2018-04-02 Emmett's Progress - Spreedsheet advice? - AMPS (14.4/259) +1 (18.2/328)

Previous (March 24)

Hey all, haven't posted in a few weeks, Emmett is still rocking along and actually seems to be getting more active and much softer. haha. Anyway, he's still not seeing any greens, but there's a sprinkling of blues in some days. I've just been doing a steady 0.25 iu increase every 6-7 cycles. What are your thoughts? Have I increased too much or should I just continue with what I'm doing?

Current dose is at 3.75 iu (13.8 lbs kitteh) and I believe this will be his 4th cycle at that dose. So from what I've read that's 0.5 iu above recommended starting dose of 3-3.25 iu for a 13.8 lb cat.


@Wendy&Neko
@Stacy & Asia
@Bobbie And Bubba
@carfurby



Rob

 

You’ve been pretty systematic on the increases, I don’t think you’ve skipped over a good dose. If anything, it still looks like some stubborn glucose toxicity to me. I would keep on increasing .25 every 7th cycle so long as the status quo continues and you are seeing a majority of the numbers yellow and pink. Unless you hit your first green, then you’d need to hold for 10 cycles. See if others chime in and agree.

Where did you read that recommended starting dose? For TR, the formula is .25 units per kg of ideal weight. I don’t know Emmett’s ideal weight, but assuming it’s 13.8, that’s 6.26 kg x .25 = starting dose of 1.5 units.

Hopefully he will start working the juice soon. You have been remarkably patient waiting for it, and good on you. I hope the breakthrough dose is just around the corner.

 

it was actually in an article in the FAQ on this site...perhaps it was just their study. I also see the 0.25/kg mentioned a lot.

http://www.felinediabetes.com/glargine.htm

Rob

 

Yes, it's a journal article which includes Jacquie Rand of the Roomp and Rand that published the TR protocol. It looks to me like that study is older than the published TR protocol, but I can't find it in pubmed so who knows. That starting dose is large for most cats (double what we recommend to start), from the typical amounts I've seen that work for cats here. I'm sure they were able to be quite aggressive because they were running an experiment and had some checks in place to closely monitor.

Regardless, the info in the TR sticky at the top of this forum is what we use for dosing guidelines per the TR protocol.

 

I agree with Stacy. You're starting to see some progress. Just keep increasing like you have been.

 

I believe the research looking at using Lantus for cats started out with a higher starting dose, but later went down to 0.25U/kg for safety. We see cats with insulin nees all over the place. What ends up being the breakthrough dose seldom has anything to do with their weight. Just keep increasing methodically, as you have been, until you find the good numbers. If you see a really low blue (under 120), you could hold for 8-10 cycles to see if it leads to anything more.

The good news is that I'm starting to see a little more yellow, a little less pink on the SS. That's progress.

 

Yes, I agree with everything everyone is saying. That is the only place I found the 0.5 iu/kg (which I did think was weird) -- regardless, Emmett started at 1.5 iu...so exactly the dose everyone is saying.

And you mention the more yellow. I'm actually noticing that he seems to be leveling out (if that's a thing with Lantus...which I think it is) ...what I mean is, I'm seeing more consistent numbers (yellow, with some blues) which are not extreme high numbers., still not at the desired level, but overall avg BG levels seem to be trending down. Does that make sense? Is that what others see in the spreadsheet?

R

 

Yes, his high numbers aren't as high as they used to be either.

 

The first iteration of the TR protocol used 0.5u/kg. This was for cats that were hospitalized, though, and they could follow closely. The paper was also authored by Rand and someone else who's name I'm not recalling -- I think Marshall. (Jill/Alex will know if you want the citation.) When TR was being extended to home management, they dropped the starting dose to 0.25u/kg as it is safer. So, everyone is correct!!

I also agree that you're doing everything you should be doing. Slow and steady is good.

 

Hi Rob. Good job at methodically raising his dose as per protocol. He is leveling out some which is a good thing and hopefully he will just keep dropping down into the next color level as you get closer to the break through dose.

The starting dose is the starting dose and doesn't have anything to do with the dose they get to once they start staying in normal numbers.

 

Ok, thank you all. Just wanted to give an update and check in to make sure I wasn't missing something or perhaps not giving him enough time on a dose. As my signature says, all my comments and details (like colour coded date column when I increase the dose is in the World/mmol tab).

Anyway, sounds like I'm good. We'll see how cycle 4-6 go.


Rob