6/30 I cut Frodo's dosage from 2U to 1.5U, a larger cut to avoid his BG going too low overnight. At beginning of 4th cycle of 1.5 (am on 7/2), it looked like his BG was creeping up, so I nudged the dosage back up to 1.75U. And he dropped below 50 on that cycle, and the next one after I dropped it back to 1.5U. So I kept it on 1.5U for two more cycles, thru 7/3 evening. I thought again that his numbers were creeping up , and the depot should have cleared out the recent higher doses (except the 1.75 on 7/2), so I tried 1.75U again this morning. And again he went sub-50 at am+4 today.
It looks like 1.5 might be not quite enough, but 1.75 is a little too much. Wish my husband thought he could draw up something between the two numbers, but I guess we're going to have to dose 1.5 until we get a dose reduction at that level.
He also seems to eat better when his BG is below 100, so I wish we could keep it low, and not have preshots over 150.
Ordinarily, I might agree with you. There are too many dose changes that are too close together to really have a solid idea of what's going on. Looking at the bigger picture...
You held on to the 2.0u dose on 6/29 and for 2 subsequent cycles despite a 38 during the PM cycle on 6/28. Frodo's dose should have been reduced on 6/29.
The dose should have been reduced to 1.75u and held long enough to determine whether the 1.75u dose was working.
You held the 1.5u dose for 3 cycles. Frodo was seeing nadirs in the greens so it looks like despite an overly zealous reduction, he was doing OK.
You then raised the dose back to 1.75u after 3 cycles vs. waiting for 6 cycles.
You then dropped the dose back to 1.5u after one cycle of 1.75u.
You held the 1.5u dose for 3 cycles and increased this morning back to 1.75u.
One quick question. As I'm writing this out, I'm wondering whether you are misinterpreting the TR instructions. When you hold a dose, you hold it for 3 days/6 cycles when numbers are above 200. Are you confusing days and cycles? Also, when the nadir is in the blues or greens, you hole the dose for 5 days/10 cycles. If you're following SLGS, doses are held for a week. Regardless of the dosing strategy, the doses are held only if a reduction isn't indicated. I'm also wondering if you're basing your dose decisions at least in part on the pre-shot numbers. That's appropriate for ProZinc but not with Lantus.
When you make this many rapid changes in dose, you end up with hard to interpret numbers. The depot needs time to stabilize after each dose change. Frodo is seeing very good numbers. You don't need to be tinkering this much and I suspect that's why you're confused. If this were me, I'd hold the dose at 1.5u for 10 cycles unless you see numbers below 50.
Based on your last condo I can see why you thought the first increase to 1.75 was called for - however one higher preshot number doesn't constitue trending up. It's always good to post for advice before increasing until you're really confident about what you're doing
In dosing lantus we look at how low the dose is taking the kitty with very little attention paid to preshot numbers. In particular the AMPS is usually the last number to come down so please ignore it for dosing purposes.
I agree with Sienne, hold the 1.5 units and see what happens. I also recommend posting for advice before increasing again. Of course if Frodo goes below 50 reduce to 1.25.
One problem that's happened more than once is that Frodo has gone below 50 on the first cycle after a dose cut. I suspect that the Lantus holds on longer than 12 hours for him, throwing off the next cycle significantly. It happened 6/22 after the reduction from 2.25 to 2, 7/2 after the reduction from 1.75 back down to 1.5, and it's going to happen again tonight on another 1.75 > 1.5. That's one of the reasons why I have made some cuts of more than .25U. We will handle whatever low he hits tonight (Good- bye sleep!!) but not count it as a signal for reduction from 1.5 because of this quirk in the way he handles the Lantus. Now if he goes sub 50 on tomorrow's cycle.....
[And I still don't make any sense out of being able to drop his dosage (didn't get up to where he was previously) after he was off insulin for 4 days because of an infection.]
His spreadsheet is a lovely sea of blue and green! Enjoy that!
I think holding the 1.5u dose for a bit is a great suggestion.
When you increased on 7/2 it sounds like you were thinking you had a failed reduction, is that right? As long as you're having long stretches of green, I wouldn't worry about that, even if you've got a preshot that's a little higher than usual.
This is probably from the depot from the larger dose. The depot size is in some sort of an equilibrium with the dose - so a 1.75u dose has a depot that fits the 1.75u. A 1.5u dose has a smaller depot that "fits" the 1.5u dose. When you decreased the dose to 1.5u, the depot has to decrease to a smaller size. It can take as long as 6 cycles for that to happen. During those 6 cycles, the 1.75u is still having an effect on the blood sugar, probably more significant of an effect in the first few cycles than in the 5th or 6th cycle. I suspect that's why you are seeing him drop lower in the first cycle after the dose decrease.
Depending on the situation, sometimes if a cat drops under 50 in the first 3 or so cycles after a dose decrease, people might suggest not decreasing the dose yet because of the depot from the previous dose. On the other hand, sometimes kitties go down the dosing ladder quickly, so it just depends on the cat.
