? 7/11 Frankie PMPS 446 +8 124 +9 104 +10 88 AMPS 83

http://www.felinediabetes.com/FDMB/threads/7-10-frankie-amps-437-6-405-pmps-378-5-360-9-367.140775/

Frankie has been bouncing high and flat for 3 cycles now, this morning's will be the 4th. It is also his 6th cycle on 3.75 units and the lowest nadir was 220 which was actually a PMPS reading. Should I increase tonight as per TR or wait for this bounce to clear first?

 

Seems like his bouncing is getting worse!!

 

Sue, I don't do dosing advice, but I have a couple of questions. What was Frankie's starting dose? As counter-intuitive as it is, I have seen several people discussing that too much insulin can look like not enough, ie high numbers. What I'm noticing is almost every time you have reduced, you are getting some greens within a couple of days. Maybe somebody more experienced than me can take a look at it and give their thoughts?

 

He started off on 3 units. That was after being on Caninsulin for a year. He started that on .5 units, going up to 8 units twice a day before switching to Lantus.

 

No-one gave me any advice, so I shot 3.75 as usual tonight.

 

I think I asked this the other day and I apologize because I can't remember the answer....how old is Frankie's insulin?

I am inclined to say he's ready for another increase.....

 

It's only 3.5 months old. I just got another prescription from the vet though, so I will be starting a new bottle at some point next week.

 

Actually 3.5 months might be a bit borderline....it's possible that it could be petering out a bit. If you were able to start a new vial in the next day or so, I might be inclined to hold the dose, but if it could be as long as a week before you start the new vial, I would increase him sooner rather than later. I always prefer to make only one change at a time - ie, don't increase AND change the vial on the same cycle.

 

Well, the chemists are shut tomorrow. The earliest I could get one is Monday evening but he is coming down a bit now. I will see how it goes. If I can't get to a chemist on Monday it will have to be Wednesday as Frankie has a check up Tuesday. If he doesn't go much lower overnight I will increase tomorrow otherwise stay the same and start the new vial later in the week. Thanks for your help.

 

I agree with Amy, if you don't see normal numbers overnight, I'd increase in the morning. I also like to separate new insulin from new dose by a cycle. Can you get cartridges there instead of vials? Lantus in cartridges is a bit more effective. You can use each one to the end.

For what it's worth, the dose dosen't look like it's too much insulin to me. We take the dose of the previous insulin into consideration when switching to Lantus and he got higher on Caninsulin.

 

You can get the pens here but the prescription I have is for the vial. I will try the pens next time.

 

Well, it's not the insulin, it was just a pesky bounce. At pm +8 he is 6.9 (124). No increase for him! The one thing I can't get my head around is how he is supposed to get used to normal numbers when he spends just hours in them before bouncing for nigh on three days? Anyone know?

 

You've got room for an increase with that nadir. The goal is to get him a little lower overall. A little extra insulin can help flatten them out and reduce the height of the bounces. But you can wait a few more cycles to see if he repeats the lower number before increasing. From the TR protocol:

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.

 

@Wendy&Neko can I ask what is probably a dumb question? Why do we want him to get lower when this is (just) in the normal range for a non-diabetic cat?

 

Plus the protocol says that if my cat is new to nadirs under 200 to hold for 8-10 cycles. Would you class Frankie as new to nadirs of 200? He has only been reaching them occasionally for a few months.

 

Because he's not very long in the normal range for a cat. We want to try to get him regulated. The goal is to maximize the time in normal numbers, or at least below renal threshold, without him getting so low that he earns a reduction.

New to blue means the first couple of times when you are first increasing up the dosing scale. Frankie is no longer new.

 

Ok that makes sense. He is still going down. +9 and he is 5.8 (104)

What is the renal threshold level figure?

 

Renal threshold depends on the cat, but I've seen reference to around low 200's on the human meter.

Nothing like a dosecrease threat to make a cat go down.

 

Would I still increase if he is still going down? What about shooting? He Is due in 1.5 hours.

 

Let's see where he's at in 1.5 hours, but as long as you have all the supplies you need, I'd probably go ahead and increase.....just plan on getting a +1 and +2 to see how he's doing

Hopefully you'll get some other opinions too

 

+10 he is 88 (4.9)

 

AMPS is 83 (4.6). do I increase?

 

Since he's still dropping, and now he's into green, I'd probably just give the 3.75 tonight, and plan on getting those +1 and +2 tests to see what he plans on doing

 

Ok. Thanks.