6/14 Esse AMPS 193, +6.5 149; TR question | Feline Diabetes Management Board

6/14 Esse AMPS 193, +6.5 149; TR question

Lauren & Esse

Lauren & Esse

Member
Yesterday's thread!

Wanted to ask a question re: TR -- tonight WOULD have been Esse's 6th cycle in a row on 1.5u, so in theory we could evaluate for a dose increase tomorrow morning, right?
However:
1) During the day today, he spent a good bit of time under 200, including a nadir of 149! TR says "...if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing." Would we consider Esse to be new to <200 numbers, or not really?
2) He jerked a bit for his shot tonight and I believe it was at least a partial furshot... Does that reset the counter for how many cycles we've had on this dose, so we have to count up to 6 again? (I shot into trimmed fur so while I do know I definitely pushed the plunger while the needle was in the skin tent, when I pulled away there was a drop of wetness and a definite Lantus smell. I am very annoyed with myself and a bit perplexed on exactly what happened there.)

Sorry for the complexity here, just want to use this as an opportunity to make sure I understand the TR rules. Thanks!
 
I'm not qualified to give dosing advice, but yes, the count is supposed to start over with a furshot (partial or not). From the Counting Cycles sticky:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Notice the word "consecutive" is in bold.
:D

con·sec·u·tive: adj. following one another in uninterrupted succession or order.

Because of the cumulative nature of Lantus, glargine biosimilars (Basaglar/Semglee) and Levemir... stalling, shooting a reduced dose, shooting a BCS dose, skipping a shot, and fur shots can alter the effect on the insulin/depot on any given dose. If you have to do any of these things, the cycle count starts over. If you don't start over, you run the risk of kitty becoming over dose.
Click to expand...
 
Yes, fur shots reset the cycle count as per the note linked above. Since he was seeing blues, if it had been six completed consecutive cycles, you increase after 6-10 cycles. I tended to hold longer for low blues, less for upper blues. Over time you'll find out what works for your cat.
 
I just want to clarify...
There are two, 12-hour cycles each day. It looks like you held Esse's dose for 6 days or 12 cycles. With TR, the general rule is that you hold the dose for 3 days/6 cycles (unless a dose reduction is indicated).
 
Last edited:
Sienne & Gabby (GA) said:
I just want to clarify...
There are two, 6-hour cycles each day. It looks like you held Esse's dose for 6 days or 12 cycles. With TR, the general rule is that you hold the dose for 3 days/6 cycles (unless a dose reduction is indicated).
Click to expand...
We gave a reduced dose on the PM of the 11th so I started the 6-count over the next morning, was that not the right thing to do? I thought we needed 6 consecutive cycles of the same dose in order to increase--which is why I thought we'd need to start over again after last night's furshot. I'm open to an increase if he qualifies for it!
 
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