? Should I adjust the dose?

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Karen & Lily

Karen & Lily

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Can someone look at Lily's spreadsheet and advise whether I should lower her dose back to 4.25 units. It seems her #s were better at that dose than the 4.5 she is currently on. Thank you in advance!
 
Hi Karen, I just looked at Lily's ss, and I'd say yes, you're safe to lower the dose. She seems to drop a little more toward evening, if it were me, I'd drop the dose by .50 for a few cycles.
 
Thank you for you advise. I was thinking the same thing. I am going to be switching her from prozinc to lantus once I receive the new insulin. But in the meantime I want her to be at the best dose for her
 
I have to admit I don't see much difference. You can try lowering the dose but I would do that only a few cycles and then increase again. It looks to me like she needs more insulin - she certainly is flat and hasn't been in low numbers for nadirs. Be sure you are getting ketone tests in regularly.

Have we told you about high dose conditions? Anytime you are in the 4.5 and higher dose range, we think that is a possibility. No change she has an infection of some kind?
 
Lily had a full exam in October and everything was fine except for her blood sugar.

Sue, what is meant by high dose conditions?
 
When a cat is getting 5 units of insulin (Lily is getting close) we wonder if there is a reason they need so much insulin. Most cats here are on doses under 2 units. Some information is here:

http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/.

Some of the links are broken on the thread but the general information is there.

Do any of the symptoms sound like Lily?

There are lots of people here who have kitties with high dose conditions so if that is the case, you'll have resources.

It may also be that ProZinc is not the insulin for her and that a depot insulin will work better, so your change is a good plan.

My thinking in not reducing the dose is that you don't want her sitting in high numbers. Her preshots and nadirs aren't awful but if more insulin would help them drop into yellows and blues, that would be better for her pancreas. It depends on how long it will take to get the Lantus. If a week or two, if she were mine, I would increase her dose after three cycles on 4.5.
 
Sue, it doesnt seem to me that Lily has any of the symptoms of acromegaly, but I can not be 100% sure. Her biggest issue besides getting her sugar under control is that she needs to lose a pound or two. I weigh her frequently usually a baby scale, and she is holding steady between 11.2 and 11.8 lbs. She isnt gaining or losing any weight. When she was first diagnosed in November, my vet started her on 2 units of prozinc. Also during that same month of November I was out of town for a week so Lily spent that week boarded at the vet's office. During that same week her insulin was increased to 4 units. Perhaps the insulin dosage, both the starting dose of 2 units and then increasing to 4 units in a week was too much too fast? Any thoughts on this?
 
It might be that she is getting too much insulin, but I'd think we would see more movement. It is true that too much and too little insulin can look the same, but if she's been on 4 units since November and it's too much, at some point it seems like she might have crashed and dropped low?

If you want to try a reduction, I'd halve the dose. You could do an experiment and reduce back to 2 units for a cycle or two and see if the levels drastically improve. If not, then move right back up. And test for ketones if you lower the dose.

My gut says she needs more, but I have been wrong before and will be wrong again....it may be worth a try but don't stay there too long. We don't want her in blacks and reds, if that is what a lower dose gives you; the pinks and yellows are much better for her body.
 
I think it would be a good idea to decide what we call "cycle" in order to not confuse members who receive advice here.
From my reading on FDMB I understood that a cycle is 12 hour period or from one shot to the next which is usually given every 12 hours. So a 24 hour cycle would be time when insulin is given every 24 hours but we do not use such schedule, do we?
 
A cycle is the 12 hour period between shots. A typical 24 hour day would have 2 cycles. This is why when following the Tight Regulation protocol with Lantus or Levemir the protocol call for holding an increase :

GENERAL GUIDELINES:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

If using any other type of insulin the protocol could be different but the definition of a "cycle" remains the same.
 
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