7/22 Fin AMPS 401 >.<

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Fin's gotten some nadirs in the 200s. According to the protocol you would increase by 0.25u (not 0.5u):

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
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Appreciate you looking out for us. That is what I love about this board, everyone has your back! :smile:

We are not actually following the board modified protocol.

Per the tight regulation protocol:

"Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose)."

And per the AAHA protocol:

">150mg/dL,increase insulin. Cats: 0.5 to 1U per injection based on severity of hyperglycemia."

Since Fin has been horribly unregulated for years (before I adopted him), the vet is concerned with the long-term effects of having high BG's. So after reading the different protocols and discussing Fin's history with his vet, we agreed on the .5u increases until he gets to 3u BID and then we will take it to .25u increases and decreases as necessary.
 
It's your call. I would just encourage you to monitor BG levels carefully so you don't end up missing what could be an optimal dose.

From having looked at the AAHA protocol, I couldn't tell if their dosing recommendations have been empirically validated. I'd need to go back and see what they reference as the clinical trials that supported their recommendations. I believe they referenced the Lantus protocol that we use (Roomp & Rand aka the Queensland Protocol which is the basis for the Tight Regulation Protocol we use). However, as you noted, the parameters are different between what we use and the AAHA protocol.
 
Please rest assured that I have thoroughly read the ALL the documentation available on ALL major Protocol's (Dr. Rands, German Protocol, Dr. Hodgkins, Steve and Jocko). I have discussed his history and behaviors in detail with my vet. I have viewed other member's spreadsheets and looked at their approaches. I monitor Fin's BG daily, test for ketones and work from home to keep an eye on him. When I was considering adopting an unregulated, long-time diabetic cat I did an enormous amount of research. I think for Fin's case specifically (not a newly diagnosed cat AND BG's consistenly over 350 for the past 3-4 years), our approach is the right one.

I am ultimately responsible for my cat's healthcare and I do not take that responsibility lightly.
 
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