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Clarification on shot reductions

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by SarahTitus, Dec 2, 2019 at 2:30 PM.

  1. SarahTitus

    SarahTitus Member

    Joined:
    Oct 20, 2019
    Hi all,

    I am anticipating a shot reduction soon as he was 60 at amps today and riding well since (86 @ +1, 85 @ +3). I want to be prepared for a reduction when the time comes and have a few questions. I read the TR page as well.

    Is it better to give the .25 reduction for under 50 on time, or stall 20 retest and go from there keeping dose the norm if he’s gone up? Once I give a reduction, do I go back up to full dose whenever he’s over 50 or do I hold the reduced dose for 7 days and watch his numbers (going back to norm dose if they are trending up)? His 6 hour mark seems to be his highest, which is typically the lowest/nadir, with that in mind, should I be testing more frequently at certain hours when he’s earning reductions?

    Also is DKA possible in tightly regulated cats? I read it’s very rare if on TR protocol, but I also read on the TR page that you should be testing.

    Thanks for the help!
     
  2. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    With numbers running this low, I would try to get some later night tests in. It is possible you have already missed Titus earning a reduction. Can you get a +2 or +3 at night?

    There is a different approach for earning a reduction and being over 50 at shot time ( start reduced dose then), or seeing an under 50 at shot time. The Sticky Note on TR, Handling Lower Preshots tells you what to do then. We do not shoot any insulin if they are below 50, we wait until they are higher without carb influence. Post for help if it happens, there are some nuances.

    After you reduce the dose, you hold the reduced dose unless it becomes obvious he failed the reduction. You want nadirs to be back in green after any bounce is over.
     
  3. SarahTitus

    SarahTitus Member

    Joined:
    Oct 20, 2019
    @Wendy&Neko when would he have earned a reduction then? I’ve gotta few +2s but I’ll get one tonight! At this point would you recommend a shot reduction and monitor his numbers from there?
     
  4. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    The night of the 30th he was quite a bit lower than preshot, just one hour later. Could have been then, can’t tell though with no data. Or the morning of the 30th looks like a bounce. The question is, from what?
     
  5. SarahTitus

    SarahTitus Member

    Joined:
    Oct 20, 2019
    I decreased his dose to 1.75iu last night. He was 80 at pmps and 72 at +3. This morning he was 72 at amps. Do I hold this reduction for the week and the reduce again .25 next week if he continues in greens under/around 80?

    His +6 is usually his highest, when that is supposed to be lowest. Any thoughts on why that’s happening?

    Thanks!!
     
  6. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    With TR, you wait until you see an under 50 before you reduce. However, since you've done two shots at 1.75, why don't you keep that dose until he tells you it's either too much or too little. So far, he's doing well, though the 2.0 unit depot is still in play. The larger depot takes 4-6 cycles after a reduction to stop having an effect.
    You are seeing green, so keep holding this dose for now. Reduce if either you see an undcer 50, or he goes the week in all green. If his numbers start going up, you may have to increase.
    I don't see this happening at night, cause there is no +6 data on the spreadsheet. Most of the night time cycles lately are looking like normal downward curving cycles to start. One possibility is that he is going lower at night, then doing a mini bounce during the day. Neko did this for months in a row. Dropping and earning reductions at night, then bouncing during the day. If I'd only had minimal night time tests, I would have thought she needed an increase instead. It's always good to get at least a +2 or +3 at night. The +1 just shows a food bump from dinner and is before onset, so not a good indicator of what is happening at night.
     
  7. SarahTitus

    SarahTitus Member

    Joined:
    Oct 20, 2019
    Awesome! Thanks, for some reason I didn’t realize it was any 50, no matter time of day. I thought it was only 50 for shot times. I think I made a good call on the reduction as he was 56 for +5 today, so it was likely coming anyway. I’ll start collecting more +3-5 data points to see where he lands. He gets fed every 6 hours or so, which I think helps keep him surfing flat numbers and not doing crazy dives or bounces.
     
  8. SarahTitus

    SarahTitus Member

    Joined:
    Oct 20, 2019
    @Wendy&Neko titus has been on 1.75 for 3 mornings and 3 nights. He just had a 47 at +4, should I continue to hold this dose tonight or should I decrease .25? Do you think he’s still in the 2.0 depot?

    I’m going to get a +5 tonight.
     
  9. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Hi Sarah! I would take the reduction tonight since this was the 6th cycle on this dose. It can take 6 cycles for the depot to fill but it can be less. That makes the new dose 1.5 , he earned it fair and square.

    You can always take him back up if the reduction fails.

    Congrats on the reducie !
     
    SarahTitus likes this.
  10. SarahTitus

    SarahTitus Member

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    Oct 20, 2019
    Awesome @Bobbie And Bubba ! Thanks for your response! I’m excited about his reductions! Woohoohoooo!!
     
    Bobbie And Bubba likes this.
  11. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    I am glad Bobbie was around to answer your question. Good luck with the new dose.
     
    SarahTitus likes this.
  12. SarahTitus

    SarahTitus Member

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    Oct 20, 2019
    He’s been having some diarrhea...is this normal with shot reductions or glucose fluctuations?
     
  13. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    No, not directly. I did discover Neko couldn’t handle wheat, and many HC have wheat in them. So if she went low, I had to switch to HC with potato starch in them instead. Any change in Titus’s food?
    .
     
  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Like Wendy's Neko, Gabby didn't tolerate gluten well. I would use a drop or two of either Karo (corn) syrup or honey to raise Gabby's numbers.
     
  15. SarahTitus

    SarahTitus Member

    Joined:
    Oct 20, 2019
    He’s been on FF pate for about a month now. He only gets freeze dried chicken, shrimp, or white fish (more rare). He seems to be normal otherwise. He’s been playful. He’s alert. He’s eating, and I mix a lot of water with his wet food because he likes it that way, so I know he gets enough water. Perhaps a bad can that didn’t agree with him?
     
  16. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    What hight carb food do you use to bring Titus' numbers up if they drop the way they did on 12/5?
     
  17. SarahTitus

    SarahTitus Member

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    Oct 20, 2019
    I just used the FF pate that day and got him to eat more of his breakfast, since he went up I didn’t use the gravy lovers ff I have for low numbers.
     
    Sienne and Gabby (GA) likes this.

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