08/01/15 Luna Rollercoaster, AMPS 528 PMPS 141

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pevsfreedom

pevsfreedom

Member Since 2015
Old: http://www.felinediabetes.com/FDMB/threads/luna-amps-528-ketones-0-9-mmol-l.141920/

@Meya14 @Jill & Alex (GA) @BJM

I was gonna shoot at +11 tonight (1 hour early to change her schedule a bit) and she's at 141 so I am NOT SHOOTING for right now unless you guys have some info. Gonna check again in an hour. She ate ONE HOUR early (at +11) tonight.

I made a thread this morning and she was 528...

At +11 she's 141. She's never been this LOW, and was never THAT HIGH. The 528 must have been a bounce from low number's last night right?

This is a new vial of insulin from someone here on FDMB. Is it perhaps that our old vial of insulin was 'bad' and thus we weren't getting proper numbers? What precautions do I need to take if this is the cause? I'm worried she's getting TOO MUCH insulin now..? Any ideas?

Again I did NOT SHOOT so far tonight, have another hour to decide if I'm going to or not. Will report again in 1 hour at +12.
 
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Stall 30 minutes without feeding and re-test to see what is changing and in what direction. If dropping, you might skip. If rising fast, it may be OK to shoot.
 
I already fed. Current plan was to test again at +12 (1 hr from now). Didn't expect her to drop this much. I typically test 5 mins after I feed since she gets disgruntled at dinner time.
 
Next time, try giving just a few teaspoons of food to take the edge off, then test.
With a higher dose cat, a token shot - maybe 25% of the regular dose - may be given so it doesn't zoom to high over the next 12 hours.
 
BJM said:
Next time, try giving just a few teaspoons of food to take the edge off, then test.
With a higher dose cat, a token shot - maybe 25% of the regular dose - may be given so it doesn't zoom to high over the next 12 hours.
Click to expand...

Ok. Should I do that at +12? Also, do you think that perhaps our old vial of insulin was bad and this new vial (we started her on it yesterday AM) is good? I'm worried she might be getting too much insulin or something now as the old vial didn't seem to be "doing much" as you can see per the spreadsheet.

Thx BJM.
 
How old was the old vial? If it had been stored properly, was clear and less than 3-4 months old, it was probably OK, but it's always possible it just ran out of poop sooner

One way to know for sure...if she continues doing well with the new vial and you go back to the old and the numbers go back to icky, you'll know for sure it's the insulin
 
pevsfreedom said:
Ok. Should I do that at +12? Also, do you think that perhaps our old vial of insulin was bad and this new vial (we started her on it yesterday AM) is good? I'm worried she might be getting too much insulin or something now as the old vial didn't seem to be "doing much" as you can see per the spreadsheet.

Thx BJM.
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I am in a similar boat tonight pevsfreedom. I've re-tested and it's not come up much (195) even after eating some so, being at 1U, I'm going to skip tonight.
In your case, since Luna is usually really high in the AM, perhaps, waiting to see what her number is. If it's still below 200....I'd think about skipping tonight for peace of mind but, that's me and my nerve level. In this case, if Luna rises above 200...I'd perhaps, think about a "token dose" of perhaps, 1U so as not to soar as BJM has said. If not...perhaps, skip tonight and see where she's at in the morning at your regular time.

It COULD be that your previous insulin was losing strength and the newer vial is more potent??? The only way to know is to look at her numbers in the morning. If her numbers are high...you might want to give the full dose you usually do and watch her throughout the day. 141 is not hypo range so, no worries there...just that you don't want to add your normal dose to that right now.

If you're really uncomfortable/unsure...give LESS than normal doses in the morning if her numbers are up but, not through the roof and see. Better to be high for a day or so than too low is what I've been told by vets. I know everyone has their comfort zones and some are more ready than others to fight hypo situations and test every 20 to 30 mins. I'm not one of those and I don't have a cat who is that compliant.
 
Let's see what the test is on the +12 hour. Post here and do not feed anymore. Skipping insulin on a ketone prone cat is not a good idea. It's better to give some insulin and give high carb food if you need to.
 
Chris & China said:
How old was the old vial? If it had been stored properly, was clear and less than 3-4 months old, it was probably OK, but it's always possible it just ran out of poop sooner

One way to know for sure...if she continues doing well with the new vial and you go back to the old and the numbers go back to icky, you'll know for sure it's the insulin
Click to expand...

