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[eeraby]

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[Sheila & Beau GA & Jeddie GA]

Re: Bud - - We are increasing her dose.

On a current dose of .6u I would not be making .25u dose changes - and certainly not .5u ones. That is the part of the protocol I have the biggest problem with. Changes in those amounts are OK off doses of 1.5u or more - and maybe .25u increase off of 1u. Otherwise that is too much of an increase.

It's best to think in terms of percentages when increasing a dose and I think lev does better with no more than a 20-25% increase - less if the dose is getting the BGs near the normal range at nadir - so it just needs fine tuning.

So... from .6u I would be making changes of .1u or no more than .15u - next dose would be no more than .75u. Also, I would let the settle time be 5 days, not 2-3 days. This is not a process you can rush. It needs patience.

Also, I am not sure you understand the basics of the protocol by your first sentence:

From the protocol, we increase her dose 0.25 every 2 -3 days unless her nadir's over 300 and then shoot 0.50. Once the nadir's less than 200, we keep increasing it 0.25 every 2-3 days until she's in 'normal' range.

You wrote: "unless her nadir is over 300 than shoot .5u." Did you mean "increase by .5u"? Again, I would not be increasing be .5u unless it is from a much higher starting dose (like 2u). And her nadir is already near or below 200 -according to her SS - and you just increased her dose by 50% (from .4u), I would not do another increase until Monday night.

If you are going to be at home, Monday would be a good day for a curve after she has been on .6u for 5 days.

 

[Vicky & Gandalf (GA) & Murrlin]

Re: Bud - - We are increasing her dose.

Agree with Sheila. If you're referring to Tilly protocol, here's the important section to understand:

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.

Again, doses below 2U should not be increased more than .25U at a time, IMO even if there are high BGs. If you increase 1U to 1.5U that is a 50% increase and is too much. If you increase 2U to 2.5U that is only 25% increase. see the difference?

The other important part to understand is that the BG upon which you base increases is the nadir or lowest point in the cycle, not preshot numbers. It's also important to understand this:

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.

That is why I agree with Sheila again that doses should be held at least 5 days because you don't want nadirs influenced by this effect and the "bounce," as we call it, can last longer than 24 hours.

I hope the increases work. The main thing to realize is not to react to high numbers, be consistent in your dose changes by both amount and time - wait the same # of days each time and change the dose by the same amount each time. A lot of people sabotage their progress by reacting to one number or thinking a dose isn't working because the BGs are the same even after 3 days. I really think the Tilly protocol works so well because it is systematic, not because it's some magical formula.

 

[eeraby]

Re: Bud - - We are increasing her dose.

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