Re: 1/17 Shadow AMPS=160
Yes Pat I began in the German forum shortly after starting with Caninsulin. The German forum is mainly only for Lantus and Levemir and I was already looking into switching when I joined and they helped me to get thru the "red tape" of getting a Vet to Rx human insulin (which here is legally bound to using a animal approved insulin first) As Spooky and I came along the trials were in progress for Levemir, because we didn't have enough time for significant data collection and weren't OTJ at trial end (but we did get there!) our data was not included. The German way isn't really any different, it actually is the Tilly protocol, here in this forum they always always say "a modified version" is used. I haven't found anywhere a written explaination of the "modified" parts, but in my observations it seems dose increases are made more slowly and reductions are earned with 1x <50, whereas the protocol allows for 2x below 50 and immediatley decreasing for BG's <40. The other difference is the meter type but nowadays is also insignificant and would mean that decreases would actually be given at values <60 or 55. In the Glossary here in LL "Being German" or "visiting German" is defined as shooting low PS's or Low preshots after sliding. The main preface to using the Tilly method is the ability to monitor (spot check) frequently the first few days of dose change. Dose changes should occur every 3 days or based on nadir sooner. A dose can be held longer than 3 days if "good" nadirs are acheived. Based on the protocol I suggested Shadow need 2x below 50 to earn a decrease because previous decreases were often unsucessful (I thought he needed to really prove himself worthy

) I also suggested that you increase the dose based on several parts of the protocol (depends on which phase you are in)
Phase 2 (working up to a dose=increases)
If nadir blood glucose concentration 200-300mg/dL (11-17
mmol/L)
Increase every 3 days by 0.25-0.5 IU depending on if
cat on low or high dose of insulin
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
Phase 3 (holding the dose)
If nadir or peak blood glucose concentration > 200mg/dL (11
mmol/L)
Increase dose by 0.25-0.5 IU depending on if cat on
low or high dose of insulin and the degree of
hyperglycemia
Here is where I place Shadow this stage doesn't specify when the changes should occur, so we can say after holding the dose for 3 days (settle time) if the following cycle no <200 numbers are measured increase the dose by .25U
What you see last night and this morning are still very good numbers and is likely a very small "bounce" from the run of greens he had but is still a very mild bounce (a slightly deflated ball). It should clear out during this cycle after the onset. If it happens at peak insulin time then he will scuba dive. He is beginning to get more overlap now and the higher PS's are leveling out. I would say it's reasonable to hold this dose for another 1-2 days, should he not have a green number in a 48 hour time I would increase and be prepared that he will drop after the shed is full.
The basic concept is to find a dose that keeps them as much time as possible in the physiologic range of healthy cat (70-120 mg/dl) this leads to maximum pancreatic healing. Shadow is getting very close to that now. You will see that the very low BG #'s will likely come early in the cycle after shooting a low PS (with the exception of last night which has bounce behind it.) As the insulin wears off towards preshot time the BG will rise slightly, you will be shooting a rising but low PS, with 3 hours till onset the BG would normally have risen quite a bit before it starts falling due to the onset. However, as the own pancreas starts working a little on it's own this happens.....
Your dose is waering off at +12 and your PS is rising but low (<150) you shoot your regular dose which has been getting good result, then you feed the cat. All of a sudden the pancreas kicks in in response to the food and begins lowering the BG before the onset of your current shot (it is working like a bolus insulin-R to lower the PS number before the onset of the basal insulin) now when your shot begins onset at +3 the BG is lower than it normally would be at this time and your heading for a "scuba dive" which will usually happen in the next 2 hours. The uncertainty here is rather feeding during that time will slow the drop or speed it up (due to action of the pancreas) My feeling is because of the presence of insulin the pancreas will be supressed (through feedback) and will not release a significant amount of insulin.
Does that make any sense? :mrgreen: