Hold it or raise it?

[donaleen and Ozy]

The vet finally called. I expected them to call on Sunday to review his blood glucose curve from Saturday...they are only three days late (yes I complained about that). They want me to raise the dose tonight. I explained that I was following tight regulation as outlined here and wanted to wait until tomorrow night, which would be three days since I raised it by a .25 units.

Had they called on Sunday, she said she would have told me to go to 3 units but given that he is now in the 200's that she thinks 2.5 units is right. And I should raise the dose tonight.

I am torn about what to do. I think that I am supposed to wait three days to see how he adjusts to this dose adjustment. Isn't that to keep his body from freaking out and bouncing/rebounding? Is he more likely to have an issue if I raise it tonight?

thanks,
donaleen

 

[KarensPoe]

Lantus Tight Regulation protocol states that a dose should be held for 6 cycles, and I see your next PM is the 5th. viewtopic.php?f=9&t=1581 is the Tight Protocol sticky, also found at the top of this message board.

Although it does look like a dose increase of .25 is in order based on nadirs being between 200-300, I would wait until after the 6th cycle to raise. 6 cycles allows the depot to fill completely. Normally, with Poe and an increase, I'd see some affect of that increase on the 3rd cycle, but he's been fooling me lately. ohmygod_smile viewtopic.php?f=9&t=150 explains the insulin depot

Either way, though, I have been pretty consistent in increasing after the 6th, just to be sure I didn't miss that "magical" dose.

There have been times I held the dose longer only because I was either afraid I could not be there to monitor when I thought it might "kick" in or I was waiting to clear a bounce.

Others will be around soon to better advise though

 

[Sienne and Gabby (GA)]

Holding the dose for 6 cycles/3 days may or may not have an effect on bouncing. The reason for holding the dose is to give the depot time to adjust to the amount of insulin. If you increase too rapidly, you can end up going past what could otherwise be a good dose for your cat. Realistically, will your vet really be that put out if you hold the dose for an extra day? (I won't say anything about the vet's office apparently not operating on the same calendar as you given that they called 3 days late so.......)

At some point, you might want to share a copy of the Tight Regulation protocol with your vet. A dose increase of 1.0u is way too much. Lantus dosing, at least if you're following TR, is aggressive but it's systematic so you don't miss what would be a good dose. Increasing by 1.0u could be unsafe. I'm attaching a copy of the journal article with the protocol if you want to share it with your vet.

 

[donaleen and Ozy]

That makes sense. Thank you Karen and thank you again, Sienne. I am going to wait until tomorrow to raise the dose.

As for the vet's office, the front office just doesn't communicate very well. I complained. The office is open 7 days a week. The practice has four vets. I was told to do a glucose curve on Saturday (just as I did the previous week) and that I would get advice on Sunday. The woman who has been treating Ozy was out of town and somehow no one communicated that to me. And when I called, they said a different vet would call but I didn't get a call until today.

It seems to me that medical offices for people and animals, especially those that are medium sized, are poor at communication. I broke my wrist last fall and my experience with the orthopedist office was also difficult.