07/11 Jake's AMPS (HI) PMPS (HI)

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breayle and jake

breayle and jake

Member Since 2010
Hello All:

Back from internet/computer hell!

Jake's not doing so hot with his numbers the past few days, my monitor does not read above 500 after that I just get a HI reading. I do not have a condo for yesterday, and I've actually forgotten how everything is totally done here. So right now I'm just going to post here and then look at everything all over again.

Jake was doing pretty well for a couple weeks. He was ranging between 50 - 150, now I keep getting mixed reviews on the "Norm" for kitty. According to this site, it is 80-120.
http://www.sniksnak.com/cathealth/diabetes2.html

According to my vet it's 120-200.

This site states 50-120.
http://yourdiabeticcat.com/examples.html

I've even read in a few pages I can't even remember that you don't need to worry if your cats BG level is 40! So I'm utterly confused, exasperated and if you read this thread: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=19468 you can see that I'm a little freaked.

So here is JAKE'S sheet: http://spreadsheets.google.com/pub?key=0AgUMsjJc7hILdGNqR0VCRVBGbnI3c0o0U1VzYUdfVmc&output=html

I'm kinda lost, I've been here before and I was suggested to up his dose 'cos the numbers never went down. Now some people are saying I should lower it. My Vet says don't give him any when he's below 150. Others say give it to him only cut it in half... so I don't know what I should do.

Help :( :oops: :oops: :oops:
 
It's good to see you back in LL.

I have a couple of thoughts...
Lantus requires a great deal of consistency. You have to shoot as close to every 12 hours as you can. Likewise, dosing needs to be consistent. Just because a pre-shot number is high, you can't increase the dose and expect to get immediate results. Likewise, while it might not be safe to shoot a number in the 40s, there are other times when you've skipped a shot. There are alternatives to skipping, such as shooting a reduced dose or stalling for a little while to see if numbers are rising. Doses of Lantus have a cumulative effect. You build a shed and if you keep changing or skipping the dose, the shed is either too full or not full enough for you to see a good effect on numbers. Instead, numbers get wonky. I think this is what you're currently seeing. Remember, dosing decisions are not made based on pre-shot numbers. They are made based on the lowest point in the cycle (i.e., the nadir). This is why getting spot checks during the cycle is so important. I probably nagged the heck out of you about this when you first posted here. To be honest, you really do need to get the spot checks. Many of us work or are in school. If you can't get checks during the day, you can get them at night and weekends. But, not having mid-cycle data makes it very tough to get a full picture of what's going on with regard to dose.

If you refer back to the dosing protocol that we use here, Jake would have earned a dose reduction when he had a test result of below 50. There are at least 3 instances on his SS that I see where you should have reduced his dose if you were following the protocol.

You were correct in that it is possible to get more than 28 days of use from an opened Lantus pen or vial. And, some people can get as much as 6 mos. from their Lantus. However, you need to be alert to any changes in the physical properties of your insulin (e.g., floaties appear) or that Jake's numbers start to get weird. I do suspect that you needed to switch out your Lantus sooner than you did, though.

Jake's having free access to dry food is going to play havoc with his numbers. To the extent that sitting down with your parents and brother and educating them about the physical danger they are putting Jake in by letting him outside and the risk in terms of managing his diabetes may help. Failing that, I'd probably resort to my grandmother's suggestion regarding how she dealt with her 8 brothers -- a very sharp hat pin in a very tender spot! (Syringes can serve the same purpose, I suspect.) My grandmother was a classic!

I realize you feel like you didn't get a warm welcome here. LL is a social Board. If you visit other condos, people will visit you in return. Reading other people's condos and asking questions, as well as looking at other kitties' spreadsheets is also a great way to learn about how Lantus works. I hope that you will start to post regularly. I do think we can help you to understand what's going on with Jake and feel like you have a better sense of what to do. There is a lot to learn and we are here to help.
 
The only reason I kept his dose where it was, is because my vet asked me to do so. She also told me not to shoot below 150.

I do spot checks, and I have said this before. I am not home during the day sometimes, when I'm home he gets lots of checks. The past few months have been very tight, even to the point where I was unable to use but the very BARE minimum of strips per day. that was before his shot and after. I know this isn't that great but honestly unless someone is willing to pay for them besides me, that is going to happen from time to time.

As you can see I do get in spot checks... not all the time as I cannot afford it. I'm not sure how else I'm supposed to do it with little money and no one willing to help me out.

-Breayle
 
hello breayle. welcome back!
just want to add a little bit to what sienne has already written. i would drop jake's dose to 2.5u bid. decreasing should allow you to shoot twice a day. lantus has a cumulative effect. skipping shots because of low preshot numbers tends to mess things up. once jake has been on 2.5u for a few days we can re-evaluate. spot checks will give us a better picture of what the dose is doing. since lantus dosing is based on nadirs, not preshots... those mid-cycle spot checks are very important. if you can't get them during the day because of work, get them at night and on weekends. post jake's numbers and we'll all take a look.

eventually (after you collect more data), you'll be shooting on preshot numbers much lower than 150. if you browse through the other threads here, you'll see what i mean. eg.: my own cat's pmps tonight was 64. however, i'm not suggesting you shoot that low. you don't have the data to support that kind of decision at this time, but there will come a time when you will.

have you tried the relion meter from walmart? the meter and strips are less expensive than most. many use it.
 
Hi Breayle, a couple of us have been looking at Jake's numbers. I saw the suggestions on Health to reduce the dose, and I do think that reducing is a good idea. However, I wouldn't reduce all the way to 1.5 units since Jake does have a tendency to show Trace ketones sometimes. It's less risky to reduce just a little bit, to 2.5 units, and monitor closely to see how he does. If he gets low numbers on 2.5 too, then we can reduce again. You should always reduce the dose if he goes below 50. It's not safe to let him run lower than that, especially if you are not home during the day and not able to spot check a lot.

I'm sure you're wondering why to reduce the dose instead of increasing, which seems like the normal thing to do when he is HI. To me, it looks like the high numbers are partially caused by bounces off the lower ones (with some influence of the depleted shed from skipped/late shots and some influence from whatever food he might be getting into, and some influence possibly from old insulin). When he hits a number lower than what his body considers the safety zone, his liver will compensate by spilling more sugar into the bloodstream. Those highs do clear out on their own, but can take up to 3 days to clear. Jake was probably lower than 59 on 7/8, and he might have been dropping low the last couple of nights. The HI could be a reaction to those lows.

I do think that if your insulin is 5 months old, I would consider replacing it. One of the things we look for to determine that insulin might have lost its potency are wonky numbers, and these numbers are definitely wonky. Might as well remove that variable too, if you are able.

Just my suggestions. :smile:
 
Hello everyone, and thank you. This time is scary for me, he's my baby! I've had him for 16 years... and I'm fine with him getting old, dying going to kitty heaven and all that. I would just like to make that transition comfortable, and easy. I did give him a 3.25 dose today, but if you think I should take it to 2.5 I will. Hes been over 500 for the past two days and it's horrible. In fact I think it's been more horrible for me than him considering he's acting fine/feeling fine. I'm sorry if I seemed short with anyone, I am just so freaked out. I'm worried... I'm afraid I hurt him.

A couple of questions:

When he's at 60 and I hold the shot, when do I give it to him?
On 6/22 his AMPS was 77. I did not shoot, then I checked and hour later and it was 57. I had to go to work, and when I got him he tested 132, no shot was given (because my dr said no shot) also, she requested the same dose for at least a month. When I tested again he was 177, gave him the 3u BG went up and got to 301 the next day.

Did I do the right thing there?

Second:
Can I give a different dose each 12 hour cycle as needed? Say he goes to 400 in the AM and I give him 2.5u. Then in the PM he's at 120... do I give him a reduced dose? Hold for a couple hours? What if his BG is 70 before bed? And I wake up and he's 400?

What do I do there? Cos I'm lost...

-Breayle
 
Hi Breayle.
I am looking at your SS. To answer your question about 6/22-
In the morning the number was pretty low and I understand you not shooting. I probably wouldn't have given 3 units either.
So you skipped shot in AM. At PM Jake was 132 and you delayed the shot until he was 177, correct? That was good.

In your SS, the 177 should be in the PMPS space... it doesn't matter what time it was. You just make a note in the comment space that you gave the shot at +15 hour or whatever it was... I guess it was actually +27 since you skipped the morning shot.

Anyway, the next day 6/23 at AM +9 Jake was 39. That number means REDUCE. So you should have reduced the dose by .25u for the next shot. You had to skip again instead since Jake was 133 at PMPS time. The next morning he was in the 300's so now you shot the full dose. But that was too much of a dose. I know the whole day was pink or yellow but that was just a bounce from going so low.

Most every time Jake went low, he bounced high the next day. This combo of bouncing and skipping shots makes it hard to see what to do.

Anytime you see a number below 50 it means you should drop Jake's dose by .25u. The idea is to get a low enough dose to do some good without making him drop too far. When he gets those low numbers his liver over-reacts to this low number and thinks it has to rescue the body and a form of sugar is dumped into the bloodstream to force the BG up. That is what you are seeing after the lows... a reaction from the liver. It's a roller coaster ride.

If you have to skip shots, this is telling you that the dose is too high. The numbers under 50 signal a dose reduction. You NEED to take the reductions. Even if you skip a shot, take the reduction on the next shot after seeing a number below 50. We are looking for a more even response... less dropping and less bounce. Skipping shots makes it hard to get a flatter series of numbers. But just because you skipped, it doesn't mean the dose is fine for the next time. If it was too high that day, it will be too high the next time you shoot.

It's better to get two equal shots a day with LESS insulin per shot rather than too much. Two shots of the same dose, not different doses in the morning and evening. Same dose both times.

