5-21 Mijo AMPS- 519

DaveL

DaveL

Member
Hello- New member here for my cat Mijo. He is a 15.5 year old Birman that was diagnosed about a month ago. As you can see his numbers are very high. They seem to be slowly coming down. He is currently on Prozinc, but my doctor and I are currently discussing moving him to Lantus. His Fructosamine test came back poor but that seems like it was pretty much a given and a ripoff of test to perform so early. I don't know what method I am using yet as we started out somewhat slow and have stayed at 2 units per day. Let me know if you can review his chart.

> Mijo also has Stage 2 CKD as you can see in his bloodwork

> I am currently feeding him Royal Canin Renal for the CKD which is pretty high in carbs (24%). I am looking to transition him to Weurva Play which i have research is good for CKD and diabetes to hopefully help regulate and bring his figures lower. Does anyone with CKD and diabetes use this food and how has it been working long term. It seems very good (<8 carbs, lower phos, lower protein)

>Vet and I have discussed moving to Lantus to reduce his jumping so much. He is getting down to low 100s but jumping 400-500s at night and sometimes higher. I believe I did have a muscle shot lately which made him jump into the 700 range.

>With Lantus I only see the pen or a larger vial. Are there any other options? Can you use the pen longer than the suggested 28 days? And do pen users keep it refrigerated the entire time like Prozinc? It says not to keep it refrigerated. It seems it would be extremely expensive if you have to rebuy every 28 days. Also i see the pen is not usable in lower increments. Would a vial be more suitable in my situation.

>Should I start the food switch now and finish off my vial of prozinc and then begin to transition over to Lantus? The Royal Canin was suggested for his CKD but it seems the Weurva Play could provide same quality of food and numbers with lower carb count.



Thank you I appreciate any guidance you can provide me as I am very new to this! I am trying to get my chart in order. As you will see i switched from the pet to human meter.
 
Hi welcome Dan and Mijo you couldn't have found a better group to join
Great job setting up your SS already, most of us use human meters, that's what our numbers ate based on
I see on your SS on 5-14 Mojo dropped to 72 @+3 you should have reduced the insulin by 0.25 units , because he dropped below 90 when following SLGS method, you have SLGS method on your SS
From the SLGS method for prozinc
Requisites when following the Start Low, Go Slow Method:
  • Learn the signs of and how to treat Hypoglycemia and prepare a Hypo Toolbox.
  • Test regularly for ketones and know about Diabetic Ketoacidosis (DKA).
  • Use a meter calibrated for humans, not a pet-specific meter. Reference numbers given are for measuring blood glucose with a human meter. If you still wish to use a pet meter, you will use the same reference numbers for making dosing decisions as you would with a human meter. For example, with a human or pet meter, a drop below 90 requires a reduction.
  • Most kitties are easier to regulate when fed small meals throughout each cycle. Others adapt well to free feeding.
Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

You can read all the yellow stickys about Lantus here ,following SLGS you would still reduce by 0.25 units if Mojo drops under 90 at any time
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
 
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DaveL said:
Mijo also has Stage 2 CKD as you can see in his bloodwork

> I am currently feeding him Royal Canin Renal for the CKD which is pretty high in carbs (24%). I am looking to transition him to Weurva Play which i have research is good for CKD and diabetes to hopefully help regulate and bring his figures lower. Does anyone with CKD and diabetes use this food and how has it been working long term. It seems very good (<8 carbs, lower phos, lower protein)
Click to expand...