It is not even 2 months old and stored properly but the #'s don't add up. New vial is working immediately (or so it seems)?

Both vials are the same age, 2 months.
 
Wendy&Neko said:
Let's see what the test is on the +12 hour. Post here and do not feed anymore. Skipping insulin on a ketone prone cat is not a good idea. It's better to give some insulin and give high carb food if you need to.
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What amount of insulin are we talking here if she's ~150? Received 5.5 u this morning. On my way to check her now.
 
+12 she's at 199 (1 hour after eating). Giving 1.5 units to be safe. Will start back up regular 5.5 tomorrow and monitor again I guess.
 
You probably would have been fine to go half dose, but at least the 1.5U will give her some insulin. If you could get a +2 tonight, that will probably be very informative. Today it looks like Luna was breaking a bounce. That type of cycle combined with a dose increase means you can see a lot of action. On the positive side, she got to 141 on this dose! :cool: I'd hold it at least 8 cycles, unless she goes below 50.
 
Wendy&Neko said:
You probably would have been fine to go half dose, but at least the 1.5U will give her some insulin. If you could get a +2 tonight, that will probably be very informative. Today it looks like Luna was breaking a bounce. That type of cycle combined with a dose increase means you can see a lot of action. On the positive side, she got to 141 on this dose! :cool: I'd hold it at least 8 cycles, unless she goes below 50.
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Will do the +2. I did just above 25% per BJM's advice.
 
I think that's a good idea....She's obviously clearing a bounce tonight and since we don't know where she's been going at night for the past several nights, it may be that she's been dropping lower than you know of
 
I have a cat with two high dose conditions (IAA and acromegaly). Usually 1/2 to 2/3 of the shot is OK, but it's best if you can monitor. Once you have enough data you should be able to shoot lower. She did come up quite a bit in the hour. Being prone to ketones also means getting as much insulin in as you can is best. Just something to keep in mind for next time you see a lower number, and paws crossed you will see that. It's a good sign of progress. On this forum, if you are following TR, we say it's OK to shoot anything above 150. Below that you test, do not feed, and post for help on what to do.

I notice that you've gotten a couple of +1 tests on your SS, which is great. Those times it looks like she didn't get much of a bump up from her dinner. Getting a few more of those tests will confirm whether feeding her makes much of a difference when you are stalling. Next time you get a lower preshot, try stalling without feeding carbs. You can feed some freeze dried chicken or even pieces of boiled chicken breast, both of which are no or very low carbs.
 
Chris & China said:
I think that's a good idea....She's obviously clearing a bounce tonight and since we don't know where she's been going at night for the past several nights, it may be that she's been dropping lower than you know of
Click to expand...

I'm assuming she went really low last night with this new vial of insulin. Assuming she'll also be super high for AMPS.
 
Wendy&Neko said:
I have a cat with two high dose conditions (IAA and acromegaly). Usually 1/2 to 2/3 of the shot is OK, but it's best if you can monitor. Once you have enough data you should be able to shoot lower. She did come up quite a bit in the hour. Being prone to ketones also means getting as much insulin in as you can is best. Just something to keep in mind for next time you see a lower number, and paws crossed you will see that. It's a good sign of progress. On this forum, if you are following TR, we say it's OK to shoot anything above 150. Below that you test, do not feed, and post for help on what to do.

I notice that you've gotten a couple of +1 tests on your SS, which is great. Those times it looks like she didn't get much of a bump up from her dinner. Getting a few more of those tests will confirm whether feeding her makes much of a difference when you are stalling. Next time you get a lower preshot, try stalling without feeding carbs. You can feed some freeze dried chicken or even pieces of boiled chicken breast, both of which are no or very low carbs.
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Great thanks. New to this world of 150 BG levels. I hope it continues (without the >500's!). I didn't even think of the +1 as a tool for monitoring how the food works. thanks for that idea. Basically it can be presumed perhaps that her going from 150 to 199 was not necessarily all because of the food then? I will start testing BEFORE I feed, and she just has to deal with it! Lol.
 
I don't know why I don't get a notification when tagged in a post. Sorry.

