Question about rise in glucose after dose increase

[Buffy-&-Cindee]

Buffy's numbers have been slowly going up instead of down so I did curve on her yesterday and followed the "Five Steps to Regulation", increasing her dosage by .5. Instead of going down, her numbers have gone up. I'm not quite sure what to give her this morning. Does anyone know why this is happening and what I should do?

Cindee

P.S. Why is everyone posting the date and AMPS and PMPS in their "title"? Did I miss something?

 

[Wendy&Neko]

Hi Cindee - what you are likely seeing for the first couple of cycles after an increase is what we call New Dose Wonkiness or NDW. It's a temporary thing.

What is the "Five Steps to Regulation"? The two methods people here use are either the Tight Regulation Protocol or Start Low Go Slow Method. You are missing a lot of mid cycle data. Even SLGS that requires less testing recommends a weekly curve. We dose Lantus by the nadir or how low the insulin is getting the cat, so it's always good to get a few of those spot checks before doing in increase. In either case (TR or SLGS), you increased by too much. With the nadirs you have been getting, a .25 unit increase would have been the maximum increase. Cats are sensitive to just very small changes.

A lot of us post here daily, the AMPS and PMPS data gives people an at a glance status of how the cat is doing. It's also really helpful for those of us who check to see if anyone is in trouble or needs help.

 

[Libby and Lucy]

Wendy, "Five Steps to Regulation" is the original Start Low Go Slow approach. We updated it recently to be more specific to Lantus and Levemir: Lantus & Levemir - Start Low, Go Slow Method (SLGS). In this adaptation, we adjusted the recommended dose change from 0.5 units to changing by 0.25 units at a time. Random spot checks are not required in addition to the curve, but they are recommended and will give you a better picture of how the insulin is working in your cat.

The START LOW, GO SLOW METHOD (SLGS) with LANTUS or LEVEMIR for DIABETIC CATS has been adapted from the FDMB's original 5 Steps to Regulating Your Diabetic Cat (the "Start Low - Go Slow" approach). Adaptations were necessary to accommodate the action, nuances, and exceptions of the newer Lantus and Levemir insulins.

I see a curve yesterday with a nadir of 179, so according to the original SLGS, a 0.5 unit increase is appropriate. According to the updated Lantus and Levemir SLGS, a 0.25 unit increase would be recommended. We do find that smaller dose adjustments tend to work better for these insulins, at least for most cats.

Wendy is correct in that we do often notice an increase in numbers in the first day or two following a dose increase. Usually they will come back down after a few cycles and you'll be able to see what the dose really can do. Especially since you increased the dose by more than we usually recommend, I would plan to do another curve (or at least some spot checks) on the 4th or 5th cycle of this dose so you can see if it is working yet.

eta: never mind, I see that you reduced the dose to 1.25 this morning. Carry on! I think that will be a bit safer and you can always increase again if needed.

 

[Buffy-&-Cindee]

You guys are too quick for me. Thank you both for the information. As you see, I decreased her dosage this morning and I'll test her every three hours to see how she's doing.

 

[Wendy&Neko]

@Libby and Lucy - Thanks for the clarification. The name sounded familiar but it's ages since I read that version. Cindee is using the AlphaTrak so that 179 may be less than the 150 mentioned in the 5 steps document for a .5U increase.

Good luck Cindee with the increase, I hope you see a better overall range for Buffy.

 

[Libby and Lucy]

I know it has become popular around here to do a lot of math to try to translate AlphaTrak number to human meter numbers. I just don't subscribe to popular belief. ALL glucometers have a large variance even if you test twice on the same blood drop. AT tends to run a bit higher, but it doesn't make sense to think that it will be a consistent amount higher in any range. It only really matters in the low numbers when you are looking to preserve your safety net (and it's also why we HAVE a safety net to begin with, and a bigger one in SLGS).

Just my opinion, your mileage may vary.