2/28 Oren; AMPS-425 Advice on dose adjust.

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Megan & Oren

Megan & Oren

Member Since 2015
Yesterdays condo: http://www.felinediabetes.com/FDMB/threads/2-27-oren-amps-441-5-398.133827/#post-1379974

Got the results of the fructosamine: he was 410, which is considered Fair regulation (400-450). Good is 300-400. that's not BG, that's fructosamine.
ANyway, vet suggested a .5 u increase to 2.5. From everything you all have suggested and BOTH the protocols, it sounds like .25u is the usual increase/decrease increment. I asked if he'd read the protocol i left with him stating that, and he said 'if you think you can do it, go ahead and try'. Sounded very skeptical. In any case, he said increase tonight and follow him for the next week, then let him know the numbers. I didn't do a pm+5 last night because he was off meter at PMPS and had had a rough day w/ a big blood draw at vet.

Today i can do a +5 but am going out this evening and wouldn't be able to do anything sooner than pm+5 probably. Then tomorrow, normally i would be around in a.m for testing, but can't until +5 again.

If i go up .25u should i just leave food out?
 
most of the time adjustments are in the 0.25u increments, yes.

Did you make a decision about whether you want advice per the SLGS or the TR protocol guidelines?

From the TR Protocol, I've highlighted what I think would apply to Oren right now. Your last curve showed pretty much everything over 200 (the yellow day).
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • 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.


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From SLGS, I've highlighted what I think would apply below:
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.

  • 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 do 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!
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I upped him 0.25 tonight. Still leaning towards SLGS for now. yes, I have a timed feeder, but I'm home now (changed plans a little and came home early), only gone 2.5 hrs post shot. Still hardly any water missing from bowl, one pee in box since i left. He seems fine; i will do a pm+4 or 5. (he's actually playing w/ his sister right now, they're zooming back and forth b/n kitchen and den.)
 
Sounds like he is feeling good. :D You have to be comfortable with whatever way you treat the FD. You will get support here whether you do SLGS or TR. I'd do whatever feels right. JMHO.
 
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