? Dosing advice for Eddie

Jodey&Eddie&Blue

Jodey&Eddie&Blue

Member Since 2021
Eddie, who has had surgery (hypophysectomy) and SRT for acromegaly has, for me, a confusing BG pattern, as you can see from his SS.

I recently increased his insulin (Glargine) from 13u to 14u in response to the variations on the BG theme. I was feeling quite encouraged yesterday when he started out in the blue zone (158) and stayed there at +5 (110) but then went all the way up (PMPS 365) and then again at +2 (434).

I emailed my vet who is not all that well-disposed to "internet advice" to ask his opinion on dosage and he was more annoyed that he didn't like the spreadsheet so didn't give any advice. I was having an online discussion on a FB Acromegaly group page about Eddie's numbers and someone said this: "you've been at 14u after fluctuating since 12u in the last two months. You're seeing occasional good numbers, and lower preshots, but you're still spending quite a bit of time in the pinks and some yellows. The occasional blue, though a little startling to you, have been good blues, and no greens exc 9/14. If it were me, I would do a bigger increase. 20% is 2.8u, and 25% is 3.5. 18% 2.5u. At a minimum, I would do the 18% increase, so 16.5u. Do you feel comfortable with that bump?"

I was a bit shocked at the suggestion of increasing 2.5u (!) but don't know if I should be shocked? I've always been told that increases should be moderate (like .5 or 1u) and I'm wondering what would be accomplished going to 16.5u from 14u??? I do not have enough experience to judge this suggestion.

Not having the experience and unable to assess the suggestion, I am seeking advice (given the variables in Eddie's case) from those experienced with dosing according to the spreadsheet.

Honestly, I'm at the limit of my experience when it comes to insulin (I've got the basics but not when it comes to regulation) and I would really appreciate some help here.

Thank you.
 
I'm tagging @Wendy&Neko who had considerable experience with acromegaly kitties.

I tend to agree that the suggestion of the FB group seems rather extreme. We tend to encourage members to use the parameter of the Tight Regulation (TR) Protocol with acromegaly-kitties. The exception is that the dose changes are in larger amounts when the basal dose is large. I've been around here a long time and I can't really anyone increasing a dose by 2.5u. I will, however, defer to Wendy.

I do suspect you're seeing some bouncing off of the lower numbers. With TR, you would be evaluating Eddie's dose every 3 days/6 cycles. It is possible that you've been holding doses a bit longer than necessary.
 
Sienne and Gabby (GA) said:
I'm tagging @Wendy&Neko who had considerable experience with acromegaly kitties.

I tend to agree that the suggestion of the FB group seems rather extreme. We tend to encourage members to use the parameter of the Tight Regulation (TR) Protocol with acromegaly-kitties. The exception is that the dose changes are in larger amounts when the basal dose is large. I've been around here a long time and I can't really anyone increasing a dose by 2.5u. I will, however, defer to Wendy.

I do suspect you're seeing some bouncing off of the lower numbers. With TR, you would be evaluating Eddie's dose every 3 days/6 cycles. It is possible that you've been holding doses a bit longer than necessary.
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Thank you for this response, especially about possibly holding the doses longer than necessary. Originally the vet wanted doses held to 7 days snd no testing except for a single BG curve. I realized then that he was not familiar with acromegaly nir with any variation of dose regulation in an acro at. My challenge is to learn how to evaluate the doses and change them (up or down) with any confidence.
 
Was Eddie diagnosed with both acromegaly and IAA? It looked like he was based on your signature. With the IAA, it's important to get ahead of the insulin resistance. In other words, you don't want to hold the dose overly long or the antibodies build up again. Obviously, it's complicated!
 
Sienne and Gabby (GA) said:
Was Eddie diagnosed with both acromegaly and IAA? It looked like he was based on your signature. With the IAA, it's important to get ahead of the insulin resistance. In other words, you don't want to hold the dose overly long or the antibodies build up again. Obviously, it's complicated!
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Yes, both acromegaly and IAA (76%). Whether the Percentage is the same or not now I don’t know. He will be having complete blood work done on Tuesday with results to come. But in the meantime I feel like his BG/insulin situation has so many variables that I’m scrambling.
 
On FDMB, we tend to be a bit more conservative on dose increases, more like 10-15% of dose. So over 5 units the increases are by 0.5 units, over 10 units are 1.0 unit. Over 15 you could do 1.5 and over 20 a 2 unit increase. But that also depends on what sort of numbers you are seeing. Whether you are just tweaking a pretty good dose, or still have a way to go. That 110 yesterday is getting there, but I still think you could do a 1.5 unit increase safely.

He's definitely bouncing from yesterday's blues. To follow TR, you would have to make sure to get a second test each and every night, to make sure it's safe to increase. With acros and IAA, I strongly recommend following TR if you can.

Don't bother retesting the IAA, it won't have changed much. Others have tested it with similar results as the first time.
 
Wendy&Neko said:
On FDMB, we tend to be a bit more conservative on dose increases, more like 10-15% of dose. So over 5 units the increases are by 0.5 units, over 10 units are 1.0 unit. Over 15 you could do 1.5 and over 20 a 2 unit increase. But that also depends on what sort of numbers you are seeing. Whether you are just tweaking a pretty good dose, or still have a way to go. That 110 yesterday is getting there, but I still think you could do a 1.5 unit increase safely.

He's definitely bouncing from yesterday's blues. To follow TR, you would have to make sure to get a second test each and every night, to make sure it's safe to increase. With acros and IAA, I strongly recommend following TR if you can.

Don't bother retesting the IAA, it won't have changed much. Others have tested it with similar results as the first time.
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Thank you for this reply! It makes much more sense to me that just diving in with a 2.5 u increase without the testing each and every night. So, when you say to make sure to get a second test each and every night, are you referring to a second test at +2? And, is following the conservative dose increase what is meant by TR?
 
Jodey&Eddie said:
Thank you for this reply! It makes much more sense to me that just diving in with a 2.5 u increase without the testing each and every night. So, when you say to make sure to get a second test each and every night, are you referring to a second test at +2? And, is following the conservative dose increase what is meant by TR?
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I can tag
@Wendy&Neko
 
Hi. TR is actually our more aggressive method. It’s not as aggressive as the FB GROUP suggests. . A +2-3 or before bed test would be the second test since lantus onsets for most cats then. If that the is lower than the amps/pmps you might need to set an alarm for a test later in the cycle depend7ng in how low and/or leave food out. An auto feeder helps with that.

I wanted to answer in case Wendy is no longer around.
 
With TR, it's best to get a test at +2 of +3 or even later. Lantus onset is at roughly +2. If your +2 or +3 is appreciably lower than your pre-shot value, it is likely that your cat's numbers are dropping and you may need to get additional tests. Thus, getting a "before bed" test lets you know if it's OK for you to head off to sleep knowing that your cat is in safe numbers.

Elise - I think the FB group was an acro group, not the FDMB counterpart.
 
Sienne and Gabby (GA) said:
With TR, it's best to get a test at +2 of +3 or even later. Lantus onset is at roughly +2. If your +2 or +3 is appreciably lower than your pre-shot value, it is likely that your cat's numbers are dropping and you may need to get additional tests. Thus, getting a "before bed" test lets you know if it's OK for you to head off to sleep knowing that your cat is in safe numbers.

Elise - I think the FB group was an acro group, not the FDMB counterpart.
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Thank you!!
 
Good morning, well, here we are now back at 12.6 AMPS. I think we should stay @ 14u???

Stayed @ 14u Glargine.

@ +3 - 277
@ +5 - 248

I'm thinking we stay with 14u tonight?

Thank you!
 
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Going by that lower AMPS, it's possible that he is clearing the bounce this cycle. You don't want to increase in a bounce clearing cycle because there is additional downward momentum when clearing the bounce and an increase could add to it.

So yes, stay at 14U.

Will you be able to get a +2 or later test to see how this cycle plays out?
 
So Eddie at +3 is 277. I’ll do another at +5.

+5 248
+10 302

Again, he's on 14u Glargine. Hold steady?

Thank you!
Jodey and Eddie
 
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Ok, so if I'm understanding correctly, the recommendation is to go from 14u to 15u or 15.5u?
@Wendy&Neko
PMPS 382

We have to go for all the blood tests tomorrow at 9:00am so I'm wondering if I just increase tonight or wait until he's been at the vet?

Earlier @Bandit's Mom said
"Going by that lower AMPS, it's possible that he is clearing the bounce this cycle. You don't want to increase in a bounce clearing cycle because there is additional downward momentum when clearing the bounce and an increase could add to it.
So yes, stay at 14U"

So, I'm wondering which it is? Stay @ 14u or increase given the PMPS.
Le sigh.
Thank you, everyone.
 
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Jodey&Eddie said:
Ok, so if I'm understanding correctly, the recommendation is to go from 14u to 15u or 15.5u?
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You can go to 15.5U.

Jodey&Eddie said:
Earlier @Bandit's Mom said
"Going by that lower AMPS, it's possible that he is clearing the bounce this cycle. You don't want to increase in a bounce clearing cycle because there is additional downward momentum when clearing the bounce and an increase could add to it.
So yes, stay at 14U"

So, I'm wondering which it is? Stay @ 14u or increase given the PMPS.
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I had suggested not increasing this morning because it looked like he was clearing the bounce and heading lower. But he didn't do that, so it's fine to increase.
 
Bandit's Mom said:
You can go to 15.5U.


I had suggested not increasing this morning because it looked like he was clearing the bounce and heading lower. But he didn't do that, so it's fine to increase.
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Ok, thank you. I decided to take the middle road since I hadn't yet heard from anyone at shot time. I gave 15u. Tomorrow I'm going to ask the vet about a switch to Levemir.
I'll also do a +2 tonight and more if I can swing it.
Goodnight and thank you again.
 
Good morning. I was exhausted last night and fell asleep without an alarm and didn't get Eddie's + 2 or +3

I gave 15u (on the side of caution). This morning he is at +24 !!!!!

What is happening? Perhaps the bounce wasn't cleared?

@Wendy&Neko @Bandit's Mom
 
It's possible he dipped into blues the night before last (10/3) - that was quite a dip from 20.8 at PMPS to 13.9 @ +3 - maybe he dipped to 10 or lower and is bouncing from there?
Some cats go high before they clear a bounce and today's AMPS could be that high.

Btw, a small housekeeping note, we request members to post a new thread every day. This ensures that the thread doesn't get too long to read. Especially in time-critical situations like low numbers or a member stalling a shot.

The thread title nomenclature is:
<Date> - <Kitty's Name> - <AMPS/PMPS number and any other BG numbers you may have for the day> - <Question, if any>

Use the the '?' prefix in the thread title if you have a question, so people know that it's not just an update.

For e.g.
"? 10/5 - Eddie - AMPS 432 - Who so high?"
 
What Bhooma said, please start a new thread. We have enough people posting that we've set up some posting conventions to make it easier on those of us helping others.
POSTING GUIDELINES PLEASE READ

Without any tests last night, we can only guess what happened last night and whether this is a new bounce, an old one or who knows what. Data from each and every cycle is what gives us a clue to what is going on. Try drinking a large glass of water before bed. Test when the inevitable happens and you have to get up.
 
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