8/26 Tiggy PMPS 344

[Wendy&Tiggy(GA)]

Yesterday's condo

PINK today after a nice blue green yesterday. Not sure whats going on. I am looking back at his SS and whats weird that on other occasions where he had some blues and greens, within three hours he shot up to yellow i.e.

Aug 14: + 6 56 + 9 149 + 12PMPS 187 PMPS+3= 279. Did he drop low in these 3 hours after the shot and bounce? And then pinks and yellows for a few days.
Aug 19: +6 54 +9 133 + 12PMPS 254 would he have dropped and bounced between +9 and +12? Seems unlikely no? And then yellows for a few days.
Aug 25: +6 68 + 8 83 + 12PMPS 110 PMPS+3 124 But pink this morning.. AMPS 358 Did he drop after the PMPS+3?

Probably I get loads of yellows for the next few days now but I dont know what to do with his dose. I am wondering if I am raising his dose all the time (since Aug 14 anyway) based the after effect of bounces holding him in yellows for a few days?

I am considering waiting till end today ( thats 3 days of 4.5IU) but taking him down to 4.25IU again and holding it for longer than the 3 days to try and let the results of this suspected bounce clear. What do you think?

 

[rhiannon and shadow (GA)]

Re: 8/26 Tiggy AMPS 358 - dosing question

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.

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.

Hi Wendy,
You haven't had the minimum 3 days yet.
You should see what today brings.
One of advisors will be along.
Just be sure and tell if you are going to have a day where you can't be home to supervise.
You never know when you might get some action.

 

[Jane & Jack & Karre the Emperor]

Re: 8/26 Tiggy AMPS 358 - dosing question

Hi Wendy

Looking at the SS, I'm not sure why you're leaning towards reducing Tiggy's dose. The 4.5u has given Tiggy some very nice greens. There have been no low drops asking for a reduction. I would suggest you stick with this dose for at least another day. Remember that bounces are normal for a cat that is not yet used to healthy ranges, and reducing the dose to try and avoid them would not only most likely not work, but it goes against what TR aims for - healthy BG ranges :mrgreen:

Do you think you could have a re-read through the stickies? The "New to the group" and the "TR Protocol" stickies are well worth revisiting - I do often myself.

Consider this and come back with any more questions ok? We want to make sure you're ok and confident in how to move forward.

Hugs
Jane

 

[Sienne and Gabby (GA)]

Re: 8/26 Tiggy AMPS 358 - dosing question

Your question regarding decreasing to reduce bouncing is one that comes up frequently. On some of the other ISG boards, there are a few people who make this recommendation. If you want links to the discussions, I can provide some of them. However, the bottom line is that decreasing the dose to try to prevent bouncing doesn't work -- at least not with Lantus. You end up losing time and having to increase the dose back up -- often to an even higher dose. Bounces last up to 72 hours. The drop into numbers that are lower than what Tiggy is used to is causing the bounce. To try to offset the bounce so you get flat yellows is only going to cause Tiggy to treat those yellow numbers as "normal," which I doubt you want. Most cats will bounce and continue bouncing until their liver decides that lower numbers are not cause to panic. It takes some cats longer than others to graduate from Liver Training School.

I think you need to pay closer attention to the protocol and increase and decrease doses by 0.25u. I would also not hold a dose more than 3 days (providing nadirs are not under 200) so you don't lose momentum. Obviously, there may be times when you need to hold the dose longer but increasing every 3 days may end up helping to get the numbers down.

 

[Wendy&Tiggy(GA)]

Re: 8/26 Tiggy AMPS 358 +6 297 dosing question

OK I think I get it, from what you are saying, it could be just because he isnt used to the greens that he is getting. Even if they arent that low, they are still low enough for his body to react cos he just isnt used to them?

So by tomorrow morning he will have had three days at the 4.5IU dose and his nadirs have been all over the place ie 293, 65, 297 and probably the same kind of thing at night. So I am guessing I should increase to 4.75 as per the protocol? I am home all day.