5/19 Sushi - [DOSE ADVICE] AMPS~54 | +4~398 | PMPS~402

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Sushi (GA 5/05-3/14)

Sushi (GA 5/05-3/14)

Member Since 2011
I increased Sushi's dose last weekend by 0.5u, from 3u to 3.5u. I got feedback that that was too high of an increase, never got a response about where to go from there. I wasn't sure if I should stick with the 3.5u since I already did an injection at that dose, or go ahead and drop down to 3.25u. So, having to make a call on my own ignorance, I stuck with the 3.5u.

Sushi's numbers have been MUCH better at this lower dose; it's been so long since I've seen green, and we've had a lot of blue as well! Makes me :-D! But I am concerned about a few things:
  • Sushi seems to be bouncing around a bit. I'm not accustomed to dealing with bounces that aren't associated with skipping or giving a decreased/"hold over" dose. And his numbers seemed to make drastic changes within just a few hours.
    • - On Monday 5/14, he was at 146 @ PM+3 and up to 409 at his AMPS.
      - Wednesday 5/16, he went from a PS of 337 to 66 at +4.
      - This morning, his PS was 54 and he was up to 398 by +4.
      This concerns me; not really sure what to do to make him stop bouncing around like that. Is this a sign that his dose is too high?
  • This morning his PS was 54, so I went with a "hold over" dose of 1u. Where do I go from here?
    According to the protocol, this doesn't earn a reduction, because reductions are based on nadirs, correct? So just jump back in to the 3.5u?

Looking forward to some wisdom! Hope you're all having a great Saturday!
;-)
 
Re: 5/19 Sushi - DOSE ADVICE AMPS~54 | +4~398

One more question:
We've always used 29 gauge needles. Looks like the pharmacist gave us 31 gauge needles this time. Does that matter?
 
Re: 5/19 Sushi - [DOSE ADVICE] AMPS~54 | +4~398

The 31 gauge needles are in fact better, the higher the gauge the slimmer the needle so less ouchy for him.

Reductions are earned for numbers under 50 no matter where in the cycle they occur (assuming that you're following TR protocol) nadir is the lowest point in the cycle and may not always occur in the middle where you're expecting it. The bouncing is perfectly normal. It shows that his liver is working well and having a little panic when the BG is lower than it is used to. You have previously noticed that it is associated with skipped or reduced doses but what it is really associated with is the lower numbers that led to you skipping or reducing

I think you have been a little over enthusiatic about your increases (several at .5 over the last 2 months), particularly when you didn't know where he was going at night. I am leaning towards a drop back to 3.25 if there was no particular reason (e.g. off his food) for that 54 this morning but wait for some advice from others too.
 
Sorry didn't realise how close you were to shot time and was taking my time studying his ss :?

I'm assuming you've shot 3.5 now but I think it would be worthwhile for you to leave your question up to get some advice about whether to reduce a little tonight.
 
Ashley

I'm so sorry but I can't read your SS! When we try to pick up patterns, the SS must be so one day follows the next so the top of the SS should be the "oldest" date chronologically. The way you have it is really confusing to me and I can't pick up any patterns this way. For instance, 4/30/12 should be followed by 5/1/12 instead of you adding the months on like you have.

Is there any way to put in the proper order please? It's just to confusing to me to sort it out and I'm thinking most of the others offering suggestions will think the same thing.

Thanks, Ashley.
 
Seconded, it was a lot more difficult to try and read this way so I ended up just concentrating on the last two months. Also, what do the column of numbers to the left of the shot columns mean??
 
Okay, I think I have it fixed. Not all of the cells are picking up the formatting, but I need to walk away because I'm getting frustrated with it! ;-)

The #s to the left of the dose are the minute increments I tested/shot, to help me keep track of consistency of dose time.
The #s to the right of the dose are the cycle # of that dose.

Thanks so much for your help! I'm really excited about getting Sushi regulated! :-D
 
A couple of points. Sushi was diagnosed over a year ago. A dose reduction is indicated if:
  • he drops below 40
  • he drops below 50 on three separate days

As far as dose increases, please review the Tight Regulation Protocol sticky. The protocol states:
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.
Click to expand...
It looks to me like you are increasing your dose based on the pre-shot values you're seeing. With Lantus, dosing is based on the nadir. You have not had nadirs consistently over 300 since Sushi was diagnosed. If you keep raising the dose by 0.5u and not testing at night, you are putting Sushi in jeopardy. The guidelines for the Tight Regulation protocol are there to insure your cat is safe. If your lifestyle is such that you can't follow the protocol, please switch over to the Start Low, Go Slow approach. Even with SLGS, for Lantus and Lev the increases are in 0.25u increments.

If you want to stick with Tight Regulation, you have been at this long enough to begin to shoot low numbers. Shooting a reduced dose is only accentuating bounces. Sushi is bouncing because he has not spent any amount of time in even close to normal numbers. His body isn't used to experiencing blue or green numbers and, as a result, is bouncing.
 
Re: 5/19 Sushi - [DOSE ADVICE] AMPS~54|+4~398|PMPS~402|+2.5~

Hey Gabby! As always, thank you so much for the advice & info.
As you can tell, I get stuck when it comes to applying it. Where do I go from here? Do I stay at 3.5u? Do I drop to 3.25u? Do I start over at 1u?
I interpret the protocol to say stay at 3.5u until Sushi earns a reduction. But I'm notorious for getting it wrong.

I'm glad to know what's causing the bouncing, but what do I do about it? Nothing; just wait it out and it should take care of itself, right?

It's true, I've been a total slacker about testing at night. I tried to do better this week and will continue to do so. But I won't be able to stay up late enough to test Sushi at his PM nadir on weekdays; that would only allow me 5.5 to 6 hours of sleep, and I'm a gal who needs her sleep! The latest I'll be able to test him is at +4 or +4.5 during the week. Will that suffice?
 
I'm Sienne. Gabby's claws get in the way of her using the computer.

Getting a +4 at night is fine. However, if Sushi's numbers are dropping, you are going to have to stay up and make sure Sushi is safe. There have been many days we've all operated on less than the optimal amount of sleep. Your cat's safety is a priority.

If you are still struggling with figuring out dose, please post. We're all happy to help you. It's better to ask to someone lend a hand vs. putting Sushi at too high of a dose. The increases specified in the protocol are geared to bringing the dose up quickly but safely. Being too aggressive about the amount of insulin is risky especially if you're unable to test.

I would hold the dose at 3.5u and be consistent about getting PM tests. With having shot a reduced dose this morning, your cycle count re-starts. This is Jill's post about cycle counts.
 
Sienne! :oops: You know I know your name is Sienne. ;-) IDK what happened there--typing too fast I guess. I'm so sorry!!! :oops:
Thanks for your response, and for the specific dose advice! Yeah!! :-D
 
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