? Mimi 4/23 Had 49 two cycles ago- reduced and now it’s +9 @59 and +11@63

https://www.felinediabetes.com/FDMB...gave-1-unit-instead-of-2.261642/#post-2934383


What should I do? Should I skip again??

@Sienne and Gabby (GA)

@tiffmaxee

 

Since you are following TR and Mimi is a long term diabetic reductions are earned if the bg is under 40 or if she doesn’t hold reductions well if 3 times under 50 on three different days. You shoot any bg over 50 as long as you have supplies and can monitor.

 

What’s sad is she’ll probably just bounce

Her cycle lately has been 200s with some 100s for a few cycles then BOOM- a PS of like 48, or 52.
Something crazy low…

what is happening?

 

It’s 52… I’m skipping. I won’t shoot under 55- I don’t care what TR says- human meters are all off a little even on the same meter a minute later.
I actually prefer to skip under 60 but know that’s pushing it
52 is just too close.


There has to be some revisions/exceptions to some protocols. Everything gets revised at some point or looked at based on more studies or new evidence right? When was TR created and wasn’t it done with the Free style lite? Any time i check it against the free style lite it’s like 10 points lower…


What is going on with her why are her PS like nadirs??



i don’t know- if I skip she’ll be so high tomorrow that can’t be good. Maybe half the dose?

it does show that her +11 was 63 and now her PS is 52 so she’s steadily dropping…

 

If you can test tonight and have plenty of supplies, how about giving a token dose just to help reduce the chances of a big bounce?

 

Eh I'd consider that flat and within variance. What you have to remember is that she'll start to climb again before the shot would onset. And the drops are not the same in these lower numbers as they are in higher. Chances are if you had done 4 other tests strips at PMPS you'd have had a smattering ranging from 50-60.

So just for safety reasons and I would also say to keep TR straightforward, we do not allow it to be customized. Someone with more knowledge can chime in about possible revisions, but it actually originally comes from a German forum. But honestly, I see TR work so well in so many cats I don't see a huge need to revise it in any way.

If the lower numbers make you uncomfortable, you can instead either customize SLGS, or just go completely custom dosing. But either way, we would want your "parameters" specified - what number you'd take reductions at, what numbers you'll shoot, etc. The most important thing is consistency in whatever you choose to do (and cat safety goes without saying!).

 

“What is going on with her why are her PS like nadirs??”

This may help you a little...Max started having no clear nadirs and I was perplexed but found the answer in this sticky, look at the section ‘Becoming data ready’: https://www.felinediabetes.com/FDMB...y-to-shoot-handle-lower-pre-shot-numbers.147/

“When was TR created and wasn’t it done with the Free style lite? Any time i check it against the free style lite it’s like 10 points lower…”

Not sure of the date or meters, but it was created in Getmany by people like us...their research was then vetted and published as the Rand & Roomp paper. Look over Tilly’s page for detailed info:
http://www.tillydiabetes.net/en_6_protocol2.htm

I am not an admin here, but I did follow TR with Max which is what got him into remission. While it is NOT part of the TR protocol, a few times I just had to get sleep (also had a dog with canine dementia at that time) so I gave a token dose. I did not want to skip, because that lost all the progress we made. Shooting a token dose still bit me in the butt the next cycle, but no where near as bad as a skip.

 

I ended up skipping because I didn’t want to mess up her schedule too much. I also think she’s sensitive to any time changes - like not a minute past 15 minutes in her shot time…
She’s so sensitive in general.. poor Mimi

 

How long was he diabetic before remission? I just think it’s been almost 3 years she’s probably not going into remission?

 

There was a member who joined shortly after I did. Devon's cat, Mocha, went into remission after 3 years. That said, it's far more likely for a cat to go into remission within a year of diagnosis.

I also agree with Melissa. Either follow TR or customize SLGS and say what you're doing in your signature. It looks like every time you see a low pre-shot number you skip. The point of TR is "shoot low to stay low." You're seeing higher numbers because when you skip, there's not enough insulin available to offset the food and to keep numbers flat. In addition, if there's a bounce, the lack of insulin that cycle only serves to keep the numbers elevated. If you take a look at that spreadsheets of cats who are approaching remission, the "curve" is flat -- that's what an ideal Lantus curve looks like. In addition, if you're following TR, you need to evaluate the dose every 6 cycles except when you skip or change a dose in which case, the cycle count starts over.

I hesitate to say this but you're not following TR.

 

It’s not the lower numbers- it’s anything under 60 (because 50 is the dose you should skip)
The bigger reason I skipped was because she was dropping as I was monitoring it starting at +9
I fed her some LC @ +9 it brought her to 63 then it ranked to 52 an hour later. Something seemed off.
I dont mind TR- it’s been successful(ish) - I just have an issue with PS numbers being 50 and up is ok to shoot. In hind sight I wish i shot a half dose. 50 just seems so low.

This is also a newer habit she’s giving me- she never used to have such low PS numbers. So maybe having said that I will be ok once I notice this is now her “thing”
Does that make sense?

 

wait when you say customize SLGS- that protocol can be customized?

 

I should have… I think her cycle is behaving so differently than I’ve seen in the past - her PS numbers being what nadirs should look like-
And me freaking out thinking I’m overdosing my cat which I know now seems silly…

next time she’s above 50 I’ll shoot... maybe 55 to count for variance and not to prick her ear 10 times to find out.
(When she’s that low she’s really difficult to handle- she’s not the mellow cat- she cries and squirms- I’m lucky I got one test)

 

This is what I was saying last night. We do not customize TR (unless the cat has an underlying condition that requires it, like acromegaly), but you can customize SLGS.

I do not consider her numbers dropping last night, they were all within meter variance...if curiosity is really getting to you, do 2-3 more tests and you'll see they'd all very likely be in the 50-60 range. I consider those pretty flat and therefore shootable. Caregivers with experience following TR don't usually hesitate to shoot 50 or higher as long as it's flat or rising, and don't give much thought to if it's 40, 50, or 60. We take the test at face value, shoot, and then manage the curve later with food if needed.

But again since you're uncomfortable, it sounds like the better option for you may be customizing SLGS.

 

Correction, it is under 50 that you don't shoot at that time. It is not an automatic skip. You can delay and see if the cat comes up. With Neko I only needed a 10-15 minutes delay and she would come out of the 40's to a safe shootable number.

That is not clear. Either she was flat or within meter variance, or it is possible that what you saw was a Lantus double dip where they do a little downward curve at the end of the cycle.

I see many times this year where preshot was a lot lower than the previous preshot. Both AM and PM it happens. That looks like a normal Mimi trend. So I took a look at the first part of 2021 spreadsheet, same thing. 2/1/2021 you shot a 55 and I saw other times you shot low 60's and 70's. But sometimes you also skipped. This year the trend is that you are skipping mostly below 70. Maybe you need to start those 60's when you can monitor, and get your confidence back. You have done it before safely and have the data from last year.

 

So I didn’t shoot because +11 was 63- and PS was lower. But you said it could have been a “double dip”? I couldn’t wait any longer to shoot her because it would go into my work schedule too.
I’ve been kind of not wanting to shoot her if it’s under 60- at least that’s what I thought I was doing. I’ll need to review my SS.
I didn’t give her a reduction for next cycle-
I’ll post a new condo

 

i thinks what has always made me nervous was when she was on freestyle she always displayed lower numbers against the Relion. I know it’s to use one meter and stick with it but I guess I was kind of trying to maybe believe 52 was just too close to 50 for a PS.
I need to look over my SS and see what I was doing. I feel like her cycle now is different- she gets a lot of low PS numbers than she did before (low like 50-60)