7/1 R.'s AMPS 328, Dosecrease

After 7 x 1U doses, we are still seeing mid- to high pinks with very few yellows. Come on, depot!

Hind leg neuropathy, which was nonexistent about 4 weeks ago (and led to DX), is still showing, so we're going to 1.5U doses as of this morning. R. was pretty peppy this morning. We're hoping the dosecrease will start nudging him in the right direction. We're expecting we may have to bump to 2U by 7/4 given the lack of movement. We're going to likely do a full curve on the holiday, as soon as we start seeing some action!

Sage opinions welcome!

 

+4 at 309... It'd be nice to see a yellow today, but that seems unrealistic given how stubborn the levels are in the pinks.

 

I am sorry R is stuck in the pink. When I started this dance, my girl LOVED pink. We normally do dose increases in .25u increments. Since you went up to 1.5u, I would stick with that for at least 6 cycles and then re evaluate. If you are following the TR protocol, you will hold the dose for 6 cycles and then decide what to do. If you are following SLGS, you will hold the dose for 7 days and then decide.

link for TR protocol

link for SLGS protocol

Once you have decided which protocol you are using, please put it in your signature line. This will help others give you dosing advise.

 

Oh, also just as an administrative function, we put the last post link in our posts so people can follow what is going on. Here is your post from yesterday...

6/30

 

Thanks for the advice, Osha!

We're following TR, as best we can. We increased the dose .5 based on these parts of the TR post: "Kitties experiencing high flat curves ... may want to increase the starting dose after 3 days" and also "After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit." We're worried that we started at too low of a dose to begin with (1U BID) based on the dosing table in Roomp & Rand's 2013 Management of Diabetic Cats with Long-acting Insulin, which indicates "Begin with 0.5 IU/kg [BID] if the blood glucose is >360 mg/dL (>20 mmol/L)." So, we're hoping we can gradually move him up until we can start seeing some yellows, at a minimum.

 

Initial doses are held 5-7 days to build the depot. You went up a little soon. It's hard to do, but you really have to learn to be patient. Not my strong suit. With seeing some yellow, you would have gone up by 0.25 units, not 0.5, according to TR. high flat cycles means red and pink, not pink and yellow. Our starting dose formula is 0.25 units per kilogram, which ends up at 1.0 units for a lot of kitties.

Hmm, read your last post. I see Sienne already mentioned that P word. Regulation cannot be rushed. TR is already aggressive but safe. You will get their safely following the guidelines in our TR protocol Sticky Note.