12/27 Henry AMPS 144, +6 82, PMPS 96, +2 91, dose question

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ramonaghan

ramonaghan

Member Since 2014
Yesterday's condo

Wondering if we should bump Henry back up to .5u. His numbers have been nice and safe at .25u, which my sleep schedule appreciates, but I miss all those lovely greens! I'm sick and my husband is leaving town for a couple of days, so I won't likely make a change til Monday when he's back, but what do y'all think? Stay the course at .25u or increase back to .5u?

ETA: One point in favor of the .25u is that he actually seems more energetic in the blues than he was at the greens. We've had some major zoomie sessions the past couple of days. Any idea why that would be?
 
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Maybe split the difference and go with a fatter 0.25?
Every cat is different, so if it works better for him, go for it.
 
Are all of your tests now on an AlphaTrack? If so, the cut offs for dose reductions are different than on a human meter. Depending on whether you're looking at the old guidelines (i.e., below an 80 gets a reduction since the AT runs about 30 points higher than a human meter so below an 80 is equivalent to below 50) or the newer guidelines where 63 is the cut-point for a dose reduction, Henry is in good numbers. For example, using the newer guidelines, your AMPS is around a 106 on a human meter. Numbers below a 134 on an AT are green based on the guidelines.

The color coding on the SS is set-up for human meters so it's a bit deceiving. That said, I would encourage you to get some additional tests at night when you're seeing a number like the 104 at +2 last night. Henry might have dropped even lower. In other words, if these are AT readings, I would hold the dose.
 
I agree with Sienne. If you're using an Alpha Trak, I would hold the dose for a bit.
 
BJM said:
Maybe split the difference and go with a fatter 0.25?
Every cat is different, so if it works better for him, go for it.
Click to expand...

I suspect calipers are in my future!

Sienne and Gabby said:
Are all of your tests now on an AlphaTrack? If so, the cut offs for dose reductions are different than on a human meter. Depending on whether you're looking at the old guidelines (i.e., below an 80 gets a reduction since the AT runs about 30 points higher than a human meter so below an 80 is equivalent to below 50) or the newer guidelines where 63 is the cut-point for a dose reduction, Henry is in good numbers. For example, using the newer guidelines, your AMPS is around a 106 on a human meter. Numbers below a 134 on an AT are green based on the guidelines.

The color coding on the SS is set-up for human meters so it's a bit deceiving. That said, I would encourage you to get some additional tests at night when you're seeing a number like the 104 at +2 last night. Henry might have dropped even lower. In other words, if these are AT readings, I would hold the dose.
Click to expand...

Dyana said:
I agree with Sienne. If you're using an Alpha Trak, I would hold the dose for a bit.
Click to expand...

Yes, all tests as of Dec 18 are AlphaTrak (cha-ching! :eek:). I have been following the newer guidelines with 68 as the dose reduction point (from here). So he seems pretty regulated at the current dose, but if our goal is OTJ (which our vet has already given us the go-ahead to try, but I don't think he's there yet), am I just waiting for him to drop under 68 to reduce to .1u regardless of some of the higher blue numbers (177, 189) we're occasionally getting? I know dose changes are based on nadir, but aren't those numbers a bit high if we're aiming for OTJ? What AlphaTrak numbers am I looking for eventually to know he's ready for an OTJ trial?

Sorry for all the questions. I seem to have confused things by using an AT! I will get some mid-cycle PM tests ASAP but need to kick this cold first (worst Christmas present ever from my sister).
 
Fundamentally, the longer that Henry spends in normal numbers while on insulin, the longer you're giving his pancreas support during the healing process. I wouldn't want to hurry down the dose ladder unless Henry tells you to. He's still throwing you some slightly higher than desirable numbers but his numbers are largely in the normal range and that's exactly what you're looking for. If you read the wording in the TR protocol closely, it doesn't say that every, single number needs to be in the normal range. The protocol gives you some bandwidth for an occasional number to be outside of that range. So, for now, remember that above all, Lantus teaches us to be patient. Henry is moving in exactly the right direction.

What I said earlier I think answers your question about what numbers on an AT to look for to know if Henry is ready for an OTJ trial:
Sienne & Gabby said:
Numbers below a 134 on an AT are green based on the guidelines.
Click to expand...
Either Henry will get a dose reduction by dropping below 68 once he's at a 0.1u dose or he will spend a week in normal numbers at that dose. That's when you'll know he's ready.
 
Sienne and Gabby said:
Fundamentally, the longer that Henry spends in normal numbers while on insulin, the longer you're giving his pancreas support during the healing process. I wouldn't want to hurry down the dose ladder unless Henry tells you to. He's still throwing you some slightly higher than desirable numbers but his numbers are largely in the normal range and that's exactly what you're looking for. If you read the wording in the TR protocol closely, it doesn't say that every, single number needs to be in the normal range. The protocol gives you some bandwidth for an occasional number to be outside of that range. So, for now, remember that above all, Lantus teaches us to be patient. Henry is moving in exactly the right direction.

What I said earlier I think answers your question about what numbers on an AT to look for to know if Henry is ready for an OTJ trial:

Either Henry will get a dose reduction by dropping below 68 once he's at a 0.1u dose or he will spend a week in normal numbers at that dose. That's when you'll know he's ready.
Click to expand...

Gotcha. Thank you!
 
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