12/16 Munchie AMPS 327- Need new action today

[ewest]

So Munchie's numbers haven't improved and my vet is trying to do consult with endocrinologist on her today. Increasing the dose for Munchie doesn't seem to be working as she's dropped below 40 four times on 1.5 or higher doses (2 of those on recent attempts). So if I can't increase her, that leaves me to think she is either rebounding due to too much insulin or I need to try another insulin such as Levemir. Is there a protocol on lowering the dose outside of getting low numbers? Folks seem to be indicating it should be below 1 unit dose, but should it be .25, .5, .75? She's been on .5 in the beginning (the 1wbu) and that didn't seem to regulate her and she still bounced from low numbers- I don't really see a change in that for her on lower dosage. So would she have needed .25??? I want to try a change in tonight's dose if possible after I talk with my vet today as I don't want her high numbers continuing like this.

Thanks.

 

[Sienne and Gabby (GA)]

I think you're looking at dose as something static. Just because a dose was too much or too little last week, it may not be the case this week. I'd encourage you to read through the Tight Regulation protocol, and not just the modified version in the sticky. With Lantus and Lev (it's the same protocol), you try to not hold on to doses for more than 3 days (the exception with with nadirs under 200 or with bounces). Holding on to a dose for too long can create glucose toxicity -- the body regards higher numbers as "normal."

Most of us have run into a dose that dropped numbers into the 40s (or below). You reduce and see if the reduction holds. If not, you bring the dose back up. Bringing the dose back up doesn't mean that you're going to overdose your cat. I've been at this for a while and Gabby's dose has never been above 2.0u but her dose goes up and down as her numbers indicate she needs more or less insulin.

I posted on the tight regulation board this morning but looking for more information on reduction or switching to Levemir.

It wasn't clear that you want information on reducing or Lev. With respect to a different insulin, this article summarizes the differences between Lantus and Lev. You may want to ask the question about the differences on the Lev ISG, as well. As I noted however, the dosing protocol is identical.

To be frank, I'm not comfortable providing recommendations about dose if you are posting multiple places seeking that information. I don't have time to routinely check what information you're getting elsewhere and I don't want to put you in an awkward position. What I will point out is that in general, high numbers and a history of DKA suggest that more insulin, rather than less, is indicated.

 

[ewest]

Hi Sienne, I hear your frustration and appreciate your thoughts and information. I also hear that it wasn't clear to you that I wanted information on reducing or Levemir and that may have been frustrating as well. I was trying to communicate this with "So if I can't increase her, that leaves me to think she is either rebounding due to too much insulin or I need to try another insulin such as Levemir. Is there a protocol on lowering the dose outside of getting low numbers? " I do appreciate your responses and will be mindful of multi-posting on both Lantus boards (having both is a learning experience in terms of how to navigate).

Thanks.

 

[Sienne and Gabby (GA)]

There's not a protocol for reducing without low numbers indicating a dose reduction is needed. Some people have tried "starting over" with respect to dose if they have thought that their cat was doing better on a lower dose vs. bouncing. To be honest, I've yet to see that as a successful strategy. It looks to me like Munchie needs more insulin.

FWIW, I'd like to make a suggestion. You have some of Munchie's low numbers coded in red on your SS. Since the red is usually meant for numbers in the 400s, you might want to consider replacing the red coding to something in the green family.