? 5/10, Ivy AMPS 64, 149 +1, 136 +2, 184 +3, stalling (dropping) new dose 5/9, do I shoot?? New to TR

Previous post
https://felinediabetes.com/FDMB/thr...o-tr-higher-doses-causing-steep-drops.277276/
Begin a new dose yesterday morning, new to TR. She was pretty much high (morning over 400) all day yesterday and this morning. I’m ready to shoot now but she’s dropping like a rock.***
Do I shoot or do a reduced us or skip? Advice needed please, thank you.
Edit: Now at 94

 

Hi Staci, did you retest the 94?
Have you fed yet? Since this is your first lower BG, you stall without feeding and test again to see if the BG is rising. Sometimes though, the BG continues to drop without food.
If you shoot, can you monitor? Do you have a hypo kit, myriad of carbs and/ honey or karo?
With a history of ketones, we generally don't recommend skipping, but depending on the next BG, maybe a reduced dose.

 

Hi. I’m still stalling, I’m almost an hour past usual **** time. Using Libre 3 to monitor. Will test with handheld meter to double check. I will be home to monitor.

 

She’s at 106 on Contour One meter and 61 on Libre!!

 

I just fed her now. She’s at 56 on Libre

 

First YOU hold the syringe. How do you feel about shooting the full dose or would you be more comfortable reducing it to 1.5? Whatever you decide, remember this from the sticky:
"Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower".

 

I had the Libre2 for a short while (a loooong time ago) and it did read much lower than the ear prick in the blue/green range. it's great you have the contour to check them.

 

I’m terrified to tell you the truth. If I shoot 1.5 what do I do going forward? Is this dose too high for her (only 1 day into the dose?)
I’m already an hour late with dosing time. @Angela & Cleo

 

Terrified, that sounds about right .
If it were me, and this was my first lower reading (very happy to see btw) I would shoot the full dose and get a +1 and +2 to start.
With TR you can shoot any number over 50. Since this is your first blue/green and you don't have much data, giving a reduced dose may be more of your comfort level.
Either way, full or reduced, remember 2 things
1. Get a +1 and +2 to start feeing a smidge of low carb (LC) food and
2. I'll stick around

 

She’s at 64 even after eating. Do I shoot or skip dose, do you think ?

 

Food takes about 20-30 minutes to affect the bg. With ketones at diagnosis, I wouldn't skip. It sounds like maybe you're more comfortable shooting a reduced dose?

 

Ok I just gave her 1.5 units. I will continue to watch her closely. She’s at 56 now. Keeps dropping. (Her lc food doesn’t really give her a bump. It’s about 6% she eats normal homemade diet.)
Does it seem the new 3 unit dose began yesterday is too high to send her so low so quickly?
What shall I dose her this evening and going forward?
And thank you for the close supervision @Angela & Cleo

 

She’s dropping still. 54 (libre) At what point do I give her some mc food to raise the number?

 

I'm glad you shot something. Soon you'll shoot the full dose without hesitation. It takes some time, but you'll get addicted to greens.

I'm going to try and answer your questions as best as I can, but may need to tag some more experienced members to chime in .

The 56 and 54 are practically the same number and both VERY SAFE numbers. Remember she was also 106 on the Contour when the Libre read 61. All very SAFE numbers.
Do you have other food with higher carb % just in case? Do you have honey, karo or syrup?
How is Ivy acting?

 

Ok, some housekeeping while we wait for the +1 test. In the AMPS Column we're going to ask that you stack the readings so people helping can see that you stalled and shot an hour late. It should look something like this from the how to use a spreadsheet sticky:
"Sometimes it is necessary to stall at PS if the BG is too low to shoot and tests are taken every 20-30 minutes apart and must be recorded. The BGs are then “stacked” as shown below and, in this case, recorded in the +11 column so the PMPS, which was at +14 can be recorded in the PMPS column:


The above tells anyone looking at the SS that testing for PMPS began at +11.75 but the BG was too low; subsequent testing every 15 minutes occurred until the Caregiver felt the BG was safe enough to shoot at +14."

After putting in all those readings, you'll need to change the color of the cell. Then please put 1.5 in the units column so we'll know you shot a reduced dose. If you need help, let us know and @Bandit's Mom can fix it in a jiff. She's the SS rockstar.

Next, if/when the Libre gives you a number under 50, please check it with the handheld meter.

It seems to me that 3 units may have just been the "breakthrough" dose.

