New Member (1/26/2025): Sheldon was recently diagnosed; your guidance is most appreciated

Rishi

Rishi

Member
New member here from Northern New Jersey. I figured this community would be a great resource to help set me in the right direction. Amazing!

Anyway, here are some quick facts.

In June 2024, we took Sheldon (15 yo domestic shorthair) to a new vet for help with his increasingly frequent grooming, hairballs, vomiting. These behaviours had been noted for years without any particular diagnosis or plan, except for more recent indications of intestinal inflammation. Eventually, this new vet pet him on prednisolone. He responded well and almost immediately stopped throwing up.

However, in December we noticed that he was very thin and lethargic. We took him to the vet and his blood sugar tested 653 via actual lab results. He had lost over 2 lbs (down to a little over 12 lbs). We switched him to a canned wet food diet with <10% carbs based on catinfo.org's database, avoiding gravy, starches, etc. in the ingredient list. We also started him on 2 units of Lantus every 24 hours. His initial recheck after 3 days was in the low 400s. For a while after that, we continued this protocol and he continued to improve in terms of vigor and personality, but I was a little burnt out and hadn't started testing at home yet.

Two weeks ago, we went for a checkup with the vet, and I also got an AlphaTrak 3 and got the hang of testing him at home, although we haven't done a full curve or anything just yet. I'm getting a feel for the levels he tests at during various times of day (his insulin shot is around 3-3:30pm). I tested him once before giving the insulin shot, and it was in the 620s. Otherwise, the post-shot readings were in the high 400s or low 500s. Not great.

After consulting with the vet this past Monday, I increased his dose to 3 units once every 24 hours. I tend to check his blood sugar 3 hours after the insulin shot, so 6-6:30pm. After increasing to 3 units, his numbers improved slightly, with one reading as low as the 350s, but others hovering in the low to mid 400s. Still way too high.

His initial blood sugar levels before starting the prednisolone, back in July and August 2024, were in the low 100s, seemingly totally normal to my untrained eye. It's hard not to think that the diabetes was induced by the prednisolone.

His current dose of prednisolone is 2.5 mg every other day, and has thrown up once (3 weeks ago) over the last nearly 4 months. Hopefully that stability will continue at this relatively low dose so we can focus on the diabetes and working towards lower levels and hopefully remission.

Is it likely that he should have more units of insulin? I haven't done a curve yet because we still haven't gotten a single reading down into an acceptable zone yet, and I wondered if that might be a priority before doing a lot of testing?

Thanks for reading any of this and whatever input you may have!
 
Hi and welcome to the forum.
Lantus is a twice a day insulin, not a once a day insulin. If you only give it once a day you are leaving Sheldon without insulin for 12 hours and his blood glucose (BG) will rise back up high during the period he does not have insulin.
Cats have a much faster metabolism than dogs and humans and that is why they need insulin twice a day.

If Sheldon was my cat I would give him 1.5 units of Lantus twice a day…12 hours apart.
You need to feed a good meal before every dose of Lantus and then offer 2 or 3 snacks of low carb food during the first half of all the cycles.

I would also test before every dose of insulin to make sure it is safe to give the dose. And then test at least once sometime around +4 to +7 to see what the lowest point in the cycle is. Lantus dosing is based on the nadir not the preshot BG so it is important to find out what the nadirs are.

Would you like to setup one of our spreadsheets? We can then help you with the dosing
Here is the link to the SS HELP US HELP YOU

I would ask the vet about swapping from prednisolone to budesonide. It is better for diabetic cats.

Rishi said:
Is it likely that he should have more units of insulin? I haven't done a curve yet because we still haven't gotten a single reading down into an acceptable zone yet, and I wondered if that might be a priority before doing a lot of testing?
Click to expand...
Until we can see some data on a spreadsheet we can’t tell if an increase in dose is needed. First I would change to twice a day dosing of 1.5 units and see how he goes with that.
If you can get a test in before every dose and then one test at least between the cycles, you don’t need to really need to do a curve.
And you don’t wait until he gets into better numbers to do a curve or collect data. We need to see what is happening now:)

Keep asking questions
 
Welcome to FDMB!

