Sorry, Newbie here...AMPS 553;+3 + 425; .

[Tiger(GA) and Ruth]

Hi All, and Happy Mother's Day to all moms of kids and kitties! I'm new to this, so here is my last post: viewtopic.php?f=28&t=117296

After the fiasco of 4/25/2014, it's been all red and black, colors which used to be my favorite- but not anymore! ohmygod_smile

If I am understanding correctly, per 5/9/2014, Tiger barely qualifies for an increase of .25, meaning from current 1.50 up to 1.75? Another question, she seems to be stuck in the reds, how long can this keep happening? is this a "bounce"? Or do you think I now have an insulin resistant cat? She eats well, still pees a lot, but she did manage to get her weight up to 8lb 10oz at last week's vet appt. Both vets insist she cannot survive dental work at this point and admit this could be affecting her numbers. Thank you for any input.

 

[Deb & Spot]

Hi Ruth! Those are some yucky numbers for sure! I don't know about Tiger being insulin resistant, but I'm thinking it may be a good idea to increase the dose tomorrow. See what the others think.

Hope you have a good evening....and happy mothers day!

 

[Wendy&Neko]

Hi Ruth, no need to apologize for being a newbie - we were all there at some point. Welcome to you and Tiger to Tight Regulation. This is a great place to get support and information. You could put Tiger's name in the first subject line so we know who you are. Maybe something like "Newbie Tiger"?

Bounces can last up to 6 cycles, and when cats are used to higher numbers, then can even bounce from yellows and blues. It looks like the night of the 8th or morning of the 9th Tiger saw some numbers that panicked her liver.

It's important when you are seeing high numbers like this that you don't hang onto a dose anymore than you need to. If her numbers are still high after 6 cycles, and you will be around to monitor her, I'd keep on increasing and getting her out of those higher numbers. From the protocol on increasing when seeing higher numbers:

Increasing the dose:

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.

It's hard to say at this point if you have an insulin resistant cat, we usually don't consider that until the dose is a lot higher. You might want to read Julie's post on glucose toxicity.

 

[Sienne and Gabby (GA)]

Hi Ruth and welcome to Lantus Land!

If you're referring to the 48 on 4/25 as a fiasco, I wouldn''t be so hard on yourself or Tiger. I suspect that no one mentioned that Lantus isn't raised in large amounts and going from 1.0 to 2.0u is a BIG dose increase. It looks like you handled the situation well.

With Lantus, dose increases are done as follows:

"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.

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.
  if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
• 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.

The above information is contained in the Tight Regulation Protocol sticky.

You'll note from the TR protocol info that doses are held for 3 days/6 cycles (consecutive days or cycles) so you have enough information to evaluate how well or not well the dose is working. Given the fur shot on the evening of 5/7, you've been at the 1.5u dose for 7 cycles. If you want to increase Tiger's dose, you can do so tonight at PMPS. In addition, since the majority of her nadirs have been over 300, you can increase the dose to 2.0u. (If nadirs are over 300, you can incrase by 0.5u otherwise, increases are 0.25u.)

I don't think this is a bounce. To a degree, the fur shot may be a factor but it's been several cycles and the depot has caught up with the lack of insulin. It's possible that Tiger is bouncing off of the yellow from the AM cycle on 5/9. It's feasible to increase a dose after 2 days and given where Tiger's numbers are typically sitting, if it were me, I'd increase the dose.

I'm really glad you've been testing for ketones! That's one issue we can cross off the list.

I suspect the vets would like to see Tiger in better numbers. I would be interested in their reasoning for holding off on a dental but I also think you need to pick your battles. If they won't schedule a dental, you really don't have much of an alternative.