BFF play chicken Checkmate
Protein 31%
Carbs 5%
Phosphorus 133%

BFF play chicken & turkey topsy turvy
Protein 32%
Carbs 5.20%
Phosphorus 134%

BFF play chicken cherish
Protein 31%
Carbs 4.90%
Phosphorus 132%

BFF chicken & turkey tiptoe
Protein 31%
Carbs 5.10%
Phosphorus 133%

BFF chicken duck & turkey take a chance
Protein 32%
Carbs 5.20%
Phosphorus 152%

BFF play chicken & lamb laugh out loud
Protein 31%
Carbs 5%
Phosphorus 152%

BFF play chicken & duck destiny
Protein 32%
Carbs 5.10%
Phosphorus 163%

BFF play chicken & beef best buds
Protein 33%
Carbs 5.30%
Phosphorus 175%

Don't know if your kitty likes pate but here is the list of the BFF line.
YOU WANT CARBS UNDER 10% AND PHOSPHORUS IDEALLY LOW 200's OR LESS
 
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DaveL said:
With Lantus I only see the pen or a larger vial. Are there any other options? Can you use the pen longer than the suggested 28 days? And do pen users keep it refrigerated the entire time like Prozinc? It says not to keep it refrigerated. It seems it would be extremely expensive if you have to rebuy every 28 days. Also i see the pen is not usable in lower increments. Would a vial be more suitable in my situation.
Click to expand...
That 28 day is for humans , one pen should last you at least 6 months kept in the middle shelf of the fridge

You are right the pen you can only adjust by whole units
We buy U-100 syringes with half unit markings so we can adjust byb0.25 units, even though they come in 1/2 units it makes it much easier when you have to adjust by 0.25 units ,we just eyeball it
30-unit-insulin-syringe-markings.jpg
 
Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there
syringe-in-pen-pic-jpg.45006
 
Lantus is very expensive to n the US
you can get generic lantus from a pharmacy,most members here use the generic
You can have the vet write the script for generic lantus the 5 pens ,many members use it, The brand is much more expensive, just call around and see who might have the generic brand with the best price for 5 pens , just keep them in the fridge they are all good until the expiration date. The expiration dates would probably be 2024 or 2025 now just look when you buy them
Here is some info
Check this out also
https://www.goodrx.com/insulin-glargine?dosage=five-3ml-prefilled-pens-of-100-units-ml&form=carton&label_override=insulin glargine&quantity=1




Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.
 
One thing I would definitely suggest that you start getting a few tests in after your PMPS test, most cats drop lower at night , plus you are only seeing half the picture and might miss a reduction

Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature which I see you have already set up We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

You can tap on your name above ,then tap on the word signature and add what is asked on the Blue link I gave you and tap Save
 
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As for the U-100 syringes with half unit markings
You can get the syringes with half unit markings at a Walmart. Their ReliOn Brand syringes of 0.3 cc (30 unit) capacity come with half unit markings. Cost $12.58 for a box of 100
This is what the packaging looks like: either box is fine
They won't say it half unit on the box but the are . open then and look before you leave the store, can't be ordered on line , need to go into the store
:




upload_2021-9-5_23-18-9-jpeg.62508

Or any of the ones listed here
  • U-100 3/10cc syringes with half unit markings are the best to use for drawing Lantus, Levemir, or the Biosimilars from vials, cartridges, and pens.
  • BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort,
  • Some members like the Sure Comfort or the UltiCare tap on the blue name of the syringe and it will bring you right to the site
  • You will most likely need a script from your vet ,ask him to give you refills
  • If you get them from ADW Diabetes you can call them tell them which ones you want, give them that coupon code every time ,they will get some info from you and then contact your vet and he can fax the script over, then you can just order more if you need them

  • If you do not get them from Walmart and you get any of the other ones I listed
  • Here is a coupon
  • DIA10
    adw-coupon-dia10.jpg

    10% off your next order!
 