In order to get you back to your normal shot time, you can shoot the PM Dose 11.5 hours from this morning and again tomorrow night. Or you can shoot 15 minutes early for the next four cycles. An exception to this rule is if tonight Ivy is really high, you may be able to shoot an hour early. BUT PLEASE post for help first.

 

She’s acting fine.
Yes I have Fancy Feast Gravy lovers 20% for hc and FF Grilled 13% for mc. I have honey and karo. (I don’t love feeding her those as she has some IBD and is on a specific novel protein diet of lamb as her regular food, but in a hypo I assume it’s fine, and she loves it, lol)

 

How soon before the +1?

 

Now is +1, she’s at 149 on the Libre. Acting fine. No symptoms.
**When you said earlier that you thought the 3 units was her breakthrough dose, what exactly does that mean?
I’m also trying to work on updating the spreadsheet with the multiple tests and trying to figure that out right now so that I can post. If I can’t figure it out I will ask @Bandit's Mom for help (I see she’s the queen of ss!! )

 

Looks like Ivy's bouncing from the greens.

Basically, and most probably our kitties have been diabetic for awhile before getting the formal FD diagnosis and starting on insulin. During that time, its body got used to the higher numbers and considers them the new normal. That's a simplistic way of defining glucose toxicity.
One of the goals of insulin treatment is to get the cat in normal BG range, not what it thinks is normal. On a human meter, that would be 50-100 overall. With TR, we increase slightly (0.25 units at a time) and more often (every 3-5 days) to bring those BGs down into a better range and ultimately the coveted greens, ie the Real Normal.
When the cat has BG readings lower than what its used to (even bgs in the 200s if its used to 400-500s) it can cause a bounce.

So I meant that the 3 units may have been the "breakthrough" dose to cut through the glucose toxicity. I'll look for the stickies that it explains glucose toxicity and bouncing more eloquently than I .

 

I got you. And yes she bounces hard.
She’s definitely gotten used to being in higher numbers. Does it seem I would give her 3 units tonight if her pmps is high enough and see how her day goes?

 

Absolutely! I would give the 3 units tonight at any BG, but since you're new to lower numbers, get a AMPS +10 and see how its trending. Ivy will most likely bounce (and rightly deserved given the lower BGs than she's used to ) which will make the decision to shoot the full 3 easier. Try not to get caught up on the number of units in the syringe. A cat needs as much insulin as it needs. The numbers you want to focus on are the nadirs. Also, a cat is more than its numbers, ie the 5 Ps (peeing, pooping, preening, playing and purring). I think I hit on most of the FDMB cliches
I hope this helps with the nerves

 

Looks like you've figured out the SS Did you shoot at +13.75 when she was 54 on the Libre? (Btw, the SS says +12.75 instead of +13.75).

Angela has pretty much covered everything so I won't repeat them. Like she said, the Libre can read MUCH lower in normal numbers. And can also give wonky numbers. We always recommend cross-checking a lower number with a regular meter - especially numbers that affect dosing decisions.

 

Ok, will plan on full dose tonight 3 units, based on how it goes today. Should I give lc snacks through the day or not unless she bounces low?

Once she’s back on track, would I still consider dose increase if her Nadirs don’t consistently decrease after 3-5 days? I assume today is a wash and included in her dosing TR timeline?
Many thanks

 

Update @ +3 bg: 185, gave lc snack +2.
Will give 1 oz lc snack (normally give 2 oz lc snack @ +3 am but split snack today given Ivy’s extreme low bg, low for her on new dose).

 

You're doing great and so is Ivy. Just confirming these BGs are from the Libre? Looks like she's bouncing, so I would stick to my normal feeding schedule.
You are correct and Dose Adjustments are based on nadir .

 

Thank you so much for that information. @Angela & Cleo
I’m a little confused about where to put the SS values (since her +1, +2 etc is actually an hour later than her norm, we gave her dose 1 hour late this morning) @Bandit's Mom please advise so my SS is accurate

 

Yes, values ongoing on the Libre, you are correct. If I get an extreme low, will double check with Contour.

 

You would put all the numbers from +12 till the time you shot in the AMPS cell and then numbers after would be just as you would normal log it after the shot. So +1 after the new shot time would be in the +1 cell.

 

Fixing your previous post
https://felinediabetes.com/FDMB/thr...o-tr-higher-doses-causing-steep-drops.277276/

When you post your previous post it needs to show up in blue , that's how you know it worked ,
I'm glad Ivy's numbers came up

 

Thank you, @Diane Tyler's Mom, clearly still learning the protocol

 

No problem at all Staci