6/19 Jude | AMPS 130; +4 94; PMPS 118; +3 50; +4 59; +5 72 | Honoring the passing of Storm tonight | Feline Diabetes Management Board

6/19 Jude | AMPS 130; +4 94; PMPS 118; +3 50; +4 59; +5 72 | Honoring the passing of Storm tonight

Mary & Jude said:
Jude was only 90 this a.m. and then 69 at +1.5, so I had to leave him with some HC while I went to work. I left after my class and rushed home to test him at +5 and even with the HC, he was only 78, so I'm glad I left it for him.
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And he dropped to 50 tonight at +3. Were you/would you be able to get a +3.5/+4?

Rather than use HC, I wonder if you want to try a reduction? (based on a week in largely normal numbers)
 
Bandit's Mom said:
And he dropped to 50 tonight at +3. Were you/would you be able to get a +3.5/+4?

Rather than use HC, I wonder if you want to try a reduction? (based on a week in largely normal numbers)
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He's 59 @ +4. After the HC @ +3. IDK. Does he earn a reduction?

ETA, his appetite is really poor tonight. I couldn't get him to eat at +4.
ETA, he just ate a good amount of MC.
 
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Mary & Jude said:
Does he earn a reduction?
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He has been largely in normal numbers for the last week with nadirs between 50-80. You find yourself having to feed HC often enough to keep him safe/over 50. You are seeing some low blues (within meter variance of green), but I wonder if those could be bounces from lows (or sharp drops), some of which you might not have been able to catch because of work (although dosing is based on numbers we see and not what could have been). You could try a reduction and see. You can always go back up if he doesn't hold it.
 
Mary & Jude said:
He's 59 @ +4. After the HC @ +3. IDK. Does he earn a reduction?

ETA, his appetite is really poor tonight. I couldn't get him to eat at +4.
ETA, he just ate a good amount of MC.
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Honestly, I wouldn’t have decreased the dose. Here’s why: he’s been OTJ and when coming back from remission, you need to be more aggressive than you were before (that doesn’t mean “dangerous”, it just means not holding on to doses too long that aren’t working) not reducing the dose if he doesn’t drop below 40 because he is not newly diagnosed), not less, so you can get him back into remission. You are also more experienced at handling FD than you were the first time. Yes, he’s seen a nadir or two in the 50s but under TR, he hasn’t really earned a reduction from being at a dose for a week because he’s got too many blue BGs. And he’s not bouncing; those blues are because his duration is over and he’s showing a normal curve.

If he were mine, I would have increased the dose and monitored closely. I’m not a big fan of fat and skinny doses for cats that are on more than 0.1u but you could have just added a little extra to the 2.25u if your work schedule worries you. I understand you have to balance this with his eating if he is normally not a good eater. If that is a concern, I would have continued to hold the dose and not reduce it. But, ideally, he needs an increase. If you increased the dose, you could also feed a little higher LC food to help keep the curve a bit flatter.

Keep in mind a cat doesn’t earn a reduction just because you feel you might have propped up their BG with a bit of HC. But...he’s not even close to earning a reduction because under TR, his reduction point is below 40 unless he actually has a week of mostly green BGs.
 
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Mary & Jude said:
Thanks @Marje and Gracie! We’ll leave him here for a few cycles and take him up if the reduction doesn’t hold.
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You’re welcome. If he looks like he does now, he definitely needs an increase. IMHO, unless he starts tossing out all green cycles, for the most part, or drops below 40, I would consider it a failed reduction. You can always tag me if you are unsure :)
 
Marje and Gracie said:
If he were mine, I would have increased the dose and monitored closely. I’m not a big fan of fat and skinny doses for cats that are on more than 0.1u but you could have just added a little extra to the 2.25u if your work schedule worries you. I understand you have to balance this with his eating if he is normally not a good eater. If that is a concern, I would have continued to hold the dose and not reduce it. But, ideally, he needs an increase. If you increased the dose, you could also feed a little higher LC food to help keep the curve a bit flatter.
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Hi Marje, I get why you're saying that a reduction was not earned but I wanted to understand why you are suggesting an increase? At the current dose, Mary is using HC to prop his numbers up, and that might be affecting duration, like you pointed out. (BTW, can carbs fed in one cycle, affect duration/numbers in the next cycle as well?) Considering she cannot monitor closely, would it not be better to hold the dose and use higher LC food to flatten the curve, rather than increase? Thanks!
 
Bandit's Mom said:
Hi Marje, I get why you're saying that a reduction was not earned but I wanted to understand why you are suggesting an increase? At the current dose, Mary is using HC to prop his numbers up, and that might be affecting duration, like you pointed out. (BTW, can carbs fed in one cycle, affect duration/numbers in the next cycle as well?) Considering she cannot monitor closely, would it not be better to hold the dose and use higher LC food to flatten the curve, rather than increase? Thanks!
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I’m glad you brought this up bc I was going to ask this question, too. Why, if I am struggling to keep Jude from going too low right now, would I increase? It seems as if Bhooma is seeing Jude’s situation (re: higher end cycle numbers) as possibly bouncing, while Marje is seeing it as a duration issue. Maybe I’m interpreting that incorrectly. I appreciate you both thinking through this with me.
 
Bandit's Mom said:
Hi Marje, I get why you're saying that a reduction was not earned but I wanted to understand why you are suggesting an increase? At the current dose, Mary is using HC to prop his numbers up, and that might be affecting duration, like you pointed out. (BTW, can carbs fed in one cycle, affect duration/numbers in the next cycle as well?) Considering she cannot monitor closely, would it not be better to hold the dose and use higher LC food to flatten the curve, rather than increase? Thanks!
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Mary & Jude said:
I’m glad you brought this up bc I was going to ask this question, too. Why, if I am struggling to keep Jude from going too low right now, would I increase? It seems as if Bhooma is seeing Jude’s situation (re: higher end cycle numbers) as possibly bouncing, while Marje is seeing it as a duration issue. Maybe I’m interpreting that incorrectly. I appreciate you both thinking through this with me.
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Sorry for the delay in response. I volunteer on Wednesdays and Saturdays and am out the door by 6 am.

I would not say she has to use HC to prop up the numbers. She used HC once the cycle he dropped to 50 and then she used MC and he came up nicely to 72. It’s likely a higher LC or the MC would have worked fine.

Anytime you have a long-term diabetic cat returning from remission on a dose this long and most of the nadirs are 70s and 80s and preshot are almost all blue, there’s room for an increase even if it’s only for a cycle or two to kickstart things. The goal is to get him back into remission ASAP. If your goal is not remission and you are happy with where he is, that’s a different story and you can handle it in this manner but it’s not TR.

For Jude, he now earns a reduction in three ways:
—one drop below 40
—3 drops between 40 and 50 on separate days
—one week in mostly BGs below 100.

He hasn’t done any of the above and, again, if you want him back in remission, you need to be a bit more aggressive with dosing.

I hope that helps
 
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