05/03 Lady AMPS 306

EM96

EM96

Member Since 2021
Hi,

We have increased Ladys dosage up to 5U on the vets advice however, her numbers are still very unpredictable. Yesterday her AMPS was 63 today its 306. She seemed more stable on 4U but still was too high apart from one day. We aren't sure what to do, or what dose we should give. I've attached her spreadsheet.
The vet wants us to go to 6U.
She's on Lantus we are testing with the Freestyle Libre and we are feeding low carb wet food.
Thank You.

https://docs.google.com/spreadsheets/d/1MPZIFE7GWosDvdXs5Ee8ZgeyH0PoHB7mvjVzJi2YQd0/edit?usp=sharing
 
Hello and welcome Ellie and Lady. Sorry to say this, but your vet is completely wrong about dosing. Since you saw a 63 today on the Libre and are feeding dry food, you should be reducing the dose, not increasing it. That would put her in danger of hypo.

We increase by much smaller amounts than 1 unit at a time. Cats are sensitive to small changes in dose. Are you using 1/2 unit marked syringes to draw the insulin? Or still using the pen as per your first post here? Just wondering what dose to suggest for you.

With cats eating dry food (is there a reason she won't eat all wet food), we decrease if their blood sugar goes below 90. You saw a 86 on 4 units, so should have decreased the dose then.

I rather suspect you are seeing a lot of what we call 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).
 
Hi Ellie, I can see the AMPS of 17 is the world number and not the US....it startled me at first.
Several things to mention.
  • I would go out and buy some U100 3/10 30 or 31 gauge 6 or 8 mm insulin syringes with 1/2 unit markings, so you can give smaller increases and decreases. Increasing doses in 1 unit increments means you often go past the best dose
  • The number you must reduce the dose is 90. You have a 63 and a 67 in the last couple of days and those BGs should have triggered a reduction in dose
  • Please do not increase the dose to 6 units.
  • What Ellie is doing is bouncing from low numbers and the that is why you are seeing lots of high numbers and some low numbers. Bouncing happens when the BG drops too low, too fast or lower than the cat is used to. She panics and dumps regulatory hormones and stored glucose into the system and the BG goes up high. Bounces can last for up to 6 cycles.
  • You need to reduce the dose of insulin. Not sure what dose to suggest...let me think. Don’t give the dose if it is under 150. Stall, don’t feed and Post and ask for assistance if this happens.
  • Are you testing for ketones in the urine? If not I would go out and buy a bottle of Ketostix from a pharmacy or Walmart.
ETA you have in your signature that you are using the alphatrak meter. Could you please change that to the freestyle libre please as it is confusing, thx
 
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Sorry! i never updated my signature from when i first created an account, I've fixed it now. We are using the Freestyle Libre and feeding only low carb wet food now, have been for months now. We did buy some needles (BD microfine u100 insulin syringes 0.3ml) but my sister is the main person who does her dosage because of my hours and she is kinda afraid of blood and needles... and the vet kept saying that we need to go up by 1U and insisting therefore we didn't need the training on how to use the needle instead of the pen, so we haven't really used them, but we are willing to go back to trying them.

We are thinking we need a new vet, if anyone knows of a good vet in Perth, Western Australia....
Thanks for everyones help, sorry for the confusion.
 
EM96 said:
Sorry! i never updated my signature from when i first created an account, I've fixed it now. We are using the Freestyle Libre and feeding only low carb wet food now, have been for months now. We did buy some needles (BD microfine u100 insulin syringes 0.3ml) but my sister is the main person who does her dosage because of my hours and she is kinda afraid of blood and needles... and the vet kept saying that we need to go up by 1U and insisting therefore we didn't need the training on how to use the needle instead of the pen, so we haven't really used them, but we are willing to go back to trying them.

We are thinking we need a new vet, if anyone knows of a good vet in Perth, Western Australia....
Thanks for everyones help, sorry for the confusion.
Click to expand...
Hi Ellie, I live in Australia but in Sydney. We do have some people here who live in WA but I can’t think who they are at the moment...
You don’t really need a vet.......you just need good dosing advice.
We can’t buy 1/2 unit syringes here in Australia but you can buy them from the UK if you want to.
what time is your next dose due?
Were ketones ever mentioned at diagnosis?
I am going to send you a link to Australian information
https://www.felinediabetes.com/FDMB...for-aussie-feline-diabetic-caregivers.217781/

Here is a picture to show you how to use the cartridge from the solostar pen you have.
upload_2021-5-3_16-2-35.jpeg



And here is a diagram to show you how to measure the units on a syringe. The left hand side is showing the 1/2 unit markings which you can’t get. Look at the right hand one.
upload_2021-5-3_16-3-56.jpeg
 

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Bron and Sheba (GA) said:
Hi Ellie, I live in Australia but in Sydney. We do have some people here who live in WA but I can’t think who they are at the moment...
You don’t really need a vet.......you just need good dosing advice.
We can’t buy 1/2 unit syringes here in Australia but you can buy them from the UK if you want to.
what time is your next dose due?
Were ketones ever mentioned at diagnosis?
I am going to send you a link to Australian information
https://www.felinediabetes.com/FDMB...for-aussie-feline-diabetic-caregivers.217781/

Here is a picture to show you how to use the cartridge from the solostar pen you have.
View attachment 60759


And here is a diagram to show you how to measure the units on a syringe. The left hand side is showing the 1/2 unit markings which you can’t get. Look at the right hand one.
View attachment 60760
Click to expand...

Ketones were never discussed. Our next dosage is due in 4.5 hours at 7pm.

Thank you!
 
I am confused looking at the SS. Are you saying the first Test was 63 this morning, then you waited and it went up to 308? And did you feed in between those two tests?
Also in the remarks column you say you gave 4 units but there are 5 units in the U column of the SS.....no criticism at all... just wanting to find out what you did.

Would you be willing to swap to the syringe?
 
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Bron and Sheba (GA) said:
I am confused looking at the SS. Are you saying the first Test was 63 this morning, then you waited and it went up to 308? And did you feed in between those two tests?
Also in the remarks column you say you gave 4 units but there are 5 units in the U column of the SS.....no criticism at all... just wanting to find out what you did.

Would you be willing to swap to the syringe?
Click to expand...
It was 63 yesterday morning at out usual shot time of 7am we waited until about 9am when she was up to approx 144 then shot 4 units, after that within an hour she was up to approx 234 and kept going up.... for some reason my spreadsheet is showing up as different days on the US compared to the world, I'm fixing that now, I was working on the world side which was right...hopefully it's fixed now.
This morning it was 306...hopefully it's clearer now. If i can figure out how to attached the image I'll attach yesterdays graph.
Yes, I'm willing to switch to syringe
 
Graph of yesterday.
 

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Yes I can see it more clearly now thanks.
There are quite a few blank spaces in a few of the cycles on 27, 28 and 30 April. Was insulin given then?
As you are feeding a wet low carb diet only now you can choose whether you want to do the tight regulation method or the Start Low Go Slow method.
I will send you the link so you can look at it.
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

For tonight I think I would go back to 4 units, as long as Lady is eating well, and stay with that dose for at least 6 cycles, unless Lady drops under 90 with SLGS or 50 with TR.
If you choose TR you can increase the dose each 3 days if needed. If you choose SLGS you have to wait 7 days to increase the dose. You can decrease the dose whenever it is needed with either method.
It’s important that the Lantus has a chance to stabilise the depot.
Get a test done before every shot and a few during both cycles.
Give a couple of snacks during the cycles as well as the main preshot meals.
If you are concerned at all post and ask for help.
It would be good if you can post each day so we can see what is happening.
On this Lantus page you start a new thread each day. You put the date, cats name and the AMPS and anything else you want to ask.....eg 5/4 Lady AMPS xxx
 
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Hi Ellie, welcome tot the forum :) i hope the advise receive here is as useful for Lady as it is for Chico, we do no interact with our vet regarding FD anymore.
What i noticed is that some days you test every hour meanwhile some other days there is no preshot value and no value during the cycle. I understand it is a struggle if your work hours don’t allow you to test, it is amazing that your sister is willing to help though :)

what i would suggest is always (really always) test the preshot, in an unregulated cat it can change a loot from cycle to cycle and shooting at too low of a preshot without knowing can be life-threatening. Then what helped us a lot was the advice to test the +2 every cycle: if the +2 is the same or lower than the preshot it will most probably be an active cycle and it would be safe to test more often during that cycle; if the +2 is higher than the preshot than its usually an indication it will be a bounce and therefore such frequent testing is unnecessary. An example of an active cycle is 04/24 AM cycle, and example of a bounce cycle are 04/26 AM and 05/02 AM.
Good luck with your FD experience, it is a steep learning curve :)
 
Bron and Sheba (GA) said:
Yes I can see it more clearly now thanks.
There are quite a few blank spaces in a few of the cycles on 27, 28 and 30 April. Was insulin given then?
As you are feeding a wet low carb diet only now you can choose whether you want to do the tight regulation method or the Start Low Go Slow method.
I will send you the link so you can look at it.
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

For tonight I think I would go back to 4 units, as long as Lady is eating well, and stay with that dose for at least 6 cycles, unless Lady drops under 90 with SLGS or 50 with TR.
If you choose TR you can increase the dose each 3 days if needed. If you choose SLGS you have to wait 7 days to increase the dose. You can decrease the dose whenever it is needed with either method.
It’s important that the Lantus has a chance to stabilise the depot.
Get a test done before every shot and a few during both cycles.
Give a couple of snacks during the cycles as well as the main preshot meals.
If you are concerned at all post and ask for help.
It would be good if you can post each day so we can see what is happening.
On this Lantus page you start a new thread each day. You put the date, cats name and the AMPS and anything else you want to ask.....eg 5/4 Lady AMPS xxx
Click to expand...

Yes we gave insulin on the 27th, 28th and 30th, sorry, I've just adding the details now, I was just away those days and hadn't saved the results, but my sister did.
Ok we will give 4 shots and give snacks, she is eating...extremely well to say the least, I'll try and update each day, thank you!
 
EM96 said:
Yes we gave insulin on the 27th, 28th and 30th, sorry, I've just adding the details now, I was just away those days and hadn't saved the results, but my sister did.
Ok we will give 4 shots and give snacks, she is eating...extremely well to say the least, I'll try and update each day, thank you!
Click to expand...
4 units you mean, right?
I would try and get a + 2 and a+4 test in at least if possible. That will give us an idea of how he is going.:)
 
Welcome, Ellie, to this wonderful site. Please listen to these folks and not your vet. You do need a vet but not for diabetes information. I know the vets try to help but they do not have the experience these folks have. These people are here to help and they pull out all the stops to make sure your kitty stays in save numbers. There is a lot to learn. Try reading the yellow "Sticky" notes at the beginning of the Lantus, Basaglar, Levemir site and ask any and all questions. That is how we learn. Good luck with your Lady!
 
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