Time for an Increase? Need Help - Regular dose but numbers not going down

[Sissy's Mom]

So I screwed up and didn't give a shot at 197 a few days ago. Result was she was HI. I continued her normal dose of .75 which doesn't seem to be bringing her numbers down below 200. Is it time for a dose increase. Would someone with more experience than me take a look at her SS and provide some guidance? This .75 dosage has had her in the blue before - what happened?

I can tell she feels terrible today.

Thanks

 

[Gill & George]

Hi,
She's possibly bouncing of those blues.
She may come back down when the bounce clears (up to 6 cycles)

On TR when they start seeing blue we would usually hold the dose for at least 8 cycles. She probably will need a dose increase but best not to rush it.
So I would hold for now and reassess in 8 cycles

 

[Wendy&Neko]

With TR, you hold doses with nadirs under 200 for 6-10 cycles. Since she's not new to blues, and so far those blues on this dose are all mid blues and above, I think I'd increase tomorrow if you don't see anything lower before then.

 

[Sissy's Mom]

With TR, you hold doses with nadirs under 200 for 6-10 cycles. Since she's not new to blues, and so far those blues on this dose are all mid blues and above, I think I'd increase tomorrow if you don't see anything lower before then.

That's what has me confused - she was in blues with .75 (at least 3 times) but now is primarily reds and pinks for 6 cycles (if a cycle is a 12 hr period - not sure). I thought she might be what bouncing (from what I've read), but not sure anymore. Thanks for the suggestion. I was thinking the same about a dose increase but was hesitant because I don't want her to drop too fast.

Another question - in the past she's dropped very quickly into the 90s and would probably go much lower based on the rate of drop. But, I've never let her go that low again - for a couple of reasons - one - I'm scared, and two - the time it takes for her to recover from a drop to 60 or lower. It just takes so much out of her. So, the question is, what is the normal procedure - let her drop until it's 50 and then start with the karo - or watch for a rapid drop and give a few carbs to prevent her from falling completely?

I am so thankful for this site. Would be lost without it. Thanks much.

 

[Wendy&Neko]

Your goal is to get her to spend as much time in healing green numbers as possible. That may mean using food to slow fast drops (fast drops can cause bounces). We call it Using Food to Manipulate the Curve. So that's more like giving a few carbs to prevent her from falling all the way, and hopefully to encourage her to flatten out. The more time she spends in normal numbers, the less she bounces. At some point you just have to bite the bullet and let her spend time in numbers under 100, as long as you are around to monitor and give her food to keep her in safe numbers.

A cycle is a the time between shots, so yes, a 12 hour period. Bounces can take up to six cycles to resolve.

If you don't see green tonight, you'd be fine to increase tomorrow morning.

 

[Sissy's Mom]

Your goal is to get her to spend as much time in healing green numbers as possible. That may mean using food to slow fast drops (fast drops can cause bounces). We call it Using Food to Manipulate the Curve. So that's more like giving a few carbs to prevent her from falling all the way, and hopefully to encourage her to flatten out. The more time she spends in normal numbers, the less she bounces. At some point you just have to bite the bullet and let her spend time in numbers under 100, as long as you are around to monitor and give her food to keep her in safe numbers.

A cycle is a the time between shots, so yes, a 12 hour period. Bounces can take up to six cycles to resolve.

If you don't see green tonight, you'd be fine to increase tomorrow morning.

Great info. That's kind of what I was doing when she rapidly dropped - gave her a few crunchies or food. She hasn't really been in the green unless she dropped like a rock and I've been trying to avoid those. Thanks much.

 

[Gill & George]

gave her a few crunchies or food

If by crunchies you mean regular dry food, this is not the best idea.

When using food to manipulate the curve, as you are doing TR you should not be using dry food at all. You should be using wet food, of varying carb content.


If you found yourself in an emergency (she was well below 50, and not coming up and won't eat anything) then you could use dry, it is in the hypo kit. But other than that it is a prerequisite of TR that no dry food is used.
Dry food can stay in their system longer and can really inflate those numbers, increasing her insulin requirement.

