Need to adjust R dose?

Howiesmom

Howiesmom

Active Member
@Wendy&Neko
Howie is on Day 10 of cabergoline. Prior to starting, it looks like we finally broke through his glucose toxicity. He was up to 55 units BID at his peak, was at 46 units when we started cabergoline, and is now down to 30 units. It is hard to say what effect the cabergoline has had so far vs trying to slide down the scale to get him to some better/safer numbers that are more blue than green! After a couple BCSs and a decrease from 35 units to 30 units in the last couple of days (all under Wendy’s guidance, of course!) I must have drained a lot of the depot as he was up as high as 175 today (nadir was 152 at PMPS). Let me tell you how nice it is to be back to just 1 syringe and I can get through 10 cycles in a levemir pen instead of 5-6!

Assuming I can start him back on using some R at some point (if he is above 175), do I need to restart his scale or do I start where I left off? He hasn’t had any since Jan 19, but I never found a dosage that had any dramatic effects besides maybe just holding him steady from going higher. Thanks!
 
I would back off the R scale, maybe start with half of where you last were. Take a look at what your R scales were when you were on this dose but on the way up. My experience was smaller R needed when the L dose was smaller. R scale at 7 units was 0.25/0.5 units depending on preshot, down to drops/0.1 unit on much smaller doses.

Be interesting to see where Howie goes the next day or so. That's be when the large depot is fully drained and we can see what this dose is doing. As long as he's still under renal threshold, no need to push him lower. That would give you that buffer for cabergoline.
 
Wendy&Neko said:
I would back off the R scale, maybe start with half of where you last were. Take a look at what your R scales were when you were on this dose but on the way up. My experience was smaller R needed when the L dose was smaller. R scale at 7 units was 0.25/0.5 units depending on preshot, down to drops/0.1 unit on much smaller doses.

Be interesting to see where Howie goes the next day or so. That's be when the large depot is fully drained and we can see what this dose is doing. As long as he's still under renal threshold, no need to push him lower. That would give you that buffer for cabergoline.
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I asked my vet about renal threshold and he said he was taught in vet school that it is usually around 188. I guess that is the magic number I’m going to use? I know you said it could be higher (?). Also, is my goal with the R now to still drop him lower by up to 100? I just looked at his scale and SS of when he was around this dosage before and it really had no effect as it was such small amounts. But that’s also when he lived almost solidly in yellows.
 
Renal threshold varies by cat, and of course if using pet or human meter. Neko's was closer to 220 on my Relion.

I don't see any reason to use R just yet. The goal would till be not to drop him any more than 100 points.
 
Wendy&Neko said:
Renal threshold varies by cat, and of course if using pet or human meter. Neko's was closer to 220 on my Relion.

I don't see any reason to use R just yet. The goal would till be not to drop him any more than 100 points.
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Interesting...his PM +3 is 210. I’ll get a +4 when the L starts kicking in. He hasn’t seen a yellow since Jan. 24. He’s definitely on a swing! I really want to see what he does without R for 6 while cycles at 30 units but am not sure if I shouldn’t start R tomorrow if he’s in yellows again/still at PS times? And now I’m confused...at what point do I determine if he needs an increase??? I know we want his nadir around 100. Anything I used to follow on TR seems to not really apply while he is in this spot and on cabergoline!
 
By end of tomorrow we should have a pretty good idea what 30 units does without the larger depot influencing it. And if he's running a little high you have two options. One is to increase the Levemir, maybe 33 units? The other is to use some R to bring him down a bit. The nice thing about R, is that you don't have to give it. If cabergoline makes his dose needs drop, you aren't left with as large a Levemir depot. The question is whether using R gets him to the numbers you want.
 
Wendy&Neko said:
By end of tomorrow we should have a pretty good idea what 30 units does without the larger depot influencing it. And if he's running a little high you have two options. One is to increase the Levemir, maybe 33 units? The other is to use some R to bring him down a bit. The nice thing about R, is that you don't have to give it. If cabergoline makes his dose needs drop, you aren't left with as large a Levemir depot. The question is whether using R gets him to the numbers you want.
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I just tested his PM +4 and it was 227. The last dose he had on 1/19 was 5.5 units when he was at an AMPS of 184 and he was at 50 units. It never actually dropped him. On 1/18 he dropped 80 points by +12 but he also had 11 units of R that day as he had a mid-day dose.

2-14-21 update: his AMPS was 156 and his +3 was up to 207. He is all over the place!
 
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Wendy&Neko said:
Absolutely. On Levemir, Neko's was between +5 and +15, though most often between +9 and +12.
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His AMPS was 239 on 2/15. I gave 5 units of R as I’m working from home today so we’ll see how that goes. I don’t want glucose toxicity to start building up again. His PM +4 last night was up to 259. Any thoughts on when I should consider increasing L? Thanks!
 
Looks like it'd be worth taking him up to 33L again. Guess you'll have to go back to two syringes.
 
Wendy&Neko said:
Looks like it'd be worth taking him up to 33L again. Guess you'll have to go back to two syringes.
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He keeps me/us guessing...!
2-15-21:
AMPS=239 (30L, 5R), +3=245, +5=221, +6.5=176 (gave 4R), +9.75=124, +11=105, PMPS=90. So we’ll see what he does before bed and in the AM. I work at the office tomorrow so won’t get home much before +9.5. If he is high blue or yellow, I’ll increase his L. Obviously 9 units of R was going to do something today. It must not really take effect just in the first 4 hrs (?).
 
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