Need Advice! Zoot! Vet recommends doubling dosage

Zoot! has been in red and yellow consistently for the past week and I showed my vet his chart. Today he has been AMPS=297, +5=325, +7=281 . Our Vet is out of the office till Friday but her staff told me she recommends increasing his dosage from 1 U 2 times a day to 2 Units 2 times a day.

Given all I have see on this site, I am nervous about taking that advice. His numbers are in the high 200s most of the time with low 300s occasionally. Can someone here help me think through what might be the right steps to take until we see the Vet on Friday?

 

I strongly suggest that you read the yellow stickies TR and SLGS. I wonder never double the dose. You just might miss the right dose and never know it. His beginning dose was low for his weight so I might consider a .5 increase rather than the .25 will usually do unless approaching a high dose. @Bobbie And Bubba what do you think?

 

Absolutely - Thank you so much for weighing in on this - I read the stickies and that is precisely what has given me pause. I got half unit syringes today, and I am comfortable doing a half unit increase but agree not the full amount. I was debating whether to change at all - I don't want to disregard her directions but I feel like she is giving me the standard Vet recommendation, which I question. Thanks and I will wait to see what others say before I make a final decision. The last thing I want is him to be hypo.

 

Here is the link to your previous post here: http://www.felinediabetes.com/FDMB/...nd-understanding-glucose-measurements.215794/ We included those links to give people history of what has happened before and what people might have suggested in the past.

As I suggested before, since you did see a blue on this dose (198 on the 13th), I would only increase by 0.25 units. He does need an increase, but you don't want to go too fast. Cats can respond to small changes in dose. I also suggest that you read the Sticky Note on Dosing methods, and decide which one you want to follow and which suits your lifestyle. Both of the dosing methods listed would only have you increase by 0.25 units at this point, regardless of size of starting dose.

 

True we did have one blue reading. I will only increase .25 U.

As for TR or SLGS, I am still uncertain what might work - maybe TR - I have a hard time understanding the differences. With both, I am past the starting dose phase but I have all the prerequisites done. He is on wet food (Purina DM - we switched before I joined this group and I don't want to change now as he has already adjusted). Since we are down the road a ways, do I just ignore the initial phases for both and only focus on the testing/dosing procedures?

 

Hi. I'm like Cinnie...week 1 of Lantus. I'm just trying to understand the recommendation for 0.25 because of the one blue BG & only because that blue BG was only after 4 doses of Lantus which takes time to build? Appreciate any insight!

 

I think since Zoot! is new to insulin and did pop a blue number on the 13th, I would only increase by .25. Also, another thing to consider is that he is presently on an AB for a urinary tract infection. You might start to see his number coming down once the AB has subdued the infection which should be soon. Looks like you have a few more days on the AB.

 

Cinnie,

The main difference I'm seeing with TR vs slow is testing & dose changes. With TR, you are testing more often (pre, +3, +6, +9 etc & then getting some additional spot to try to "fill in the blanks"), & then making dose changes as early as 3-5 days based on NADIRs. With Slow, you hold the dose for 1 week unless you get a BG <90 & then you do the BG Curve. Based on the curve, you adjust the dose. As cats stay mostly in the desired range, you lengthen the time between dose changes.

From what I've read & then read some more, you are able to maximize the chance of remission with strict glycemic control. Dr Rand, School of Vet Science, U of Queensland, Australia, recently published a review & touched on it. The aim in a newly diabetic cat is to do establish strict glycemic control by keeping them in the range of 72 to <180/mg/DL, while avoiding hypoglycemia. The idea is that it can resolve glucotoxicity before there is permanent loss of sufficient Beta cells to maintain euglycemia.

Hope that helps! Let me know if you want the link to the article. It was an easy read & interesting.

 

Yeah I kind of feel like that 198 was the result of less than perfect dosing. But it is what it is.

 

Thats exactly what my vet just said about my T. We are going to hold off on any increase until later this week because he's had a pancreatitis flare & that is most likely effecting his #s. I've put off the curve until Friday & will try to grab some # before then, but we don't want to increase based on #s influenced by something else.

