3/31 Sebastian AMPS 288 +3 280 +6 236 +9 257 PMPS 247 +3 254

@Bobbie And Bubba So help me understand your thoughts on the dose increases. It sounded like you were saying we didn't increase quick enough but looking back at his data I'm not seeing it.

I reviewed the TR guidelines and I don't see where we didn't follow that.
"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.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300."
His last <100 was 3/19, at which point it says hold the dose for at least 10 cycles. We increased the dose .25u 9 cycles after that. We then saw a 111 as the lowest, at which point it says to hold the dose for 6-10 cycles. We increased the dose .5u 10 cycles after that. Even the jump from 4.5 to 5 seems to go against the guidelines since we weren't seeing nadirs greater than 300. It looks like it was the right call, I just want to know how you arrived there.
 
Justin & Sebastian said:
@Bobbie And Bubba So help me understand your thoughts on the dose increases. It sounded like you were saying we didn't increase quick enough but looking back at his data I'm not seeing it.

I reviewed the TR guidelines and I don't see where we didn't follow that.
"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.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300."
His last <100 was 3/19, at which point it says hold the dose for at least 10 cycles. We increased the dose .25u 9 cycles after that. We then saw a 111 as the lowest, at which point it says to hold the dose for 6-10 cycles. We increased the dose .5u 10 cycles after that. Even the jump from 4.5 to 5 seems to go against the guidelines since we weren't seeing nadirs greater than 300. It looks like it was the right call, I just want to know how you arrived there.
Click to expand...
Hi Justin, sorry and I am just getting online now. Those guidelines are for the beginning of your Lantus journey. Once they start seeing green numbers, you want to keep that ball rolling and after any bounces clear in 3 days or 6 cycles, and he hasn't returned to greens again, you would increase. You don't want him to set in higher numbers any longer than necessary and the chance of glucose toxicity setting in. You have lots of data now and can keep the momentum going and increase safely every 6 cycles if no greens.
 
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