10/24/14 Oz Dosing Advice

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Ian & Oz

Member Since 2014
Hello,

I'm wondering if any of the experienced people here could help me make sense of Oz's spreadsheet.
He's been on a "new" dose of 2.0u for seven days now. Since raising his dose, his levels have risen from what they were.
My guess is that it must have to do with bouncing, but if so, then is each bounce causing another bounce & will his levels ever head back down again. Just when you think things are getting better, this happens.

Thank you for any help you may have.
Ian
 
Re: 10/24/14 Oz Levels not moving much

No dosing advice from me but my guess is that you haven't found the right dose yet. One of the advisors will be on at some point for help. You might want to add to your first post and put dosing advice instead of what you wrote to get eyes on it. See what happen today though as it looks like some blue might be coming your way.
 
I think this is Oz bouncing. Is there any chance you can get a few tests later in the cycle when you see blue numbers? I'm wondering whether Oz is dropping lower than what we're seeing. It's also possible he has a late nadir (e.g., the 115 at +8 on 10/14) at least some of the time. It's possible he dropped lower than the 138 during the AM cycle yesterday. In any event, Oz has some pretty significant drops so it's not surprising that he's being a bit bouncy.
 
i think i'd follow Sienne's advice about getting another test after you see those blue tests and seeing if he's going lower. Then, if you don't see something green in the next 2-3 cycles, i'd go ahead and increase by 0.25u. I also suspect Elise is right that he hasn't gotten to the right dose yet. It looks like most of his nadirs in the past 3 days aren't lower than 130's you got yesterday. You've got 14 cycles at this dose, and if it were going to get him lower, I think you'd be picking up some lower tests.

Increasing the dose:
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.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
 
Thank you Julie & Sienne,

I can understand why you're suggesting to raise the dose by .25u based on his recent numbers, what I don't understand is, at the 1.75u dose 10/07 thru 10/14 he had the best numbers so far, so why is the higher dose (2.0u) not doing the same? Is 2.0u actually too much & causing a continous bounce?

Ian
 
I don't think so. It just works that way sometimes. The dose that seemed to work before doesn't seem to do it later. Following Tight Reg means that you tweak the dose every 3-10 cycles, depending on the numbers. Absorption can vary by as much as 50% from one shot to another, even if you feed exactly the same and try to keep all factors the same.

Adjusting the dose is just part of it. It is a good idea to do those follow up tests, though, so you catch how low the cycle goes when it finally bottoms out and begins to rise again.
 
Ian --

What you're seeing this cycle is Oz's bounce breaking. Without seeing where Oz's numbers are closer to PMPS, I can't make a suggestions regarding whether to raise the dose. Usually, if a bounce is breaking, you don't want to increase. However, given the speed at which Oz's numbers dropped, it's entirely possible that he'll bounce back up tonight.

There's not always a good explanation for why a dose increase doesn't produce the desired results. One thought that immediately comes to mind is that you're holding Oz's doses for longer that what the protocol suggests. It's possible that what you're seeing is that Oz's body is treating the higher numbers like his new "normal." (Technically, this is called glucose toxicity.) It's one of the reasons that the TR protocol has you increase the dose if the numbers aren't in the desired range in 3 days (if nadirs are over 200).
 
Hi Sienne,

Thank You.
So should I be bumping up his dose every three days from now on, as long as his nadirs are above 200 & if they're below stay at the current dose?
That would mean I would have to know when that nadir occurs, so far his has been jumping around a bit, I haven't tested as much recently because of the higher readings.
What numbers at PMPS would you be looking for that would tell you to raise or stay at the same dose?

Ian
 
Lantus dosing is based upon how LOW the dose is taking a cat. We don't increase a dose because a preshot number is high. That's hard for people to wrap their heads around, but the most important number in regards to dose is how low the dose causes the cat's BGs to go.

I think it was fine that you stayed with the 2.0u tonight. I'd suggest making a practice of trying to chase how low the dose is taking Oz. When you get a blue midcycle like you did today, get another test in an hour or so. If it's still going down, get one more test in another hour. Once you see it begin to rise, then you'll be confident how low he's going.

We have cats (Sienne's Gabby is one) that can go from amps 400 to pmps 400, but drop to 40 in between. If you look at JD's, you'll see he can (and does almost every cycle) go from amps 500 to less than 100 midcycle and back to pmps 500.

In case you're not familiar with how bounces work, it's described in the second post in this thread. I think the 406 you saw last night was the apex of the most recent bounce. Probably he got a little lower than the 138 the day before, which is what set him off. I can't tell if he cleared the bounce earlier this afternoon or if he's still in the process of clearing it. Even if a cat is not in danger of going low, more tests still give more information. Although I have to say you do a pretty great job of getting tests in, Ian.

You don't want to automatically bump up his dose every 3 days - you want to re-evaluate it every 3 days. Look at the nadirs and compare them to the part of the protocol guidelines that i quoted earlier. See where most of his nadirs are, look at the recommendations on how long to wait if the nadirs are in that particular BG range, and then make the appropriate increases. This can be trickier than it sounds, so feel free to ask for help making these decisions until you get the hang of it. Most people do want help for the first few months til they get the hang of it.

At this point, I think you could probably increase by 0.25u.
 
Thank you Julie.

Staying with the 2u at the moment but will probably raise it soon. I had stopped taking so many readings because of his pre shot numbers, I'll need to take more to see where his lowest point is now.
Thank you for your help!

Ian
 
Hi Ian

You've gotten some great info from Julie and Sienne. I just have a couple things to add, as well.

I've noticed in many cats, including my own, that sometimes there is a really good initial response to a dose increase. But then the kitty seems to fizzle. I don't know why this happens just like we are unsure why cats get new dose wonkiness. But I often see members ask why their cat looked good on a dose...and then didn't.

When you see a bounce and then all of a sudden see a really high number, like that 409, it can be a hint thst the bounce is soon to break. We call this a "high before a break". When I see that, I monitor a little closer.

My last comment is that fast drops can cause big bounces.

Good luck with the increase!
 
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