Re: 11/11 Tidus AMPS 279
miso00 said:
yesterdays condo
http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=82913
In LL I was increasing Tidus .25u every 6 cycles. Is it the same protocol here?
You have switched to a very similar insulin, but it seems that you have been told to start over at 1u dose. There is no reason for you to go slowly up to the proper dose for Tidus.
The protocol is to up .25u every 6cycles if you have nadirs that are between 200 and 300.
The same general rules/guidelines can be used for Lantus and Levemir:
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.
Because you don't want to prolong the possibility of damages to kidneys, and you already know that a dose of close to 7u made no dent in Tidus' numbers, you could very easily go with every 2 days / every 4 shots at a dose. To take 12 days to increase from 1u to 2u, going by .25u increases would be harsh to the animal. To take another 60 days to reach the 7u dose again is just wrong.
Renal threshold is somewhere around 200-220, and you want to keep the cat's numbers under those numbers.
For a cat just starting on insulin, it's a very good idea to go as slow as above, but when a cat has already gone through the slow climb, switching to a very similar insulin does not require any sort of start over in the dosing. The majority of cats who switch insulin switch at about 70-75% but only for safety; the odd person switches at 50% but nobody should be advised to start over.
I was advised/pushed by many on the board to start over with my Oliver and I did, watching him suffer terribly. He was at 4u and I went down to a 1u dose. It was horrible to watch him get worse, so I would never advise another, especially one who has an insulin resistance issue, to start over.
A dose of 4u or 5u would have been fine for a switching dose, and I hope that you will consider fast track in the dosing so that you can lessen the suffering on the cat....
Watch close for ketones every day and be sure that Tidus eats well because 2 of the ingredients for DKA are not enough food, and not enough insulin.
