? 03/01 Dosage increase advice

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Arman Matin

Arman Matin

Member Since 2017
Are you following SLGS (start low go slow method) or TR (tight regulation protocol) for dosing? If you could put either TR or SLGS in your signature, we can stop asking that question. Which method you pick determines the amount of time you wait before increasing and by how much.

If you can't get mid cycle tests, then getting at +2 or +3 would help, as would a before bed test. It's usually a good indicator of how the cycle is shaping up and whether it's an active one, meaning more monitoring needed. Typically a +2 that is quite a bit lower than the preshot means more monitoring needed and the need for those mid cycle tests.
 
Arman Matin said:
Background on Raja
http://www.felinediabetes.com/FDMB/threads/need-help-with-dosage-for-raja-the-savannah.173883/

After giving him 3u ( a little up down in the beginning as i learned more) for a bit I have noticed that his curves are not all over the place but not getting lower than 300. Is it time to increase the dosage by.25 ?

Due to my schedule it might not be possible for me to get readings every mid day of mid night. But I will be trying .

thanks

Arman
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You said in your initial post that your vet recommended a starting dose of 3 u. There's a distinct possibility that this is too high a dose and the high numbers are from a continuous state of rebound. We recommend that newly diagnosed cats start at 1 u twice a day and increase in 0.25 u increments so you don't accidentally pass right by the good dose.

ETA: I see that there was a lot of discussion earlier about whether the dose was too high or whether there was bouncing from that blue number. In my opinion, if it was bouncing from the blue 107 it would have resolved by now.
 
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Kris & Teasel said:
ETA: I see that there was a lot of discussion earlier about whether the dose was too high or whether there was bouncing from that blue number. In my opinion, if it was bouncing from the blue 107 it would have resolved by now.
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Please explain what you mean by the bounce being resolved . even if the initial dosage was too strong how do you back pedal ?
 
Wendy&Neko said:
Are you following SLGS (start low go slow method) or TR (tight regulation protocol) for dosing? If you could put either TR or SLGS in your signature, we can stop asking that question. Which method you pick determines the amount of time you wait before increasing and by how much.

I am currently trying to follow TR as I have time during the day to monitor. However that will change any day as I freelance and would only be able to monitor mid points at night. Is it possible to follow TR and then slow down dosage adjustment or that defeats the purpose of a regulation
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Bounces can take 6 cycles to resolve, during which time the higher numbers bobble around a bit. The low blues were almost two weeks ago, so Raja is no longer bouncing.

We typically find that it doesn't help to go back in dose, but rather better to gather data on an existing dose and see how it's doing before deciding what to do next.

And yes, you can follow TR now and change when you need to, just put in the signature what you are currently following.
 
Arman Matin said:
Please explain what you mean by the bounce being resolved . even if the initial dosage was too strong how do you back pedal ?
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Generally a bounce caused by a reaction to a low number will go on for up to 6 cycles (3 days) and then a BG-lowering response to that insulin dose will be seen again. The blue number was 11 days ago and since then the lowest you've seen is pink.

If a dose is too high and continues to be given it can set up repetitive rebound cycles that overlap one another as kitty's counter-responses work hard to prop up BG against the insulin overdose. If the high numbers continue the cells can lose their sensitivity to insulin. It's a complex physiologic web.
 
As you can see from the comments it can be difficult to know for sure what's going on and how to proceed. My own cat's experiences with chronic rebound causing some glucose toxicity are the basis for my opinion. I could be wrong.
 
so looking at this chart does it give the impression of repeat bouncing ? In that case would we be seeing more blue and jump into reds ?
 
Wendy&Neko said:
Bounces can take 6 cycles to resolve, during which time the higher numbers bobble around a bit. The low blues were almost two weeks ago, so Raja is no longer bouncing.

We typically find that it doesn't help to go back in dose, but rather better to gather data on an existing dose and see how it's doing before deciding what to do next.

And yes, you can follow TR now and change when you need to, just put in the signature what you are currently following.
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thank you. as i try to understand.. so..it doesnt make sense to go back..but at the same time I am having no way to tell whether he is getting too much or too little to begin with.
From where he was two weeks ago he looks better and walks better and has a better appetite.
 
Arman Matin said:
thank you. as i try to understand.. so..it doesnt make sense to go back..but at the same time I am having no way to tell whether he is getting too much or too little to begin with.
From where he was two weeks ago he looks better and walks better and has a better appetite.
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Those are good signs. You are in a tight spot:
  • Keep this dose to see if it shows any positive effect.
  • Raise the dose every 3 days in 0.25 u increments if you can follow TR protocol.
  • Go out on a limb and drop the dose to, say, 2 u to see what happens.
 
If you are following TR, you would increase to 3.5 units, as he isn't seeing anything under 300 on this dose.

Often cats will have a strong initial reaction to insulin, which could be why you saw those low blues early on.
 
Talked with the vet. His pre insulin numbers were lower before inulin. in the low 400s. She recommended increasing the dosage by 1 but after my concern recommended .5 for three days and and then another .5 increase
 
Let's see where the first .5U increase takes you first, and if you can get at least two tests per cycle (preshot and one other), then we can evaluate what size increase is next based on the data.
 
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