5/17 Esse AMPS 248 +5 232

Lauren & Esse said:
Such a relief to see a lower PS number today! We're going to be out and about a bunch today but would love to get a +5 or +6 if I can to see how the cycle goes when he starts lower (as opposed to yesterday). Or even a PM test! :)

Safe surfing and happy Caturday!
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Hi Lauren, Here's yesterday's post for continuity: https://felinediabetes.org/fdmb//threads/5-16-esse-amps-413-2-326-3-313-7-279.231/#post-2054

Have you considered a strategy for dose increase? I know you've been working toward getting Esse used to testing and you discussed that you are considering the Libre which will help you build more data. I cannot give dosing advice, but it looks like he might be ready soon (if not now) for an increase (and then you might begin seeing better numbers). Below is the information from the sticky.

"Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose." (Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) | Feline Diabetes Message Board - FDMB)
 
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Mary & Jude said:
Have you considered a strategy for dose increase?
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I've been wondering about this too. I know the SLGS guidelines want you to have a full curve before increasing the dose, but I'm wondering at what point we have enough data to make an educated guess that it's okay to increase. But maybe we need PM cycle values first--really going to try for that tonight. When I emailed the vet to ask about the Libre, I linked the spreadsheet, so she may have some feedback too.
 
Lauren & Esse said:
I've been wondering about this too. I know the SLGS guidelines want you to have a full curve before increasing the dose, but I'm wondering at what point we have enough data to make an educated guess that it's okay to increase. But maybe we need PM cycle values first--really going to try for that tonight. When I emailed the vet to ask about the Libre, I linked the spreadsheet, so she may have some feedback too.
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I would ask an expert here to check your sheet and give some advice. If you put your "dose" question flag up, that will alert someone.
 
I just checked his sheet, and that 129 last night puts him in the nadirs between 90 and 149, which is the maintain zone. I'm not sure how SLGS works for sure and if you start back over with the seven-day count at that low nadir point (this is why it's good to get an adviser's eyes on this). You want to get his numbers down into the low blue and green zone--those are healing numbers for his pancreas (and healing can lead to remission), but you also want to get him below 200 because those yellow and higher numbers are harder on his kidneys. The additional data you get from testing helps you get a better picture of what is happening in a cycle. You can see how low he's actually going in a cycle, and that will help you understand what the higher numbers are a result of--is he bouncing? Or does he need more insulin. :)
 
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