4/18 Morlei AMPS 267 +7.5 183 PMPS 201

[Becky & Morlei]

Yay for more blue!
I was planning on increasing tomorrow but now I'm not totally sure by how much or if I should at all.
The lowest number we have gotten so far is 138. This was on 4/15 at 7.5u. However we did go back down to 7u that night and just started the 7.5u again yesterday morning (4/17).
So do I:
-Hold the 7.5u for another few cycles? I wouldn't be able to do another increase until Saturday, that would put her at 8 cycles of 7.5u.
-Increase the dose by .25u tomorrow?
-Increase the dose by .5u tomorrow?
DH is home tomorrow so he can monitor all day long. Because she's hitting blues now I'm unsure if I continue going up by .5u because she's at a higher dose or start going up by .25u to lessen the risk of a hypo. I'm looking at her numbers from yesterday and it looks like we're continuing to see improvement on the 7.5u. Yesterday at +6 she was 193, today at +7.5 she was at 183. I think an increase is necessary to get her nadirs lower and for her to stay within the ideal 50-200 range, but I need advice on how much to go up. But again, if you guys think I should hold the 7.5u I'll do that!
:smile:

 

[Blue]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

You can see that the 7u dose is not enough, and if the 7.5u is a concerned, why not just go with 7.25u, hold it for 4-6 cycles and then go up to 7.5u if it is needed.

 

[julie & punkin (ga)]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

i would stay with the 7.5u for another shot and see how it goes. personally, i see no reason for decreasing the dose at all.

btw, can you update your ss - and doublecheck on when you went back to the 7.5u? i thought you only dropped back from 7.5u to 7.0 for one shot, then returning to 7.5u, but your ss shows 2 shots of 7.0 and you're missing the later data.

 

[Becky & Morlei]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

i would stay with the 7.5u for another shot and see how it goes. personally, i see no reason for decreasing the dose at all.

btw, can you update your ss - and doublecheck on when you went back to the 7.5u? i thought you only dropped back from 7.5u to 7.0 for one shot, then returning to 7.5u, but your ss shows 2 shots of 7.0 and you're missing the later data.

SS is updated now.
I don't want to decrease the dose, I want to increase but am unsure if I should go up by .5, .25, or hold the 7.5u for another couple of cycles. Sorry if I didn't explain it well enough.

 

[Blue]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

If you are following this TR, you need to hold the 7.5u for 2 more cycles.

 

[julie & punkin (ga)]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

thanks - that really helps to see it like that.

if you want to go up, i'd probably just increase by .25u. she's looking pretty good, but it wouldn't hurt to push her down a little.

your husband is good on the testing tomorrow, right? have him catch at least a couple of tests if he can - i'd love to see a +4 and a +6 maybe.

 

[Blue]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

Are you fast tracking her dosing now or following TR? Just wondering because TR states the following:
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.

 

[Blue]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

Are you fast tracking her dosing now or following TR? Just wondering because TR states the following:
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.

 

[Jill & Alex (GA)]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

I'm looking at her numbers from yesterday and it looks like we're continuing to see improvement on the 7.5u.

this is because of the cumulative nature of lantus/levemir.
with mid-blue nadirs, you'd want to continue the current dose for a total of at least 6 cycles... if you are following the TR protocol.

 

[Becky & Morlei]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

Are you fast tracking her dosing now or following TR? Just wondering because TR states the following:
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.

We were following TR when we started Lantus but her numbers were so flat that we started fast tracking the dose. Now that it seems like we are getting out of those flat numbers I don't know if I should stay on the fast track or go back to TR.

thanks - that really helps to see it like that.

if you want to go up, i'd probably just increase by .25u. she's looking pretty good, but it wouldn't hurt to push her down a little.

your husband is good on the testing tomorrow, right? have him catch at least a couple of tests if he can - i'd love to see a +4 and a +6 maybe.

Yep, he's home all day so as long as I write down what time to test her he'll do it (and sending a text message when test time is coming up doesn't hurt either haha).

 

[julie & punkin (ga)]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

Becky, your earlier dose increases were based upon the Tilly Protocol http://www.tillydiabetes.net/en_6_protocol2.htm because of those solid high numbers that weren't moving.

Phase 2: Increasing the dose

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU.

if jill recommends holding it 2 more days, then i would go with that. she's come down off of that high plateau now and it's a good idea to let it settle and see what the dose will do.

 

[Jill & Alex (GA)]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

We were following TR when we started Lantus but her numbers were so flat that we started fast tracking the dose. Now that it seems like we are getting out of those flat numbers I don't know if I should stay on the fast track or go back to TR.

sounds to me like you may need to make a decision based on ability to monitor.

chances are, you'll eventually be looking at another increase. however, you're now seeing some nice movement. unless you can monitor carefully, it might be a good time to give this dose a full 6 cycles to see what it can do. it's really up to you.

just my thoughts...

 

[Becky & Morlei]

Re: Increase tomorrow?? 4/18 Morlei AMPS 267 +7.5 183

Becky, your earlier dose increases were based upon the Tilly Protocol http://www.tillydiabetes.net/en_6_protocol2.htm because of those solid high numbers that weren't moving.

Phase 2: Increasing the dose

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU.

if jill recommends holding it 2 more days, then i would go with that. she's come down off of that high plateau now and it's a good idea to let it settle and see what the dose will do.

Ok that's what we'll do, thanks! We'll start following TR again now that she's out of those high numbers.

I'm looking at her numbers from yesterday and it looks like we're continuing to see improvement on the 7.5u.

this is because of the cumulative nature of lantus/levemir.
with mid-blue nadirs, you'd want to continue the current dose for a total of at least 6 cycles... if you are following the TR protocol.

Thanks for stopping in Jill!