Chloe is 173 @+9

Status
Not open for further replies.
Do you believe I got the Chewy order this morning with the gravy-lovers FF?! I ordered it last night! Also, Chloe went UP on her midday test and I want to get her back in the blues, so depending on what the PMPS is, I may go back to .5. Oh, it was the night before last. Still...
 
You didn’t ask for advice so I hesitate to post... but I really hope you stick with 0.25u tonight and give it a bit more time. And I RARELY post dosing advice. I’m just looking at that notable drop at last night’s +2 with no further testing through the PM cycle, and I’m really wondering how low she ended up going. Today flat yellows could be a follow-up to what might have happened last night.

I’m cheering you two on... and speak up only because what’s happening feels very familiar to me. I helped in a situation where a vet who was stellar in all ways (as yours seems) also dosed Lantus based on pre-shots. The cat ended up at a vet school teaching hospital with an internal medicine specialist (who specializes in endocrinology) and she really raised her eyebrows when told the dosing. She gently advised to be patient with the lower dose and sit one’s hands for a few cycles and that the cat might be trying to go into remission but that the variable dosing was tripping things up. It made a world of difference.

It seems Chloe has a (distant?) history of DKA so that does matter, though I’m not clear that that’s why your vet is recommending up to 0.75u. For what it’s worth, I really appreciate (and agree with) most of her opinions as well as her dedication; it’s hard to find these days.

If you go with 0.5u tonight — and you’re holding the syringe so it’s totally your prerogative — I encourage you to get a +2. If it’s lower than the pre-shot value, as it was last night, then I encourage you to monitor the cycle and get additional test(s) in as it could be an active cycle and I’m sure no one wants to see another BG in the 30s. That can be scary!
 
JL and Chip said:
You didn’t ask for advice so I hesitate to post... but I really hope you stick with 0.25u tonight and give it a bit more time. And I RARELY post dosing advice. I’m just looking at that notable drop at last night’s +2 with no further testing through the PM cycle, and I’m really wondering how low she ended up going. Today flat yellows could be a follow-up to what might have happened last night.

I’m cheering you two on... and speak up only because what’s happening feels very familiar to me. I helped in a situation where a vet who was stellar in all ways (as yours seems) also dosed Lantus based on pre-shots. The cat ended up at a vet school teaching hospital with an internal medicine specialist (who specializes in endocrinology) and she really raised her eyebrows when told the dosing. She gently advised to be patient with the lower dose and sit one’s hands for a few cycles and that the cat might be trying to go into remission but that the variable dosing was tripping things up. It made a world of difference.

It seems Chloe has a (distant?) history of DKA so that does matter, though I’m not clear that that’s why your vet is recommending up to 0.75u. For what it’s worth, I really appreciate (and agree with) most of her opinions as well as her dedication; it’s hard to find these days.

If you go with 0.5u tonight — and you’re holding the syringe so it’s totally your prerogative — I encourage you to get a +2. If it’s lower than the pre-shot value, as it was last night, then I encourage you to monitor the cycle and get additional test(s) in as it could be an active cycle and I’m sure no one wants to see another BG in the 30s. That can be scary!
Click to expand...
Totally agree with you :cat:
 
Sorry, I didn't see your posts until after I gave Chloe her shot. I was uncomfortable with seeing her midday shot up 18 from her AMPS. I thought the numbers should be going down at that time. Then, when her PMPS was up in the magenta, I decided to up the dose a notch. I now have the FF gravy if she goes hypo again. I don't think she will.
 
I agree with JL, I would keep testing, usually with Lantus I look for a drop by +2 of around 20%. If it is more than that, it likely signals an active cycle, and warrants closer monitoring through at least the earlier part of the cycle if you can. The difficulty is that we have what appears to be a cat who often has more than typical duration, and quite good carryover.

What do you think about at least getting a +4 or +5, Roberta, and depending on how that number looks (i.e. continuing to drop), I'd feed some higher LC or mix in some of the new MC you got with Chloe's regular food, to slow her down a bit, and I would consider setting the alarm to check somewhere around +7 or +8. Of course, if the numbers at +4 or +5 are substantially lower, it would mean checking more frequently and feeding more of the higher carbs. Just trying to offer some suggestions, since I can't stay up any longer this time, I have to go to work tomorrow, so won't be able to steer you, as the test numbers come in.
 
You guys worry too much. I went to bed. Chloe slept on one side of me and Fuzma on the other. She's at 204 this morning and I'll test again in +2. Chloe has a voracious appetite.
 
Roberta and Chloe said:
Today and Yesterday, her numbers went up at +2. Why?
Click to expand...
Sometimes you can get a bit of a food bump before the cat onsets, so that is why a much lower +2 than preshot can often signal some action.

