low nadirs , high pmps

Here is your previous post: Low nadirs We include these with our daily links so that others can look back to see how kitties are doing.

Your signature indicates you are following TR; if that is the case, can you add that detail to Puffy's spreadsheet?

Both dosing methods follow specific guidelines which are mentioned in this sticky: Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

Under TR, here are the guidelines for holding doses and increases/decreases:

"General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.
  • 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.
  • Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
  • Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to 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.
  • 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 an in-between the dose.
  • We've found many kitties benefit from reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission. Most kitties will be in the range of a healthy cat (50 - 80 mg/dL) overall."
Do you have data from 2/23 to present? I'm not seeing that on your spreadsheet.

It looks like you were holding some doses for the 3-5 days but you've also had some inconsistencies (between 2/18 and 2/22). Because it is a depot insulin, Lantus is an insulin that likes consistency, and when you adjust the dose up and down, the depot needs to readjust and numbers can get wonky. That said, without seeing more recent numbers, it's hard to tell what's happening.
 
As Mary said above, you are increasing the dose too fast. With Lantus and TR, the fastest you can increase is every 6 cycles or 3 days. Lantus is a depot style insulin, meaning you have to wait for the depot to build to see what a dose can do. With green nadirs, you should be staying with the same dose for 10 cycles.

We have a saying here, Lantus teaches patience. I know it's hard when you see high numbers, but waiting the full amount of time is what keeps your cat safe.

I'm not sure you actually will be able to follow the Tight Regulation protocol, unless you can test more? With TR, you need to get the preshot plus at least one other test per cycle, both AM and PM. Your spreadsheet has too many cycle with just the preshots and no other test. We need those second tests to try to get an idea how low the dose is taking the cat, as we determine how to change the dose based on what the low numbers are.
 
I think something is wrong with my SS. I have been testing at least 3 times a day, lots of times 4 even 5 times, at night too quite a few times . The ss is filled up to date. I'm not sure why you can't see it completely. And those dates when I was inconsistent with the dose, was because I saw low numbers and I panicked. Then I read more about TR, and learned about" shot low to stay low ". What worries me, are those consistent high numbers at PM shot, it's like those numbers are stuck to him, 350 -375..
 
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Do you have a different spreadsheet that you are updating? If so, you would need to link that one in your signature.

If you are using the one in your signature...then I have no idea. So weird.
 
My advice would be to get a fresh link to your spreadsheet (make sure when you do that you're looking at all the updates, and not accidentally linking a copy). This could be a glitch, etc, but if you give us a link to what you're looking at, hopefully we can all be (literally) on the same page.
 
@danowics I’m going to send you a PM because I want to keep your email private. However, I sent the SS that is linked in FDMB to your gmail address some time ago for you to accept ownership. That’s the SS that you should be using. The only other one I show for you is the one you came with from another group that has issues when linked in our forum; that’s why I made you a new one.

You’ll have to transfer the data from whatever you’ve been using to the one I made for you which is linked in your signature box. If you need help with that, just let me know.
 
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