7/12 Jessi, PMPS 267 +1 282 +2 259 +3 203 +4.5 187 +5.5 229, took the reduction

[Stefania S]

https://www.felinediabetes.com/FDMB...8-3-5-276-5-264-stress-another-bounce.279426/

and she just vomited her meals

Feeding MC 12% and LC, should I wait knowing Libre reads low before pulling out HC??

Will post more numbers soon, this one caught me by surprise while I was busy with something urgent.

Numbers dropped fast starting at +1

I don't know if this qualifies as a 911 so I took it off. She is not symptomatic and I can't know for sure what the 'real' BG number is. On the Libre it only shows me 'LO' meaning below 50, I think, but I don't know how far below and this is a very early onset and nadir.

 

[Bandit's Mom]

Did you feed HC? Any scans after?

ETA: I see a 51 at +4. What did you feed?

 

[Stefania S]

Did you feed HC? Any scans after?

ETA: I see a 51 at +4. What did you feed?

after she vomited I fed almost a half pouch of MC, it's actually 12% carbs, I made a mistake and after I gave her some of her LC too which has some squash in it. she is at 45 now on the Libre.

Attempted to coax her to the spot for a blood test, but she could feel it coming from a mile away and went into hiding.

Her behavior and appearance is normal.

 

[Stefania S]

I forgot to refresh the page earlier so I didn't see your message until now, Bhooma.

 

[Bandit's Mom]

I see she is still swimming with the sharks - at least as per the Libre. What are you feeding her? It might be better to take a reduction to be on the safe side.

 

[Nimi S]

Wow, she’s finally up! I’m impressed you didn’t break out the honey or HC
That must have been a long 5 hours..good thing it’s during the day

 

[Stefania S]

we're at 71 right now, looks like she's starting to head up, hopefully not too quickly...

I wish I could get a BG test because I'm pretty sure those numbers are nowhere near as low as they seem on the Libre. It's a shame to take a reduction. What if I just skinny the dose rather than doing an entire .25? In any case the differences are so tiny. Yesterday at PM shot I opted for a teeny tiny bit less than 1, today I opted for a teeny tiny bit more, mostly because it's so hard to get it exactly right. It can't be that that tiny bit made the difference between up in the upper 200s and low 300s and today's low greens...can it? I hope not because I'll never be able to regulate her if that's the case.

 

[Staci & Ivy]

Hi Stefania, I have found that on the Libre “Lo” and 40s readings are usually under 90 on a human meter when I cross check.
50s numbers are usually around 100 or higher.
If you can check with human meter, that’s when I cross check to be sure what is going on.
I am using the Libre 3 but probably very close to the Libre 2.
I hope you and Jessi and doing well. Sending you big hugs of support.

 

[Stefania S]

Wow, she’s finally up! I’m impressed you didn’t break out the honey or HC
That must have been a long 5 hours..good thing it’s during the day

Her digestive system is somewhat compromised and slow, so when she vomited, that's when I got nervous for real. That meant we were now several steps behind in getting glucose into the bloodstream and we had to catch up. I gave more MC and after LC and watched closely. She's pretty carb sensitive, it just takes her digestive system longer than a perfectly normal one to break the food down.

Actually, these days I avoid HC and sweet stuff as long as I can because of how much it spikes her BGs. Like you said your mother said, in that case why are you giving her insulin for? (or something like that)

Why disrupt her healing greens when I can just get her to coast and stay above the 40 mark on the Libre. It definitely kept me running around on my tippy toes today, yup, and that was while managing several other stressful situations simultaneously, but I knew we had leeway because of the Libre's lower reads. And since we have been down here many times before, we're both getting the hang of it.

I just so wish I could get some blood tests in.

I'm actually at the point where I want to do them, that's a big shift for me. The times I managed to get the needles in, even though I did hit the marginal veins too many times, I also was able to hit the sweet spot and get blood with almost every try. I just couldn't get it onto the darned stick. Have to work on that. But Jessi is veeeery wary of it. She knew what I had in mind today and started hiding preemptively when I offered her treats in our usual place. Clever girl. Way too clever! So I didn't push because I know it has to happen in a way that is at least tolerable to her. This is one kitty that remembers and she'll be looking over her shoulder even more if I force it.

I better not get too complacent here though, sometimes the numbers go back down again...

 

[Nimi S]

Actually, these days I avoid HC and sweet stuff as long as I can because of how much it spikes her BGs. Like you said your mother said, in that case why are you giving her insulin for? (or something like that)

Why disrupt her healing greens when I can just get her to coast and stay above the 40 mark on the Libre. It definitely kept me running around on my tippy toes today, yup, and that was while managing several other stressful situations simultaneously, but I knew we had leeway because of the Libre's lower reads. And since we have been down here many times before, we're both getting the hang of it.

