5/10 Topper AMPS 257 Question

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Jan and Topper

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http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=94800

I was happy last night, his PMPS was 204. Now he's way up again.
I raised him to 4u two days ago.

Following SLGS, what numbers should I be aiming for? I'm not comfortable with very low numbers.

Sorry I haven't posted since the 6th, I've been sick and couldn't get to the neighbors house to use the computer.

Good news though - Topper is over his gastrointestinal upset. Guess I won't be giving him bites of boiled turkey again!
 
I think there's a broader issue. Are you hoping for remission or regulation?

Ultimately, none of us are comfortable with low numbers initially. Over time you get more comfortable with lower numbers. If you are hoping for regulation, you want your kitty's numbers to be below renal threshold (approx. 200). If you are hoping for remission, then you need to get comfortable with Topper being in the normal BG range -- 50 - 120.
 
I'm glad he's over his tummy upset.

I would keep the same dose for a couple more cycles. Can you get some more tests in this weekend?
 
I'm going for Regulation.
I can get more tests in, but in SLGS, I'm supposed to wait at least a week to raise the dose. I'm getting so confused.
His numbers are looking better. I think.

5 Steps to Regulating Your Diabetic Cat
(the "Start Low - Go Slow" approach)

Step 3.
After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve (blood glucose tests every 2 hours, starting at shot time and continuing until the next shot). Follow the cat's normal feeding schedule during the curve. The curve should be evaluated by someone experienced at interpreting feline blood glucose curves, in order to check for signs of rebound and other possible problems. If no rebound is present, follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):

If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.

If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.

If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.

Step 4.
Repeat the cycle of curving and waiting 1-2 weeks. As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Click to expand...
 
Jan --

The timing of when to raise a dose on SLGS isn't carved in granite. With Tight Regulation, you really don't want to increase the dose much sooner than specified (3 - 5 days depending on whether nadir is over or under 200) because the protocol is more aggressive than SLGS. With nadirs in the 100s like Topper is seeing now, with TR you would hold the dose for 5 days vs. SLGS, where you'd hold the dose for a week. You're good anywhere in between that time span.

I agree -- Topper's numbers are looking much better.
 
It's looking like you guys are on the right track! At this point, if you feel comfortable, you have room to do an increase to 4.25 to see if you get even better numbers than you're now seeing. Topper seems to adjust to dose increases quite nicely and relatively fast and his numbers are looking so much better! You're doing a great job and if you want to hold this dose a little longer to make sure, that's all right, too because he is going low enough that he's not over the renal threshold. Either way, I think you're getting closer to the right dose because his numbers are leveling out beautifully.
 
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