11/14 Portia- AMPS 180 +3 250- dose increase?

Hi all
Yesterday's condo viewtopic.php?f=9&t=108099
I would like some advice on dosing. Portia's been on 1U for a week now and as you can see in her ss, her values have all been yellow (great!!) but I dont see a major decrease. Note the values in pink were made with alphatrak and so cant really be compared. I think she made need an increase in insulin. 1.25U BID? I would like to hear your thoughts on the issue.

Thanks
Rita

It would be easier to tell if she needs a dose adjustment if we could see some night time tests. Cats will often go lower at night and she may have last night. Do you think you would be able to test tonight?

Hi Dyna,
I will be testing tonight. I meant to last night but fell asleep on my couch!!! I was so mad at myself. I will test her tonight (Atleast get a +3). How do her day levels look to you though? Good or not as good as they could be?

Rita

Her daytime levels look like you have room for a dose increase. We usually tell people to hold the same dose for the first 5 to 7 days initially. Are you just on day 7 of Lantus?

Here's the part of the protocol that helps with dosing decisions:

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

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.

if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

Click to expand...

Today is day 7 on Lantus for Portia. There have been at least 2 blue numbers on here, and based upon the 182 at +12 this morning, I would guess she'd been lower during the few hours prior to that. Usually the +12 is when the insulin is beginning to wane and the numbers have risen over the past several hours.

what are the 2 numbers in the amps box this morning and again at +3 today? is that an on the hour test and another one a half hour later? or a recheck of the first test, so 2 test results at the same time?

i think given that today is just the first week, and you've seen at least a couple of under 200's, and there have been some moving around of the shot times, that i would hold another day or so. try to keep the shots at +12 and try to catch some evening cycle tests. Lantus likes consistency and you can't really rush things. Overall her numbers aren't bad - do you see how the pinks have gone away as the lantus built in her body? She is mostly below renal threshold, so i think it's ok to wait and give this a little more time.

That's what i would do if she were mine. ;-) let's see if someone else has another opinion for you to consider.

Hi guys .. no dosing advice from me, but what a nice start to the day! Maybe with more juice on board we might see more and more blues! have a great day guys!

i see dyana and i posted at the same time.

the other thought i had is that i would encourage you to not feed her after +9 so that these preshot numbers are definitely not influenced by food. hard to say how much they've increased the number, but on 11/12 she ate an hour before her preshot test and on 11/13 she ate 2 hrs before.

we do say to pick up the food 2 hrs prior to a test, but for many cats, the numbers are better if the majority of the carbs are in the body in the first half of the cycle, ie, before +6. some cats graze successfully, but i found with punkin that feeding him at preshot and +3 gave him the best numbers. we don't know yet how much food inflates her numbers.

Hi Dyana and Julie,
Yes, this is day 7 on Lantus for Portia.
The two numbers on todays reading are Relion and alphatrak (alphatrak is in the bracket). Im doing alphatrak today because my vet wanted a curve today and she prefers alphatrak.

Ive been delaying her dose by 15 min every day because I know Im going to be a few hours late on friday night and instead of being a few hours late, Ive been pushing each dose by 15 min. Is that not a good idea?

The pinks on the first few days were read on alphatrak which reads higher than ReliOn (I've indicated this in the comments). My guess is those pinks on the first few days would have probabyl been yellow had I been using ReliOn.

However, I will take some evening readings today and see how they are. The problem with taking Portia's food 3 hours before is that she has pancreatitis and is generally inappetant because of which she is on an appetits stimulant to make sure she eats. This makes her hungry all the time and I hate to induce hunger and then not feed her. However, I will try and be more careful and try not to feed her 3 hours before testing. It's so difficult to juggle work, portia's inappetance, medication and insulin schedules not to mention testing.I will try to feed at AMPS/PMPS (which I do) a feeding at +3 for both cycles. Let's see how she does.

So as of now, the general consensus is to hold the dose for a few more days (2 day?), take some tests during the PM cycle and try not to feed her atleast 3 hours before AMPS and PMPS. Do I have it?

Thanks a lot!
Rita

Hi Peter,
Thanks for stopping by) Hope you have Mocha are having a great day!!

Rita and Portia

ah, i wondered about the moving time shot. no, that's ok. it's also ok to just give it on time now and let it be late on friday night. that's probably what i would do - then all the cycles between now and then would be 12hrs. it's the working it backwards that gets harder. so whenever you shoot on friday night, you need to shoot again saturday morning 12 hrs later (or 11.5 if she's high).

at this point, you're almost to Friday!

one thing i've done when i was out at shot time - a vet tech from our vet's office was willing to come and test punkin, feed both of our cats and give punkin his shot for me. Cost me about $15-20, but she knew what she was doing (had her own diabetic cat for a while), was a college student (so no doubt needed the extra $$) and i got to enjoy my time out without worrying about punkin.

if she were mine, i'd get a night time test tonight - say +4 - +6, somewhere in there, and then let's see where she is in the morning. i can understand why you're hoping to increase, and she's probably going to need one soon - it would just be best if we could see where this dose is already taking her.

it is difficult to juggle all of those things - didn't realize that was what was motivating things. many of our cats have concurrent problems, so we understand. you just do the best you can. chicken breast (boiled) has almost no carbs, so perhaps that would be a good late-in-the-cycle treat if she likes it to help her hold out.

and yes, you have it!

Hi Julie,
Sounds like a plan. Ill keep her on 12-12 cycle then and just be late on friday night. She seems to be doing quite well with 1 feeding at AMPS and another at +4. She hasnt eaten anything since and has been fast asleep all day on her fav chair so this schedule actually might work. Ill take a +3 and and +6 test tonight and see where she's at. Thank you so much for helping us out.

Rita and Portia

you're welcome! sounds like a plan - i'm glad things are working out ok.