6/26 Whitey PMPS 242 - time to increase dose?

[ryanms3030]

we've been on 1 unit 2x per day for a month (minus a few .50 and not shoot because I was afraid to shoot full shot under 200). He seems to be living in 200-300 range with a few spikes to upper 300s and dips to mid 100s. Would it be good to inch up to 1.25 unit 2x day and see where we go?

 

[Marje and Gracie]

I would take Whitey up .25u.

A few thoughts:

--it's important to always get a preshot test.....every cycle. We've seen too many extremely low numbers and a few serious clinical hypos from caregivers not getting a preshot and evidently shooting too low.

--I wouldn't hold doses so long. General guidelines on holding the dose and increasing are:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
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.

If you skip a shot, shoot a reduced dose, stall, the cycle count starts over.

Good luck with the increase and let us know how we can help.

 

[Sienne and Gabby (GA)]

I think it's time for an increase, as well.

The risk of holding a dose overly long, especially when the dose isn't bringing numbers into a closer to normal BG range is that glucose toxicity can develop. (The term sounds worse than it is.) What this means is that Whitey's body begins to become adjusted to higher numbers and treats them as the new normal. As a result, it's harder to get the numbers to come down. Even if you're opting to follow Start Low and Go Slow (vs. Tight Regulation), the dose needs to be evaluated every 5 - 7 days.