A titration plan written down in advance is easier to stick to and easier to abandon deliberately. An improvised one becomes a series of decisions made on the worst day of each week.
0 likes 3mo
Practice · Dosing & titration · continued
Micro-titration: a disputed topic, argued properly — one year on posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
I think the Micro-titration question is answerable and has not been answered, which is a more optimistic position than most of this thread.
32 likes 3mo
On post #31 — agreed on the reasoning, with one qualification.
The four-week step is a trial convention, not a pharmacological constant. It is roughly four half-lives for a week-long half-life, which is the interval at which you are assessing a stable concentration rather than a rising one.
Same conclusion as the reply above, reached differently, which is mildly reassuring.
11 likes 3mo
Collapsed as off-topic by two members at trust level 3 or above
Seconded. It reads as careful rather than confident, which is the right register.
Worth separating two things that post #35 runs together.
The maximum studied dose is a fact about the trial and not a ceiling on the molecule. It is also the last point at which anything is known, which is the reason to treat it as one.
That has held every time I have looked, which is not the same as always.
17 likes 2mo
plateau_notes, post #15: No disagreement from me. Posting only so the question does not look ignored. Go to post
Concentration and dose get conflated constantly in this subcategory. Changing how much diluent you add changes the volume you draw and changes nothing about the dose.
Everything in post #35 holds. The case it does not cover is the one I have.
Micro-titration sits at the boundary between what this community can usefully discuss and what it cannot, and I think it falls on the discussable side, narrowly.
3 likes 2mo
Narrowing post #39, because the general version has more than one answer.
Dose equivalence between different incretin analogues is a weak concept. The molecules differ in structure, half-life, receptor selectivity, and in what has been studied clinically. One mg of semaglutide is not equivalent to one mg of something else in any meaningful sense.
Written from notes rather than memory, which is why the numbers are specific.
0 likes 2mo
Collapsed as off-topic by two members at trust level 3 or above
Worth separating two things that post #38 runs together.
Concentration and dose get conflated constantly in this subcategory. Changing how much diluent you add changes the volume you draw and changes nothing about the dose.
Noting that I have skin in this question and have tried to discount for it.
i.wojcik, post #28: Concentration and dose get conflated constantly in this subcategory. Changing how much diluent you add changes the volume you draw and changes nothing about the dose. Go to post
Two questions I would want answered before drawing anything from the Micro-titration data above: how were the cases selected, and what happened to the ones that dropped out.
On Micro-titration the community has more anecdote than the confidence in this thread implies, and I include my own contribution in that.
15 likes 2mo
bench_entry, post #25: Confirming post #22 from a second method, which matters more than confirming it from a second person. Micro-titration: the concept of increments smaller than the labelled steps. It has no evidence base from trials but is described by some people. The downside is that very small increments are hard to measure accurately with a syringe. A… Go to post
Post #43 and I disagree about the size of the effect, not about the direction.
A titration plan written down in advance is easier to stick to and easier to abandon deliberately. An improvised one becomes a series of decisions made on the worst day of each week.
Speaking for myself and not for anyone else who has posted here.
Concentration and dose get conflated constantly in this subcategory. Changing how much diluent you add changes the volume you draw and changes nothing about the dose.
21 likes 2mo
sa.okonkwo, post #32: I think the Micro-titration question is answerable and has not been answered, which is a more optimistic position than most of this thread. Go to post
Nothing here is medical advice, and a titration question is one of the few where a prescriber can genuinely answer in a minute what a thread will take a week to circle.
Someone should write this up properly, and it should probably not be me.
a.cabrera, post #5: Taking post #4 at face value and following it one step further. Small correction to my own earlier position on Micro-titration. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely. Go to post
Post #49 put the caveat in the right place and I want to underline it.
The claim about Micro-titration upthread is stronger than its source supports. I have read the source. The source says "associated with" and the post says "causes".
Dose equivalence between different incretin analogues is a weak concept. The molecules differ in structure, half-life, receptor selectivity, and in what has been studied clinically. One mg of semaglutide is not equivalent to one mg of something else in any meaningful sense.
Anyone who has looked at this more carefully, please correct the record.
19 likes 1mo
t.kulkarni, post #23: Concentration and dose get conflated constantly in this subcategory. Changing how much diluent you add changes the volume you draw and changes nothing about the dose. That is the practical version. The rigorous version is longer and says the same thing. Go to post
The arithmetic in post #53 is right; the assumption feeding it is the part to check.
My understanding of Micro-titration is a few years old and may have been superseded. If it has been, I would genuinely like to know rather than keep repeating it.
Reaching a dose and staying there for a year: the question of whether a stable dose remains effective over years is mostly answered by the withdrawal trials and by real-world reports. The dose does not seem to stop working, but the longest trials are not indefinitely long.
2 likes 1mo
Everything in post #53 holds. The case it does not cover is the one I have.
Micro-titration has a well-known answer and a correct answer, and the interesting work is establishing that they are the same. Nobody has done that here yet.
26 likes 27d
f.petrov, post #30: Coming back to post #28, because the follow-up matters more than the original answer. Answering the Micro-titration question as asked, then the question I think is meant. As asked: yes, with the qualification below. As meant: it depends on how the first measurement was taken. Go to post
Useful. I had the fact and not the reason, which turns out to be the important half.
Concentration and dose get conflated constantly in this subcategory. Changing how much diluent you add changes the volume you draw and changes nothing about the dose.
4 likes 22d
Confirming post #57 from a second method, which matters more than confirming it from a second person.
Offering a way to settle Micro-titration rather than another opinion about it. Two measurements, taken the same way, a fortnight apart. If the difference is within the noise, the question was not answerable at this precision.
0 likes 20d