oscar, repeat low AMPS & skipped doses, need to increase dosing ?

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hailey & oscar

hailey & oscar

Member Since 2020
hi!
this is hailey on behalf of oscar, i am extremely grateful for finding this community! so far it has been very helpful for me but i am still finding myself a bit confused about levels while we try to regulate....

oscar has been on 2 injections of PZI 1 unit per day since his DX on 12/13/19.
his first vet curve showed readings in the 400s and we went back for a second curve about a week and a half later (12/27/19) with readings in the 300s. vet said we could come back in 3 months for a curve and urinary analysis (he’s transitioning off RC urinary SO food (wet & dry) to purina DM wet only. post diagnosis i stopped feeding kibble unless he won’t finish a meal and i place several pieces to trick him into finishing off the plate of wet food so i could give an injection.

have been learning to home monitor, haven’t developed spreadsheet yet or gotten consistent enough numbers to really understand patterns but working on it. pre-meal am BG yesterday am was 327. +3 BG 321. pre-meal pm 186. i gave pm dosage as usual.
pre-meal am BG today 74-haven’t had any readings this low and was afraid to give dosage at that level for risk of hypo episode with the vet closed today (sunday) so i skipped dosage. fed as usual (1/2 urinary SO 1/2 purina DM) and took +3 post meal BG measuring 422. he seems comfortable and at ease, napping peacefully in the sun at the moment.

should i have given his dosage this am despite the low reading? should i resume the dosage this evening at scheduled time if BG remains in the high zone? if he regularly dips low like that pre-dosage, should i continue to skip or should the dosage be decreased? am planning to call the vet tomorrow for their advice too, but would love to have some more eyes on this here. we haven’t had any hypoglycemia that i’m aware of and would of course prefer to avoid going there...

i was also wondering how quickly his levels could come down/regulate with the food transition since he will be on purina DM (wet only) fully within next couple of days...
coming off a grazing kibble plus wet, into only lower carb wet, seems like it could make some changes quickly so that has been on my mind. any advice is very appreciated as we navigate this tricky new life. thanks for taking the time to read this lengthy intro post :) thank you thank you thank you!
 
Welcome, Hailey.

It is recommended that no shot be given if below 90. You did the right thing.
Switching to a low carb diet can make a big difference in numbers. As you can tell, Oscar's numbers are coming down quite quickly with the transition. The switch needs to be gradual and monitored carefully. It is great that you are testing.
The s/o wet foods are over 20% carbs.
I'm sure the dry food is even higher.
The DM pate is 6%.

There is nothing special about the DM, except the fancy name and price.

Can you tell us why Oscar was on the S/O? If he can tolerate regular cat food, there are much cheaper alternatives.

Tagging
@MrWorfMen's Mom
and
@Marje and Gracie
regarding dosage.

Ask any and all questions. We want to help keep your cat safe.

It would help tremendously if you could set up a spreadsheet with what test numbers you have. We are fairly data driven and refer to the spreadsheet often. There are people here who can help you set it up if you run into difficulty.
 
We really are dependent on the spreadsheet. It allows you to track Oscar's progress and we can also help you to see patterns.

Skipping the shot was fine. There are also two other options when you get a number that is lower than expected.
  • You can stall. Do NOT feed your cat and then re-test in 20 - 30 min. The goal is to determine if numbers are rising to a range that's safe enough for you to give an insulin shot. You can repeat this process. The downside of stalling is that you will be off your 12-hour shot schedule.
  • You can shoot a reduced dose. Ordinarily, this is a good option. Given how new you and Oscar are to feline diabetes, I would not have recommended this option at this time
We generally suggest starting at a dose of 0.5u twice a day. At this point, you know that the 1.0u dose brings Oscar's numbers down to 74. I tend to think it's easier on the caregiver's nervous system to start at a lower dose and work your way up if necessary than to start at a higher dose and be worried about low blood glucose (BG) numbers. This is especially the case if your are transitioning to a low carb food. I'd consider a 0.5u dose but it may be helpful hear what others have to say.

If no one has linked this for you, this is the information on dosing with Prozinc.
 
If you need help doing the SS, I can help you. Please send me a private message by clicking on “Marje and Gracie” to the left and then “start a conversation”.

I know it seems like you don’t have enough tests to do a spreadsheet but we are very good at looking at them and figuring out where you should go next. It’s more difficult to just see a list of numbers and put that into context. We look at waves of action on the SS and that helps us visualize what might be going on and a good dose to recommend.

