2/25 Oren; AMPS: 451; +3-271; +5-225; +6-190; +7-245; +10-hi; PMPS-hi; pm+5-413;

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damn, I wish he'd go lower, but at least its still the right direction... maybe I should do +6 and +7 ? (another damn failed teststrip!!)
 
rats, that was shortlived. No sign of green for a while (very doubtful he got there M-Tue when I was at work..)
Do I smell a dosage increase? I have a friend who is a vet (out of state) who suggests dosage increases based like this:
1. Increase by 1/2 unit if pre-insulin glucose is >216 AND nadir is >180.
2. Maintain current dose if pre-insulin glucose is <180 - <216 AND nadir is 90-160.
3. Decrease dose by 1/2 unit if pre-insulin glucose is <180. If nadir is <54, decrease by 1 unit.

I think you all work in .25 unit changes; does her plan sound reasonable?

i plan on giving his spreadsheet to MY vet and suspect he'll suggest an increase too, I'll be curious to know what he suggests..
 
I am just going to give you a little of advice about trying to follow several different protocols or taking advice from multiple vets and this group at the same time. DON'T DO IT! I know from personal experience that trying to get input from the vet and follow TRP was making me so CONFLICTED. The vet would tell me one thing and this group and TRP would say another. In the beginning when all you want to do is get those numbers down is to try everything possible. But honestly, the best luck I have had getting Sami's numbers to come down is to follow the advice given on this board by the experts. I can't say how much they have helped me, even when I get a little FREAKED out and don't take their suggestions. Don't torment yourself, stick to one protocol and go with it. Otherwise you will be constantly second guessing, well you still might, but it won't be about whether you should have gone with the advice of someone else.

That is just my personal experienced. Obviously you need to do what is best for you and Oren!

Congratulations on seeing that Blue today, too bad it didn't last long, but I am sure you will see it again soon.
 
Yeah for blue!:cool:

Time to strap on a fetching pair of patience pants and wait. I see fur shots or partial fur shots on the spreadsheet. Yeah, I'm an expert at those too. :rolleyes: Every time you skip or do a fur shot, the cycle count starts over. Here's a post on Counting Cycles. With the possible fur shot on the AM of the 23rd, that makes today cycle number 4. It can take 6 cycles for the depot to get back in shape for us to see what the dose is really doing. Blue after 4 cycles is positive.

I agree with Tina - pick a protocol and stick with it. We use .25U increases and decreases when kitty is seeing nadirs below 300. Cats are sensitive to small changes. Heck, Neko sees a difference with a change of .125 units! Increase by too much and you can go overdose.
 
thanks again all. I wondered how badly I'd messed him up w/ the PFS(partial fur shots). The good/bad news is, more snow coming tonight, so good chance I'll be home tomorrow and can do more testing. (bad news for Oren's ears;)). please send positive energies for my shots all to be true...
 
I'm so stumped. how do we go from yellow and blue to HI in just 3 hrs?! :arghh:
I did feed him a bit of his regular fancy feast food after +7 cuz he was hungry... but it wasn't much
if he'll let me, i want to do more in tonight's cycle...
 
what his zoom back up to HI tells us is that Oren's body has forgotten what normal cat blood sugar range feels like. He probably was diabetic for a while before he got diagnosed - it's not uncommon. It just means that his body thinks that 190 is a disasterously low number and it's quickly responding to get him out of there and back into what it now thinks is normal - 500/high, whatever it is.

The good news is that his body can re-learn to accept normal numbers as normal. the bad news is that it might take some time to have that happen - but he'll get there.

I'm glad to see that blue today, though. Think if you hadn't been here, you'd have gotten the amps 451 this morning and a pmps of HI and never known that he had something lower during the day. It happens. Some cats can go from amps 400 to 40 and back to pmps 400 without blinking. Tricky little squirts! It is definitely possible that he did this very same thing on Monday or Tuesday, too. Are you around anytime mid-cycle tomorrow to get a test in? that'll tell us if he's doing this daily or if his bounces are lasting longer than a day.

With the furshots your count starts over. You want 6 consecutive shots that you're confident got in at any particular dose, then let's re-evaluate the dose and see if he needs an increase. That looks like it's going to be tomorrow night that you could increase if you don't see green numbers before then. Try to focus on the lowest numbers you're seeing instead of the highest.

We see kitties like this all the time - don't despair - it's not unusual at all.

As far as the protocol goes, we use the Tight Regulation Dosing Protocol for diabetic cats that was published by Rand/Roomp in a professional veterinary journal. It is the only dosing protocol that has been published in a professional vet journal - and it is a good one. It's been used on this site for a long time.

The guidelines for increasing the dose are as follows:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Looking at that, once you've got the 6-10 consecutive cycles, if most of the nadirs are under 200, you would increase by 0.25u. If the nadirs are over 300, you would increase by 0.5u. Oren is seeing nadirs less than 200, so I'd go with the 0.25u increase. But don't increase til you've got the 6 consecutive shots in.
 
Thanks Julie; should I always at minimum do amps and pmps? wondering if there's much value in a PMPS tonight, and instead, trying to get a few later this evening? I'm pretty much anticipating being home tomorrow due to snowstorm, and thus hoping to get midday tests in as well. (please let me be sure handed tonight and tomorrow w/ the injections! )
 
We always encourage people to get a preshot, just in case there are any surprises. you want to know what you're shooting. Then i'd get only 1 test again tonight, just before you go to bed.

