? 5/6 AMPS 314 dosing advice needed.

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Magda

Magda

Member Since 2016
Please review my chart. I won't be around this weekend to monitor during the day.
 
My trusty experienced dosing advisors could you please look at Menda's ss and help with dosing recommendations for Acro kitty that started on Levemir week ago. @Wendy&Neko @Marje and Gracie @Bobbie And Bubba ......anybody.

We also looking for B12 supplement for Menda to help him with neuropathy that is more economical then Zobalone.

Thank you so much.

Elizabeth and Gus
 
I've been having issues with my computer so using my phone now. Hoping it's not virus. I'm trying to respond as quickly as I can. Not easy one the phone

Thank you. I wonder if I could get b12 they injecting at the vet office. How much and how often would I need to do it because it is pretty big bottle.
 
I'm going to add @julie & punkin (ga) , as she also has experience with acro dosing. If you are not going to be around during the day this weekend, I would keep your dose for now. But get the before bed test and if you get up before AMPS, that would be a good test too. Looks like Menda wants to nadir late, so PM+10 or +11 tests could be interesting. I think you should increase t0 9.5 units next week, when you can monitor. We'd like to get the nadirs just a little bit lower, which will also help reduce some of the higher numbers.

Could you make some changes to your signature line? You are now on Levemir so it's worth noting you've made the change. I would also note that you are using the Target meter, cause you started out with the AlphaTrak and that's the type of spreadsheet you have. It'll just help us giving advice know that you've made the switch.

The b12 from the vet's office is not methylcobalamin b12, which is what you need. If you look at the link Sharon gave you, that is methyl B12. The only thing it's missing is the folic acid that is in Zobaline. This link here contains a formula someone used to make her own version, from Vitacost methly B12.
 
I noticed that you increased to 10u tonight. I agree with Wendy that I would have held the dose at 9u. If I were you, I would drop back to 9u with your next shot.

Here's my reasoning. All of my attention is focused on that sweet little 106 in the middle of the day yesterday. That 106 makes me wonder what Menda was at in the hours just before that. Whatever happened yesterday is the reason for the high numbers today. This is a bounce. Bounces are described in the second post in this thread. Remember with depot insulins, Lantus and Levemir, you're going to make dosing decisions by asking the question "how low can this dose make my cat's blood sugar go?" If it got her below 100 yesterday, it may very well do it again.

With a 10u dose, she's highly likely to go lower than that. If you're not going to be home this weekend, that could be dangerous for her.

I'd spend some time thinking about what your goals are for Menda, how low you want her to go? That range should guide your dosing decisions.
 
With Menda not reacting to insulin anymore I decided to increase it little bit more at faster pace. I'm here today and i will be monitoring him for next few days. I can always go down. But I think he will need more than 11
 
The numbers were going low at first after changing insulin. But than went back up. I was able to check at night and my husband was able to watch him during the day just in case
 
Though I have no experience with high dose kitties, I am concerned that you are taking the dose up too quickly. Usually those following Tight Regulation, which is considered a fairly aggressive approach to dosing, we would hold doses for a minimum of 3 days / 6 cycles, it takes a while for the dose to settle and for you to see where it is going to take kitty.

As Julie pointed out that 106 on the 5/5 ( a mere 4 days ago on 9u ) may be indicating that you were approaching a good dose for Magda. Too much insulin can sometimes look like too little, and by going up so fast you may miss that sweet spot. With high dose kitties you would take them up faster, but perhaps not as fast as you have done over the last 4 days 3u in 4 days is a lot.

I am going to try and get some of our very experienced members with high dose kitties to look in on you, they are mostly west coasters so may not be up and about yet, please be patient, so you can get better advice. But please, in the meantime, don't take Magda up any further just yet and try and get some more midcycle tests in today, if at all possible,I am concerned that if you do increase again you may risk a serious hypo event.
 
Hi Magda

Again I am not experience enough to give dosing advice especially for Acro kitty. All I know is that Lantus/Levemir is depot insulin and dose adjustments should be earned (reduction or increase) base on the nadirs in 0.5U increments for high doses. Please refer to the link I have send you earlier. Simply increasing dose 1U every couple days is not going to brake insulin resistance. It is not that Menda is not responding to the insulin but most likely bouncing ( liver is damping sugar because of low # that are new and the body didn't adjust to it (it takes time). I know that it is very confusing I wish it was easer. Please don't increase his dose as I suspect he is getting to much, just wait and see if he will clear bounce. Please read what Julie posted:

I noticed that you increased to 10u tonight. I agree with Wendy that I would have held the dose at 9u. If I were you, I would drop back to 9u with your next shot.