I want to add that with PZI, you can shoot up to an hour late and still shoot at your regular time the next cycle. Sienne was likely thinking about Lantus where we don’t have as much flexibility; but with PZI/PZ, you do. The starting dose with PZ/PZI is usually 0.5u as Sienne said and, normally, we would recommend a dose reduction if the BG drops below 90 which Oscar’s did. So I agree with Sienne that you would want to reduce the dose. I would suggest you shoot no more than 0.75u twice a day; however, as long as he has not had ketones, it would also be acceptable to be more conservative while you stop the dry food and test more to just shoot 0.5u twice a day.
 
hi all,
firstly thank you so much for the responses here-i have just created oscars SS which is pretty sparse so far, but working on regularly taking BG levels to get consistent data uploaded...
as of today (1/6/20) oscar is on exclusively wet food and about 80% transitioned to purina DM from the RC urinary SO. by wednesday he will be 100% on the DM wet food.
(he's been on SO for about 5 years due to recurrent urinary blockages, the most recent of which occurred in february 2019. it is my thought that these blockages were caused primarily from dry food although the vets never substantiated this and maintained that so long as he was eating SO dry or wet he should be alright and it was rather stress/changes bringing them on, though oscar is an only cat and we've been in the same home long term. i was always too afraid to change diet despite reading about the dangers of commercial cat foods, even 'vet prescribed'. either way since the last urinary flare he has been alright. i reluctantly kept dry food around since he was a free-fed picky eater and would leave most of a serving of wet food uneaten.)

since his diagnosis (dec 2019) we are on a meal schedule in accordance with the shot times, so he has been cleaning the plate regularly and i've been able to wean off dry altogether; with my concern to preventing any more blockages i didn't even want to go into the zone of introducing the purina DM dry into the mix of things.
has been gaining weight back with the insulin and canned food (lost 1.2 lbs from oct-dec prior to diagnosis)

after skipping yesterday's AM dose based on AMPS of 74 we had numbers: 422 (+2) and PMPS 358. i gave 1 unit (u40 syringe) at yesterday's PM regular time.
this AMPS also registered low as yesterday's did (74). we use a contour next monitor. i was hesitant to deliver dose again this AM so called vet for advice. they told me that i should maintain the 1 unit dosage and that this low number was due to him being in a fasting state since last night's meal. at their suggestion i gave it then retested at +2 registering BG 60. despite his acting normal (or just asymptomatic?) seeing that number concerned me and i knee-jerk responded by giving about a teaspoon of food, then thought maybe i shouldn't have done that? then took a +5 reading at 61. would this presumably be oscar's nadir zone?

i have been taking in a LOT of information the last several weeks and feeling back and forth confident about understanding things.
what i remain a bit confused on is (probably a lot, but working to learn!!):

-when BG is low pre-shot and stalling on feeding by 20mins is done to see if it rises, it is rising because the last dosage has worn off finally? for what reason would it remain low after stalling on food, that the last dosage is still active?

-is he dropping BG this rapidly from the food transition, and if so, does that suggest quick regulation could be happening? vet mentioned nothing on this and also had mixed messages on remission (1 doc mentioned he would be on insulin indefinitely, another said remission totally doable)

-if he is low again tonite at PMPS, should i stall and see, possibly skip dosage again, or just plan to reduce the dosage to .75 or .5 from now on? (times have been 10am/pm EST). because he went up into the 400s after the skipped dose yesterday it seems like he still requires some amount. nighttime dosage is a little more concerning to me because i typically go to bed within a couple of hours of it and am unable to monitor the cycle overnight. i am fortunately available during most days to be home or very close to home when working to monitor.

-since our last vet visit on 12/27 for a curve with highs in 300s, they told us to come back in 3 months maintaining current dosage 1 unit. i feel in opposition to this based on what has been happening, but they didn't say anything to me about decreasing the dosage if numbers consistently read lower. should i make this executive decision in moving forward? are his numbers seemingly all over because he's still very new and due to the new food/low carb transition?

