2/7 Maki, PMPS 259
- Thread starter Patricia & Maki (GA)
- Start date
JaxBenji
Very Active Member
Hi - Welcome - here's your post from Health - just linking for background - https://www.felinediabetes.com/FDMB...t-way-buy-insulin-so-much-i-dont-know.242652/
Perhaps someone with more experience can stop by and help guide you - please at a minimum get pre-shot tests (so AMPS and PMPS) - those tests tell you if it's safe to give insulin. A kitties' numbers can change a lot in an hour. Tagging a couple of people who may be around - @tiffmaxee or @Marje and Gracie or @Sienne and Gabby (GA)
Perhaps someone with more experience can stop by and help guide you - please at a minimum get pre-shot tests (so AMPS and PMPS) - those tests tell you if it's safe to give insulin. A kitties' numbers can change a lot in an hour. Tagging a couple of people who may be around - @tiffmaxee or @Marje and Gracie or @Sienne and Gabby (GA)
FrostD
Very Active Member
Quick summary for everyone:
Maki was started on 2U Prozinc two weeks ago, the usual story of not needing to home test, wrong food, etc. Had a symptomatic hypo, emergency vet said it was just a "bad reaction" to ProZinc so switched her to 1U Lantus. Vet did a curve Monday (2/1) and instructed Patricia to go up to 2U. She was at that dose until coming here, where the recommendation was 1.5U.
In her previous thread we got her started on home testing, and now she has all supplies (meter, strips, ketone test strips). She's just trying to get the hang of home testing. Advised no food changes until the testing was more consistent.
We decided to send her here because there were a few too many questions we couldn't really advise on, and felt she would benefit more here than on the main board.
Maki was started on 2U Prozinc two weeks ago, the usual story of not needing to home test, wrong food, etc. Had a symptomatic hypo, emergency vet said it was just a "bad reaction" to ProZinc so switched her to 1U Lantus. Vet did a curve Monday (2/1) and instructed Patricia to go up to 2U. She was at that dose until coming here, where the recommendation was 1.5U.
In her previous thread we got her started on home testing, and now she has all supplies (meter, strips, ketone test strips). She's just trying to get the hang of home testing. Advised no food changes until the testing was more consistent.
We decided to send her here because there were a few too many questions we couldn't really advise on, and felt she would benefit more here than on the main board.
FrostD
Very Active Member
I'm glad to see the spot check, also glad that it's not too terribly high. Hope she didn't give.yiu too much trouble!
Re: the depot from previous thread, and a note for you. Keep in mind Maki may still be seeing some effects from the depot and it may be helping her even though there was no shot this morning. Like Mogs shared, it takes about a week to fill provided there's consistent shots.
Welcome, Patricia. I skimmed your post from Health. It sounds like you and Maki had quite the introduction to feline diabetes!
My first suggestion is that you read over the sticky notes at the top of the Board. You will be overwhelmed. There's a lot of information there. Please don't hesitate to ask questions. There are conventions on the Lantus board that are different than on Health. I addition, Lantus is very different than Prozinc.
Did you skip Maki's shot this AM? There's no dose noted for AMPS today.
Where the two insulins are alike is in the need for tests. It's important to always get a pre-shot test. It's the only way to know if it's safe to give insulin. With Lantus, the dose is based on the lowest number in the cycle (the nadir) and not on the pre-shot number. Thus, getting spot checks during both the AM and PM cycles is important, as well. We encourage people to always get a "before bed" test so you know that Maki is in safe numbers before you turn in for the night.
With being new to Lantus and to FD, you want to do what you can to avoid skipping a shot. Lantus is a depot type of insulin. What that means is that a small amount of each dose forms micro crystals that are deposited in the fat tissue. These crystals dissolve slowly and give Lantus it's duration. If you skip shots you end up depleting the depot. It can take some time for the depot to recover. In fact, with your just having switched to Lantus, it will take 5 - 7 days for the depot to become established. It also means that you generally hold the dose for several days in order for the depot to catch up to any change in dose. How long you hold the dose depends on the dosing method you choose -- either Tight Regulation (TR) or Start Low Go Slow (SLGS).
If you look over the New to the Group sticky, it will tell you about subject lines. If you look over the titles on the Board, you'll not they look similar. We include the date, the cat's name, AMPS-#, +time and #, etc. In other words, just stating you have a spot check of 278 only gives us a partial picture of what's going on. When did you test and get the 278? I reapplied that 1300 is helpful to you but I may be in a totally different time zone. It's why we use the +time that's noted on the spreadsheet (SS). It gives us a common language when talking about time. It's also helpful to make sure you enter the information on Maki's SS. For many of us, as soon as we open your thread (aka "condo"), we open your cat's SS.
One quick tip re. testing -- treats! Any time you test, whether successful or not, Maki gets a treat. Many people use freeze dries chicken (or any freeze dried protein). Or some people will poach/cook chicken and use that as a treat. Basically, you can use anything that Maki likes whether it's food, brushing, etc. You want testing to be associated with something positive.
