1/29 Midas AMPS 271 +7 233
- Thread starter colin72
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Bandit's Mom
Member Since 2019
Please increase his dose to 4.5U. All you can do is keep increasing his dose systematically while getting tests to see how low he is going on the dose.
It's a matter of getting to a good dose.
If you get to 6U and still don't see good numbers, we ask caregivers to test for secondary conditions like Acromegaly and Insulin Auto Antibodies (IAA) that could be causing insulin resistance.
Let us see if you get there or you get him to good numbers between 4U and 6U.
Hang in there. I know it's hard to see this high numbers.
Are ou testing regularly for ketones? How is he doing besides the numbers?
It's a matter of getting to a good dose.
If you get to 6U and still don't see good numbers, we ask caregivers to test for secondary conditions like Acromegaly and Insulin Auto Antibodies (IAA) that could be causing insulin resistance.
Let us see if you get there or you get him to good numbers between 4U and 6U.
Hang in there. I know it's hard to see this high numbers.
Are ou testing regularly for ketones? How is he doing besides the numbers?
I am testing regularly for ketones. He seems perfectly normal. He's drinking more water than usual but I know that's to be expected.
I am completely in the dark as to how common or unusual Midas' situation is.
For example...
How common is it for a cat to start insulin, the numbers aren't coming down, and you have to increase the dose of insulin to 4.5 units?
Does a cat sometimes require a high dose like 4.5 units or more to get their blood glucose under control and then the dose required comes down significantly?
Thank you very much for your help!
Chris & China (GA)
Member Since 2013
A cat needs however much they need. There's no such thing as a standard dose for each cat. All you can do is increase as directed and hope you reach a "breakthrough" dose and then hope he starts to come down.
As Bhooma said, if you get to above 6U, we usually suggested getting then tested for acromegaly and IAA to see if there's another reason he's needing so much but it's also possible that he has neither and is just a high dose kitty.
Thanks for the reply.
I understand what you're saying but there has to be an average dose of Glargine insulin for a diabetic cat. And there are obviously common cases and cases that fall outside the norm.
I assume people who have seen case after case over years could say... we've seen many situations like Midas' before... or say that what I'm experiencing with Midas is very common... or say what I'm experiencing is very abnormal.
Yes we’ve seen many cases like Midas so what he is doing is not abnormal. However, it’s too soon to tell whether he’s just dealing with some glucose toxicity or he’s going to be a high dose cat. As has been said before, we don’t start thinking about a high dose condition until the dose gets to 6u.
Even at that, I have seen some cats at 6u that ended up not having a high dose condition, hit their “breakthrough” dose, and headed down the dosing scale.
I also agree you should hold this dose six cycles and if you don’t see some movement below 200, raise the dose by 0.5u. You are doing a great job of testing.
We don’t think in terms of an “average” dose of Lantus. Generally, most cats are somewhere in the 1-3u range at some point.
Bandit's Mom
Member Since 2019
Hi Colin,
Can you get some tests in the first part of the PM cycle, if you shoot? Have you fed him?
Can you get some tests in the first part of the PM cycle, if you shoot? Have you fed him?
Bandit's Mom
Member Since 2019
Sorry, what I meant was, can you get some tests in the first part of the PM cycle if you give him his shot?
177 is a safe number to shoot, but since it's lower than you've shot before, you want to get some tests to ensure he isn't going too low. He seems to be clearing a bounce and has therefore been going down through the AM cycle. Similar to 1/17. It's possible he may head higher from here, but we want to test till he heads up or stays flat.
177 is a safe number to shoot, but since it's lower than you've shot before, you want to get some tests to ensure he isn't going too low. He seems to be clearing a bounce and has therefore been going down through the AM cycle. Similar to 1/17. It's possible he may head higher from here, but we want to test till he heads up or stays flat.
Bandit's Mom
Member Since 2019
Great! Then go ahead and give the shot. Let's start with a +1 and +2 and take it from there.
Don't fill him up too much. We may need him to eat a little every hour.
Congrats on your first blue! Looks like it was a matter of getting to a good dose!
See you in an hour after the +1 test.
Great! Then go ahead and give the shot. Let's start with a +1 and +2 and take it from there.
Don't fill him up too much. We may need him to eat a little every hour.
Congrats on your first blue! Looks like it was a matter of getting to a good dose!
See you in an hour after the +1 test.
But I shouldn't give him 4.5 units right now should I? I read something about a token dose of 10-25%
Bandit's Mom
Member Since 2019
Since you can monitor, I would suggest giving the full shot.
