Martini 12/19 Reductions earned then failed?

[SMM]

http://www.felinediabetes.com/FDMB/threads/martini-12-12-tr-problem.187917/#post-2086768
This is the third time now on 2 units that Martini has earned a reduction. (Anything less than 68 on TR is correct isn't it?) I gave her a MC treat and LC food to get her up a bit this morning.
1.75 seems too little and 2.00 seems a bit much. Even with calipers it's difficult to go in between so I'd rather stick to 'whole' #'s if possible. Are my patience panties not doing a good job on dosing?
I can pretty well see if she is lower AMPS/PMPS she will have a good run after +3#/+4#. I try to feed her bits when I can.
Should I reduce again even after 2 failures in the past few weeks? Should I keep 2 units? I'm afraid I will not catch her real lows all the time with my job. The sticky with how TR is possible with a job is good info in ideal situations, just not entirely possible with me.
She has also started to be VERY picky with food - all kinds - I have to add in Orijen dry tiny balls to get her to eat (these don't seem to have affected her sugar levels)
Any input would truly be appreciated.

 

[Mandy & Rex (GA)]

There is a suggestion for diabetic cats that cannot hold reductions. 3 times under 50 or 1 time under 40 before letting the cat earn the reduction. Would you be comfortable doing that?

 

[SMM]

She's gone twice now under 50, would another time really make a difference? I called in sick to work earlier with the 43. If I could be home all the time to test, I'd do the 40, but the circumstance now would stress me. What would you shoot next Mandy?

 

[Mandy & Rex (GA)]

I think I would do 1.75u. I looked longer at the SS and realized you increased 3 cycles after Martini's 85 on 1.75u. I think that 1.75u is actually the right dose because he was getting some greens and had some bounces. It may be that you aren't waiting long enough to let the bounces clear. Before you try another dosecrease after dropping it back down to 1.75u, post and ask for advice.

 

[SMM]

Thank you Mandy!
So my patience panties aren't doing well is your thought, thank you for the input! I'm not really clear on how long to wait and for how many greens on a reduced dose you have to get before increasing. I will drop back to 1.75 for my sanity as well.
Any other thoughts/advice? Anyone?

 

[Stacy & Asia]

I agree with Mandy, the increases to 2 were on the tail of a bounce each time, it looks like 1.75 could have done a little more. At the end of the day, though, you might have to give a hair over the 1.75 to fine tune it. See what others things, I'm certainly not steeped in experience, but that's what I see.

 

[SMM]

Thanks also Stacy! I hope I do get other input but I'll definitely follow Mandy's recommendation. I hate putting her thru these bounces too.

 

[Mandy & Rex (GA)]

I'm not really clear on how long to wait and for how many greens on a reduced dose you have to get before increasing.

It looks to be around 3-4 cycles after a bounce starting for it to clear. Every time the bounce starts to clear, notice that each number is dropping from the last one.

I am not sure what you mean by "how many greens on a reduced dose"... if you are getting greens, it's a good dose. If the nadirs are trending higher and higher, then you may have to do a dosecrease. But again, post first for advice.

 

[SMM]

Yes, I've seen that but thought little of it I guess I'm not too savvy on staying on a dose - I thought you had to have greens every day to be more stable? Her bounces are really throwing me off
Thank you again!

 

[MyTitan (GA)]

Remember with the human meter, 50 is your target number not 68 that's for the pet meter (Alpha Track) . I agree with previous posts. Let those bounces clear 6-8 cycles and base on nadirs.

 

[Mandy & Rex (GA)]

I thought you had to have greens every day to be more stable? Her bounces are really throwing me off

If the cat is bouncing, then no, you cannot expect to have greens every day. You want to see greens when you know a bounce is not happening.

 

[tiffmaxee]

Your reduce number is under 50. I agree that with the green numbers 1.75 is the correct dose for now.

 

[Marje and Gracie]

There is a suggestion for diabetic cats that cannot hold reductions. 3 times under 50 or 1 time under 40 before letting the cat earn the reduction. Would you be comfortable doing that?

