? 10/31 Salem AMPS 355

[Salem & Angus]

10/30 POST HERE

Starting higher this morning, definitely feels like bouncing. Got a 319 on +3 PMPS last night which is still quite high for my liking but was down from 364. Especially just considering that he was lower when he was on 0.5U.

Thankfully though he seems to be feeling just fine. He was angry about breakfast not coming fast enough (lol) but he's not ravenous despite the high numbers.

 

[Mary & Jude]

Hi Angus, Are you thinking about an increase as Salem is approaching a week on this dose? Here is the dosing methodology for SLGS, including the increase detail:
Starting Dose. Feel free to check in with any questions:

• 1u BID if kitty is not on a wet/canned low carb diet
• 0.5u BID if kitty has been switched to a wet/canned low carb diet
• If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
• Generally, shots are to be given 12 hours apart.

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!

 

[Salem & Angus]

Hi Angus, Are you thinking about an increase as Salem is approaching a week on this dose?

Hi Mary! I am considering an increase but I would like to do the curve first. His numbers do seem consistently higher end where he'd probably benefit I think. I'm just nervous about the bouncing especially considering that for a while on 0.5u it felt like his numbers were going down. Maybe I had just decreased it too quickly since I was going by what his vet suggested (unfortunately dosing changes weren't as far apart as I'd have liked)

Now if only these dang alphatrak strips weren't so pricey. I know a lot of people use ReliOn since it's cheaper but I really like that the Alphatrak is specifically geared to animals.

 

[Mary & Jude]

He's likely going to bounce a bit, especially until his pancreas and liver get used to remaining in lower numbers. It's annoying, but it happens. If you look at Jude's spreadsheet, you'll see he bounced quite a bit last year when he came out of remission (in October) and he continued bouncing earlier this year. (I think he bounced longer than he should have, though, because I probably should have started him back at a higher dose of insulin.) Once I got him up to 3 units, things leveled out for him (and then he came back down the dosing ladder!!). The good news about increasing and decreasing in .25 unit doses is that these smaller adjustments can minimize bouncing. So right now, you are easing him up until you get him into better numbers (nadirs in the 50-80 range with no numbers above 120 = regulated).

While we keep our eyes on the dosing guidelines (yours is SLGS), we also keep our eyes on the nadirs, and that's where the curves come in handy. The curve is designed to let you know how he's doing through an entire cycle--to identify where he's nadiring, to make sure it's not too low, etc. Bouncing can occur when a kitty goes too low in a cycle, and sometimes we miss that data without doing a curve. We adjust doses based on the nadirs--if they are running too low, you probably don't have room for an increase; too high, you might want to consider an increase (based on the dosing guidelines, of course, which show us how long to hold decreases/increases). The curves are also designed to gather data, so that you can continue building information on how Salem responds, in general, to the insulin.

My Alpha Trak is in the hall closet . As frequently as I found I was testing Jude, I couldn't afford the test strips, so I went with the ReliOn, and it's been perfectly fine and much cheaper.

I can't offer dosing advice, but feel free to put up your question mark on the title when you're ready, and one of the more experienced folks will weigh in.