8/10 Tigger PMPS/97; +1/125 +2/124 - Reduction Question?

Our last post 4/21 http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=117607

Hello Everyone In LL! :YMHUG: cat_pet_icon

It's been almost 4 months since I've been on the Board, so I know there are alot of changes. I hope everyone is doing well, and send healing vines out to Zener & any other kitties and beans in need

DM had her pancreatic cancer surgery & I spent several weeks there - she's almost completely back to normal - a miracle for a 92 y/o. Thanks everyone for your support and sugar cat advice - it helped me leave without totally stressing for Tigger.

Tigger liked his reduced dose soooo much he dropped to 48 on the CG's first morning alone - :shock: - she handled it calmly & called me, then took control from there. Luckily she didn't have to go to work that day! Thanks, Sienne & Wendy, for telling me about Gabby liking her reduced dose - I warned the CG before I left, so she was prepared.

:?: Tigger is doing GREAT dancing_cat & seems to be settling into his dose in the last few weeks, but of course I have questions ;-) :
FYI: Tigger weighs about 16 pounds now, but his appy is slowing, I think from boredom with his old 4.5% fuds + he's not in yellows & pinks much. He' eating 4% divided into 4 meals, at PS, +1, +2, +3, & +4, with larger meals at PS, +1 & +2.

Lately I have to feed 18% hc at +1, +2 & +3 & sometimes PS to get him to a safe cruise level so I'm not having to test every 30 min. Today I gave approx. 6 tablespoons of 18% gravy + some 9% to keep him at 64 before I left at AM+5. (I also gave him some contraband #25 18% kibble I hoped would last longer). When I got home @ AM+10 he was at 109.

I'm fine tuning his doses - going up or down .05mm each time - Tigger is sensitive to small increases now, but I don't know if he's as sensitive to small reductions.

This last reduction I was worried his depot might get ahead of me, so I reduced .05mm, then another .10mm in the AM.

I'm going to take a 10mm reduction tonight to be on the safe side until I hear from the experienced members about my questions below. Any advice & input will be greatly appreciated!

:?: 1) How frequently can I reduce ?
:?: 2) is it better to take 1 larger reduction when fine-tune dosing or several smaller reductions every few days if the depot still seems too full?
:?: 3) Is giving so much HC (Tigger is a Large-boned cat) normal at this point, or do I need to keep reducing?
:?: 4) Do I reduce the same amount each time or can I vary it within a range?

Thanks to you all for having patience with me - its kept me going each day - I know without your help & support we never could have got here - even DH sees all the good the FDMB has done for Tigger - that's BIG! Gotta go - its dosing time! Thanks again!

 

Re: 8/10 Tigger AMPS/125; +1/70 +5/64 +10/109 - Reduction Qu

Hi, Suzanne. I'm glad to hear that your DM is doing so well. I'll do my best to respond to your questions.

How frequently you can reduce can be a difficult question. Theoretically, you need to give the depot a chance to catch up when you reduce a dose. It can take several cycles for a depot which is too full to level out at a reduced dose. This can be very individual though. There are times when a cat is coming down the dose ladder when you do have to reduce more frequently or even skip a shot to let the depot drain. There is a consideration with Tigger, though. You're not reducing by the recommended 0.25u so there's a reasonable likelihood that you may need to reduce more frequently but I think you may need to base your decision on what Tigger is telling you. I would, however, offer a word of caution. The TR protocol is aggressive. When you're not reducing by 0.25u, you could risk dealing with very low numbers. In other words, be careful. Since you've noted that Tigger doesn't do well with larger changes in dose, if you feel like he'll do better with a 10mm reduction, that may make sense but there is a clear trade off and you risk numbers dropping low and you could be struggling to get them to come back up.

I think the issue with how to feed the curve is one that you need to put some thought into. Has Tigger always taken dives early in the cycle? If this is a pattern, then using food to prop up the numbers so Tigger can spend as much time in green numbers as possible is a good plan. I do the same thing with Gabby. However, if you feel like you are consistently having to fight to keep numbers up, reducing the dose may be a distinct possibility.

When a cat is a longer term diabetic, a lot of the questions you're asking are based on your knowledge of your cat. Whether to vary the amount you're reducing by is another judgement call. What I would remind you of though, is that when you're on a small dose of insulin, if you are used to reducing by a larger amount can end up being a very large reduction as the doses get even smaller. For example, at a dose of 2.0u, reducing by 0.25u is 12.5% of the dose. Reducing by the same amount when your dose is 1.0u is 25% of the dose. Again, if the goal is to keep Tigger in green numbers for as long as possible, you may need to think about how you calibrate the reductions.

I realize I'm not giving you hard and fast answers. In part, I don't know how the dosing scale you're using relates to units. That aside, though, once you have the data and provided you understand your cat's patterns, you can adapt the protocol. The TR protocol is a set of guidelines. As long as you understand the risks and understand your cat's patterns and acknowledge that those patterns can change, you can adjust the protocol to fit Tigger.

