9/16 Oberon +9.5 340, AMPS 339, +2 329, +7.5 331, PMPS 325, +3.25 280, +5.5 259

yesterday (still high; dose increase in the evening): https://www.felinediabetes.com/FDMB...mps-401-new-dose-3-75-u-3-378-5-5-371.235333/

 

Okay Oberon, time to start working the new dose.
Have a great day, Lisa.

 

Come on Oberon...let's lose the pinkies ok? Not a good look on such a handsome dude!

Good luck with the increase...let's hope this is the 'magic' dose...

Have a great day Lisa!

 

Good luck with the new dose.

 

Starting cycle 3 at the new dose. Still pink so far, though coming down very slowly today. Hmm. Too soon to think about an increase, but I suspect he's heading that way.

Also, I could swear I read something somewhere suggesting that at higher doses (over 3 U, maybe?), dose increases should be in increments of 0.5, not 0.25. But now I can't find it. There's a logic to it because at higher doses the same increase is a smaller fraction of the dose, so maybe larger increments would make sense. But at the same time, you wouldn't want to overshoot (so to speak) the dose the cat needs. Am I misremembering that, or is it something that doesn't apply when following TR?

 

I'm not qualified for dosing advice but maybe you were thinking of increasing if nadirs > 300? Below is from the TR Guidelines

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.
• Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
• Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.

 

No, it wasn't that. (I've done that one, and if he keeps this up I may be doing it again.) It was definitely related to high insulin doses. But I have no idea where I read it now. It was fairly early on when I was reading all sorts of stuff, not just here. Might not have even been about Lantus, now that I think about it.

 

Oh, I found it. It was the Roomp and Rand 2013 paper that I was reading last week. It gives an overview of what's essentially the TR protocol, but with the following sort of phrasing: "Increase by 0.25–0.5 IU depending on if cat is on low or high dose of insulin" in addition to considering the nadir. Can't find what they consider a high dose, though.

 

Finally heading down a bit (259 at +5.5)... doesn't look like he's going too far or too fast, so I'm heading to bed. My husband should be able to get a +9 or so.