AMPS 320 - PMPS 342 Bashful - Need Advice Dosing

Okay guys, I've posted a few questions on the main board, but not over here. I guess these are more lantus specific.

[FORGIVE MY VERBOSE NATURE...I'M SLEEP DEPRIVED AND CAN'T FIND MY HINEY WITH TWO HANDS AND A MAP AT THIS POINT. LOL]

Bashful just came back from the falls. Took Kitty to vet and had full blood workup to make sure nothing else was wrong and that this was just him needing to get back OTJ. All numbers ok, other than off pancreas numbers, which would make sense given that his BGs were high. Bash is about 17 years old, no major health concerns. He's on all wet gluten free diet with FF.

They kept him 24 hours to start on Lantus (even thou I know how to do curves, I wanted to have a better average going in - given that this was a new insulin - I was on PZI last time). They had him 1 unit every 12 hours. When he came home he had some much lovelier numbers, He went in there at 400 and came back out around 195 - and at BG shot +11 (1 hour before next shoot - and before I was due to give my first virgin (again) shot he was at 151. I waited a bit and he came up to 232 in an hour and a half and I shot a skinny 1 unit then.

1/17 - Vet return
PMPS - (+11 - 160), (+12 - 198), (+13 232), - shot skinny 1 unit

SUMMARY:

PMPS 232 - shot 1skinny unit lantus
+1 255
+2 181
+4 171
+5 173
(at this point it's 1:30 a.m. and I can hardly see and had to get back up early to do it all again...yeah...so went to snooze

1/18
AMPS - 320 - Shot 1 unit lantus, and apparently not very well (CAUSE I GUESS YOU CAN TELL BY THE NUMBERS HE WASN'T MOVING MUCH)

+1 - 327
+2 - 280
+3 - 305
+4 - 287
+5 - 346/338
+6 - 336
+8 - 375 - AT THIS POINT CAN I SAFELY GUESS I MUST HAVE SHOT A FUR SHOT???...GRRRR....

PMPS - 342- shot 1 unit Lantus (I and am pretty positive I did this one correctly and felt the plunger move and such (IT'S SUCH A SMALL AMOUNT TO CONTROL....DOES ANY ONE ELSE HAVE THESE STRUGGLES?).

1/18/10 -
PMPS - 342
+1 - 347
+4 - 287
+5 - 343
+6 - 393 (CRANKY VERY TIRED BEAN NOW JUMPS UP AND DOWN ON BED AND HAS A FULLY NINNY HISSY SNIT!)

SO what is the deal with all these high numbers???? I am totally un-used to the Lantus shed issue (used pzi before-which had a tendency to jump him low somewhat quickly).

I am not sure, but could have done a fur shot this a.m. that's going to screw these all up again shed wise. But I'm very very frustrated by the fact that at I started tonight PMPS at 342 and now at +6 I am back up to 393, with not much downswing in between.

Is this just shedding issues? Not doing my 12 hour at exactly 12 hours because of the lower number the first time? Maybe a fur shot? Am I not using enough insulin? Do I try this another 24-48 hours and then if they stay high like this do I then up the dose to 1.5 and then leave it for 2-4 days to then even out again? nailbite_smile nailbite_smile

Do I just have to be on Lantus for close to a week to see if the shed buids up and things even out (AT LOWER NUMBERS DARNIT!) - or do a smidchen increase somewhere along the way?

I'll create the spreadsheet tomorrow (with what little I know) while I am at work. I had limited access today to my computer.

Trying to remember to breathe, but go to freaked out land when his numbers stay too high because of fear of ketones...numbers to too low I freak out cause I think he might to hyp ;(not that the little skinker is going anywhere near that direction at the moment.

Going to get more test strips and ketone strips tomorrow on the way home from work.

Any advise would be so gratefully appreciated!

Theresa & Bashful (age 17)

Welcome to Lantus Land, Theresa! :smile:

It does look like what you are going through is the fairly typical start to Lantus. It is not uncommon for cats to get action off their first Lantus shot (which happened at the vet's office), and then have to go through the normal stage of higher numbers as the shed builds. You can read more about the Lantus shed here.

We typically hold the starting dose for 5 to 7 days in order for the shed to be constructed. You can look at any Lantus user's spreadsheet and see the same higher beginning numbers. I know how odd it is to see this coming from being a PZI user (I was over over a year as well), but Lantus is so vastly different than PZI. It is best to just forget anything you knew about PZI, as the majority of it does not apply with Lantus dosing.

