3/27 Mags PMPS 168; +3 108; +4 105; +9 126 (ATrak)

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=67182

Monday, March 26
AMPS 136
+2 62 Wellness turkey lc
+2 42 Relion Micro
+3 95 Wellness Turkey lc
+4 102 Wellness t
+5 110
+9 158 small lc mini bite
PMPS 185
+4 119 Free feeds overnight

Remember that if you are doing three below 50s for a reduction, then the protocol calls for a .25u reduction and not a shave. The reason is because waiting for three numbers below 50 and shaving are both aggressive forms of reductions so you don't want to do both.

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Morning all is well with Maggie, and it looks like she surfed well last night. A question for Marje or someone on the above input in yesterday's condo from Marje regarding the tight protocol for Maggie earning a reduction. Maggie is a long term diabetic and returning from the Falls kitty, so the reductions for her on the tight protocol are three below 70s to earn a dosecrease. Maggie is on the AlphaTrak meter, so three below 70's would equal your three below 50's on the human meter.

The last time Mags had three below 70's, I did a shave by a drop from six drops to five. Marje stated with the tight protocol Maggie next time would earn a .25 reduction with the three below 70's. Being a long term diabetic and also returning kitty from the Falls, I wonder if the shave would keep her numbers in a more normal range. I notice there are some here who do a shave rather than a .25 reduction with three below 50's on the human meter. If I take her down by a whole .25 reduction, that seems too aggressive. She would only be on a fat two drops, and I worry she would drop too low. Mags is very sensitive to just a drop, and if she drops to a 62 on 5 drops, I worry she may go too low on the .25 reduction/fat two drops. If I take her down by a drop or shave, she would be on four drops and more juice. I count drops as it's easier for me with the variances in the lines of the syringes. I hope this makes sense! Any thoughts?

Re: 3/27 Maggie AMPS 148 ATrak Question on reductions

Good morning!! I understand why you would shave rather than take a full reduction. You know Maggie best and know how she reacts to reductions, so I would go with the shave since she hasn't been able to keep a full reduction.

I haven't been around much with life getting busy, but know that I am always thinking about you and peeking in on Maggie and you. Hope you have a great day Ann! :YMHUG:

Re: 3/27 Maggie AMPS 148 ATrak Question on reductions

Shaving worked for Maggie last time...

With her being on such a low dose already maybe a 0.25 reduction is too much. Whatever you decide, congratulations to Miss Maggie for earning it :mrgreen:

Re: 3/27 Maggie AMPS 148 ATrak Question on reductions

The 3 drops below 50 (or 70 on an AT) is an aggressive approach to dose reductions. Likewise, shaving the dose is, in a sense, an aggressive approach -- you need to monitor carefully because you don't have the safety margin of a full reduction. The concern is that by pairing 2 aggressive approaches to dosing, there is a greater risk to Maggie being over a good dose.

I understand your concern about Maggie being a longer term diabetic and that she's on a small dose. Let me see if Jill has any insights or suggestions.

Re: 3/27 Maggie AMPS 148 ATrak Question on reductions

Thanks Melissa and Serryn for the visits and your thoughts on the reductions.

Thanks Sienne, as I was just about to ask your thoughts on Mags.

Re: 3/27 Maggie AMPS 148 ATrak Question on reductions

Hope you figure things out with Maggie's dose. I'm sure great advice is on its way.
Hope you and Maggie have a lovely Tuesday

Re: 3/27 Maggie AMPS 148; +2 142; +3 115 AT ? on reductio

Hi, I'm a complete newbie, no advice here... but I just wanted to stop by and say hurray that Maggie is doing so well!!! dancing_cat

Re: 3/27 Maggie AMPS 148; +2 142; +3 115 AT ? on reductio

Hi guys .. no advice from me, but if I remember right (which I probably don't) it seemed that mocha also needed under 50 three times on the human meter before we would drop her, and when we did drop her, it was a shaved reduction. But she always had a hard time keeping reductions. At least, I think that's how we did it with her .. Have a great day!

Re: 3/27 Mags AMPS 148 +2 142 +3 115 +4 13; +6 122 (AT) dose

I'll be watching to see what Jill says. With the tiny dose Maggie (and Tess) are on, it would practically be an OTJ trial to reduce a full .25u. Tess actually has been set at 3 times under 40 and then I still just shave. She is notorious for not holding reductions. :? I thought the idea was to keep them on the low doses as long a s possible to give the pancreas as much help as possible to heal.

Re: 3/27 Maggie AMPS 148 ATrak Question on reductions

Sienne and Gabby said:

The 3 drops below 50 (or 70 on an AT) is an aggressive approach to dose reductions. Likewise, shaving the dose is, in a sense, an aggressive approach -- you need to monitor carefully because you don't have the safety margin of a full reduction. The concern is that by pairing 2 aggressive approaches to dosing, there is a greater risk to Maggie being over a good dose.

I understand your concern about Maggie being a longer term diabetic and that she's on a small dose. Let me see if Jill has any insights or suggestions.

