Another reduction in dose

I am feeling very happy with Lucy's glucose levels the past few weeks and tonight she earnt another reduction in dose. This is the first time we have been at 1 unit. Lucy enjoyed her higher carb food with a little honey tonight.

My previous post:
http://www.felinediabetes.com/FDMB/...-8-56-10-52-ambg-63-3-65.147713/#post-1538152

 

I'd be wary of reductions that are too close together. Likewise, we tend to reduce when the nadir is below 50 on a human meter versus a reduction based on the pre-shot number. I think you're using the wrong table in the Roomp & Rand protocol. You should be using Table 3.

 

Thank you Sienne. Yes I know when reductions are too close together they often lead to a need to increase again. I understand reductions are earned when BG goes below 2.8/50. The 1 unit at PMPS tonight was not an earnt reduction but a one time reduction because BG was between 2.8/50 and 5.5/1o0 . It is one of three options in table 3 of the Roomp/Rand protocol when there is concern about hypoglycemia when dosing a green number. I usually use option 1 or 2 because I am not comfortable dosing a green number before bed that is closer to 2.8/50 than 5.5/100, due to my own health issues and fatigue issues, and because Lucy sometimes continues in green numbers even without insulin beyond +12 so I worry about giving her insulin with green numbers particularly at PMPS. Our vet suggested using one of these options given Lucy's patterns with her BG and my health issues that sometimes make it hard for me to wake up during the night because of fatigue issues. Thank you again.
From table 3 of the Roomp/Rand protocol found at http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf are the options.
If blood glucose at the time of the next insulin injection
is 2.8–5.5 mmol/L (50–100 mg/dL)
Initially test which of the alternate methods is best suited to the individual cat:
1. Feed cat and reduce the dose by 0.25–0.5 IU depending on if cat is on low or
high dose of insulin
2. Feed the cat, wait 1–2 h; when the glucose concentration increases
to >5.5 mmol/L (>100 mg/dL), give the normal dose.
If the glucose concentration does not increase within 1–2 h, reduce
the dose by 0.25 IU or 0.5 IU (as above).
3. Split the dose: feed cat and give most of dose immediately and
then give the remainder 1–2 h later, when the glucose
concentration has increased to >5.5 mmol/L (>100 mg/dL).
If all of these methods lead to increased blood glucose concentrations, give the
full dose if preinsulin blood glucose concentration is 2.8–5.5 mmol/L
(50–100 mg/dL) and observe closely for signs of hypoglycemia. In general for
most cats, the best results in phase 2 occur when insulin is dosed as consistent
as possible, giving the full normal dose at the regular injection time.
These options are in table 3A in the link I provided but in table 3 in my newer document that I have on my computer. I will see if I can find the link to that on the internet.

 

Thanks for the clarification.

 

That is okay. I understood what you meant about not taking an ongoing reduction in dose based on pre-dose numbers. If the reduction hadn't been earnt at PM +2 because of the 2.6/47 BG I would have returned to 1.25 units for the morning dose. Thank you again Sienne. You are always so supportive and I appreciate it.

 

Lucy is doing great! Her spreadsheet the last few weeks reminds me a bit of my Lucy's. When she was on her way down the dosing scale, I had to fight like crazy to try to keep her over 40. Feed high carb, number would bump up, next test it was back down, for hours. She was determined to stay low! Now that she has been OTJ for a bunch of years, she is still in the 30s or 40s most of the time when I test. I guess maybe her body really did think that was normal, but it was tough to deal with at the time.

It doesn't mean anything, obviously you can't let her run that low all the time while she is on insulin even if she wants to, I just think the similarity between the two Lucys is interesting. Have a great Sunday!

 

Thank you so much Libby. Yes this is what I am finding that normally some high carb food and honey raised my Lucy's glucose level and it stayed up. But now it goes up a bit and then goes back down again so I am getting up every hour or so and checking her glucose level and giving small amounts of high carb food with a little honey each time to stay safe as I worry without it her glucose level might drop too low especially during the night. Pats and purrs to your Lucy from me and my Lucy and thank you again.

 

when I was posting, they called my condo "The Lucy Show." She was such a drama kitty and she put on a show every night for a while.

When they start getting good numbers in back to back cycles, and start earning a lot of reductions, it can be a lot of work to stay ahead of them. The payoff can be SO worth it though.

 

Yes I do feel I have to monitor my Lucy more the past few weeks. Because I am home most of the time it is easy but I was happy to see studying your Lucy's spreadsheet that you dosed not exactly at +12 every time and also gave a few BCS doses too. I hope and pray that we will have the same result as you and your Lucy have had and your experience also gives me hope because my Lucy was diagnosed a little over a year ago. Thank you so much for your replies and love and best wishes for continued success to you and your Lucy too.

 

Looking good Lucy and I'm sure the mumbean will feel much more comfortable giving you your little 1 unit dose when you're green

 

Thank you Serryn. Your comment made me smile because as I was drawing up the dose it looked so small that I made it a generous 1 unit. Lucy enjoyed her higher carb snacks through the night. Love to you and Vyktor and Meg and best wishes to Purrdy and your mum too.

 

This new pattern of good glucose levels without bouncing makes me wonder how much I should be testing Lucy's glucose levels and also I have to get used to leaving the house with green numbers now. Just when I thought I had it figured out. But I do hope these good glucose levels continue though I may not sleep through the night or leave the house for more than a few hours at a time. I am sure I will get used to it as others have done.