Re: 4/10 Oliver amps 437 +9~319
allowing for a 20% meter variation... looks like oliver has remained rather flat today. the R took the edge off by dropping him 100 points and the lantus has maintained the numbers. not bad!
good luck with the increase tonight!
Venita and The Boyz wrote: I continue to believe that Oliver is being overdosed and that increases are being made too fast."
i disagree for the same reasons i explained in my response to claudia's PM regarding dosing on 3/29 (venita, you were cc'd).
the PM in part:
"i'll be honest with you... while i didn't see any harm in dropping oliver's dose down to 1u bid, i really didn't agree or see any reason for it based on the little bit of data collected at that point. 3u bid only brought oliver down to the 100s. if he were my own cat (given the unknowns), i would probably have kept him at 3u bid for 5 - 7 days and collected as much data as i possibly could. my *guess* is the dose would have needed to be raised from there. i suspect his "break through" dose (producing double digits consistently) will be somewhere around 3.25u to 3.5u bid (most likely the latter). the longer he stays in higher numbers, the higher that break through dose may become.
after looking at oliver's spreadsheet, i see what gayle is doing. she's raising the dose after every 4 cycles... by 0.5u if nadirs remain over 300 and by 0.25u if nadirs remain over over 200. yes, this is an aggressive approach, but still within the suggested guidelines of rand and roomp's tight regulation protocol. i have not talked to gayle, but if she suspects he's under dose (as i do)... she's doing exctly what i would do given the same set of circumstances. i wouldn't recommend fast-tracking any kitty to a caregiver who didn't test often, nor would i recommend doing this unless i knew a caretaker was comfortable bringing up low numbers they had to. gayle is the type of person who will do whatever she has to do, up to and including staying home from work or staying up all night to make sure kitty is safe."
the dose was dropped to 1u bid 2.5 weeks ago and oliver has remained in high numbers while traveling back up the dosing scale. i'm really not surprised the dose has now surpassed 3u bid because the longer a kitty stays in high numbers, the better chance of glucose toxicity setting in... which *usually* ends up requiring a higher dose of insulin to cause a break through. kwim?
as has been pointed out... there have not been any huge drops to indicate the dose being too high. imho, i believe gayle is on the right track.
as far as oliver being an acrokitty... that remains to be seen. from the same PM i sent claudia on 3/29 (in part):
"imo, people are jumping to conclusions when a kitty gets up in dose to 3u - 5u bid. some cats are just plain old high dose cats. we've been seeing more and more of that this past year. actually, we're seeing exactly what the german katzen forum has been seeing amongst their lantus and levemir users... lantus and levemir DO appear to have a lower potency than some of the other insulins. therefore, it just stands to reason we'll see some kitties reaching higher doses before we see a break in their numbers. again, just a personal opinion based solely on observation... we can no longer assume a kitty is an acro or IAA kitty just because the dose reaches the vicinity of 5u bid. yes, acromegaly and IAA should be considered, but that break through dose *could* be at 5.25u or 6u bid. not all big cats are acros."
having acromegaly is certainly a possibility. given the percentage of diabetic cats now known to have acromegaly, in a perfect world all feline diabetics should probably be tested... especially those who have reached high doses of insulin. however, there are also high dose cats... cats who for some reason or another just need a high dose of insulin.
lantus or lev? gayle, if you have any doubts about the insulin... i'd go with the lev if i were in your shoes. if nothing else, it will eliminate a variable which *could* be contributing to the numbers. if you switch to lev, i would not raise the dose tonight. fwiw, jmo...