 

Yes he has another 6 days on the AB.

 

I also had the 1st experience with getting a really low odd ball # this morning pre shot & remembered what I read about check it again if it seems off. Sure enough it was off. So, I will be re checking any outliers from here on out!!

 

As far as TR or SLGS, as long as dry food is not in the mix and you can test pre shots and another test in each cycle , I would go with TR. The reason is because you can move the dose up every 3 days if needed. With SLGS you would hold the dose 1 week before increasing. That allows you to get them into better number faster. Also the reduction number for SLGS IS 90 . With TR it is 50 with a human meter and 68 with a pet meter. That allows them to be in green numbers longer.

What kind of meter are you using? Could you add it to your signature as knowing whether it’s a pet or human meter will effect people’s dosing advice.

 

I would love the link. I can share with my Vet as well.

 

But that 198 was pre shot & it wasn't so far off the evening check #s even though they were yellow the night before. I would think that even if you shot more insulin the PM before you would have seen lower #s that evening vs pre shot the next morning?

 

By reduction #, just to clarify, with SLGS, if you get a BG of 90 you reduce the dose vs TR its 68? Just want to make sure I understand "reduction #"

 

Hi Amy! I was looking for your thread today so I could comment on your concerns and questions. I’m not seeing one and don’t want to highjsck Zoot!’s thread.

But yes, with SLGS, the reduction is 90 for a human meter or a AT2 meter.

With TR it’s 50 with a human meter or 68 with a pet meter.

 

@Cinnie Cole
@Bobbie And Bubba

Sorry about that!! Totally didn't mean to hijack your thread Cinnie. I actually didn't have these questions until they came up here with Cinnie's dosing question & then your additions about the reductions. Didn't want to be redundant & make you jump over but am happy to in the future & thought the questions/answers may help Cinnie as well. Again, sorry about that.

 

No problem! Most peeps don’t mind someone asking questions on their thread. I never did because all information is good information.

If you start a thread today and still have any questions tag me. Tonight, after I get me pets fed and dosed and dinner out of the way, I’ll try to get back on abs peeled at your SS.

 

Managing feline diabetes: current perspectives
Susan Gottlieb & Jacque Rang

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053045/

 

I will let you know for sure! I appreciate your desire to help. Right this minute I don't have any specifics yet for my guy because I just need to be patient, wait for his flare to calm down, do the curve Friday & hear the dosing recommendations. I may have concerns/questions at that point.

Have a great evening & no rush with my SS since we are Day 7 today w/pancreas flare so nothing happening with us until this weekend

 

Zoot! was 308 at PMPS, so I increased dosage to 1.25 U. At PMPS+2 he is at 275 so at least he is back in the yellow; will try to get BG every 2 hours to monitor how he is doing.

 

Since his +2 was lower than the pre shot number , it would be a good idea to get a test in @ +3. Whenever the +2 is lower than the pre shot number, the cycle could be active and some more testing tonight might be necessary along with some food steering if he drops too fast or too low. See where he is at @+3

 

Okay - I will test in a few minutes at +3 Thanks!

 

What constitutes dropping too fast? So PMPS=308, +2=275, +3=238 and I just gave him two tiny pieces of chicken (size of my thumbnail; baked, no skin, no seasoning)?

Should I test again at +4 or +5?

 

The chicken pieces will help to keep him from dropping too fast. I think you’d be okay to wait till +5. He doesn’t seem to be be dropping too fast right now.

 

Man! I cannot tell you how helpful your guidance is right now. I am so new, I don't know what constitutes a fast drop . He will be so happy that I am not going to test for a couple of hours. But he is starting to equate a little treat with the testing so that is good! If +5 is continuing to drop I may give him 1/4 can of DM.

 

Oh crap - at +5 he is 160 what do I do? Feed him - is this serious?

 

Hi - again So PMPS=308, +2=275, +3=238 and at +5 he is 160 - I can give DM or Dry food - what options do I have do I need to give karo syrup or honey? I am kind of freaked out?

 

I see you got advice on your other thread. That 160 is safe, especially this far into the cycle, but I'm glad you didn't double the dose like the vet suggested!