LOL. Never thought my mom would be quoted by someone else on this board
But you’re right. It’s good to surf the greens. I was usually too chicken to look at the 40/50s and would give honey and he’d jump to the 70/80s then.

But Jessi is veeeery wary of it. She knew what I had in mind today and started hiding preemptively when I offered her treats in our usual place. Clever girl. Way too clever! So I didn't push because I know it has to happen in a way that is at least tolerable to her. This is one kitty that remembers and she'll be looking over her shoulder even more if I force it.

I can imagine Jessi giving you the side eye (¬_¬) and noping out of your reach. I used to have a very food motivated paraplegic cat once, who needed a ton of medicines. I used to lure him with food but he caught on to my intentions pretty quick and would try to escape. They’re too smart

I better not get too complacent here though, sometimes the numbers go back down again...

Yep, I’ve had the honey wear off on me a few times and his BG drop to the 50s again. But in your case, since you aren’t using honey, I guess you don’t see an immediate bump and drop.

 

[Stefania S]

+8 151

what a ride!

I just realized it truly is like surfing, not that I have done much of that I my life, but...at first, you're kind of afraid to get out on the water, maybe you find ways to avoid it, just hang out in the nice, mellow, shallow waters near the shore, then a little further out where the water is up to your waist...then a wave grabs you and out you go, and if you're lucky you manage to stand on that board you had strapped to your ankle for a few moments, then you fall into the water, get back up, fall in, get back up...and by the time you're back in calm, shallower waters, you're panting and out of breath but you feel exhilarated and satisfied that you did it!

that's if you can keep from getting dragged under by the undertow!

ooh, good metaphor y'all! it works!

 

[Stefania S]

LOL. Never thought my mom would be quoted by someone else on this board
But you’re right. It’s good to surf the greens. I was usually too chicken to look at the 40/50s and would give honey and he’d jump to the 70/80s then.

Hee, hee, see what happens when you quote your mom! Better think twice next time!

If I give her honey she'll jump much farther than the 70/80s unless something is off. But then, I'm looking at the Libre, and that could distort everything.

I can imagine Jessi giving you the side eye (¬_¬) and noping out of your reach. I used to have a very food motivated paraplegic cat once, who needed a ton of medicines. I used to lure him with food but he caught on to my intentions pretty quick and would try to escape. They’re too smart

No, she doesn't waste time with any side eyes because she's already trotting on under the bed where I let her believe she is safe from me...for now.

Yep, I’ve had the honey wear off on me a few times and his BG drop to the 50s again. But in your case, since you aren’t using honey, I guess you don’t see an immediate bump and drop.

True, but I have had it happen even without sweets, that it seemed to be going up just to plop down again. Not today, though!

 

[Stefania S]

Hi Stefania, I have found that on the Libre “Lo” and 40s readings are usually under 90 on a human meter when I cross check.
50s numbers are usually around 100 or higher.
If you can check with human meter, that’s when I cross check to be sure what is going on.
I am using the Libre 3 but probably very close to the Libre 2.
I hope you and Jessi and doing well. Sending you big hugs of support.

Hi Staci, I know, I have gotten that from several members over the last months since I joined the forum. And I soooo want to check her BGs especially when they're super low or super high on the Libre. So many people say that both extremes are exaggerated with the sensor. Today, I got myself all set up to test her, and as I mentioned above, Jessi was like, oh, no, not that...then again, it was in the same location as where I do everything else, including shots and bandaging. The shots she's fine with, if I'm fast. The bandaging not as much. Sooo, she was betting on avoiding whatever it was I had in mind and quickly left the scene. So I just let her and her pancreas be. They so need breaks from all the stress.

I do have it as a goal, though! So it will happen! Thanks for the hugs of support!

 

[Nimi S]

+8 151

what a ride!

I just realized it truly is like surfing, not that I have done much of that I my life, but...at first, you're kind of afraid to get out on the water, maybe you find ways to avoid it, just hang out in the nice, mellow, shallow waters near the shore, then a little further out where the water is up to your waist...then a wave grabs you and out you go, and if you're lucky you manage to stand on that board you had strapped to your ankle for a few moments, then you fall into the water, get back up, fall in, get back up...and by the time you're back in calm, shallower waters, you're panting and out of breath but you feel exhilarated and satisfied that you did it!

that's if you can keep from getting dragged under by the undertow!

ooh, good metaphor y'all! it works!

Wow. Do you write well or do you write well?
As someone who doesn't know how to swim and is scared of drowning, reading the first part gave me some anxiety

Not today, though!

Yep, Jessi's done swimming and is now drying herself off. I hope she takes her time with it

 

[Stefania S]

I see she is still swimming with the sharks - at least as per the Libre. What are you feeding her? It might be better to take a reduction to be on the safe side.

Are you still awake @Bandit's Mom? You think I should take a reduction? I'm afraid she'll go right back into higher numbers. But I will follow your guidance.

I only hesitate because so many people are telling me how much higher the actual BG is compared to the Libre lows. But safety is important.

 

[Stefania S]

Wow. Do you write well or do you write well?
As someone who doesn't know how to swim and is scared of drowning, reading the first part gave me some anxiety

Aw, thanks Nimi! That means a lot to me. I love writing and I've done a lot of it in my life but I never actually made it become a true calling. I guess there's still time...

sorry it made you anxious! I never imagined that could be an effect!

Yep, Jessi's done swimming and is now drying herself off. I hope she takes her time with it

she's going a little high now but then I did feed MC so it's to be expected. If I hadn't she might still be in blues, but it's almost shot time, so, she can't go too high!

Actually, what am I saying, there are no rules here, so she could go high too! She was supposed to go much lower last night and instead, she was all yellows and pinks.

 

[Bandit's Mom]

Are you still awake @Bandit's Mom? You think I should take a reduction? I'm afraid she'll go right back into higher numbers. But I will follow your guidance.

I only hesitate because so many people are telling me how much higher the actual BG is compared to the Libre lows. But safety is important.

Hi Stefania, just saw this. The Libre does read much lower than a regular meter. If you see @Staci & Ivy 's spreadsheet, there are several instances where the Libre has shown a number around/below 50 while the meter has shown 50 to 100 points more. Fortunately, Staci is able to verify Libre lows with a meter. My only issue is, if you cannot rely on the Libre - or do not base your dosing decisions on the Libre - then what is the basis on which you take dosing decisions/reductions in the absence of a meter reading? Take the reduction and if she doesn't hold it, maybe you could look at trying the 3 drops between 40 and 50 rule for cats that don't hold reductions.

 

[tiffmaxee]

I agree with Bhooma. You need data for dosing. Guessing can get dangerous. I would not base the decision on the Lo reading but on the other ones. When you are able to check with an ear prick again you can go with that. So I too would take the reduction.

 

[Stefania S]

Hi Stefania, just saw this. The Libre does read much lower than a regular meter. If you see @Staci & Ivy 's spreadsheet, there are several instances where the Libre has shown a number around/below 50 while the meter has shown 50 to 100 points more. Fortunately, Staci is able to verify Libre lows with a meter. My only issue is, if you cannot rely on the Libre - or do not base your dosing decisions on the Libre - then what is the basis on which you take dosing decisions/reductions in the absence of a meter reading? Take the reduction and if she doesn't hold it, maybe you could look at trying the 3 drops between 40 and 50 rule for cats that don't hold reductions.

Ok, got it. Really must get to blood testing soon. I just can’t see it happening as long as the SCC is there.

I’m not familiar with the 3 drops rule. Is that in the TR description?

 

[Stefania S]

I’m still having such a tough time with dosing. My eyes are exhausted from it. I just spent 30 minutes reducing the dose. One problem for me is how the calipers don’t rest flat against the syringe at the top the way they do on the body of the syringe. It makes seeing where the right points are very hard st least for me. I’m going to get some of those craft glasses but that won’t resolve the position of the caliper against the syringe.

How do you all resolve this?

Or am I being too perfectionistic about it?

 

[tiffmaxee]

From the sticky on earning reductions:


Newly diagnosed diabetics - less than one year since diagnosis

• reduction *earned* after a single drop below 50 mg/dL and following TR, or
• reduction *earned* after 3 dropsbetween 40 - 50 mg/dL on threeseparate days for kitties who have shown they do not hold reductions well and following TR, or
• reduction *earned* when the catregularly has its lowest BGs in thenormal range of a healthy cat (50 - 80mg/dL) and stays under 100 mg/dloverall for at least one week andfollowing TR.

 

[Nimi S]

I’m still having such a tough time with dosing. My eyes are exhausted from it. I just spent 30 minutes reducing the dose. One problem for me is how the calipers don’t rest flat against the syringe at the top the way they do on the body of the syringe. It makes seeing where the right points are very hard st least for me. I’m going to get some of those craft glasses but that won’t resolve the position of the caliper against the syringe.

How do you all resolve this?

Or am I being too perfectionistic about it?

I don't use calipers so I couldn't really visualize the problem you were describing but here's a post from Bhooma describing the set-up she uses for dosing with the calipers. It might not be helpful for the positioning issue you're facing but could help with the magnification
https://www.felinediabetes.com/FDMB...-3-108-6-61-9-79-pmps-99.270807/#post-3017060

 

[Stefania S]

From the sticky on earning reductions:


Newly diagnosed diabetics - less than one year since diagnosis

• reduction *earned* after a single drop below 50 mg/dL and following TR, or
• reduction *earned* after 3 dropsbetween 40 - 50 mg/dL on threeseparate days for kitties who have shown they do not hold reductions well and following TR, or
• reduction *earned* when the catregularly has its lowest BGs in thenormal range of a healthy cat (50 - 80mg/dL) and stays under 100 mg/dloverall for at least one week andfollowing TR.

ok, got it. So does that make Jessi a candidate? I'm pretty sure we have had issues with reductions in the past. By 'hold reduction' I assume this means, holding good numbers, but is it more specific than that?

