7/24 Bubbas 387 PMPS 414, +2 384-more dosing questions

Bubbas and Katrina

Bubbas and Katrina

Member Since 2023
https://felinediabetes.com/FDMB/thr...63-2-252-4-184-curve-day.279816/#post-3090366

AMPS 387.

I wanted to double check when I should up his dose. So she’s been on 1.25 units for 9 days now. That unit brought him down to 90 on 7/21. So he’s bouncing, and should break his bounce by today or so? (His numbers jumped pretty high from last nights +4 reading). So when should I up his units to 1.50? Is it when his nadir for 6 days doesn’t go below 200? Can someone tell me what number I have to see or not see in order to up it?

I thought the process for that is do a curve once a week, and if his nadir is 200 or higher, up his dose, or something of that sort. That’s what I thought the frequent curves are for, to weekly determine his dosage. I also thought you determine if up or not the dose of on his CURVE day, if his nadir goes above or below 200. I thought curve days were the only days you can determine if they need upping or holding.
 
I'll let some of the gurus chime in here but no, under SLGS, you reduce the dose immediately if you see a BG below 90 on a human meter. But you also do weekly curves with the goal of understanding if you should reduce or increase. So you got it partially right.


From the sticky thread


Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
 
Hmm, so I guess if we are going off Bubbas curve from yesterday, I should technically increase because his lowest number of the day yesterday was at +4 which was 184, so higher than 150…I think I’m wrong cuz I was told yesterday to hold the dose which I’m a bit confused about, but I think it’s because he was bouncing, but his number was still high this morning and he should be out of his bounce.

So overall, dose increase, decrease or holding is based on day by day. If ANY day his lowest number is more than 150, increase. But if one day his nadir is below 90, immediately decrease the dose?

it sounds to me like the dosage thing is a day by day thing. What I’ve been doing is maintaining the dose no matter the number for 7 days, and using the curve day numbers to determine the possible new dosing starting the next day.


So for example..his AMPS was 387 this morning..let’s say when I get home and do his PMPS, if it’s 89…I would give him only 1 unit rather than 1.25?

and let’s say tomorrow his AMPS is 410 or something…than would I go back up to 1.25 units? Again I am just trying to figured out if figuring out dosing is a day to day, hour to hour thing, or you hold the dose pretty much no matter what for 7 days than reevaluate.
 
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Bubbas and Katrina said:
Hmm, so I guess if we are going off Bubbas curve from yesterday, I should technically increase because his lowest number of the day yesterday was at +4 which was 184, so higher than 150…I think I’m wrong cuz I was told yesterday to hold the dose which I’m a bit confused about, but I think it’s because he was bouncing, but his number was still high this morning and he should be out of his bounce.
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I see that @Wendy&Neko did indeed instruct you to hold. She is one of the gurus around here, so I would go with that guidance. But yes, going strictly by SLGS you would increase based on the curve yesterday.


Bubbas and Katrina said:
So overall, dose increase, decrease or holding is based on day by day. If ANY day his lowest number is more than 150, increase. But if one day his nadir is below 90, immediately decrease the dose?
Click to expand...

increases are not day-to-day, but yes, in order to keep kitty safe and avoid a hypoglycemic episode, a decrease can be based off of a single BG test.


Bubbas and Katrina said:
So for example..his AMPS was 387 this morning..let’s say when I get home and do his PMPS, if it’s 89…I would give him only 1 unit rather than 1.25?
Click to expand...

correct. This, again, is to keep kitty safe. Safety is a top priority.


Bubbas and Katrina said:
and let’s say tomorrow his AMPS is 410 or something…than would I go back up to 1.25 units?
Click to expand...

No. You would hold the 1U for 7 days unless you saw a number below 90. Dosing is not based on the AMPS or PMPS being high, it is based on the lowest number -- whenever it happens.
 
Hendrick Cuddleclaw said:
maybe Bhooma can chime in here because I do not quite understand holding the dose. Looks to me like an increase is the guidance under SLGS.

@Bandit's Mom
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She said because he was bouncing, but yeah, his numbers today are still high, so I don't think it's a bounce anymore, I think his number is still just high and needs 1.50 units. I was told the bounce should clear today, but it didn't. I personally think hes needs an increase but what do i know lol
 
Bubbas and Katrina said:
She said because he was bouncing, but yeah, his numbers today are still high, so I don't think it's a bounce anymore, I think his number is still just high and needs 1.50 units. I was told the bounce should clear today, but it didn't. I personally think hes needs an increase but what do i know lol
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It's my understanding that deciding whether to increase a dose we look at how low the dose brings the BG. We then wait for that bounce to clear to see if that dose can do it again. If it does, then hold that dose a little while longer. If it doesn't, then its time for an increase. This is one of the reasons those "spot checks" when following SLGS are important in addition to the weekly curve.