Its possible that the change in vial is doing something, but I think what you are seeing is the beginning of the "breakthrough" from the dose increase from 5 to 5.5. If you don't have to work and can monitor, I would have personally shot the whole thing if you are confident that you could handle a hypo if it happened. If you were not confident handling lower numbers yet, I would have shot 1 unit less.

Lantus doesn't begin to work for hours after you shoot which gives a lot of time for the numbers to keep climbing before it kicks in. Due to this, the best way to get numbers to stay in the blue or green is to be shooting on blue or green numbers. It's scary at first, and in your cat being higher dose it seems scarier. However, backtracking the dose every time you get a good PS number will just make insulin resistance worse. We regularly shot anything above 70, sometimes lower, but that was with a lot of data. Since he is new to the low numbers you will have to see what happens.

Once you breakthrough the insulin resistance, however, sometimes the numbers do go down, and you can reduce the dose overall. That's great when it happens. Sometimes you end up much lower than where you started after a few weeks.
 
John --

With a cat that is prone to ketones, especially if there is an acknowledged source of inflammation/infection (e.g., Luna's teeth), it is hugely important that you get insulin in. The fundamental recipe for ketones is:
ketones = infection/inflammation + not enough food + not enough insulin​
Because @Jill & Alex (GA) and I were assuring you that Luna's ketone levels were not worrisome, it doesn't mean they will stay that way if you skip a shot or shoot reduced doses. In your situation, it is a wiser course of action that you give the full dose and feed higher carb food in order to keep numbers in a safe range. In all honesty, I don't know if the people providing you with guidance at PM shot time were aware of Luna's ketone situation or knew how to factor that in to the information they were providing. IMHO, until you know that Luna is reliably past the point of developing ketones, you need to do whatever is safely possible to get as much insulin in her as you can even if it means a meal of high carb (HC) food. (I've told people to feed their cat an ice cream sundae if necessary.)

I think it's way to early to interpret what the numbers from yesterday mean. Rather than look at one cycle, in order to interpret the data on a SS, it's more reliable to look for trends. This is why getting PM tests is also important.

There is also one aspect of using a long-acting insulin like Lantus that I don't think you're aware of. The desired Lantus "curve" is flat. This flat curve is characteristic and you'll see that we often talk about a cat "surfing" -- our lingo for a flat cycle. What that translates to is that you can't assume that because Luna's numbers dropped from 528 to 141 during your AM cycle that if you shoot a lower number, that Luna will have a symptomatic hypoglycemic episode and spend the night in the ER. If you look at the subject lines on the Board, you'll see that people routinely shoot low numbers. Many experienced members shoot any number above 50. (Of course, we do that when we have sufficient data to support the decision and because we know our cat and can monitor.) The basic premise of a long-acting insulin is, "Shoot low to stay low." providing you are data ready.

 
Sienne and Gabby said:
With a cat that is prone to ketones, especially if there is an acknowledged source of inflammation/infection (e.g., Luna's teeth), it is hugely important that you get insulin in. The fundamental recipe for ketones is:
ketones = infection/inflammation + not enough food + not enough insulin Because @Jill & Alex (GA) and I were assuring you that Luna's ketone levels were not worrisome, it doesn't mean they will stay that way if you skip a shot or shoot reduced doses. In your situation, it is a wiser course of action that you give the full dose and feed higher carb food in order to keep numbers in a safe range. In all honesty, I don't know if the people providing you with guidance at PM shot time were aware of Luna's ketone situation or knew how to factor that in to the information they were providing. IMHO, until you know that Luna is reliably past the point of developing ketones, you need to do whatever is safely possible to get as much insulin in her as you can even if it means a meal of high carb (HC) food. (I've told people to feed their cat an ice cream sundae if necessary.)

I think it's way to early to interpret what the numbers from yesterday mean. Rather than look at one cycle, in order to interpret the data on a SS, it's more reliable to look for trends. This is why getting PM tests is also important.

There is also one aspect of using a long-acting insulin like Lantus that I don't think you're aware of. The desired Lantus "curve" is flat. This flat curve is characteristic and you'll see that we often talk about a cat "surfing" -- our lingo for a flat cycle. What that translates to is that you can't assume that because Luna's numbers dropped from 528 to 141 during your AM cycle that if you shoot a lower number, that Luna will have a symptomatic hypoglycemic episode and spend the night in the ER. If you look at the subject lines on the Board, you'll see that people routinely shoot low numbers. Many experienced members shoot any number above 50. (Of course, we do that when we have sufficient data to support the decision and because we know our cat and can monitor.) The basic premise of a long-acting insulin is, "Shoot low to stay low." providing you are data ready.
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I agree with every point Sienne has made in this post. Couldn't have said the above better! In fact, you might want to copy and/or bookmark this post to have as a reference for the days ahead.
Meya14 said:
If you don't have to work and can monitor, I would have personally shot the whole thing if you are confident that you could handle a hypo if it happened.
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Me, too. Just want to add, I would have personally shot the whole thing if you are confident, available to monitor for as long as necessary, and that you could handle a hypo if it happened.
Meya14 said:
Lantus doesn't begin to work for hours after you shoot which gives a lot of time for the numbers to keep climbing before it kicks in. Due to this, the best way to get numbers to stay in the blue or green is to be shooting on blue or green numbers. It's scary at first, and in your cat being higher dose it seems scarier.
Click to expand...
How many hours after shooting does the insulin begin to take effect (onset)? Where she is at at onset is the number you're actually shooting because as Meya14 has said, the BG numbers will continue to climb before the insulin kicks in. Onset for *most* cats on Lantus is at +2, but ECID. That's something you'll have to figure out for Luna.
Meya14 said:
However, backtracking the dose every time you get a good PS number will just make insulin resistance worse.
Click to expand...
I see good/lower preshot numbers as an opportunity to bring BG numbers down overall. Lower preshot numbers are what you want to see. Lantus is known to have a harder time pulling down higher numbers. If one starts with a lower preshot number, there's a better chance of obtaining that low flat curve that Lantus is famous for when used to it's full advantage/correctly in felines.

Don't get me wrong. Making progress by shooting lower preshot numbers comes with it's own set of responsibilities as mentioned above: a well-stocked hypo tool kit, confidence in handling low numbers/a hypo, and the ability to monitor for as long as necessary.

Jojo's HYPO TOOLBOX
SYMPTOMS OF & HOW TO TREAT HYPOGLYCEMIA
LANTUS & LEVEMIR - TIGHT REGULATION: SHOOTING & HANDLING LOW NUMBERS



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Just some thoughts...
have a good day!
 
John, I have the luxury of seeing your ss this morning, after the reduced dose. One of the benefits of the spreadsheet is that you can glean valuable information from being able to look back and analyze what happened.

One observation worth noting is that Luna was clearing a bounce yesterday - note the black amps, the descent of her BG tests during the day. She bottomed out in blue numbers, and only spent something like 2 hours before she bounced from it again. I'd suspect the +2/315 was likely not very influenced by the reduced shot, but instead was her beginning another bounce.

The take away is that her body is very used to high numbers and only spent a short time in blue numbers at the bottom of the bounce. That still suggests that she's going to likely need more insulin - remember dosing decisions are made by the low points (nadirs) on any given dose. You want her in green numbers, so unless you see some drastic change, and as long as you continue to measure ketones present, if I were you, I'd only hold this dose a short time (4-6 continuous cycles, count starting this morning as #1 on the 5.5u dose) before increasing the dose again. Let's see what others suggest on how long you should hold the dose.

The brief time she spent in blue numbers also reinforces the need for pm cycle tests, just in case she's showing her low points briefly in the night instead of in the day, which many cats will do.
 
julie & punkin (ga) said:
if I were you, I'd only hold this dose a short time (4-6 continuous cycles, count starting this morning as #1 on the 5.5u dose) before increasing the dose again. Let's see what others suggest on how long you should hold the dose.
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FWIW, we don't know what a 5.5u dose is capable of. I'd see what the 5.5u dose can do before making suggestions on when to increase the dose.
julie & punkin (ga) said:
The brief time she spent in blue numbers also reinforces the need for pm cycle tests, just in case she's showing her low points briefly in the night instead of in the day, which many cats will do.
Click to expand...
I agree! For all we know, Luna was seeing seeing blues in the PM cycle on the 5.0u dose.

Just throwing this out there because I have no idea what your circumstances are...
Would it help/is it possible to figure out earlier shot times so PM tests could be a little more frequent?
 
