03/16 Richard AMPS 333 +6 268 PMPS 292

[Alex&Richard]

03/14
Hello,

We've bumped the dose to 0.75U yesterday. Richard seems to handle increase well so far. PreShots are getting closer to 300, curve is relatively stable. We will keep this dose for several more days to ensure all goes well.
Hope he'll spend most time below 300 soon Ketones are still there though.
I've also re-calibrated the CGM at AMPS+6 today (1:30 PM), hope it will be more accurate now.

CGM

Warmest regards.
Alex

 

[Allie & Gen]

Oh, you have a CGM that requires calibration! I was vaguely aware from some of my reading that they exist, but the Libre 3+ doesn't require it. I'm quite curious how that works.

Best of luck with the increase. It's good to see Richard on track. How are things with the ketones?

By the way, I noticed that you keep talking about dose increases in terms of % of the previous dose, which is a different approach than the protocols here use - they increase by a set amount of insulin, not dose percentage. (I'm not sure this distinction has been clear to everyone in past conversations.) Doing it by percentage could bring you to exponentially larger increases, depending on how consistent you are, which I would be wary of. That said, you've been very cautious so far and it seems to be working well, which is great!

Regarding holding the dose, some food for thought - it takes time for the cat's body to adjust to each new dose, which is why we hold doses for as long as the dosing methods advise. It's hard to be patient, but seems to be worth it, at least for most cats, and especially early on. (The dosing methods used here are actually a bit more aggressive than my veterinarian advises - she counsels 1-2 weeks in between to make sure you really have a handle on what each dose can do. I haven't always stuck to her recommendations, but they're not without merit.)

 

[Alex&Richard]

Oh, you have a CGM that requires calibration! I was vaguely aware from some of my reading that they exist, but the Libre 3+ doesn't require it. I'm quite curious how that works.

Best of luck with the increase. It's good to see Richard on track. How are things with the ketones?

By the way, I noticed that you keep talking about dose increases in terms of % of the previous dose, which is a different approach than the protocols here use - they increase by a set amount of insulin, not dose percentage. (I'm not sure this distinction has been clear to everyone in past conversations.) Doing it by percentage could bring you to exponentially larger increases, depending on how consistent you are, which I would be wary of. That said, you've been very cautious so far and it seems to be working well, which is great!

Regarding holding the dose, some food for thought - it takes time for the cat's body to adjust to each new dose, which is why we hold doses for as long as the dosing methods advise. It's hard to be patient, but seems to be worth it, at least for most cats, and especially early on. (The dosing methods used here are actually a bit more aggressive than my veterinarian advises - she counsels 1-2 weeks in between to make sure you really have a handle on what each dose can do. I haven't always stuck to her recommendations, but they're not without merit.)

I'm all for 0.25U steps done at higher insulin base (0.75U+). It is just my Vet suggested not to do increases with more than 30% of current dose at once (e.g. 0.5U -> 0.75U is +50%) unless the BG is way to high, so I've been extra cautious with it. If we'll need another increase - it will likely be proper 0.25U as per protocol.
My aim is to hold the dose for a week as SLGS suggests, or at least 5+ days, unless something unexpected happens. I have to keep ketones in mind, so might have to be slightly more aggressive if they will be rising.

 

[Allie & Gen]

I'm all for 0.25U steps done at higher insulin base (0.75U+). It is just my Vet suggested not to do increases with more than 30% of current dose at once (e.g. 0.5U -> 0.75U is +50%) unless the BG is way to high, so I've been extra cautious with it. If we'll need another increase - it will likely be proper 0.25U as per protocol.
My aim is to hold the dose for a week as SLGS suggests, or at least 5+ days, unless something unexpected happens. I have to keep ketones in mind, so might have to be slightly more aggressive if they will be rising.

Gotcha! I do appreciate a cautious vet (especially after one or two cases we've seen recently where there were really alarming starting doses recommended that could have been fatal to the cats involved). Good for you for thinking it through so carefully, which can be pretty challenging for a new diabetic caregiver, too.

I hope those ketones stay put. (My cat was in DKA and hospitalized when he was first diagnosed, so I know how scary that can be.) I hope things go well on this new dose, without anything dramatic to worry about.