It sounds like you've been doing your homework. I'm truly surprised your vet doesn't know that Lantus is dosed twice a day in cats. A cat's metabolism is faster than a human's and twice a day dosing is necessary. If your vet suggests that you don't know what you're talking about, this is a link to the diabetes guidelines from the American Animal Hospital Assn. The section on treatment (see p. 3) indicates that Lantus (and Prozinc) are dosed every 12 hours. Given the timing of when you're giving Sheldon his shot, you may want to think about the timing. (I doubt you want to wake up at 3:00 AM to give him insulin!) Just so you're aware, Lantus is dosed once a day in humans but cats are not tiny humans and have a different metabolic rate.

If Sheldon has an inflammatory GI condition, you may want to give some thought to his diet. Cats with inflammatory bowel do well on a diet of novel proteins. I have a cat with IBD. He was fed a diet of chicken and turkey which is what I was feeding my diabetic cat. I switched him to a diet that includes pork, venison, and rabbit. I don't know if you'll be able to eliminate the prednisolone with a diet change but it may be a possibility. This is link to a website I like for information on IBD. They encourage a raw diet which is a lot easier than it may sound. There are pre-mixes that you can add to raw or cooked food that supply all of the necessary supplement to make sure your cat's diet is nutritionally complete. However, there are low carbohydrate canned foods and raw-based commercial foods that contain limited proteins.
 
Thanks for the responses so far. The vet did mention giving shots twice a day as an option, but since I was just starting, I thought once a day would be easier to handle. She didn't indicate a strong enough preference, so we went with that approach.

I can try twice a day shots. Do you really think that could bring down his numbers with that change alone?

What do you think about Smalls food? We've used that in the past. Although not technically "raw food" as far as I know, it's described as "gently cooked," which is an enjoyable phrase. Is that helpful to reintroduce into Sheldon's diet?
 
I'm going to speculate since you don't have a spreadsheet for Sheldon to look at so I really can't give a fully informed answer.

Lantus is one of the longer acting insulins available. The longer duration is due to it being a depot type of medication. What that means is that when you give an injection, the insulin forms microcrystals that deposit in the fat tissue. Those crystals mostly dissolve over the course of a 12 - 14 hour cycle. However, not all of the crystals dissolve which allows for some overlap between cycles and there's always a small amount of insulin that's bioavailable. This is what stabilizes the depot. If you give an injection only once a day, your cat is without benefit of insulin for roughly 10 hours. In addition, because of the absence of insulin beyond the action of the insulin, the depot never stabilizes. What you will see with your home testing, is that Lantus starts to work about 2 hours after a shot. The numbers theoretically continue to drop until nadir (low point in the cycle) which is roughly 6 hours later and then begin to rise until the next shot. If you give the next shot 12 hours after the previous shot, numbers will theoretically stay in a good range. If you give a shot once a day your low point is at 6 hours and then they are high until you give another shot.

The other aspect of Lantus is that it's easier to get a "flat" curve if the numbers are lower. Lantus is an insulin with a gentle action. It's not great at "yanking" high numbers down.

If you look at any of the Lantus users spreadsheets, you'll see a very different pattern than what it sounds like you're seeing. It may be that you'll need to give a higher dose but I wouldn't base any dosing on a once a day shot schedule.

You may want to take a look at the sticky notes that are at the top of the Lantus forum. They discuss the basics of Lantus and its use.
 
Sienne and Gabby (GA) said:
I'm going to speculate since you don't have a spreadsheet for Sheldon to look at so I really can't give a fully informed answer.

Lantus is one of the longer acting insulins available. The longer duration is due to it being a depot type of medication. What that means is that when you give an injection, the insulin forms microcrystals that deposit in the fat tissue. Those crystals mostly dissolve over the course of a 12 - 14 hour cycle. However, not all of the crystals dissolve which allows for some overlap between cycles and there's always a small amount of insulin that's bioavailable. This is what stabilizes the depot. If you give an injection only once a day, your cat is without benefit of insulin for roughly 10 hours. In addition, because of the absence of insulin beyond the action of the insulin, the depot never stabilizes. What you will see with your home testing, is that Lantus starts to work about 2 hours after a shot. The numbers theoretically continue to drop until nadir (low point in the cycle) which is roughly 6 hours later and then begin to rise until the next shot. If you give the next shot 12 hours after the previous shot, numbers will theoretically stay in a good range. If you give a shot once a day your low point is at 6 hours and then they are high until you give another shot.

The other aspect of Lantus is that it's easier to get a "flat" curve if the numbers are lower. Lantus is an insulin with a gentle action. It's not great at "yanking" high numbers down.

If you look at any of the Lantus users spreadsheets, you'll see a very different pattern than what it sounds like you're seeing. It may be that you'll need to give a higher dose but I wouldn't base any dosing on a once a day shot schedule.

You may want to take a look at the sticky notes that are at the top of the Lantus forum. They discuss the basics of Lantus and its use.
Click to expand...

Thank you for this. The idea of the depot is particularly interesting. I read the sticky in the Lantus forum. That clarifies the cumulative effect of dosing across the cycles.
 
Although I will stick with the AlphaTrak 3 for now since I already have it, it seems like it might be better to switch eventually to a human meter simply because many of the people and resources on here use them? Or would that not be too much of an obstacle?
 
Bron and Sheba (GA) said:
Hi and welcome to the forum.
Lantus is a twice a day insulin, not a once a day insulin. If you only give it once a day you are leaving Sheldon without insulin for 12 hours and his blood glucose (BG) will rise back up high during the period he does not have insulin.
Cats have a much faster metabolism than dogs and humans and that is why they need insulin twice a day.

If Sheldon was my cat I would give him 1.5 units of Lantus twice a day…12 hours apart.
You need to feed a good meal before every dose of Lantus and then offer 2 or 3 snacks of low carb food during the first half of all the cycles.

I would also test before every dose of insulin to make sure it is safe to give the dose. And then test at least once sometime around +4 to +7 to see what the lowest point in the cycle is. Lantus dosing is based on the nadir not the preshot BG so it is important to find out what the nadirs are.

Would you like to setup one of our spreadsheets? We can then help you with the dosing
Here is the link to the SS HELP US HELP YOU

I would ask the vet about swapping from prednisolone to budesonide. It is better for diabetic cats.


Until we can see some data on a spreadsheet we can’t tell if an increase in dose is needed. First I would change to twice a day dosing of 1.5 units and see how he goes with that.
If you can get a test in before every dose and then one test at least between the cycles, you don’t need to really need to do a curve.
And you don’t wait until he gets into better numbers to do a curve or collect data. We need to see what is happening now:)

Keep asking questions
Click to expand...

This is great. Today, I gave Sheldon 1.5u at 12pm and will go with the 12-hour cycle. I'll test him at +6 for now as a starting point.

I've setup a spreadsheet, started entering data, and put it in my signature. Hopefully that works.
 
The human meter is like $9 at Walmart in the US. Everything here is human numbers so it’s just easier. Then keep AT as a backup or if the vet asks. Welcome to the board!
 
Rishi said:
This is great. Today, I gave Sheldon 1.5u at 12pm and will go with the 12-hour cycle. I'll test him at +6 for now as a starting point.
I've setup a spreadsheet, started entering data, and put it in my signature. Hopefully that works.
Click to expand...
Well done in getting sorted out promptly. Thank you. It makes it much easier for us to help Sheldon.
Looking at the +6 today I think Sheldon is most likely bouncing from lower numbers with the 3 unit dose you were giving. You might not have seen the lower numbers but they could well have happened.
Don’t get disheartened with the higher numbers for a couple of days. Bouncing is very common in newly diagnosed cats.
Here is an explanation on bouncing
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Looking forward to seeing the next several days data.
 
The other big plus with a human meter is the cost of strips. All of the human meters use strips that cost less than the $1.00 each for an AT strip. As a comparison, if you get the Walmart brand meter -- the Relion -- the strips cost $0.17. That's a huge savings.
 
Sienne and Gabby (GA) said:
The other big plus with a human meter is the cost of strips. All of the human meters use strips that cost less than the $1.00 each for an AT strip. As a comparison, if you get the Walmart brand meter -- the Relion -- the strips cost $0.17. That's a huge savings.
Click to expand...

True, true. I'll buy one of those, probably the Relion, and then set up a new/separate spreadsheet for that eventually. I'll stick with the AT3 for the moment just to get sorted with the tracking and dosing.
 
Bron and Sheba (GA) said:
Well done in getting sorted out promptly. Thank you. It makes it much easier for us to help Sheldon.
Looking at the +6 today I think Sheldon is most likely bouncing from lower numbers with the 3 unit dose you were giving. You might not have seen the lower numbers but they could well have happened.
Don’t get disheartened with the higher numbers for a couple of days. Bouncing is very common in newly diagnosed cats.
Here is an explanation on bouncing
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Looking forward to seeing the next several days data.
Click to expand...

BTW, Sheldon's AMPS reading today was 676, the highest yet. A little concerning, although he seems ok. I gave him a snack just before the reading and shot (Halo freeze-dried raw 100% chicken breast treats).

This must be part of the "bouncing" you mentioned? Will it take 6 or so cycles (3 days) to give this a proper try?



Also: Can I still use this thread for the time being, or should I start a new daily thread as per the guidelines?



Thanks again!
 
Yes you can stay with this thread for now. We don’t like them to get longer than 50 replies as it is a lot for helpers to read through to help.
When you do start a new thread, can you copy and paste the previous thread for continuity. You can change the subject line of this thread at any time.
Bounces can last for up to three days. We don’t know what happened before you tested, we just have to wait and see.
He may need more insulin…only time will tell.

Are you testing for ketones? With high BGs it is a good idea to test for them a couple of times a week. You will need a bottle of Ketostix from a pharmacy for that and a urine sample from Sheldon.
Collecting a urine sample
 
Bron and Sheba (GA) said:
Yes you can stay with this thread for now. We don’t like them to get longer than 50 replies as it is a lot for helpers to read through to help.
When you do start a new thread, can you copy and paste the previous thread for continuity. You can change the subject line of this thread at any time.
Bounces can last for up to three days. We don’t know what happened before you tested, we just have to wait and see.
He may need more insulin…only time will tell.

Are you testing for ketones? With high BGs it is a good idea to test for them a couple of times a week. You will need a bottle of Ketostix from a pharmacy for that and a urine sample from Sheldon.
Collecting a urine sample
Click to expand...

Haven't started with the ketone testing yet. I remember getting a blood ketone monitor for myself years back, but don't know if I still have it. However, I've found it difficult to get Sheldon to pee
into a litter box with non-absorbent pellets in it. He did so before, but for whatever reason, it's a challenge now. Will figure it out though.

BTW, he tested 518 about 20 minutes ago, before his first shot of the day. He also seems a bit weaker, slower to climb stairs, etc. Taking him to the vet this afternoon.

Today is the 3rd day of this new protocol. If there's no improvement in his numbers today, I think I need to change something. I'll see what the dr. says, but I hope it can be coordinated with
the advice I'm getting here.


Thanks,

Rishi
 
Rishi said:
What do you think about Smalls food? We've used that in the past. Although not technically "raw food" as far as I know, it's described as "gently cooked," which is an enjoyable phrase. Is that helpful to reintroduce into Sheldon's diet?
Click to expand...

Smalls is fine. It does have useless fillers in it (the vegetables) but not a problem. You can make your own cooked cat food without useless fillers with a pre-mux supplement such as Food Fur Life. Many cats enjoy a variety of foods in their diet.
 
If you haven’t been to the vet yet I would ask for a ketone test just to check there are no ketones. I always get concerned if I hear a kitty is weaker or more lethargic
And a blood ketone meter is fine to use if you have one.
I see he dropped to 232 at+3.5 Have you tested again since then?
 
Bron and Sheba (GA) said:
If you haven’t been to the vet yet I would ask for a ketone test just to check there are no ketones. I always get concerned if I hear a kitty is weaker or more lethargic
And a blood ketone meter is fine to use if you have one.
I see he dropped to 232 at+3.5 Have you tested again since then?
Click to expand...

Just tested now at +6. It was 440. Is there any reason to hold off on increasing his dose starting tomorrow? Unless his PMPS reading tonight (around midnight) is also substantially lower than the usual, then maybe not.
 
Rishi said:
Just tested now at +6. It was 440. Is there any reason to hold off on increasing his dose starting tomorrow? Unless his PMPS reading tonight (around midnight) is also substantially lower than the usual, then maybe not.
Click to expand...
We really need to see a few tests taken in the on cycle before recommending an increase in dose. Sheldon could be dropping lower at night and we don’t know. Can you do that?
 
Can see in the SS the vet says to increase the dose of insulin. I would wait for another couple of days to let the depot fill. Up until 3 days ago you were only giving the insulin once a day.
And when you do increase, I would only go up to 1.75 units. You can’t rush this journey.
And I would ask before you increase to check it is still ok to do so.
It’s good to see he is responding to the insulin.
 
Bron and Sheba (GA) said:
Can see in the SS the vet says to increase the dose of insulin. I would wait for another couple of days to let the depot fill. Up until 3 days ago you were only giving the insulin once a day.
And when you do increase, I would only go up to 1.75 units. You can’t rush this journey.
And I would ask before you increase to check it is still ok to do so.
It’s good to see he is responding to the insulin.
Click to expand...

Just tested at +8.75, and the result was 140! I did leave him some food before going to bed as well, and he did eat most of it sometime in the 3-4 hours before the reading.

I think you're right. I will wait and see how the numbers move at this dosage.


Thanks again!
 
Rishi said:
Just tested at +8.75, and the result was 140! I did leave him some food before going to bed as well, and he did eat most of it sometime in the 3-4 hours before the reading.

I think you're right. I will wait and see how the numbers move at this dosage.


Thanks again!
Click to expand...
Now that you have seen a blue BG with this dose, you need to stay with this dose for at least 10 cycles.
The bouncing makes it look as if it isn’t a good dose but it is
 
Bron and Sheba (GA) said:
Now that you have seen a blue BG with this dose, you need to stay with this dose for at least 10 cycles.
The bouncing makes it look as if it isn’t a good dose but it is
Click to expand...

Makes sense to me. I will stick with this. Definitely want to be careful about numbers that get too low.

Speaking of that, someone else in the house gave him a very small amount of vanilla cream filling (from a cookie) shortly after his 12pm dose. I prefer to just give him his regular low-carb food right after the shot, but she felt he hadn't eaten enough of it. His AMPS reading was 395.

Is there a problem with that? If it's a very small amount (finger tip sized), will that still skew a mid-cycle reading 4-5 hours later?


Thanks

p.s. got my ReliOn Premier Classic meter and strips today.
 
Rishi said:
someone else in the house gave him a very small amount of vanilla cream filling (from a cookie) shortly after his 12pm dose
Click to expand...
It is better to stick with the low carb treats as the vanilla cream filling would have been high carb. It can be surprising how little high carb can raise the BGs. It wont do any harm except raise the BGs but I would stick with low carb:)
 
Sugar is a no-no for any diabetic. Keep diabetic-friendly low carb and sugar free treats on hand if someone feels the need to give a treat.
 
Bron and Sheba (GA) said:
It is better to stick with the low carb treats as the vanilla cream filling would have been high carb. It can be surprising how little high carb can raise the BGs. It wont do any harm except raise the BGs but I would stick with low carb:)
Click to expand...

Agreed. Is it possible that even a little bit of high-carb snack will skew the BG readings for even 12-24 hours afterwards?

BTW, I started using the ReliOn a little bit, along side the AlphaTrak 3, from the same drop of blood, etc. I've noticed that the ReliOn gives a reading 25-50 points *higher* than the AT3. From my cursory searches, it seems that the human meters should usually read *lower* than the pet meters.

Is that not always true? There's no control solution, etc. to test the ReliOn with, so is it possible the meter/strips aren't operating within the normal parameters?
 
Rishi said:
There's no control solution, etc. to test the ReliOn with, so is it possible the meter/strips aren't operating within the normal parameters?
Click to expand...
You can order free Relion control solution every 10 weeks! Just google that and it’s the first link.
 
Rishi said:
Agreed. Is it possible that even a little bit of high-carb snack will skew the BG readings for even 12-24 hours afterwards?
Click to expand...
A high carb snack will effect the cycle it is given in as the higher carb food will probably shorten the effect of the insulin.
Rishi said:
BTW, I started using the ReliOn a little bit, along side the AlphaTrak 3, from the same drop of blood, etc. I've noticed that the ReliOn gives a reading 25-50 points *higher* than the AT3. From my cursory searches, it seems that the human meters should usually read *lower* than the pet meters.
Click to expand...
In my experience the AT meters read higher than the human meters.
I would stick with one or the other of the meters, otherwise it will drive you crazy.
 
Bron and Sheba (GA) said:
Now that you have seen a blue BG with this dose, you need to stay with this dose for at least 10 cycles.
The bouncing makes it look as if it isn’t a good dose but it is
Click to expand...

Ok, it's been at least 10 cycles since that blue BG reading. Think it's safe to move the dose up to 1.75u twice daily?
 
Bron and Sheba (GA) said:
Yes. Good luck with the increase in dose
Click to expand...

Hello! It's been over a week since this dose increase. Seems to be going well.

I know I don't have as much data over the last few days, particularly after the PM shot, but it seems the numbers might still be trending down.

Would you leave the dose at 1.75u, or increase to 2u? My instinct is to wait a little while longer to see if the numbers continue to drop mid-cycle, etc.


Thanks
 
If you could get a curve done…that is every 2 hours for 12 hours, that would be good or at least try and get at least one test in every cycle as well a the preshot BG.
If could do that we can look at an increase. We don’t want to leave him in those high numbers longer than necessary…
 
Bron and Sheba (GA) said:
If you could get a curve done…that is every 2 hours for 12 hours, that would be good or at least try and get at least one test in every cycle as well a the preshot BG.
If could do that we can look at an increase. We don’t want to leave him in those high numbers longer than necessary…
Click to expand...

Hello! I thought I posted a reply a few days ago, but apparently not.

1. Although I haven't done a full curve yet, I did get a few more mid-cycle numbers. It was pretty steady in the mid 300 to mid 400 range. I decided to move up to 2u on 2/14. If you think that's hasty, let me know.

It seems like he might be bouncing to higher numbers since the increase, but I haven't caught any mid-cycle numbers that seem low enough to explain that. Maybe a full curve is needed to assess, or maybe just a few
more cycles to see if this starts trending lower?


2. Btw, I think the ReliOn meters just aren't going to work for me. I bought a 2nd one to try, same weird (much higher than AT3) numbers. I got the free control solution and tested one of the meters. It was within range.

I've tried 5-10 simultaneous readings with a FreeStyle human meter as well, and that's more reasonable. At first, it was giving slightly higher readings than AT3, now the last few readings are 20-70 points lower than the AT3.
 
Rishi said:
Hello! I thought I posted a reply a few days ago, but apparently not.

1. Although I haven't done a full curve yet, I did get a few more mid-cycle numbers. It was pretty steady in the mid 300 to mid 400 range. I decided to move up to 2u on 2/14. If you think that's hasty, let me know.

It seems like he might be bouncing to higher numbers since the increase, but I haven't caught any mid-cycle numbers that seem low enough to explain that. Maybe a full curve is needed to assess, or maybe just a few
more cycles to see if this starts trending lower?


2. Btw, I think the ReliOn meters just aren't going to work for me. I bought a 2nd one to try, same weird (much higher than AT3) numbers. I got the free control solution and tested one of the meters. It was within range.

I've tried 5-10 simultaneous readings with a FreeStyle human meter as well, and that's more reasonable. At first, it was giving slightly higher readings than AT3, now the last few readings are 20-70 points lower than the AT3.
Click to expand...
@Bron and Sheba (GA)
 
Bron and Sheba (GA) said:
What dosing method are you following?
Click to expand...

I didn't specifically choose a method per se, but I have looked at the sticky in the Lantus forum about TR / SLGS.

Since this is relatively new and his numbers are still quite high, I've just been using the guidance in this thread to increase dose, which seems more similar to the TR method perhaps,
but not in every detail.
 
Rishi said:
I didn't specifically choose a method per se, but I have looked at the sticky in the Lantus forum about TR / SLGS.

Since this is relatively new and his numbers are still quite high, I've just been using the guidance in this thread to increase dose, which seems more similar to the TR method perhaps,
but not in every detail.
Click to expand...
Have a good look at both the dosing methods and see which one suits you best. To do TR you need to test at least twice every cycle (preshot and during the cycle) and only be feeding low carb wet food.
Once you choose a dosing method we can help you with dosing.
 
Bron and Sheba (GA) said:
Have a good look at both the dosing methods and see which one suits you best. To do TR you need to test at least twice every cycle (preshot and during the cycle) and only be feeding low carb wet food.
Once you choose a dosing method we can help you with dosing.
Click to expand...

Ok. I'm testing 3-4 times a day now usually, and the diet is basically all canned wet food and home made or fresh proteins and fats with very little carbs.

Is TR more effective for achieving remission, or more quickly? I can test 4-6 times a day. It seems like I'm a bit closer to that method anyway. I'm still on the AT3 while I test out other human meters to see how they relate before switching over.

I also tested his ketones with a blood meter and they seem to be low: 0.4 - 0.5 mmol/L
 
Rishi said:
Ok. I'm testing 3-4 times a day now usually, and the diet is basically all canned wet food and home made or fresh proteins and fats with very little carbs.

Is TR more effective for achieving remission, or more quickly? I can test 4-6 times a day. It seems like I'm a bit closer to that method anyway. I'm still on the AT3 while I test out other human meters to see how they relate before switching over.

I also tested his ketones with a blood meter and they seem to be low: 0.4 - 0.5 mmol/L
Click to expand...
@Bron and Sheba (GA)
 
With TR you can increase every 3 days if needed. With SLGS you can increase after 7 days if needed.
TR is more aggressive and you will get results quicker but you have to be testing more often.
 
Bron and Sheba (GA) said:
With TR you can increase every 3 days if needed. With SLGS you can increase after 7 days if needed.
TR is more aggressive and you will get results quicker but you have to be testing more often.
Click to expand...

@Bron and Sheba (GA)

Ok, I think a TR approach make sense for us. But, do you agree with raising by .5u when nadirs are 300+? Or stick to 0.25u increases only?

Also, is this even possible while still using AT3 numbers, or do I need to fully switch over to a human meter and start that spreadsheet first?

p.s. I'm doing a curve today, every 2 hours.
 
Rishi said:
@Bron and Sheba (GA)

Ok, I think a TR approach make sense for us. But, do you agree with raising by .5u when nadirs are 300+? Or stick to 0.25u increases only?

Also, is this even possible while still using AT3 numbers, or do I need to fully switch over to a human meter and start that spreadsheet first?

p.s. I'm doing a curve today, every 2 hours.
Click to expand...
If you have decided to do TR can you put that into your SS and signature please?
It is easier for us if you are using a human meter as our dosing methods are based on the human meter numbers. You can just swap to the human meter and I can get @Bandit's Mom to fix the SS for you if that’s what you decide.
Let’s see what the curve shows us today before deciding on the dose moving forward.
If the BGs are all over 300 then you would go up by 0.5U
This 0.5U increase would just be a one off and we would see how the numbers are tracking before deciding how much you would increase, if another increase is warranted, at the time. Does that make sense?
 
Bron and Sheba (GA) said:
If you have decided to do TR can you put that into your SS and signature please?
It is easier for us if you are using a human meter as our dosing methods are based on the human meter numbers. You can just swap to the human meter and I can get @Bandit's Mom to fix the SS for you if that’s what you decide.
Let’s see what the curve shows us today before deciding on the dose moving forward.
If the BGs are all over 300 then you would go up by 0.5U
This 0.5U increase would just be a one off and we would see how the numbers are tracking before deciding how much you would increase, if another increase is warranted, at the time. Does that make sense?
Click to expand...

So far today, these numbers are frustrating because I don't see much of a dip at all. I think he's been at this dose long enough to see an improvement, but it just seems worse.

It seems going up in dose at this time makes sense, but are you saying that I shouldn't do more 0.5u increases in the future, even if the nadirs remain high?
 
Rishi said:
So far today, these numbers are frustrating because I don't see much of a dip at all. I think he's been at this dose long enough to see an improvement, but it just seems worse.

It seems going up in dose at this time makes sense, but are you saying that I shouldn't do more 0.5u increases in the future, even if the nadirs remain high?
Click to expand...
What I am saying is… it will depend how the BG numbers are going as to whether you do increases of 0.25 or 0.5 unit. Each increase is looked at on its own.
You can’t rush this process. It’s a marathon not a race. I know it’s frustrating.
Let’s see how it goes with this increase. Make sure you get at least one test in every cycle:banghead:
 
Bron and Sheba (GA) said:
What I am saying is… it will depend how the BG numbers are going as to whether you do increases of 0.25 or 0.5 unit. Each increase is looked at on its own.
You can’t rush this process. It’s a marathon not a race. I know it’s frustrating.
Let’s see how it goes with this increase. Make sure you get at least one test in every cycle:banghead:
Click to expand...

@Bron and Sheba (GA)

Ok. I increased to 2.5u last night for the PM shot. His AM reading at +8.5 was 152, the lowest reading in a while.
 
Bron and Sheba (GA) said:
Ok. Stay with this dose unless it drops under 50 in which case you would reduce the dose back to the previous dose.
Yes the black AMPS is a bounce from the yellow BG the night before
Click to expand...

@Bron and Sheba (GA)

Just a while ago, I tested him at +6.25 and he was 56 on the AT3, and LO on the FreeStyle Lite human meter. That was quite a surprise. He also threw up various foods in various places over the last few hours.

He didn't exhibit any strange behaviour like dizziness, seizures, etc. Just a little unhappy and sitting on the couch. I gave some high-carb snacks, food, etc and checked again in 15-20 minutes, and saw some rising
numbers, albeit slowly (42 on the Freestyle and 67 on the ReliOn Compact). Will keep feeding and testing.

I assume there's no real reason to go to emergency unless there are symptoms, but it's a little concerning.
 
56 is too low in the AT3..
You need to reduce the dose back to 2 units at the next dose.
Keep testing the BG to make sure it stays up over 50 on the human meter and 68 on the AT3
 
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