Dose increase after 20 units

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Howiesmom, Dec 21, 2020.

  1. Howiesmom

    Howiesmom Member

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    Aug 11, 2020
    Howie just reached 22units this AM (and of course it was a fur shot :( ). I’m just wondering if I increase the increments if his doses after 20 units (I.e., when he hit 10 units, I increased him 1 unit instead of .5 units).
     
  2. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    At that dose increasing by 1 unit is fine also considering that the nadir is above 200.

    I not you are giving a little R sometimes. In order to reduce costs I wouod consider using some N as a substitute for Levemir. With my MurrFee (GA) I was giving 25 units of each at the end. With Snuffles I am doing the same with about 5 and 5 now.
     
  3. Howiesmom

    Howiesmom Member

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    Aug 11, 2020
    My vet has never had a patient who has used the 2 insulins together before. His research had indicated a 2:1 ratio of L to R. However Sandy and Wendy are coaching me through using R and have given me dosing scales of .25-1 unit depending on his BG. I would certainly love to save some money on L as he is going through flex pens so quickly!
     
  4. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Think of the increase as a percent of the total dose, around 10-15%. So you can go ahead with a 2 unit increase at this point. You need to be a bit aggressive with the antibodies.

    Might be time to tweak those R scales. @Sandy and Black Kitty
     
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  5. Howiesmom

    Howiesmom Member

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    @Sandy and Black Kitty
    Just wondering your thoughts on tweaking the R scale for Howie now that we have more data? He doesn’t seem to be getting very big drops from it besides when I gave him 1.25u when he was at 400 due to a fur shot of L that morning (12-20).
     
  6. Howiesmom

    Howiesmom Member

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    Aug 11, 2020
    Thanks! The 2 unit increase this week will be interesting to see what happens over time. He starts 25 units tomorrow. Almost time for 2 syringes just for his L!
     
  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Maybe you can try bumping each of the R scale doses up a 0.25 unit. It might be useful to add a tab to your spreadsheet with the current R scale, so we can see what it is at a glance. Have you seen Black Kitty's R scale?
     
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  8. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    Yes to tweaking- R scales are dynamic. Do take a look at the R scale tab on Black Kittys ss. It’s not all of them but a good example. Please do something similar. Include the date it was created and keep them in date order. It will make it easier for all. Might be time to consider some mid cycle R usage, one good place for that would be on a cycle when you know you gave a FS.
     
  9. Howiesmom

    Howiesmom Member

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    Yep! I can work on creating a new tab with R scales. Remind me...what’s the “hopeful” drop that the R will create/do for his BG if we find a good scale for him? How often should I consider increasing the scale? Knock on wood I don’t give too. Any fur shots, but I wish I would’ve seen Wendy’s message earlier that day with the recommendation!
     
  10. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    You don't want him dropping more than 100 points by the end of the R action, so approximately +4. Take a look a the scale when it stops doing what you want it to. Don't base the analysis on just one cycle but a few, as other things can impact the numbers (bounce clearing, depot filling, absorption, etc.).
     
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  11. Howiesmom

    Howiesmom Member

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    Merry Christmas and A blessed New Year to you both!
     
  12. Howiesmom

    Howiesmom Member

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    I want up to a 100 point drop from the PS number, right? On many cycles, the R has not even gotten him below the PS. Not sure what that means?
     
  13. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    I would say the increase in BG due to food is more than the decrease due to the insulin. I wo8ld increase the R
     
  14. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Since Howie is on Levemir, and doesn't onset until +3, the first three hours after R you also have the natural rise from the insulin from the previous cycle wearing off. Plus you could also be working against bounce numbers. I rather suspect he went into the blues last night while you were asleep.

    Glad you increased the R today. Did you increase the L to 25 as well? That's what the spreadsheet is showing.
     
  15. Howiesmom

    Howiesmom Member

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    Yes, I went up to 25L today as that is on my 6 cycle pattern.
     
  16. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I only counted 5 cycles at 23 units. We also suggest not giving R on the cycle you increase the L, as sometimes cat have a strong reaction on the first cycle of an increase. Seems he did OK today though.
     
  17. Howiesmom

    Howiesmom Member

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    @Wendy&Neko @Sandy and Black Kitty
    Good Morning! I’m just wondering after how many cycles I should do an R increase if I’m not seeing significant drops? I’ve increased it after about a week (not giving it everyday/cycle with the holidays) but am wondering if that is too long? He’ll be starting 29 units of Levemir tomorrow
     
  18. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    At +5 today did you give 5.75U of R? Or maybe the 5 shood have been on the first line of that cell.

    At the amount of basal dose of Levemir you are giving and the results (or lack of results) from the R, I wouod try giving more R. like 3 units. I myself prefer N since I can give more of that and not dose R frequently like you are presently doing.
     
  19. Howiesmom

    Howiesmom Member

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    Aug 11, 2020
    No, I wrote down that I checked his BG at +5.75. I haven’t tried giving a mid-day dose of R yet. I’m a little hesitant to make a jump to 3 units of R since the most he’s had is 1.5 units.
     
  20. Howiesmom

    Howiesmom Member

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    @Wendy&Neko , @Sandy and Black Kitty
    Any recommendations you can share about how long i should go in between increasing the R dose if I’m not seeing good results? After x cycles? Or after x days? I feel like I don’t have a good feel/rhythms on this and his L just keeps going up and up. Also, after he hits 30 units of L (this weekend), do I start increasing that by 3 units?
     
  21. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    Ruminating...
    bbl
     
  22. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    To me, learning to manage BG using fast acting R along with slow acting L is like trying to draw the perfect curve on an etch-a-sketch. You’ve got to figure out which knob to turn when, how much to turn it, and in which direction.

    As far as increasing R dose amounts goes, I would not at this time increase by more than 0.5u increments-you don’t want any surprise trips to the lowlands In terms of frequency that’s going to depend on the numbers and having a grasp on what the current L dose is or isn’t doing.

    Good job with the R scale tab on the ss. For the time being increase all except the 175-199 range. Keep that at 0.75u while you tweak the rest of your scale. Keep in mind you can play with the ranges, making them wider or narrower. One item to add is an R dose for when PS BGs are >400

    It may not seem like it now but you will get in the groove with all of this.


    If ever in doubt about what action to take (or not take) remember the time honored maxim below-

    Better a day too high than an hour too low.
     
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  23. Howiesmom

    Howiesmom Member

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    Aug 11, 2020
    Thank you so much! This is helpful. I appreciate it!
     

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