? 5/18 TR Increase Tonight or Hold

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Susan G & Jimmy G

Susan G & Jimmy G

Member Since 2017
Two days ago Jimmy was under 200 and held that for three hours for the first time (since starting in April). He has not tested under 200 since Tuesday. However, his AMPS for the past two days have been the lowest he's had since his first week. Based on TR, this evening's cycle will be #7 and suggests I could increase. Do I hold at 4 U tonight and increase tomorrow AM? Or yes, follow the TR and increase tonight? His SS is up to date - I am due to test/feed/shoot at 5:15 tonight.
 
Can you monitor tonight? If so, I'd say go ahead with the increase to 4.25.

ETA: Here is your most recent post. We like to have you link the last post each day so it's easy for folks to go back and see what has already been discussed.

I believe when a cat gets to 5 units is when we recommend you start considering testing for high dose conditions. People here with the most high dose experience are @Wendy&Neko, @julie & punkin (ga) and @Sandy and Black Kitty, although there are others.
 
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Thank you. I'm not clear on how to link my posts yet...
I gave him a fat 4 units. Looking at his patterns he takes a good couple of hours in to the cycle to respond and his PMPS was nearly 400. Is it correct to assume these 300+ may be from the blues on Tuesday? I know he's going to go up for the next few hours...unless he throws a curve ball. I am home all night and tomorrow to monitor.
 
Hi there! The blues you got on the AM Cycle of 5/16 could be enough to have Jimmy (love the name ) bouncing and since this is the 5th cycle since blues it was probably good that you only fattened the dose because he just might start to trend downward for you. With TR, we say give a bounce 6 cycles or 3 days to clear. Get a plus +2 tonight to see how active the cycle could be.
 
Actually tonight is 7th cycle since my last increase was a PM cycle. But yes, I'm thinking perhaps because of Tuesday's low-ish numbers he may be reacting. I'm glad you said to get a +2 because as a serial poker I was tempted to grab +1. o_O
 
If you're following TR, the general approach is to increase the dose after 6 cycles if the nadirs are generally over 200. If the nadirs are below 200, you hold the dose for 10 cycles before increasing. If this were me, I would have increased to 4.25u.

 
Grabbed a +1.75 and he's down to 326. Does this indicate potential active cycle? Should I let him go a few hours then retest? Or do every other hour? His feeding schedule is every few hours so he will want some more noms between 8 and 9. TIA
 
Susan G said:
Actually tonight is 7th cycle since my last increase was a PM cycle
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Yes, it was 7 cycles since the last increase but, since he gave you the blues 5 cycles ago and you haven't seen anything in the blue range since 4/30, that is why I am saying he could be in a bounce and I am glad that you only fattened up the dose.

Just saw your post, and yes, it could be an active cycle and I would grab a test at +3 which is usually the onset for Lantus. Depending on that number, if lower yet, you will want to keep testing through nadir around + 6 - +7 to make sure he is safe.
 
Bobbie And Bubba said:
Yes, it was 7 cycles since the last increase but, since he gave you the blues 5 cycles ago and you haven't seen anything in the blue range since 4/30, that is why I am saying he could be in a bounce and I am glad that you only fattened up the dose.

Just saw your post, and yes, it could be an active cycle and I would grab a test at +3 which is usually the onset for Lantus. Depending on that number, if lower yet, you will want to keep testing through nadir around + 6 - +7 to make sure he is safe.
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Ah ok. Now I understand re: bounce cycles. Thank you! +3 will be good timing with his noms too. I will grab a test first then let him eat. I've had lots of iced coffee today so I can def hang with him even thru +8 if needed.
 
I know there's not "typical" in these instances but I'm wondering if we need to look in to other potential causes for these numbers? I emailed his SS to the vet...waiting to hear back.
 
Susan G said:
I looked at the sheets...(with envy).
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Ahhh, but if you looked at Cinco's earlier sheets, you wouldn't be quite so envious. After he went back on the juice, I mean. No, neither of my boys ever got to big doses, but they kept me on my toes, for sure

The two most common high dose conditions are IAA (Insulin Auto Antibodies) and Acromegaly. Here are a couple of post on Acromegaly: http://www.felinediabetes.com/FDMB/threads/acromegaly-the-basics-hope-you-will-read-n-like.45324/, http://www.felinediabetes.com/FDMB/threads/acromegaly-interesting-posts-from-the-past.46820/
 
Thank you. I will take a look. @Bobbie And Bubba I am leaning toward keeping dose at 4 units for a few more cycles based on TR notes for Lantus. Says if new to numbers below 200 to hold 6-10 cycles (not there are a whole of these #s). I'm really trying to look at the SS using a wide lense. But my eyes are going crossed trying to figure out some sort of pattern.