The other possibility, she went lower last night and may be starting a little bounce this cycle as she did yesterday. Hard to know for sure without having seen additional tests last night.
 
Roberta and Chloe said:
I'm not understanding. Her +2 is higher. Same as yesterday.
Click to expand...

That particular part of my comment was referring to the +2 last night and previous night being lower.

Her +2 today is technically flattish, since numbers look to be within allowable meter variance. Most cats on Lantus begin onsetting at +2, which is when numbers should start to come down as the insulin has started to reach the bloodstream.

As for today, as I said, depending on what you feed at shot time, and how carb sensitive she is, you may get a small bump in numbers, usually a +1 gives you a better idea of that, but she may be in a mini-bounce if numbers continue to not move much or trend back up to pm preshot.
 
Roberta and Chloe said:
I'm not understanding. Her +2 is higher. Same as yesterday. Is there somewhere a visual of what the curve should look like, or the percentages + or - for each interval?
Click to expand...

We do have something here...
https://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/

I like thinking of the tests relative to meter variance, which is where my reference of 20% comes from. I found it helped me get a feel for what the cycle was looking like. If numbers were within meter variance, they were arguably "similar" tests. Any lower numbers that were greater than meter variance made me keep a closer eye on things. Like Chloe's cycle last night. PMPS 345, +2 was 251, the difference is more than meter variance... perhaps just a wee bit, but if I had seen that with Mav, I would have checked one more test to see if he was dropping further.
 
@Roberta and Chloe I too suggest that you read through the info @Christie & Maverick linked above. Even though you’re trying to navigate your way through this with somewhat conflicting dosing advice from your vet and this board (and Lantus protocol offered here), it’s still really valuable to have a general understanding of Lantus and how it tends to work in felines. I remember re-reading the above link as well as some of the other Stickies posted on the Lantus forum regularly ... especially the part about what a cycle might look like and how the depot and bouncing can impact things.

You can always take what you feel applies and ignore the rest. Those Stickies have evolved over the years and reflect a wealth of real-life experience and knowledge.... and are good “food for thought.” Knowledge is power, right?

So sometimes it’s about setting expectations. Christie has already tried to answer your question about why the +2 isn’t lower. If the answer didn’t make sense, please ask questions, and keep asking questions, until it does. In the meantime, here’s an excerpt from the Sticky linked above:


Learn how YOUR kitty is responding to insulin:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
  • How to do a Curve - a simple explanation
Example of an ACTIVE, but NOT necessarily typical Lantus/Basaglar cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
 
Roberta and Chloe said:
What do you mean by 'active'? I don't remember that term from a couple years ago.
Click to expand...
The extract that @JL and Chip posted shows what an active cycle is. I guess the way I might choose to further explain it, it is the continued (sometimes quick drop) until you reach nadir. It is just a phrase we use which means additional tests are required, until you get a test where you've reached nadir and/or a test that needs intervention if she drops lower and needs higher carbs to come back up.

Something about the long acting insulins that also might help you, that I have seen explained in the past, try and look at the data /tests you have in terms of "waves of action". Don't focus on one cycle exclusively, you won't necessarily see the same blood glucose lowering effects of the insulin every cycle. Try and look at the patterns over a period of 6 cycles. @Wendy&Neko used to call it looking at the tea leaves :). If we did that, what does that look like for Chloe? What patterns can you see?

Try and see from last low, next few cycles, what did she do? Numbers rose, bounce started. Numbers stayed high, bounce continues. Numbers start coming down ... bounce breaks, maybe today, since I see 173 @+9 today (good job getting that spotcheck Roberta). When a cat becomes closer to well-regulated, the cycles on L&L get nice a flat. Don't ask me what that's like I don't think Mav is quite there yet :p.

The only wild card for me is the jumping around in dose, but I feel the general idea should be helpful to you. Does this help?
 
@JL and Chip
Hi JL I was just reading what you posted above
I'm a little confused by this


Example of an ACTIVE, but NOT necessarily typical Lantus/Basaglar cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

It says example of an active , but NOT necessarily typical Lantus cycle
Until kitty is well regulated the description below is NOT not what you'd consider a
typical cycle.

Then says the example below is what you're working towards a nice shallow curve flat cycle is the ultimate goal
OK what I'm confused about to me it says in one breath its an example of an active cycle, then at the end it says the example below is what we are working towards

So which one is the example for
an active cycle or what we should be working towards
I hope you understand what my question is lol
I definitely do understand what an active cycle is though
I'm just confused which one the example is for

Thank you JL :bighug::cat:
 
Status
Not open for further replies.
Back
Top