? Yum: Dose increments at higher doses

Yum is at 5 units with pink nadirs.
I will probably increase her dose tomorrow morning after 4 cycles.
I am debating increasing by .5 units or 1 unit. If people are advised to increase by a quarter unit at 1 unit, a quarter of 5 units is greater than 1 unit.

So is 5 units big enough to merit a 1 unit increase?

I know I will probably be told to wait and do the increase after 6 cycles, but I need to get her back into safe territory. I did read the sticky on the depot just now. It does say depot effects can be more dramatic at higher doses. I need to read that sticky a few more times. Of course, mostly she has smooth curves. She has just been too high for too long.

I will probably have her tested for IAA and Acro next week. I want her to go 14 days at least between blood draws. @Marje and Gracie . @Wendy&Neko
(I don't really know how to tag people. Maybe that didn't work.)

I also read the sticky on early and late doses just now, as I was thinking about her numbers while she was boarded at the vet over Christmas and when she first came home last Wednesday. I guess those yellows and blues were due to early doses. I think the clinic probably dosed her at least 2 hours early in the evenings. I dosed her an hour early for her first 2 shots at home. Since I stopped early dosing she hasn't seen yellow.
Kind of makes me want to shoot her at an 11 hour interval, but I know that isn't how it works. Is it?

 

Take a deep breath and slow down. I know you are anxious about Yum's numbers, but patience is required.

Over 5 units, we suggest 0.5 unit increases, which is what you have already been doing. But I want to stress one thing - you really need to be getting data each and every cycle, especially since you've been fast tracking and increasing sooner than 6 cycles apart. I see no tests last night. You held 4.5 units after boarding for only 4 cycles with only test data on 3 cycles. Given that she got down to 100 at boarding (for whatever reason), caution is required. I would hold this dose for 6 cycles and get 6 cycles worth of data before increasing, if needed. Until you have a diagnosis of a high dose condition, moving faster may be dangerous.

We wait until the total dose is 10 units before increasing by 1 unit. Please don't increase by more than 0.5 units at this point in time. She had low yellows/almost blue at 4 units at home last week.

I got your tag - waiting for the tests is fine. I can understand wanting to have time between blood draws.

Could you modify your spreadsheet to help us easily see when you shot early. In the PS column when you shot at +11, put the BG # and "@+11" so we can see when you shot early. I can't easily tell from the Remarks if it was AM or PM you shot early, and that part isn't in view when I look at the SS numbers. Yes, there are times when people can shoot ONE TIME ONLY an hour early, if the numbers are high enough to justify it. It's not something you want to do long term. Besides being hard on the caregiver, it's better just to get to a good dose with other tools. Don't muddy the waters on us trying to figure out what a good dose is for her. And shooting one hour early might not have gotten her down to low yellows.

 

It's painful for me to look at her SS. This has been going on for more than a month. Granted pinks are better than blacks.

Okay. My next increase will only be .5 units. I am still contemplating holding just the 4 cycles, following Tilly's "2-3 days" recommendation on her diabetes homepage. I know Yum's numbers pretty well: she never (so far) has lows in the evening/night. I will test her this evening, but I am sure she will be on her way up. Maybe it is because she is less active at night. Maybe it is because she has her bowel movements a bit before AMPS. Whatever the reason, I feel pretty lucky about her not going low at night (so far).

I thought she was going low at night at the vet, but probably that was not the case. She had her blues there at PMPS. Her PMPS was probably always 10 hours or less after her AMPS. I was thinking that would cause a low overnight or in the morning, but the TR sticky says "Oftentimes the effects of an early or late shot will not be seen until the next cycle.". Now those boarding numbers make sense to me. Maybe.

Okay. I will do that. My notes always start with her water intake in ounces, her AM shot time, and her PM shot time. Sometimes I forget to enter the PM shot time.

Thank you so much for your comments.

 

The holding 2-3 days on Tilley's page is if nadirs are over 300. You saw some 200's on a lower dose. When we fast track kitties, we slow down to 6 cycles one they start seeing yellow.

Never assume what a cat will do overnight. They are masters at surprising us. And without those night time numbers, it just isn't safe to increase faster.

 

Point taken. Still, I do think the 200's were due to early shots. And I won't count the 299. Of course I should also factor in my AT2 meter.

 

Definitely!

 

Just getting here today on the board but I see Wendy has given you some very astute advice. If Yum does have acro or IAA, you might see her SS looking like this for a while so it’s really important to don those patience pants and not chase the numbers. Chasing numbers will only get you into trouble.

We can work hard to “know our cats” and their patterns. But my position is to never assume they will not do something just because they never have.

A long term member, who started here not long after Mike, Gracie, and I did had her cat very well regulated; she knew him and he’d been doing stellar on the same dose for a very long time. He was getting nice nadirs but not too low. She came home one day from work and found him in a severe hypo. He was still breathing but non responsive. They got him to the ER and on a drip to bring his BG up. They were able to take him home but he went downhill and they couldn’t save him. Moral of the story: don’t assume things can’t change.

 

I remember Tarragon went hypo out of nowhere last summer and passed. I think about it often.

 

Yes...that’s who it was