I think the bouncing thing is throwing you for a loop and confusing you. That's understandable, it is weird. But really, there have been several times that Jake's numbers have signaled for a reduction and you didn't reduce. I know your vet said to stay on the same dose for a month, but Jake's body is telling you something different.

June 23: BG of 39
June 30: BG of 40
Juy 5: BG of 42

All of those times the dose should have been reduced. Then perhaps the need for skipping shots would have not happened so frequently. I hope that makes sense. :-D

Second:
Can I give a different dose each 12 hour cycle as needed? Say he goes to 400 in the AM and I give him 2.5u. Then in the PM he's at 120... do I give him a reduced dose? Hold for a couple hours? What if his BG is 70 before bed? And I wake up and he's 400?
Click to expand...
No. Same dose each time.
If Jake is 400 in the AM, just hang in there with the same dose and try to get a test somewhere in mid-cycle so you can see if he's dropping low. If he's at 120 in the PM it may mean he's rising from a lower number, but we can't know that without a test. I understand you have to work so we try to get tests when possible and make judgments on patterns that Jake has. If you just cannot shoot a number because it seems too low... There are 3 things we try:

1. Stall until the number rises (you've done this, good for you!)
2. TEMPORARY lower dose is shot. We call it a BCS dose. (Big chicken sh#t dose :-D ) We try not to do this very often, but sometimes it's necessary.
3. Skip a dose... last choice.

In Jake's case you've seen some low preshots because the dose had been too high as shown by those below 50 numbers.

I hope this makes some sense. :shock: Please keep asking questions, we really want to help you.
Those 400+ numbers are hard to bear, but don't increase based on the preshot. Hang in there and give the insulin a chance to work through this. If the dose is right he shouldn't go TOO low and as a result eventually ease up on the bouncing so high. That's the goal anyway! Doses need to be adjusted based on the BG tests, so sticking to one dose for a month... is just not going to work.

Best of luck for a good day tomorrow!
 
Thank you so much, it's incredibly helpful. He did get a high dose today 'cos I was freaking out. I am going to drop him to 2.5 tomorrow and see how he does. He tested at 445 tonight about an hour ago... thank god I finally got a reading!! I will keep posting, hoping that internet/PC will keep working. Been gettin' the blue screen of death here :(

thank you all so much, jake thanks you! My vet wanted me to keep in on 1u of lantus once a day. When I read up on it and found out lantus is a 2x a day insulin i upped it to 1u 2x daily. The vet kinda freaked out a bit and kept asking I keep the dose for a month 'cos she wanted to see how he reacted. When i spoke to two pharmacy students at my work they said that was sill 'cos it was based on a sliding scale. However my ver insisted I do it. So I finally broke down and did it. I kept changing his dose and she kept giving me the speech blah blah. Anyways... thank you again. I'm so sleepy! And jake's just bummed that he's been trapped inside. Soon I will have to introduce him to three younger, healthy cats to live with when I bring him in my little house and out of the parents. I'm sure it's gonna stress my pooper out but it's the only way I feel i can give him 100% attention. I'm worried he'll get beat up by my other cats and it'll stress him out and his BGs will rocket. Not to mention the fights :(

ARG! Anyways... here's to a better tomorrow!
 
Listen to these beans - they know what they say!

And do what you can to keep Jake inside with you and your others. You may want to try feliway a diffuser to help calm the savage beasts. and do what I do, just tell them this is how it's going to be and they need to figure out how to get a long and live together.

good luck and please listen to these beans.....
 
It is wonderful to see you back - I had wondered what happened to you. I won't go over what ha already been said here, as those ladies do know their stuff, and understand Lantus and how it works very well. I would encourage you to listen to their advice. There is no question to small or too silly. so ask away. We are all here to support you and help you, and keep Jake safe and healthy. in a way he is our baby too.

I will make a comment on vets. I love my vet - I find her knowledgeable and supportive. but as far as Lantus, and the intricacies of FD, well they are just, to be blunt, out of the loop, and uninformed. We went through hell and back with Mannie initially because they did not understand Lantus and how it works. This forum here does. I too was told once a day, had a dose way too high for him, was on an unbelievable roller coaster, as they did not know what to do to get him on a correct dose. Since then I have made several trips up there to show them several things - at least they listened! I guess my bottom line is that you can trust what you read here in regards to Lantus, dosing, when and how much. my vet - no. It is important to remember twice a day, stick with a dose, be consistent, have patience, and love your little guy to death. And for when you are stressed out, or just don't know if you are doing the right thing - just ask. there are so many people here who want to help. lay down the rules to your family, and with Jake. They will listen. be strong for them and especially for Jake.

I wish you luck - together all of us here help you, and Jake. He's worth it to all of us.
 
I will also make a comment about my vet I work there and really love him and overall I think he takes good care of Do Lou but I had to stop listening to him and starting trusting the great folks here on this board and it really has make a diff for Do Lou these people will not steer you wrong you are getting some really great advice so hang in there it will get better for Jake cat_pet_icon :YMHUG: :YMHUG:
 
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