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Hi and welcome to Dave and Mijo
Looking at the spreadsheet, I can see you are not doing any testing during the PM cycle. This is missing 1/2 if the picture and cats often drop lower at night. I can also see that Mijo is bouncing from the lower BGs and this is causing the low and then the high numbers. He is also dropping fast which will also cause bouncing.
From the Basics
  • 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).
Are you giving snacks during the cycles as well as the 2 main meals?
I would give a snack at around +2 and +4 during both cycles to try and slow the drops. A snack is a teaspoon or two of low carb food.
I would also start to get some tests in during the pm cycles to see what is happening there.
You can start off getting a before bed test
If that test is quite a bit lower then the preshot BG, that is a heads up that the BG could keep dropping so I would set the alarm and test again a bit later.
I think swapping to a low carb alternative for Mijo for the CRD is a very good idea. However when you do the swap over, do it slowly and monitor closely, as it is most likely he will need less insulin as lowering the carb content of the food can drop the BGs up to 100 points.
I am going to tag @Bandit's Mom to swap your SS over to one that uses human meters now that you have changed to the ReliOn meter.
Keep posting so we can see the progress of Mijo and asking questions
Bron
 
Thank you all for this great info so far! I really appreciate it

If I where to move forward with Generic Lantus do I need to use the pen? Do people use the 10ML vial and how long does it last refrigerated? I assume that would be easier when i need to move in smaller increments then the pen.

Also i currently am feeding him 3 times a day wet food (morning and night Royal Canin Renal, and afternoon he gets Weurva Play). He is a somewhat grazing eating so he is not ingesting the food all at once. I assume the Royal Canin is causing him to bounce quite a bit also with the large carb count.
 
I found my two vials lasted about 6-7 months before losing potency but I was able to use the pens to the last drop. You use them with a syringe just like a vial but since each pen is not pierced until you use them they stay fresh.
 
I think @tiffmaxee means cartridges not vials. You can get 5 cartridges with Lantus.
The vial is a 10 ml bottle and you probably would not get through that before it lost potency.
I hope I haven t confused you
 
Actually I meant what I wrote. A vial lasted me 6-7 months.That’ s when they lost potency and I wasted a lot having to throw out vials that were more than half full A box of 5 pens lasted a year. I bought from Marks in Canada. Costco sells the generic pretty cheap if you live near one. You don’t have to be a member to buy from their pharmacy.
 
Allie was using the Lantus and I just switched to the generic and using the GoodRX I got 5 pens for $81.30 at Walgreens. GoodRX has a 1-800 number to assist you in using their services to get your pets prescriptions filled if the pharmacy gives you any issues.

Good Luck everyone here has been so helpful for me and my cat Allie! I don't know what I would have done had I not found FDMB!
 
tiffmaxee said:
Actually I meant what I wrote. A vial lasted me 6-7 months.That’ s when they lost potency and I wasted a lot having to throw out vials that were more than half full A box of 5 pens lasted a year. I bought from Marks in Canada. Costco sells the generic pretty cheap if you live near one. You don’t have to be a member to buy from their pharmacy.
Click to expand...
Got It...now I reread it I can see I read it wrong:banghead: Apologies Elise.
 
DaveL said:
I am trying to get my chart in order. As you will see i switched from the pet to human meter.
Click to expand...
Bron and Sheba (GA) said:
I am going to tag @Bandit's Mom to swap your SS over to one that uses human meters now that you have changed to the ReliOn meter.
Click to expand...
@DaveL , if you will share the link you use to edit the SS, I will request edit access so I can make the colour /formatting change to it to reflect the changes from pet to human meter.
 
As you can see he bounced again big time last night and I'm not sure why his bounce is so dramatic? I am going to switch him to full Weurva BFF Play today and stop using the Royal Canin Renal. I will closely watch his numbers.

Also is the Lantus for cats the same as humans use? I have about 2-3 weeks left of my prozinc and plan to transition to generic Lantus then.
 
DaveL said:
Let me know if this works
@Bandit's Mom https://docs.google.com/spreadsheets/d/1fXnnAtYA3EIFHz9u6s09RFY5o4Mh9Z7v3vNmfdZYtts/edit?usp=sharing
Click to expand...
Yes it did. Sent you a request for edit access.


DaveL said:
I am going to switch him to full Weurva BFF Play today and stop using the Royal Canin Renal. I will closely watch his numbers.
Click to expand...
The food change can make a big difference to his numbers. You want to make the change slowly.