Stay with the 1u dose and shoot as close to 12/12 as you can every shot. Post here in LL daily and we will help you along the way. If you can get a spreadsheet set up tomorrow that would be incredibly helpful to people looking at it to help you with dosing. Please mark any time differences from the 12/12 schedule on your spreadsheet. With Lantus, an early shot equals a dose increase and a late shot equals a dose decrease. Lantus likes consistency with both dose and time.

Read the starred stickies at the top of Lantus Land, particularly the New To Lantus sticky. Refer to them often, and ask whatever questions you may have.

I understand you had blood work run on Bashful to figure out why he came out of remission. Were his thyroid levels normal (T4, Free T4)? What about his teeth? Does he perhaps need a dental done? Even a cleaning can make a kitty come out of remission. Was a urinalysis run?

There are generally people here in Lantus Land 24/7 to help you with anything you may need. For right now, I would just stay with the same 1u dose every 12 hours, get spot tests when you can (more info on data collection here), and test for ketones daily.

Looking forward to seeing you post often!

Hi Theresa!

Just want to welcome you to Lantus Land! Sorry to hear Bashful needs a bit of juice right now, but I think you're gonna like lantus.

Hope to see you posting often and looking forward to meeting Bashful.

When u have time, u can learn how to add his pic (called an AVATAR) in the Tech forum, and test the pic in the Everything forum.

Read up on lantus in the info stickies up top and the info threads with the star symbol attached (Cleaning up LL, and Filling the Shed"

Have a good day

Good morning Teresa and welcome to Lantus Land (LL)

I think Cassandra provided the answers to your questions. If not, or if you have more questions, please let us know. The couple of housekeeping details that will help us include setting up a spreadsheet and profile. Information and templates are found in the Tech Forum. Both can be linked to your signature.

Posting: We open one thread (or condo) per day per cat. The subject line should read: todays date/your cat's name/ AMPS and subsequent #s. So today would be: 1/19 Bashful PMPS 342 Need Advice Dosing. Any requests for help, etc. should be included in the subject line and then edited out once your question has been answered. The subject line will only allow for a certain number of characters so you can list the AM vs. PM cycle or whatever makes sense as long as current numbers are visible -- especially if you need help.

I suspect the greatest challenge for you will be to forget what you know about insulin since Lantus is so different than PZI. Not only will pre-shot BG values be important, it's also important to get mid-cycle checks, which is seems like you are already doing.

Please ask questions and let us know how we can help.

Hi guys, thanks very much. I think I got like 4 hours of sleep last night...sigh...

This morning Bashful's AMPS is 395. I'll keep with the 1 unit for now. The unfortunate thing is that I work 45 mins away and I won't be able to do spot checks during the day in the work week. I can do spot checks most evenings and can do curves on weekends.

Bashful seems to be feeling okay. He's drinking a bit more water than is usual, but seems to be eating and going to the bathroom fine and is in good spirits, other than the irritation at me poking the heck out of him. I have a Precision Xtra BG Meter, which also can test for ketones with bg like strips. I'm going to pick some up on the way home (they are super expensive, but I can order subsequent boxes on ebay) - I just don't want to wait since his numbers continue to be so high.

What do I do if ketones show up? back to the vet right away, yes?

Thanks,
Theresa

Theresa&Bashful said:

Hi guys, thanks very much. I think I got like 4 hours of sleep last night...sigh...
This morning Bashful's AMPS is 395. I'll keep with the 1 unit for now. The unfortunate thing is that I work 45 mins away and I won't be able to do spot checks during the day in the work week. I can do spot checks most evenings and can do curves on weekends.
Bashful seems to be feeling okay. He's drinking a bit more water than is usual, but seems to be eating and going to the bathroom fine and is in good spirits, other than the irritation at me poking the heck out of him. I have a Precision Xtra BG Meter, which also can test for ketones with bg like strips. I'm going to pick some up on the way home (they are super expensive, but I can order subsequent boxes on ebay) - I just don't want to wait since his numbers continue to be so high.
What do I do if ketones show up? back to the vet right away, yes?

Thanks,
Theresa

Click to expand...

ok, question: how soon after ur shot time do u leave for work?

we do suggest an "out the door" spotcheck, so there's one spotcheck u can add to ur spreadsheet data,,,then when u get home a "in the door" spot check"

Are u adding water to his wet food? a bit of extra water to the wet food helps with the excess drinking and peeing..overtime that will gradually decrease too.

If ketones show up at any given time - post here, note it in ur spreadsheet always
u will prob need to learn about ketones a bit further just in case and so u are prepared.
I'll let others give u a bit more info on ketones for now.