? dosing question

[William's Mom]

After 3 weeks on Lantus and increasing bg due to probable pancreatitis, a reaction to Convenia, stress of MANY vet visits the last 2 and a half weeks, and some WBC in urine, my vet and I agree that William's insulin should be increased. I have gone from about 1.75u to 2u over the last week or so. She understands that his range of late is in the 400s to the mid 300s. She suggested that I give 2.5u for one shot and 2u for the other. If I were to do that I think I would give the higher dose in the AM, but is this something that is done? It seems a bit odd to me unless a cat has particularly different AM and PM cycles to split the dose in that way. SHouldn't it be consistent? Or something? It seems like it could play tricks on the system. I don't know...

I explained to her that I'm a pretty diligent home tester and that I would like to be a little more proactive in driving his very high numbers down using a variation on the TR protocol. Nothing crazy - just small, incremental changes, but that I can't wait around for a week or two to sit on a dose that is keeping him so high all cycle long (fear not! no ketones, just a slew of other issues). If I were to base my increase on the TR protocol he would be increased by .5u all around. She seemed a bit tense about that prospect and me taking matters into my own hands. It seems to me that vets are so scared of cats going hypo that they'd rather keep them in some unsavory high ranges. It also seems like there are so many vets who don't know enough about this disease considering how prevalent it is.

I have attached a previous thread that may shed a bit more light on my situation and the circumstances William is facing in addition to diabetes if that's relevant.
http://www.felinediabetes.com/FDMB/threads/bg-consistently-high-considering-insulin-switch.140316/

 

[Chris/China (GA)/Garfield]

Since you just skipped the morning of 6/30, that re-sets his "shot clock". I know it's really hard seeing those icky red and pink numbers, but the protocol works but you have to stick to it. It already is an aggressive treatment....much more than most vets are comfortable with (as you've seen)

I'd hold the 2U dose for a total of 6 cycles, then if he's still getting nadirs in the pinks/reds, go up by .5 to 2.5 (both AM and PM) for 6 cycles and just keep increasing every 6 cycles until he starts to get nadir's in the yellows, and then go to .25U increases after that.

At some point, he's probably going to hit his "best dose" and things will start to fall into place, but you just can't rush it. No, you shouldn't sit on a dose that's not working for a week, but you do need to give it 3 days and then go up as needed

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.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.