DaveL said:
Also is the Lantus for cats the same as humans use? I have about 2-3 weeks left of my prozinc and plan to transition to generic Lantus then.
Click to expand...
Yes, it is the same Lantus as humans. You want a prescription for generic insulin glarine pens. If you search the forum you will find numerous posts by people who have gotten Lantus or the generic cheap using coupons from GoodRx etc.
 
DaveL said:
As you can see he bounced again big time last night and I'm not sure why his bounce is so dramatic? I am going to switch him to full Weurva BFF Play today and stop using the Royal Canin Renal. I will closely watch his numbers.

Also is the Lantus for cats the same as humans use? I have about 2-3 weeks left of my prozinc and plan to transition to generic Lantus then.
Click to expand...

Hi Dave,

If you prefer a vial over a pen, Wal-Mart carries generic Lantus. It is the same Manufacturer (Sanofi). The package will say Winthrop. The vial is about $136, and like Elyse noted, it will last up to 6 or 7 months in the fridge.

Deb
 
I bought a glargine pen at Walgreens for $25. The pharmacist has several diabetic kitties and will sell the pens individually….. can’t hurt to ask.
One important point about withdrawing the dose…Insert the needle with the syringe plunger already pushed to 0.0. Do Not inject air into the pen, so this is different than the procedure for vials. This is mentioned somewhere in a sticky. I just draw up a little extra, remove the pen, then fuss with bubbles and getting the dose right. This procedure protects the glargine from air and the silicone lubricant in the syringe barrel, both of which can destabilize glargine.
 
Well feeding strictly the Weurva BFF Play compared to the Royal Canin Renal made him bounce down to 61@+6. Would it be better to take a (-.5) correction tonight on my PM shot or just a -0.25? I assume the food is having a pretty drastic change to his sugars as it is 25% carb vs the 5% in Weurva.
 
Correct he ate at 9am which is his AMPS. He has also had low carb treats several times in between (Vital Essentials Minnows). I usually feed 3oz at 9am, 4pm, 9pm.
 
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G2 & Buddy said:
I bought a glargine pen at Walgreens for $25. The pharmacist has several diabetic kitties and will sell the pens individually….. can’t hurt to ask.
One important point about withdrawing the dose…Insert the needle with the syringe plunger already pushed to 0.0. Do Not inject air into the pen, so this is different than the procedure for vials. This is mentioned somewhere in a sticky. I just draw up a little extra, remove the pen, then fuss with bubbles and getting the dose right. This procedure protects the glargine from air and the silicone lubricant in the syringe barrel, both of which can destabilize glargine.
Click to expand...
Hi Dan before I would insert the syringe into the lantus pen I would move the plunger up and down a few times to losen it up. Then push the plunger all the way in and then draw out the insulin. To tell you the truth I never had to draw more out and if I did have a bubble I would just flick the syringe a few times, but you can definitely draw more out and squirt the excess out in the sink.
When are you going to be starting the lantus?
@DaveL
 
Probably 2-3 weeks once my prozinc vial runs out. I need to get his food in line first. He is still at 82 at +8 and not rising yet tonight. Not good… I assume I will need to administer a reduced dose or skip if it don’t start rising quick…
 
DaveL said:
Probably 2-3 weeks once my prozinc vial runs out. I need to get his food in line first. He is still at 82 at +8 and not rising yet tonight. Not good… I assume I will need to administer a reduced dose or skip if it don’t start rising quick…
Click to expand...
I see Suzanne is on she's a prozinc user let me tag her now
@Suzanne & Darcy
Suzanne Dave just started feeding Weruva was feeding hc before royal canin renal 24%
 
DaveL said:
Well feeding strictly the Weurva BFF Play compared to the Royal Canin Renal made him bounce down to 61@+6.
Click to expand...
Hi Dave I was just wondering if you are still feeding any of the Royal Canin Renal yet, I'm only asking because if you aren't I would take the Royal Canin Renal off your signature.
Congrats on the reduction tonight
 
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Yes Kind of still feeding Royal Canin to keep him eating. He is not eating well today and he is not a big fan of pate so far. So the Weruva BFF Play has been touch and go so far.