Btw, what do you have in terms of higher carb food? Any honey/karo/syrup at home?
I'm very afraid to give the full 4.5 units to be honest.
I do have a higher carb food and I have karo.
EDIT TO ADD: I just tested him again and he's down to 67
Bandit's Mom
Member Since 2019
With SLGS you can shoot any number over 90 and with TR any number over 50 (68 on a pet meter) if you can monitor.
I know shooting lower numbers can be very scary to begin with, but we like to say shoot low to stay low.
The size of dose does not make a difference in a decision about shooting. A cat needs however much insulin he needs. The size of dose doesn't impact how the cycle will play out, if it's a good dose for that cat. We have people with cats on higher doses shooting much lower numbers. Lantus (and Levemir) are great at giving you a nice flat cycle when you shoot those lower numbers.
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Bandit's Mom
Member Since 2019
Just saw this. This test is how long after food?
ETA: A 67 on a pet meter is too low to shoot with any protocol. Please feed him some more and skip the shot. Test in 30 mins.
He has earned a reduction back to 4.25U from tomorrow AM.
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About 30 minutes after eating.
Bandit's Mom
Member Since 2019
A 67 on a pet meter is too low to shoot with any protocol. Please feed him some more and skip the shot. Test in 30 mins.
He has earned a reduction back to 4.25U from tomorrow AM.
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Bandit's Mom
Member Since 2019
ETA: Can you get another test to check it was not a faulty strip?
Bandit's Mom
Member Since 2019
Hi Colin, just checking in to see where Midas is? Did you get any more tests?
I just took a reading. He's at 352 now. He was very hungry and I let him eat a lot.
So he went from PMPS 177 to +1 352 ... with a 67 in between
Bandit's Mom
Member Since 2019
I suspect the 67 was a bad strip. Did you give him his shot? If you can accommodate the delay in your schedule, I would suggest you can still give it.
If I had to guess, I'd say the 67 reading was correct. He was ravenous and would have kept eating if I kept feeding him.
So, it's now 1 hour after I usually give him his shot. Are you saying that if I give him his shot now, I would have to completely change his schedule from this point to 1 hour later than usual?
Bandit's Mom
Member Since 2019
You can make up the delay 15 mins per cycle or 30 mins per day. So if you shot at 11pm tonight, you'd shoot at 10:30am/pm tomorrow and at 10am/pm day after.
You would be off schedule by 30 mins tomorrow but back on schedule the day after.
Getting back on a 12/12 shot schedule
I don't know what to do at this point.
You suggested a full shot of 4.5 units at 177 but if I wouldn't have tested again, I would have given 4.5 units to him when he had actually dropped down to 67. Like I said, I think the 67 was accurate and not a faulty strip.
I'm definitely not comfortable giving him a 4+ unit shot right now and it's over 1 1/2 hours after his normal time.
I don't know if it's best to do nothing at this point or try a token dose of, say, 1 unit.
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It's highly unlikely he went from 177 to 67 and hour later then up to 352. I rather suspect the 67 test might not have had enough blood on the test strip.
I think you'd be safe with a full dose, but at this point any insulin is better than none. Looks like he's starting to bounce big time.
I think you'd be safe with a full dose, but at this point any insulin is better than none. Looks like he's starting to bounce big time.
All that I can say about the 67 is that his ear bleeds easily when pricked and the monitor beeped as soon as I touched the blood drop like it normally does. And like I said, he was unusually ravenous when eating.
I decided to give him 2 units.
Thanks to everyone for their help.
He also isn't used to blues, and that 177 was a new low number for him. When my Neko first got to blues, she was "starving!". My girl was one of those cats that needed more than 4.5 units. She got up to 8.75 units.
By the way, I've combined your two posts today into one. Due to the number of cats on this forum, we request that you just start one post per day and add to it. You can always change the subject line if you have a new concern or question.
By the way, I've combined your two posts today into one. Due to the number of cats on this forum, we request that you just start one post per day and add to it. You can always change the subject line if you have a new concern or question.
I do appreciate everyone's help.
Over the last 8 months, I've had two cats pass away. They were both 16+ years-old but as I'm sure most of you know, dealing with illnesses and the eventual passing of pets is devastating.
I also had another cat, Leo, who had diabetes, developed CKD and passed away in 2018 the month he turned 10 years-old. I can't even begin to describe how traumatic that experience was.
I hoped to never have to deal with another diabetic cat again. Midas' situation not only has me stressing out about him, but I'm constantly haunted by memories of what happened with Leo.