Here's my reasoning. All of my attention is focused on that sweet little 106 in the middle of the day yesterday. That 106 makes me wonder what Menda was at in the hours just before that. Whatever happened yesterday is the reason for the high numbers today. This is a bounce. Bounces are described in the second post in this thread. Remember with depot insulins, Lantus and Levemir, you're going to make dosing decisions by asking the question "how low can this dose make my cat's blood sugar go?" If it got her below 100 yesterday, it may very well do it again.

With a 10u dose, she's highly likely to go lower than that. If you're not going to be home this weekend, that could be dangerous for her.

Good luck and keeping fingers crossed for better BG soon
Elizabeth

 
Magda said:
The numbers were going low at first after changing insulin. But than went back up. I was able to check at night and my husband was able to watch him during the day just in case
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Here is more info:

What is the Somogyi Effect?

Glucagon and insulin are released by the pancreas. Glucagon and insulin have opposite effects: insulin makes the blood sugar go down and glucagon causes blood sugar to go up. They work together to balance blood glucose levels. Glucagon can increase blood glucose levels by causing the liver to release its stored glucose to the blood stream. Insulin lowers blood glucose by allowing tissues to use or store glucose.

When too much insulin is given the blood glucose drops rapidly and hypoglycemia (low blood sugar) results. This can trigger the body to release glucagon (and other hormones) and the result is that glucose is dumped into the blood. This can lead to hyperglycemia (high blood sugar). So, you have hyperglycemia induced by hypoglycemia, or the Somogyi effect. (Somogyi was a scientist who did research on glucose production by liver during times of stress.)

The method of determining if Somogyi effect is occurring is to do a blood glucose curve. Your cat will have a specific pattern of hyperglycemia if the Somogyi effect is occurring. Although at first it seems odd, the treatment for this type of hyperglycemia is to DEcrease the insulin dose. This prevents the hypoglycemia from occurring and triggering the Somogyi effect.
 
I'm. Checking his insulin every hour today to see how he reacts. He had blue numbers on 5th but than I was checking him at night and than next day and his numbers stayed in 300s all the reserve is gone now. I was able to check him couple times later on but forgot to write number. So didn't want to write it in but always staying In 300s even at his nadir
Let's see what this brings and we will see what to do next
 
Don't forget my cat is not diabetic he is acromegaly can and rules apply differently. His IGF is over 521
 
Magda said:
Don't forget my cat is not diabetic he is acromegaly can and rules apply differently. His IGF is over 521
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So you are in the right place because here is a good number of people with lots of experience with acro kitties including Wendy and Julie.

Menda is your cat and you decide what is best strategy for him not the rules. The guidelines used here are based on many years of experience and are individually adjusted for each individual with consideration given to many health conditions.

Good luck with finding dose that will help Menda's BG regulated.
 
Magda said:
Don't forget my cat is not diabetic he is acromegaly can and rules apply differently. His IGF is over 521
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I realize she has Acro, and there are different 'rules' that's why I have asked some of the High Dose /Acro members to pop in when they can. I've just not seen people adjust dose so aggressively so it makes me a little nervous.
Both Julie's and Wendy's cats were/are are Acro. They both advised to be cautious at the weekend.

I see that Menda has dropped into the yellows she's dropped 100pts in 2 hours, that's quite a lot, remember with lev you are looking at onset at around +4 /+5 and the nadir would be around the +8 to +10 mark, though every cat is different and with time you will know when her usual nadir is.

So looking at her numbers today it is looking likely she might drop further. Paws crossed for a nice cycle for her.


Magda said:
all the reserve is gone now.
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What do you mean by this Magda? What is the reserve you are talking about?
 
elizabeth and gus said:
The guidelines used here are based on many years of experience and are individually adjusted for each individual with consideration given to many health conditions.
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Actually, the guidelines for TR are based on studies and published reports, not just the experience of laypeople.

Magda, I know it's frustrating and upsetting to see the high numbers, but you've gotten some excellent info from very experienced people that are extremely familiar with the protocol AND high dose kitties. It really is important that you give each dose time, in order to let the depot adjust to that dose. By increasing so fast, you run the risk of overdosing your kitty. It's much easier and safer to prevent a hypo than it is to treat one. I agree with what others have said, that Menda is bouncing. You need to let the bounce clear before changing the dose. You could miss the perfect dose by increasing by such large amounts so fast, as has been said, too much insulin often looks like too little.

I see Gill just posted, as I was typing. By "reserve", do you mean the depot? It's not gone. It just hasn't had a chance to catch up to the dose you're at.

Magda, please don't feel that we are ganging up on you. You asked for dosing help, and you've received it, along with sound reasoning for the suggestions. Please take the time to read what has been written and think about it. We really care about your kitty and want what's best.
 
Magda said:
Don't forget my cat is not diabetic he is acromegaly can and rules apply differently. His IGF is over 521
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Not true. Menda is diabetic and needs insulin. There are many reasons a cat may have diabetes. The latest research shows that one in four diabetic cats has acromegaly. We have had many diabetic cats with acromegaly on this board, and other than some with bigger doses, there isn't a lot of difference in the way we decide how to change doses. We always decide how to change a dose based on how low a dose can take a cat.

