? 09/05 Kai AMPS 303 +4 85

[Maddie & Kai]

This is my first time posting on the Lantus Form and probably my 3rd post overall on the site. Please let me know if I’m doing something wrong.


For more back story on Kai please see this Thread.


2 weeks ago I increased Kai's Lantus to 2 units. I know SLGS method says he can be increased after 7 days but we were coming off of an antibiotic and struggling with some bouncing numbers, possibly dealing with glucose toxicity from where I was overly cautious and kept him on too low of a dose previously.


He has been doing well on the 2 units and acts like he feels great. We are getting a lot more yellow and blue readings and fewer pinks, however, I would like to see him drop lower. I was thinking of increasing him to 2.25 or 2.5 units. My vet recommended 2.5 units but i am unsure. We did a AM curve on the 2nd. I still need to do a PM curve. I am going to try and do his PM curve today or tomorrow and then increase him over the weekend when I am able to be home to constantly monitor him.


However, today I am conflicted because he dropped so rapidly to 85 at his +4 hours after having an AMPS of 303. He acts fine and has zero hypo symptoms, but that number is just not normal compared to his other readings on 2 units. Should I be concerned about that before increasing this weekend?


Can one of the experienced Lantus users please take a look at his spreadsheet and let me know your thoughts on increasing this weekend? As well as why he might have dropped so low at his +4.


Please and thank you in advance.

Maddie & Kai

 

[Wendy&Neko]

Can you get another test at +5 or +6 today? I want to make sure that 85 is as low as he goes. That was a huge drop from AMPS.

When following SLGS, any number below 90 means an immediate reduction in dose. Not an increase. You will find that threatening an increase will often mean the cat has an active cycle, proving you wrong. Maybe 1.75 unit will be his sweet spot.

 

[Maddie & Kai]

Sorry, I wasn't able to get a +5 or +6. I was only able to obtain that check during my lunch break. However, his PMPS is back up to 140.

It feels like every-time I think i know what i'm doing and I get ready to adjust his insulin, he throws me a curve ball like this.

Could that lower number be a result of glucose toxicity? Have I screwed up beyond repair.

For tonight i'm going to decrease back to 1.75 units.
Then should I stay at 1.75 units for the next few days even if his Pre-shots are in the 300s-400s?

Also, I use the u100 syringes for the Lantus. Are there other syringes that make it easier to measure in 0.25 increments. Should i be concerned about that?

 

[Wendy&Neko]

Breaking glucose toxicity can mean he'll need less insulin.

Then should I stay at 1.75 units for the next few days even if his Pre-shots are in the 300s-400s?

If following SLGS, you hold the dose for 7 days, regardless of preshot numbers (we dose based on nadirs) except you would reduce again if he goes below 90.

Also, I use the u100 syringes for the Lantus.

Do your syringes have half unit markings? U-100 syringes are for Lantus. You want the U-100 3/10 syringes. From the Sticky Note on Insulin Care and Syringe Info (a recommended read for all):

• U-100 3/10cc syringes with half unit markings are the best to use for drawing Lantus, Levemir, or the Biosimilars from vials, cartridges, and pens.
• BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn are just some of the brands available with half unit markings.
• Syringes come in 5/64 inch (6mm), ½ inch (8mm) or 5/16 inch (12.7mm) needle lengths. Needle gauges are 29, 30 or 31 (31 being the thinnest)

 

[Maddie & Kai]

Yes! I have the u-100 3/10 with the half markings, it just feels like i'm guessing too much when drawing for the .25 mark between the whole unit and the half unit. It still feels like i'm giving him 2 units. I didn't know if there might be syringes with .25 increments that could help me be as accurate as possible lol

Thanks for your help Wendy! I am going to keep him at the 1.75 for the next few days and see how he does. If his numbers remain high and he dosen't drop back down past 90 again within that time, I'm going to increase him back to 2 units. Run that does for 7 days and then go from there. I have a feeling we will need to go back up to 2 units. If that is the case, do you have any thoughts on what could have caused that low reading. Is that what glucose toxicity really looks like or could that number have been just a fluke? Also is there document that I haven't found on glucose toxicity and how to break it that you can share with me?

Once again, thank you for taking the time to offer advice.