Over the last 8 months, I've had two cats pass away. They were both 16+ years-old but as I'm sure most of you know, dealing with illnesses and the eventual passing of pets is devastating.
I also had another cat, Leo, who had diabetes, developed CKD and passed away in 2018 the month he turned 10 years-old. I can't even begin to describe how traumatic that experience was.
I hoped to never have to deal with another diabetic cat again. Midas' situation not only has me stressing out about him, but I'm constantly haunted by memories of what happened with Leo.
Bandit's Mom
Member Since 2019
Yes. He had not earned a reduction, so hold the dose.
The 582 is thanks to him bouncing from the 177 as well as the token shot.
Considering how high he is, you can advance your AM shot by 1 hour instead of 30 mins. That is, you can shoot 11 hours after your PM shot. This is sometimes okay when the cat runs really high. Otherwise, it's 30 mins per day.
The 582 is thanks to him bouncing from the 177 as well as the token shot.
Considering how high he is, you can advance your AM shot by 1 hour instead of 30 mins. That is, you can shoot 11 hours after your PM shot. This is sometimes okay when the cat runs really high. Otherwise, it's 30 mins per day.
Marina & Chico
Member Since 2021
What a ride today Collin 
i understand your fear having 2 cats pass away in a short time, i can only imagine the pain and fear you face right now.
I wanted to share with you a case of a higher dose kitty that is now headed on the way down the dosing ladder, check Callies SS. I really hope Midas’s case will be similar to Callies
Having passed thru a lot of rollercoaster numbers with Chico, i have to agree with @Wendy&Neko that the chance of Midas going from 177 to 67 and back to 352 in 1 hour seems unlikely. We once measured 30 on the meter, which for that moment was extremely unlikely nonetheless you can imagine how much my hands where shaking and how much my heart was beating… What we found to be helpful is when we measured an unlikely number we repeated the test just to make sure it wasn’t a faulty measurement, which apparently is not unusual.
i really hope you will get to the moment when you will start trusting @Bandit's Mom, @Wendy&Neko and other experienced people that will give you advice here, its incredible the dedication they put into this and how much they care to give safe advice and to guide us all thru these very difficult process of FD. Until then just continue doing what gives you the most comfort, because we all do the best we can for our little furry babies, and it is clear that you are very committed to Midas
i understand your fear having 2 cats pass away in a short time, i can only imagine the pain and fear you face right now. I wanted to share with you a case of a higher dose kitty that is now headed on the way down the dosing ladder, check Callies SS. I really hope Midas’s case will be similar to Callies
Having passed thru a lot of rollercoaster numbers with Chico, i have to agree with @Wendy&Neko that the chance of Midas going from 177 to 67 and back to 352 in 1 hour seems unlikely. We once measured 30 on the meter, which for that moment was extremely unlikely nonetheless you can imagine how much my hands where shaking and how much my heart was beating… What we found to be helpful is when we measured an unlikely number we repeated the test just to make sure it wasn’t a faulty measurement, which apparently is not unusual.
i really hope you will get to the moment when you will start trusting @Bandit's Mom, @Wendy&Neko and other experienced people that will give you advice here, its incredible the dedication they put into this and how much they care to give safe advice and to guide us all thru these very difficult process of FD. Until then just continue doing what gives you the most comfort, because we all do the best we can for our little furry babies, and it is clear that you are very committed to Midas
Colin
I am deeply sorry for your losses. That’s so very difficult and it’s understandable how you want to handle Midas’s issues with kid gloves.
From what I understand, you did not shoot the 177 but stalled 1 hour 45 minutes and gave 2u. We need to be sure you record that correctly so it’s abundantly clear without us having to rely on the “Remarks”.
Did you test again before you shot the 2u? If so, you would record it in the +11 column as:
177 @ +12. Then in the PMPS column, put the BG in that you got before you shot. As an example, if you tested 1 hour and 45 mins later and got 250, you would enter 250 @ +13.75 in the PMPS column. That would tell us you stalled 1 hour and 45 mins and then shot. I’m assuming the 352 was +1 from when you shot, correct?
As you probably remember, we have two dosing methods, SLGS and TR, as Bhooma referred to earlier. When I told you that you’d hold each dose six cycles and then raise by 0.5u if the BGs were over 200, that was assuming you would be following TR in order to get him out of those high numbers sooner. I’d suggest you read those two dosing methods and decide which you want to follow so we can better help you; that would then go in your signature block and at the top of his SS.