There's a lot to get used to. Please let us know how we can help.
My first suggestion is that you read over the sticky notes at the top of the Board. You will be overwhelmed. There's a lot of information there. Please don't hesitate to ask questions. There are conventions on the Lantus board that are different than on Health. I addition, Lantus is very different than Prozinc.
Did you skip Maki's shot this AM? There's no dose noted for AMPS today.
Where the two insulins are alike is in the need for tests. It's important to always get a pre-shot test. It's the only way to know if it's safe to give insulin. With Lantus, the dose is based on the lowest number in the cycle (the nadir) and not on the pre-shot number. Thus, getting spot checks during both the AM and PM cycles is important, as well. We encourage people to always get a "before bed" test so you know that Maki is in safe numbers before you turn in for the night.
With being new to Lantus and to FD, you want to do what you can to avoid skipping a shot. Lantus is a depot type of insulin. What that means is that a small amount of each dose forms micro crystals that are deposited in the fat tissue. These crystals dissolve slowly and give Lantus it's duration. If you skip shots you end up depleting the depot. It can take some time for the depot to recover. In fact, with your just having switched to Lantus, it will take 5 - 7 days for the depot to become established. It also means that you generally hold the dose for several days in order for the depot to catch up to any change in dose. How long you hold the dose depends on the dosing method you choose -- either Tight Regulation (TR) or Start Low Go Slow (SLGS).
If you look over the New to the Group sticky, it will tell you about subject lines. If you look over the titles on the Board, you'll not they look similar. We include the date, the cat's name, AMPS-#, +time and #, etc. In other words, just stating you have a spot check of 278 only gives us a partial picture of what's going on. When did you test and get the 278? I reapplied that 1300 is helpful to you but I may be in a totally different time zone. It's why we use the +time that's noted on the spreadsheet (SS). It gives us a common language when talking about time. It's also helpful to make sure you enter the information on Maki's SS. For many of us, as soon as we open your thread (aka "condo"), we open your cat's SS.
One quick tip re. testing -- treats! Any time you test, whether successful or not, Maki gets a treat. Many people use freeze dries chicken (or any freeze dried protein). Or some people will poach/cook chicken and use that as a treat. Basically, you can use anything that Maki likes whether it's food, brushing, etc. You want testing to be associated with something positive.
There's a lot to get used to. Please let us know how we can help.
Patricia & Maki (GA)
Active Member
Good afternoon everyone,
So far today
AMPS=268
Spot check @1300 EST = 278
Spot check@1600 EST= 288
Next is PMPS @1800.
So what do the 268, 278, 288 teach us?
Thanks for all the great teaching, pointers. I will get the formatting of threads and titling... You folks have really thought this all thru to be worldwide real time help.
So do I need to ketone test now? I could not find a cutoff number in all the readings and stickies. Trust me I keep going back to so many links and stickies. I just have retention challenges.
Since getting the ReliOn this morning I have found that easier to use than the contour. Much less blood needed and I think my vein aim is improving. I really do try to get AMPS and pMPS now that I know what they are.
So far today
AMPS=268
Spot check @1300 EST = 278
Spot check@1600 EST= 288
Next is PMPS @1800.
So what do the 268, 278, 288 teach us?
Thanks for all the great teaching, pointers. I will get the formatting of threads and titling... You folks have really thought this all thru to be worldwide real time help.
So do I need to ketone test now? I could not find a cutoff number in all the readings and stickies. Trust me I keep going back to so many links and stickies. I just have retention challenges.
Since getting the ReliOn this morning I have found that easier to use than the contour. Much less blood needed and I think my vein aim is improving. I really do try to get AMPS and pMPS now that I know what they are.
FrostD
Very Active Member
Yes, I would test for ketones given the skipped doses, in addition to the reduced dosage you had after the hypo.
Right now the numbers don't tell us a whole lot, given the different and skipped doses. What is good is that she's not going too high without insulin (look at my spreadsheet for a comparison, eek). And once you do eventually transition to low carb food, those numbers will drop even more. As an example, look at the 2020 tab on my spreadsheet. What you see in June was solely transitioning to low carb.
For guidance with shots, here's an excerpt from the Start Low Go Slow part of the Dosing Methods sticky (which by default is your dosing method, since dry/high carb food is still in the picture):
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
Right now the numbers don't tell us a whole lot, given the different and skipped doses. What is good is that she's not going too high without insulin (look at my spreadsheet for a comparison, eek). And once you do eventually transition to low carb food, those numbers will drop even more. As an example, look at the 2020 tab on my spreadsheet. What you see in June was solely transitioning to low carb.
For guidance with shots, here's an excerpt from the Start Low Go Slow part of the Dosing Methods sticky (which by default is your dosing method, since dry/high carb food is still in the picture):
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
- Below 150 mg/dl (8.3 mmol/L), don't give insulin.
- Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
- a.) give nothing
- b.) give a token dose (10-25% of the usual dose)
- c.) feed as usual, test in a couple of hours, and make a decision based on that value
- Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
- In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
Patricia & Maki (GA)
Active Member
Hi again,
I just don't know what to expect. Somehow I thought Maki's 2+ and 4+ would be lower this evening? Not enough insulin? Not enough depot yet? Stay at the 1.5U or increase?
She has been mid to high 200s all day and evening today. Eating fine. Not ravenous like she was. No excessive urinating or drinking.
Been resting a lot, however.
I just don't know what to expect. Somehow I thought Maki's 2+ and 4+ would be lower this evening? Not enough insulin? Not enough depot yet? Stay at the 1.5U or increase?
She has been mid to high 200s all day and evening today. Eating fine. Not ravenous like she was. No excessive urinating or drinking.
Been resting a lot, however.
Hello and welcome to the LBL forum.
I've merged your two posts of the day. Due to the large number of cats here on this forum, it's easier for us to keep track of everyone if they post once per day.
POSTING GUIDELINES PLEASE READ
Sienne asked a question that I also wondered about. Did you shoot insulin this morning? The spreadsheet shows 0 in the units column. Please keep the spreadsheet up to date with the latest tests and doses. It helps us help you more easily. If you didn't shoot this morning, that would be one reason for higher numbers. The other possibility is that Maki is bouncing from the blues she saw yesterday. In the spreadsheet, it looks like the +2 is the same as the preshot tonight. That's quite common in a typical Lantus cycle. From the New to the Group Sticky Note, here is a description of a typical Lantus cycle.
+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.
Note that it takes a while before cats reliably have "typical" cycles. There are all sort of factors on why the cycles could look differently, from bouncing, absorption issues, reduced doses, depot stabilizing, just to name a few.
I've merged your two posts of the day. Due to the large number of cats here on this forum, it's easier for us to keep track of everyone if they post once per day.
POSTING GUIDELINES PLEASE READ
Sienne asked a question that I also wondered about. Did you shoot insulin this morning? The spreadsheet shows 0 in the units column. Please keep the spreadsheet up to date with the latest tests and doses. It helps us help you more easily. If you didn't shoot this morning, that would be one reason for higher numbers. The other possibility is that Maki is bouncing from the blues she saw yesterday. In the spreadsheet, it looks like the +2 is the same as the preshot tonight. That's quite common in a typical Lantus cycle. From the New to the Group Sticky Note, here is a description of a typical Lantus cycle.
+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.
Note that it takes a while before cats reliably have "typical" cycles. There are all sort of factors on why the cycles could look differently, from bouncing, absorption issues, reduced doses, depot stabilizing, just to name a few.
FrostD
Very Active Member
Probably the best thing is to not expect anything in terms of numbers, it'll drive you crazy.
Maki is newly diagnosed, the depot hasn't had time to build, we haven't transitioned food yet...so there's a lot of things at play that make it hard to predict. And even cats that have been on insulin awhile can be hard to predict! It's why we test, test, test lol
I linked the dosing methods sticky earlier, SLGS is the protocol you'd be working with. Give that a read when you have some time. Per SLGS you need to hold the 1.5U dose for at least one week, then perform a curve. Reminder: dropping below 90 at any time is immediate 0.25U reduction. And if you get a preshot below 200, I posted an excerpt from the guidelines a few posts up.
Given the confusion around this morning's dose, I'd put "ns" there, for "no shot".
Wendy posted the sample cycle - this explains why we've recommended testing at certain times in your prior threads (just didn't go too in-depth to spare you from information overload). Mogs and I stressed the "before bed" (+2/+3) test because that's a good indicator if a cycle will be active - meaning you'll see a drop towards nadir vs no change (see my spreadsheet recently...we've had all flat cycles with no dips...my PM +2/+3 tests are often showing an increase, so I don't do a +5/+6 test).
So:
- Continue to hold the 1.5U dose for at least a week (again, keeping safety guidelines we've mentioned in mind)
- Tests - AMPS, AM +2/+3, PMPS, PM +2/+3 all required. If the +2/3 is the same or lower than the preshot, you'll want to keep testing, especially around nadir. Scatter in some other tests as you can, like +1, +9, etc.
- Food - after a week consistently at 1.5U (or whatever reductions may happen if below 90) I think that's when we'd look to transition food. But I really can't give advice there, I've never transitioned food on a depot insulin. I assume that dose changes will happen along with food transition.
Patricia & Maki (GA)
Active Member
Thank you yet again. I come to read the posts as my lifeline. Just so ya know I am reading and reading but I am slow learner from Reading/Writing. I can watch or learn in person but reading has just been tough for me all my life. I was a straight A student with special ed reading instruction and tutors. I will get this.
Ok, starting new today thread, but I guess I like to acknowledge that I read your last notes. I am now set to test test test...the ear vaseline trick has soooo helped with getting a good blood drop.
Ok, starting new today thread, but I guess I like to acknowledge that I read your last notes. I am now set to test test test...the ear vaseline trick has soooo helped with getting a good blood drop.