Vet wants to up to 2 units 2x 's per day

:? I know Loki fructosamine was 506 at the vets, but I am confused about my numbers because they do not seem to warrant that 506 or an increase but I could be wrong, all 5 P's are in place, he has gained back 3 1/2 lbs back and looks awesome, great coat and a happy boy. Plus what confuses me is the fact that I read here to up a dose slowly, going from 1.25 to 2 units 2 times per days seems too much at once, am I wrong?
The vet heard my hesitation and told me to think on it and to check with you guys to see what your thoughts were and I am to call him back to discuss more.
I really would appreciate your input.
Thanks,
Mimi and Loki

 

Going from 1.25 straight to 2 units is a big jump. I would not want to increase more than 0.25 units at a time. You may miss the 'good dose' if you skip right from 1.25 to 2u.

To put it in perspective, the dose increase (0.75U more) your vet recommends is a 65% increase in the dose.
The 0.25 increase in dose we recommend is a 25% increase.

 

I agree with Deb. It is best to follow the protocol so that you don't miss your best dose and so that you don't put your kitty in danger.

Welcome to LL! (somewhat belated!!)

Ella & Rusty

 

Yes, and if you only did the 0.25U increase, we would suggest you hold that increase for a minimum of 6 cycles. Some mid-cycle tests would be very beneficial during this increase. Remember too, the depot needs a few days to build up also with a dose increase.

After 6 cycles at the new dose, we would reevaluate based on your SS, and maybe make another change then. The TR protocol holds the dose for basically 3 days before thinking of doing an increase.

 

Mimi

I haven't visited your condos yet so welcome to you and Loki!

We normally don't recommend fruc tests because you are getting real time data. The fruc test is just an average over a few weeks and good glucose control is less than 450.

You can't compare the fruc test to real time tests. In other words, the fact that the fruc test was 506 doesn't mean he's been running in high numbers like that. I wouldn't worry about the fruc test. I'd focus on the numbers you get; and I probably wouldn't pay for another fruc test either.....ESP because I'm sure that also includes some vet stress

I would not suggest that you increase the dose more than .25u. You've been doing a good job of getting a midcycle test during the day and a +2 at night although I don't see anything for last night. I would increase Lokis dose to 1.5u in the morning unless he drops into mid blue or lower tonight. I would not make a larger increase than that in his dose.

Let us know if you have questions.

 

vets tend to look at dosing in terms of full units, probably because that is what is marked on most syringes. They don't even think about dosing in smaller increments. The way I see it, most vets say to increase by 1 unit and hold the dose for a week or two. If I follow the tight regulation protocol and increase by 0.25 units or 0.50 units (depending on the numbers), and hold the dose for 3-4 days, it will still only take me a week or two to increase the dose by a full unit. I'm just taking some intermediate steps in between. So often, we see cats who don't respond well to one dose, but they respond remarkably well to a dose just 0.25 units higher. It's worth it to take the extra small steps, plus it makes you more comfortable. You feel like you're just inching things along, but really you're probably moving faster overall than your vet's recommendation because if a particular dose isn't working, you just move on to the next one. Make sense?

Loki's numbers are good, but there is room for improvement. Now that he is under 300 pretty much all the time and under 200 some of the time, your next goal should be to get him under renal threshold pretty much all the time. Officially renal threshold is around 230ish for cats, though cats will vary. I usually aim for under 200, and with Jazzy I could tell she felt much better when she was under about 180 all the time (less peeing, less drinking, less eating, less hissing and biting!). Increasing the dose just a little bit should help shift Loki's range downward so you can keep him under about 200. He's almost there, and he is spending some time each day under 200, so you're just trying to help him to stay there.

My recommendation would be to increase his dose to 1.5 units BID and see where that takes him.

 

Thank you all. I did re test him at +2 and got 250 last night, but with this condo viewtopic.php?f=9&t=95644, from yesterday. I just knew he would be higher. I feel more confortable raising him by .15 for the next increase.
Now should I wait 5-7 days because of yesterday? Or can I start him today. He is due for his amps in 1 hr and 45 minutes.
Thanks so much
Mimi

 

Mimi --

Could you clarify? You didn't get an AMPS yesterday but did you give a shot in the AM? (I wouldn't put a 0 in the AMPS column since it color codes the number and I would have assumed it was a typo. How about putting some dashes in the block instead?)

You said:

Do you mean you want to fatten the dose or was that a typo and are you thinking of increasing by 0.25u? I agree with what others have posted. I think you have room to increase b 0.25u.

 

I wasn't sure what you meant by "Now should I wait 5-7 days because of yesterday? Or can I start him today."
Depending upon his AMPS number this morning, I think you can start the increase today. I hope you're going with the 0.25 increase.

 

Great job with Loki! Isn't it wonderful to see him feeling and looking better? that's nice that your vet is open to hearing other input.
Liz

 

To clear up (so sorry) for the misunderstanding. I am confident to start him today on a .25 increase but wanted to know how long to see results 5-7 days perhaps? Will fix his SS thanks for letting me know.