Dosing increase?

[atajev]

As a recap, Mona has been riding fairly flat, but above normal BG on a drop of insulin (basically solid 100s for the past week). It's been 5 cycles so far on this drop dose. I'm going to be home and able to do a full curve during the day today (only part of the day tomorrow because of the holiday). Should I go ahead and bump her up a tad earlier than 6 cycles since that'll fall overnight tonight?

She is at 174 an hour before her am shot, and in terms of her most recent nadirs (or as close as I was able to test to mid-cycle), she was 157 at pm+4.5, and 110 at am+6.

Should I:

1) hold for today?
2) increase to .1 now?
3 increase to .25 now?

Thanks!

 

[Angela & Blackie & 3 Others]

Morning, guys.

I don't have any dosing advice to give you, unfortunately. All I know is that the #s need to be within 50-120. I took a quick peek at your SS, and I see #s that are higher than that. Hopefully someone will come back to help you very soon.

 

[julie & punkin (ga)]

Good morning!

I wouldn't increase just yet. Since you had a several day break before restarting insulin, you want to give it 5-7 days before adjusting the dose. Mona got to 98 last night, which is great, especially considering the "depot" isn't going to be equalized to the dose yet.

I'd just continue with the same dose.

 

[julie & punkin (ga)]

I wanted to go ahead and reply to you immediately, but here is the part of the guidelines that i'm referring to for Mona:

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Her numbers are overall very good. As you stick with this dose, she will likely "settle in" with it and her numbers will come down a little more.

by the way, you can take off the 911 now.

 

[atajev]

Thanks, Julie. She just tested at 234 preshot, but I'm starting to wonder if I gave a fur shot with the drop last night. I'll hold steady for now, especially since that's the most conservative way to go. She's obviously feeling much better at her current levels than she has in MONTHS, so I'm not worried about her comfort.

 

[julie & punkin (ga)]

the protocol puts most of the focus on how low a dose will take a cat, so don't worry about this morning's higher numbers.

The good news is that she got to less than 100 on one drop of insulin! :mrgreen:

 

[atajev]

Also, it seems to me that she falls into the category of a "high, flat curve," which is why I was wondering if folks thought I should do an increase after 6 cycles instead based on how things have been going.

Thanks for the 911 reminder. It felt weird to put that on for this anyway since there wasn't an emergency situation really no matter what I shot her with. But, that's right for looking for a quick response when stalling, right?

 

[atajev]

the protocol puts most of the focus on how low a dose will take a cat, so don't worry about this morning's higher numbers.

The good news is that she got to less than 100 on one drop of insulin! :mrgreen:

I'll admit to doing a little dance when I saw that number last night!

 

[julie & punkin (ga)]

a high flat curve is when we see numbers over about 300 - and that's all we see. literally - some cats will test HI HI HI HI for days on end. if they are starting on insulin, over 300, and especially if they have a history of ketones, we might not wait the 5 days to increase the dose.

but that's not the case with Mona. I think it's likely she's bouncing a little from the 98. It's just a range that is a bit lower than she's used to, so her body has perceived it as a danger and released hormones and stored sugars to bring her up. A bounce can last 3 days, so she might even stay high for that long. But our focus is on the 98, so we'll wait til the bounce clears and see where she lands then.

here's a thread describing what happens in a bounce. It's in the second post: New Dose Wonkiness & Bounce

eta - the 911 is reserved for medical emergencies. typically low numbers (less than 50) when you don't know what to do. sometimes people use it for stalling, but it's really more for a genuine emergency. but it was fine - it definitely caught my eye.

 

[atajev]

Ahh, thanks for the clarification on both the "high, flat" bit and the 911 marker. Yeah, she's definitley not riding way up there and it definitely wasn't a hypo event either. And both are very good.

Thank you again for all the quick responses, Julie. You've eased my mind on many fronts, and I feel like I might actually be getting a handle on this protocol!

 

[julie & punkin (ga)]

you'll get it, katie. it's a steep learning curve at the beginning, but pretty soon it will be easier. that's why it's nice to have people here to help point out what to look for and interpret what it might mean. even the protocol, which is pretty spelled out, isn't always clear how it applies in various situations.

and you're welcome! i'm glad i got on when i did this morning, since a lot of people don't feel comfortable giving advise on dose changes.

have a great day!