-testing for ketones: he uses a top entry litterbox currently so achieving a urine sample seems next to impossible to do. is this something as necessary as home monitoring? feeling a bit at a loss for how to navigate that as of now.

i will be trying to maintain daily bg readings until there is some more data input, for now i know there area a lot of blanks...SS link in our signature and updated to current.
reading a ton more, and all the PZI links included above, apologies if i've asked a question clearly outlined in one of those links i did try not to do that!!

remain confused but optimistic
thanks so much :)
 
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I do not agree with the advice of your vet to go ahead and give the 1 unit when the BG was 74, when Oscar is a newly diagnosed kitty. Thank goodness you tested again and gave some food...that was the correct thing to do. Always test again to see the BG is rising not dropping further.
After skipping a dose, the BG will go back up higher. That is to be expected at this stage.

Are you giving some snacks during the first half of the cycles as well as the Preshot meal?
I will tag @MrWorfMen's Mom as she uses prozinc
 
honestly i cut out treats from his diet once he began the SO diet, if anything he gets a spoonful or two of food in the first half of the cycle as a snack but only if he seems wildly hungry- and nothing for a few hrs before the shot time/meal. since i haven’t been getting a curve daily should i take mid cycle hunger as a hypo symptom that i just haven’t connected yet? he’s only acted that way a couple of times so far..
would also be open to reintroducing some safe treats if they’re out there!
 
I would routinely give him a couple of snacks of low carb food during the first half of each cycle apart from his Preshot meals. Most of us here do this. It is better for the pancreas to be getting smaller meals throughout the cycles then just one before the insulin. And it’s good to have some food aboard when the insulin is at its strongest.
If cats are wildly hungry it usually means they need some food to counteract the insulin.
As far as treats go, you can use ordinary cubes of cooked chicken or some of the low card freeze dried treats available now.
 
hailey & oscar said:
honestly i cut out treats from his diet once he began the SO diet, if anything he gets a spoonful or two of food in the first half of the cycle as a snack but only if he seems wildly hungry- and nothing for a few hrs before the shot time/meal. since i haven’t been getting a curve daily should i take mid cycle hunger as a hypo symptom that i just haven’t connected yet? he’s only acted that way a couple of times so far..
would also be open to reintroducing some safe treats if they’re out there!
Click to expand...

My cat was on C/D for urinary issues ( crystals and FLUTD) . He likes the freeze dried raw treats- chicken and duck. Occasionally I give him eggs or organic turkey deli meat (no brine) and give those with his testing so he tolerates it .
You will find out what works for you. I'd try getting the cat used to testing- set up the test kit and grab his ear/paw- the reward him for tolerating it but don't test. Then overtime you might be able to get test without pushback because he will be anticipating a treat.
Good luck :)
 
Looks to me like the dose is a bit high now probably thanks at least in part to the diet change. Those low AM pre-shots suggest that Oscar has been dropping low at night and BG hasn't yet had time to rise back up by pre-shot. The much higher BG readings are bouncing. Bouncing occurs when BG drops quickly, drops a lot or drops to levels kitty is no longer accustomed to which is relative. If kitty has been in the 500, a drop to 300 could cause a bounce. Likewise if kitty is used to being in the 200 range, a drop to the 70s would cause a bounce to higher numbers.

A normal curve would have BG at its lowest point generally in the +4 to +7 post shot hours with ProZinc. If readings were plotted on a graph, they should look like a smile. In Oscar's case, his PMPS and AMPS appear to be his lows but I think there likely have been others you have not caught with testing especially at night.

Normally we would recommend no shot unless BG at pre-shot is 200 or above until you get more data. Shooting at a pre-shot of 74 is not advised. If BG is below 200 but close, you can stall for 30 minutes without feeding and retest to see if BG is rising naturally. Yes being hungry can cause lower BG but since one expects the insulin to be wearing off by pre-shot and BG to be rising naturally, one would not expect to see that low a BG resulting solely from hunger. Hunger can also be stressful for cats which can cause them to dump stored glucagon into the bloodstream to raise BG.

I'd reduce the dose to 0.5u and get some mid cycle tests in the +3 to +8 post shot timeframe. At night, at a bare minimum, get a test before you go to bed. A test at +2 or +3 post shot at night can give you a clue whether the cycle will be active or not and allow you to the opportunity to leave extra snacks out for kitty to eat during the night if they need food. If you can get more tests at night even periodically (if you wake up middle of the night for instance) it will give you even more information on what is happening at night. Without night time data, you are missing half the picture and a lot of cats go lower at night than they do during the day. While a pre-shot test tells you it's safe to give insulin, it's the mid cycle tests that will dictate dosing.
 
i rechecked BG 3x in the last 1.5 hrs with a 20-30 min stall in between each.
we read 133, 136, 146. i didn't want to extend any longer than that or risk throwing off dosage schedule, so i've just fed him.
i guess we are forgoing the dosage tonite and should resume in the morning at .5 units?
i will try for a recheck again tonite before bed just to track BG post meal.
 