Last thing....I know you were worried especially getting that 67 which, although the strip seemed to fill appropriately, etc, for the future, keep in mind that if you get a number you don’t feel comfortable shooting, then stall without feeding until you get advice from here as we can help you shoot safe numbers. Once you feed, the BG will be affected by the food especially at the end of the cycle. That’s why I also do not believe he went from 177 to 67 because you fed the 177. At the end of the cycle, that would keep him from dropping more. Add onto that that the BG just doesn’t go from 67 to 352 that fast; I’m just repeating that so you’ll know more than one member agrees
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Thank you for understanding. I'm very scared, overwhlemed, and at times do not trust myself to handle this. I keep thinking this isn't going to end well and Midas won't make it.
Correct, I did not shoot the 177 and waited 1 hour 45 minutes and gave 2 units.
No, I did not test again before I shot the 2 units (because I had just tested about 45 minutes earlier and got 352).
The PMPS was going to be 177, but I didn't shoot.
As I was trying to get help about what to do with the 177, about 35 minutes passed and I shot again and got 67. Bandit's Mom said, "A 67 on a pet meter is too low to shoot with any protocol. Please feed him some more and skip the shot. Test in 30 mins." After I saw that, my concern was watching Midas as I thought he was at 67. Bandit's Mom posted for me to do another test to check for a faulty strip but I didn't immediately see that.
My next test was 352 which was about 1 hour after the 177. I then decided to do a token dose of 2 units which occurred 1 hr 45 minutes after the 177.
I have no idea how you want me to record that. But if you tell me what to out where, I will do it.
I just got a new Relion Premeir meter and test strips. I had hoped things would get under control with the Alphatrak because my vet is not familiar with a human meter.
How do I switch to a human meter spreadsheet?
Thanks for all of the help.
What a ride today Collin
I wanted to share with you a case of a higher dose kitty that is now headed on the way down the dosing ladder, check Callies SS. I really hope Midas’s case will be similar to Callies
Having passed thru a lot of rollercoaster numbers with Chico, i have to agree with @Wendy&Neko that the chance of Midas going from 177 to 67 and back to 352 in 1 hour seems unlikely. We once measured 30 on the meter, which for that moment was extremely unlikely nonetheless you can imagine how much my hands where shaking and how much my heart was beating… What we found to be helpful is when we measured an unlikely number we repeated the test just to make sure it wasn’t a faulty measurement, which apparently is not unusual.
i really hope you will get to the moment when you will start trusting @Bandit's Mom, @Wendy&Neko and other experienced people that will give you advice here, its incredible the dedication they put into this and how much they care to give safe advice and to guide us all thru these very difficult process of FD. Until then just continue doing what gives you the most comfort, because we all do the best we can for our little furry babies, and it is clear that you are very committed to Midas
Thanks for your kind words and for sharing Callie's experience.
Yes, you are absolutely right about this forum and the people here. Having been through this before and having dealt with other medical issues with my cats, one of the best things the internet has given us is the ability to connect with others in situations like this.
I wouldn't say that I don't trust the advice here. But I've learned from past experience that in these tricky medical situations, sometimes people are wrong... our vets, us as caregivers, everyone. Of course, no one is perfect but we all struggle for perfection in handling our pet's health.
Because of my past experiences with a diabetic cat and his death, I struggled with depression, panic attacks, PTSD... I won't drone on but you get the point. I just keep having the thought that this is not going to work out and Midas won't make it.
But again, thank you so much for taking the time to write.
Thank you. I moved the dose as suggested.
I assume that I should increase the dose from 4.5 now?
Bandit's Mom
Member Since 2019
Hi Colin, just to be clear the 352 was 1 hour after the 177 and you shot 45 mins after the 352? I guess you didn't test again before the shot? The 582 recorded under +4 that night was how many hours after the shot?
You can use the same spreadsheet. It requires some formatting changes when you switch between a pet and human meter and I can help you with that.
Once you start seeing nadirs below 200, you hold doses 10 cycles. The token shot on 1/21 would have disrupted the depot leading to higher numbers as the depot rebuilds. He would also be bouncing from that 177 which would also have contributed to the higher numbers in the last 2-3 days. I would suggest you hold the dose today and we could revaluate the dose tonight. If needed, you could increase tomorrow morning.