Sienne and Gabby said:
John --

With a cat that is prone to ketones, especially if there is an acknowledged source of inflammation/infection (e.g., Luna's teeth), it is hugely important that you get insulin in. The fundamental recipe for ketones is:
ketones = infection/inflammation + not enough food + not enough insulin​
Because @Jill & Alex (GA) and I were assuring you that Luna's ketone levels were not worrisome, it doesn't mean they will stay that way if you skip a shot or shoot reduced doses. In your situation, it is a wiser course of action that you give the full dose and feed higher carb food in order to keep numbers in a safe range. In all honesty, I don't know if the people providing you with guidance at PM shot time were aware of Luna's ketone situation or knew how to factor that in to the information they were providing. IMHO, until you know that Luna is reliably past the point of developing ketones, you need to do whatever is safely possible to get as much insulin in her as you can even if it means a meal of high carb (HC) food. (I've told people to feed their cat an ice cream sundae if necessary.)

I think it's way to early to interpret what the numbers from yesterday mean. Rather than look at one cycle, in order to interpret the data on a SS, it's more reliable to look for trends. This is why getting PM tests is also important.

There is also one aspect of using a long-acting insulin like Lantus that I don't think you're aware of. The desired Lantus "curve" is flat. This flat curve is characteristic and you'll see that we often talk about a cat "surfing" -- our lingo for a flat cycle. What that translates to is that you can't assume that because Luna's numbers dropped from 528 to 141 during your AM cycle that if you shoot a lower number, that Luna will have a symptomatic hypoglycemic episode and spend the night in the ER. If you look at the subject lines on the Board, you'll see that people routinely shoot low numbers. Many experienced members shoot any number above 50. (Of course, we do that when we have sufficient data to support the decision and because we know our cat and can monitor.) The basic premise of a long-acting insulin is, "Shoot low to stay low." providing you are data ready.
Click to expand...

Figuring out the right/wrong thing to do is quite difficult sometimes I'm finding.
 
Jill & Alex (GA) said:
FWIW, we don't know what a 5.5u dose is capable of. I'd see what the 5.5u dose can do before making suggestions on when to increase the dose.

I agree! For all we know, Luna was seeing seeing blues in the PM cycle on the 5.0u dose.

Just throwing this out there because I have no idea what your circumstances are...
Would it help/is it possible to figure out earlier shot times so PM tests could be a little more frequent?
Click to expand...

Yeah I'm working on that starting today. Getting a +2 at 1am isn't too easy so I'm gonna slowly roll her to an earlier time.
 
pevsfreedom said:
Figuring out the right/wrong thing to do is quite difficult sometimes I'm finding.
Click to expand...

It can be complex to figure out at times - you're not alone in that! Your situation is a little different than the norm because of the ketones. Don't worry, it all gets easier. Just take what you learn and move on with it. :bighug:
 
julie & punkin (ga) said:
It can be complex to figure out at times - you're not alone in that! Your situation is a little different than the norm because of the ketones. Don't worry, it all gets easier. Just take what you learn and move on with it. :bighug:
Click to expand...

Well she was 239 tonight and my first thought was "WHOA THATS LOW *alarms alarms*" and then I remembered this thread and.. shot her up normally and everything will probably be fine. Lol.
 
It's great to see those preshots coming down.:) If you can get a +2 tonight that will tell you whether you need to set an alarm to get up any later to test her. If the +2 test is quite a bit lower than the preshot, that's a good indicator on Lantus that she's going to see an active cycle.
 
julie & punkin (ga) said:
It's all perspective, isn't it?!

It's a good idea to read other people's threads - you can see from the subject lines what kind of numbers other people shoot.
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Yeah I try to read as much as I can. The 'hypo' thing just scares me, and it's still sinking in the insulin isn't quite medication and results aren't always typical. I just think for some reason that @ 200 points I give 5 units and (oh my god) she's gonna drop 200 more points to zero! and am slowly learning that's not how it works! Lol.
 
Wendy&Neko said:
It's great to see those preshots coming down.:) If you can get a +2 tonight that will tell you whether you need to set an alarm to get up any later to test her. If the +2 test is quite a bit lower than the preshot, that's a good indicator on Lantus that she's going to see an active cycle.
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Thanks. So if she's lower at +2 (by how much generally?) then pre-shot I should probably set an alarm for +5 or so?
 
Maybe 15-20% lower? If you look at yesterday's day cycle, her +2 was 110 points lower than her AMPS (around 20%), and she did end up going down quite a bit that cycle. After that, a +5 might be a good one. If she was a lot more down, I'd go for a +4.
 
Wendy&Neko said:
Maybe 15-20% lower? If you look at yesterday's day cycle, her +2 was 110 points lower than her AMPS (around 20%), and she did end up going down quite a bit that cycle. After that, a +5 might be a good one. If she was a lot more down, I'd go for a +4.
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Thanks.
 
One counter-intuitive thing about Lantus and Lev both - shooting lower numbers, ie, shooting the full dose into normal blood sugar (50-120) can have the effect of lowering the entire blood sugar range & flattening out the "curve" and turning it into a flat line. These insulins work better at holding blood sugar flat than they do at bringing down high numbers.

Here are a couple of posts that might help you understand more about how that works in real life. The first one has some spreadsheets linked as examples and they are worth taking a look at. There are also some quotes in there that you'll have to expand to be able to read:
Shooting Low (post #16)
Shooting a Dropping Number (post #6)

The difference between shooting a 500 and shooting a 60 is like the difference between regular golf and mini golf. They are totally different games.

Often people have to work up to shooting low by gradually lowering the number they're shooting. With your situations with ketones, however, you may need to make a leap of faith and lower it fairly quickly. So far the lowest you've shot without reducing the dose is over 200. Experienced people will shoot most everything over 50 as long as their cat is eating normally, and they can monitor afterwards the first few times until they learn, from experience, what the cat will do when you "shoot low."
 
Thanks for the great info. I'm glad I have all of you @ FDMB to help me. I'd be lost otherwise. What a great video with Punkin & Anya!
 
Thanks! Anya and Punkin were so cute together! Like a little bonded couple - Anya was pretty depressed when Punkin died. Then we got 2 kittens 4 months later and I'm sure she wanted us to send them back! She likes one of them now, but the other one . . . not so much.

I'm off to bed - have a good night!
 
Wendy&Neko said:
If the +2 test is quite a bit lower than the preshot, that's a good indicator on Lantus that she's going to see an active cycle.
Click to expand...
True, but let's not forget (with Lantus) if the +2 is about the same as the preshot number one can usually expect to see some pretty good movement. Up 'til recently (last couple of years), we've said if the +2 is around the same as the preshot number... be on alert for an active cycle. If the +2 test is 10 - 20 % lower than the preshot number, one should be on the lookout for a very active cycle. :)

julie & punkin (ga) said:
Experienced people will shoot most everything over 50 as long as their cat is eating normally, and they can monitor afterwards the first few times until they learn, from experience, what the cat will do when you "shoot low."
Click to expand...
And experienced people with cats who are throwing even "Trace" ketones on a ketostix will shoot a cat even when they aren't eating normally because they realize the importance of getting insulin into the cat. What they do is get food into the cat by doing whatever they have to do... up to and including feeding whatever the cat will eat... dry food... or syringe feeding... every few hours if necessary. It may even come to using karo syrup to bump up the numbers. Whatever it takes. It's not always easy, but heading off DKA is so worth it.

Alex was a ketone prone cat. She threw "Trace" ketones several times in the 8.5 years she was diabetic and never had to be ho$pitalized once since her week long hospital stay with DKA at diagnosis. I credit getting enough insulin into her, food, fluids, and treating infection or other systemic stressors (in her case primarily p-titis, liver & kidney disease, gingivitis) as key to preventing a repeat of a full blown episode of DKA. It worked!

Of course, monitoring carefully is a given.


Ask as many questions as you have. You're dealing with more than the usual and as a result, have many eyes on Luna.
I have an early day tomorrow and should have been in bed hours ago! LOL!
Have a good night.
 
She's 237 at +2 tonight.

We only use the blood ketone meter and have never been >2.1 per your posts in this same thread, so I think she's right under/around trace levels off of that. I won't alter her dose again, I got conflicting info. Luna will eat everything in the house if I let her lol.

Thanks for all the info and good night.
 
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