2/25 Tommy's AMPS 277 (+5) 311, (+9) 240

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Tomtomsmom

Member Since 2012
Hello everyone and Happy Saturday! I am noticing a little bit of a trend. On my last thread I explained that the vet wanted me to up him to 2 units and I only raised it to 1.5 units instead as I did not feel comfortable raising and thankfully I received some great feedback from a lot of people stating that even 1.5 was a bit high. He is still on the 1.5 and I am not noticing his numbers going low at all, but instead rising. I believe he was doing better on just 1 unit than he is on the 1.5 units. I have been spot testing him and tomorrow I am going for a full curve and hopefully paint a better picture for us to grasp at what is going on. Depending on his nadir probably go down to 1.25 units. He is still on DM and Iam's kitten food been off dry since December.

Any clues as to what might be happening?

Mimi & Tommy
 
Re: 2/24 Tommy AMPS 341 and a couple of questions

Good morning and happy Friday. So after a few weeks at 1 unit twice daily Tommy's vet called us Wednesday night and told us to raise it to 2 units and I really wasn't too comfortable with that and kind of decided to just raise it 1.5 units x2 daily for now to see how he responds to that before moving over to 2 units.

Wed 2/22: PMPS: 255; (+4): 144
Thur 2/23: AMPS: 288; PMPS: 284 (+4) 290 -- Did I give him a fur shot?

I will be spot testing more over the weekend (day and night) and possibly run a curve on Sunday. I am down to a few testing strips and that is why I haven't tested more. I will be running out tonight to Walmart and get more strips so that I can see what is going on.

Was I ok not to up him to 2 units? I don't want to be too aggressive too soon. I feel like this still way too new for me and I thankful for any guidance.

Mimi & Tommy
 
Re: 2/24 Tommy AMPS 341 and a couple of questions

Hi guys .. I don't really feel comfortable giving out dosing advice myself, but I tend to agree, I wouldn't have gone up to 2 units either . you very well may miss the perfect dose for tommy .. I hope the extra bit you did give him, gives you nice numbers! have a great weekend!
 
Re: 2/24 Tommy AMPS 341 and a couple of questions

Hi Mimi,
You were definitely correct not to raise Tommy's dose by a whole unit. Even 0.5 unit of a unit might be too much. We generally raise the dose by 0.25 of a unit (see the "sticky" on the protocol). By raising by quarter units and following the protocol, we make sure that we don't miss the correct dose. (My GA kitty, Stu, was a victim of a vet raising him by 1 unit at a time every several weeks; we were lucky that we found this board in time!!).

Keep in mind that Lantus dosing is based on the nadir, not the pre shot number. In looking at your spreadsheet I see that you only have mid-cycle numbers for one day, and that the nadir on that day was under 300. According to the protocol, you should therefore be increasing the dose by 0.25 units, not by 0.5:

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive 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 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive 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 consecutive cycles) if nadirs are less than 200 before increasing the dose.
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.
Click to expand...

If it is at all possible, you should try to get more mid-cycle tests in so that you have an idea of what Tommy's nadir is.

Hope this helps. I'm not sure, but I think that you could safely give 1.25 units, since you only gave 1.50 units for several cycles. I hope someone else will look at Tommy's SS and chime in with an opinion.

Have a good weekend,

Ella & Rusty
 
Re: 2/24 Tommy AMPS 341 and a couple of questions

Hi there,

I can't remember - you are doing SLGS, correct?

In any case, you made a good call not increasing by 1u.

Like Ella pointed out, .25u increases are recommended.
That goes for both TR or SLGS. Here is the SLGS guideline:
After 1 – 2 weeks at a given dose perform a 12 hour curve, testing every 2 hours

if nadirs are more than 150, increase by 0.25 unit

if nadirs are between 90 and 149, maintain the same dose

if nadirs are below 90, decrease the dose by 0.25 unit
Click to expand...
In general, larger increases are recommended only when a High Dose condition exists, or ketones are detected.

Glad to hear you will have an opportunity to gather more data this weekend.
any extra checks you can do to break up the "wide open spaces" on the ss will be very informative.
 
Re: 2/24 Tommy AMPS 341 and a couple of questions

Hi Mimi

You've gotten so good ideas from Ella and Sandy. In looking at Tommy's SS, IMHO the 144 was not from the 1.5u increase as it would have been too soon for the increase to have affected his BG. I am not a proponent of raising a dose when there are very few mid cycle tests. On any one of the days where he was high at AMPS and PMPS, he could have come down and bounced back up.

For that reason, it's a really good idea for you to get some good spot checks this weekend just in case the 1.5u is too much. One other thought is now that you have increased him, I'd leave his dose alone until he earns a reduction. If you are doing SLGS, that would be a number below 90. If you are doing TR, it would be a BG below 50.

If you are doing the SLGS protocol, could you please add that to your signature block? It would help us help you. :-D Thank you :-D
 
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