? 6/3 (June)- Bella Insulin increase. BG 28-11.9

I have been reading the Tight Regulations Protocol- I believe we are due for an increase from 2U to 2.5U for 3 days? Have I understood it correctly?
https://docs.google.com/spreadsheets/d/122kuqwMWNe78vVA1q6HDRl8qTvU4MGP5mBBl-aQoGXI/edit

 

To answer your question - no on the increase. In fact, she earned a reduction down to 1.75 units when she got that 38 (2.1) on May 28th. The Tight Regulation protocol says to reduce by 0.25 units when they go under 50 (2.8). Following the TR protocol also means getting at least two tests per cycle, including the PM cycle, which means the preshot test plus one other. TR is a somewhat more aggressive protocol and getting minimum number of tests is what allows you to follow it safely. It's possible you've been missing some other low numbers during the night. You don't have to test at nadir, but a before bed test, if at least 2-3 hours after shot time, will tell you if she's going to go lower at night.

Can you tell me a little bit about your cat and how she was diagnosed? What dose did she start at? How did she get up to 2.0 units. Increases with TR are by 0.25 units at a time if nadirs are below 300, so even if she did need an increase, it wouldn't be by 0.5 units.

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Thanks for that… a little about Bella.

Bella 15 year old, tonkanese 3.5kg
Diagnosed Chronic Kidney Disease stage 1/2 (22/3/23 -blood work showed NO diabetes), dental/parathyroid cancerous mass surgery/removed successfully (29/3/23)- two/three weeks post surgery started showing symptoms and diagnosed Diabetes (28/4/23).

My old vet said she will be on insulin the rest of her life, (started on 2U - 28/4/23, remain 2U -3/5/23, 3U - 10/5/23 then 4U -24/5/23 @ each date we had an appointment and BG check.) and said she needs RC renal diet- this vet also said home testing was not necessary. I can only assume my old vet ment she will be on insulin ongoing because of the renal diet prescribed.

Anyhow last weekend I finally bought a home test because she was off on Saturday/Sunday and the FB group plus an after hours vet helped me get her through a Hypo 2.1 on 28/5/23- we skipped the dose that night. I have decided to see the new (after hours) vet, we have had a few phone calls and our first appointment is next Wednesday. After Hypo we started on 1U but the when numbers were over 20+ the advice was to increase to 2U This new vet has her on 2U Glargine, said we need to give her a good week to settle before anymore tests. The new vet wants to investigate the impact of having two parathyroid removed. Plus the new vet suggested to feed her anything because she is picky and we want her eating.

So I’ve been doing a combo of FF pate, FF Gravy Centre, tuna, and RC renal biscuits. Some days she is easy but other days she just sniffs and moves on until I find what she wants. Yesterday she has not touched the FF Chunky chicken but happy to eat RR renal biscuits‍♀️ ‍♀️ I do feel I’m wasting so much food but I do want her eating. Most days I try to avoid the biscuits if she will eat something else. Bella is also free feed as she has always grazed.

Sorry I’ve misunderstood the TRP, only read today and clear I need another read as well as more data. Hard to balance vet advice and this page.

Now totally unsure, does Bella need a decrease or should she remain on 2U now you have more information?

 

@Wendy&Neko does Bella still require a decrease after this background information? Do I need more data BG Checks before I do anything?

 

Just FYI, she had been giving 4 units twice a day but Bella had starting acting weird a few days before she started testing so even though she hypo'd on 2U, it's probably from the carryover of the 4U dose

Here's her spreadsheet. I'll try to help her tomorrow (later today) with her Signature.

https://docs.google.com/spreadsheet...XUlYvVcr26Yv_Be4QE8QY9bkMfmeOvp12j2LLUs#gid=5

 

I'd love to see the previous record of units shot on the spreadsheet, which is why I asked how she arrived at a 2 unit dose. You don't "need a good week" to settle on a dose. But a couple more days with data in both the AM and PM cycles will tell us if she's diving down, which would indicate an overdose.

 

@Wendy&Neko great idea I can easy back date it - but I was not home tested but it will give better insight into our journey

 

She didn't start home testing until the 28th. She started due to how strange Bella had been acting the past few days. From what I understand, she just pulled the 2U out of thin air to see if Bella continued to act strange (but I'm sure glad she did!) Then when Bella hypo'd, she was getting help from an ER vet as well as from group members on what to do to get her up into safer numbers and the ER vet told her to continue on the 2u dose. (and then we got her posting here)

@TaraAllington if any of the above is wrong, please correct it in your new thread today.

I also just found out that she removed the kibble, and her AMPS looks much better!

Since the only syringes she has are whole unit and she needs to give the insulin (she stalled at the 9.2 AMPS), I suggested 1.5 since it could take some time to figure out where she thinks the .25 and .75 doses are going to be

I've also told her to get a +2 to start with and to come here and start a new thread for today.

 

Just a few previous days, showing what dose was shot would help. Most people take a while to start testing, so we understand.

Looks like the reduction was needed.

 

So my old vet had prescribed 4U on 24/5 after BG check but I have been told if I’m doubt she has eaten enough just to half her dose. So on the Saturday 27th PM shot and Sunday 28th AM shot I halved because she was off. On the Sunday I bought a home test monitor and tested as soon as I got home. Got through the Hypo with FB group support and an after hours vet whom I have changed to now. The new vet initially started her on 1U. He did a calculation and came up with 1.75-2U based on her body weight because her numbers had gone high again he suggested 2U.