Its so hard as there are not a lot of foods out there that are low carbs, low phos, and low protein to address both diabetes and CKD... He loves the BFF Gravy but that is not the greatest values wise.
 
You want the metabolizable energy profile percentage of carbs to be less than 10%, and the phosphorus which Weruva lists in Minerals to be less than 250 mg per 100 cals. So you have to look at two different places in the Weruva charts.

I'm going to give you 2 links for the Weruva they are not pates ,some of them you can feed Mijo

Look at the chicken cans and go by what I posted above meaning you have to look at two different places
https://weruva.com/nutrition-landing/bff-omg-ni/

https://weruva.com/nutrition-landing/wcc-ni/


If you click on this link all of the weruva nutritional values come up, you can tap on each one and see what you can find there , plus you can also look for medium and high carbs foods still with low phosphorus if you need to bring his BG up

https://weruva.com/nutrition-landing/
11% -15 is medium carbs.

16- 24 is high carb.

@DaveL
 
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Thank you all for all the help you are giving me!

@Wendy&Neko I did the reduction down to 1.75U last night, however, he did drop to 79 at+6 last night. Do you do another reduction in succession? He is back to 519 this morning so pretty big jump.
 
@DaveL
Hi Dave As far as I know if you were following TR method you DON'T take back to back reductions ,but with SLGS you do.
He is probably Bouncing like Bron described in her post #9
When posting on the Lantus we do a new post everyday and link your previous post to it,so you would link this post to today's so members can go back and read it if needed, I can never explain it right lol but just copy and paste what is above that pic of that cat all the way up top on the left side ,it starts with https://feline diabetes.com/FDMB/threads/5-19 this is what you will copy and paste to today's thread

So today you would start a new post like this
5-21 Mijo AMPS- 519 then add the additional tests after that, you continue with the PMPS # and the tests after that
To add the tests look to the right tap on the word Thread Tools, then tap on Edit Title add you tests then tap save or done

Congrats on the reduction, transitioning him to low carb food is really making a difference :cat:
You can then ask Wendy your question on today's post about the reduction


https://felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/

Correction I forgot Dave was still using Prozinc until he used up the vial, then will start Lantus
I told him to post on the Feline Health below until then
 
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Did you see the other Weruva foods I gave you the links for in my post#31
Just so we know you have read our replies we like you to tap the work Like that's to the right :cat:
 
Hello- I did I plan to get out today and see if i can find some of the ones listed. I did have that CKD Food list already printed off, but thank you for resending.

He is eating Weura BFF Play-- But only the checkmate. So i will see what else i can find as he usually only usually likes gravy type foods. He was on Tiki previously
 
@DaveL
Dave you want to post 5-21 Mijo AMPS-519 on this board that's in blue that I posted below then link the 5-19 to today's

I would put back 5-19 above and put what you had like New Member Mijo numbers are high ,or however you had it just before you changed your title to 5-21
Here is the link
https://felinediabetes.com/FDMB/forums/feline-health-welcome-main-forum.28/
@DaveL
When you have a chance can you please correct it

I just don't want people to think you are using lantus yet

Sorry for all the confusion
 
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DaveL said:
I did the reduction down to 1.75U last night, however, he did drop to 79 at+6 last night. Do you do another reduction in succession? He is back to 519 this morning so pretty big jump.
Click to expand...
Yes, when using Prozinc and following SLGS, you'd take another reduction, down to 1.5 units as you did this morning. The high AMPS is just a bounce - it will pass. And looks like he's already hurrying out of those high numbers. :) Experienced help for Prozinc dosing would be better/faster on either the Prozinc forum or Feline Health forum.
 
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