This is incorrect. The one time under 40 is for long-term diabetics (diagnosed over a year). Reductions for newly diagnosed diabetics are earned by:

• Dropping below 50 on a human meter or 68 on a pet meter once or
• Staying in normal numbers mostly under 100 for a week or
• For cats who fail reductions, dropping between 40-50 three times on separate days when you’ve been giving the same dose.

I don’t know when Martini was initially diagnosed that she was “diet controlled” but she started insulin last Feb so I would put her in the newly diagnosed category.

If the cat is bouncing, then no, you cannot expect to have greens every day. You want to see greens when you know a bounce is not happening.

This is also incorrect. A cat that bounces can easily have green every day.

She hasn’t gone under 50 twice on 2u because you reduced to 1.75u in between the two times she dropped below 50. When you reduced her on 12/8, she hadn’t earned a reduction so that’s might seem why it failed.

She likely dropped today because you weren’t able to test until +4. I know your work schedule makes it difficult to test at +2 but every time that you can, I suggest you do. Then you can feed these drops so she doesn’t go below 50.

While she might do better at 2u if you could be there to test and feed, 1.75u is probably a safer dose for her with your schedule. Remember that the shots are cumulative so if you are seeing green between bounces, hold the dose. She was clearing bounces pretty fast on 1.75u.

Please let me know if you have questions.

 

[Mandy & Rex (GA)]

Obviously, Marje is the pro here. I hadn't seen a cat that bounces and still sees greens every day. My mistake...

 

[Bobbie And Bubba]

Obviously, Marje is the pro here. I hadn't seen a cat that bounces and still sees greens every day. My mistake...

I've learned that just recently with Bubba. When his cycles are flatter and don't drop 30 points or more from Pre shots, he doesn't bounce. If he starts off with a blue pre shot and drops 30 or more points, the next morning we've got another blue AMPS number. Sigh....... check out after I did a FS the PM cycle of 12/16, after the 4th cycle he started to level out and stay flat and gave me a green AMPS yesterday morning. Today was cycle 5 and the depot was probably full and now he has another 30 + point drop today so, I am expecting another blue AM tomorrow. Sigh.

At least this is what I think is happening....... and I am not sure how to remedy it. I need to fine tune my caliper calculations perhaps.

ETA: What do you think @Marje and Gracie ?

 

[Marje and Gracie]

Obviously, Marje is the pro here. I hadn't seen a cat that bounces and still sees greens every day. My mistake...

I've learned that just recently with Bubba. When his cycles are flatter and don't drop 30 points or more from Pre shots, he doesn't bounce. If he starts off with a blue pre shot and drops 30 or more points, the next morning we've got another blue AMPS number. Sigh....... check out after I did a FS the PM cycle of 12/16, after the 4th cycle he started to level out and stay flat and gave me a green AMPS yesterday morning. Today was cycle 5 and the depot was probably full and now he has another 30 + point drop today so, I am expecting another blue AM tomorrow. Sigh.

At least this is what I think is happening....... and I am not sure how to remedy it. I need to fine tune my caliper calculations perhaps.

ETA: What do you think @Marje and Gracie ?

Excellent point, Bobbie....bounces can be just in blue...absolutely and can’t clear every day into green.

However, I don’t think Bubba is bouncing. I think he’s got the old “last number to come down is the AMPS”. I see you sometimes feed him at +8 in the p.m. cycle but is there any way to feed him a snack at +9 every night so we can see if his pancreas is working and the AMPS will come down? Or will Forrest eat it if you set up a timed feeder?

 

[Bobbie And Bubba]

Excellent point, Bobbie....bounces can be just in blue...absolutely and can’t clear every day into green.

However, I don’t think Bubba is bouncing. I think he’s got the old “last number to come down is the AMPS”. I see you sometimes feed him at +8 in the p.m. cycle but is there any way to feed him a snack at +9 every night so we can see if his pancreas is working and the AMPS will come down? Or will Forrest eat it if you set up a timed feeder?

I feed Forrest the same times I do Bubba, so no problem with that. What has been happening is Bubba is relentless waking me up anywhere from +6 to + 1 so I usually cave in a just feed him and grab a test. I will try to hold him off tonight for a +4 mini meal and see if I can push him till +9. However, in the past I have noticed if I feed any time later than +8 prior to his AM test, he is high. But, what I don't understand is why was he in all greens for a while and then decided to throw me these blue AM pre shots? Sigh.

