i think you were smart to skip - as wendy said, with the larger doses you can skip and hardly even tell sometimes. you'll get back on track quickly with tiggy. no worries. :YMHUG:
i looked at the link to your previous condo on 3/7 and the discussion about dosing. the only thing i would add for you to consider is that it's helpful to make decisions on size of dose increases by taking into account how tiggy reacts to them. the general wisdom is that you want to increase by the percent that is roughly the same as with a 1.0 unit dose to 1.25u dose. That's the "normal" increase that the protocol was based upon, right? you're adding on 25%. So with a 5.0u dose, in theory, you could increase by 1.25u, or 25%. with a 10u dose, you could increase by 2.5u . . . most people wouldn't do that however. Most people (generalizing) with higher dose cats think in terms of 10%, and then round it to an easy to shoot number. Punkin's highest dose was around 15u and i think the largest dose increase i made was 1u. i do use R to knock the top off the bounces and now that i'm comfortable with it, understand when to use it and can anticipate how punkin will respond to it, i really like having it in my toolbox.
The thing that's important however, is how each cat responds to dose adjustments. at the beginning, i increased punkin's dose a few times by 1.0u, following that 10% guideline, but when i realized that he still responded to a small increase, i changed back to .25u and .5u increases. even at 15u i could see that .5u made a difference in his numbers. i think the closer you are to an "ideal" dose (and good BGs) the smaller your dose changes. anytime i felt like his numbers were rising out of control, I also have done the dose increases every 4 shots until you're seeing good numbers - like a nadir in lower blues. then shift to holding the dose longer and making the dose changes in smaller increments.
It's also important to have a strategy for decreasing doses. the tactic i have used if i thought he needed a dose decrease is to drop the dose significantly for one dose to allow the shed to drain some, then return to a slightly decreased dose with the subsequent shot. So if he was at 10u and hitting too low, I would give the next shot at 7u and the following shot come back up to 9 or 9.5, something like that. my husband and i have laughingly named this strategy "Dialing for Doses" because sometimes you are just making the best decision you can make. :lol: it is very important to understand the shed action of the lantus/lev insulins. when you decrease the dose you can still see effects from the original dose for several cycles after the decrease. it seemed to us that doing a significant reduction on that first reduced dose helped to keep the next cycle from dropping too low. In my previous example, if he was getting 10u dose in the morning and hit a 30, and i decreased to 9.5u that evening, i would almost guarantee i'd see a 30 again that pm cycle. that's not enough of a reduction to prevent it.
Did you get a chance to look at Tommy's ss? His looks a lot like Tiggy's and Lauren's done a fantastic job at managing his diabetes. He's an older kitty - I want to say he was 14 or so when he was diagnosed diabetic 2.5 years ago.
anyway, those are the strategies that we've used with punkin. maybe something in there will be helpful to you. holler again if you have any questions.
scritches to your sweet Tiggy! cat_pet_icon
