What happen if I skip the optimum Dose?

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ftsang & Jessica

ftsang & Jessica

Member Since 2013
If I increase the dose too fast and too much? How would I know I have skipped the optimum dose and what happen?
Please explain, thanks
 
You started at 1 unit according to your spreadsheet.
So let's check that starting dose.
1) How much does he weigh (8 lb 13 oz) and what is his ideal weight?
2) Which is lower?
3) Convert the lower to kilograms (pounds / 2.2)
4) multiply by 0.25, then round down to the nearest half unit.
Is that higher or lower than 1.0?
Next, review dose increases.
1) Did you stay with a given dose for 10 shots on 1 unit and 6 shots on later dose levels?
- no, 1 unit was given 1 day, then increased to 1.5 units by the next day.
2) Were the increases 0.25 or larger? Larger
3) Were the increases based on nadir test values, ie the lowest test value between shots?
- appears to have been increased without knowledge of nadirs, possibly based on pre-shot levels, which doesn't assess how low the insulin is dropping the glucose between shots.
 
Its great that you are testing your kitty to keep him safe and to know when to adjust dose, however to get a better picture on when and whether to change dose you need to start getting a preshot test before every shot. AM and PM. For all you know you could be shooting when he is very low. I know it looks like he is pink all the time but you are getting the tests in at the same time each day and Lantus works on a curve so he could be going lower and you dont know.

I always recommend a test before every shot (to be safe)
A midcycle spot check
A before bed test

Try and fill up some of those blanks to see what he is doing in the middle of the cycle.
Wendy
 
Thank you BJM & Wendy.
To answer the question from BJM: My initial dose of 1U was started from 2/24/13 until 4/16/13 (1.5U). Yes, I can't locate the nadir value but I will try.
Wendy, I will try to take PS test on Jessica but quite often it is very difficult when she was hungry. Instead, most of the time, I will take a test right after the food.
One thing I would like to ask. She still drinking quite bit of water today. Is it because of the rebound effect due to increase in insulin? How do I know I have missed the optimum dose and what happen if I miss it?

Thanks
 
If your pre-shot test is within 15-20 minutes of your cat starting to eat, the BG number will likely not be higher due to the food. We want to see those pre-shot BG tests uninfluenced by food if possible.

Drinking more water. A cat will drink more when the numbers are still unregulated. Was the water intake today higher than most days recently, say in the last week? Or does your kitty always drink a lot of water still?

If you increase the insulin amount too fast, you may bypass a 'good dose' that keeps your cat in better BG numbers. That is one reason we recommend only increasing by 0.25U at a time. That is the protocol we are using.
 
Thanks Deb.
The lowest water intake since I have record on her is about 132ml ( please see attached Jessica's SS). She drank about 397ml yesterday but today I would guess about 198ml much less since I increased her dose to 2U 4 days ago. Her BG level still stay above 200 most of the time. Should I increase the dose to 2.25u tommorrow?
 
Without those pre-shot tests, it's impossible to tell if the mid-cycle tests you are getting are a dropping number, a rising number or staying about the same. I don't have that pre-shot baseline number to help put those mid-cycle test numbers into context.

The mid-cycle numbers you did get today are all about the same, within that 20% meter variance. If you plotted them on a graph, it would be a fairly flat curve. I wouldn't raise the dose yet without a bit more test data, especially those pre-shot tests.

The most useful BG tests to get are pre-shot, +2 and somewhere between +5 and +7. Would your schedule allow you to get some of these test numbers? Many people take a BG test before they go to bed. That can be another useful data point since many cats get lower BG's at night.

I'm a little surprised at the still high water intake 400 mL (14 ounces) is a lot of water for a cat eating canned food. Do you live somewhere that is really hot or have the temperatures been getting warm?
 
I think you are asking about the optimum dose because you are wondering why her BG levels are still yellow and pink. I think its unlikely you missed the optimum dose, if anything you held some prior doses too long when they werent working and of course (nag nag) you really really need to get those preshot tests in. Maybe feed two hours before her shot, then test and shoot and feed again?

Now as regards dose, I think you should start posting on the tight regulation forum. Its very active and they are very experienced members there who can advise on what to do. Start your first post with "newbie" within the subject line and they will welcome you!! Expect a bit more nagging on the preshot tests too- we really need to fill in that chart ;) http://felinediabetes.com/FDMB/viewforum.php?f=9

Deb - I am not surprised at the water intake - her BG are still pretty high.
 
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