6-10 Gizmo AMPS=296; +2=426; +6=389; +8=447; +10=416; PMPS=449; +1=416; =3=405

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Nice to see a yellow AMPS! If you are following TR protocol, it is time to increase to 3.25u and hold for 6 cycles, if you see no blues (less than 200 nadir) after those 6 cycles then increase again to 3.5u:

INCREASING THE DOSE:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
 
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Chubba said:
Vet suggested +6, so that is why I always tested at +6.
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Cat's don't always have their lowest numbers at +6, even though this might be roughly where you are getting peak insulin action. Until a cat is well regulated when they have their nadir (lowest number) can be anywhere in the cycle. Before George became well regulated he nadired as early as +2 and as late as +13:rolleyes: though he was more usually in the the +5/+6 mark for his nadir.

I would encourage you to spot check at other times, it can help build a cleared picture, and can help you manage his cycles and dosing more easily.

With his amps being lower than that +6 last night, I'm wondering whether his BG is acutually dropping into preshot (or even flat), it may indicate an active cycle, for George it was usually a signal for me, so I would be sure to get a +2 so I could manage his numbers if need be.

ECID, judging when they drop and how far they are likely to drop by, will come by gathering the appropriate data.
Though this dose, on the surface, does appear to not be getting him into nice numbers, for me, there are a few to many unknowns to suggest an increase just yet. On june 7th he dropped by almost 200pts (could have been clearing a bounce, that can lead to lower numbers), but there are no test after +6 that day nor indeed a pmps or tests that evening, with the way he shot up by June 8th, I wonder if he saw something lower in that pm cycle.
If he did see something lower on June 7th which triggered a bounce that would be due to clear by end of today (bounces can last up to 6 cycles/ sometimes less). So if you are able to get some tests in this morning (earlier in the cycle +3 at the latest) or run a curve perhaps if you have time. The fact that his ps is lower than +6 last night, makes me think that he may be looking to clear a bounce.

If you are able to get those tests in today and you don't see any green/low blue, then perhaps an increase would be indicated.

But please note that with SLGS you would hold the dose for a week, and run a curve before taking the dose up.
If you want to follow TR, you need to always be getting at least one test in the PM cycle, always testing before giving the shot, goes without saying.

Perhaps see what today brings and ask a question about dosing after you have todays numbers in.
 
Sorry for posting so often with all of my questions. I am just trying to decide and understand what would be best for Gizmo. I have definitely decided not to increase from 3 units to 5 units (per vet's advice). I am still unsure about SLGS or TR. From what I am reading, there is better chance of remission with TR. I have the next several months available to monitor him closely as required by TR. By only concern is ... would SLGS be better for him? I could be wrong, but I am guessing that it would lower his BG levels slowly, which I think might be better since he started in the 500s and might be bouncing now with just a few high 100s and 200s (although I could have missed lower numbers since I wasn't testing that often before).

I am also confused about bouncing ... if he is bouncing, that would indicate that the dose is too high and it should be lowered correct? And bouncing could mean that his numbers aren't really that low, just lower than his body is used to?

Hopefully, I will be able to get half unit syringes when I run out of these ones, but in the meantime I have purchased a digital caliper to help with fine tuning the dose.
 
Glad to hear you won't be increasing from 3-5! I wanted to get Bronx under the renal threshold as soon and safely as I could since he was stuck in high numbers for so long so I went with the TR protocol. TR requires more monitoring than SLGS & no dry food either.

Renal threshold refers to the blood glucose level at which the kidneys begin to extract glucose from the blood and excrete it into the urine, causing glycosuria, or glucose in the urine. Usually around 200-250 (with a human meter) is the renal threshold in cats.

This explains bouncing:
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Chubba said:
have definitely decided not to increase from 3 units to 5 units (per vet's advice)
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Good move, I think that would not be safe.
Chubba said:
From what I am reading, there is better chance of remission with TR. I have the next several months available to monitor him closely as required by TR. By only concern is ... would SLGS be better for him?
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Within the dosing guidelines of TR you reassess the dose every 6 cycles, potentially that allows you to get Gizmo's BG into a better range more quickly, with SLGS you can only take the dose up once a week, so it takes longer to get there. From a health point of view, the quicker you get a kitty into good numbers the better, unregulated diabetes is hard on the kidneys and the quicker you get to regulation the better the chance of remission.

SLGS allows a caregiver who is not able to monitor to raise the dose a little more slowly to keep kitty safe.

Personally I'm a fan of TR, it got George into remission, took about 5 months to get there, but we started seeing progress after following the protocol for a couple of months. ECID of course, some respond sooner and others take a little longer, other health issues can of course impact the results you might expect.

Chubba said:
I have the next several months available to monitor him closely as required by TR.
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If you have time now, if it were me I would take the bull by the horns now with TR and see what happens, in a few months time, when you are going to monitor less you can always drop back to from TR to SLGS if need be.
Chubba said:
. if he is bouncing, that would indicate that the dose is too high and it should be lowered correct?
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No, that's not what we call bouncing here. What you may have read is about somogyi effect and rebound checks, suffice to say that somogyi was a theory based on a very small number of human patients, and has later been disproven, it was never researched in cats but the theory was just extrapolated and vets still hold on to it, even though it's been disproven.

When we talk about bouncing on the forum what we refer to is a physiological reaction to lower than normal BG, for a cat that has had BG in the 400 in a while, dropping to 200 fast can set off a bounce, that doesn't mean he's on too much insulin. With any luck the more time that kitty spends in lower numbers the more used to it his body gets and the bouncing can eventually stop. Some cat's bounce more than others, but either way it's part of the process, we ignore the bounces when making dosing decisions and look to see where the nadirs are, that will govern your decisions.
 
Thanks. I will go with TR for at least the next few months.

Just to clarify ... his nadir can be at any time during the cycle? For example ... if his AMPS is the lowest for that 12 hour period ... would that be his nadir?
 
Chubba said:
Thanks. I will go with TR for at least the next few months.

Just to clarify ... his nadir can be at any time during the cycle? For example ... if his AMPS is the lowest for that 12 hour period ... would that be his nadir?
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Yes that's right, nadir is simply the lowest number in the cycle.
 
Good job with the testing today.
If you are decided on TR, could you pop it on your sig block, for anyone trying to help, it's one of the first things we look for.

If you can grab a +1 or +2 tonight as well as a just before bed test that would be great, and if you haven't seen any blue/green, you would be ok to take him up to 3.25 tomorrow. I'm going to ask some others to stop by just in case I'm missing anything.

Heading off to bed shortly, nite nite, see you tomorrow.
 
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