3/5 Oren; amps-221;+2-297;+5-321;+7-308;+10-394;PMPS-516

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so I don't get it, his low point today was AMPS-221. but at PM+5 last night he was still 411. doesn't that suggest b/n then and AMPS he went even lower than 221? How often would nadir be at AMPS? then look at PMPS today, zooming back up.

i guess i may have to try and stay up or get up late tonight to get a plus 6 or 7 or 8?
 
It's possible he got somewhat lower, but because of how high he was at pm+5/411, I don't think he got much lower than the amps/221.

Cats can and do nadir at any point in the cycle. When there is a bounce cycle, it completely wipes out the normal Lantus cycle. A bounce can clear at any point in the day/night. I think what you were seeing last night was a clearing of a bounce that landed Oren somewhere around 200.

According to the SLGS you don't change the dose more than about once a week. That's one of the significant differences between it and the Tight Reg Protocol, which has you adjusting doses as early as every 3 days.

Here's the part that I think would apply to you right now:

Starting Dose
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
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
  • As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). 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.
Lather, Rinse, and Repeat!
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You've just got 9 shots at this dose, and yesterday your note says it might have been a furshot. Furshots start the count over again, unfortunately. In Oren's case, I keep looking at that little blue 190 on 2/25, after an ugly red amps and an uglier black pmps - that one test tells us that Oren is capable of zooming down and up in a very short amount of time. Rather than increasing without giving it enough time, I'd keep the dose for the moment and give it a full week, then do an 18 hr curve (I only suggest that because I think those pm cycle tests are so incredibly important - so many cats have their low numbers at night.)
 
Julie; sorry to be a bit obtuse; but do you mean keep it 2 more days for a full week, or restart the count from the missed fur shot for a full week. Oh my god, you have no idea how much i hate that i did that...
 
You're not obtuse - i wasn't very clear. If you really think you gave a furshot yesterday, then your count starts over and you hold the dose for one week.

everyone does furshots - it just happens. I read your notes about the possible furshot - some people do great with that skin roll, some don't. I pulled up a big tent and put the needle in closer to the body with plenty of "tent" above and didn't have too many furshots.

One time I helped a person (at her house) who was having a hard time with her shooting and discovered she was using the roll method, but the needle was so close under the surface you could see the needle outline under the skin. She was having lots of trouble with furshots. It's whatever works for you, but it sounds like you're pretty sure some didn't get in. It's not the end of the world, but it's better to be safe than sorry.

If you're anxious to increase the dose faster than once a week, you can switch to the Tight Reg Protocol. People do work full time and still follow it, so it's possible for you if that's what you want to do. The minimum testing for TRP is 3x per day - both preshots and at least one mid-cycle test, which most people who work full time get at night. You're already testing that much. But it's totally up to you, i'm just picking up from your posts that you'd like to be adjusting the dose more often than once a week.
 
thanks Julie; well, i am anxious to get him feeling better mostly! I understand one doesn't want to 'shoot past the dose' that works (in either protocol), but i feel like he's just not reliably getting into lower numbers even with this increase from 2. I don't know WHY i tried the other method, when it seemed i had finally gotten fairly stable w/ the tent method. so disappointing.
My vet actually wanted me to go from 2 to 2.5, and I talked him into letting me try the 2.25. Now I'm wondering if he'll be smug towards me about it... and am i making Oren suffer by keeping him in higher numbers for another week if an increase might help? These are just the things running through my head, I certainly don't have enough experience yet to have a good feel for all this. as for the protocols, yes, so far I'm doing a fair bit of testing, i just have a feeling that it might be harder to maintain as the winter finally breaks and I'm not 'homebound' as much (aside from work).

And, I'm not quite sure I understand why the count has to start completely over, doesn't the 'depot' mitigate somewhat, considering that I had gotten 7 good shots at the new dose before the fur shot, and now another 3? Just trying to understand it all..
 
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I understand completely - of course you want him to feel better! One option might be to follow the TRP at this stage, when you're home and available, and switch to SLGS later. Nothing is locked in. It is important to be confident about how low a cat is getting on a dose before increasing the dose. A cat that's overdosed can have a spreadsheet that looks very much like a cat that doesn't have enough insulin, so it's super important to be pretty confident about how low the cat might be getting on a given dose before increasing the dose.

You've got good questions about the count post-fur-shot. Here is a post Jill wrote about "should I increase the dose?" and another one on "Counting Cycles."

 
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