8/11 Shadow PMPS 88 +2~105 +3~86 +4~82 +8~104 (food)

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Re: 8/11 Shadow AMPS 81

Yes, I just received it now, Rhiannon. Thanks. As you know, we prefer to keep dosing discussions in the condos - it helps make sure that any advice given is safe. Here's what you asked:

RHIANNON WROTE:
"Hi Jane, would you look at our ss? I don't know if I should be taking a reduction. I figured out why my numbers were stranger than last reduction. I can't see well enough and have a bubble here or there in the cone that I likely missed."

I'm looking at your SS now, but I'd also like you to add "Dose Question" to your original subject line, ok? That way, more people will know you're looking for some input. (Also, I'm not sure what you mean by bubbles in the cone?)
Be right back.
Jane

Edited to Add: Back now. Looked at your SS. It doesn't look like Shadow is asking for a reduction in an obvious way, to me. Though there are approaches to 50, there are no dips to sub-50 (unless I'm missing something on the SS) so far on this dose. Also, the nadirs on this dose aren't creeping or suddenly dipping lower as far I can see, and I see no typical inverted curves of the type we sometimes see when a cat wants less insulin. So, no, I don't see that Shadow is asking for a reduction. I do see that you're at a week on this dose, so according to protocol, the assessment period of 5-7 days is complete for the current dose, and that justifies at least asking if the dose should be adjusted. Given the few blues we're seeing now, more than on the previous dose, again - I don't see that as a sign for needing a reduction. If anything, I'd try maybe fattening the dose to see if you can get the blue BGs to subside or get another obvious reaction... Let's see what the others think.
 
Re: 8/11 Shadow AMPS 81 Dose Question

Here's some information from one of the stickies with regards to reductions:

Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.

You can find this in the Tight Regulation Protocol sticky. Hope that helps! :mrgreen:
 
Re: 8/11 Shadow AMPS 81

rhiannon and shadow said:
I was referring to the 7 day cycle part - the slow way.
Click to expand...

I don't know what you mean by that. Please alter your original subject line - the one heading up your *first* post of this thread - to include "Dose Question" so that others know you'd like some feedback.

Jane
 
Re: 8/11 Shadow AMPS 81

Phase 4: Reducing the dose. Phase out insulin slowly by 0.25-
0.5U depending on dose.
When the cat regularly (every day for at least one week), has its
lowest blood glucose concentration in the normal range of a
healthy cat, and stays under 100 mg/dL overall
Reduce dose by 0.25-0.5 IU depending on if cat on
low or high dose of insulin
Click to expand...

Here's the part I was referring to.
 
Re: 8/11 Shadow AMPS 81

Hi Rhiannon,
As I understand it, the guidance here for dose decrease offers Shadow 2 options
1) slow way: keep bg in 120 - 50 range for 7 consecutive days/14 doses
2) low way: one bg of 49 or less
If I am getting that correct, to get a decrease the slow way, Shadow needs some more low blue-all green days. Looks like she had 3 tests >120 on 8/9 so her 7 day count starts 8/10, yes?
I trust others will advise if I am missing something.
Jane mentioned the protocol says 5-7 days, I don't know what would merit decrease at 5 days vs. full 7 days. I am hoping full 7 days at dose will decrease likelihood and severity of bounce.
 
Re: 8/11 Shadow AMPS 81

If a cat is in normal (50 - 120) numbers for a week, the dose can be reduced. There are a couple of factors to consider. In favor of a reduction, there are a couple of cycles where it looks like a there's an inverted curve. Sometimes, this means that a dose reduction is needed OR it can mean an increase is warranted.

The other factors that mitigate against a reduction is that if a fur shot or partial fur shot was given on 8/6, the day count starts over. Further, if you have not been measuring consistently, there's no way to know how much the inconsistent dose is effecting Shadow's numbers.

What I would suggest is that you figure out a way to measure the dose consistently, stick with the current dose for a few cycles and we'll re-evaluate then.
 
Re: 8/11 Shadow PMPS 88

I agree with Sienne....you had a couple cycles that looked inverted so it was kind of hard to tell if she was wanting more insulin or less.

Hopefully, you can dose it a little more consistently. Don't be surprised, though, if numbers go a little wonky as you switch syringes. It can happen due to the variance from one syringe type to another. Paws crossed for a week's worth of green numbers.
 
Re: 8/11 Shadow PMPS 88 +2~105 +3~86

I was just staring at the ss.

I wasn't getting food spikes before. Now we are, along with the inversion you just mentioned,
What does that indicate?

And is there some literature , reference material other than the TR protocol .
I'd like some reading material.
 
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