My first few days starting the insulin - I misread the syringe and was giving him 4 units 2x/day vs the 2 units the vet suggested. Yea, I know. I'm still kicking myself. That could have gotten real ugly. The first time I was able to test - (3 days and 6 cycles later I got a 77). Something in my gut is telling me to stay put with this 4u dose. I don't like to see him hanging out in the high numbers...but I also don't want all the quick increases catching up with him. Luckily, I work from home and plan to be around all weekend. I apologize to Jimmy everytime I test and tell him that I'm trying to get him better. When the numbers are lower he is in good spirits. When they are high - he's not quite himself and doesn't want to move much. Ugh. :banghead:
 
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Tricia Cinco(GA) & Harvey said:
Are you giving him treats when you test him? Harvey didn't like treats (at least not the ones he could have) so I'd give him a teaspoon of food.
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Oh yea. He's totally ok with the testing. I just feel bad I can't get this under control for him. I give him fingernail size bites of lightly boiled chicken breast. He's very food motivated...I only have to insert the test strip in to the meter or open the lancet and he jumps up on the table and lays down ready to go. The only part he doesn't like is the wee bit of vaseline on the ear, but his ears are furry and without it, the blood just absorbed right in to his fur. I tested his sister (non diabetic) tonight for the first time. She is not food motivated and needed my husband to hold her while I quickly tested. Of course, her ears were quick to warm and less furry so no vaseline but she had no interest in sticking around for treats afterward. lol. But hey, she tested at 51 - so I was quite happy with that. :cat:
 
It's as if he never got an injection tonight (+7/392). Which he did. No fur shot. I always do a sniff test afterwards. 5 more hours until AMPS. I need to see what's going on with him at night and I think tonight's that night. Grrr.
 
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Tricia Cinco(GA) & Harvey said:
I believe when a cat gets to 5 units is when we recommend you start considering testing for high dose conditions
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Actually we wait until kitty gets to six units before suggesting testing for the high dose conditions as we have seen cats get to 5.5 units and turn it around. The phrase high dose condition is a bit of a misnomer, some kitties with acromegaly have smaller doses, as low as 1 unit in the recent study that showed one in four diabetic cats has acromegaly.
 
Just had a huge thunderstorm roll through - and he awoke from a nice peaceful sleep to hide under the chair. Doubtful that I'll get true numbers now. Blerg.
 
Wendy&Neko said:
Actually we wait until kitty gets to six units before suggesting testing for the high dose conditions as we have seen cats get to 5.5 units and turn it around. The phrase high dose condition is a bit of a misnomer, some kitties with acromegaly have smaller doses, as low as 1 unit in the recent study that showed one in four diabetic cats has acromegaly.
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I've been going over and over his SS to see if perhaps I increased too fast or whatnot. I am following TR. I am still on the fence whether or not to increase to 4.25 tomorrow morning. A couple of hours ago I was leaning toward keeping at 4U - but now, I think I want to increase. I am home all day tomorrow to test - but will be out in the evening after his PM shot. His AMPS numbers are looking good (getting lower and lower) - it's all the highs in between that are baffling me. Slow and steady...I know. *sigh*
 
Interesting. A bit of a double dip. But still pretty high. If he were my cat, I'd increase in the morning. How late do you expect to be out tomorrow night? Will he eat while you're gone?

Wendy&Neko said:
Actually we wait until kitty gets to six units before suggesting testing for the high dose conditions as we have seen cats get to 5.5 units and turn it around.
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As I typed that, I was thinking "Or is it 6?" Sorry, my bad. That's why I tagged the "experts"! :oops:
 
Thanks fellow serial poker Tricia! lol I did the increase to 4.25 U. Will test at +2 this morning. I will be gone from 5:30 to around 11. He will most definitely eat. His appetite has been quite good since starting the insulin. He will most likely finish his food before I leave. I will plan to leave out a frozen food cube as well and test when I get home. Fingers, eyes, toes, and paws crossed for some bluezzzz.:confused:
 
Wendy&Neko said:
we have seen cats get to 5.5 units and turn it around
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Bubba was a kitty who got as high as 5.25 and started coming down the dose ladder.

Good luck with the increase today and so glad that Jimmy is food driven as it sure helps with the testing.

Just some housekeeping: Each day we start a new post with date and kitties name and link the previous thread to the new one. That way we can go back easily and see what transpired the day before.
 
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