 

[Sienne and Gabby (GA)]

This is the third time now on 2 units that Martini has earned a reduction. (Anything less than 68 on TR is correct isn't it?)

If you are using a human meter, then the dose reduction point is 50, not 68. The latter is if you were using a meter calibrated for a kitty (e.g., an AlphaTrack).

 

[Marje and Gracie]

I feed Forrest the same times I do Bubba, so no problem with that. What has been happening is Bubba is relentless waking me up anywhere from +6 to + 1 so I usually cave in a just feed him and grab a test. I will try to hold him off tonight for a +4 mini meal and see if I can push him till +9. However, in the past I have noticed if I feed any time later than +8 prior to his AM test, he is high. But, what I don't understand is why was he in all greens for a while and then decided to throw me these blue AM pre shots? Sigh.

I will look back a ways and see if I can figure it out. I did see a few days where he started in green dropped almost 30 and had a green AMPS the next day. I’ll post on your condo so we don’t hijack Martinis.

 

[Bobbie And Bubba]

I will look back a ways and see if I can figure it out. I did see a few days where he started in green dropped almost 30 and had a green AMPS the next day. I’ll post on your condo so we don’t hijack Martinis.

Okay, I will start a thread for today. Sorry Sandy for the highjack. But, all info is good info.

 

[SMM]

Yes all info is good info, thank you sincerely to all for your opinions. I thought the number was 68, therefore the reduction on 12/08 - mea culpa.
What I do know is 2.4 is WAY too too low for her. She was afraid to stand up and when she did she was staggering.

 

[Marje and Gracie]

Yes all info is good info, thank you sincerely to all for your opinions. I thought the number was 68, therefore the reduction on 12/08 - mea culpa.
What I do know is 2.4 is WAY too too low for her. She was afraid to stand up and when she did she was staggering.

That’s is low 40s so, yes, it might be too low for her.

 

[Juliet]

If at a later date you do need to go in between 1.75 and 2 - when I have to do that I put 2 in the syringe and squeeze out one drop. So long as you do that consistently then it works. With the syringes I use - 0.5 is four drop; 0.25 is two drops.

 

[Toro & Ovi]

TR protocol - by who invented it:
"When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose. Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. If the cat drops below 40 mg/dl once, reduce the dose immediately! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further.

If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose. Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet. Try to go from 0.25 IU to a drop before stopping the insulin completely. Reducing the dose too quickly generally does not work: most cats do not go into remission with fast reductions."

I hope the above will answer to all your questions.
I strongly believe that Toro would still be not regulated if we didn't follow the above instructions by the book.
And don't forget: ECID. That is very important.

 

[Marje and Gracie]

TR protocol - by who invented it:
"When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose. Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. If the cat drops below 40 mg/dl once, reduce the dose immediately! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further.

If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose. Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet. Try to go from 0.25 IU to a drop before stopping the insulin completely. Reducing the dose too quickly generally does not work: most cats do not go into remission with fast reductions."

I hope the above will answer to all your questions.
I strongly believe that Toro would still be not regulated if we didn't follow the above instructions by the book.
And don't forget: ECID. That is very important.

BTW, looking at Toro’s SS, he’s dropped below 50 four times since he’s been on 2u this time. You are risking a major hypo from an overfull depot by continuing to hold him at this dose. What compounds it is that you don’t know how many other times during the day, when you can’t test midcycle, that he’s dropped below 50.

I urge you to take a reduction to 1.75u with the next shot. If you’d like to see what can happen when you miss a reduction, you might want to read my post on Reductions. I missed one and it was a scary, scary night. And I was very experienced at that point.

Sorry, again, Sandy, for another condo hijack. I don’t see a recent condo for Toro so I wanted to point it out here.

 

[Mandy & Rex (GA)]

looking at Toro’s SS

That made me look and I could see only until November. Is there December?

 

[Bobbie And Bubba]

That made me look and I could see only until November. Is there December?

Look to the right of Toro's SS, right up against it is another link for the SS human meter. They run together and are easy to miss. I missed it too the first time.