Questions about TR protocol

Hello everyone! Chesters BG is becoming a really nice flat curve which is so refreshing compared to all the bouncing before. I had a few fur shots when getting the dose right so that made it a bit messy at first. Now tho it seems like Chester has been hanging in the 100s for just over 24 hours.

My question is since his curve is so flat and under 200 does that mean this is a good dose for him? Or I should I increase to try to get him in green numbers? He also seems to be going slightly lower every day. Today his AMPS is 108 which is so close to green! Also I’ve gotten very comfortable with his curve so giving him insulin in the 100s doesn’t make me nervous anymore. I guess I just don’t know what to do because he has went down to the 80s twice but hasn’t since I had those fur shots... and we’ve been on this dose for two weeks now.

Also it seems like some of his lowest numbers are his Pre Shot numbers. I don’t know if that’s strange or normal

 

According to TR you hold the dose 1 cycles when you start to see nadirs like yours. I would increase to 2.75 tomorrow morning if you don’t see green.

 

I think Elise is typing on her iPad. You hold doses 6-10 cycles when you are seeing nadirs under 200. Time for that increase.

 

Yes and got a call so I didn’t read it back. Let me see what I wrote. Yes. It was supposed to say 10.

 

Okay thank you very much for your advice! My needles sadly don’t have markings that indicate half and quarter doses so I’ve been using the thickness of the plunger to gauge. It isn’t perfect accuracy wise but I’m confident that he gets the same exact dose each time. I’m curious if he will be in the green tomorrow since he was 108 this morning but if he’s still in the blues I will definitely give him an increase. If he’s in the greens I should probably keep it the same right?

 

They don’t make syringes with 1/4 unit markings but you can get them with 1/2 unit markings when you buy syringes next time. Many use digital calipers for fine dosing. Here’s a video about them.
https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/#post-862835

 

Update: Chesters Bg is 92 3+ after PM injection yay!! I will of course be checking it again in the morning. I’m very tempted to keep it the same dose and see if it keeps getting better. Would love to hear what more experience folks think of course thank you all

 

Lovely flat cycles in the last two days To me it’s a close call as to whether you should increase now he’s got the green. I probably would, but it won’t hurt to wait another cycle or two to see what he does if that’s what you’re more comfortable with. But don’t leave it longer than that if he’s still mostly blue or goes higher.

 

I would have gotten another test after the 92 last night. You have no idea how much he continued to drop. I would not increase this morning because of that.

 

No dosing advice from me, but to add to what Elise suggested, I bought calipers when I switched to Lantus and holy smokes, they are a *game* *changer*! They make dosing so much easier, especially those tiny 0.25u and 0.5u increments.

Not to mention, it makes the “subtle” differences between syringes SO much more noticeable. Drawing up to the same caliper measurement for 3.75u, some syringes it looks like I’ve draw up 3.25u, while others it looks like 3.5u - the fluctuations are wild.

My only regret is not buying them sooner! They’re really reasonably priced too - I think mine were around $15 on Amazon

Good luck with your dosing! Chester is super cute - he looks very silky soft

 

I think both of you are right. That was my before bed test and since he’s been in the 70s before I wasn’t too worried but now I definitely wish I’d gotten one more. He’s at 182 this morning which isn’t the worst thing imaginable. But I think I will give him a fatter dose today to hopefully clear the bounce; just not a full dose increase in light of potentially missing a lower Bg. And I’ll probably keep it fat until I decide to fully increase or to lower it back
You guys are super helpful and I’ll definitely be looking into those calipers

 

Giving more insulin won’t clear a bounce. The bounce happens from going lower than they are used to so you need to ride it out. The only reason to increase would be if it’s not a bounce. Let’s see what happens with the f2.5. It might be just what was needed.

