3/28/14 Prince AMPS-410

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Hi Emily,

He is bouncing, but looking again at his ss tonight, he's had 19 cycles at this dose and he hasn't seen greens for 15 cycles. it's pretty clear that in between bouncing he's getting into the blue numbers. I think i'd go ahead and increase by 0.25u.

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.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
 
The 2.5 dose brought him into the very low green numbers before. Wouldn't he just drop too low again if I increased his dose?
 
that's a possibility, but that doesn't always happen. He's been several days past the previous dose and if he were "holding the reduction" he would've continued to have green numbers like he did on the previous 2.5u.

if you're nervous about it, you can try to hit a dose slightly less than the 2.5u. We call them "skinny" or "fat", and that tweaking is usually best done when you're very close to the just right dose. If Prince were mine, i'd probably go ahead and go back to the 2.5u, and then if he goes under 50, perhaps just skinny it. Sometimes coming in with a larger increase (the full 0.25u) helps more than just a tiny incremental increase.

however, it's your choice. you can definitely go to a "f2.25" or a "s2.5" if you want to try that first. The important thing on measuring doses is always that you pay attention to where your plunger is so that you can replicate a dose. You can mentally decide what the inbetween dose would be. You can also make a "cheat sheet" that shows different doses. People apparently make little cards on a key ring that show various doses so you can hold the card up next to the syringe and compare to hep with accuracy. The card idea is relatively new to me, but seems like a great idea. The directions on how to do that are found on the Tight Regulation yellow starred sticky, about 5 paragraphs down from the top in the pdf on "Management of a Diabetic Cat Using Long-lasting Insulin." It's good information if you haven't read that yet.

a lot of this "dance" is trial and error - what works for this cat at this time? so whichever you want to do.
 
I actually agree with Julie, Emily. I was looking at his SS and was going to suggest you increase the dose back up but then saw Julie beat me to it.

Sometimes the increase kick starts them and they only need a cycle or two at the higher dose. Sometimes, you might have to go higher. Step at a time :-D
 
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