3/21 Emmy AMPS 400 - Appreciate advice - ALPHATRAK

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JAAshwell

JAAshwell

Member Since 2015
Emmy has been on 3u Lantus for more than a month (we were moving her dose around prior to that). Some days she drops nicely into green and blues but has not done so for the past couple of weeks. My vet wants to increase her dose to 4u but I'm a little nervous about that.

Emmy does seem to be drinking more water, etc., showing symptoms of not being regulated. Could the Lantus have gone bad? It looks fine, is clear, no particles, always refrigerated (we're using vial) and was purchased mid-January.

We are feeding only from Dr. Lisa's low-carb list with some dry EVO.

Would some of you experts look at her SS and give your opinion? Before any one asks, there are not a lot of readings for night because I have a sleep disorder and if I have to get up every two hours I might as well stay up for 24 hours.

We shot 3.5u (eyeballed) this morning.

Thank you!!
 
Sleep problems are the worst. It's so hard to function when you don't get enough sleep. Is there any way you could test just before you get in bed? Also, dry food of any kind can mess with BG. Any chance Emmy would eat all canned? I can't give you specific dosing advice, but I'm sure someone with more experience will be along to give you some input.
 
What time do you go to bed?
it looks like shot time is early evening so if you are up until 9 or later.... it would be great for you to get a before the bed test.....
+2 tests are very helpful for indicating whether you might have an active cycle and want to stay up a little later to keep Emmy safe.

generally it's better to only go up in 1/4 u increments.....
maybe today you could get a +3 , + 6, +9 for a mini curve....
(that changes if she starts dropping into greens)
 
Welcome to the forum!

No doubt, you’re feeling more than a little overwhelmed. If you take a look at the number of people in this forum, you’ll realize that there is a lot to learn and a lot to do but it is very manageable once you learn the ropes. The front end of the learning curve is rather steep, though. The people here will answer your questions and help you. All you need to do is ask!

if you don't mind, I'd like to offer a few suggestions.

Please read the "sticky" notes at the top of the board. One of the things you will note, regardless of which of the two protocols you may prefer, dose changes with Lantus and Lev are done in much smaller increments that your vet has suggested. Doses are increased or decreased typically in 0.25u. It is very easy to miss what could be a very effective dose for your cat if you increase in large amounts. Frankly, too large and too little insulin can result in very similar looking numbers and the best way to know that you're not giving your cat too much insulin is to work the dose up systematically.

Lantus dosing is based on the lowest number in the cycle (the nadir). You're doing a fantastic job of testing during the AM cycle. You could easily be missing numbers that indicate a your kitty's dose needs to be reduced. Even getting a "before bed" test will help.

 
rhiannon and shadow said:
What time do you go to bed?
it looks like shot time is early evening so if you are up until 9 or later.... it would be great for you to get a before the bed test.....
+2 tests are very helpful for indicating whether you might have an active cycle and want to stay up a little later to keep Emmy safe.

generally it's better to only go up in 1/4 u increments.....
maybe today you could get a +3 , + 6, +9 for a mini curve....
(that changes if she starts dropping into greens)
Click to expand...

I'll compromise - I can do a +4, a +8 and +10/11 - I've already missed the +3. Cat food run :-) Just tested at 277, not expecting to see green today.

What would be the symptom of too much insulin? A bounce? We aren't seeing that so I am having a hard time being convinced to roll her all the way back to a very small dose.

My goal is to get her regulated with a dose that keeps her numbers between 50-150. That's all. I understand about the .25 increments but both my vet and I feel that is not doable for me. May work very well for others I'm sure - I bought the calipers, etc. and then realized that it is way too much precision for a woman that doesn't function without at least two cups of coffee under her belt.

I can do 9pm and 11pm sometimes. Of course I would stay up if concerned about anything.

Thank you!
 
Hi, It can take a while to get a kitty regulated.

If you are using an alpha track meter, you don't want any numbers below about 68. That is too low. The alpha track meter reads a little higher than the human meters that most people use on this sight.

If you get a reading below 68, you should reduce the dose by .25. People on human meters use below 50 as a reducing point for new diabetics.

Normal blood sugar measured on alphatrak is about 68-150.
 
I might drop back the dose and check if you can before bed at +3. Let's see what others think. You can move shot times so you don't need to stay up late unless your cat is unsafe.
 
lovey11 said:
Hi, It can take a while to get a kitty regulated.

If you are using an alpha track meter, you don't want any numbers below about 68. That is too low. The alpha track meter reads a little higher than the human meters that most people use on this sight.

If you get a reading below 68, you should reduce the dose by .25. People on human meters use below 50 as a reducing point for new diabetics.

Normal blood sugar measured on alphatrak is about 68-150.
Click to expand...

Thanks - It's good to have the normal numbers on alphatrak.
 
What would be the symptom of too much insulin? A bounce? We aren't seeing that so I am having a hard time being convinced to roll her all the way back to a very small dose.
Click to expand...
A bounce is not necessarily an indication that a cat is over dose. Numbers can sit in a higher than desirable range if too much insulin is on board or the numbers can tank. I didn't suggest dropping your dose back.

