6/21 Turner (alphatrack) AMPS: 235, +2: 254, +4:199, +6:211

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A couple days ago we had a very low preshot number, so we skipped a dose and then reduced. Still seeing some pretty low numbers at the new dose, but not having done a reduction before, I'm not sure if we should give it a bit more time so that the depot can drain or go ahead and reduce again. Didn't get below the 68 alphatrack threshold last night, but were darn close.

 

One of the requirements of TR is that you get at least 1 mid cycle test during AM & PM. If you are unable to do so than SLGS is the safer option which means you reduce below 90. If you can get the mid cycle tests in than I'd hold the dose but if not than he should be reduced by .25 for safety.

 

I can't get a mid cycle on Mondays. Mon and Wed are the really hard days as both myself and my husband are away all day. But today's Tuesday! I work from home on Tuesdays and can test all day long

 

Maybe it is time to switch to the SLGS protocol. Getting those mid cycle tests consistently is hard. And we're not very good at it

 

Hope Turner has a good day

 

Went ahead with the 6. It appears that he's bouncing. Not sure if it's the same going down as going up with bounces, but my gut is telling me to see if it clears before deciding anything on dose?

 

It does look like he's bouncing and could take 6 cycles to clear. Regardless if it were me and I couldn't monitor regularly with mid cycle tests I'd move to SLGS and take reductions at 90. If you aren't able to catch those lower numbers, it can create high numbers and the temptation would be to increase when he may need a decrease. I think you are fine with shooting 6u today but would reduce at PMPS especially with the size depot you are dealing with. Does this make sense?

 

Yep. I'll have to go read the SLGS sticky. But, I'm guessing take a reduction any time you see a 90 regardless of how long they've been on the dose?

 

Yes, that is correct and you also hold the dose for 7 days before increasing.

Here are the main guidelines but it's good to read the Sticky SLGS

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit

• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose

• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit