Question about stalling on TR protocol

Rosie & Bailey

Rosie & Bailey

Very Active Member
Hi everyone,

Condo: http://www.felinediabetes.com/FDMB/...-296-6-236-9-183-pmps-118-1-162-2-292.203631/

I would like to switch Bailey from SLGS to TR (thanks @Gill & George for suggesting)

With regards to stalling, I've read that you can hold off on feeding, then retest, but I've also read that you feed, then retest.

Any thoughts on one method over the other?
Bailey has presented with low AMPS and PMPS numbers where we chose to skip the dose, so I think we will be encountering many opportunities to stall.:)
 
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When you stall, you don't feed.....you want to see if the BG comes up on it's own without the influence of food.

Yes, you can stall "too long".....at some point, if you don't feed, the numbers can keep dropping so it's a delicate balance...but generally, if you keep it to under an hour, you'll know if it's going to be safe to go ahead and shoot or not.

Those of us with enough data and experience will shoot anything over 50 (on a human meter) so there's rarely a time we need to stall, but at first, we suggest stalling at anything under 150 and having someone with experience able and willing to stay online with you the first few times you shoot a lower Pre-shot
 
Thanks Chris.

It does make sense to me that we want to see what BG would have done without food.
Have you ever fed, tested, then given a reduced dose? That's what we considered last night, but then decided against it.

If we stall an hour and then shoot, do we maintain the regular schedule for the next shot time?
 
You don't need to stall when you first see under 150, but if unsure what to do, do not feed and post here for help. There are other options besides stalling, shooting is one of them,. Typically you wouldn't stall more than say 15-20 minutes at first. That way if you have a delayed shot, you can still shoot on schedule next time. Also, once the insulin starts wearing off, numbers can rise fast and the new shot doesn't onset for a couple hours so you do want to get the insulin in soonest.

If you shoot an hour late, you don't go back to the same schedule next shot. You can move the shot by 1/2 hour once a day, or 15 minutes a shot. There are times if kitty is really high that you can shoot sooner, but I would post here and see if there is an experienced person around to help you see if it's appropriate to do so.
 
Thanks Wendy.

The last time we had to make a decision, my daughter tested and got 135. Then I got home 15 minutes later, and I re-tested and got 105.
The numbers are very close, but I may have considered shooting at 135 whereas the 105 made me chicken out.

How do you feel about shooting reduced doses? It seems like that can be a good compromise, but it's a bit of a gamble. Also, most of her lower preshot numbers seem to happen at PMPS. Is that the norm from what you've seen?
 
I never did shoot reduced doses due to low preshots. We determine dose based on nadirs, not preshots. And due to the nature of the depot, the cycle you do the reduced dose often plays out like shooting a full dose. However, it's a strategy you can try when you get your first low preshot. It will give you a chance to gather data and make you feel more comfortable with shooting low. You will eventually find that shooting low tends to give you flatter cycles.
 
Maybe that's why I'm struggling so much. I keep focusing on preshots, probably because Bailey's vet was making decisions based on preshot values, and I've gotten that stuck in my head.

I'm trying to understand Bailey's SS, and I'm seeing her nadirs are still happening at AMPS for day cycle, and then either at +1 or +6 at evening cycle.
It seems like for half the time, her normal curve is spread out over 24 hours instead of every 12 hours.

Am I understanding it right?

Also, when calculating nadir for changing dose, do you average out the nadirs or just look at where most of her nadirs hover? Her daytime nadirs seem to basically be in the 200s, but then evening nadirs are in the 100s. How would I handle dose change in this case?
Last week, the vet's office recommended switching back to 1/2 unit once a day.

12 118 1 162 *skipped PM dose
6 283 7 230
12 290 6 71
12 286 4 258
12 76 1 95 * skipped PM dose
6 261 5 118
12 135 1 144 * skipped PM dose
12 219 5 156
 
The problem with skipping is that you impact the depot. Meaning that you need several cycles to build it up again. Your numbers may be higher until the depot is back in play. I see you increased to 0.25 today. If you can, hold this dose for at least 6 cycles.

The nadir is the lowest number of a given cycle, it can change when that is from cycle to cycle. I joke that Neko's nadir when she was in Lantus was reliably from +3.5 to +13. When making dosing decisions based on nadir, we ask the question "'how low can this dose take my cat?"

Since you haven't been giving the same dose for at least six cycles in a row, it's hard to say when the nadirs are happening. Skipping, reduced doses, fur shots or bounces will all impact the nadir timing.
 
Thanks Wendy. That was such a great explanation. I've been reading so much, but it just wasn't connecting with my brain.

Now it's up to Bailey to cooperate. :)
 
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