Dose Finding Mission Part 4

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Kris & Teasel

Kris & Teasel

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His PMPS yesterday was 10.7 after an AM dose of 2.6 u so I reduced his evening dose to 2.2 u. At +3 in the evening, BG was 18.2 so I left it at that. Today AMPS was 18.6 so I decided to up his dose again to 2.5 u, not 2.6 u. I did my best to eyeball between half marks on a U100 syringe (after dose conversion of course). Hardly scientific and reproducible! Yesterday, 2.6 units did a great job but left him low at PMPS. That's why I'm trying an estimated 2.5 u today. I have no idea if this will have a difference in effect compared to 2.4 . Gathering data ...

I did a LOT of testing yesterday (9 ear pokes) and I'd like to back off today to fewer, but strategic, tests. Maybe +5 and +7 in addition to AMPS/PMPS. My goal is to find a dose that gives me two shootable numbers and a decent nadir and can be kept constant for several cycles. I'm reluctant to get into too much up and down dosing because it gets confusing. I still don't know if Teasel is truly a constant dose or sliding scale cat. Opinions anyone?
 
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It's hard to know for sure Kris. I don't think we have enough data to decide if a sliding scale would work. We do know for sure that shooting 2.2 wasn't enough...so next time you got a lower preshot is go 2.4 maybe and see if that is better. As you get lower preshots and try different doses we'll figure out if he needs consistency or a sliding scale.
 
Thanks, Rachel. I agree that I need more data. I would prefer more consistency in dosing but who knows? One thing I'm sure about is that Teasel is not an easy cat to regulate. He'll throw me a curve ball any chance he gets. I have 6 months of experience before joining FDMB to prove that.
 
The other option to consider - if he is consistently lower at pmps than amps is to try 11/13 or even 11.5/12.5 instead of 12/12. So shoot in the morning a half hour or hour early depending on the level and then your pm shot can be 30/60 minutes later, giving that pm level time to go up a little. Make sense?
 
This makes sense, Sue. Wouldn't keeping his AM shot time constant at, say, 7:30 a.m. and moving his PM shot time to 8:30 p.m. accomplish this? That's 11 hours between shots overnight and 13 hours during the day, giving him an extra hour before PMPS for BG to rise. Or I could do PM shot at 8:00 p.m. to create a 12.5 daytime/11.5 overnight split. He won't like waiting an extra half hour or hour to eat supper but he'd learn. I might consider doing this once I have a few more days' data.
 
As an aside: the test strips for the AlphaTrak are horrendously expensive! I could switch to another human meter but my brain can only handle one complication at a time so I'll stick with what I know and trust. The Pet Pharmacist (online) here in Canada sells the AT strips for about $15 less (after taxes and shipping) per 50 strip container than what I pay at my vet's office. Every little bit helps ...
 
BG just now at +3 was 21.1. Probably aftermath of dose lowered to 2.2 last night and this morning's "2.5"u hasn't kicked in. I do think I'm closing in on an effective dose that's around 2.6 u. Onward we go ...:)
 
not such a great cycle today I see, but you know what I think..... that this is yet another bounce...:banghead:
Yesterday evening he was at 10.7mmol and you gave him 2.2U and I think this was too much considering his +3 going up instead of down.
So you shouldn't have to increase this morning but rather stick to the same dose.
If a bounce happens than it's recommended to stick to the dose so the bouncing would not get worse, hope that makes sense?
I would recommend you to stick to the same dose for the next few cycles (if it's possible of course, not when it's a NS number.)
 
Ruby&Baco said:
not such a great cycle today I see, but you know what I think..... that this is yet another bounce...:banghead:
Yesterday evening he was at 10.7mmol and you gave him 2.2U and I think this was too much considering his +3 going up instead of down.
So you shouldn't have to increase this morning but rather stick to the same dose.
If a bounce happens than it's recommended to stick to the dose so the bouncing would not get worse, hope that makes sense?
I would recommend you to stick to the same dose for the next few cycles (if it's possible of course, not when it's a NS number.)
Click to expand...

This really helped when Tempest was bouncing however I did adjust a little during it.
 
Yes that's exactly what I'm saying. You ofcourse can adjust a little here and there, but then rather to do .20 off make the dose a 'skinny' dose.. So it's just a tiny amount less but not THAT less you know? Try sticking with it untill the bounce clears and then check what the nadirs are too determine if you are going to increase of or reduce the dose again.
 
Hi Ruby,

I had given 2.6 u in the morning yesterday which led to some nice blue but he was low at 10.7 PMPS (long duration). That's why I dropped his dose to 2.2 u last night. I was worried about him going too low in the middle of the night because of overlapping doses. If I understand you correctly, you're saying I should not have lowered his dose down to 2.2 u (0.4 units less than AM) but I should have given him a skinny 2.6 u last night? Yes, his +3 after his PM dose was rising so I guess that tells me his PM dose of 2.2 u was too low.

I understand the concept of holding a dose to clear a bounce. I just get confused because Teasel seems to either not react much or overreacts to different doses as we get into the better dosing territory. He's not an easy cat to work with but I never give up either!
 
Yes you understand this correctly, he dropped indeed, and he dropped more than 50% what can cause a bounce, what you already know and witnessed a lot off times;) But if the nadir isn't below 5mmol you should not have to reduce the dose.(just give a skinny one)
I know it's a little scary but if you are around to test Teasel you should be fine, and if not, you know already how to steer him up again.
If you reduce the dose (and you may, don't get me wrong) it may cause Teasel to stay in higher numbers with a reduced dose longer than needed, and eventually (3 to 6 cycles later) will come to the conclussion that you need to increase the dose again, do you know what I mean? Hope it makes sense.
It does not mean that you need to let him be, you really should be testing him if you give the same dose on a lower PS, but you can give it to him.
If the numbers come out lower in the next few cycles, then you should reduce the dose again.

Please look at Baco's SS, she was all over the place. I was searching for the right dose but as you can see it was really hard because she was bouncing A LOT! But eventually you will get there!:bighug:
 
I really appreciate the advice, Ruby :). You can see that I tried a "skinny" 2.6 this AM and called it 2.5. I was guessing at the level between two half unit marks on the U100 syringe - not easy! Maybe I'll try working with letting drops out in future. I could have just used 2.6 and let this dose do its work to clear the bounce over the next cycle or two. Depending on what his PMPS is this evening, I'll give him 2.6 u because this is looking like the magic number right now.

Tomorrow morning I'll have to think hard about what to do because I have to be out almost all day. I might be able to fit in a +6 and a +9 but can't be home to steer with food if needed. We'll wait and see what tomorrow's AMPS is.
 
+6 should be enough Kris, that is around nadir time so if he goes too low you can steer him them at +6 with medium carb food (or even high if you really need to leave) and he should be fine but I would stick to that dose, unless the PS is really low!
 
Hey Kris, it's still the bounce from the day before I think... So annoying that bounce. And you know whats even more annoying?
A bounce stops, when a bounce stops.... :rolleyes:
 
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