? 03/15, Shmee, AMPS 373, +2 292 - vet moved from 1U to 2U?

[Amanda & Shmee]

Hello,

Today is the day for my second curve. My vet started him on 1U 2x/day, and then after one week and the first curve she upped him to 2U 2x/day. I have learned more from this message board since then, and realizing this was a high jump in dose. When I call my vet with the results from the curve today, I assume she will up his dose again. If I wanted to start to follow TR, what would you next move be since I do not have a complete three days worth of "in-between" data to get his nadir (I do want to start doing this in the future though)? Should I just keep him on 2U for the next two days, get his nadir, and go from there? Or would you lower him back down to maybe 1.5 and see how he reacts to that? Now that he has had the 2U for a week I am afraid I may have missed his "match" but I don't know if going back is a good idea either.

I have tried to update the SS to the best of my ability. Thank you for any advice you may have, I appreciate it!

 

[Carol in Chicago]

My vote is stay where you are in terms of dose and use this period of consistency in dose to collect more data. Dose decisions are made based on the nadir. Right now we don't know what and when that is.

Go ahead and let the vet recommend whatever she wants to recommend - no need to follow her advice immediately.

I'm interested in what others might recommend. Here is a link to your last post - others will want to review before jumping in.

 

[Amanda & Shmee]

My vote is stay where you are in terms of dose and use this period of consistency in dose to collect more data. Dose decisions are made based on the nadir. Right now we don't know what and when that is.

Go ahead and let the vet recommend whatever she wants to recommend - no need to follow her advice immediately.

I'm interested in what others might recommend. Here is a link to your last post - others will want to review before jumping in.

Thank you so much Carol, I was thinking this is a safe route as well. I will try to get three days of solid numbers at +3 +6 and +9.

 

[Wendy&Neko]

You don't have to get a +3, +6 and +9 for every cycle to get an idea how the dose is doing. The +2 test is usually a good indicator. If it's around the same as the preshot, you'll be seeing a "normal" Lantus cycle. A +2 that is lower means you need to do some extra testing, as it'll be a more active cycle. A higher +2 is most likely a quieter cycle.

Getting a few more data points so you have a better idea how low the dose is taking Shmee is a good idea. If you can get those +2 or later at night (whatever is just before bed), that'll fill in that part of the picture. Keep in mind that not all cats have a "typical" Lantus cycle. My girl sure didn't. It's better to sprinkle some tests around various times of the cycle to get a better picture of how Shmee is doing. Doing the occasional curve will help you determine the Lantus onset and nadir, which are important things to know.

 

[Amanda & Shmee]

You don't have to get a +3, +6 and +9 for every cycle to get an idea how the dose is doing. The +2 test is usually a good indicator. If it's around the same as the preshot, you'll be seeing a "normal" Lantus cycle. A +2 that is lower means you need to do some extra testing, as it'll be a more active cycle. A higher +2 is most likely a quieter cycle.

Getting a few more data points so you have a better idea how low the dose is taking Shmee is a good idea. If you can get those +2 or later at night (whatever is just before bed), that'll fill in that part of the picture. Keep in mind that not all cats have a "typical" Lantus cycle. My girl sure didn't. It's better to sprinkle some tests around various times of the cycle to get a better picture of how Shmee is doing. Doing the occasional curve will help you determine the Lantus onset and nadir, which are important things to know.

Thank you Wendy, the next few days I am going to get as much testing as I can in and be sure to get a few +2's as well, and then I will start to follow TR. Last night his lowest was 277 at +10 after two in the 300's which made me super confused! I know to look for the nadir for the dosing, I just thought the timing of that was odd.

 

[Sienne and Gabby (GA)]

Amanda asked me about a comment I made previously:

"One other point is that we don't raise doses by more than 0.5u and generally, the increases are by 0.25u. It can be rather easy to fly past what would be a good dose if you increase by too much. Frankly, too much insulin can look like too little insulin so increasing the dose in a systematic manner insures that you haven't gone past an effective dose."

Amanda's question was:

My cat was first given 1U 2x/day, and then after his curve my vet upped him to 2U 2x/day. After reading the message board more, I want to start tight regulation. But I am worried I might have missed a good dose in between 1 and 2. Do you happen to know where I can find more information on this situation, if there is any info out there? I was thinking I should just keep him at 2 since he has already been on it a week, get more numbers these next few days, and then after I figure out his nadir I will go from there? I don't know if taking him back down would be beneficial at this point

Right now, based on the amount that you're testing, there's no way to know if Shmee's dose is fine or not. Since you're wanting to start TR, you will need to get more tests in. Basically, the answer to your concern is based on the data you collect. If you're giving more insulin than what would be a "good" dose, ultimately, Shmee's numbers will drop and you'll reduce the dose. There isn't any formal research that discusses missing a good dose -- or at least none that I can think of. The statement is an observation that reflects what many of us have seen. It's especially the case if you're not able to test and what's on your spreadsheet are high pre-shot numbers. You may be missing lower numbers that are occurring at other points in the cycle and when you are testing, you're seeing a bounce. Remember, Lantus dosing is based on the nadir, not the pre-shot numbers. If you look at the links to the actual journal article on the TR protocol, you may have a better feel for how the protocol came about. It's linked in the sticky note. If it's not there, let me know and I can upload it for you. It's particularly important to get tests in the PM cycle. Many cats experience lower numbers at night.

Also, I would encourage more testing so you know what's going on. You don't want to hold doses overly long if the dose isn't getting your cat into a better/normal BG range.

 

[Amanda & Shmee]

Amanda asked me about a comment I made previously:
Amanda's question was:

Right now, based on the amount that you're testing, there's no way to know if Shmee's dose is fine or not. Since you're wanting to start TR, you will need to get more tests in. Basically, the answer to your concern is based on the data you collect. If you're giving more insulin than what would be a "good" dose, ultimately, Shmee's numbers will drop and you'll reduce the dose. There isn't any formal research that discusses missing a good dose -- or at least none that I can think of. The statement is an observation that reflects what many of us have seen. It's especially the case if you're not able to test and what's on your spreadsheet are high pre-shot numbers. You may be missing lower numbers that are occurring at other points in the cycle and when you are testing, you're seeing a bounce. Remember, Lantus dosing is based on the nadir, not the pre-shot numbers. If you look at the links to the actual journal article on the TR protocol, you may have a better feel for how the protocol came about. It's linked in the sticky note. If it's not there, let me know and I can upload it for you. It's particularly important to get tests in the PM cycle. Many cats experience lower numbers at night.

Also, I would encourage more testing so you know what's going on. You don't want to hold doses overly long if the dose isn't getting your cat into a better/normal BG range.

Thank you so much, I appreciate all of this. I will make it a point to stay up late tonight and get some good PM data. I am thinking that by Monday I should have more BG info and be able to (most likely) increase from there per the protocol. And yes I think I do have the actual protocol from the website it links too - I printed out lots of information and now have a binder to read over! Again, I appreciate you taking the time out to help me. He is everything to me.