5/4 Eddie AMPS 272, +6.75/77, PMPS 317, +2/290, +6/127

Eddie's 5/2 Condo

Happy Sunday LL!

Today:
AMPS = 272
+3 = 165
+6.75 = 77
+7.5 = 98
+8 = 100
+9 = 102
+10 = 162
PMPS = 317
+2 = 290
+3 = 278
+5 = 178
+6 = 127
+7 = 126
+8 = 134

The sun is shining here today, and the kitties are going to get some deck time today. It's starting to actually feel like spring. :smile: Yesterday, Eddie saw some mid-blue nadirs, and then bounced to the moon for the PM. His PM +2 was 430. :roll: But, he seems to have cleared that yucky bounce out overnight, and is having a nice cycle again today. I suspect that Eddie may have been lower than the 77 at +6.75, given the pretty big drop by +3. Fingers crossed that he surfs to PMPS rather than shooting up into another bounce. He seems to maybe be clearing the bounces a little faster the last few cycles. (anti-jinx).

On the protocol, one thing I'm not 100% clear on is whether you keep going up in dose if nadirs are in the 50-80 range to flatten out the overall cycle? Or basically, keep going up unless a reduction is earned? Is that right?

From the PDF linked in the TR sticky, "If nadir blood glucose concentration < 200mg/dL but peak is >200mg/dL (11 mmol/L) Increase every 5-7 days by 0.25-0.5 IU depending on if cat on low or high dose of insulin" - is this basically the next step?

Re: 5/4 Eddie AMPS 272, +3/165, +6.75/77

Nice cycle again today! I hope Eddie surfs that green for a while.

Good questions Jen. I think you do have room for an increase. My understanding is you do go up until you go down (earn a reduction). And a little more insulin might help flatten out those higher numbers.

As a side note, this part of the protocol always confused me when we were going up the dosing scale, because Neko started getting green at 3 and something units, but never did get a reduction until 8.75U. But she's an acrocat with IAA and the insulin antibodies kept on fighting back. A much different case than Eddie.

Re: 5/4 Eddie AMPS 272, +3/165, +6.75/77

Thanks Wendy!

I think we're going to try 2.5u tonight unless something crazy happens before PMPS. :smile: Those half units are a little easier to measure, so I'm ok with increasing. ;-)

I hope it might flatten him out a bit and help with the bouncing some.

I do think it's interesting that increasing a dose, even with good low nadirs doesn't automatically result in nadirs that are too low. I suppose it's all about keeping up with the relative insulin deficiency and trying to increase insulin sensitivity of the receptor cells. For example, I thought Eddie might earn a reduction by sitting in the low 50's on 1.75u, but he didn't and hasn't gone lower on an increased dose. Whether or not I can wrap my head around it is sort of irrelevant since we know that the TR protocol works!

Re: 5/4 Eddie AMPS 272, +3/165, +6.75/77

jen, one thing that people can try when they are getting close in dose, but still having some highs at preshot, or some bouncing highs, is to go up in dose a small amount while "holding up" the lowest numbers.

So in your case, you might fatten the 2.25u when you're going to be around for a few days, and then give enough carbs before they are needed at the middle of the cycle to hold up the nadir. That allows you to give a little more insulin while preventing a dose decrease. You would need to do that for a few cycles, not just one - gotta work with that depot!

If you choose to do that, what you need to watch for is not getting to the point where you're seriously giving too much insulin. If you're having to work hard to keep his numbers over 50, using a lot of carbs, or spending a lot of hours there, then you would want to consider taking a reduction. but done carefully, it can be effective in helping to bring down those high numbers.

What I might do in this situation is to increase the dose of insulin slightly, feed your regular low carb food, then when you see his BGs drop to about 100, give some medium carb food in little snacks to hold his numbers up. They don't need to stay at 100, just above 50. Starting around 100 gives you some working time. You'll have to experiment a little with this to see what works best with Eddie.

Make sense?

Re: 5/4 Eddie AMPS 272, +3/165, +6.75/77, PMPS 317

Hi Julie!

Thanks for the input! That does definitely make sense.

So to clarify, if nadirs are in the 50-80 range, looking strictly at the protocol, is that when you go to the "holding the dose" instructions, subject to some "fattening" or tweaking? Or do you increase after holding the dose for 10 cycles per this:

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...

I didn't see your post before we did the TFS routine, so I did increase to 2.5u. nailbite_smile Was that incorrect?

Re: 5/4 Eddie AMPS 272, +3/165, +6.75/77, PMPS 317

the protocol doesn't exactly address this question. In general, when you are getting nadirs you want, usually 50-80, you want to hold the dose. Often if a cat is seeing green numbers daily, their bouncing will lessen until it stops. How long it takes for that to happen is anyone's guess, and some continue being bouncy.

I don't think you were wrong to increase to 2.5u. It is definitely easier to measure on the 0.5u line! I'm just thinking it might be a little too much given that you've had regular nadirs the past couple of days in the 60's and 70's. But we'll see! I would just carry on with your new 2.5u dose, try to keep those nadir numbers up and see what happens.

Some of what we do is to tinker with things to see what works with a particular cat. That's what you're doing. I think it's ok. Just monitor, of course!

Perhaps others will have different thoughts on it, but i think it was ok.

Re: 5/4 Eddie AMPS 272, +3/165, +6.75/77, PMPS 317

Nice to see that green today. Good luck with the new dose.

Re: 5/4 Eddie AMPS 272, +6.75/77, PMPS 317, +2/290

Thanks Julie! I'll keep close tabs on what he does with the dosecrease tonight, although it looks like he's going to bounce. It does seem like it takes Eddie a few cycles to settle into a dose, so it will be interesting to see how long it takes to see the effects (if any) of the dosecrease.

I do think it may be time to study up on using calipers if we ultimately start doing "fat" and "skinny" doses. :smile:

Thanks for the encouragement Carla! :smile: