9/26 Toby's PMS=367

[Peg and Toby]

Toby is in the red again this morning not seeing the results I was hoping for. I guess I should consider going up sooner on the dose. Never thought his dose would get this high . Guess it is what it is. How much would you increase tonight .25 or.5 .
Peg and Toby

 

[julie & punkin (ga)]

Re: 9/26 Toby's AMS=404 Seeing Red!!!

Hi Peg!

Marje, Sandy, Wendy & I all agree that you should increase every 4 cycles until he is at least getting some solid yellows. At this point his nadirs in the past 6 cycles are almost all over 300, so you would increase by 0.5u.

Don't sweat on the dose - it is what it is. Punkin's high was 15.5u per shot. You just want whatever it takes to meet your goal! The goal is to get his blood sugar down into better numbers!

from the TR Protocol guidelines on FDMB:

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.
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.

The Tilly version that I gave you yesterday has the option of increasing after 2 days if the numbers are high and sustained, so that's why we're suggesting that you increase after 4 cycles on a dose if he's still showing lots of pink and red.

There's likely some insulin resistance going on with Toby - at the least, he's showing signs of glucose toxicity, which just means that he's become accustomed to high numbers and it takes even more insulin to bring them down. That's the reason for not holding a dose longer to see what it might do eventually. The trouble with that is that while he's sitting in high numbers, and you're hoping that he might eventually come down, his body is saying "these 300's and 500's must be my normal range." As much as you test, you'll be able to keep him safe. Keep in mind that a non-diabetic cat's normal range is 40-120, and the goal of TR is 50-120 - so he's got plenty of space between these 500's and 50.

I would go to 5.75u tonight and give it 4 cycles, then re-evaluate based upon what the numbers are between now and then.

 

[Wendy&Neko]

Re: 9/26 Toby's AMS=404 Seeing Red!!!

Sorry about that red, but he did get pink later today. However, I agree with Julie that it's time to increase the dose. I know it's hard to not think about the size of the dose when you are going up the dosing scale - been there, fretted about that too. :YMHUG: The cats here are really all quite different and what works for one doesn't work for another. It's more important to focus on what you are seeing as nadirs and trying to get those down to good numbers as quickly as it is safe to do so. Good luck with the increase.

 

[Peg and Toby]

He's not as high as he has been mostly pinks. I hope this dose helps get him down to where he is at least in the yellows. He has been high for so long. Peg and Toby

 

[julie & punkin (ga)]

I've seen cats be high like Toby before, peg. Punkin was like that too - the whole summer of 2011 I increased his dose and nothing happened. For whatever reason, it seems like inching up the dosing scale will often result in the same numbers until you suddenly get to the dose the cat needs. Then the action all starts. So don't be discouraged that he's staying high as you go up the scale - there will be a dose that moves him!

Here's a spreadsheet of a kitty that is a good example of that. What I would point out is that this kitty's blood sugar stayed basically the same as the person increased the dose, per the protocol, until kitty got to 10u. Then there was a sea change, and a lot of green appeared.

This is a bit of an unusual situation, because this person's vet was very unhappy that the person was increasing the dose per the protocol, against the vet's wishes. Right about the time the cat started responding the the 10u dose, the vet basically drew the line and said in order to remain a client, she had to follow the vet's dosing directions. So she dropped out of FDMB and has obviously tried a couple of different things, including switching insulins. It's likely this cat has something else going on - if i recall correctly there was a thyroid issue. It's possible that there is a high dose condition too.

The point that I thought was worth pointing out to you was the first half of the spreadsheet when she just kept increasing the dose and the numbers didn't budget - until she got to 10u. It's very counter-intuitive to think that increasing the dose won't change the blood sugar along the way, but that's often the case.

Now I'm not saying Toby needs 10u! Just making the point that sometimes BGs just don't budge until you hit the right dose for that cat.

 

[Peg and Toby]

Julie, looked at the spreadsheet can see how it took 10 units to start to take it down. Hope Toby starts to respond soon. I thought we would use less levermir Than we did the PZI but, I guess not. Do you think he will reduce after awhile? Peg and Toby

 

[Wendy&Neko]

It's really hard to predict what will happen with Toby at this point. Each cat truly is different. For a spreadsheet of a cat that had a huge change around 8.5U, check out this one. This is the most dramatic I've seen, most are not quite that extreme. But it's also a good example of marching up the dose ladder every 4 cycles until action happened. The spreadsheet notes the switch to Young Again food, but he had been eating low carb wet food before then, so I'm not sure it made much difference.