I am worried about your potentially dangerous increases in dose. The latest research also shows that the number one cause of death of acromegalic cats is from hypos. This latest research I'm referring to is from the Royal Veterinary Clinic in London, England. They have an acromegaly cat clinic and have probably looked at more acrocats than anyone else.

You saw a 106 on a dose of 9 units, then Menda probably bounced.
Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Bouncing is a perfectly normal reaction for a cat (it's not the Symogyi referred to above which has been proven not to happen in cats on long lasting insulin). When a cat bounces, their numbers go high, and go high for up to 6 cycles. Do not increase the dose based on these temporarily higher numbers. But rather wait to see where Menda's blood sugar will go after the bounce is cleared and the numbers go back down. The other phenomenon you can see is something we call New Dose Wonkiness, or NDW, which is a temporary increase in numbers that can happen after you first increase, as the depot builds. Again, this is perfectly normal and you just have to wait it out. Patience is a very important part of managing feline diabetes with the depot insulins.

As a guideline, please hold doses for at least 6 cycles at this point. If you are seeing numbers like that 106, I would hold a dose for at least 8 cycles. And since you've gone up the dosing scale so quickly, I would monitor especially closely the next couple of days as you wait for the depot of this current dose to build.
 
Magda,

Please hold the dose like everyone is saying. You received a pen from me today and you have atleast 300 units. Though Boo did not have Acro I hear the same desperation in your voice as I had.. I know what you are feeling. I wanted to see the numbers come down quickly and it's just not the way this works. It takes patience and time. Boo Boo started on Lantus and we kept increasing the dose but he was bouncing and I had no idea that I was giving him to much insulin. My vet kept increasing the dose and that's when I found the board. Please take it slow and don't change doses so quickly. It does take time to regulate them and it can become very frustrating. You're doing a great job but please hold the dose. Please take the time to read what all these wonderful people are sending you.

You are in my thoughts and prayers,
Nadine
 
You've gotten some great advice already, so I won't add too much more. Nadine's comment really resonated with me:

BooBoosMom said:
I hear the same desperation in your voice as I had.. I know what you are feeling. I wanted to see the numbers come down quickly and it's just not the way this works. It takes patience and time.
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I felt that same way. I spent the summer of 2011 chasing Punkin's high numbers, increasing the dose (but not by large enough increments for the dose size we were at), and feeling like nothing worked. It was incredibly discouraging. Nadine's right, Lantus and Lev don't work as quickly as we'd like sometimes, but they are excellent at holding blood sugar down once you're at a good dose.
Think of changing doses like steering a barge - a small shift in the steering wheel can completely change the direction the barge is headed. Once it's nudged that direction, it will keep going strong that way. Another small shift will take a while to show its effects. With these depot insulins, you make a change, then you need to wait to let the depot catch up with the new, larger dose, and then you'll be able to see what the dose can really do in Menda's body.

The depot is an important player in our cats. The size of the depot corresponds to the size of the dose. When you increase the dose, it takes about 6 cycles or so for the depot to grow to match the new, larger dose. When you decrease the dose, it can take 4-6 cycles to have that depot decrease to "fit" the new, smaller dose. That's the reasoning for typically holding doses 6 cycles and not rushing dose increases. With a large depot, sometimes we can even skip a dose and not have it be noticed in the cat's blood sugar.

I do agree with you on the size of the increases. At 10u, it's pretty typical to increase by 1u increments. I'd just want to give it long enough to see what that new dose can do before you increase again.

Believe me, anyone with a high dose cat, or a cat that's been difficult to get regulated, understands how frustrating it is. This is a situation where slow and steady wins the race.

:bighug::bighug::bighug: Hang in there! Keep asking questions. You know we're happy to help.
 
elizabeth and gus said:
My trusty experienced dosing advisors could you please look at Menda's ss and help with dosing recommendations for Acro kitty that started on Levemir week ago. @Wendy&Neko @Marje and Gracie @Bobbie And Bubba ......anybody.
Click to expand...
Just a reminder...
@elizabeth and gus
Please be aware: There are not any "dosing advisers" or "experts" on the FDMB (per the owner of the board). The FDMB is an open board subject to peer review where laypersons with varied degrees of knowledge and experience are free to share their own thoughts and opinions through explanation and by making suggestions.

Tricia Cinco(GA) & Harvey said:
Actually, the guidelines for TR are based on studies and published reports, not just the experience of laypeople.
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Actually, the TR Protocol mostly used in this forum was created by laypersons... members of the German Diabetes-Katzen Forum and was published in the Journal of Feline Medicine and Surgery several years later (much like how SLGS was created by laypersons of the FDMB, although SLGS was never published).


 
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