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i think sienne sums up my thoughts well.

there is definitely an increased risk and caregiver responsibility in pairing up reduction methods mentioned in the modified version of the protocol by shaving doses rather than taking reductions in increments of 0.25u for kitties who have shown they do not hold 0.25u reductions well and the reduction method mentioned on the tillydiabetes web site allowing kitty to drop below 50 (human meter) or 80 (AT meter) three times before taking a 0.25u reduction.

kittties can easily become over dose when combining these reductions. the result may be seen in one of two forms. kitty may bottom out unexpectedly OR too much insulin can actually cause the numbers to go up. when the latter happens, we mistakenly continue adding more insulin into the mix. eventually, the increased doses will cause kitty's numbers to plummet and the caregiver has to catch the low (increased responsibility).

imho, it's not necessary and carries too much of an increased risk (danger) for newbies, caregivers of newly diagnosed kitties, and/or those who cannot monitor very closely to combine these reduction methods.

otoh, an experienced caregiver who knows their cat may find that (after trying both of these methods separately), they must become more aggressive with handling reductions because neither one of these methods by itself works for their cat. when one becomes more aggressive there's an added responsibility as well as risk involved. combining these reduction methods adds increased risk that kitty will become over dose and drop unexpectedly. caregivers must be acutely aware of the risk they're taking. monitoring carefully becomes a must.


just my thoughts...

Re: 3/27 Mags AMPS 148 +2 142 +3 115 +4 13; +6 122 (AT) dose

Ann

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Re: 3/27 Mags AMPS 148 +2 142 +3 115 +4 13; +6 122 (AT) dose

Thanks Jill and Sienne, I think I'm folllowing now, but this morning I was still half asleep. Maggie just had a shave reduction March 19 by having three below 70's, taking her dose down to 5 drops or half a unit. I guess I should have then given her a .25 reduction, but I just reduced by a shave/drop. Are you saying I still need the three below 70's for her to get a reduction, but this next time I should give a .25 reduction. It will be approx two + drops. This is the first below 70 she's had since the last shave. I do hate to see her get as low as a 62, even though she's easy to bring up almost on her own just with lc. If I understand correctly, it sounds like the next reduction should be .25 down to approximately two drops. I'm wondering if the dose she's on now is too high.

ETA: Thanks Marje on the deleting of posts - got it! I have lots of deleting to do!

Re: 3/27 Mags AMPS 148 +2 142 +3 115 +4 13; +6 122 (AT) dose

Ann & Maggie11 said:

Are you saying I still need the three below 70's for her to get a reduction, but this next time I should give a .25 reduction

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I think what Jill is saying is that if you have already tried waiting for three drops under 80 before reducing (by .25) and she didn't hold the reductions well, AND if you have tried shaving the dose for one drop under 80 and she didn't hold those reductions either, then you might decide that the best approach for Maggie is to combine the two methods. Combining two aggressive methods is not something anybody can advise you to do. it is something you can decide for yourself based on your data. If you decide to combine methods then you should do it with a full understanding of the extra responsibility you are taking on. However, it really might be the best approach for your cat. Does that help?

I hate putting words into someone's mouth, so I hope Jill will stop by and clarify if I am interpreting her post incorrectly.

Re: 3/27 Mags AMPS 148; PMPS 168 (ATrak)

well.... FWIW. I think alot of this depends on KNOW THY CAT, especially for those of us that have long term diabetics. I so understand the concern presented above, and would advise that for any and all newbies. having said that - When Mannie earns a reduction by the less than 50 rule I will shave. always a shave. he does not hold reductions well, I know i'll have to take him back up and then I end up dose hopping. So... it will always be a shave for us. I also will monitor him alot after said shave, just to verify that the step that I have taken for him will work, and that he remains safe. You simply have to know your kitty, and if you do not, then reduce the full .25. IMHO.

Maggie looks good today too. Well done Ann.

Re: 3/27 Mags AMPS 148; PMPS 168; +3 108 (ATrak)

I think what Jill is saying is that if you have already tried waiting for three drops under 80 before reducing (by .25) and she didn't hold the reductions well, AND if you have tried shaving the dose for one drop under 80 and she didn't hold those reductions either, then you might decide that the best approach for Maggie is to combine the two methods.

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Libby, thanks for stopping by, and yes, I have tried both of the approaches above, and she didn't hold the reductions. I ended going back up on the dose. She seems to be doing best combining the three below 70's and a shave dose. I do understand the extra responsibility of it and monitoring closely. She has two more below 70's to earn a shave. After she earns a shave with the three below 70's, I might try the next one under a 70 and do a shave just with the one under 70 and see how Maggie fares.

Re: 3/27 Mags AMPS 148; PMPS 168; +3 108 (ATrak)

Thanks Michelle for your input. I see how you monitor and do shaves with Mannie, and you have the data and do a great job on it and know Mannie. It's taken me a long time to get to this stage, as I've always been very conservative. I want to keep her safe, too.