Bubbas 1.25 dose got him down to 90mg/dl on 7/21 PM. This is great! Now give Bubbas 3 days/6 cycles to see if he can get you a nadir of 90-149mg/dl. If my counting is right, that should be at most tonight's cycle. He may have done that already later in last night's cycle. So if it were me, and tonight the BGs aren't 90-149mg/dl, then I would increase tomorrow morning.
 
Angela & Cleo said:
It's my understanding that deciding whether to increase a dose we look at how low the dose brings the BG. We then wait for that bounce to clear to see if that dose can do it again. If it does, then hold that dose a little while longer. If it doesn't, then its time for an increase. This is one of the reasons those "spot checks" when following SLGS are important in addition to the weekly curve.

Bubbas 1.25 dose got him down to 90mg/dl on 7/21 PM. This is great! Now give Bubbas 3 days/6 cycles to see if he can get you a nadir of 90-149mg/dl. If my counting is right, that should be at most tonight's cycle. He may have done that already later in last night's cycle. So if it were me, and tonight the BGs aren't 90-149mg/dl, then I would increase tomorrow morning.
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Thank you for explaining that so well!! If his BG's aren't within the 90-149 range, then I will increase to 1.50 tomorrow!

I will do my best to check a +2 and a +4 (are you meaning if his numbers within the PMPS, +2 AND +4 aren't in the 90-149 range) than increase it tomorrow? Not just if his PMPS are not within in the 90-149 range, like looking at all 3 numbers.

So, let's say his PMPS is 350, his +2 is 180 and his +4 is 130, I WOLDNT increase. Because one number out of those 3 are within the 90-149 correct? Due to lower number(s)
Let's say his PMPS is 350, +2 is 312 and his +4 is 212, then I WOULD increase it right? Due to higher number(s)
 
Bubbas and Katrina said:
So, let's say his PMPS is 350, his +2 is 180 and his +4 is 130, I WOLDNT increase. Because one number out of those 3 are within the 90-149 correct? Due to lower number(s)
Let's say his PMPS is 350, +2 is 312 and his +4 is 212, then I WOULD increase it right? Due to higher number(s)
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Theoretically Yes, but let me add that this is ALSO because he is newly diagnosed and not used to lower numbers.
With time, experience and more data on how your cat responds to carbs and insulin, you might lower that threshold.

Let the numbers be your guide. Worry about PMPS when you get there. As an experienced member once told me Hooman makes insulin plans and Cat laughs! :joyful:

PS that cell of 90 in the PMPS 7/21 should be GREEN. He earned that :D :kiss: !
 
Bubbas and Katrina said:
so I guess if we are going off Bubbas curve from yesterday, I should technically increase because his lowest number of the day yesterday was at +4 which was 184, so higher than 150
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Angela is right. You don't base decisions on just the curve, but all the data you've seen in the last week. Ask yourself the question "how low does this dose take my cat". If that answer is 90-149 in the past 7 days, you keep the dose. You also don't know how low he got last night. He was breaking his bounce last night. Bounces can take up to six cycles to resolve, but can be sooner than six. Resolving earlier is a good sign by the way. Unfortunately, he's now bouncing again from last night's numbers. :rolleyes: You can't decide how to change the dose based on the numbers you see until this bounce resolves.
 
Wendy&Neko said:
Angela is right. You don't base decisions on just the curve, but all the data you've seen in the last week. Ask yourself the question "how low does this dose take my cat". If that answer is 90-149 in the past 7 days, you keep the dose. You also don't know how low he got last night. He was breaking his bounce last night. Bounces can take up to six cycles to resolve, but can be sooner than six. Resolving earlier is a good sign by the way. Unfortunately, he's now bouncing again from last night's numbers. :rolleyes: You can't decide how to change the dose based on the numbers you see until this bounce resolves.
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Oh darn!! so i might have to wait to up the dose for another 3 days?? I dont know what to do lol I want to up the dose since his numbers have been pretty much high all the time, but also i want to see how his numbers look after the bounce :banghead:
 
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