? Increase?

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Squeakycats

Squeakycats

Member Since 2017
Hi, all--

Can anybody comment on Misha's spreadsheet? He is starting to see a few blue numbers, and occasionally even a few greens, at 1.75 units. On the other end, though, he's had some pinks. How do I know when/if it's time to go up to 2 units?

(I know I went from 1.25 to 1.75 without much of a stop at 1.5--I was thinking that since his numbers overall are not super-low--not like when he was hanging around in the low blue/high green all the time before his remission--it might be ok to increase by .5 rather than .25)

I'm taking him in on Wednesday for a checkup--she'll check his teeth, run some bloodwork, maybe try to get a sense of whether he's got some arthritis, which I suspect. I suppose she may also give me some diabetes advice, whether I want it or not--but I think she respects that I'm managing him very carefully at home.

He's heavier than I'd like (14 lbs when he should be about 12); I know it would be desirable to reduce his weight. He is entirely on canned and raw, but I leave some out for him during the day (in case he goes low while we are both at work) and at night (so he'll let me sleep a little); that's probably not helping.

Any tips? Thoughts on the spreadsheet? Hope everyone is well!
 
I think it's time for an increase. Since he's come out of remission, you need to be a little more aggressive trying to get him back into good numbers. But I would just increase by 0.25 units. The aggressive part is the timing of the increases. Don't hold any dose longer than the TR protocol calls for.
Squeakycats said:
Is it typical to go lower at night?
Click to expand...
Most definitely. Not all do, but mine sure did. Which is why we always nag new people who aren't testing at night.
 
Thank you, @Wendy&Neko! I re-read the protocol a couple of days ago and wasn't sure how to interpret it, since his nadirs have been all over the place. I interpreted it as saying that you should increase the dose only if nadirs are greater than 200. Looking again now, I realize that I have once again misinterpreted. I read it as saying "if the nadirs are greater than 200, go up by .25; if they're greater than 300, go up .5; if they're under 2oo, whatever you do, don't change anything for at least 3-5 days, and if they're under 100, hold for at least 10 cycles!" I guess I was expecting it to spell out "if the nadirs are above 100 but below 200, keep going up by .25 every 3 days until [something]," and I didn't know what the something was.

I am now interpreting this as meaning "keep on going up by .25 every 3 days until you get to your ultimate goal"--and the goal (if remission isn't possible) is to keep the cat under 200 all the time and in normal numbers (50-80) as much as is possible without causing hypoglycemic episodes...is that right? Hmm. The sticky doesn't have a "holding the dose" section, but Tilly's page does: "Try to keep the cat at a dose where the BGs are in the 50 to 200 mg/dl range for as much of the day as possible. The majority of cats are actually able to achieve consistent BGs in the 50 to <100 mg/dl range with consistent dosing."

The section I misread...sigh:

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.
The next time I get a couple of days off of work, I may try to write "The Idiot's Guide to Tight Regulation"--a version that includes language to prevent skilled mis-readers like me from misreading :rolleyes: Maybe a flow chart.

I guess I'm still not sure what to do if he has, say, one nadir in a 6-cycle period that's under 100, but the rest are higher...is a single low nadir like that a reason to do the "hold the dose for at least 10 cycles" thing? Or do you look at the most frequent nadirs?

Anyway...for tonight, we're going up, and I guess we'll just keep seeing what happens, and I'll be back here pestering everyone again...I truly don't know what I would do without you all--especially you, @Wendy&Neko, always riding to the rescue!
 
Ask yourself the question " how low can my cat go on this dose?" That's the nadir you pay attention to. If your cat is seeing green in those six cycles, but it's a high green, there is usually room for an increase.
 
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