Tomorrow I'd get amps, then repeat something similar to what you did today.

ya just do the best you can. everyone has some furshots!
 
thought just occurred; i don't have syringes marked w/ .25 or .5 markings, only full units. if i need to increase tomorrow night, can anyone offer advice on best way to eyeball this? I probably won't be able to get out to get different syringes tomorrow due to weather... (crap)
 
You may be in luck. Take a look at the Tight Regulation Protocol Sticky, at the bottom there is an article attached called Management of Diabetic Cats. On the 5th page of that document, there is a discussion on administering small doses, and a link to a document you can download with rulers, just for the BD U100 insulin syringes with the BD Ultra-Fine™ Needle 0.3 ml. Or, one of the Australians may have some input, as all they have is 1U marked syringes. @purrdydolly (Serryn) may be able to help.
 
julie & punkin (ga) said:
As far as the protocol goes, we use the Tight Regulation Dosing Protocol for diabetic cats that was published by Rand/Roomp in a professional veterinary journal. It is the only dosing protocol that has been published in a professional vet journal - and it is a good one. It's been used on this site for a long time.
Click to expand...
Whoa! On the FDMB and in this group we use and promote two dosing protocols for use with Lantus or Levemir: the Tight Regulation Protocol as well as the Start Low, Go Slow Method (SLGS). We offer both options to our members.


julie & punkin (ga) said:
he guidelines for increasing the dose are as follows:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Looking at that, once you've got the 6-10 consecutive cycles, if most of the nadirs are under 200, you would increase by 0.25u. If the nadirs are over 300, you would increase by 0.5u.
Click to expand...
Julie copied and pasted the suggested guidelines for increasing the dose when following the Tight Regulation Protocol.



If you have chosen to follow the Start Low, Go Slow Method, here are the suggested guidelines:

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


Just wanted to clarify the dosing options currently supported on the FDMB for Lantus and Levemir users.

Initially, it makes things easier for caregivers to stick with a chosen protocol or method at least until the caregiver gets a good feel for their kitty's response to the insulin used.
Wishing you the best Megan and Oren!
 
thanks Jill (and hello!). I was aware of the two protocols actually (certainly haven't memorized them yet!!) and to be quite honest, I am a bit intimidated by both in the sense of my ability to stay w/ the strict testing guidelines required by either over time. I completely understand the suggestions of choosing either one or the other OR to go w/ my vets suggestions, and not mixing matching. I guess my problem is my confidence level in working such a tight edge. I am single and have no other help at home, travel fairly regularly and work a full time job. I'm not sure which is going to be right for me at this point. I have a fear of not being sure what to do, coming here and posting a question and not getting an answer in a timeframe that works for me (and of course, ultimately, Oren). Again, meaning NO disrespect to all the amazing folks here... I know everyone is busy, but I'm aware lots of folks are all over the country (and world even!) so timezones can cause problems. I will just have to try and do my best.
The advice and support in the early stages to just get me able to even DO successful home testing has been invaluable. I guess the rest will fall into place as well.
 
Hi there! You're right. Becoming comfortable with all this is important. It takes time to get organized... the figuring out how one can fit everything in when you're the sole caregiver... holding a job, juggling responsibilities, and still have a life! All I can tell you is it does get easier.

I was hoping you had seen both dosing methods described in the Stickies at the top of the forum, but I wasn't sure so I wanted to let you know there's more than one option supported in this group.

Actually, I think you'll find the guidelines described in the Start Low, Go Slow Method (SLGS) are better suited for those who want to take things a little slower for one reason or another. Whenever you're ready, you might want to take a look at it, show the method to your vet, and discuss it with him/her. It's a method created years ago by FDMB members (before practicing tight regulation was widely accepted on the FDMB) and it's worked well for many kitties. Many of our members start out with SLGS and then switch over to the TR Protocol at some point. After all, there's more than one path to regulation and possibly going OTJ! :)

*Usually* someone is around to answer questions, but if you ever need an immediate answer and you're not getting one here... please cross-post on Feline Health - The Main Forum.


Hope to see you posting often! :D
 
Hi Megan

Serryn here, the same Serryn as Vyktor's Mum, there isn't two of us, Purrdy is my mum's cat. We can't get syringes with half units measured here and to start off with mum didn't think she'd be able to manage the .25 measurements but she has found that it's not as daunting as it seemed. She does use a magnifier but I don't need to, depends how good your close vision is.

The important thing with Lantus dosing is to be as consistent as possible. So if your .25 measurement is slightly different to mine that's ok as long as you're consistent with the dose you give. The best way to do that (unless you're using callipers) is to have a sample syringe done up using coloured water that you can compare to your dose each time.

The physical descriptions of the .25 increment dosing as I do it using BD syringes are as follows (where I refer to the front or back of the first part of the plunger I am referring to that first thick black part at the end of the plunger):

.25 - the front of the first part of the plunger is just behind the back of the dose line so you can see a tiny sliver of clear after the back of the dose line - tiny sliver

.50 - the back end of the first part of the plunger is level with the side of the next dose line that is closest to the needle end of the syringe

.75 - the back end of the first part of the plunger is level with the side of the next dose line that is furtherest away from the needle end of the syringe.

Hope that helps. Because we are dealing in such small doses with cats changes in .25 increments are really important to make sure that you don't sail straight past the right dose for the cat.
 
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