5/31 Schmitty +11 145 AMPS 165 +1 205 +2 221 +6 200Question?

[Chippy]

Hi,

Can y'all look at Schmitty SS and let me know if I need to do anymore checks before his insulin shot tonight. It looks like he is staying around the 200's so I was wondering if I could increase his dosage tonight.

He's doing well other than always hungry!! :razz:

Thanks,

Mary

Yesterday's Health Condo

 

[MJ+Donovan]

Re: 5/31 Schmitty +11 145 AMPS 165 +1 205 +2 221 +6 200Quest

I'd stick with 0.5U tonight. There was so much drama not long ago that I don't think giving him another day or so on this dose would be a bad thing. BG looks pretty steady now, all things considered. If he continues to stay low yellow, then a small increase is in the cards. I just don't want to rush it.

MJ

 

[Sienne and Gabby (GA)]

Re: 5/31 Schmitty +11 145 AMPS 165 +1 205 +2 221 +6 200Quest

I agree with MJ.

Generally with Lantus, you need to hold the dose for several days. However, if you give a reduced dose or an increased dose like you did on 5/28, your count starts over. According to the protocol, here's what you need to consider:

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.

You've been at the 0.5u dose now for 5 cycles (2-1/2 days). It's hard to decide if the nadirs are generally below 200 especially since you are not getting spot checks during the PM cycle. At the very least, you'll want to hold the dose for tonight so you have a total of 6 cycles at this dose. Given that you are seeing at least some nadirs below 200, you may want to hold the dose for an additional 2 days/4 cycles.

 

[Libby and Lucy]

Re: 5/31 Schmitty +11 145 AMPS 165 +1 205 +2 221 +6 200Quest

Hi Mary,

I'm just getting caught up on all the "fun" you have had recently! I'm glad you found us.

Is it possible to get at least one spot check each evening? It doesn't have to be at +6, though it is nice to get those every now and then. Most of us try to make it a habit to get a "before bed test" every night - just grab a test before you go to bed, whatever + hour that happens to be (but of course if that number shocks you, then it might not be bedtime yet!).

The reason an evening test is important is because many Lantus cats run lower at night than they do during the day. That test is our insurance policy to be sure we know how low the dose is really taking the cat. For that reason, I pretty much insist on seeing a couple of nighttime spot checks before I will recommend a dose increase to anyone.

There are hints that Schmitty could be hitting green at night, even on this low dose. During the day, it looks like he usually hits his lowest point right around mid-cycle (+6 or so). The fact that you have caught a 131 and a 141 at +11, then he rises from there, implies that he was probably lower than 131 in the middle of the cycle. We just need to get an idea of approximately how much lower. Make sense?

 

[Chippy]

Re: 5/31 Schmitty +11 145 AMPS 165 +1 205 +2 221 +6 200Quest

That makes sense. My daughter usually stays up late and she knows how to test glucose, so I'll see what she can get tonight.

I'm glad you addressed the lower # at night because I did notice that on other SS and I wondered why that was...

Thanks for the replies!

 

[Marje and Gracie]

Re: 5/31 Schmitty +11 145 AMPS 165 +1 205 +2 221 +6 200Quest

Hi Mary

I'm glad you are going to get some pm tests..like Insaid yesterday, he could be going lower and then popping up...in that case, we probably wouldn't want to change his dose yet.