? Dose increase?

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Sue484

Sue484

Member Since 2015
Frankie doesn't appear to be doing so well on the fat 3 unit dose that he has been on for 5 days. Should I increase to 3.25 again?
 
yes, i know you're using AT. I still would. The primary difference with an AT is that the dose reduction point is at 68 for a human glucometer or 90 for SLGS - above that you can just follow the same guidelines for increasing.

I just pulled up the SLGS guidelines again. It says:
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
  • As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Lather, Rinse, and Repeat!
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Since the dose decrease you've had one nadir in that range. I guess it's up to you - if you're satisfied with that, then hold the dose. If you're wanting to bring down the rest of the numbers, then I'd go back up to the 3.25.

I know you must've explained before, but what's the reason you're using SLGS instead of Tight Regulation? It seems like you're hoping to have him more tightly controlled, and you certainly test more than enough to follow TR.
 
If I could get him in yellow and blue numbers all the time that would be great. I can't test during the day and if he were to go low it would worry me too much as the numbers are too low than I am comfortable with. Plus I can't get to grips with converting into human numbers so I would like him to nadir about 5 on an AT. I know he won't go into remission, he is too long diagnosed. There is still hope for his neuropathy though.
 
Sue484 said:
about 5 on an AT
Click to expand...

Then make that your goal - so if his nadirs are higher than that, increase. If they are lower than that, adjust the dose accordingly.

It's a juggling act, isn't it?! We just do the best we can - and you're so devoted to Frankie he's lucky to have you!
 
Sue:

I understand that you're apprehensive about Frankie dropping too low if you're not home to monitor. I understand completely since I'm not home during the day and have the same concern. I do think you need to weigh your dose increases against allowing glucose toxicity to build up. If you could consider raising Frankie's dose by 0.25u until you start seeing numbers closer to the range you're looking for might be to his benefit. The longer he spends in these higher ranges, the more wear and tear on his system. Generally, people make the "fat" and "skinny" dose adjustments once their cat is in the desired range.

 
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