Dosing Advice, Please

[Tricia Cinco(GA) & Harvey]

Cinco has been posting great numbers for the last several weeks, and we have him down to .25 units. However, we just can't seem to take the next step. When he was at 1 unit and seemed stuck there, we fattened one dose, on advice from board members, and it did the trick. He earned the next two reductions on his own, but now we're stuck again. He consistently is in the green with his post shot numbers, but pre-shots are still blue, although just barely. According to the protocol, all his numbers need to be green for a week to earn a reduction, drop below 40 once, or have three 40-50 readings on separate days. He hasn't quite hit any of those goals. Should we fatten the dose once? When you get to this small of a dose, it's so hard to know you're giving him the same amount every time - even the smallest syringe we can find - 3/10ml, don't make it any easier to measure. I'd appreciate some advice on this, please. Thanks so much!

 

[Libby and Lucy]

Hi Tricia,

Cinco is looking GOOD. :mrgreen:

He doesn't really have to be under 100 *all* the time to try a reduction. We do like for them to be spending the majority of their time under 100, and to not really venture over 120 at all. Cinco is pretty much there.

One thing that helps sometimes once a cat is on a tiny dose and still getting blue preshots is to try giving a small snack at about +9 each cycle. If the pancreas is working, that small snack might stimulate his pancreas to produce a little insulin at a time in the cycle when the Lantus is wearing off, helping to pull that preshot number down. Is that something you can do?

If not, then what I would probably do would be wait until it has been at least a week since his last number over 120, then try reducing the dose a little and see if he can still hold on to those numbers. If he can't make it a week between high numbers, or if he starts going up before that week goes by, then adding some fat to the dose should help.

 

[Tricia Cinco(GA) & Harvey]

Hi Libby:

Thanks for your input. I will try the snack at +9. He's always ready for a snack! I like the 120 rule better, since most of his readings are under that. I can pretty much explain the ones that were over - stress, etc. Hopefully we will be able to drop him down one last time this next week - we'll see how this goes! :smile:

 

[Sienne and Gabby (GA)]

Tricia --

In addition to what Libby noted, it also looks like you ended up with some higher pre-shot numbers when you had a series of days when your shot times were about an hour or so off. Cinco may be sensitive to your keeping to a 12-hour schedule.

 

[Tricia Cinco(GA) & Harvey]

Interesting theory, Sienne. I notice that on 1/16 the shots were exactly 12 hours apart, yet the PMPS was 150. The day before that, the PM shot was half an hour late. I would expect that to cause a lower AMPS, but then a higher PMPS following that? Stress definitely played a part in that one. And on 1/14 the PMPS was almost an hour early, which you would think would mean that reading would be low, but instead it was quite high. This is definitely more complicated than one might think. We do our best to keep the schedule consistent, but sometimes you can't help a slight varience. Hopefully we can still get him where he needs to be to once again go into remission. Thanks for your support and advice!