? Jack 02/23 - AMPS 315, +3 167, +6 62, +8 112, PMPS 389, +3 399

AngelaMiao

AngelaMiao

Member Since 2019
Previous threads here and here.

Doing TR protocol and wondering if I should be changing dose tonight/tomorrow and by how much. Did 7 cycles at 0.75 units so far. 1/7 cycles where his nadir was below 300, 6/7 cycles he was constantly above 300, 4/7 cycles where he went higher post-shot than pre-shot. He's had better numbers on lower doses but I'm starting to think that they were influenced by the move from my parents' house to my house where he wasn't eating much as he got used to a new home with a big dog.

Will check +3, +6, +9 during the day today and can do +2 and +4 or +5 tonight (I changed his shot time to 5am the day that I skipped AM dose on Feb 15th to make it easier for me to stay up for PM tests).

Also, do you guys usually take away the food before pre-shots? My cat nibbles all day and night, so I'm sure a lot of my tests are within an hour or 2 of eating. I haven't noticed a huge difference in BG the times he hasn't eaten for a while vs the times that he has so I don't think he's a big food spiker, if anything I think his BG is lower when he eats. When I bring him to my mom's once a week (to see his cat brothers and because I stay overnight with my son) he doesn't eat as often because the food is further away from where he sleeps and his BG is always really bad while he's there - cat is lazy so won't go far for food and my parents have a big house with cats that steal his food, so I always find myself having to lock out the other cats and bring him food. Even at home, I need to keep his food in the room or he'll forget to eat.
 
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Hey there. It is looking like he can use an increase. He did give you a few numbers under 300 on this dose so I would only increase him to 1.00 unit. Glad you can get some more test in today, all the data you can get is helpful.

The pre shot numbers can be influenced by eating within 2 hours of the shot. Since you haven't too much difference with him grazing up to the time to test for AMBG or PMBG, it might be worth an experiment to take his food up two hours before to see if it dose make a difference. And since he is higher and flat, it would be interesting to see if it will make a difference.
 
Update! His +3 today was 167 so I think I'm gonna wait it out a couple more days. I have a feeling he's going to bounce tonight or tomorrow since it happened all the other times he went down so quickly.
 
I agree with Bobbi (of course, Jack will now probably drop below 50 to make a liar out of me).

Here's how I would think about the dosing issue. Jack's lows, based on the nadirs you've seen over time, are generally in the higher 100s -- a safe range for increasing. He's bouncing off of those numbers. With increasing (or decreasing, for that matter) the dose, it's likely you won't see an immediate response. Because Lantus is a depot type of insulin, the depot needs to catch up with any change you make. For many cats, this can take a few cycles. This is why, with TR, you give a dose 3 days/6 cycles to stabilize. If you increased this morning, there's a chance the increase would have had an effect on the numbers. However, you are likely correct that Jack will bounce. As the depot is catching up to a dose increase, it will help to offset the bounce. He also seems to have an early nadir -- although given his pattern of numbers, I don't want to swear to that. If that is the case, his numbers will be rising shortly which would be another reason to have considered increasing at AMPS.

 
I didn't increase his dose yet, I gave him the same 0.75 unit as the past few days, or did you mean catching up to the 0.75 that I've been giving him? I definitely do think he does nadir early.

Let's say he keeps bouncing and I continue with whatever dose, will he eventually just stop bouncing or do I need to play with the dose until he doesn't bounce anymore?

Will try the food experiment tonight. I'm sure there have been days that he didn't eat for 2hrs before pre-shot but I didn't notice (I leave him a bowl at night and never know when he finished it, unless he wakes me up for food when his BG is high). I give him his insulin as soon as I wake up, around 5am. Tonight I'll take the food away before his PM shot, as long as his sugar isn't too low.
 
AngelaMiao said:
Let's say he keeps bouncing and I continue with whatever dose, will he eventually just stop bouncing or do I need to play with the dose until he doesn't bounce anymore?
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One way to help with bouncing is to safely increase the insulin according to the protocol so he gets into lower safe numbers. His body right now is reacting to lower numbers as a threat and sending out counter regulatory hormones to bring his numbers up. Over time, after being in lower numbers more often, the bouncing will get less and maybe even go away. It's an Every Cat IS Different (ECID) kind of thing.

I would increase while you have time to monitor the increase while he's with you and not your mom. JMHO .
 
His current blood sugar is 62 so I'm not sure if I should still be increasing tomorrow. Is it possible that the 0.75 took this long to kick in?

I don't actually leave him with my mom, I stay there with him and actually have more time when I'm there since my mom helps me with my 7 month old son. I'm on maternity leave so I'm home all day no matter where I am.
 
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