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ss updated- this AMPS after skipping last night he was at 264, ate and with .5 units he is measuring +2 268.
although it hasn't lowered, based on skipping the last dose this seems ok, no? wondering if anything we would take dosage up to .75 moving forward but i would like to do a few cycles at this dosage and not switch it up again right away, for an overnight to do some rechecks and with the diet fully switched to LC by tomorrow. was planning to give him a snack around now if BG was lowered but am not going to based on it's steadiness as i don't want it to rise more... will recheck in a couple hrs.
 
Sometimes feeding them brings numbers down so if Oscar usually gets a snack in the morning, give it to him regardless of whether he is dropping or not. The 0.5u dose may need to be adjusted but for now I suggest you stick with it for at least 6 cycles and then re-evaluate as long as pre-shots are high enough to shoot and he doesn't drop too low mid cycle.
 
ss updated for today's readings, but i am a little confused why he's reading lowest at pmps today - i had to leave the house for a bit today mid cycle, and thought it might be too late to give him a snack when i got back (+6hrs) so i held off, but we just skipped his pm dose again after reading low and stalling one round. are seeing these lower ranges ultimately a good thing? or would it be better if he got some food in between the shots throughout the day? before diagnosis he was free fed and is always starving by the time i feed him again so i am not opposed to him snacking if that will mellow him a bit between meals, just trying to be really on top of not messing with levels too close to shot time.
we gave a half dose (.5 unit) this am instead of the full unit.
going to try for a couple re-checks this evening.
 
Since you've had to skip shots the last 2 nights, you could try reducing the dose to 0.25u and see if that gives you two shootable pre-shots. Those higher numbers you are seeing in the mornings seem to be at least in part from bounces. Oscar seems to clear bounces quickly which is great but the skipped shots are probably part of the cause for those bounces.

ETA No reason to only feed Oscar twice daily. Better to offer some snacks through the day/night except for that 2 hour period prior to pre-shots tests. More frequent feeding actually helps to level out BG.
 
ss updated.
lowered AM dosage to .25 and gave several small snacks so far today after rechecks at +2.5 & +4 which has kept him in mid-high 200's. going to test again in a couple hrs and give 1 more snack before 2hr window prior to evening meal, and hoping that he stays high enough for pm shot.
if this seems to level him should we keep it at .25 for several cycles and then re-evaluate if he needs to go up to .5?
i have some of the u100 syringes that i was originally given when we got the insulin (which for 1 unit i was drawing 2.5 units on u100), to confirm dosage for .25 units in a u40 syringe, based on the chart i would draw to the .6 line in a u100 syringe? seems a little more accurate than trying to eyeball 1/4 of the 1 unit line on the u40 syringe although that is what i did this AM.
 
One cycle on the 0.25u dose doesn't tell you much. It was a very flat cycle and may be partly bounce from the low blues yesterday as well as the skipped shot last night so just hold the 0.25u dose for the 6 cycles and then re-evaluate.

You can use the U100 syringes and to draw up 0.25u, since there is no 0.6 line on the U100 syringes, you would draw till the black stopper on the plunger in the U100 syringe is just barely under the 0.5u line. The dose may not be precisely 0.25u but it's close and it's more important to be consistent than absolutely accurate.
 
he showing 164 this morning, i am stalling and going to recheck in 20, should i skip again if he’s still low this am? or give it and continue with the snacks throughout the day-
was not able to snack overnight, i am looking into auto feeders for this purpose now...
 
Did you shoot last night? What was pre-shot if you did? If you did shoot last night, it looks like 0.25u may be a little too much too. I'd skip today and see what Oscar does.
 
Ok so he might have been breaking a bounce from lower BGs ending with the lower pre-shot today. Since we don't know how low he might have gone last night or even where he was heading after his shot, I think the 0.25u may be too much. Are you available to monitor today's cycle? If so for how long?
 
