? General question re dosing and acceptable range when absent

Hi all

Previous

I'm back in the office more now and have been worrying about Lily's dose with me being out.

TLDR: Keep her curve between yellow to green for long-term health or pink to blue for short-term safety?

I'm at the point of only changing it by 0.12iu because her reaction is quite different. She was still chucking me the odd low on 0.62iu but always going back up to yellow - my dreams of a lovely shallow curve are fading - and for two reasons I decided to try shaving her dose to 0.5iu. 1. in the interests of avoiding any dangerous lows I wasn't going to be around to head off, and 2. in the hope of reducing any element of bounce response in her curve. She's got a good strong response to a low and it can take her a while to settle again and it gets confusing for me what's actually going on.

You'll see I had a week of not being able to test her as much as I normally would, certainly on a new dose. The bedtime tests I did get suggested she was reacting to the insulin but not going low low, but unfortunately she was higher than usual and certainly higher than I'd like in the mornings. On the day I increased her dose again she had dandruff in her fur again, was off her food and was generally lethargic. Her ketones were 0.1 but I think I was right to think that the pinks were doing her no good. Increasing her dose back to 0.62iu had a fairly immediate effect - and I think you can see why I don't go with a 0.25iu increase any more - followed by a predictable stubborn response yesterday morning. She's eating, peeing, grooming and purring again so back to her only moderately grumpy self.

I'm at work today. I've left food down and am just crossing fingers which I don't like.

My nursing ability is severely compromised by having to go to bed and work. There's only so much I can do so please be gentle with me re testing. I haven't recorded last night's figures yet but she was yellow PMPS and PM+3 so still stubborn.

Thanks as always

Liz

 

Hi Elizabeth,

From what I understand, in order to prevent glucose toxicity you'd want to keep your cat below renal threshold. I've seen a lot of different opinions as to what that means, but I generally understand it to mean keeping your kitty in numbers below 250. That way, you will give Lily's pancreas a chance to heal and get to some of the lower numbers on her own with less insulin. Once she spends more time in those blue and green numbers, she will stop bouncing into the yellows and pinks. Being that you have a demanding work schedule, it's going to be harder to guide her towards those lower numbers unless on weekends you can do curves and test every 2-3 hours to really see what the insulin is doing over an extended period of time. I see you've also been reducing even though she hasn't gone below 50, which is not really following TR, but I know you're concerned about her dropping too low. Perhaps following SLGS would be better for your schedule and your peace of mind with reductions below 90?

 

Hi Katherine

Thank you. I think you're right, I'm at the point of needing to switch to SLGS rather than TR. I was hoping a lower dose would gradually ease her down so she could get used to a slightly lower BG and I could creep her down without the bouncing but she's not subscribing to my theory! Hopefully the yellows will stop of their own accord because I don't think I can increase her dose given the lows.

Thanks for the reassurance. Feel slightly less like I'm floundering or winging it now.

xx

 

It must be so hard worrying about Lily when you're not there. I understand why you've taken the steps that you have to try to keep her safe, but I think she might need more insulin in order for the bouncing to stop. It looks like you've taken her up to some good doses but then she dropped low and you reduced quickly. You might need to nudge her slowly back up to a higher dose in .25 increments, perhaps on weekends when you'd be around to monitor?

It also looks like Lily likes to drop early in the cycle, and we usually try to head that off by feeding some medium carb food around +2 to prevent the steep drop. That way she can stay on a dose longer and receive the therapeutic effect of it while staying within a safe range. It's called Feeding the Curve. I'm not sure what your feeding schedule for her is or whether you can leave her food in an automatic feeder when you're working. I feed Ruby 3 meals per cycle, usually one at shot time, one at +2 and one at +4 or +6. Depending on the reading I get at +2, I might feed her a higher carb LC food like something 7%, or if I have to leave the house I leave medium carb or even high carb food for her. It's better for her numbers to be higher than for her to drop low if you can't be around to keep an eye on her.

 

Gabby was a bit of a drama queen -- she would drop fast and early in the cycle. To complicate things, like you, I work full time. A few things that helped me not be a nervous wreck. I got as many early tests in as was feasible so I had a sense of whether her numbers were dropping before I had to leave the house.. (This worked for me because she had an early nadir.) She was fed several installments of her food early in the cycle (e.g., pre-shot, +1, +2). If her numbers were dropping, I gave higher carb food, Admittedly, some of this was a matter of knowing my cat and my having collected tons of data. If is was in the least bit unsure about what was going on with her numbers, I made sure there was higher carb food in her feeder. She had access to food up to about +5 or +6.

And, I followed TR.