Marina & Chico
Member Since 2021
I am very sorry for all you went thru
i went thru a very harsh period as well when we found out, to be honest i believe there are very few people on this forum that didn’t have an anxiety, fear or blame attack…I think in life it is helpful to know our “enemies”. I will try to decrease the amount anxiety you are facing at the moment by reminding you that the “enemy” for our insulin dependent diabetic kitties in a short term is hypoglycemia - and i am not saying it is not scary but it is something we can prepare for and manage. Please reread this post on how to handle low values, and remember that as long as you follow Misas BG, you have the power to intervene. In the moment when we filled our supply closet with all the tools for managing low BG i started sleeping better. For all the time when Chico needed insulin though we managed his lower values by adding honey to his raw meat (he is allergic to commercial foods) and without much dramatic lows; actually from what i managed to gather on the forum most of the people here manage glucose without many extremely low values by intervening soon enough. It is a matter of getting to know our cats and that comes with time, until then we have the forum, honey or caro close by to help.
Take care
Thank you.
- put 177 @ +12; in the +11 column followed by 352 @ +13
- put “NT @ +13.75” in the PMPS column
Thank you. I received your PM. I will send you the link as requested after tonight's BG check and make the change tomorrow.
It looks like I'm going to be increasing the PM dose tonight. By how much? .25 or .5?
Thank you!
Bandit's Mom
Member Since 2019
Now that you are seeing nadirs under 300, you would increase by 0.25U.
Have you switched to a human meter?
ETA: I would suggest you get at least 1 test in the first part of the cycle (between +2 and +5)? Considering how bouncy he is, it is possible that he can dip into blues/greens and bounce to yellows/pinks in a 2-3 hours. For eg. I am curious about how low he went last night with a PMPS of 203 before bouncing to 296 by +7.
I have been getting some readings with the human meter and the pet meter at the same time just to get used to using the human meter. But of course I was just recording the pet meter readings on his ss.
I can get readings between +2 and +5 after his PM shot (which I’m doing in about 3 hours). Just to be clear, you are saying to increase the dose by .25 and then get the +2 to +5 readings correct?
Thank you!
Bandit's Mom
Member Since 2019
A human meter will read lower than a pet meter. Don't bother wasting strips and pokes comparing meters though! A lot of have gone down that road and trying to arrive at some correlation is an exercise in futility. Just put away the pet meter as a back up and switch to the human meter.
Yes.
I would suggest you follow TR. Once you consistently start see nadirs below 300, you increase in multiples of 0.25U every 3 days. If you see nadirs below 200 on a dose, you hold the dose for 5 days.
A human meter will read lower than a pet meter. Don't bother wasting strips and pokes comparing meters though! A lot of have gone down that road and trying to arrive at some correlation is an exercise in futility. Just put away the pet meter as a back up and switch to the human meter.
Yes, I know you can't compare or correlate between the two meters. I was just getting used to it because it's not as sensitive as a pet meter and takes a second to wick up the blood into the strip. I've used a human meter before.
I increased to 4.75 and did checks at +2 and +4. Please let me know if there's anything else I need to do.
I'm sending the link to Midas' ss for formatting changes via PM now.
Thanks again
Bandit's Mom
Member Since 2019
Yes. Unless you get any numbers below 200 which would mean you hold the dose for 10 cycles.
I would get at least one test in the first part of every cycle - especially when he starts lower - like last night. Typically, Lantus nadirs are between +4 and +6 (though nadirs can and do move around), so if you'd like to see how low he is going on a dose, you'd want to test around then. A newly diagnosed, super bouncy cat, can dip low at +3 and be much higher by +7, so a test in the second half of the cycle doesn't give you an idea of how low he has gone - a very critical data point for dosing.
And can you please start a new thread next time? This one has gotten too long. Thanks!
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I just took a +3 and the meter said "HI". I retested and got the same thing. Do I just record this as "HI" on his ss?
Is there a good time to do another check after this +3 "HI" reading that would give any helpful info?
And can you please start a new thread next time? This one has gotten too long. Thanks!
Yeah, I'll start a new one after today.
Bandit's Mom
Member Since 2019
Yes. I see you've input it as HI in the SS which is correct.
We like to suggest getting a +2 because it can act a lot like a crystal ball about what the rest of the cycle is going to look like.
- If the +2 is about the same as the PS, it's usually going to be a pretty normal cycle....gradually down to nadir and then gradually back up to the next PS.
- If the +2 is a lot higher than the PS, that usually means there's a bounce starting and it's usually OK to take a little bit of a break on testing.
- If the +2 is lower than the PS, that's your "early warning" that he might be going a lot lower later in the cycle and it's important to try to get some other tests to see how low he goes.
Midas seems to be bouncing tonight - his +3 is much higher than PMPS - so it's okay to take a break from testing till AMPS.