6/12 Bat Boy AMPS 277 | Feline Diabetes Management Board

6/12 Bat Boy AMPS 277

I wanna preface this by saying that I'm not experienced to give dosing advice, but from my relative experience's POV: yesterday PM was only the fourth cycle after reducing, so those greens could very well have been residual depot action (which can stick around for up to 6 cycles). That's why with TR we generally don't take reductions back-to-back so quickly; they won't hold if it's just depot action and not that the dose is too high. Considering he also didn't actually go <50 I personally wouldn't have taken another reduction.

Again: not qualified to give advice for what you should do; this is just my observation.
 
Hi Molly!

Are you following the TR method? If so, here is the dosing method's information regarding reductions from the sticky:

"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."
Since Bat Boy did not fall below 50, nor did he have his bg in the normal range while staying under 100 for a week, he did not technically earn a reduction. He had a very nice Lantus-looking surf last night, though. Good for him! Those are healing numbers for his pancreas!

Remember, Lantus is a depot drug: "Lantus (and the biosimilar versions of glargine -- Basaglar and Semglee) and Levemir fall into the category of “depot drugs.” Pharmacologically, the insulins work in different ways, but each have the characteristic of being absorbed slowly by the body. The result is an extended action. These insulins tend to display a cumulative effect, meaning that what happens in one cycle can affect the next cycle, or even the next several days."

What you saw last night was likely the result of the 1.75 dose's depot. As the depot drains (or builds, if you give an increase), Bat Boy's numbers begin shifting--what you see today is affected by the dose you shot a few days ago.

This article (below) is one I read and re-read (I re-read it again last night). It is from the original group that started using the TR dosing method. One of the things they mention in the article is the importance of consistency with dosing: making sure to give the same dose both cycles, and holding those doses for appropriate lengths of time, taking reductions and increases when indicated. This is a part of the method these people followed that eventually got several cats into remission, which, I'm sure is what you want for Bat Boy.

From Tilly's Diabetes Homepage

Today, he is likely bouncing from the lower numbers last night.

I know those lower numbers can be scary when you first see them, but those are the numbers that you are eventually aiming for Bay Boy to enjoy. Take a look again at yesterday's post where a couple of our long-term members weighed in with advice for you and Bat Boy.

@Chris & China (GA), what dose should Molly give Bat Boy on the next cycle?
 
Since you are following TR for dosing (as per the signature), you wait for them to drop under 50 before reducing. I'd go back up to 1.5 units tonight, and wait for him to drop below 50. The Libre also tends to show lower than a hand held meter does, so he could have been above those 50's by a BG meter. Since you can't use the hand held to double check, I wouldn't reduce at the Libre 50's. The guideline of 50 for reductions was determined during the research that developed TR. It is a guideline at which there is a better chance that reductions will hold.
 
0k. I’ll go back up to 1.5. I can’t continue to have 2 hours of sleep at night, though, and function at my job and in general. I have MS and it’s affecting my walking ability. Let’s just say that my more youthful days are behind me 😀
 
Do you have an autofeeder for Bat Boy? When you see a cycle like last night, where the +2 is >20% lower than preshot, those are the active cycles that will either need more monitoring, or a lot more food/carbs to keep him safe. I don't know when you feed him normally, but when you see drops at +1 then again at +2, it's time for some food to try to slow him down some.
 
Thank you Wendy. That is valuable information for me! I want to continue the protocol for his sake, but my own health is also at stake. I can’t stay awake all night every night in case he drops 3 more points into a true danger zone. Also at work all day. I could feed more carbs at +2 or +3.That’s doable. I will watch for this sort of drop.
Wendy&Neko said:
Do you have an autofeeder for Bat Boy? When you see a cycle like last night, where the +2 is >20% lower than preshot, those are the active cycles that will either need more monitoring, or a lot more food/carbs to keep him safe. I don't know when you feed him normally, but when you see drops at +1 then again at +2, it's time for some food to try to
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