11/18/14 Keiko AMPS 462 today; 243 yesterday ???

What a difference a day makes. I was celebrating some 200s now that K's on 7 units :razz: .
Last post: viewtopic.php?f=9&t=128444
Here's a recap:

AlphaTrak Curve on 11/14 - 6.5 units
AMPS - 340
+3 - 312
+6 - 294
+9 - 440
PMPS - 595
+3 - 464

Human meter - dose increase to 7 units all below:
11/15/14
AMPS 402
+4 - 522
PMPS/+10 - 329
+4 - 365

11/16/14
AMPS - 338
PMPS - 387
+2 - 304

11/17/14
AMPS - 243
+6 - 305
PMPS/+10 - 266
+6 - 431

11/18/14
AMPS - 462

I was thrilled to see some 200s. Keiko is acting like his old self in more ways, even getting mischievous! Are the 400s dose wonkiness?
Thank you in advance. Thank you FDMB and blessings.

M & K

Yellows are much nicer to see! From Keiko's spreadsheet, it looks like he spend a good part of the night of the 16th in yellow, if not some blue. Thanks for getting those tests at night Maria, it does give a clearer picture of what is happening. The +2 test (which you got on the PM cycle of the 16th) is a good test to get on Lantus. If it's quite a bit less than the preshot, it means an active cycle is happening, which depending on the numbers, may mean more monitoring is good idea.

Today's numbers (400s) are probably a bounce. His little body isn't used to yellows so his liver is reacting. Good news that Keiko is starting to feel better, and getting into trouble. They usually start to feel better as the dose gets close. When you have a chance, I think it would be a good idea to increase to 7.5U. From the protocol:

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.

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Since Keiko is on a larger dose (greater than 5U, then the increase is .5U instead of .25U. Paws crossed this next increase brings blues.

So in another 2-3 days increase the dose by .5?

Thanks Wendy and Neko! It helps to have other cat folks to check in with about this.

Maria & Keiko

No, you only need to hold the dose for a total of 6 cycles if the nadirs are yellow. You can increase any time it's convenient for you to do so.

Maria, you asked me in a PM:

Regarding increasing the dose at any time, my veterinarian recommends 5 days on a dose. I don't know how to increase it without her OK. nailbite_smile Maybe I'm afraid to challenge her? Did you have this experience? I sent her the article about the protocol used here and she did not comment on it. She may not have read it. It's similar to what she has recommended.

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In the interest of keeping all advice about dosing in the open, I'm copying my reply here.

Your vet is not there when you fill the syringe - you get to make those changes when you think it's time. Keiko is now on a higher dose of insulin, greater than 6 units. When that times comes, it's likely that there is an underlying high dose condition. You might want to get Keiko tested for them. Neko has two high dose conditions, IAA and acromegaly. The chances that your vet has experience with either of those is highly unlikely. With both those conditions, there is a type of insulin resistance. In order to beat the resistance, it's important to keep increasing as per the protocol so Keiko can get out of those high numbers. There is probably a lot more high dose experience on this forum than your vet has. Other high dose kitties whose SS you can look at are Cobb/Suzanne, Polly/Marilyn, Toby/Peg, Punkin/Julie. There are others, but those are the most active posters around now. I saw some reference to research that says acromegaly is the cause of 25% of hard to regulate cats. Vets used to be taught that it is vary rare.

On how to approach the vet, just tell her that you think there's a possibility of a high dose condition. The current method of waiting 5 days isn't changing Keiko's numbers much. The protocol you gave her allows changes every three days, and you are going to try that to see if it can make a difference. My vet didn't think Neko had a high dose condition but humored me by ordering the tests. She was more surprised than I was by the results. She sees how much I test, she trusts me to do the right thing.