For example you fed 8 crunchies on March 7th at pm +8.75 when she was in low yellow, to bring her numbers up, that wasn't necessary, with Lantus apart from having her spend most of her time in green you want to be aiming to shoot progressively lower numbers, ideally you want to be shooting green. On march 7th after those 8 crunchies she climbed and climbed and hit black, the dry food you gave could well be responsible for that.

I know from experience with my George that when he accidentally got into kibble, it took about 8 hours to see his numbers rise like crazy and about 24 to 36hours to see his BG return to normal. This can of course vary from cat to cat.
In any case using HC kibble will make her numbers look worse on any dose.


Is she a recent wet food convert, it seems from your notes on the SS that you are struggling to get her eat?
I sprinkle freeze dried treats (zero carbs) on the top of LC food when when one of my cats is being fussy about eating his fuds, perhaps you could try that.

 

[Sissy's Mom]

If by crunchies you mean regular dry food, this is not the best idea.

When using food to manipulate the curve, as you are doing TR you should not be using dry food at all. You should be using wet food, of varying carb content.


If you found yourself in an emergency (she was well below 50, and not coming up and won't eat anything) then you could use dry, it is in the hypo kit. But other than that it is a prerequisite of TR that no dry food is used.
Dry food can stay in their system longer and can really inflate those numbers, increasing her insulin requirement.

For example you fed 8 crunchies on March 7th at pm +8.75 when she was in low yellow, to bring her numbers up, that wasn't necessary, with Lantus apart from having her spend most of her time in green you want to be aiming to shoot progressively lower numbers, ideally you want to be shooting green. On march 7th after those 8 crunchies she climbed and climbed and hit black, the dry food you gave could well be responsible for that.

I know from experience with my George that when he accidentally got into kibble, it took about 8 hours to see his numbers rise like crazy and about 24 to 36hours to see his BG return to normal. This can of course vary from cat to cat.
In any case using HC kibble will make her numbers look worse on any dose.


Is she a recent wet food convert, it seems from your notes on the SS that you are struggling to get her eat?
I sprinkle freeze dried treats (zero carbs) on the top of LC food when when one of my cats is being fussy about eating his fuds, perhaps you could try that.

Got my answer - I was giving her a few dry kibble - won't do that again. I found her sneaking a few kibbles from the other cat's food last night - and this a.m. her BG is HI. Will hide their treats from now on. So much to learn. I had no idea a few pieces of dry kibble could have that impact. She is eating the Weruva slide and serve really well. I feed her multiple times a day anyway because she doesn't eat much at one time. Thank you so much for responding. This website needs to write a book! Not advice - just what all of you have learned from your diabetic cat.

 

[Gill & George]

The most dramatic effect of dry food on BG can be seen in Scooters SS he went OTJ in 24hours, Scooter was on a wet diet, the other cats in the house still ate kibble, CG did not think that Scooter was getting any, when she finally managed to transition all the cats onto wet Feb 15, it had a dramatic effect on Scooter's insulin requirement.

Scooter 5u to of the juice
Scooter SS, look at feb 19

The reason I am telling you this is that if you manage to keep Sissy off the kibble you will need to keep a close eye on her, her insulin requirements may well change.

 

[Sissy's Mom]

The most dramatic effect of dry food on BG can be seen in Scooters SS he went OTJ in 24hours, Scooter was on a wet diet, the other cats in the house still ate kibble, CG did not think that Scooter was getting any, when she finally managed to transition all the cats onto wet Feb 15, it had a dramatic effect on Scooter's insulin requirement.

Scooter 5u to of the juice
Scooter SS, look at feb 19

The reason I am telling you this is that if you manage to keep Sissy off the kibble you will need to keep a close eye on her, her insulin requirements may well change.[/QUOTE\\

Thanks. Will watch her closely. I hover over her. She's getting sick of me just staring at her. I only gave it to her when she was dropping drastically, and then she accidentally got some last night - won't let that happen again. I won't make any increases in insulin for a couple of more cycles to see what happens.