DOSE? 8/21 Sushi AMPS~344(?)|+3.75~276|+6~303|+11~292

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Sushi (GA 5/05-3/14)

Sushi (GA 5/05-3/14)

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Today is piggy backing on all that happened Yesterday. It was quite and adventure!
I went ahead and kept the 4.5u dose for this morning, but judging by Sushi's numbers, I'm thinking we should go up to 4.75u for this evening's dose. I'd love to get some advice on that before I dose him in an hour :!:
A huge fator/issue is I'm going to be gone most of the week and a cat sitter will be testing/feeding/shooting Sushi twice a day. I need to find a dose that won't cause any trouble, even if it keeps his #s a bit higher than we'd like.

...I'd like to continue our discussion on doses, protocol and how much Sushi should be eating, but I'm in the middle of 92834039 things right now getting ready to be gone most of next week; hopefully I'll have time later this evening!

Thank you all for everything!! :-D
 
Ashley:

I haven't posted yet on your condo because you've had lots and lots of help. I read through yesterday's excitement (nice job) and looked at his SS.

So...to be sure I have it right:
1. earned a .25u reduction to 4.75u
2. due to last night's low PS, you shot 4.5u....reasonable
3. you shot 4.5 again this morning...you definitely should have shot the 4.75u especially given his high number

As Julie said last night, when we give a BCS dose (a big chicken s@*t dose) it's only done for one cycle; the next cycle we would go back to what the dose should be (unless his PS was really low again).

He's bouncing today due to the low numbers yesterday. Bounces are caused by the release of a form of glucose and counterregulatory hormones when the BG gets too low..i.e. the liver gets panicky and decides to help out ;-) Bounces can last up to 72 hours or six cycles.

I understand you wanting him to stay at higher numbers while you're gone. The problem is, we don't know yet what he'll do at 4.75u and one cycle (tonight) is not going to tell you most likely because...most likely...he may still be in a bounce. IMHO, if I was worried about what he wii do while you are gone, I'd leave him at 4.5u.

I hope that helps....pls let us know if you have questions.
 
ashley, not sure if you're looking for a different answer or what, but this is the last post from your condo yesterday. The purpose of the protocol is to work towards getting the cat off of insulin. if your goal is something else, ie, high enough that he doesn't go low enough to need tending, you're going to have to put some thought into it to figure out for yourself what a good tactic is.

julie1220 said:
i wanted to post a little from the general guidelines (from the sticky on the Tight Regulation Protocol) for you to help in your decision:

"General" Guidelines:
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.
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.
Click to expand...
Click to expand...
 
...forgot to NOTE:
I took a PM+11 this morning. It was 266, and 30 mins later at his AMPS he was at 344. I tried to take another test to verify this number, but after poking him at least 10 times and getting a "not enough blood" error on the monitor, it just wasn't happening. Is it possible that he could have jumped 122 in 30 minutes??

Julie, thanks for posting that; of course I have the protocol printed out, and got this post yesterday, but it's really confusing me on how to apply it to this situation. I held the 4.5u because it says to hold each dose for a minimum of 3 days.
julie1220 said:
julie1220 said:
i wanted to post a little from the general guidelines (from the sticky on the Tight Regulation Protocol) for you to help in your decision:

"General" Guidelines:
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.
Click to expand...
Click to expand...
Click to expand...
...but at the same time, he earned a reduction yesterday. I just need help applying it here.

I will dose Sushi in 30 mins, and tomorrow morning. But I have to be out the door as SOON as I dose him.
The cat sitter will not be shooting blind; I trained her how to test him.
 
I agree with Marje. If you are concerned about Sushi's numbers with the petsitter, stick with the lower (i.e., 4.5u dose). To be honest, when I travel, I drop Gabby's dose proportionately more than what you're reducing to. Part of this is due to Gabby not allowing anyone else to test. However, she tends to have unpredictable plummets into low numbers and this is my way of keeping her safe.

I really want to encourage you to get more familiar with the dosing protocol. One of the more basic principles is that your cat will have a better experience with Lantus if you are consistent with your dosing. Dose changes are based on specific criteria. The more you change around the dose the weirder Sushi's numbers will get.
 
Ashley:

Yes....it can jump that fast. It probably didn't. It probably jumped up a little less but because of the 20% meter variance...it could seem that much. 266 x 20% would be 319. There isn't that much difference between 319 and 344 and if you take 20% x 344....you could just be looking at a little jump with the meter variance factored in. But I wouldn't focus on that....the trend was upward.

Here's what Julie told you last night:
if you drop a dose because the preshot number is too low, usually that's only for that cycle. what that's going to do is allow the shed (depot, storage deposit of lantus) to be used up a little more. unless the numbers for that cycle (tonight) were unusually low, you probably would continue with your same dose that you would've shot. so in this case, you shot 5.0 this morning, with the drop below 50 sushi would've been dropped to 4.75. but you decided because of a lower preshot to drop to 4.5. unless tonight's cycle went below 50 you would ordinarily return to the 4.75 dose.
Click to expand...

Maybe you didn't see it? So, again....his dose tonight would normally be 4.75u. But I wouldn't give him that and then plan to reduce him for the petsitter this week. I'd give him a little more consistency than that and if he's high when you get back, you can increase back to 4.75u.
 
i hope that didn't look like i was shouting at you with the font - i just wanted to make sure you saw that when you change doses, you then hold the dose for 6 cycles. so if i were you, i wouldn't be considering changing it tonight - or for 6 cycles - unless sushi goes below 50. that's the trigger for making another change - you're looking for 6 cycles at each dose unless they go too low, or the nadir is consistently over 300.

likely his numbers today are a response to his low numbers yesterday. when they hit a number lower than they are used to, their liver releases hormones/glucose that shoot them up high. and then sushi also got high carb food yesterday, so higher numbers today are what one would expect.
 
Okay! Thank you all!!
I'm confused but don't have time to ask right now...we'll stick to 4.5u for now.
His PMPS was 307 BTW.

Thanks again!!!!!!!!!!!!!!!!!! I so appreciate all of you!!
 
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