Already this evening isn't looking good and to add to it I had to change the bandage which I had put off for far too many hours. It still stresses her, except the one occasion when she was purring the whole time...who knows....

How long will I have to hold this dose or do I have to if numbers stay high again?

 

[Stefania S]

I don't use calipers so I couldn't really visualize the problem you were describing but here's a post from Bhooma describing the set-up she uses for dosing with the calipers. It might not be helpful for the positioning issue you're facing but could help with the magnification
https://www.felinediabetes.com/FDMB...-3-108-6-61-9-79-pmps-99.270807/#post-3017060

OMG the small arms! How did I miss this? I have been trying to use the bigger arms, no wonder! Now I have to relearn how to do this.

Bhooma had mentioned about the magnifier on the phone but I couldn't figure out how to make it work out. Duh, rest it on something higher up so you don't have to hold it in your hands! Brilliant! I guess I didn't really take the time to think about it.

But I can't get the light app on the other phone I have, too old, so is there another way to get a bright screen other than the Google homepage!

 

[Staci & Ivy]

Hi Staci, I know, I have gotten that from several members over the last months since I joined the forum. And I soooo want to check her BGs especially when they're super low or super high on the Libre. So many people say that both extremes are exaggerated with the sensor. Today, I got myself all set up to test her, and as I mentioned above, Jessi was like, oh, no, not that...then again, it was in the same location as where I do everything else, including shots and bandaging. The shots she's fine with, if I'm fast. The bandaging not as much. Sooo, she was betting on avoiding whatever it was I had in mind and quickly left the scene. So I just let her and her pancreas be. They so need breaks from all the stress.

I do have it as a goal, though! So it will happen! Thanks for the hugs of support!

I know you’re dealing with a lot of factors. And Jessi isn’t cooperating with the testing program. I get it. (You should see the scratches on my arm.) Oh well.
Just keep on trying. You’re doing great with her

 

[Nimi S]

ok, got it. So does that make Jessi a candidate? I'm pretty sure we have had issues with reductions in the past.

I assume you meant to ask if Jessi's reduction history makes her a candidate for earning reductions after 3 drops between 40-50 mg/dl on 3 separate days.
While you wait for responses from the experienced folks, have a read of this post and the first 2 posts from this thread on New Dose Wonkiness & Failed Reductions (in case you already have, ignore )

By 'hold reduction' I assume this means, holding good numbers, but is it more specific than that?

I would imagine that when a dose needs to be reduced, it implies that the kitty needs lesser insulin at that point (if BG is dropping below 50 while following TR) and the newly reduced dose should be able to achieve BGs in the range of the previous dose. A reduced dose, which is not able to bring about or maintain those BGs and which instead leads to higher BGs than before, would indicate a reduction which kitty did not hold and hence a reduction which failed.
I think good numbers are subjective, since I would think good numbers are 50-100 (on a human meter) and someone else may think good numbers are 100-250. So holding a reduction would mean that the BGs don't increase beyond what they were on the previously higher dose, whatever those BGs were (i.e. good numbers as per the CG)
Sorry, this was my crude attempt at understanding and explaining it I'm sure it's a lot more refined than this

How long will I have to hold this dose or do I have to if numbers stay high again?

If you took the reduction from 1U to 0.75U, then from the thread on New Dose Wonkiness & Failed Reductions,
When following TR you'll want to hold the reduced dose:

• until kitty falls below 50 mg/dL and earns another reduction, or
• unless the reduction has failed (if you see BG numbers trending upwards after any bounce clears... you'll want to take the dose up), or
• for at least a week (stabilize the cat) if kitty's numbers maintain that of a normal cat (50mg/dL to 80mg/dL) and under 100 overall.

If the 0.75U dose did not hold and was a failed reduction, then the TR & SLGS Dosing Sticky says:

Reducing the dose:
The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.

• If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
• Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
• Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
• If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
• Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
• If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
• We've found many kitties benefit from reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission. Most kitties will be in the range of a healthy cat (50 - 80 mg/dL) overall.

 

[Nimi S]

But I can't get the light app on the other phone I have, too old, so is there another way to get a bright screen other than the Google homepage!

I think the Google homepage is a good idea. You could probably use a tablet or a laptop, if there's one handy at home, instead of the phone screen.

sorry it made you anxious! I never imagined that could be an effect!

Don't worry, I was exaggerating a bit but that speaks to how well you write too