Split Dosing Trial

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WenDawg

WenDawg

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In an attempt to try and getting Abernathy's BG under control, I decided to do a split dosing trial. I'm giving a main dosage followed by a smaller secondary dosage 2 hours later since it appears that the PZI is wearing off around +10. It's been several cycles and while I am seeing a slight improvement with the AMPS/PMPS readings, it seems that I might need to up the dosage slightly. Should I up both the main dosage and the secondary dosage or just the secondary dosage? I'd love some advice. Thanks!
 
I have never advised on the slit dosing before. It does look like it helped with a lower preshot. :-D maybe send BJM a PM and see if she will jump in?
 
Hi hon,

I haven't looked at your cats spread sheet, I apologize, but wanted to say that some cats, like my Lucian, refuses to keep a steady schedule and still have decent numbers.

I start testing at +10 now and shoot as soon as he hits 200. He is on PZI and when we first started, earlier this year, he was getting shot every 8 hrs, that's as long as it would last. Over time I started changing the dose dependent on his numbers and it has worked well for him. Not where I'd like it to be, but a million times better than when we started 2 yrs ago on Lantus.

If you'd be interested in the way I do it, check out Lucian's sheet and let me know and I'll go into more detail.

Been gone for a few months, sorry I wasn't here to welcome you.
 
Rather than 1 main nadir, you now have 2 which are likely to be a little higher than the main one previously. If you decide to go back to 1 shot ever 12 hours, you'll need to back off on the total dose given.

Yes, you may need to slightly up 1 of the 2 - your choice. I suspect I'd go with the 2nd one. Be cautious - 0.2 to 0.25 units increase at a time.

You may find that instead of a primary plus a booster, it works better with 2 even amounts. This is an experiment, so you'll want to give a particular split enough time to show if it is helping out - maybe at least 3-6 shot cycles?
 
nckitties3 said:
Hi hon,

I haven't looked at your cats spread sheet, I apologize, but wanted to say that some cats, like my Lucian, refuses to keep a steady schedule and still have decent numbers.

I start testing at +10 now and shoot as soon as he hits 200. He is on PZI and when we first started, earlier this year, he was getting shot every 8 hrs, that's as long as it would last. Over time I started changing the dose dependent on his numbers and it has worked well for him. Not where I'd like it to be, but a million times better than when we started 2 yrs ago on Lantus.

If you'd be interested in the way I do it, check out Lucian's sheet and let me know and I'll go into more detail.

Been gone for a few months, sorry I wasn't here to welcome you.
Click to expand...

This is great advice. If the split dosing doesn't work, I will definitely try this. I'm glad that you stopped by to post this info. Thanks!!
 
BJM said:
Rather than 1 main nadir, you now have 2 which are likely to be a little higher than the main one previously. If you decide to go back to 1 shot ever 12 hours, you'll need to back off on the total dose given.

Yes, you may need to slightly up 1 of the 2 - your choice. I suspect I'd go with the 2nd one. Be cautious - 0.2 to 0.25 units increase at a time.

You may find that instead of a primary plus a booster, it works better with 2 even amounts. This is an experiment, so you'll want to give a particular split enough time to show if it is helping out - maybe at least 3-6 shot cycles?
Click to expand...

Thank you for this information. I am starting with increasing the booster today. It still doesn't seem to be lasting long enough. Maybe I've just not gotten the dosing right yet. I'll see how this new increase goes. Thanks again!!
 
Good luck with the split dosing. We'll be watching and hoping it helps kitty. I may try it with Lucian, but for now, I'm just chasing numbers. ohmygod_smile
 
You want to consider the 1st of the pre-shots for gauging your total dose, no matter how you split it.

I think I'm leaning towards the 2 even doses with the 2 hour interval between shots based on how he is responding.

And when the lowest numbers are above 300 mg/dL, you may increase by 0.5 units divided across the 2 shots.
 
BJM said:
You want to consider the 1st of the pre-shots for gauging your total dose, no matter how you split it.

I think I'm leaning towards the 2 even doses with the 2 hour interval between shots based on how he is responding.

And when the lowest numbers are above 300 mg/dL, you may increase by 0.5 units divided across the 2 shots.
Click to expand...

OK...this is a great guide. Thank you! I have raised the booster dose today, but am not seeing anything significant. I'll continue this for a few more cycles and then increase it again as I'm still not up to the total dosage that I was giving previously before splitting.
 
I think you are going to need the amount of the total dose divided into 2, and possibly increased some more.

Here's why.
Normally, 1 dose gives you a rough U shape curve. The more insulin, the deeper the U shape.
If you split the dose in half, the first half will drop less than the full dose.
And when you add the 2nd dose, it too, will drop less than the full dose.
Imagine shallower U shapes, overlapped, like double vision.
The nadir for each dose, if both get used at the same rate, should be roughly 2 hours apart. Sometimes, it may not work out that smoothly, so you do want to be careful in case the 2 nadirs actually line up.
The 2 doses' duration will overlap for about 10 hours, so the maximum effect should be during that overlap.

Does that make sense to folks?
 
Anyone interested in taking a look at my spreadsheet and give your thoughts? I'm now dosing the same amount for all shots as was suggested. And per usual, Abernathy is still all over the place with this BG. I have the exact same routine day and night, so I don't know why the PMPS don't seem to mirror the AMPS :?
Such a guessing game still :YMSIGH:

On the positive side, his hair has grown back on his back legs where it was rubbed off from being weak and always resting on them. So, all of my struggling to get his BG stabilized seems to be worth it.
 
Interesting. Looks like an overall downward trend. Very interesting amps today. I like that there are more blues and yellows and very few blacks.

If I were you, when you have time, I'd get some curves in, at night and during the day. Then you'll have a clearer picture of what is going on. Does he drop low and are those higher preshots bounces? When he has a low preshot, is it because he has been gradually dropping the whole cycle or does he have a low nadir and is just on his way back up?

If you knew if the insulin is lasting too long or taking him too low, then you could reduce the dose a smidge and see if the cycles become more normal and if you get two shootable preshots (preferable). If some are high and flat and some are low, the high flat ones may be his version of a bounce. Knowing what is happening midcycle can guide your responses.

Generqlly, I see his numbers as encouraging and headed in the right direction. Good job!
 
It is looking like the split dosing is helping him out. As Sue notes, getting a curve would be really helpful to identify just how low he goes and how fast he comes up. The lowest should be somewhere between the 2 nadirs.
 
Thanks to both of you for reviewing and adding suggestions. I really appreciate it. I am going to do both a day and night curve in the next couple of days. I became really concerned this morning as at +11 he was at 59. So I am very worried that he dropped dangerously low during the night while I was sleeping. But true to form, he was high at his PMPS yesterday. He's just so confusing ohmygod_smile
 
The curve will let you know how low he could be going, and many cats do go lower overnight, so if you want to be more cautious, shaving off the night doses makes sense.
 
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