Dosing Advice TR Hold or Increase?

Jordenne/Barb and Jospeh

Jordenne/Barb and Jospeh

Member Since 2020
We are getting solid blue numbers and the odd green result thus far. Hold the blue numbers and be happy with it or increase the dose to him push to stable green numbers? We will do a detailed curve this weekend regardless of whether we increase of not.
 
Hi. With those midday greens, I believe you hold this dose. Someone with more TR experience should be by, but I believe the idea is to hold and let your cat get used to these nice numbers and hope it signals their pancreas to do it's thing.
If you go to the THREAD TOOLS option to the right, you can click the " edit title " option and add the " ?" Prefix so folks know you are still waiting on an answer.

Just for reference

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
Reducing the dose:
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit.
  • Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
  • Please do not let yourself become complacent or blasé about drops into the 20s or 30s.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
 
Hi there :cool:

The TR recommendation is to hold the initial starting dose for 5 to 7 days (unless the numbers show reason not to) and when your cat starts to see nadirs under 100 to hold the dose for at least 10 cycles before increasing.

In light of all that and being that you are at seven consecutive cycles of .5u right now, hold the dose and get in as much testing as possible in the next few cycles until you reach 10 consecutive cycles of .5u.

questions?
 
Joseph is looking good!

Yes , hold this dose for a total of 10 after seeing nadir under 100. That should take you to tomorrow PM cycle . Maybe he’ll even decide to earn a reduction before then. ;)
 
Okay thanks for the advice. I wasn't clear on increasing with low numbers and this makes sense.

If numbers hold we will increase to 0.75 on Saturday AM and do a full curve as well. I'm hesitant to increase the dose on a Friday PM

You guys are awesome!!
 
Jordenne/Barb and Jospeh said:
Okay thanks for the advice. I wasn't clear on increasing with low numbers and this makes sense.

If numbers hold we will increase to 0.75 on Saturday AM and do a full curve as well. I'm hesitant to increase the dose on a Friday PM

You guys are awesome!!
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Please post again and ask for advice before you go ahead and increase the dose. If you are going to do a curve, you would do that first, before you increase.
 
Bron and Sheba (GA) said:
Please post again and ask for advice before you go ahead and increase the dose. If you are going to do a curve, you would do that first, before you increase.
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I guess that makes sense. A dosing change will change the depot as well and that would take 6 cycles to settle down and give you a clear true picture.

When I do the curve I was planning on doing it as in depth as possible. With a check every hour from pre shot to +12 with additional checks at +5.5 and +6.5 so I have a really good picture of how where exactly the nadir is and how his curve is through the day. Is that going overboard?
 
Every 2 hours is generally enough. I recommend some testing to illuminate the wide open spaces of the ss; the AM +3 to +5 and +7 to+11 both AM and PM.

what you’re looking to do is identify onset, nadir and duration. Knowing those 3 items will make your dosing decisions much easier. One important thing to keep in mind is that nadir is not static. It can and often does move around.
 
Sandy and Black Kitty said:
Every 2 hours is generally enough. I recommend some testing to illuminate the wide open spaces of the ss; the AM +3 to +5 and +7 to+11 both AM and PM.

what you’re looking to do is identify onset, nadir and duration. Knowing those 3 items will make your dosing decisions much easier. One important thing to keep in mind is that nadir is not static. It can and often does move around.
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Really appreciate this advice. I put it to good use today and caught an early dip I've never seen before. Gonna fill out the rest of the holes over the weekend and put any dose increase off for the time being and re-evaluate on Monday
 
Jordenne/Barb and Jospeh said:
Really appreciate this advice. I put it to good use today and caught an early dip I've never seen before. Gonna fill out the rest of the holes over the weekend and put any dose increase off for the time being and re-evaluate on Monday
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based on the overall numbers as well as a nadir of 50 today I believe your next dose adjustment will likely be a reduction. An AM+1 and an AM+2 would be valuable to see when onset happens. If you can get those on one cycle-great. If not you can do an AM+1 one day and an AM+2 on another.

I see you fed the +4 with some LC. How much food was it? Any other snacks/mini meals today? Also, do you have a set feeding schedule? If so what are the times and amounts?
 
The +4 today was about 1/8th of a can of Fancy Feast.

We have so far been basically free feeding whenever he has shown interest in food. With him going from a solid dry food diet we wanted to make sure we solidly established a willingness to eat wet food.

He is overweight and maintenance levels of wet food is supposed to be 3 cans of the Fancy Feast pate. He is generally around 2-2.5 cans worth a day now.

Typically he will get up around 5am wanting food which he will get 1/4-1/2 of can. AMPS is generally around 6:30ish and he gets another 1/4-1/2 can or so before his shot at 7am. He will then nap until around 11am when he is mostly active for the rest of the day. I'll give him a 1/4 can of food whenever he asks for it which is generally about 2 times sometimes 3.

Evenings look similar to the mornings. With most of the eating being done between 5 and 7pm. He is asleep by 8pm until I get home around around 1am. Generally 50/50 if he gets up and has a midnight snack with a quick trip outside

It's much easier to manage with free feeding but it does take its toll on the reliability of the numbers. I really don't want to have to do structured feedings but if it needs to be done we will figure it out and make it happen
 
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