9/9 Buzz AMPS:81, PMPS: 321

Yesterday's condo: viewtopic.php?f=9&t=24491

WCR: We're off to the races this morning, that's for sure! Buzz is handling it like a champ so far. She turned up her nose at her +2 food, but I brought out the big guns (24%!!) and she polished that off with no qualms. I'm glad I went with my gut and fed her MC at AMPS!
Gotta change the subject line so here's the recap of this morning:
AMPS: 81 (MC)
+1: 75 (MC)
+2: 67 (HC)
+3: 55 (HC)
+3.5: 42 (HC)
+4: 50 (LC)

As far as dosing, Buzz was on the "3x < 50" plan but I'm thinking she's no longer a newly dx kitty, so should it be below 40? She hasn't gone below 40 today, but with a constant stream of 24% food being given, I almost wouldn't expect her to. I'm about to get a +4 so we will see. Just wondering what I should do for tonight's shot, although I suspect she will be bouncing by that time. Shoot through, then reduce? Wait until she goes below 40? Does how much food you've had to give factor into a reduction decision? So many questions! Off to check BG!

Re: 9/9 Buzz AMPS:81, +1:75, +3.5:42/Dose ?

Looks like Buzz would like to go back to the Falls(antijinx)--As I am an old timer, I have to hold a 40's number 2-3 times before dose reduction--
I would say to see where she goes tonite as she will probably bounce from the HC-
You could shoot reg. dose to get her through the bounce & maybe reduce tomorrow--
But PLEASE get other opinions on this--We know Buzz has her special ways of being!
You have been on this dose for a bit--You know of course, if you get a 30's number it's an automatic does recuction, so guess a wait & see tonite
where she goes--Looking Really GREAT!! Thanks for being with Moonie at the party--She loves her BFF Buzz!!

Re: 9/9 Buzz AMPS:81, +1:75, +3.5:42/Dose ?

congratulations, great numbers for Buzz lately.

I thought it was 3 x <50 for an old timer, 1 x <50 for a newbie and any <40 is an automatic decrease. There may have been some adjustments made to the protocol and I'm not sure exactly where it stands now.

Re: 9/9 Buzz AMPS:81, +1:75, +3.5:42/Dose ?

And I thought that it was <40 for an old timer...but no one told me how long one had to be here to be labeled and "old timer" but that I was not one...I mean Shadow was not...dx a month after Buzz I guess.
(I am but he is not...LOL)
Maybe someone will come along and say when one becomes and old timer...
Until then, I will just say that Buzz is looking SO good! :mrgreen:

Re: 9/9 Buzz AMPS:81, +1:75, +3.5:42/Dose ?

the modification LL has been working with was a long term diabetic (over a year since dx or a kitty who has returned from the falls) would earn a reduction after dropping below 40 one time. however, since then Rand published the study which suggested reducing:

If the nadir glucose concentration is 40 - <50 mg/dL (2.2-<2.8 mmol/L) at least three times on separate days

some caregivers of kitties who have trouble holding reductions have begun using Rand's suggestion.

Re: 9/9 Buzz AMPS:81, +1:75, +3.5:42, +4:50, +4.5:53, +6:59

Thanks for the clarification Libby, it would help if the definition of "newly diagnosed" and "old timer" were added to the LL protocol. Also the "3 x <50" usage. Apparently several of us were unsure of how to understand the different protocols. All this made me go back and reread all the protocols. When did the Rand change, it is the same now as what I printed out in January, which is the same as Tilly.

Here is the comparison I got from all 3:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Reducing the dose...
--- 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, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
--- If an attempted reduction fails, go right back up to the last good dose.

Click to expand...

http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

aiming for 50-100mg/dL (2.8-5.6 mmol/L)

Phase 4: Reducing the dose. Phase out insulin slowly by 0.25-0.5U depending on dose.
--When the cat regularly (every day for at least one week), has its lowest blood glucose concentration in the normal range of a healthy cat, and stays under 100 mg/dL overall Reduce dose by 0.25-0.5 IU depending on if cat on low or high dose of insulin
--If the nadir glucose concentration is 40 - <50 mg/dL (2.2-<2.8 mmol/L) at least three times on separate days Reduce dose by 0.25-0.5 IU depending on if cat on low or high dose of insulin
--If the cat drops below 40 mg/dL once (2.2 mmol/L) Reduce dose immediately by 0.25-0.5 IU depending on if cat on low or high dose of insulin
--If peak blood glucose concentration > 200mg/dL (11 mmol/L) Immediately increase insulin dose to last effective dose

Click to expand...

http://www.tillydiabetes.net/en_6_protocol2.htm

normal range of a healthy cat (50 to 80 mg/dl)

Phase 4: Reducing the dose
When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose.

Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose.
If the cat drops below 40 mg/dl once, reduce the dose immediately!

Click to expand...

Re: 9/9 Buzz AMPS:81, +1:75, +3.5:42, +4:50, +4.5:53, +6:59

Sarah, you had such beautiful numbers today. Buzz is doing great! I hope she can keep that surf going.

Re: 9/9 Buzz AMPS:81, +1:75, +3.5:42, +4:50, +4.5:53, +6:59

Thanks for the clarifications, Jill and Ann! I will count this as Buzz's first time in the 40-49 range then.

Sadly, PMPS was a big fat pink, but I actually guessed that it would be higher so I guess I'm happy (?!). She has been clearing her bounces pretty quickly recently (antijinx) so hopefully that will be the case again tonight!

PMPS: 321

Re: 9/9 Buzz AMPS:81, +1:75, +3.5:42, +4:50, +4.5:53, +6:59

Ann & Tess said:

When did the Rand change, it is the same now as what I printed out in January, which is the same as Tilly.

Click to expand...

lol! which time?

i assume you're asking me, not libby. i mistakenly referred to the name "Rand" when i copied and pasted from the Tight Regulation Protocol with Lantus or Levemir which is available as a link from the University of Queensland web site.

Allow me to clarify:

There is no longer a protocol called the Rand Protocol.

There is no longer a protocol called the German Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats.

There never has been a protocol for lantus or levemir named the "Tilly Protocol". Some LLers started calling the now defunct German Tight Regulation Protocol the "Tilly Protocol" for short... and it stuck. if you mention "tilly" in veterinary circles, they would have NO idea what you're talking about.

Today, there is only one protocol called the Tight Regulation Protocol.

once you've been around long enough, you'll notice changes are made to protocols from time to time. most of the time, they're subtle changes. although one of the major changes in the Rand protocol (when it was in existence) was the change to a lower starting dose. i could dig through old files to find all the minor changes made over the past 4 years, but there's really no point.

here in LL, we've made some of our own minor changes to the protocols available based on our own observations and experiences from dealing with more cats than have been in any of the studies. this is where the "modifications" were born... those listed in the sticky. frankly, to officially assign an exact time period to what is considered a "long term" or "newly diagnosed" diabetic kitty is counterproductive. for example, there could be a kitty less than a year out from diagnosis whose response is typical of a long term diabetic, but we had to come up with a general guideline. this is why we use the term "newly diagnosed" as a kitty who has been diabetic less than a year and "long term" as more than a year. however, i'm sure you've noticed there are some kitties who are tougher to regulate than others. the approach with those kitties may have to become more aggressive. they may need to follow guidelines suggested for long term diabetics even though the kitty is less than a year out from diagnosis.

unfortunately, dealing with feline diabetes is not as black and white as most of us would like it. 1 + 1 does not always equal 2 in feline diabetes.
this is where experience comes into play...