If you opt to follow the Tight Regulation Protocol once your cat is transitioned off of dry food, the dose is evaluated every 3 days. TR is a very aggressive approach to dosing. I would be uncomfortable suggesting that you increase by more than 0.25u given that you are routinely seeing nadirs that are under 300. Obviously, this is your decision but I believe that I would be negligent if I didn't point out that increases of this magnitude could endanger your cat.

I'd also be remiss if I didn't point out that by the approach many of us use (i.e., TR), you missed a dose reduction on 2/25 and 3/1.

FWIW, I don't function without a double espresso every morning. I've been using TR for over 5 years.
 
I agree with Sienne - you missed some dose reductions with Emmy on 3 units. Whether you are using Tight Regulation (dose reduction below 68) or Start Low Go Slow Method (reduction somewhere around 120 on an AlphaTrak), Emmy has been below that. Tight Regulation requires an all wet food diet, so you'd be following SLGS for now, and the higher reduction point. Being over dose can show up as higher numbers. I definitely wouldn't increase her, and in fact would go back down if you see those lower numbers again.
 
Thank you all very much. I see where I should have made dose reductions. This is very helpful to get me trained on reading my own SS.

If all these changes are made in .25u I assume everyone following these protocols is dosing with calipers?

I wish I had read these responses before this morning's dose, but now I see a way forward to have this conversation with my vet. I will review all the required stickies again.

Should I back down to 3u and wait for the appropriate low numbers, backing down each time? That is, I shouldn't back down by a huge amount and work back up??

Thank you!
 
JAAshwell said:
If all these changes are made in .25u I assume everyone following these protocols is dosing with calipers?
Click to expand...

Not necessarily....but it is important to have syringes with half unit markings if you can find them. Nobody makes syringes with .25 unit markings so if we're not using calipers, you have to eyeball the .25 unit doses between the lines.

Looks like she's earned a reduction today too, so you'd go down to 3.25
 
Chris & China said:
Not necessarily....but it is important to have syringes with half unit markings if you can find them. Nobody makes syringes with .25 unit markings so if we're not using calipers, you have to eyeball the .25 unit doses between the lines.

Looks like she's earned a reduction today too, so you'd go down to 3.25
Click to expand...

Thanks for the dosing advice. I scared myself today and I deserve it, by bumping up her dose to 3.5u when the vet wanted me to go to 4! We are going to work our way down using the Tight Regulation Protocol. I did find a source for the needles with .5 units.

Now I know 4 Temptations will raise her BG 10. Always handy. Thanks Chris and all!
 
I agree with the reduction, and hope she does well on it.

I know it took me about a week to get good at using the calipers.
 
I agree - I'd reduce her dose immediately to 3.25u because you got the test under 68 today. Actually, following Start Low Go Slow you reduce the dose when you catch a test under 90 on a human glucometer.

You don't have to start your dosing over - just respond to the tests you get. One thing that's hard for many people to wrap their heads around is that Lantus dosing is based upon how LOW the dose gets the cat. So your focus is on that low point because IT determines the dosing - not the random high numbers that you get in between the low numbers.

Most people don't stay up testing all night! We all need sleep! Just getting a before-bed test will reveal any sneaky low numbers that might be lurking in the night cycle. Sometimes that works best for people if they move their shot time a little bit earlier. Whatever works for you. We shot punkin at 7am/7pm - right when we first got up, and then were still able to get at least a pm+3 before heading for bed - and if needed, I could get a +4.5 because most of the time I go to bed around 11:30pm. Just consider what works for you and if you don't sleep that full 12 hours of the pm cycle, get one test whenever you can.

A prerequisite for following the dosing guidelines of the Tight Regulation Protocol is that there can't be any dry food normally eaten by the cat. If Emmy's going to be eating dry food, just opt to follow the Start Low Go Slow guidelines. It's a slower method, but with dry food in the picture it's the only choice. If you can get rid of the dry food, then you have the option of following Tight Reg.

REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

  • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
    Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
    More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet.
  • Feed small meals throughout the day. Some kitties adapt well to free feeding.
 
julie & punkin (ga) said:
A prerequisite for following the dosing guidelines of the Tight Regulation Protocol is that there can't be any dry food normally eaten by the cat. If Emmy's going to be eating dry food, just opt to follow the Start Low Go Slow guidelines. It's a slower method, but with dry food in the picture it's the only choice. If you can get rid of the dry food, then you have the option of following Tight Reg.
​
Click to expand...

Thanks so much for the advice! I don't have the 1/2 unit syringes yet so I eyeballed to 3.25 this morning.

My struggle with phasing out the dry food completely is that I have another cat with hypertrophic cardiomyopathy and he is adamant about having his dry food. Obviously I don't want to stress the heart kitty out. But we are getting low on EVO so now's the time to try. He's just not much of a fan of wet food. Well, honestly none of my five cats are fans of Fancy Feast and I can't afford to feed all of them Tiki! Will keep working on that.

Thank you!

Judy&Emmy
 
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