Meatball AMPS 391, +4 79, +5 91 Increase or hold?

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meatball_mommy

Member Since 2013
Hi there, after the vet playing with the dosing more than we would have liked, we're now home and have some data holding at 2 units. However, in reading the protocol, I'm thinking we should hold the dose. One line indicates to increase .25 units if he's going over 200 (which he is fairly consistently). On another line it says if he dips below 80 (which he has slightly) to decrease the dose by .25. If you have a chance, take a look at his spreadsheet-would appreciate dosing thoughts. Thanks!
 
Hi and Happy Caturday!

Remember, when using Lantus the PS numbers don't really mean a lot, other than to tell you where you're starting from, and making sure it's safe to give any insulin. It's the nadir numbers that the TR Protocol uses for increases/decreases.
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Since Meatball has been getting greens mid-cycle, I would continue to hold the dose where it is. It might also help to try to get some tests in after his PMPS times to help give us more information on what he does at night. Most kitties go lower at night, but without more consistent tests, it makes it harder to know if his AMPS is really high, or just a bounce from the PM cycle.

Here's the info on increasing, which is where I'm getting my advice from:

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.
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.

Meatball seems to under 200 (and sometimes much lower) at his nadir.

I'm sure more experienced eyes will be along soon to help advise you too. Have a great Caturday!!
 
All of the numbers on your SS, are those all from an AlphaTrack meter?
 
If you are using an AT meter, then you have missed reductions and I would reduce his dose tonight.

The numbers Chris gave you above are for those using a human glucometer. From the Tight Regulation Protocol:

Therefore, if using a meter calibrated for feline use (eg. AlphaTRAK, Abbott Laboratories, CA, USA), or a serum chemistry analyzer, add approximately 30 mg/dL (1.7 mmol/L) to the target glucose concentrations (see Table 3B). For example, a target > 50 mg/dL (2.8 mmol/L) becomes > 80 mg/dL (4.4 mmo/L) when using a meter calibrated for feline use. Instead of aiming for 50-100mg/dL (2.8-5.6 mmol/L) , aim for 80-130 mg/dL (4.4-7.2 mmol/L [round numbers 4.5-7.0 mmol/L).

When using an AT, reductions are given when a newly diagnosed kitty's BG goes below 80 which Meatball has done four times on this dose.

I think the issue here is understanding that Lantus is dosed very differently than PZI. We don't dose on PS numbers; we dose primarily on nadirs.

The high numbers you are seeing are because Meatball is bouncing. When most of our kitties are dx, numbers have been high for a bit and so the body has acclimated to those numbers as normal. When the insulin starts to bring the numbers down lower (they don't even have to be really low) or there is a sudden drop in BG, the liver responds by releasing counterregulatory hormones and glucagon and the BG goes up. We call this a bounce. It is normal and every cat does it. A bounce from lower numbers or quick drops can take up to 72 hours or six cycles to clear. You do not want to increase a dose based on bounce numbers. Ignore the bounces and focus on the nadir when the bounce clears.

The other thing that concerns me is that Meatball can go from pink to green in four hours as he did on 7/24. We suggest you always get a +2 test as often as you can because it will give you a hint if numbers are likely to come down or go up. If the +2 is about the same or less than the preshot, you should be prepared for numbers to come down and should get additional tests. By not getting a +2 or before bed test every night, you are missing half your data and Meatball could be going low at night.

A 61 on an AT is an extremely low number. I strongly encourage you to reduce his dose to 1.75u tonight and let him clear the bounce that will probably follow today's numbers. You can always ask us for dosing help. We are pretty experienced and can help you keep him safe using the TR protocol.

I also recommend you read the Stickys at the top of this forum...especially the one regarding the insulin depot. It explains how Lantus and Levemir work differently than insulins like PZI.

Please let us know if you have questions.
 
Ditto what Marje said. That's why I asked if these were all AT meter numbers. Meatball needs a reduction in dose, which is great news!
 
Thanks, all! I must admit that I have read every sticky 4+ times, and the Univ of Queensland scheme for animal-calibrated meters (yes, we use the AlphaTrak) more times than I care to admit - and it's STILL not clear to me. I work with CEOs and business leaders all day long and can talk their lingo but admit that something about the stickys doesn't connect for me and I'm not able to draw much of anything about what to do/action from them. So, VERY much appreciate the direct feedback. I read this after we went did 2.0 units today, but we'll move to 1.75 tomorrow. We do aim to get a +2 but unfortunately, our schedules just haven't allowed it this week. Will definitely aim to try for it. That said, can you explain more about the tactical steps you're recommending for testing that is initiated with a +2? His pattern is consistently hitting a nadir at between +4 and +5 so I'm still not quite clear on the significance of the +2. Thanks again for all the replies!! Jo
 
The way Lantus works, you generally see insulin onset at around +2. (This can vary from cat to cat and even from cycle to cycle in your own cat, though.) So, normally, your +1 is a little higher than your pre-shot due to the influence of food. The +2 is about the same as your pre-shot value. If the +2 is appreciably lower than than your pre-shot, it informs you that there's a good chance that you'll be seeing a cycle where the numbers may be in the greens or a dose reduction is forthcoming. Think of it as an early warning system. It's why I test Gabby early in the cycle. She has an early nadir and is prone to fast, early drops.
 
Ah ha. Got it! THANK YOU. Talked it over with boyfriend and we'll move to 1.75 tomorrow and aim for +2s. Given what you're saying, I'm assuming we should hold the 1.75 for at least 6 cycles to clear the bounce than see what data follows to determine next steps? Am I understanding that right? Thanks again. Every comment here is so greatly appreciated.
 
Given what you're saying, I'm assuming we should hold the 1.75 for at least 6 cycles to clear the bounce than see what data follows to determine next steps?
Exactly :-) One note, though....if you were to see a very low number at nadir during that time, like below 80 (or another 61), it would mean possibly decreasing more. If that happens, holler. :-)
 
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