10/6 Minnie AMPS 342, 102 +6, do I increase?

[Ale & Bobo & Minnie (GA)]

I don’t usually post in the Lantus forum, but now that I’m trying my best to keep my big girl pants on and stick to the TR protocol, I thought it’d be best.

I’m not super familiar with TR yet so I wanted to ask if Minnie is due for an increase. Her pre shot numbers are still pretty high but I know we don’t dose by that. She cleared a bounce that started the day of her vet checkup for the pneumonia and her nadirs went back down to the 100’s. I read the protocol, but not clear on what you’re suppose to do with nadirs in between 100-200. I’d love some advice.

@Panic @tiffmaxee

Thanks!

 

[Panic]

I need to brush up on TR protocol but I was thinking if nadirs are staying under 150 you maintain the dose ... Will need to double-check that I'm not mixing it up with SLGS.

I thought Elise had a guess over why the high pre-shots/green nadirs but I will also have to go recheck what that was. I'm getting forgetful!

 

[Ale & Bobo & Minnie (GA)]

Elise? I know someone tagged Mogs but she never replied with an answer. She wasn’t feeling well then

 

[Panic]

Yes let me go look again, I thought it was her. Meanwhile:

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.

Perhaps someone can confirm but my understanding from this is if numbers are between 100-200 at nadir wait 3 days before increasing. The 150 nadir I was thinking of must be for SLGS.

 

[Panic]

Here it is, it was Elise. I'm not sure if this still applies.

I think it’s because of the reduced doses shot when the preshot was lower at night. Maybe if a reduced dose if felt needed it needs to be higher than a half dose.

 

[Ale & Bobo & Minnie (GA)]

Thanks Panic, I did read that part but when do I not increase? That wasn’t clear to me. Only when nadirs are between what and what?

 

[Panic]

I think you maintain the dose as long as she stays under 100 at nadir.

 

[Christie & Maverick]

A few thoughts. Nadirs can and do move around, don't necessarily get stuck on +6 for am mid cycles, unless of course that happens to fit into your schedule in some way. I'd often get some surprising numbers on Lantus at +3 or +4. Or if a bounce was breaking, later in the cycle, +8 or +9. Last greens were 12 cycles ago.

Minnie really isn't new to blues or greens for that matter.

The way I look at your SS the last 8-10 days (16-20 cycles) you got green earlier, then a little bounce, back to green, and this continued for a few more cycles. Holding the dose was fine then, we're getting into greens. Then, it went a little haywire, and back to some better blues, but really nothing as good as you saw 12 cycles ago. Green really is what you are striving for, so I'd consider and increase. Once kitties get to 5u, the increases and decreases are by 0.5u. Just my two Canadian cents, for what they are with these days . Hope others come by to chime in as well.

 

[Ale & Bobo & Minnie (GA)]

A few thoughts. Nadirs can and do move around, don't necessarily get stuck on +6 for am mid cycles, unless of course that happens to fit into your schedule in some way. I'd often get some surprising numbers on Lantus at +3 or +4. Or if a bounce was breaking, later in the cycle, +8 or +9. Last greens were 12 cycles ago.

Minnie really isn't new to blues or greens for that matter.

The way I look at your SS the last 8-10 days (16-20 cycles) you got green earlier, then a little bounce, back to green, and this continued for a few more cycles. Holding the dose was fine then, we're getting into greens. Then, it went a little haywire, and back to some better blues, but really nothing as good as you saw 12 cycles ago. Green really is what you are striving for, so I'd consider and increase. Once kitties get to 5u, the increases and decreases are by 0.5u. Just my two Canadian cents, for what they are with these days . Hope others come by to chime in as well.

Thank you. I’ll take all the 2 cents I can get. She was tightly regulated at 2.5 units before the 2 hospitalizations in May and since then it’s been a struggle. That’s the reason I switched to TR. So I’d be increasing to 5.5 tomorrow then?

 

[Christie & Maverick]

I really do feel there is room for an increase, based on what I see in my reading of the data, but perhaps if @Wendy&Neko is around later tonight, she may have some thoughts as well.

 

[Ale & Bobo & Minnie (GA)]

I really do feel there is room for an increase, based on what I see in my reading of the data, but perhaps if @Wendy&Neko is around later tonight, she may have some thoughts as well.

I feel like I agree with you actually. So 2 questions, the .5 increase after 5 units is in general or just for TR? And the 3-5 days to increase does not include the days she’s bouncing right?

 

[Wendy&Neko]

I agree with Christie and my cents are also Canadian. Your goal is to get her to a dose where she spends the majority of time in greens and lower blues. She's not near that yet.

the .5 increase after 5 units is in general or just for TR?

Depends on the circumstances. Generally SLGS dose 0.25 unit increases, but once a cat gets to 6 units, there's likely a secondary endocrine condition in play that is means the cat is needing a higher dose. Those conditions involve insulin resistance and you can't be cautions around insulin resistance. So even in an SLGS case with higher doses (depending on nadirs), I'll likely suggest larger increases. Depending on caregivers ability to monitor as well.

And the 3-5 days to increase does not include the days she’s bouncing right?

Bouncing has nothing to do with the count of days/cycles before increasing. You start counting the day the dose started. You only start the count over again if there was a fur shot/skip/reduced dose etc. The only way bouncing comes into consideration is that it's preferable not to increase the same day a bounce is breaking. You might find this post by Libby interesting.

 

[Ale & Bobo & Minnie (GA)]

I agree with Christie and my cents are also Canadian. Your goal is to get her to a dose where she spends the majority of time in greens and lower blues. She's not near that yet.

Depends on the circumstances. Generally SLGS dose 0.25 unit increases, but once a cat gets to 6 units, there's likely a secondary endocrine condition in play that is means the cat is needing a higher dose. Those conditions involve insulin resistance and you can't be cautions around insulin resistance. So even in an SLGS case with higher doses (depending on nadirs), I'll likely suggest larger increases. Depending on caregivers ability to monitor as well.

Bouncing has nothing to do with the count of days/cycles before increasing. You start counting the day the dose started. You only start the count over again if there was a fur shot/skip/reduced dose etc. The only way bouncing comes into consideration is that it's preferable not to increase the same day a bounce is breaking. You might find this post by Libby interesting.

Thanks that was helpful especially Libby’s post. I upped her this am so fingers crossed. Every time I think we found the right dose she gets back up and we have to start all over again. It’s just crazy to me that she was on a tight regulation at 2.5 before the hospitalizations and now she’s at 5.5 and climbing

 

[Sue and Luci]

Looking forward to seeing your new post tomorrow - please post with a new thread/condo tomorrow so we can see how Minnie is doing on her increase.

Glad you're posting in the LB&L group - you're among like minded folks here...everyone is on the same quest as you and trying to sort it all out. You'll get lots of help, support and advice here..plenty of people around most of the time... See you tomorrow