? Please ...advice on dosing strategy.. my mistake

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Arman Matin

Arman Matin

Member Since 2017
Hi everyone

I am trying to the best of my ability to follow TR guidelines despite my limited schedule.

I made the mistake of not realizing that the numbers corresponded to human meters until last week.
So looking back at my chart I feel like i made the mistake of increasing dosage on 3/8 as i considered his nadir above 200. And i kept increasing until i realized my mistake. Should i just kept his dosage at 4 and gave it more time and response ?

Do we keep holding dosage until the nadir point shows whether to increase or decrease ?

Now what should i do from here ? I am only able to measure mid day on weekends

please help

Arman
 
I think you are being too hard on yourself on this one, honestly. First off, there really isn't any way to "convert" AT numbers to human numbers. Second, even though you did see a single number (222) that may have been below 200 while measured on a human meter, that's not the same thing as "seeing nadirs below 200"-- it still looks like Raja needed that increase as he was still mostly in quite high numbers throughout the day.

He's still in high numbers, so give this current dose a chance, but be ready to give even more juice if he stays high in the next few cycles. Just keep following the TR guidelines and hopefully you will get to the "breakthrough" dose soon. You're testing enough to keep him safe, just keep doing what you're doing!
 
Don't worry - we don't have a scale to convert AT numbers to those on a human meter, except we know that the reduction point of 50 on a human meter is 68 on an AT. So we just use the AT numbers at face value when looking at increases as per the protocol.

It looks like Raja is still seeing high numbers, so it was just as well you increased as you did. I am glad to see you are now increasing by 0.5 unit amounts - that's what is recommended over a 5 unit total dose, unless you are seeing green. It's good that you increased last night - you should be able to get a good idea of what the 5.5 unit dose can do this weekend. I personally don't think you are missing any low numbers.

Something we usually suggest to people whose cat gets up to 6 units without a breakthrough, is getting them tested for the "high dose" conditions, acromegaly and IAA (insulin auto antibodies). Provided however that the cat is eating a low carb wet food or raw diet, and have increased safely as you have. From what I see on the spreadsheet, I expect you'll be getting to 6 units soon. Usually cat's don't get to that high a dose unless there is a secondary condition present. My Neko had both acromegaly and IAA. One in four diabetic cats has acromegaly - which is a benign tumor of the pituitary that sends out excess growth hormone that ultimately causes the diabetes. Not all acrocats need high doses, but if there is a high dose, there is a chance that either it or the insulin auto antibodies is present. Testing is done via a blood draw which is sent to Michigan State University.
 
The protocol suggests increases and decreases but not situational issues like missed shots, over shots etc.
I even went through the published document.

Going to get my relion this Thursday. Have a call in with the vet to look at his chart shortly.

Thank u for the reassurance
 
I know how worrying it can be that you cat might be overdosed. :bighug: Especially as you climb the dosing ladder. You WILL find a dose that starts to move Raja. How is he acting, feeling these days? Cats will often start to act/feel better as you get close to a dose that will bring better numbers.

For missed shots, this note on Counting Cycles is helpful.
 
Wendy&Neko said:
I know how worrying it can be that you cat might be overdosed. :bighug: Especially as you climb the dosing ladder. You WILL find a dose that starts to move Raja. How is he acting, feeling these days? Cats will often start to act/feel better as you get close to a dose that will bring better numbers.

For missed shots, this note on Counting Cycles is helpful.
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Thank you. Just got off the phone with the vet. She took her time with the numbers and was supportive of my effort. However she recommended that i kept the dosage of 4 for at least two weeks if not one week! ( i know). I had forwarded her literature regarding the research before . Her point was that with slow acting insulin the cat's body takes time to get used to the dosage. I have to think about this now.

on the side note ..he has been feeling better.. most significant improvement was two weeks ago.
 
she also suggested the idea of "symogi" effect ( she is probably aware of it's grey area) and said the only way to rule that out would be to do a at vet curve using a fast acting insulin and I dont have the finances to afford that now. :(
 
Arman Matin said:
she also suggested the idea of "symogi" effect ( she is probably aware of it's grey area) and said the only way to rule that out would be to do a at vet curve using a fast acting insulin and I dont have the finances to afford that now. :(
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Symogyi isn't a gray area, it's actually black and white in a published resaearch article that for cats on long lasting insulin and increased in methods such as Tight Regulation, it very rarely happens. We might see it if a cat is started at too high a dose, but I don't think Raja falls into that category. The original symogi research was done with just a few humans and short acting insulin. Forget the vet curve with fast acting insulin, that's a waste of your money and you will learn nothing by it. I'm willing to bet my boots I have seen more spreadsheets of high dose cats than your vet has.

You hold the syringe, but I would not decrease the dose at this point. You said he is starting to feel better, and two weeks ago was when the black started becoming rarer in the spreadsheet. My Neko always felt horrid in black. Raja's spreadsheet does not look unusual for a cat that needs a higher dose. If you do choose to reduce, please be diligent about testing for ketones.
 
Great input from Wendy. I completely agree. I honestly wish vets would get up to date on the issue of Somogy. This is research that was done in 1938 and was never able to be replicated in humans, let alone with cats and it certainly doesn't apply to depot-type of insulin. As Wendy pointed out, there is now research that debunks Somogy in cats that are using long-acting insulin.

 
Arman Matin said:
wish I had more confidence in what I am doing.
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Actually, you are doing great Arman. :bighug: I've been sneaking the odd peek at your spreadsheet and you've been increasing as you should. I was much less confident when I started. I was posting every day and had to keep asking if I should be increasing. It's hard enough with a diabetic cat, but when you've got one that seems to be taking forever to get into good numbers, it's easy to question what you are doing. But you are doing all you can. The rest is up to Raja.
 
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