1/18 Max AMPS 248.4 +9 316.8 4 unit Libre

J&Max

J&Max

Member Since 2023
Dear Admin,

Can someone who is very very experienced on TID can help Max?
The vet suggested to give Max 2 unit after discharged and his BG level was keep in high level. Then he allowed me to give Max 3 unit on the next day AMPS and 4 unit PMPS.
My friend who is experienced SPCA Volunteer and guided me to give Max 3 dose yesterday.
Hong Kong Time
1/15/24 Discharged from hospital at 5pm
10pm 2 unit
1/16/24
10am 3 unit
10pm 4 unit
1/17/24
06am 4 unit
06pm 4 unit
1/18/24
01am 4 unit
11am 4 unit
06pm 4 unit

I don't have permission to upload the SS can ADMINs help me here? Thank you so much.
 
J&Max said:
I don't have permission to upload the SS can ADMINs help me here? Thank you so much.
Click to expand...

Your spreadsheet opens fine. The link in your signature opens it but you can't edit it from that link. If you need to edit it, you need to use the link I sent you in Facebook Messenger.

Lantus really shouldn't be given 3 times a day. There are some other insulins that can be used more than twice a day, but lantus should last 10-16 hours.

Also, going from 2U to 4U in 12 hours could have been too much, too quickly. Insulin like R that are commonly used in DKA's at ER vets can be given more often and in different amounts (as needed) but Lantus takes time before you will know how well the dose is working. It's possible that 4 units three times a day is too much, which can look like it's not enough.

How is Max acting today? Is he eating?

Hopefully, @Marje and Gracie, @Sienne and Gabby (GA) or @Wendy&Neko can stop in and add some extra information.

Please remove the 911 prefix. We use that for life-threatening cases like a cat that's dropped too low which can kill quickly. Hi numbers are distressing to see, but not usually a medical emergency. You can use the ? prefix which will show your post has a question you need an answer to in it.
 
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While Lantus can be give three times a day, it is a very advanced technique and should not be done without the assistance of someone who has done it, understands it, and can be there for you to help you with it. Thus, we do not recommend it here. You can get way too much overlap and carryover with it and if you, and the person helping, doesn’t understand the concepts of onset, nadir, duration, you can put Max at great risk.

Max was on 4u twice a day (8u overall in 24 hours) and an experienced person would have known that giving it three times a day would have meant dividing that 8u between the three shots so he should have just gotten about 2.5u per shot. Please, for his own safety, do not shoot three times/day again unless your veterinarian is working directly with you and is the one determining what is safe.

It is better for you to do the TR protocol with Max as the doses can be increased much faster than with SLGS. Right now, he is bouncing from those blue numbers yesterday. Are you able to do TR?
 
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Thanks for the
Chris & China (GA) said:
Your spreadsheet opens fine. The link in your signature opens it but you can't edit it from that link. If you need to edit it, you need to use the link I sent you in Facebook Messenger.

Lantus really shouldn't be given 3 times a day. There are some other insulins that can be used more than twice a day, but lantus should last 10-16 hours.

How is Max acting today? Is he eating?
Click to expand...
Thanks for the reply. yes I know that Lantus should last for longer so twice a day of injection is enough. However it seems doest work for Max and my friend who also has a 17 yrs old sugar cat and she gives her insulin so flexible so I followed her advice and give a try. Now I received and finished the SS and hope someone who is well experienced can help and guide me.

Max seems a more tired today, may be his K is low, he is taking Hypokal 1 tablet 2 times a day. Glad that he has good appetite but most of the time he likes me to feed him by syringe. He is spoiled.
 
tiffmaxee said:
Here’s your previous post.
https://felinediabetes.com/FDMB/threads/can-someone-help-max-insulin-resistance.285682/#post-3144048

The spreadsheet can be seen. I can’t help as I don’t understand your dosing but maybe someone else can. 911 is usually reserved for when a cat is hypo. I’ll tag a few who might be able to help. @Marje and Gracie @Wendy&Neko
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Thanks for the reply. Im new joined so i don't know 911 is for a cat with HYPO. thanks for reminding and tag members for me.
 
I should add 911 can be for any serious emergency. DKA, would be another reason. You can add a question mark prefix for questions and add TID help for example.
 
I see he just tested at 81. Please keep testing. He is seeing the effects of the most recent 4 units, and possibly. the final action from the previous 4 units shot a few hours before PMPS. He could still go lower. I expect that 4 units 3 times a day is too much insulin. Besides being an advanced technique we don't suggest to people, shooting 3 times a day can be really hard on the caregiver. It is better to just shoot twice a day but a dose that can also get him into good numbers.

I see a recent DKA. Are you testing at least daily for ketones?
 
Wendy&Neko said:
I see he just tested at 81. Please keep testing. He is seeing the effects of the most recent 4 units, and possibly. the final action from the previous 4 units shot a few hours before PMPS. He could still go lower. I expect that 4 units 3 times a day is too much insulin. Besides being an advanced technique we don't suggest to people, shooting 3 times a day can be really hard on the caregiver. It is better to just shoot twice a day but a dose that can also get him into good numbers.

I see a recent DKA. Are you testing at least daily for ketones?
Click to expand...
Tested 81 before He had 60 g of raw meat grinded with 30 g of water at 4am HK time (0500 now) ! It’s 174.6 now!
Urine tested everyday by the test paper and No ketones.
I know I’m too aggressive as it was HI again after discharged from hospital and I was told he won’t be survived if it’s happen again…… I have to try my own method and take the risk.
Hope anyone of you can help me with that.
Please guide me to adjust the amount of insulin and give Max twice a day. Really appreciate that.
 
Marje and Gracie said:
While Lantus can be give three times a day, it is a very advanced technique and should not be done without the assistance of someone who has done it, understands it, and can be there for you to help you with it. Thus, we do not recommend it here. You can get way too much overlap and carryover with it and if you, and the person helping, doesn’t understand the concepts of onset, nadir, duration, you can put Max at great risk.

Max was on 4u twice a day (8u overall in 24 hours) and an experienced person would have known that giving it three times a day would have meant dividing that 8u between the three shots so he should have just gotten about 2.5u per shot. Please, for his own safety, do not shoot three times/day again unless your veterinarian is working directly with you and is the one determining what is safe.

It is better for you to do the TR protocol with Max as the doses can be increased much faster than with SLGS. Right now, he is bouncing from those blue numbers yesterday. Are you able to do TR?
Click to expand...
Thanks Marje, may I know what’s the meaning of TR ?
 
TR is Tight Regulation. It's described here: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
Provided you are feeding an all low carb wet food or raw diet, you can follow TR for dosing. It allows you do do faster increases.

If you do a test for ketones, could you put the result in the Remarks column. It's great he's negative for ketones. If they start to show up, we may be more aggressive with dosing increases.

I would shoot 4 units this morning. It's likely he will bounce from the 81, but there isn't anything you can go about that, except test for ketones when he gets high. High numbers from bouncing doesn't seem to impact ketones as much as high numbers from too little insulin.
 
Wendy&Neko said:
TR is Tight Regulation. It's described here: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
Provided you are feeding an all low carb wet food or raw diet, you can follow TR for dosing. It allows you do do faster increases.

If you do a test for ketones, could you put the result in the Remarks column. It's great he's negative for ketones. If they start to show up, we may be more aggressive with dosing increases.

I would shoot 4 units this morning. It's likely he will bounce from the 81, but there isn't anything you can go about that, except test for ketones when he gets high. High numbers from bouncing doesn't seem to impact ketones as much as high numbers from too little insulin.
Click to expand...
Got it thanks. I had added the note of urine tested No Ketones. The last injection was at 7pm last night on 1/18. Any idea what number of BG level I should give him 4 unit? Thanks.
 
J&Max said:
Any idea what number of BG level I should give him 4 unit?
Click to expand...
If you are following SLGS for dosing, anything above 90 give 4 units. If you are following Tight Regulation protocol for dosing, anything above 50 gets 4 units. That is provided that you can monitor him somewhat this cycle. I expect he may bounce, giving you some time to get a nap. Test the +2 test after AMPS, and if higher than AMPS, you can get some rest.

We determine how to dose the cat based on how low the dose is taking him. But that is based on twice a day dosing. We don't decide what to shoot based on preshot numbers. We do the preshot test to make sure it's safe to give insulin.
 
Wendy&Neko said:
If you are following SLGS for dosing, anything above 90 give 4 units. If you are following Tight Regulation protocol for dosing, anything above 50 gets 4 units. That is provided that you can monitor him somewhat this cycle. I expect he may bounce, giving you some time to get a nap. Test the +2 test after AMPS, and if higher than AMPS, you can get some rest.

We determine how to dose the cat based on how low the dose is taking him. But that is based on twice a day dosing. We don't decide what to shoot based on preshot numbers. We do the preshot test to make sure it's safe to give insulin.
Click to expand...
Thanks a lot.
Marje and Gracie said:
While Lantus can be give three times a day, it is a very advanced technique and should not be done without the assistance of someone who has done it, understands it, and can be there for you to help you with it. Thus, we do not recommend it here. You can get way too much overlap and carryover with it and if you, and the person helping, doesn’t understand the concepts of onset, nadir, duration, you can put Max at great risk.

Max was on 4u twice a day (8u overall in 24 hours) and an experienced person would have known that giving it three times a day would have meant dividing that 8u between the three shots so he should have just gotten about 2.5u per shot. Please, for his own safety, do not shoot three times/day again unless your veterinarian is working directly with you and is the one determining what is safe.

It is better for you to do the TR protocol with Max as the doses can be increased much faster than with SLGS. Right now, he is bouncing from those blue numbers yesterday. Are you able to do TR?
Click to expand...
Dear Marje,
Thanks for the advice. I’m giving Max SLGS and twice a day.
 
Looks like he's come back down into blue this evening.
Keep testing those ketones, great to see he is still negative for those.
How's he doing overall today? Eating?
 
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