01/13 Apple PMPS 399 - When to stop increasing with TR

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Caren & Apple, Jan 13, 2020 at 5:07 PM.

  1. Caren & Apple

    Caren & Apple Member

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    Oct 15, 2019
    Previous post: http://www.felinediabetes.com/FDMB/...-blue-numbers-after-amps.224176/#post-2507773

    We've gone up 3 times so far, and we haven't gotten any greens. I'm assuming you hold the dose once he gets below 100?

    Edit: I was reading the SLGS protocol and saw this: "Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose." This seems to contradict the idea of TR.

    -Avery
     
    Last edited: Jan 13, 2020 at 6:25 PM
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  2. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Now that nadirs are under 200 you can hold the dose from 8-10 cycles. Once under 100 the same applies unless a reduction is earned from dropping under 50. I would read the dosing guidelines again. When new I read them often. I tended to wait too long too increase at the beginning. I had to be gently reminded because my vet was too conservative.
     
  3. Caren & Apple

    Caren & Apple Member

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    Oct 15, 2019
    Ok, we'll hold the dose then. We were just wondering because of the inconsistency in numbers, the nadirs being in the 100's then jumping to 300's.
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    That’s likely bouncing from going lower than he’s used to. If you don’t see blue after a couple cycles you can always increase but I’d see what happens if he were mine. .
     
  5. Caren & Apple

    Caren & Apple Member

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    We totally agree. Thanks for the reply!
     
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    @tiffmaxee

    I'm going to muddy the waters. Nadirs are not generally in the 200s or below and Apple isn't really "new" to numbers in that range. I'd keep increasing until you are seeing more consistency with regard to lower nadirs.

    As to your question, you keep increasing until you're seeing normal range numbers. Apple isn't on a particularly high dose of insulin so I wouldn't be concerned about increasing. I do think if you're going to follow TR, you do need to evaluate the dose every 3 days/6 cycles and not hold a dose overly long.
     
  7. Caren & Apple

    Caren & Apple Member

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    Oct 15, 2019
    Sorry I didn't see your reply earlier and respond.
    I was hoping you would see the post along with Sonia and Leo. Let me ask you this because reading information here and on the Facebook page associated, 2 units twice a day has been mentioned as being high and higher doses can cause higher BG #'s. that's why we questioned the continued increase. Along with the info we quoted from the SLGS protocol that states, paraphrased, that rushing the dose you'll miss the optimum dose with increases, I guess we should, at this point, ask what is considered a high dose?
    His next shot isn't until 6:00 p.m.est, we have time to wait.
    I should also take this opportunity to thank tiffmaxee for her input, I know this isn't a precise science and all replies are greatly appreciated, however they differ.
     
    Last edited: Jan 14, 2020 at 10:34 AM
    Reason for edit: addl info
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  8. tiffmaxee

    tiffmaxee Well-Known Member

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    Two units is not a high dose. Don’t quote me on this as I’m going from memory that 6 units is when we start to consider high dose and testing for the cause. Sometimes you just have to keep going up until you hit the magic dose that gets your cat in normal numbers of 50-120. There’s veterinary literature supporting TR. SLGS was added for those who feed dry food or can’t monitor closely enough for TR. It’s not as aggressive. That’s my two cents FWIW but others may disagree.
     
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  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    I agree - 2u is not a high dose.

    Please, do not the information on the FB group is accurate. There are only a handful of experienced people, let alone experineced Lantus users that spend time on the FB group. Generally, the people who are responding are new to FD, have a limited understanding of how a depot insulin works, don't look at your spreadsheet, don't have a spreadsheet for you to look at in order to gauge if their advice has merit, and don't have a means of keeping a history of your cat. Dosing advice is not allowed on the FB group for all of those reasons and probably more reasons that I'm not thinking of. If people are dispenseing advice, a moderator hasn't caught it.
     
  10. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    At the risk of offending some, the Facebook associated with FDMB is NOT the best place to be getting advice. I see many people on the FB FDMB that are unfamiliar and really shouldn't be giving advice. I may sound harsh, but it's like the blind leading the blind. Please for the sake of Apple and possibly your sanity - listen to the advice from this forum - there are far more experienced people here - ie Sienne and Gabby and tiffamaxee (above) - just to name a few - than there are on the FB pages - not to disparage Chris who is a godsend there - but she can't prevent others from advising when in fact they are in no position to do so.
     
  11. Caren & Apple

    Caren & Apple Member

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    Warning taken, thank you.
     
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  12. Caren & Apple

    Caren & Apple Member

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    Done and done. It's a sensory overload as it is.
     
  13. Caren & Apple

    Caren & Apple Member

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    Oct 15, 2019
    Great answer, I must have missed the hard food reference.
     
  14. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

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    Counts as 2;)
    2 units BID (twice daily)
     
  15. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    Yes, 2 units twice a day - in the am and pm you should give the same dosage - unless of course a reduction or increase has been recommended.
     
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  16. Sue and Luci

    Sue and Luci Well-Known Member

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    Oops...looks like we posted at the same time...sorry I didn't see your reply before hitting the button :)
     
  17. Caren & Apple

    Caren & Apple Member

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  18. Caren & Apple

    Caren & Apple Member

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    Oct 15, 2019
    Just got our first green, 96, +5. He's been steadily going down from last night. Is testing every 2 hours enough?
     
  19. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

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    Jul 24, 2019
    Very nice day for Apple!!
    This might be close to the lower part of the cycle, but I'd be curious to see a + 6
    When was his last snack, or will the next one be?
    To get more eyes, you could start a new thread. 1/15 Apple AMPS 114, +3 101 +5 96, and link this thread at the top of the new one.
    Congrats on the green!!

    Are you available to check all day? If not, leaving food out is always an option.
     
    Last edited: Jan 15, 2020 at 10:52 AM
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  20. Caren & Apple

    Caren & Apple Member

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    Hi There...I just did a +7 and it was 91. I'm home all day so no problem there. He's eating after every test with one treat. Just wondering at this point where we are getting results I should be more vigilant. Thank you for replying
     
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  21. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

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    Jul 24, 2019
    This is a beautiful flat cycle, just the way Lantus is supposed to work! It looks like you are safe to get a +9, then +11 or PMPS. Much like you were thinking and/or planning. I'm curious whether Apple keeps inching down . . . especially as PMPS arrives.

    Apple loves this dose so far; I hope these great numbers don't cause a bounce back up - paws crossed no!

    You are doing great . . . just right so far from what I see. Can you remind me of Apple's eating routine?
     
    Last edited: Jan 15, 2020 at 12:27 PM
  22. Caren & Apple

    Caren & Apple Member

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    Oct 15, 2019
    That's what I'm wondering too..I thought he would be inching up at the +5 and then with the +7 still going down. We'll get a +9 and of course preshot. I can't help but worry that his next shot, having more Lantus in his system, will bring even lower numbers. Apple is a free feeder, which means he jumps on my desk he eats, or pats my face when I'm asleep, he eats. When the teenager gets home at +9, I'll have him post this in a new thread and we can both see the replies :)
     
  23. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    He’s surfing nicely. Just keep posting as he’s guiding the ship right now and we can’t predict where he will be at PMPS.
     
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