Re: 03/27 Furball, AMPS=351, PMPS=386 Vet Visit Update
here's a link to the
Start Low Go Slow protocol. i want to highlight a couple of parts for you:
Step 3.
After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve (blood glucose tests every 2 hours, starting at shot time and continuing until the next shot). Follow the cat's normal feeding schedule during the curve. The curve should be evaluated by someone experienced at interpreting feline blood glucose curves, in order to check for signs of rebound and other possible problems. If no rebound is present, follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):
If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.
i think it's difficult to tell when a rebound is going on unless you have learned to read the spreadsheets. your vet is looking at the numbers for last weekend, which standing alone would say that the line i've highlighted in brown applies. it would, except that you caught that sweet little 190 on Friday night. it is highly likely that furball was lower than 190 in the hours before that, just because of the way the lantus curve normally goes.
if Friday night had been in the 300's, i'd have agreed with your vet that an increase is due. HOWEVER - there is also the caveat that i highlighted in green above. Lantus dosing is adjusted by .25units when it's increased. a very small amount of lantus can make a big difference in numbers. we also don't want to ignore that 190 that popped up 12 hours after the previous shot - it is sending a very important message.
so . . . . if you're wanting to follow the SLGS protocol, because of the rebound curve on saturday, it would have you holding the dose for another week. i know you're wanting to be cautious because you're not home to test during the day, so wanted to make sure you knew the reasoning for serryn's suggestion for you to hold the dose.
i would agree with her that unless furball won't eat because she's sick or vomiting, she doesn't have to eat at the same time as the injection. that is true of the older insulins. with those, you were shooting the number you saw, the insulin was effective right away and was out of the body in a few hours. lantus works differently - which is why it's a better insulin for cats. lantus doesn't "onset" (see the "new to the group?" sticky if you're not sure what onset is) for about 2 hours so it is not critical for her to eat at the exact time as the shot.
anyway, there's my 2 cents worth. i would err on the side of caution in your particular situation.
i'm sure this is confusing - do you have questions that we can help answer?
have a great day guys!