 

Re: 8/10 Tigger AMPS/125; +1/70 +5/64 +10/109 - Reduction Qu

Hi Suzanne, I'm glad to hear your mother is doing so well and Tigger too! We've missed you.

 

Re: 8/10 Tigger PMPS/97 - Reduction Question

Wow - thank you for the very detailed response, Sienne! I've read, re-read & discussed with DH. It makes perfect sense & helps very much.

With Tigger's .10mm reduction tonight, he's now at 2.10mm / 1.39u (1.52mm = 1.0u). Tigger's highest dose was 3.05mm / 2u.

Including tonight's reduction, I've reduced .25mm (.17u) = 9% - since Thursday 8/7 PM. Your point re. TR protocol .25u reductions is well-taken. Also dose amounts and reduction percentages.

I take reductions when Tigger drops below 50, and if I 'feel' he's pushing to drop and (new) once a week if he's doing really well.

I'm feeding more hc early in the dose & pre-emptively at higher numbers (I used to wait longer). I realized at 16 pounds, Tigger needed more than 1-2 tsp. hc to have an effect on his BG.

You gave me so much important information; the biggest difference I see with 'fine tuning' for Tigger is reducing the rollercoaster 300's to 50's. Tigger's always dropped early. NOW I see more carryover from the previous dose, though, and also more dropping at the end of the dose between +10-12.

:?: Even with 'alot' of HC we're not having rollercoaster BGs right now. As cats level out / regulate, do they still need as much HC on a dose or should ideally the HC be more infrequent

To be clear, I have no problem reducing by .25u / .38mm, it's the increases I want to go slow with. But - the .25u increases & reductions weren't holding, so I tried 'fine tuning' / individualizing Tigger's dosing.

But - I don't want to do anything dangerous or foolish or push the envelope. I understand I must stay on top of the depot.

After reading & discussing your input I feel I should drop 5% - 10% each week if Tigger's numbers are near normal, and at least 10%, perhaps 12% (using the %s in your example) if he drops below 50. I never wait till below 40 to take a reduction.

Please let me know if I mis-interpreted anything you said - again, I appreciate so much your help in deciphering a grey area for individual cats!

 

Hi Suzanne - it's great to hear from you. Fantastic news on DM. :YMHUG:

Tigger's SS is looking SO much better the last little while. Whatever you are doing seems to be working for him. You asked about the use of HC, and I think ideally cats would not need HC at all, except when low. As they start to even out you do get less of the drastic drops. Neko's finally starting to flatten out (antijinx) with less pink, and I only give her HC if she goes below 50 or close enough in the middle of the night when I want her up so I can sleep. You can try reducing the amount or frequency of HC and see what happens. Or maybe try MC instead.

 

OK, Thanks, Wendy! That helps me realize I may be propping Tigger up too much with HC & I need to keep reducing him. It's definitely a balancing act!

 

After reading your reply and doing a little more pondering, I was thinking along the same lines as Wendy. You might want to try raising the overall carb level of Tigger's food. If you're normally feeding 5%, you could try feeding 8% and see if that helps to flatten things out, as well. I agree that feeding as much HC as it sounds like you've been doing may be an indication that the dose is too high.

All of that being the case, one of the strategies for dealing with bouncy numbers is to intervene with food while you try to keep the dose as high as you need to to get lots of mid-cycle green and blue (or green) pre-shots. If you look at Gabby's SS, you'll see I intervene with food if it looks like she's dropping fast and early in the cycle. I don't necessarily reduce the dose.

 

I don't have advice to add, other than i agree that you shouldn't normally be needing to use high carb gravy daily, and that adjusting the dose and perhaps increasing the regular low carb food, while still remaining in the low carb category, might alleviate the need for high carbs.

At the same time, it looks like whatever you're doing is working. Tigger's spreadsheet looks great. kudos to you!

and nice to see you! :mrgreen:

 

Thank you again, Wendy, Sienne, & Julie for your knowledge & input. It makes sense & feels like a solid plan of watch & see ;-) . I feel more confident in the path we're taking - & that I'm not doing something to jeopardize Tigger unconsciously. I'll hold Tigger at this lowered dose (unless he drops below 50) & play around with some higher 8-9% carb. I have a 9% Weruva he loves & doesn't usu. get.

After this conversation, Tigger bounced today (AMPS 230) - in part no doubt to all the hc he got 8/10 (& now seems to expect, too! :roll: ) but dropped quickly by AM+2. More HC today as we left early for a MD visit & back late.

Tuesday we'll have a chance to settle him into his new dose & see how it goes. Thanks again for all your help!

Good thoughts, well wishes & healing vines out to all in LL :YMHUG: