2/9 | Jude: AMPS 134; +3 64; +4 49; +4.75 69; +7 64; PMPS 64; +1 71; +2 72; +3 69; +4 73

Loving these cycles for Jude recently. Meant to follow up with you, I’m assuming the Relion transition has been going well?
 
Tim & Pookey said:
Loving these cycles for Jude recently. Meant to follow up with you, I’m assuming the Relion transition has been going well?
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Thanks, Tim! This dose has done well to get Jude into some consistent greens, for sure. He's gone a little lower than I would like at some points (and I've had to manipulate with carbs), so maybe the perfect dose for him is a tiny reduction. I'd feel more comfortable leaving him at home while I'm at work if I felt he was surfing a little higher in the greens.
And, yes, the Relion is great--especially the price :cat: I'm very glad we made the switch. I have had to poke more than once occasionally, which is something I rarely did with the AT3, but I'm becoming better at prepping the ear before the poke, which has helped that.

I hope you and Pookey have a quiet and enjoyable Sunday!
 
Tim & Pookey said:
Loving these cycles for Jude recently. Meant to follow up with you, I’m assuming the Relion transition has been going well?
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I was just attempting to find some new foods for my clowder, and I thought about you--did you find a new food for Pookey??
 
Marielle said:
I was just attempting to find some new foods for my clowder, and I thought about you--did you find a new food for Pookey??
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Congrats on the reduction! Still looking, but have you looked at Koha limited ingredient foods? Their foods check a lot of boxes.
 
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Tim & Pookey said:
Congrats on the reduction! Still looking, but have you looked at Koha limited ingredient foods? Their foods check a lot of boxes.
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I haven't looked at Koha, but I will. I was looking today at Rawz. Are you familiar with it? It's not sold anywhere close to me, so I'd have to order it from one of their dealers.
 
Marielle said:
I haven't looked at Koha, but I will. I was looking today at Rawz. Are you familiar with it? It's not sold anywhere close to me, so I'd have to order it from one of their dealers.
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Only that I’ve seen it mentioned here. I’ll check that out too. Same issue with Koha - seems like it would be online ordering, which is fine for us, just would have to stock up…
 
I'm nervous. Jude is 64 @ his PMPS; I've never shot this low before. He's been low all day and has earned a dose reduction because he fell below 50 today. Yes, I can monitor; yes, I have supplies.

Also, his appetite hasn't been as good lately since he's been in the greens.
 
You could also give him a little higher carbs at +1 and/or +2 based on tests to give him a little boost so you aren't up all night testing.

You have the means to keep him safe with tests and food. :-)
 
He might not need the HC at +2, but sometimes he sees action later in the cycle. It's better to feed the carbs in the first part of the cycle itself rather than later in the cycle.

Meant to say this earlier, but technically he hasn't earned a reduction. For long term diabetics, the reduction point is 40 with a human meter. However, I think you might be dealing with a situation where a cat hits a breakthrough dose and "flips a switch" to greens and then decides to race down the dosing ladder. So the reduction might just hold and be the first of more to come. If it doesn't hold, you can always go back up after 6-8 cycles.
 
Bandit's Mom said:
He might not need the HC at +2, but sometimes he sees action later in the cycle. It's better to feed the carbs in the first part of the cycle itself rather than later in the cycle.

Meant to say this earlier, but technically he hasn't earned a reduction. For long term diabetics, the reduction point is 40 with a human meter. However, I think you might be dealing with a situation where a cat hits a breakthrough dose and "flips a switch" to greens and then decides to race down the dosing ladder. So the reduction might just hold and be the first of more to come. If it doesn't hold, you can always go back up after 6-8 cycles.
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He was first diagnosed last March, went into remission in May, and then back into diabetes this past Oct. I thought someone here told me that cats who’ve been diagnosed for less than a year are not considered long term diabetics. Was that incorrect?
 
Marielle said:
He was first diagnosed last March, went into remission in May, and then back into diabetes this past Oct. I thought someone here told me that cats who’ve been diagnosed for less than a year are not considered long term diabetics. Was that incorrect?
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No. That was correct. Cats over a year in diagnosis are long term diabetics. But with cats trying for remission for a second time, we like to be a little aggressive wrt dosing and apply the rule for LT diabetics when taking reductions.
 
I think you’re absolutely right about the breakthrough dose. Something I’ve wanted to ask about is this. Shouldn’t we aim to get our cats within normal bg levels of 80-120? As Jude’s numbers have come down, I’ve been concerned about him being in the 70s and 60s on a regular basis because those numbers put him closer to being too low, and a possible hypo event. This is a problem for him, of course, but it’s also a problem when I’m trying to go to work and leave him alone and not worry all the time that he’s on the edge of being too low. So with this current dose, while his numbers have been in the greens, am I wrong to want to decrease the dose to get him in the 80-120 range on a steady basis, if possible. Does this make sense?
 
Marielle said:
I think you’re absolutely right about the breakthrough dose. Something I’ve wanted to ask about is this. Shouldn’t we aim to get our cats within normal bg levels of 80-120? As Jude’s numbers have come down, I’ve been concerned about him being in the 70s and 60s on a regular basis because those numbers put him closer to being too low, and a possible hypo event. This is a problem for him, of course, but it’s also a problem when I’m trying to go to work and leave him alone and not worry all the time that he’s on the edge of being too low. So with this current dose, while his numbers have been in the greens, am I wrong to want to decrease the dose to get him in the 80-120 range on a steady basis, if possible. Does this make sense?
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Tightly regulated cats can have flat and predictable cycles with greens at the lower end of the normal range with no issues. Such caregivers are used to the cats surfing the 50s and 60s through the cycle. It's unregulated cats that can go from 400 to 40, or cats that have flipped the switch, that can be unpredictable and give the CGs sleepless nights! Your wanting to keep Jude in slightly higher numbers is understandable. Unfortunately, cats do not always stick to the ranges that we want them to be in. Let us see how he does on this dose and if he looks like he is racing down the dosing ladder, we can take reductions so that he will stay in numbers that will keep him safe. :-)
 
Bhooma's point (post #25) about tight regulation is well taken. We regard normal blood glucose (BG) range as 50 - 120.

I just took a look at your spreadsheet. It looks like your plan is to follow TR. Unfortunately, how you're reducing Jude's dose is not based on TR guidelines. While I can appreciate being a bit nervous about lower numbers, how you've been reducing isn't allowing you to give Jude's pancreas sufficient support to keep him in a normal BG range. You're also not basing reductions on what TR indicates are dose reduction criteria nor holding the dose for the requisite number of days. At this point, it looks to me like you need to increase his dose if you're hoping to either keep him tightly regulated or back into remission.
 
Sienne and Gabby (GA) said:
Bhooma's point (post #25) about tight regulation is well taken. We regard normal blood glucose (BG) range as 50 - 120.

I just took a look at your spreadsheet. It looks like your plan is to follow TR. Unfortunately, how you're reducing Jude's dose is not based on TR guidelines. While I can appreciate being a bit nervous about lower numbers, how you've been reducing isn't allowing you to give Jude's pancreas sufficient support to keep him in a normal BG range. You're also not basing reductions on what TR indicates are dose reduction criteria nor holding the dose for the requisite number of days. At this point, it looks to me like you need to increase his dose if you're hoping to either keep him tightly regulated or back into remission.
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Hi Sienne, I'm sorry, but I've just now noticed this message from you. Thank you for looking at Jude's SS and offering your advice. I've had to take some reductions recently because Jude's numbers began to nose dive on each dose. I was propping him up with carbs in each cycle, but then his appetite waned (at times he refused to eat at all), and I had to resort to propping his numbers up with honey. This went on for 8 or 9 cycles. I took Jude to the vet because of his appetite (we discovered he has a UTI, that we're treating, and some dental issues). Jude's vet looked at his SS and advised that I reduce his dose from 2.75 to 2.25 because he was concerned that Jude was falling into lower numbers (again, numbers I was propping up with carbs) for several cycles. I realize that this reduction was not in compliance with the TR protocol, but I didn't want him to continue receiving a dose that was throwing him into low numbers, a dose I was fighting to keep up with carbs. It looked to me (and his vet) that the dose was simply too high. If I had not given him carbs/honey in each cycle, he very likely would have fallen below normal range (and earned a dose reduction). Even with the lowered dose to 2.25, he continued to have low numbers each cycle. I was concerned about this, and I asked on the forum for advice and the advice I received was to lower his dosage to 1.50, so that's what I did. When do you suggest I increase his dose? And to what?
 
I'd like to offer a suggestion. If you are making a dose change that isn't in line with the dosing method you're using, put a note in the comments section of your spreadsheet. I would also indicate when I was feeding Gabby higher carb food to prop up her numbers. I had no way to know why you made the changes you did and your rationale makes good sense. Not everyone opens spreadsheets. The moderators and experienced members do and it's helpful to have information both from the standpoint that you may not make a dose change immediately and it's also helpful to know if you've been steering the curve with high carb.

Also, just as an FYI, I don't push for a dose reduction based on an assumption of what a cat's numbers may do. Cats can be quite unpredictable given it's their nature to keep us confused. I generally advise waiting to see if the numbers really do drop to a dose reduction point.

Given that Jude is back seeing greens, I would hold this dose for a total of 6 cycles unless a dose reduction is indicated. I think it would be helpful to get back in the rhythm of the TR protocol.
 
Sienne and Gabby (GA) said:
I'd like to offer a suggestion. If you are making a dose change that isn't in line with the dosing method you're using, put a note in the comments section of your spreadsheet. I would also indicate when I was feeding Gabby higher carb food to prop up her numbers. I had no way to know why you made the changes you did and your rationale makes good sense. Not everyone opens spreadsheets. The moderators and experienced members do and it's helpful to have information both from the standpoint that you may not make a dose change immediately and it's also helpful to know if you've been steering the curve with high carb.

Also, just as an FYI, I don't push for a dose reduction based on an assumption of what a cat's numbers may do. Cats can be quite unpredictable given it's their nature to keep us confused. I generally advise waiting to see if the numbers really do drop to a dose reduction point.

Given that Jude is back seeing greens, I would hold this dose for a total of 6 cycles unless a dose reduction is indicated. I think it would be helpful to get back in the rhythm of the TR protocol.
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Okay, yes, I will be much more careful and diligent with my notes. I typically write what's happening in my condos, and the advice I receive is there as well, but I can see how that's not always going to be as easily accessible as the SS to someone who is not daily looking at my condos.

@Bandit's Mom is advising me too, and I just want to make sure we're all on the same page. So, in the words of the phenomenal Clash, "Should I stay or should I go" with a dose increase and when should I do so, if one is warranted??
 
You're going to hate this but the answer to your question is, "It depends." For example, I would not have suggested such an aggressive drop in dose. I thought that Christie's suggestions (I went back and read some of your older threads.) were more in keeping with how I approach dosing. I've been around here a lot longer than most members and was trained by some of the legends of this board. However, that doesn't always mean that I'm right. There are likely people who are more familiar with Jude since I tend to not be terribly available during the week and work can occupy the majority of my attention.

I would stick with my suggestion above. Hold the dose for a total of 6 cycles/3 days. Jude was back to seeing nadirs below 100 yesterday. I'd encourage you to get back to following TR and let's see how Jude is responding to the current dose. If you keep changing the dose before the depot has a chance to stabilize, the likely result will be wonky numbers.
 
Sienne and Gabby (GA) said:
You're going to hate this but the answer to your question is, "It depends." For example, I would not have suggested such an aggressive drop in dose. I thought that Christie's suggestions (I went back and read some of your older threads.) were more in keeping with how I approach dosing. I've been around here a lot longer than most members and was trained by some of the legends of this board. However, that doesn't always mean that I'm right. There are likely people who are more familiar with Jude since I tend to not be terribly available during the week and work can occupy the majority of my attention.

I would stick with my suggestion above. Hold the dose for a total of 6 cycles/3 days. Jude was back to seeing nadirs below 100 yesterday. I'd encourage you to get back to following TR and let's see how Jude is responding to the current dose. If you keep changing the dose before the depot has a chance to stabilize, the likely result will be wonky numbers.
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What am I looking for in terms of earning an increase? His 6th cycle will be tonight.
 
I'm going to hedge a bit. But, a clarification first. With TR, you evaluate the dose after a full 6 cycles. Jude's 6th cycle will be tonight. So, hold the current dose at PMPS.

I'd like to see what happens during the PM cycle. Jude bounced into the yellows and is coming back down. You would not want to increase the dose when a bounce is breaking. There can be a fair amount of downward momentum when a bounce is breaking and increasing the dose may add to that momentum. If numbers have leveled off over the rest of the AM and during the PM cycle, it would be fine to increase tomorrow morning.
 
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