Tucker - time for a dose increase?

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Tucker'sMom-Jen

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It is such a rollercoaster! Just when I think we are heading in the right direction...

Time for a dose increase? Tuck has been curving but his numbers are not as low as they were earlier this week and then today both amps and pmps are pink.

Thinking about Lev also. I was doing some research and wonder if he would do better on a depot insulin since he is on chronic steroids... Food for thought as we go along, I guess. As we get closer to the end of the ProZinc vial I will have to do a sit down with the ss and think about it more thoroughly.

Thanks!
Jen
 
One part of the answer to his puzzle is what happens at night. Any time you can get a nadir at night will help you figure out how much of the amps might be a bounce. It does look like he could drop a little but the greens scattered in there make me nervous - it is so hard to predict with the pred. If you increase consider only .25 and do it on a cycle you can monitor?

I would check out any cats on pred on Levemir. It seems like it would be harder to work with. You can't adjust as easily - it might be harder to work around the pred because you need to hold the dose longer, but I think Lev might be more flexible than Lantus.
 
Sue and Oliver (GA) said:
One part of the answer to his puzzle is what happens at night. Any time you can get a nadir at night will help you figure out how much of the amps might be a bounce. It does look like he could drop a little but the greens scattered in there make me nervous - it is so hard to predict with the pred. If you increase consider only .25 and do it on a cycle you can monitor?
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Thanks Sue :). It is so good to hear from you!

I think I will try 3.75 starting tomorrow. His amps and pmps just aren't budging and I feel like he needs a nudge in the right direction. I was awake and able to get a nadir the other night - since he gets the increased pred dose at pmps I am not as concerned about a huge drop overnight and it was reassuring to see yellow.

It is just so frustrating!!! We had greens and blue before then back to pink and yellow. Is it possible he is getting too much?
A month ago we had blues with 2 units...
 
If the pred is daily, then Levemir may be OK. Depot insulins work best with the same dose each day and a constant level of pred will have a more level effect on the glucose.

If, however, you are on alternate day dosing, a depot insulin will be difficult to manage as the pred will have alternate days when it raises the glucose or not.
 
BJM said:
If the pred is daily, then Levemir may be OK. Depot insulins work best with the same dose each day and a constant level of pred will have a more level effect on the glucose.

If, however, you are on alternate day dosing, a depot insulin will be difficult to manage as the pred will have alternate days when it raises the glucose or not.
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Thank you for your advice, BJM :)
Tucker is on daily prednisolone at 2.5mg am and 5mg pm doses. He will never not be on it and in fact will likely need his dose increased as it becomes less effective at keeping his IMHA controlled. Time will tell if ProZinc is the right insulin for him, I guess. His vet told me to call when we get to 3u (also didn't tell me to home test when we started out, so I am ignoring her advice for now), and I am afraid when we go in for a follow up she is going to suggest Lev or Lantus. I want to be armed with as much knowledge as I can. This helps.

Thanks!
Jen and Tucker
 
The work around when you have intermittent steroid dosing is to use a supplemental, shorter acting insulin such as R or N (NPH) on top of the depot insulin. This initially means extra testing to see how the curve of the shorter-acting insulin works in your cat, plus you have to use tiny doses of them as they hit hard and fast. And you have to be careful not to overlap the likely nadirs of each.
 
I did increase this morning and his numbers didn't budge. I only changed to 3.75 u. I am curious what his pmps will be and will post it to the SS for Sue and anyone else not on the East Coast to see.

Is it possible that I missed the "good" dose for Tucker by using the U-40 syringes and increasing by halves? Should I decrease and switch to using U-100 syringes so I can do micro increases?
 
Sue and Oliver (GA) said:
I'd give the new dose a few more cycles. If he doesn't give you something new to see, then reevaluate?
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Sounds like a plan. I am going to try an automatic feeder to see if I can control when he eats, but am not sure if he will be able to use it due to his CH. If it works I can program in feeding times so I don't have to take up his food bowl at strategic times of day - and can make sure he has something for any middle of the night drops.

Maybe that is the answer...plus patience!
 
Never used an automatic feeder but I've heard good things about them! Sometimes food is the answer. I agree that waiting a few cycles to see where the numbers go could be good. Sue always gives good advice. I'll try to keep an eye out the next few days to see what happens!
 
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