05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to shoot

Status
Not open for further replies.
B

Bebe Kaye

Member Since 2013
PLEASE READ LAST POST

Hi everyone, I'm new to this part of FDMB so apologies if I haven't set things out right. It's been an interesting week, I made THE biggest mistake by changing Miley's food and actually buying the wrong one which caused his numbers to skyrocket. I discussed this with then vet and took her advice to raise the insulin 0.5 more and to go back to the old food, this caused him to have a hypo...weirdly he had a hypo with a BG level of 4.6 (83) and I thought that was way too high. It was unbelievably scary being the first hypo he has had since diagnoses.

I am a little stuck now, I really think I need to get Miley's Insulin down as he's bringing in some pretty low numbers, this is on top of him eating a LOT, due to his CKD, he was losing a little weight so I started demand feeding him, he eats anywhere from 6 to 10 times a day (sometimes a little more if he's in a particularly hungry mood). Yesterday I dropped his insulin down to 1.75 units and will continue that for the 6 cycles and then if his numbers stay down, keep reducing it until his numbers are a little more stable. I'm not sure if this correct and would really appreciate any input on this.

Miley has had diabetes for nearly a year, I only found this forum recently and with no real help from our vet, I had been doing my best to look after him at home. I have been home testing since the first day he was diagnosed, though my vet didn't support this, I just couldn't give him insulin without actually knowing where his BG levels were (I have worked in hospitals with the 2 legged diabetics so couldn't understand not testing). I have learnt so much here already and everyone has been so wonderful!

Anyway, here I am with another very low AMPS and am not sure what to do, shoot normal units and watch closely, cut back insulin or just go for it normally? confused_cat

Thanks so much!

Bebe and Milo.

EDIT: put his PMPS+11 instead of his AMPS, fixed now!
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

I fed Miley at AMPS but didn't give him insulin.

At what would have been AMPS +1 he was up to 8.5, so I gave him his insulin along with a slightly higher carb food, just in case (assumed the 8.5 was more food related than anything and wanted to play it safe).

Miley ate 90% of the AMPS food and 100% of the +1.

Hope this was the right thing to do.
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

I think you did fine. The only thing we normally do differently is to not feed when stalling, just so you can see if he will rise on his own without food influence. I think this is enough of a rise to be comfortable giving the shot, though.

I would plan to test at +1 and +2 to get an idea of what to expect from this cycle.

Milo is doing well all of a sudden. :smile:
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Welcome to Lantus Land!

If you shot at your usual +1, your schedule will be off by an hour for your next shot. You can either shoot 30 min. early once each day or 15 min. at each shot time in order to get back on schedule.

If you want to get oriented, probably the best way to do so is to read the starred, sticky notes at the top of the Board. To summarize, the notes include the following:
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
You might want to take your time reading through. There's an overwhelming amount of information in the notes and their links. The best place to start is the New to the Group and the Tight Regulation Protocol stickies.

Please ask questions. The people here are very generous with their time and knowledge. Please let us know how we can help. And, what do we call you?
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Miley's numbers have been really great, to the point of where I was going to try and get him back down to 1 unit BID, but then I stuffed up huge which accounts for the shocking numbers on the 20th and 21st, most of his rare other high numbers coincided with vet visits...for some reason I don't think he likes them :lol:. I'm really surprised that his numbers have stayed so low considering how much food I now feed him, he used to get 10-15's and I only fed him 2-3 times per day (even though he would have quite happily eaten A LOT more)...that was before I found this page and all the awesome information.

Unfortunately my old vet only had limited knowledge when it came to FD and none at all with Lantus, when Miley was diagnosed I was asked when I would be bringing him in to be put to sleep :-x. He was completely surprised that I would want to look after him and more so that I was doing home testing. As of last week I found a new surgery that seems a lot better, after only one visit the vet rang me to see how Milo was doing...it shocked me!

Anyhow, back on topic, Milo's 'official' +1 came back at 9.3, I am so glad I gave him the insulin (oh and he conned half a tin more food out of me, he has me wrapped around his paw!).