Re: 3/27 Mags AMPS 148; PMPS 168 (ATrak)

Hi Ann,
I also am having trouble wrapping my brain around this "combining of reduction methods" and how it can lead to a cat being "over dose". On the surface it seems counterintuitive. But I think it means that if you get 3 numbers under 50 (70 on the ATrak) and decide to shave the dose rather than take the full .25 reduction, you might find that when you get 3 numbers under 50 on the shaved dose you will opt for taking the full .25 reduction this next time. In essence what you have now is a shave + a full .25 reduction. Your cat could be "over dose" because her dose is higher than it would be if you had taken two .25 reductions.

So I think that either you do a shave, and then do another shave. (In other words, work your way gradually down.) Or, you do the full .25 reduction. And when your cat gets 3 numbers under 50 (70) on this new dose, you can take another .25 reduction. Bottom line is that you have to be very careful if you are combining the shave reduction and the .25 reduction.

PLEASE SOMEONE CORRECT ME IF I'M WRONG!

Good luck, Ann & Maggie!

Ella

p.s. I forgot to answer your question about By Nature 95% Turkey and Turkey Liver. YES, Rusty likes it (it was Stu's favorite food). I think it's about 2% carbs.

Re: 3/27 Mags PMPS 168; +3 108; +4 105 (ATrak)

Nice greens for Mag today!!!

Re: 3/27 Mags PMPS 168; +3 108; +4 105 (ATrak)

This is an interesting discussion, as Trix is kind of in the same boat. She hasn't been to The Falls, but at this point she's a "long termer" who historically has done better with shaves than full reductions. She just earned her first reduction since we've hit the one year mark (using the "3 drops under 50 on a human meter" method), and we did go with the full reduction. It will be interesting to see what happens. Now that it's been over a year since Trix's diagnosis, I feel like I'm playing a new ball game. Lot of learning in Maggie's condo today!

Re: 3/27 Mags PMPS 168; +3 108; +4 105 (ATrak)

Moonie is definitely long term--I just reduced her a drop sk 0.5, she held for a while & now we are back up to reg dose 0.5, but even now she needs possibly another drop added again--Trial & error--that's the safe way.
Mags is special, I would shave, see how it goes, you can always reduce another drop if it doesnt work--
Moonie is on 0.5 also--or=5 drops--Gee that sounds so much better--I like it!
Love & Hugs from us--Always be happy for any reducie we get!! Mags is doing great!--Ni Ni Pals!! ;-)

Re: 3/27 Mags PMPS 168; +3 108; +4 105 (ATrak)

let me try another explanation...

these are givens:

--- practicing TR is an aggressive approach in treating feline diabetes

--- opting to shave the dose (modified version) instead of taking a full reduction of 0.25 unit is being more aggressive than following the "normal" TR guidelines for a reduction

--- opting to hold the dose until kitty proves they're ready for a reduction by dropping below 50 three times (Rand/Roomp) is being more aggressive than following the "normal" TR guidelines for a reduction

--- opting to only reduce after a "long term" diabetic drops below 40 (modified version) is being more aggressive than following the "normal" TR guidelines for a reduction


when you combine any two or three of the options listed above the risk of becoming over dose is there because one is not reducing as much as has been deemed safe. in other words, when you deviate from the norm you have to be aware of the responsibility of monitoring carefully as well as the real possibility that you may see an unexpected drop... seemingly coming out of nowhere.

please exercise caution when deviating from the protocol. when you combine any of those methods above... you're taking a little bit from two or three different reduction methods by combining them into one plan for your cat.

I think what Jill is saying is that if you have already tried waiting for three drops under 80 before reducing (by .25) and she didn't hold the reductions well, AND if you have tried shaving the dose for one drop under 80 and she didn't hold those reductions either, then you might decide that the best approach for Maggie is to combine the two methods. Combining two aggressive methods is not something anybody can advise you to do. it is something you can decide for yourself based on your data. If you decide to combine methods then you should do it with a full understanding of the extra responsibility you are taking on. However, it really might be the best approach for your cat. Does that help?

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libby nailed it! this is not so much an ECID thing is as it a KNOW THY CAT thing. experienced caregivers have already tried all the "normal" TR guidelines and suggestions usually offered. if they don't work for their cat they explore other methods until they find one that works.

hope this helps...

Thanks Jill and it does spell it out and helps. I'm reconsidering what I'm doing right now with the shave and three below 70's. So far I've caught the below 70's, as they were in the am cycle. I may miss a below 70 at the pm cycle when I'm sleeping. On Monday when Maggie had a 62 at the +2, she came up with just her regular lc Wellness Turkey. Maggie was very disappointed she didn't get any of that yummy FF turkey & giblets which causes a spike for her. With the TR protocol and using the combination, if she had a low at night when I was sleeping, she free feeds and would eat. I don't know if I should take that chance though. I may lean towards a .25 reduction when she has two more below 70's.