Ok, you could try a dose of 0.10u if you are not too far off your regular schedule yet. To do that dose, you could use a U40 syringe and draw insulin to just below the zero line on the syringe. (Plunger lined up just below zero line. Get a test around +2 to see where Oscar is headed and then decide from there when to test again.
 
So if I am interpreting correctly, you shot about an hour late so in the dose column, instead of 10:40 put "@ +13" indicating the shot was an hour late.
 
fixed on ss. do the retests stay as they are, indicating +2 after the shot and so on?
+3 measuring at 388, he had some food at +2, should i hold off on more snacks as i don’t want to continue to rise?or should i give another small amount around +4/5? going to recheck and will update as frequently as i can for next set of hours through the rest of the day...
am trying for consistency but it’s been so back and forth. yesterday felt like a somewhat controlled day, but feel like without the repeated food offerings last night, i contributed to what’s happening today. i can order an auto feeder today but i know any food i leave out for him on a plate tonite will be eaten in one go, he’s not pacing himself at this point despite coming from a lifetime of grazing.
he’s so high now, it’s definitely giving me some confusion and apprehension about changing all the dosages up and i hope i’m not stressing his body out even more :banghead:
 
Try not to stress out over those higher numbers right now. Looks to me like those highs are likely a bounce and that will clear. The low pre-shot this AM suggests Oscar went lower than that 166 this AM last night and that can set off a bounce to higher BGs. Numbers should start coming down in the next cycle or 2 based on history but can take up to 6 cycles to clear. Patience is the name of this game an it pays off in the long run. Pushing doses up too quickly often ends up in a lot of bouncing so first you need to find a dose that allows you to dose consistently every 12 hours then if that dose is not dropping BG enough, you methodically and slowly increase ensuring you know how low any dose is dropping BG. A couple of days of higher numbers won't hurt Oscar but one time too low can be fatal.
 
You are getting excellent advice from Linda. So hang in there, the higher numbers are probably a bounce as Linda said.

With your SS are you able to either remove the colour or change it in the EST pm time of 22.00 please?. At the moment it is the line green that we use for under 50 and it is disconcerting when looking at the SS to see that colour. Thanks.
 
ss updated.
oscar at a low this am again. we tested and retested and got values of 68 & 65 20 mins apart. what does it mean when his bg is continuing to fall instead of rise as it ought to be?
we should skip the .10 shot this am based on this low value, no? i will be around to monitor today....

i have a feeder being delivered today for in between meals, especially overnight. i gave him some food +2 after last nights shot, but it was the only food he got before i was in bed and with intention of a mid twilight recheck but my alarm failed me. or i failed it. i am going to try for some late nights and wake ups to get some pm tests tonite.
 
65 is excellent but suggests Oscar again dropped low last night. If you are available, check Oscar's BG about 3 hours after his morning meal and see if his BG is up or down. If it's down, it means his pancreas is getting back to more normal function. If it's up, he may need more insulin support.
 
Ok, good. Was just wondering because the Savory selects are higher in carbs. Wondered if that might account for any of the higher BG at +2. Looks like Oscar still needs a bit of insulin but let's see what he does today. A couple of checks will suffice.
 
ss updated with +2, +4 for last night...
after using the auto feeder for intermittent food overnight last night we have an AMPS of 81, so skipping AM dose again and will recheck at +2.
 
Looks like Oscar may be on a mission... a good mission. You could try only giving him a drop dose instead of the 0.1u if and when he has a pre-shot number that is shootable. Drop dose is done by holding in the plunger in as tightly as possible while inserting the needle into the vial. Let go of the plunger and withdraw needle from vial. This allows the suction to just pull up enough insulin into the needle but you won't be able to see it. When injecting, you'll need to hold the needle in place for an extra few seconds before withdrawing while pushing the plunger in tightly.
 
updated ss- do you think a drop dose is this something i should try this evening? or stick with the .10 for some more cycles.... been in the 300s today despite this am’s lower values.
seems like he definitely has different reactions between his day and night cycles... has been getting fed primary meals at AMPS/PMPS (1/2 can each) and timed out 4 small snacks during the cycle (has been at +2, +4, +5/6, +8/9) that split 1/2 can between those 4 feedings so he’s averaging 1 3/4-2 full cans in 24 hour period. it seems a bit more than i might normally feed him but did want him to gain back some weight (normally 13lb) and he’s been eating it all... thought i might be able to cut back the intermittent feedings to 3x instead of 4 if he manages to level out some
more, if it seems excessive now.

with the auto feeder last night i didn’t think he’d drop as low as he has been, but still learning about these swings.
 
