Moving to TID

http://www.felinediabetes.com/FDMB/threads/05-30-dose-advice-dagobah-nikita.196267/#post-2197953

Hi there!

Seeing Nikita’s and Dagobah’s numbers, I’ve decided to try TID

@Stacy & Asia , I know you recommended to try Levemir before, but the vet is « too busy » to answer my messages and send me her invoice, so If I ask a prescription today I’m not sure to get it before a while, and I’m fed up to see other colors than blue and green in their charts!

TID also fits better with Tim’s rythm, so it will give me more time to rest and I think it’s better for everyone if I’m less tired and stressed

Unless you tell me it’s better to shot at 2am instead of 0:30 (BID hours) I’ll step to TID on Wednesday at 10am, 6pm, 2am (Michel is off, so we will be able to test and rest and react fast in case of problem)


With BID Dagobah gets 3ui/ day, so I’m gonna begin by giving her 1ui / shot
Nikita gets 4ui/day, so we’ll start with 1.25ui/ shot

I will also divide their meals in three parts to give them at « showtime »

Wish me good luck!

 

Wish you luck. I've been toying with the TID idea also.

 

Thank you! I’ll let you know how it goes!

 

I would not encourage a switch to TID. You just saw a 38 for Dagobah on this dose AND you didn't reduce the dose. I think Nikita needs a bit more insulin. You held on to the 1.75u dose for too long and it's likely some glucose toxicity developed.

TID is not a great solution. I've been here for 7 yrs and there are only very few people that have used TID dosing with any success. It is miserable on your schedule. I don't see any compelling data that your cats aren't getting sufficient duration to warrant TID dosing, and most importantly, you end up with overlapping nadirs which can cause numbers to plummet. Dagobah is already dropping into unsafe ranges and TID dosing could pose a considerable risk.

 

I’m not up on what’s been going on with your cat and don’t see recent numbers. Some cats take longer to level out. Max took a year and some of that may have been due to my holding his dose too long at the beginning or his chronic pancreatitis. I never considered TID as I think for us it would have caused more sleepless nights. I instead didn’t reduce until three under 50 and started smaller decreases. That worked for us but might not be what is best for you. I’d try different approaches if my cat and TID would not be one of them. JMHO. Good luck with whatever you do.

 

I see gaps in your current BID schedule at night of 8 or 9 hours without testing. Are you sure you'll be able to get a preshot and at least a +2 or later if needed, if you are giving three shots a day? It seems like it will be very difficult to do.

To me it doesn't look like you've tried all the possibilities of BID dosing. I also suggested Levemir, but I think you also need to look at what carbs you are feeding. Many cats don't do as well on zero carb food as they do with more carbs. It can still be low carb food if it's around 8-9% carb. The higher carb allows you to give a little more insulin and flatten out their numbers. For example, you should have reduced Dabogah's dose with that 38, but maybe you could stick with 1.5 units if you are giving more carbs. She also likes to do fast drops at the beginning of the cycle, and those fast drops can also cause bounces. Spreading out food to small meals in the first couple of hours of the cycle may slow down those fast drops.

 

I know you’re trying to help but all this is really frustrating and I’m starting to be at my wit’s end



Last time Dagobah went down after a dose increase, I went back to the former dose, and I have been told that I should have kept the new dose... (Dagobah is a Ketones cat, by the way…)



@Sienne and Gabby (GA) I don't know your schedule, but I know mine and TID will allow me to sleep 6hours/day instead of 4 (and I really, really need to sleep!!!)



@Wendy&Neko , Dagobah eats her bowl all cycle long, and the gaps might be due to the fact I sometimes try to sleep, when I don't try to make my baby sleep...
I explained about levemir in my thread: Vet doesn't answer my messages and she's the only one in the area to work with Lantus, so I asked but I don't know if I'll get it before next year


Now, I hear your fears, I didn't ask here but I also tought about overlapping nadirs and wondered if it wouldn't be safer to begin on a lower dose. I'm considering this option more seriously



Do you think 3x.75 for Dagobah and 3x1 for Nikita would be safer?