 

Okay this is valuable information thank you. That’s kinda what I’ve been struggling with because on 2.5u he’s already had a few numbers in the 80s and 70s but then I started having troubles with fur shots because he was jerking.
But okay I’m hearing you. I already gave him a fat dose before reading this. nothing to drastic at all but that being said, I will continue to keep him on 2.5u for the next couple days and keep you all updated. I truly feel like we’re either at the perfect dose or the slightest change will give us the perfect dose.... Then again the slightest change could also take us from the perfect dose so I’m definitely gonna keep posting here before I change his dose at all. Thank you all again

 

Since you just fattened it you can keep it if you want to see if it works well. Which method are you following, TR OR SLGS ? It’s not in your signature. That plays a role in dosing too.

 

Since you just fattened it you can keep it if you want to see if it works well. Have you made a method decision? You can change it at any time.

 

Yes I’m on tight regulation. I’ve just been on this dose for so long because I’ve had complications with shot time and some bouncing. He was able to get to the high 70s with 2.5u so I thought I might have found his dose... but now that this bounce in clearing I think I will try to up his dose

 

When you have a moment would you add TR to your signature please? No rush. Thanks.

 

Yes I can

 

Okay update on Chester. I have him a dose increase this morning, I pulled a bit too much in the syringe today so I squirted some out along with some air which I don’t usually do. I wasn’t too concerned leaving for work because my partner has checked his bg many times before. Today tho our meter was giving her trouble and she couldn’t get it to work. I do the majority of his care so she didn’t know what to do other than watch his behavior all day. When I finally was able to get the meter to work and check his sugar he’s at 41! Lucky I didn’t freak out and I have him some fancy feast treat and honey and he’s up to 77. I think what I will do is, at shot time I will reduce his shot back to 2.5u however I will start to squirt the air bubble out from now on.(it’s not something my vet informed me to do) And I will see how that dose affects his bg. Also I will stay up to monitor him tonight. And keep updating

 

Most definitely take the reduction, 41 means business, glad he came up for you fairly easily. There isn't any way to know how much lower he was before that test. Might be best to try and start another post tomorrow, I just happened by and saw your comment about testing and getting 41. If you haven't had a chance to read this info sticky, have a quick look...

https://www.felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/

 

Okay I will make a new thread tonight thank you

 

It was a bit risky to do the increase based on the data you had. Since the green 92 and the little bounce you had after you only had one test that wasn’t a preshot. I know I said this

And I’m very sorry I wasn’t more clear - I was referring to mid cycle data not preshot values. Lantus dosing is based on how low the dose is taking the kitty not on the preshots so you need that mid cycle data before making dose decisions. For TR you need at least one mid cycle test per cycle. For SLGS the minimum is a weekly curve. Chances are Chester was already spending a lot of time in green numbers before you increased.

Also it’s better to increase when you know you can monitor fairly closely - though of course you didn’t know there’d be a problem with the meter (I had a spare monitor on hand just in case) - especially when the cat is running at the lower end like Chester has been - several of Chester’s preshot numbers have been at the upper end of the normal range for a cat that’s not diabetic.

I’m glad that Christie has given you the link for posting. Many people, especially those new to FD post a thread everyday and then all the lantus aunties (and the odd uncle) can help to keep an eye on what’s happening and can give you the heads up if they see a problem and also advise you with dosing decisions. We are here to help

 

I just created another thread. No ones responded yet and I just wanted to post here as well where I know someone will get a notification. I’m sure people will respond soon I’m just a bit nervous


Yesterday I tried upping chesters dose(2.75u) and he went too low(41) so I lowered him back to his original dose(2.5u), with one caveat; from now on I will be squirting some out of the syringe to help get rid of air bubbles for a more accurate dose. My vet didn’t advise me to do this at first.

the reason I’m posting right now is because we’ve never had to deal with a preshot under 100 and he’s down to 69! Should I skip his shot tonight?

ps: I’m pretty sure shooting out the air bubble means it’s still technically a slight dose increase, I believe this is why even tho I’m at 2.5u again, he’s lower than before.

 

I have responded to your other thread. Let us keep only that one active for now. Multiple threads could cause confusion with much to and fro between threads!
Please post on that thread only. Thanks!

Here's the link to the other thread:
https://www.felinediabetes.com/FDMB/threads/preshot-69.237449/