I'd try the drop dose when you have any shootable pre-shot. Hopefully the reduction would stop or at least reduce the number of missed shots. The higher numbers you're seeing are probably bounces and will pass on their own within the next 6 cycles....probably sooner. Dosing is not based on pre-shot numbers but on how low a dose is dropping BG. 0.1u has dropped Oscar's BG down to 65 which is low enough at this point in time.

Bouncing is annoying and the bane of every sugar cat parent but it's normal and you don't want to ignore low BG readings because of the higher ones that follow. The high numbers are not dangerous short term but too low a BG is.

You can experiment a bit with the amount and timing of food to see if it will smooth out his cycles at all. Unfortunately it's somewhat of an individual thing for each cat although generally speaking, the majority of food should be offered in the first half of the cycle. That said, if you find that Oscar is continuing to get low AMPS tests, a snack around +8 or so overnight might help to bring it up a bit.
 
awesome. i have a massive amount of gratitude for the wealth of information you’ve passed to me so far, coupled with the information i’ve taken in via this website has certainly kept me from going into crisis mode more than once already.
we are staying positive! & learning more every day. will move forward with drop dose provided we are in the pre-shot zone and follow up with numbers, to be continued...

noted on food intake as well. seems that intermittent feedings have been better than 12 hr strictly spaced meals anyway, will take overnight increments into account.
thank you :)
 
ss updated.
we have had no skipped dosages since saturday morning, though oscars values have been a bit higher.
the drop dose seems a little trickier to make sure he’s gotten it but i *think* we have been successful with it each time.
with using the feeder overnight he’s eating all of the portions, but wondering if he might be snacking too close to AMPS time now bringing that value up.
am going to shift the last overnight snack a little earlier, +7 instead of +8

if he stays in the zone of 300s with the drop dose would he need an increase ? or wait it out another few cycles

also going to do some food chart research, but wanted to see if you had any input on alternatives similar to the purina dm pate- he’s going through a case of cans more quickly than i thought, based on the intermittent feedings and since he’s been off dry food, so i would like to shop around some other options may be a bit more cost effective. not urgent and think i will keep him on this for a bit since he’s just made the transition, just thinking ahead
 
Some of what you are seeing is bounce so hold the dose for another few cycles before deciding if an increase is needed or not.

On the food front, many folks here are feeding Fancy Feast Classics or Friskies. Lots of other options but those 2 tend to be the easiest on the budget.
 
ss updated-
still seen some highs in the past couple of days and noticed a fairly significant increase in urine output again the last 2 days.
i was testing the drop dose amount with one of the syringes again because i felt unsure he was getting the dosage each time, and a few of the syringes i tested with (plunging and shooting onto the countertop to see the drop) i noticed did not eject any of the insulin. so, i’m wondering if some or a majority of the dosages over the last several days were actually false dosages since nothing came from the syringe. last night i pulled the syringe just slightly enough to make sure that there would be a bead of insulin administered.
aside from that he seems alright, ears seem a little beat up from the constant rechecks so i’m feeling a little bad about that but could be overthinking it...

this amps was too low for dosing, will recheck as much as i can today but have some work obligations -
going to apply this method of drop dosing again tonight and just try to be really hawk eyed about the whole thing...
 
ss updated,
oscar has had some high days lately
the last four days his AMPS has been too low to dose so we skip, then at +2/3 things can look alright, but he ends up in much higher zones between +4-8.
his nighttime cycles are clearly different from daytime, though i haven’t been able to get readings through the entire night yet. if it will help inform things much more i can try to get up during intervals tonite for readings.
does it seem like he is still stuck in bounce cycles? i’m feeling unsure of how to regulate this, have shifted nighttime snack intervals a bit but it hasn’t seemed to help too much.
i did notice more urine output in the last couple of days and despite intermittent feedings he’s been extra whiny about food.
seeking advice on whether it seems like the drop dose is too little, and how we should proceed. back to .1?
i’m fairly certain his PMPS will afford the dosage as it has only been AM lows.

does this still seem like it’s heading in a good direction? feels like he might be backsliding a bit and it’s just got me turned around from feeling like we had a bit of a handle on things, but if he’s only requiring one dosage per day maybe that’s still a good thing- still confused by it all... :confused::nailbiting:
 
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