6/15: Sammy - AMPS 246; +6 196; +10 221; PMPS 200; Reduced to .25 unit

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Tina & Sammy

Tina & Sammy

Member Since 2010
Yesterday's Condo

Well last night didn't turn out as I expected. Sammy dropped from 231 at +8.5 yesterday morning to 162, and he continued to drop up to +4, but then he started to rise again. I know his evening cycle was a normal cycle, but I still think the higher numbers might be because of too much insulin. Depending on how the rest of this cycle plays out will help me to determine if I want to try a reduction back to .25 unit tonight. I figure that the fluids should help bring him down a bit, and hopefully with less insulin he won't spike back up quite so high.

I know this is totally against protocol but i just have to try it. I know I can always increase again, and it might be possible that we would have to go up higher in dose before he levels out again, but I just need to know for sure, and now that I am using the calipers I feel like the doses are much more accurate than the ever were in the past.
 
Tina & Sammy said:
Depending on how the rest of this cycle plays out will help me to determine if I want to try a reduction back to .25 unit tonight.
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Sammy's only had 3 cycles on this dose. It's too soon to be able to draw any conclusions about what this dose is capable of doing. Reduce now and you'll not know what this dose can do either.

Just wanted to throw that out there for your consideration...
Good luck with whatever you decide to do! :)
 
I think it's a tough call Tina - it does look as though his numbers have been less consistent since soon after you increased to 0.60U with a few runs of yellow in there where before he was blue and green with just the one weird day from the probiotic. If you do go back to the 0.25U, I really hope he turns those numbers around for you and starts giving you more green again more of the time - it's difficult to know what to do sometimes when it doesn't feel like following the protocol is working for you.
 
Jill & Alex (GA) said:
Sammy's only had 3 cycles on this dose. It's too soon to be able to draw any conclusions about what this dose is capable of doing. Reduce now and you'll not know what this dose can do either.

Just wanted to throw that out there for your consideration...
Good luck with whatever you decide to do! :)
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I went ahead and reduced back to .25 (.31 mm) tonight. I am anticipating having to go back up the dose scale, but at least I will know for sure that it wasn't too much insulin. I just couldn't get past the fact that I might have screwed up the dosing by not measuring properly before staring to dose using the calipers. My plan is to hold the dose for 4 cycles and increase according to TRP. I suspect that I will be back at the 1 unit dose by the weekend, and I am preparing myself for some higher numbers tonight, but honestly I really am hoping to see some better numbers.

Thanks so much for your advice, and I know you are probably right, but I am sometimes just hard headed and I must discover this for myself.
 
manxcat419 said:
I think it's a tough call Tina - it does look as though his numbers have been less consistent since soon after you increased to 0.60U with a few runs of yellow in there where before he was blue and green with just the one weird day from the probiotic. If you do go back to the 0.25U, I really hope he turns those numbers around for you and starts giving you more green again more of the time - it's difficult to know what to do sometimes when it doesn't feel like following the protocol is working for you.
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Yes, it was a really tough call, and I gave it an enormous amount of thought today. In the end, I did decide to give the reduced dose, because I was still very worried that I overdosed him by increasing too rapidly. I know usually if that happens they will have a low, but I just can't be certain that is what will happen. As I just mentioned in my post to Jill, I anticipate having to go back up the dose scale, but at least I will know for sure.
 
Been there, done that on the dose reduction trial. With Neko having had SRT, at the time I wasn't sure whether a few more tumor cells hadn't been killed off causing her to need less insulin. However, you don't need to wait a full 4 doses before deciding if it's a "failed reduction". When I did the trial, I knew after two cycles and some pink. If you see numbers trending up, you can go right back up to the last good dose.
 
Wendy&Neko said:
Been there, done that on the dose reduction trial. With Neko having had SRT, at the time I wasn't sure whether a few more tumor cells hadn't been killed off causing her to need less insulin. However, you don't need to wait a full 4 doses before deciding if it's a "failed reduction". When I did the trial, I knew after two cycles and some pink. If you see numbers trending up, you can go right back up to the last good dose.
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Thanks Wendy, I was wondering about that. However, I do want to make sure that I don't miss his optimal dose by jumping back up, which is why I had decided to do the 4 cycle (fast track) method.
 
I wanted to find this part on reductions for you. It's from the New to the Group sticky, in the bottom part in the post on New Dose Wonkiness, Failed Reductions and Bouncing. It's possible that the yellow numbers he's had in the past day are NDW from the dose increase.

"Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations."

The concept of "New Dose Wonkiness" is NOT applied to higher numbers which may be seen after a dose reduction.

There is no "NDW" following a dose reduction nor do we hold a reduced dose 6 cycles (as done with dose increases) to "fill the insulin depot".
"Settling time" does not apply to dose reductions. We don't wait for a reduction to "settle".

When you see numbers trending higher after a dose reduction we immediately return to the last "good" dose as described in the The Tight Regulation Protocol with Lantus or Levemir:

"If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose."
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The fast-tracking that you mentioned is a technique that, as far as I'm aware, is only suggested for a kitty that has constant high numbers, generally over 300. Usually the cat has been having regular dose increases per the Tight Regulation guidelines and is still having high numbers. Most of the time it turns out that it's a kitty that has a high dose condition like acromegaly, iaa or Cushing's. I don't think that concept would apply to your situation.

In your situation, if you reduce the dose and the numbers rise, you can "immediately increase the dose again to the last good dose." There's no waiting period after reducing the dose before assessing it to see if it's enough insulin.

Hope that's helpful.
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