Prior Thread AMPS 312 We are still within the first 2 weeks so really not sure how his numbers are going to go. Starting to look like we will have to do the twice a day dosing though. At least through the day his numbers are staying within a 100 point range. So for doing twice a day, would I reduce his dose a little? Say instead of the 1.75u like now, reduce to around 1.25u? Or just stay with the 1.75u and start giving twice? @Sam & Esse @Chris & China (GA) @MrWorfMen's Mom
Hi Meridith I have to admit I'm happy to hear you're considering twice a day dosing. It's been worrying me quite a bit that Zeke hasn't been able to surf under renal threshold since starting Tresiba. Conan hit his first blue on day 5 of once a day dosing. Sam hit blue on day 6 of twice a day -- but I was using an AT2 at the time, and his renal threshold on that was right at 300 Zeke had been at 1.37u on Lev... Usually, I see the advice when a person is going from QID to BID is to split the dose in half, but that would bring Zeke down to a .875 dose -- and I don't think that's nearly enough. There's still a lot of room for Zeke to go down. I suppose the safe call would be to do 1.25u twice a day, and the aggressive move would be 1.5 or 1.75. If it were Sam I was dosing, I would do 1.25u, but be ready to increase insanely quickly (at least, that's what Sam's SS shows I did ). I suppose a lot of it has to do with how comfortable you are. I fast-tracked Sam quite a bit; it seems he hit his breaking point at 3.75u, and then I had to bring his dose down fast. So... safest would be the 1.25u -- but I personally feel you'll need to move up from there. Since you're able to test properly (not like me ) and you're not dealing with the full depot yet (at least, not a BID depot) you could start higher, depending on your risk tolerance. Wish I had better advice to give, but there's just too many unknowns. But I definitely wouldn't backtrack to 1u, or .875
Thanks @Sam & Esse, I will probably go to the 1.25u and start from there. I don't like him staying in the higher numbers either and after having a good day of yellows, then back in the pinks, figured it was time to make the call and go to twice a day. Now the question is, do I do a small dose tonight for pm shot, or just wait until tomorrow and start it. Thinking a small dose tonight would be a good help to start taking him down to the better numbers and since he already had 1.75u this morning.
I think a small dose should be fine Even 1u, since you're able to get PM tests. It would mean Zeke would be getting 2.75u today instead of the 2.5u you have planned for tomorrow, but without a large depot it shouldn't be a problem. Knock on wood
That would be nice! This is complete speculation on my part, on the way Tresiba might work in cats... We know Tresiba forms chains, and that the insulin molecules(?) break off both ends of the chains for a timed release. Now, increasing the size of the dose probably forms a few more chains, but I think the bulk of the action is in forming longer chains. So, the larger the dose, the greater the duration of those chains -- what Lantus and Lev users refer to as the depot. When you go to twice a day dosing, you're essentially doubling the number of chains that are active. As you increase dose size, those chains will persist for longer periods of time. For an example (not to be taken for fact!) a 1u dose might form chains active for, say, 3 days. A 2u dose might form chains that last 5-1/2 days. And a 3u dose might be forming chains that will continue releasing insulin for a week or longer. Continuing with this totally inaccurate example , we can guess that the 1u dose forms... let's say 5 chains. (It's probably hundreds of times more than that, but math and I do not get along lol!) The 2u dose might form... 8? And the 3u dose, we'll arbitrarily call that 10. After shooting 1u for the sixth cycle, you'll have 30 chains working. On the seventh cycle, 5 chains are depleted and your 1u dose is adding 5 more, so you'll pretty much be maintaining 30 chains. Now, if we consider the 3 unit dose, by the sixth cycle you'll have 60 chains working. Instead of stabilizing there, though... by the twelfth cycle there'll be 120 chains, and you're left with no idea if the chain count is stable, or if it'll continue to build for another 2 to 3 cycles... or longer In my mind, this is how Tresiba works, and why it's able to keep blood sugar so flat -- there's all these chains, and they're all releasing tiny amounts of insulin at a pretty stable rate. But it also highlights why I'm so afraid if a cat gets into low numbers... Skipping a 3u dose because of low numbers barely makes a dent in the number of chains active Sam bounced once after a skipped dose, and even that bounce was pretty minimal. Again, all of this is strictly my personal speculation. I might be way off base But it's what made the most sense in my mind lol! Of course, there can never be an exact number, and even for Tresiba the breakdown rate will have some variation. Yay! Work that juice, Zeke!
PMPS 321 Back up a little but hopefully now that we are back to twice a day dosing his numbers will start going down.
