9/12 - Wally - AMPS=132, +1=174,+2=136,+5=122,+7=189, PMPS=287, +2=230,+4=274,+7=139

Awesome string of blues! :cool: If you update your subject title with the latest numbers, we can all celebrate with you.;)

If you don't see green overnight, you may wish to consider an increase. You've held this dose longer than we normally do (I know, he had lower nadirs), but after bounces are clearing, those nadirs seem to be creeping up.
 
Wendy&Neko said:
Awesome string of blues! :cool: If you update your subject title with the latest numbers, we can all celebrate with you.;)

If you don't see green overnight, you may wish to consider an increase. You've held this dose longer than we normally do (I know, he had lower nadirs), but after bounces are clearing, those nadirs seem to be creeping up.
Click to expand...
I'm reading through the TR protocols/Tilly's Diabetes Homepage and one paragraph stood out so I'm thinking I should keep him at 1.5 units BID for another day (at the very least) to see if he will stay under 200. If he doesn't, then I'll go up .25 units BID:
Phase 3: Holding the dose
Try to keep the cat at a dose where the BGs are in the 50 to 200 mg/dl range for as much of the day as possible. The majority of cats are actually able to achieve consistent BGs in the 50 to <100 mg/dl range with consistent dosing. A well regulated cat looks like this.

Don't let the cat go below 50 mg/dl (N.B. there are some cats that do well with BGs >=40 mg/dl and are difficult to regulate unless the dose is held at BGs in this range, but a cautious approach should be used until you are sure your cat reacts this way). 200 to 220 mg/dl is approximately the renal threshold for glucose and important for renal health and general recovery. This phase may last a long time (many months). Periodic slight adjustments are necessary in many cases.

If your cat remains in this range, testing for ketones is no longer necessary. But if your cat should, for example, develop an infection and suddenly have higher BGs as a result, start testing for ketones immediately and adjust the dose appropriately.
 
From the Tight Regulation protocol Sticky:
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.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
The reason I suggested an increase, besides the fact that nadirs are creeping up, and it's been a lot longer than 10 cycles, is that today is six cycles after the last green. Any bounce should be broken. Sometimes cats have an active cycle after a flat blue cycle, hence the suggestion to hold one more cycle.

This is not different from the Tilly's Diabetes Homepage. Wally is spending WAY too much time above 200 to be considered having BG's in the 50 to 200 mg/dl range as much of the day as possible. Maybe it's as much as possible with this dose, but it's the minority of his time overall. The goal is to be spending almost all of his time under 200.
 
He jumped up to 287 PMPS. I'll take another reading at +2 and maybe later if I get up in the middle of the night.

+2=230
 
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