4/1 Sebastian AMPS 149 +2 206 +4 238 +6 249 PMPS 260 +3 257

Hi Justin, here's what I wrote on yesterday's in response to your question about the protocol:

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.

After tomorrow morning which will be the 6th cycle since the last green,( 3/30 AM cycle) if he hasn't returned back to a green, I would increase him again tomorrow PM cycle. Keep up the momentum; the idea is to keep him in safe greens for longer stretches so his body accepts them as normal and the bouncing will subside.
 
Bobbie And Bubba said:
Hi Justin, here's what I wrote on yesterday's in response to your question about the protocol:

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.

After tomorrow morning which will be the 6th cycle since the last green,( 3/30 AM cycle) if he hasn't returned back to a green, I would increase him again tomorrow PM cycle. Keep up the momentum; the idea is to keep him in safe greens for longer stretches so his body accepts them as normal and the bouncing will subside.
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Okay cool, so just to distill it down, because he's such a long term diabetic and we've got data, we want to operate on the short end of the 3-5 day window and do a rolling 3-day schedule; if he doesn't hit greens within 3 days, up the dosage. I'm okay with that, even if we "overdose", at this point I'm comfortable with monitoring him and feeding him HC to keep him from going hypo and can then just reduce if he goes <40. So my only question is how to determine how much to increase. Last increase you went with .5u instead of the protocol dictated .25u. Should I just do .5u as a standard because he's so long-term or was there some data that informed that decision?
 
Justin & Sebastian said:
rolling 3-day schedule
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Yes, I think since he's a DKA kitty, I would roll with every 3 days to help tap him down.

Justin & Sebastian said:
Last increase you went with .5u instead
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That was a total mistake on my part as it should have been .25 increase to 4.75 and not to 5 units, but it looks like it was a good mistake . Usually, after 5 units we start taking them up by .50 units increases, but he's pretty flat right now and I am curious to see what he does tonight and tomorrow AM cycle. If no green after tomorrow AM cycle, I would increase to 5.5.

When he goes below 5 units again, then the dose change is in increments of .25. Sorry for my mistake and any confusion.
 
Bobbie And Bubba said:
When he goes below 5 units again, then the dose change is in increments of .25. Sorry for my mistake and any confusion.
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No problem, like you said it turned out to be the right call. So it's sounding like, with him being so long-term, his history of DKA, and him being so aggressive with the bounces, we want to be aggressive to match. Like I said, totally okay with that, at this point I'm 100% comfortable with shooting low, frequent monitoring, and HC steering. But I'll keep that in mind, >= 5, .5 increase, otherwise .25. We've been up to 7 in the past, with much higher BG, so all in all we're still in a much better spot than we've been in.
 
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