1/17 Princess AMPS 378 +3 330 Second day on BID -- Advice??

Status
Not open for further replies.
patricia&princess(GA)

patricia&princess(GA)

Member Since 2009
Not quite sure what's going on here, still new to Lantus.
AMPS 378
+3 330
+6 311

Yesterday 1/16 was our first day on BID
AMPS 351
+2 362
+4 233
+7 203
+9 142

PMPS 196 -- gave .25 because I'm not familiar with this insulin and wasn't sure about her rxn with this PS#
+3 193

I think I need some hand holding and guidance here. Why are her numbers higher this AM? Should I have gone with the .5 dosage last night? She seemed to have responded better the the Humilin N 5 years ago, but maybe I'm just being impatient with this?? cat(2)_steam
 
Re: 1/17 Princess AMPS 378 +3 330 Second day on BID -- Advic

Humulin N is very different than Lantus. N is shorter duration and much harsher. You are also more likely to see a more immediate response. However, it can drop BG levels very fast. Lantus, unlike N, is a depot type of medication. What that means is that it will take roughly 5 - 7 days for enough Lantus to build up in the depot (we call it a "shed") for all of the dose you're shooting to be fully bioavailable. The shed permits overlap between doses and, coupled with the long duration of Lantus, makes it a much gentler insulin.

We generally suggest for someone new to Lantus to be extra attentive to shooting with numbers below 150. Some people will use below 200 as a point for extra monitoring. There is information about this either in the Data Ready sticky note or this note on how to handle low pre-shots.

I'm going to get on a soapbox. I saw your note about the possibility of Somogyi rebound on your SS. The topic has come up a few times recently and I did some research -- I have access to a medical and veterinary library. The whole issue of chronic rebound (i.e., Somogyi) came up in the late 1930s. Since then, the research has been equivocal and the idea of chronic rebound has come into question. The initial research was done with humans. There is minimal research with felines. Further, there is no research documenting Somogyi with long-acting insulin like Lantus.

This is a quote from Wikipedia that I think summarizes the issue:
Although this theory is well known among clinicians and individuals with diabetes, there is little scientific evidence to support it. Clinical studies indicate that a high fasting glucose in the morning is more likely because the insulin given on the previous evening fails to last long enough.[5] Recent studies using continuous glucose monitoring show that a high glucose in the morning is not preceded by a low glucose during the night.[6] Furthermore, many individuals with hypoglycemic episodes during the night fail to wake due to a failure of release of epinephrine during nocturnal hypoglycemia.[7] Thus, Somogyi's theory is not assured and may be refuted.
Click to expand...

The relevant distinction is that Somogyi reflects chronic rebound. This is different from a cat that has bounced from a low BG number or numbers that have dropped quickly. Our cats do bounce. The bounce, however, is not chronically recurring.
 
Re: 1/17 Princess AMPS 378 +3 330 Second day on BID -- Advic

Hi Princess.

Yes, patience.
Typically you want to hold a dose for ~6 cycles (3 days) unless you have a Really Good Reason to alter it. Give it another day or two before deciding if a dose change is warranted.

MJ&Donovan
 
Re: 1/17 Princess AMPS 378 +3 330 Second day on BID -- Advic

Thanks Sienne and MJ. Perhaps we were seeing Rebound, rather than Symoges? It looked like a one time thing, but I wasn't doing frequent checks (made the mistake of starting her insulin in the evening instead of morning).

So, since I'm still not familiar with this insulin, do you think with last night's 193 PMPS, should I have given the .5 instead of .25? When Princess was on "N," I didn't shoot below 180, but I guess I'm not really wrapping my head around the depot/shed idea ... :?:
 
Re: 1/17 Princess AMPS 378 +3 330 Second day on BID -- Advic

coulda should woulda.... I don't blame you for hesitating to shoot a full dose on a blue number. It can be scary doing that on an unfamiliar insulin. I *think* it is safe to maintain the 0.50U dose for the next few cycles, but let's see what Princess does by PMPS. She's low pink the last time I looked, so unless she really plummets, keep the same dose.

MJ&Donovan
 
Re: 1/17 Princess AMPS 378 +3 330 Second day on BID -- Advic

I've updated Princess' Spread Sheet, but I'm curious. Any guesses as to why we're getting consistently higher numbers now than a week ago when she first presented with increased thirst? Could we have caught it just as her pancreas was sputtering and stalling? Could the insulin regimen somehow be making her BG go wonky on me? She's been eating grain-free canned for 5 years now, so no diet change lately ...
??????????????????????????????????????????
 
Re: 1/17 Princess AMPS 378 +3 330 Second day on BID -- Advic

I would give it at least another day until we start speculating. Give the insulin a chance to settle in. She could be higher due to the 0.25U last night, but again, it's too early to tell.

MJ&Donovan
 
Re: 1/17 Princess AMPS 378 +3 330 Second day on BID -- Advic

As MJ said, the numbers you are seeing are probably due to the reduced 0.25u dose you shot last night. You didn't do anything wrong! You have to do what you are comfortable with, and safety comes first. There are no mistakes, just opportunities to collect data.

As you can see, shooting a reduced dose does have an effect on future cycles. The shed gets depleted, and then some of the insulin from following doses has to go to refilling the shed...so there's less available to work on the BG, leading to higher numbers. It usually shows up more in the following cycle(s) than the cycle you shot the reduced dose...so that would explain today's higher numbers. Don't worry, Princess will get back on track, it just may take a few cycles.

Hang in there. ;-) Be sure to read the stickies at the top of the forum, there's a lot of great info there to help you learn about the insulin. It takes a while to wrap your head around the shed concept....don't worry, you'll get it. It's a big change from Humulin N. I think you'll like Lantus once you get used to it though. Keep asking questions!
 
Re: 1/17 Princess AMPS 378 +3 330 Second day on BID -- Advic

Welcome to lantus land--Moonie was on N and we switched to lantus, and it is much different--Normal BG numbers in the cats are 60-120 bg..That would be a totally normal non diabetic cat.--Or a really regulated one--Lantus is much easier to control & the curves are smoother than with the N--
BID will make Princesses numbers better, as look at the 2 numbers in blue(100"s) you got yesterday--That is great, but Somogyi Rebound means that the cats body, not being used to lower BG numbers dumps glucose into the blood, thereby defending itself. Thus you have higher numbers as a result--
It is just a natural thing here, If Moonie goes low into double digits, sometimes she bounces for 2 days before going back to nice blue or green numbers-
Not to worry you are doing very very well! It is a big transition from N, so Forget about N, lantus is a new day!
Good job on your second day :-D
BTW sticking to one dose & being consistant is very important on lantus--Yo can always come on here for advice 24/7-Also
Be Patient, it will take time for Princess to get into nice numbers consistantly..
 
Status
Not open for further replies.
Back
Top