without eating? During the day, I feed them approximately every 4 hours, and always pre-shot. They will eat 1/4 can each right away, then for hours graze through the rest of the can. Sometimes not even finishing the can between the 2 of them.

I'm going to try to get some late hour testing in since it the weekend, just wanted to know your thoughts on his high morning numbers.
 
Yes looks like a little mini bounce perhaps. Food schedule sounds fine! Those AMPS are usually the last numbers to come down, but yes would be influenced if he's eating a little bit in that window. I'd just keep doing what you've been doing. Love all those greens
 
@FrostD
Hi! Red has just fallen under 65 again on the 0.25 dose this morning YAY! Since his threshold was 65 for him, I want to verify that his next dose would be 0.1 U? If so, how do I measure such a small amount and how long do I hold that dose?
 
This is awesome!

Yes, 0.1U next if you can manage. These pictures say U100, but the concept is exactly the same - just a hair of space between plunger and 0 line

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Wow! We'll try! Thank you for the picture, that helps.

Does he need to stay on this until he goes below 65 again? Unless nadirs are above 90?
 
Marie & Red said:
Wow! We'll try! Thank you for the picture, that helps.

Does he need to stay on this until he goes below 65 again? Unless nadirs are above 90?
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Yes, unil he goes below 65 again. I would not think about increasing unless every nadir is above 90 for at least a week - but I don't think that's going to happen :D
 
FrostD said:
Yes, unil he goes below 65 again. I would not think about increasing unless every nadir is above 90 for at least a week - but I don't think that's going to happen :D
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Okay great! I'm hoping he stays doing as well as he has been!
Thank you for helping us both!
 
I'm pretty new to this forum but Oreo has had DM for over 3 yrs now. He was doing really well until last Aug (we had to temp evac from fires in Tahoe) when he suddenly had 3 hypo incidents. -just been reading this to try and get a handle on what my Oreo is doing...After reading the link about the Somogyi effect, I think I did the opposite of what he actually needed..I had been getting huge up and down numbers and usually high PS numbers. I increased his PZ from 2U/2x day to 2.25 U and then his numbers went even more haywire, so now I am pretty convinced I need to go back down on his dosage and see what happens. He has had some 54-57's recently. Yet his PS 3"s are in 325-400! Very stressful and no help from the vet. He has had a Freestyle Libre on for the last 4 weeks and his curves look like check marks...ughhh
 
Oreo’smamma said:
I'm pretty new to this forum but Oreo has had DM for over 3 yrs now. He was doing really well until last Aug (we had to temp evac from fires in Tahoe) when he suddenly had 3 hypo incidents. -just been reading this to try and get a handle on what my Oreo is doing...After reading the link about the Somogyi effect, I think I did the opposite of what he actually needed..I had been getting huge up and down numbers and usually high PS numbers. I increased his PZ from 2U/2x day to 2.25 U and then his numbers went even more haywire, so now I am pretty convinced I need to go back down on his dosage and see what happens. He has had some 54-57's recently. Yet his PS 3"s are in 325-400! Very stressful and no help from the vet. He has had a Freestyle Libre on for the last 4 weeks and his curves look like check marks...ughhh
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Could you get a spreadsheet set up for us, and start a new thread please? Tag me in it and I'll be happy to take a look
 
FrostD said:
Could you get a spreadsheet set up for us, and start a new thread please? Tag me in it and I'll be happy to take a look
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Hello,
Thank you for responding. Yes I can start a new thread but Bhooma (very graciously) set up a spreadsheet for me but I do not know how to attach it to my signature. And in addition to that, with four weeks of numbers, there’s got to be an easier way to input this information. I’m a very slow typist and I am not retired so I can’t spend a week inputting all of this information. I would like to be able to take screenshots and upload them because I think the visual is pretty effective. Let me know if you can help with any of that. Thank you very much.

Dawn
 
Oreo’smamma said:
Hello,
Thank you for responding. Yes I can start a new thread but Bhooma (very graciously) set up a spreadsheet for me but I do not know how to attach it to my signature. And in addition to that, with four weeks of numbers, there’s got to be an easier way to input this information. I’m a very slow typist and I am not retired so I can’t spend a week inputting all of this information. I would like to be able to take screenshots and upload them because I think the visual is pretty effective. Let me know if you can help with any of that. Thank you very much.

Dawn
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Tagging Bhooma @Bandit's Mom for the link, and also if there's an easy way to transfer Libre data?
 
Oreo’smamma said:
I do not know how to attach it to my signature.
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You can go to https://www.felinediabetes.com/FDMB/account/signature and just paste the link in the second line.
I can help you with this is you aren't able to do it.

FrostD said:
also if there's an easy way to transfer Libre data?
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I don't think so. You will need to input them manually. The most recent data is the what is really useful so you could start with inputting the data for the last week and work your way back as and when time permits. We don't need every data point. More data in active cycles and just sample data in bounce cycles.
 
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