Thanks so much for your post Libby, in future I will hold off and see what happens, Milo had a hypo a few mornings back with a BG of 4.6 and I was a little worried we'd have a repeat of that. Having a hypo at 4.6 was bizarre, especially when he had been at 3.7 6 hours earlier and had been fine, but I had a good long visit with his vet in case it was something else, possibly a stroke from his high BP, she said his actions were just a classic hypo and he was fine. Miley is just a weirdo...but I guess that's why he fits into this family so well!

Bebe and Milo
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Bebe:

Feeding multiple small meals is actually a good thing! Smaller meals don't overwhelm the pancreas the way that one or two larger meals per cycle will. It helps the pancreas to heal.

Also, I know you use mmol/L for recording your test data. We're a bit US-centric here. The convention on the Board is to report numbers in mg/dL, they way you did in your subject line. It's especially important in your subject line since there are several of us that check the Board with regularity to make sure no one is in need of help.

I'm amazed that some of the vets in Australia are as ill informed about FD as some of the vets here. Given that the Lantus dosing protocol was developed at University of Queensland, I would have hoped they would have had access to good continuing education. Oh well....
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Sienne and Gabby said:
Welcome to Lantus Land!

If you shot at your usual +1, your schedule will be off by an hour for your next shot. You can either shoot 30 min. early once each day or 15 min. at each shot time in order to get back on schedule.

If you want to get oriented, probably the best way to do so is to read the starred, sticky notes at the top of the Board. To summarize, the notes include the following:
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
You might want to take your time reading through. There's an overwhelming amount of information in the notes and their links. The best place to start is the New to the Group and the Tight Regulation Protocol stickies.

Please ask questions. The people here are very generous with their time and knowledge. Please let us know how we can help. And, what do we call you?
Click to expand...

I'm Bebe and my purrrfect sugarbaby is the magnificent Milo (or Miley).

He's been on Lantus from day 1 of his diagnoses, though until finding this site I had no idea about the depot aspect and all the other bits and pieces, so I feel like a real newbie with all this. I have been just trudging through the whole FD thing by myself, my vet was no help at all. Before this site I had been doing pre-shot BG levels and +4's (and then the occasional spot checks). Now I try and check at a variety of times to keep an eye on him, and actually understand a lot more about the insulin he's on.

The past few weeks of being here has put me in information overload, on top of all the FD information, I found out about his advanced CKD, heart murmur and high BP...my old vet has a lot to answer for! Anyway, i've had to deal with all that information as well, a lot of it is going in one ear and out the other, I'm lucky that I have bad health (never thought i'd say that lol), and am able to be home with him most of the time, which helps so much...I don't know how on earth those of you who work deal with all this!! Super-sugarkitty-owners!!

The main thing i'm currently struggling with is food, the lists just aren't making sense to me and then being in Australia really limits the availability of a lot of them. What I really need to do is get the DH to print them all out for me (trying to read the screen just isn't working), and take my time finding out what is over here and what he can have with both his FD and CKD. I'm not sure if i'll ever get it right, but I shall do my best and try and keep my Miley with me as long as he is comfy, purry and happy...after all, what are best friends for?

Thanks for your post!

Bebe and Miley
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Sienne and Gabby said:
Bebe:

Feeding multiple small meals is actually a good thing! Smaller meals don't overwhelm the pancreas the way that one or two larger meals per cycle will. It helps the pancreas to heal.

Also, I know you use mmol/L for recording your test data. We're a bit US-centric here. The convention on the Board is to report numbers in mg/dL, they way you did in your subject line. It's especially important in your subject line since there are several of us that check the Board with regularity to make sure no one is in need of help.

I'm amazed that some of the vets in Australia are as ill informed about FD as some of the vets here. Given that the Lantus dosing protocol was developed at University of Queensland, I would have hoped they would have had access to good continuing education. Oh well....
Click to expand...

It is sad that some of these people who are looking after our fur babies have very little up-to-knowledge, especially considering the prices they charge lol! My previous vet is an 'older' gent who I have been seeing for over 10 years, he has a small practice and it very much looks as though he hasn't kept up with the times. I'm glad to be with the vet, though even her knowledge was a little lacking, she was very upfront about it all, which I liked, she even recommended I leave their practice and go to the specialist cat hospital a few suburbs over. Unfortunately all the wonderful knowledge at the cat hospital comes with an obscene price tag, so I just couldn't go there. This new vet seems wonderful and very thorough, I am even heading in next week to learn how to do sub-q's (something my old vet flatly refused to do)...I have a good feeling about them and it's just a pity I didn't find them 10 years ago.

I will make sure that I post in the US numbers...thank goodness for the SS conversion...or i'd be a real mess there!

Thank you!

Bebe and Miley
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Oh and another thing, some of the numbers that I have posted on Milo's SS in the World mmol/L don't seem to appear when I check over onto the US mg/dl.

It's weird and i'm not sure if I should just create another and transfer the data and try again...I seem to break everything technological!
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Hi Bebe and welcome to you and Milo. I'm from Canada so read the World version of your SS and it seems that all the data comes across fine to the US for at least the last couple of weeks. If you ever enter on the half hour (I enter as say, 4.5@5.5) then that won't convert and you have to go to the US version and manually re-enter. It's just multiplying by 18 so not so hard to do.

I seem to remember some of our previous Australian members using Whiskas Loaf and ZiwiPeak canned foods.
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Have you found Tanya's site for CRF/CKD info? It has an incredible amount of information and is very helpful.

You may want to take a look at Dr. Lisa's food guide for low phosphorus foods. These will be better for Milo given the kidney issues.

You may want to ask on Health if thee are any members from Australia. They will be able to help you with which brands of food are available there.

Sometimes the World template isn't quite perfect. Here's a chart that will help with the conversions if you need to do it manually.
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Wendy&Neko said:
Hi Bebe and welcome to you and Milo. I'm from Canada so read the World version of your SS and it seems that all the data comes across fine to the US for at least the last couple of weeks. If you ever enter on the half hour (I enter as say, 4.5@5.5) then that won't convert and you have to go to the US version and manually re-enter. It's just multiplying by 18 so not so hard to do.

I seem to remember some of our previous Australian members using Whiskas Loaf and ZiwiPeak canned foods.
Click to expand...

Thank you!

Oh and thank you so much for telling me how to convert to the US numbers, I just wasn't quite sure, i will get to that sometime today and fix it all up.

I was feeding Milo a brand called gourmet delight, it's cereal free and seemed to be low carbs, the only problem is that I can only find it in two flavours- one chicken and one fish. To give him some variety, I recently (about 2 weeks ago) started him on whiskas food and he seems to be doing quite well on it, I'm trying to get him a variety of foods because even though he LOVES food, he gets sick of eating the same thing day in, day out...especially when he's eating so many times a day.

Thank you for taking the time to post, you've helped me a lot!

Bebe and Milo
Sienne and Gabby said:
Have you found Tanya's site for CRF/CKD info? It has an incredible amount of information and is very helpful.

You may want to take a look at Dr. Lisa's food guide for low phosphorus foods. These will be better for Milo given the kidney issues.

You may want to ask on Health if thee are any members from Australia. They will be able to help you with which brands of food are available there.

Sometimes the World template isn't quite perfect. Here's a chart that will help with the conversions if you need to do it manually.
Click to expand...

Yes I found Tanya's site the day Milo first got diagnosed with his CKD, the vet wanted him put to sleep and I had spent the day in tears until I found the site and realised things weren't as bad as I was led to believe. It's helped me so much to understand what's happening to him and I now know warning signs for things so I can get on top of any issues...I know I won't have him with me for long, he's stage 4 with a cretinine level of 500, but while he is still his normal happy self, I will do my best to keep him as such and with me where he belongs!

Thank you for the links! I've seen the food list, but just like the diabetic one, it's all gobbledegook to me, I have to get the DH to print it out, maybe on paper I will understand it more :lol:.



Thanks so much for the posts and the help! Milo would say thank you too, but then he'd probably expect you to feed him!

Bebe and Milo
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Welcome across to the new board! Loving those green numbers. Hope he keeps them up! If I were you I would definately read siennes link entitled "shooting and handling low numbers" as I think you are going to need it!!
 
Re: 05/25 Milo AMPS 5 (90) too low to shoot?

Ouch, he's down again and with myself being so unwell, I reached for a slightly higher carb food so think he's on more of a food rise than anything, I'm just so wary of late after his hypo and when he was sitting at 77 (4.3) he was doing a little bit of weird head shaking which was the precursor to his hypo early on the 23rd (Bg 83). I have just started reducing his insulin and from reading, understand I keep this level of insulin for 6 cycles before reducing it more, but I know there is no way on earth I will be up tonight and with the rest of the family also sick, I have no back ups.

I'm hoping there is some knowledgeable person out there who can advise me whether to shoot his 1.75, or take it down to 1unit just for tonight...I really don't want to risk him. Also, he has eaten 7 small meals already today, so i'd really hate to think of how low he'd be if he was off his food!

Help pretty please, I really need to crawl back into bed.

Thank you in advance

Bebe and Miley!
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

It's better if you are as consistant as possible with the dosing. However, there are times when we absolutely have to sleep or will not be around to monitor etc, where a one time reduced dose (BCS) is okay to give. Let's see what his +12 test number is before deciding. I will be around for a little over an hour here, then I have to leave for work.

Please post your +12 as soon as you get it. I'll be watching for it.
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

I'm not sure exactly what you meant by "I reached for a slightly higher carb food". We usually tell people to try not to feed for the last two hours in a cycle (unless the cat has a BG under 50). That is so we can tell if the PS test is rising or dropping or staying about the same, without the influence of a food spike. When was the last time he ate?
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

Hello Bebe, you have a few options to choose from. For the first two, you need to make sure he hasn't eaten since +10, as eating after +10 will inflate his +12 number.

1) Milo rises enough by +12 that you feel comfortable shooting his full dose
2) At +12 he is still too low for you to shoot, you wait 1/2 hour for him to rise some more (without feeding), then shoot the full dose. Or keep waiting in 1/2 hour increments until he rises enough. Your schedule has to be able to take the change in shot time because your next shot will be 12 hours after that.
3) Shoot a reduced dose at +12 (one time reduction only), affectionately called the big chicken shot (BCS)
4) Skip the shot

If you can't stay up to monitor, that may eliminate a couple of the options. Good luck and get healthy fast!

ETA: I see Dyana is up, that's great as I'm about to log off. Post your +12 and it'll help the decision making. Some cats zoom up at the end of the cycle.
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

Dyana said:
I'm not sure exactly what you meant by "I reached for a slightly higher carb food". We usually tell people to try not to feed for the last two hours in a cycle (unless the cat has a BG under 50). That is so we can tell if the PS test is rising or dropping or staying about the same, without the influence of a food spike. When was the last time he ate?
Click to expand...

+12 is 139

At +7 I gave him his ordinary food and then at +9 I gave him some higher carb food, he hasn't eaten since +10 and is still only 139. I panicked and gave him the hc food because he started getting a weird head twitch that was the same as 2 days ago before his hypo. I'm loathe to push him back as I had to do that already 2 days ago and was still in the process of getting him back on time (bringing his shots back 15 minutes Am and PM), if I wait tonight, i'll be fine to deal with him during the day, but nights will be impossible.

I have spent so long dealing with Miley's FD by myself with very little information and no vet support, I'm only just now starting to understand the immensity of it all.

I think I will just have to skip tonight, I was stuck in hospital for 9 days at the start of the month and REALLY don't want to go back in again. I know that this will affect him greatly and his numbers will be high for the next few cycles, but I'm just stuck right now.

Thank you so much for taking the time to help me, I really appreciate it.

Bebe and Milo
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

If you need to stay on schedule, you could also give him a one time reduced shot, since he is rising, and you will be feeding him to bring his numbers up some more. Or you could choose to skip, that's fine too. You're doing the best you can :YMHUG:
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

Than you so much Dyana for your reply.

I decided to do the reduced shot just for tonight so that he's not draining out that depot over the next 12 hours, I did what would have been a +1 test and he was sitting at 157, so he's still rising and I feel fairly confident that 1 unit will be okay for him overnight.

He seems to be a little off colour, it's so hard to tell if it's FD related or one of the other things (FD, CKD, Cushing's, High BP, heart murmur)...my boy certainly likes to be 'special' :lol:. With any luck i'll have one of my usual bad night's and be up sometime during the night to give him a quick test and make sure he's doing okay. After giving him his insulin, I got his food ready and for the first time in a long time, he's turned his nose up at it...his tummy is also making a little bit of a gurgling noise so I'm thinking the stomach acid issues that occur with the CKD might be starting...why on earth do these things always happen on a weekend when the vet is closed?!?

I don't think I stressed out this much raising my kids!

Thanks for your help,

Bebe and Miley
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

And as though he instinctively new I was talking about him, he got up and started eating :roll:, I do swear this cat does things like this on purpose! He's lucky I love him so much. cat_pet_icon

bebe *glaring at* Milo
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

Bebe Kaye said:
And as though he instinctively new I was talking about him, he got up and started eating :roll:, I do swear this cat does things like this on purpose! He's lucky I love him so much. cat_pet_icon

bebe *glaring at* Milo
Click to expand...

He's a CAT :lol: :lol: :lol:

(Hopefully no belly issues, just a little hunger rumble10
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

Did your vet give you any medications for Milo's stomach? I believe some of the folks here with CKD kitties will use 2.5 mg of Pepsid AC (famotidine) for acid stomach. I'm presuming that Milo is on medications for his medical problems. While famotidine can be purchased over the counter at a pharmacy, I'd check with your vet or the pharmacist to make sure it doesn't interact with Milo's other meds.

What meds is Milo on?
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

Sienne and Gabby said:
Did your vet give you any medications for Milo's stomach? I believe some of the folks here with CKD kitties will use 2.5 mg of Pepsid AC (famotidine) for acid stomach. I'm presuming that Milo is on medications for his medical problems. While famotidine can be purchased over the counter at a pharmacy, I'd check with your vet or the pharmacist to make sure it doesn't interact with Milo's other meds.

What meds is Milo on?
Click to expand...

So far the vet hasn't suggested anything for stomach acid and I haven't seen any definitive signs that he's having issues with it yet. Thank you for the name of the tummy medication, I will try to get it...just fingers crossed they sell it in Australia! So far the only medications Miley is on is Amlodopine for his blood pressure, I have him booked in on Thursday for another BP test, a vitamin B shot (I have to call Monday to make sure it's the right one) and they're also going to show me how to do subq's so I can start those at home. I will bring up that medication you mentioned with them before giving it to him...just in case.

Low numbers again today, i will start a new post for those, haven't been able to get online all day.

Bebe and Milo
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

Famotidine is the generic name for the stomach med.

Just in case you ever need consultation, THE leading researcher on the use of Lantus in cats is Jacqui Rand, DVM at the University of Queensland. She directs the Centre for Companion Animals at the university. Given her prominence, I'm very surprised your first vet was unaware of how to best treat feline diabetes.
 
Re: 05/25 Milo +7 72 +8 77 +9 77 +10 88 +11 104 scared to sh

I guess location doesn't mean too much, it seems my previous vet didn't keep up with research...Milo was the first cat he'd ever treated with Lantus. I trusted his advice, but it was more of the blind leading the blind it seems...most people on this forum know more about Lantus than he did. :roll:

I would love to see that person you recommended, but I doubt I could afford it, lol, I couldn't even afford to set foot into the cat hospital a few suburbs over! Things are a little pricey over this way and as i'm only on a disability pension, it makes things a little hard...unfortunately like a lot of people, my bank balance determines Miley's treatments. When he first got diagnosed as diabetic, it was on a weekend and I had to take him to an animal emergency centre...it cost me $4500 for 2 days care and seeing as that was around a year ago, I would have thought they'd have run more tests and found his CKD and heart murmur...but no, the CKD only came to light through a geriatric blood examination my old vet ran, the heart murmur when I went a week or so ago to a new vet.

Okay, end of rant, sorry!

Hope everyone's having a wonderful day!

Bebe and Milo
 
Status
Not open for further replies.
Back
Top