Reduce again??

[April & Quincy]

Good day, everyone! So my question is Quincy hit the 80's on 4/18. I reduced by .25. He then hit 89 again last night. My question is do I reduce again since it's under 90 or do I chalk it up to the fact that the depot from 1 unit probably hasn't emptied yet? I was thinking perhaps the depot still has 1 unit in it thus the 89 but I know the protocol is to reduce by .25 when it hits 90. What should I do?

 

[Nan & Amber (GA)]

Hmmm, good question!

After some thought, in this case I think I'd recommend holding the 0.75U dose for a little longer. The caveat is that, yes, technically under SLGS a number under 90 means an automatic reduction, regardless of when the last reduction happened. So this advice should be taken as a one-off and just based on Quincy's individual situation, not a general recommendation.

My reasoning: looking at Quincy's recent spreadsheet, he looked like he needed a bit more juice after he'd been on 1.0U for over a week. Under SLGS, with nadirs above 150, the recommendation would be to have increased to 1.25U last week. With that missed increase, your excellent testing frequency, and with the fact that he just barely dropped under 90 today, I think there's an argument to be made to be a little more aggressive than the method on this occasion.

Can I ask why you are doing SLGS rather than TR? You test enough for TR, and it allows you to be a little more proactive on dosing than SLGS.

 

[April & Quincy]

Hmmm, good question!

After some thought, in this case I think I'd recommend holding the 0.75U dose for a little longer. The caveat is that, yes, technically under SLGS a number under 90 means an automatic reduction, regardless of when the last reduction happened. So this advice should be taken as a one-off and just based on Quincy's individual situation, not a general recommendation.

My reasoning: looking at Quincy's recent spreadsheet, he looked like he needed a bit more juice after he'd been on 1.0U for over a week. Under SLGS, with nadirs above 150, the recommendation would be to have increased to 1.25U last week. With that missed increase, your excellent testing frequency, and with the fact that he just barely dropped under 90 today, I think there's an argument to be made to be a little more aggressive than the method on this occasion.

Can I ask why you are doing SLGS rather than TR? You test enough for TR, and it allows you to be a little more proactive on dosing than SLGS.

Hi!

I'm doing SLGS because normally I can't test as much. But with the stay-at-home order I'm able to do so much more frequently now.

Thank you for your answer! So hold the 0.75U for awhile. Got it. He seems to be a cat that will go lower on a dose the longer I hold the dose...if that's such a thing. It's weird. It's something I noticed after holding doses for weeks at a time and he'd have some lower numbers all of a sudden. But okay, I will hold the .75U. Thank you so much!

 

[Wendy&Neko]

The skipped dose on the evening of the 18th should have helped drain the 1.0 unit depot. The larger depot influences 4-6 cycles after a reduction. Since he went below 90 on the 4th cycle, that was probably due to the 0.75 unit dose. If you hold the dose, continue to keep a close eye on him. If you weren’t at home, a reduction would be in order,

 

[Nan & Amber (GA)]

He seems to be a cat that will go lower on a dose the longer I hold the dose...if that's such a thing.

Right! Part of that is the basaglar depot settling in. There are also some long-term encouraging signs in his spreadsheet-- you're seeing a lot more blue numbers overall now than you did before! But he's still spending an awful lot of time in pinks and yellows, which is another reason I'm encouraging you to keep this dose a bit longer. He may be asking for another reduction again before you know it, but in the meantime let's see if we can get him to stay more in the blue zone than the pink/yellow for a while.

 

[April & Quincy]

The skipped dose on the evening of the 18th should have helped drain the 1.0 unit depot. The larger depot influences 4-6 cycles after a reduction. Since he went below 90 on the 4th cycle, that was probably due to the 0.75 unit dose. If you hold the dose, continue to keep a close eye on him. If you weren’t at home, a reduction would be in order,

Okay, good to know. I will definitely continue keeping a close eye on him. If you think I should reduce though, please let me know! I'm weighing all factors.

 

[April & Quincy]

Right! Part of that is the basaglar depot settling in. There are also some long-term encouraging signs in his spreadsheet-- you're seeing a lot more blue numbers overall now than you did before! But he's still spending an awful lot of time in pinks and yellows, which is another reason I'm encouraging you to keep this dose a bit longer. He may be asking for another reduction again before you know it, but in the meantime let's see if we can get him to stay more in the blue zone than the pink/yellow for a while.

How interesting! Okay, yes, I agree - much better numbers. 0.75U is also SO HARD to measure on these little syringes so I wonder if I'm even doing it accurately. But that could be a whole different thread. I will continue to keep an eye on him and really hope he spends more time in the blue zone. .75U seems to be the number he likes from past experiences. I've had to reduce from 1.0U before. But you never know. He's weird.

 

[Wendy&Neko]

He is in safe numbers in the high 80’s. Seeing more normal numbers is good for him. Wondering if you would consider temporarily trying TR while you are home and able to monitor. Then you could switch back when you have to go out of the house again.

A cat’s insulin dose can change over time, so what worked last time might not this time.

 

[April & Quincy]

He is in safe numbers in the high 80’s. Seeing more normal numbers is good for him. Wondering if you would consider temporarily trying TR while you are home and able to monitor. Then you could switch back when you have to go out of the house again.

A cat’s insulin dose can change over time, so what worked last time might not this time.

I would and will definitely have to read more about TR before I make a decision. It seems very scary! I will read up on it tomorrow though and go from there.

Also, are those higher yellow numbers today a possible bounce from the 89 last night?