? Dosing advice needed -Dose increase or patience pants?

[Sue484]

Hi. I know Frankie has only been on his decreased dose of 3 units for 3 days but his numbers are getting worse. I presume his good AM numbers on the first day was because of the depot draining. My question is, should he go back to the 3.25 units now or should I be patient? His legs are slightly better and I do not want to lose that momentum. Any help is appreciated.

 

[tiffmaxee]

I know better than to give dosing advice as I have a 50/50 chance of getting it wrong. He's either not holding or bouncing. Let the pros figure this out. I hope it become clear. Come on Frankie, hold the reduction.

 

[rhiannon and shadow (GA)]

I look at 5/25, 5/26/5/27.... it took 6 cycles... and he saw green.... so he's not fast as clearing his bounces....
I think you'll know after tonights shot. (that's the 6th one for this dose)

 

[Sue484]

He has now gone up to 30.5 (549). Surely this can't be a bounce? Dosing advice needed please as shot is due in 30 minutes.

 

[Suzanne & Cobb(GA)]

It doesn't look like a bounce to me though. I'd be tempted to go back up to 3.25. He may have bounced off that 74 a few days ago, but it looks like he cleared that one fairly quickly to me since he came back down to 112 the next day.

There's no harm in staying at your current dose for one more cycle to be sure though. Can you be around to monitor him with in the second half of tonight's cycle?

 

[Sue484]

Yes, I'll set my alarm and up the dose to 3.25

 

[julie & punkin (ga)]

I'm seeing it a little differently. I'd go back to 3.5u asap. I think that was your last good dose. When you've reduced the dose, the idea is that the constant green numbers continue after the reduction.

If the cat bounces, then when it clears the bounce it should be back in green again. It looks to me like the green numbers on 5/29 were probably still from the depot of the 3.5u dose.

This link talks about Failed Reductions - it specifically refers to the part on the Tight Regulation Protocol page about failing reductions, but the concept would be the same no matter what dosing guidelines you are using. We don't have anything written specific to SLGS that mentions failed reductions.

There is no "NDW" following a dose reduction nor do we hold a reduced dose 6 cycles (as done with dose increases) to "fill the insulin depot".
"Settling time" does not apply to dose reductions. We don't wait for a reduction to "settle".

When you see numbers trending higher after a dose reduction we immediately return to the last "good" dose as described in the The Tight Regulation Protocol with Lantus or Levemir:

"If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose."​

 

[Sue484]

@julie & punkin (ga) The SLGS also says this though

We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, your goal is to achieve flat numbers that are greater than 90, so there is no need to push a cat into numbers lower than that

Shouldn't my goal be blue numbers then rather than green?

 

[Elizabeth and Bertie]

Surely this can't be a bounce?

Just my thoughts, but those black numbers don't look or 'feel' like a bounce to me. Frankie seems to have been tolerating low numbers better recently (dropping out of bounces faster). So, I'm wondering if the high numbers are being caused by something else...?
Any chance of a furshot?
Change of food?
Is Frankie feeling OK..? Any evidence of something else wrong..? Is he peeing and pooping OK?
(And Bertie's numbers will spike if he has a furball for example (and it seems to be furball season here...))

Eliz

 

[Sue484]

I didn't think it was a bounce as there was nothing really to bounce from. Everything else is fine. Just one thing, I am alternating him with Felix chunks in jelly which is 9% carbs, compared to Meaty Loaf which is 4% and Senior 7%. I thought it would be ok as it is on the UK list of foods and it is his absolute favourite. He also had two reductions close together, when I think now that the second one was as a result of the depot doing it's thing. Which is why I wanted to go back to the last dose that saw good numbers ie 3.25 or 3.5 and treat it as a failed reduction.

 

[Sue484]

Seems like he just needed a tad more insulin. He had the chunks this morning and at AM +6 he is 10.7 (193)

 

[julie & punkin (ga)]

Did you retest that 49 on the ss again? It seems inconsistent with the numbers around it.

I guess Frankie answered the question about the dose!

 

[Sue484]

Yes, I did double check the 49 and it was correct. Just need to wait until his bounce clears to see how the reduced dose affects him this time around.