12/29 Kokkinoulis AMPS 399, +3 362, +6 366, +9 387 increased dose,flat curve and still high BG

Kokkinoulis

Kokkinoulis

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Previous post:
https://felinediabetes.com/FDMB/thr...-380-2-386-increase-dose.285023/#post-3137577

Dear administrators,


I increased yesterday the dose from 2.75 to 3.25 unit (by 0.5) but the BG numbers are still high. It is interesting that the curve is almost peakless and there is no clear nadir. It is mentioned in this forum that you cannot easy find the nadir with high BG numbers.

Could you please take a look το my cat's spreadsheet?
Is there any explanation why while the dose of insulin is increasing the BG number remain almost the same and above 300 mg/dl?
Could this be due to glucotoxicity, long time hypergycemia or insulin resistance?

I don't know how long my cat has had diabetes before diagnosed on 29 Nov 2023 and if these high blood sugar numbers despite being on high dose of insulin mean β-cell failure and that no remission could be achieved in the future. I know it's too early for conclusions, but I'm worried that these might be negative predictors and it might be too late for my kitty and he can't achieve remission in the future (even though remission can be achieved at least 6 months after diagnosis while some studies have shown up to and 2 years after diagnosis).
 
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There is a phenonenon we call New Dose Wonkiness or NDW that occurs in the first few cycles after an increase. With NDW, the numbers are temporarily higher for a couple cycles after the increase. We don't know why it happens, just that it does. It takes time for the depot to build - one theory is that NDW is related to the depot somehow. Anyway, nothing to to but wait a couple cycles and see if he responds then.

He's not on what I would call a particularly high dose of insulin, sort of average dose. I've seen cats on higher doses eventually go into remission. I wouldn't worry about remission at this point. A prerequisite is to first get him regulated.
 
What I would also consider is that with Lantus, a change in dose does not always have an immediate effect. If you look at the sticky note regarding the depot, this can help to explain why Lantus acts the way it does. It can take several cycles for a dose increase (or decrease) to have an effect.

When you give a shot, the Lantus forms microcrystals that are deposited in the fat tissue. Over the course of the 12-hour cycle, most of the crystals dissolve. Note that I said most -- not all of the crystals dissolve. As a result, your cat isn't getting the benefit of all of what you're injecting but the positive is that there is overlap with the next shot. In essence, there's an amount of Lantus that is stored. When you change the dose, the depot needs a few cycles to get caught up with the change.
 
Wendy&Neko said:
There is a phenonenon we call New Dose Wonkiness or NDW that occurs in the first few cycles after an increase. With NDW, the numbers are temporarily higher for a couple cycles after the increase. We don't know why it happens, just that it does. It takes time for the depot to build - one theory is that NDW is related to the depot somehow. Anyway, nothing to to but wait a couple cycles and see if he responds then.

He's not on what I would call a particularly high dose of insulin, sort of average dose. I've seen cats on higher doses eventually go into remission. I wouldn't worry about remission at this point. A prerequisite is to first get him regulated.
Click to expand...

Thanks a lot Wendy for your reply. I am trying to follow TR these days. According to this if the BG numbers are still high I have to increase insulin dose by 0.5 unit on the evening of the 31Dec2023 (or by 0.25 for safety reasons as it would be in the evening). Should I do it or is it better to wait some more days (1-2) for depo reasons and also as he has not received yet Lantus many days in total so his system get used to insulin?
 
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Sienne and Gabby (GA) said:
What I would also consider is that with Lantus, a change in dose does not always have an immediate effect. If you look at the sticky note regarding the depot, this can help to explain why Lantus acts the way it does. It can take several cycles for a dose increase (or decrease) to have an effect.

When you give a shot, the Lantus forms microcrystals that are deposited in the fat tissue. Over the course of the 12-hour cycle, most of the crystals dissolve. Note that I said most -- not all of the crystals dissolve. As a result, your cat isn't getting the benefit of all of what you're injecting but the positive is that there is overlap with the next shot. In essence, there's an amount of Lantus that is stored. When you change the dose, the depot needs a few cycles to get caught up with the change.
Click to expand...
 
Sienne and Gabby (GA) said:
What I would also consider is that with Lantus, a change in dose does not always have an immediate effect. If you look at the sticky note regarding the depot, this can help to explain why Lantus acts the way it does. It can take several cycles for a dose increase (or decrease) to have an effect.

When you give a shot, the Lantus forms microcrystals that are deposited in the fat tissue. Over the course of the 12-hour cycle, most of the crystals dissolve. Note that I said most -- not all of the crystals dissolve. As a result, your cat isn't getting the benefit of all of what you're injecting but the positive is that there is overlap with the next shot. In essence, there's an amount of Lantus that is stored. When you change the dose, the depot needs a few cycles to get caught up with the change.
Click to expand...

Thanks a lot Sienne for your prompt reply. As I wrote above to Wendy should I increase the insulin dose by 0.5 unit on the evening of the 31Dec2023 if the BG numbers remain the same or should I wait 1-2 more days? What is your opinion?
 
If you are following TR and his numbers stay are still all above 300 by the end of the 6th cycle at this dose, you can increase by 0.5 units.
 
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