 

I agree with Wendy and Sienne that there are some other things you still need to work out regarding how insulin works in both of your cats, TID won’t change any of that. If you have chaos at every 12 hours, you will likely have chaos at every 8 hours too. I understand how it may help you get more sleep, but you should know pretty quickly if it’s making a difference for the cats and if it isn’t, you can and should switch back to BID because there is a lot more data and support available to you here if you are doing what everybody else is doing. I hope your vet follows up eventually about Levemir, I’m very curious to see how/if that would work for them as well.

Like Wendy said, Dagobah went into the 30s on the 1.5 dose, so it needs to be reduced to 1.25 BID or .75 TID. If nothing else, TID may give you more opportunities to have lower preshots and that may help start a trend of them being in better numbers, if you can shoot them, but a lot more depends on how you manage the cycles overall and not just preshot numbers. You can always switch back to BID if it happens that TID keeps them more consistently in lower numbers and see if it’s workable again. You do have to make sure you can monitor every cycle. The real danger is you are adding one more cycle and that is one additional opportunity for them to go low, which is one more responsibility for you to prevent that from happening. My experience has not been that the nadirs overlap (assuming you are shooting the same amount of insulin cumulatively, but each shot amount is reduced from the BID amount) so much as TID cycles are mini cycles that look much like BID cycles, but again, I am using Levemir so the onset is later than for Lantus. This makes a huge difference because if I have a low number at preshot, I know I have a few hours to make sure that number stays safe and manageable before the next shot takes hold. Dagobah has gone from 100 preshot to 50 at +1, that is alarming and will require your vigilance and if you know that is a pattern to give higher carb food at preshot or at +1 to prevent it. You won’t have much wiggle room with lower preshots and you need to think about how you can handle that in advance, especially considering Dagobah is ketone prone and you don’t have the same luxury to skip shots as you would with Nikita.

I do wish you luck and I hope it works out well, but please don’t get your expectations up that this could be a magic fix to all of the diabetes problems you are having...I’ve yet to find anything that works magically with diabetes, it’s more a case of understanding your cat, the insulin, managing/manipulating as best you can and a little bit of good luck. As much as these things seem like they should be in our control, the reality is the cat is the one making all the rules.

 

Bonjour Marie,
I have been on vacation and just logged in today and wanted to check out how your kitties are doing.
I like the pretty colours on their Spreadsheet.
Great job shooting green the other day.
I see you have also swapped food, perhaps that has also made a difference, what are you feeding now?



Keep up the good work kitties

J'ai été en vacances et je viens de me connecter aujourd'hui et je voulais voir comment vont vos chatons.
J'aime les jolies couleurs sur leur feuille de calcul.
Super boulot vert
Je vois que vous avez aussi échangé de la nourriture, peut-être que cela a aussi fait une différence, que nourrissez-vous maintenant?



Continuez le bon travail des chatons

 

Hi there,
I understand your frustration as I have been there.
I tried TID dosing before I joined the forum several years ago, when I was feeling desperate because nothing seemed to be working.
I found the schedule exhausting and I was home all day and not working. I worried about overlapping nadirs and the onset of the next dose of insulin clashing with the previous nadir and found it hard to work out when would be the best times to give food over the 24 hour period.
And the most disappointing thing of all was that the TID dosing did not help at all to lower the numbers so I stopped and went back to BID dosing.

The BEST thing I did by far was swap to levemir insulin.

I know you say your vet is too busy to answer your messages but that is outrageous! She has a duty of care to her clients and can't refuse to answer them.
I would go into the vet's place and just stay there until she sees you. Be prepared to wait a while.
I know it's hard for you but you are the cats advocate and she can't refuse to see you.
I wouldn't ask for the invoice. It's up to her to manage her accounts. I would just ask for a levemir prescription.
Good luck. I hope it all works out for you.