Tonka AMPS 380, +11.5 394 (after a drop below 50 last night)

[jmalasiuk]

Looking for advice on dosing.

So I'm not sure what Tonka is doing today. He went down below 50 last night, and of course was up at 21.2 (380) this morning - as expected since I fed him a bit of high carb food at +7 last night, and he was probably rebounding as well.

I gave him his full 2.25 unit does (though I'm debating keeping him at that level seeing as the only times when he's been in the green lately that he hasn't dropped below 50 was when I chickened out and fed him up before getting there), since i figured out that starting from that high he'd be quite safe. But came home tonight and Tonka, while acting perky, is just as high as this morning.

I'm sure I got the insulin into him this morning, and he didn't even eat all his food, so it shouldn't be a matter of lack of insulin or too much food sending him back up. Could this still be the same bounce? Or could he have fallen just as fast from this one and just rebounded again? He seems to have a one day on, one day off pattern going with the rebounds lately...

I'm just trying to figure out if I should really be keeping him at 2.25 units or not. I know the protocol says that he should be below 50 at least three times on different occasion before reducing (or below 40 once), but since I keep feeding him before he hits 50, I can't be certain that he wouldn't be dropping that low if left to his own devices, and I don't want to be leaving him alone during the day if that might be happening to him.

Thoughts??

 

[Chris/China (GA)/Garfield]

Tonka earned the reduction back to 2 units when he dropped below 50....He's a "new" diabetic (less than 1 year) so he only needs to drop below 50 ONCE to earn his reductions

Yes...today's numbers are a "bounce" off the 40's last night...It can take up to 6 cycles to clear a bounce.

It's important to get at least 1 test mid-cycle on each cycle no matter how high they start! Bounces CAN clear sooner than 6 cycles, so it's just as important to get tests when they're bouncing...just don't need to worry about getting them quite so often.

Tomorrow you should take the reduction he earned and drop back to 2.00u

 

[Wendy&Neko]

Tonka had a great day yesterday - no wonder he's bouncing today.

Before I answer the question on dose, I know you stalled the AM shot due to his numbers. How longer after the AM shot was the PM shot? If it was not 12 hours later (or 11.5) then it was an early shot, which acts a bit like an increased dose. And that increase could explain the lower numbers last night. If it was on time relative to the AM shot, then he did indeed earn a reduction. The rule for 3 times under 50 is for cats deemed long term diabetic (diabetic longer than a year).

From the protocol:

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

 

[jmalasiuk]

Thanks Chris and Wendy, I didn't see that part of the protocol (about new vs long term diabetics). That's good to know.

QUOTE="Wendy&Neko, post: 1369507, member: 5773"]Tonka had a great day yesterday - no wonder he's bouncing today.

Before I answer the question on dose, I know you stalled the AM shot due to his numbers. How longer after the AM shot was the PM shot? If it was not 12 hours later (or 11.5) then it was an early shot, which acts a bit like an increased dose. And that increase could explain the lower numbers last night. If it was on time relative to the AM shot, then he did indeed earn a reduction. The rule for 3 times under 50 is for cats deemed long term diabetic (diabetic longer than a year).

From the protocol:[/QUOTE]
I gave him a slightly later shot in the evening, to work our way back to his usual time gradually. It was probably about 11.25 hours after his am shot, and his morning shot today was about 11.5 hours after last night's.

I'm still thinking that I might just reduce him to 2.0, even if the slightly shorter time between injections could have contributed, because there's been a few cycles during which I'm pretty certain that if I hadn't fed him, he would have dropped below 50. Maybe not by much, but enough to make me uncomfortable with leaving him during the day (or sleeping at night). If I do drop him and he didn't quite earn it, it should show up in more elevated levels, yes? So if I go that route, how many days should I wait before increasing him again if he's not getting back into the greens at all? Would the 6 cycles often cited be enough to tell?

 

[Chris/China (GA)/Garfield]

If you'll post here daily, we're usually pretty good at figuring out if they're still bouncing or if the reduction has failed and you need to go back up.

There's no "6 cycle" time frame when it comes to failed reductions.....if once the bounce has cleared, the numbers start trending up, then you go back to the last "good" dose without worrying how many cycle's it's been

 

[Wendy&Neko]

11.25 hours apart is close enough. I'd take the reduction to 2.0 in the next cycle. What you are looking for in determining if the reduction has failed, is for the bounce to be over and Tonka not seeing green again after that. Lately he has been only taking a couple of cycles to get over the bounce. Sometimes you just start to see numbers trend up, that is another indicator.

 

[jmalasiuk]

Ah, so it's different than just increasing doses, then, where you do wait for a few days to let the Lantus catch up. Sounds like a plan.

 

[jmalasiuk]

Thanks folks. Now I just have to manage to stay awake long enough to get a test in around +3 or +4 to be sure he isn't coming down fast (might not make it - only got 2.5 hours sleep last night), and remember to only give him 2 units tomorrow so I can see what he does with that...
I wonder what kind of effect his dental at the end of the month will have on his sugars. He's been coming down from whatever was spiking him last month. But he does need some work on his teeth, so might as well bite the bullet and get it done and hope that that helps even more.