? 6/5 Skooter AMPS 90 +1.5 112 PMPS 151 +3.75 74 +4.5 91 +7.5 74

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MollynSkooter

MollynSkooter

Member Since 2014
Skoots skoots magroots condo (06/04)


Quick condo cuz momma has a headache she has to try to sleep off before work!

Skooter is doing well....he has been extra snuggly, that is for sure! Numbers are looking great (super mega antijinx)....

Yay for Friday.....looking forward to trying to get done this weekend what I hoped to get done last weekend :)
 
Looks like a food spike.....I should be able to swing home at lunch to check on him.....hopefully green will be back :)
 
So not a number I was hoping for! And I know I should have come home during lunch today to see where he was at. So I have no idea if this is because he went too low on the 0.10, or because I still suck at trying to dose and shoot the 0.10 or if it is a failed reduction.

I have a feeling that it is a failed reduction, but I would like to see what he does on this cycle and tomorrow's cycle. I have had a little bit of issue with getting the insulin in. So I am trying to keep the needle in for about 10 seconds after I push to make sure the drop is getting into his system. My gut says failed reduction, but I was very deliberate tonight when doing it, so I would like to do the same thing tomorrow morning and do a curve tomorrow as I will be home. If he is still high tomorrow, I am thinking of going back to the 0.25 and see if I can get him to come down a little bit more on that dose before trying the 0.10 again.

Thoughts from anyone?


ETA: He also did not eat his +9 snack today either, so I am not sure if that is playing a part in this as well
 
I'm not seeing failed reduction at this point, I agree with your thoughts on waiting a few more cycles to see what happens.
 
is your concern mostly because of the PMPs tonight being higher? If so I think I would not go back just based upon one test that's higher, but I like your idea to wait a little bit longer on it and get a little more information tomorrow by doing a curve.
 
Yes, the preshot concerns me and I know that is not what the dose is based on, but it is a bit of a jump for him as of late.

The whole failed reduction thing is new territory for me and I want to make sure I stay on top of this and bring him back up when I should. I get a little confused as to when it is considered a failed reduction (ie: as long as he is in normal numbers it isnt or if the 0.25 gives him lower normal numbers is it a failed reduction because they aren't the lower numbers he got on a higher dose --- if that makes sense)

I am starting to feel that remission is a possibility for him again, but I want to make sure I do it right. I don't want to wait too long on this dose before bringing back up if I should. I want to make sure I am doing what is best for him and if that means bringing him back up for a bit to get a little bit lower and flatten him out a bit more, then that is what I want to do.

It seems just when I think I am getting the hang of this, new territory comes up and its like learning all over again lol
 
The depot of the higher dose can last 4-6 cycles, so it is possible you are seeing that wear off. But I like your plan of doing more testing tomorrow and seeing what is really happening. Paws crossed tonight was just a blip - a weeble wobble.
 
The idea is that you were getting good numbers and that's what resulted in the dose reduction. Once the dose is reduced, those same good numbers continue as they were on the previous dose. With a failed reduction, you're looking for a trend up, it doesn't have to be much but I'd want more than one test.

There are 2 places that mention failed reductions. One is on the link about New Dose Wonkiness, Failed Reductions and Bouncing:
The Tight Regulation Protocol with Lantus or Levemir describes what we've fondly dubbed "New Dose Wonkiness" (NDW) here in L & L. You might also see this happening while following the Start Low, Go Slow Method.

"Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations."

The concept of "New Dose Wonkiness" is NOT applied to higher numbers which may be seen after a dose reduction.

There is no "NDW" following a dose reduction nor do we hold a reduced dose 6 cycles (as done with dose increases) to "fill the insulin depot".
"Settling time" does not apply to dose reductions. We don't wait for a reduction to "settle".

When you see numbers trending higher after a dose reduction we immediately return to the last "good" dose as described in the The Tight Regulation Protocol with Lantus or Levemir:

"If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose."

Hope this helps...

Last edited: Dec 29, 2014
2006 Lantus & 2009 - 2014 Levemir Spreadsheets
Lantus, Levemir, & R insulins ~ FDMB member since 2006
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The second spot is in the actual protocol, both on the guidelines and on the Tilly's Diabetes site:
from the TRP (reducing the dose) on this site:
  • 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 a dose in-between the dose that dropped kitty too low and the reduced dose.
from the Tilly's site under "reducing the dose":
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.
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One spreadsheet that demonstrates how it works when you reduce the dose and the BGs remain the same is Davidson's. Notice from February on when Shawna begins to shoot lower preshots. I think he was at 2.75u or so at that point. She reduced his dose mostly by him spending a week at a time in normal numbers on any particular dose. When she reduced the dose you couldn't even tell it by the BG tests.

If Skooter is higher tomorrow then I'd wonder about a failed reduction. Just the one pmps wouldn't be enough to make me call it a failed reduction yet, though.

For what it's worth, that's my 2 cents on it! :D
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Thanks for all the info and input! I will be going back and re-reading it so I may have questions later :P

I am wondering if the PMPS was a blip. This will make doing tomorrow's curve VERY interesting....I am thinking of trying to do every two hours and trying to do it for the entire AM cycle as I am very curious to see what he is doing.

It still amazes me how one little drop of insulin can make such an impact in such a big body (relative to the drop of course).....

I wanted to get a little earlier test, however my sister who just adopted a baby wanted some "grown up adult time" and it went later than I thought, and I couldn't say ok I need to go as she doesn't get "growed up time" a lot right now lolol

I will probably get a +4.5 or so and see where we are at from there.....
 
So from what I am reading, if by the end of the curve tomorrow, if he is trending up, then I would want to go back to the 0.25 for the PM dose?

I guess that is what still gets me is the go back immediately to the dose that was giving the good numbers...I would say based on this cycle, the reduction is working and the PMPS was just a blip. But I think by the of the end of the AM cycle tomorrow, I will have a better understanding of what is going on and if I should increase or not....
 
Well hindsight being 20/20, I am thinking I should've retested his preshot....I just really didn't have a reason to second guess it....

He seems to be doing great right now! Here is to him keeping up with these lower numbers!
 
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