1/18/12 Clyde amps 65 but have ????'s

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Richie & Clyde

Richie & Clyde

Member Since 2011
Hi folks, Clyde tested this morning at 65, I did not shoot him for fear of a overdose. The # came up after an hour after he ate. Clyde's vet wants me to test & shoot an hour after he eats. He says he want food in his stomach before the injection. I used to test/shoot/feed. This whole thing is making me frustrated, I try to talk to him about this site & he just doesn't hear me. I need some help, what is the proper procedure? Is it test/shoot/feed or feed/wait an hour/test than shoot? Clyde is currently getting 3.5ml twice a day. His health is fine, purring, jumping, chasing his sister around. His drinking has pretty much normalized, & I'm not cleaning those "rock of Gilbraltors" out of the litter box. He is fed along w/ his bro & sister a all wet diet. Friskies classic pate's. I tried to do a curve but Clyde would not have me sticking his ear anymore the other weekend. He started to hide. I noticed he was rubbing his ears so I backed off. Advise would be appreciated. I'm really thinking Clyde's vet is not up on the latest concerning Lantus.
 
Hi guys .. that sure is a nice number to start the day, especially an hour after eating! When mocha was on insulin, we would always test, shoot and then feed BUT we knew mocha ALWAYS ate her fuds *still does!* without any problem .. some people might test, feed then shoot .. but most people do it usually within a 10-15 minute window I believe .. you might want to see what others have to say .. I know most vets are not up to date with feline diabetes .. which is a shame, because every day more and more people join the board ...
 
Hi, Richie!

Your vet is conceptualizing Lantus like the other, shorter-acting types of insulin. For example, Humulin N, which lots of vets have experience with, you do have to have food on board prior to giving a shot. Otherwise, your cat's numbers will tank. Lantus and Levemir, being longer acting types of insulin, not only have longer duration, they also are slower in terms of their onset. Whereas with N, if you didn't feed, you could be struggling to keep Clyde's numbers up an hour after you shot. With Lantus, you typically don't even see onset until +2. Most of us test and feed and shoot within moments of one another. My entire routine at shot time takes about 5 min.

Maybe asking your vet a few questions would help. I'd ask him when he typically sees Lantus onset and nadir occurring. If he tells you it's something other than approximately +2 and +6, then he needs to do more homework.

I realize that Clyde may not be overly fond of getting his ear poked but, seeing that 65 at AMPS is telling you something. Clyde is likely dropping into lower numbers at times in the middle of the cycle. What you're seeing at pre-shot when the numbers are high are most likely bounces off of those lower numbers. I really want to encourage you to do what you can to get some spot checks. If you can't get a curve, getting tests at various times over the course of several days so you have a sense of how Clyde's numbers are playing out will help to fill in the blank spaces and let you know if he's in lower BG ranges. Getting a before bed test every night will also help since may cats experience lower numbers overnight.
 
I think your vet is used to the other insulins besides Lantus. For some reason, most vets seem to think that all insulins are the same and they are not. He probably doesn't know that the onset to Lantus doesn't happen until about +2 for most cats, so there is a while of time to get fuds into the cat before the insulin starts any action.
Most of us test/shoot/feed all in about the same 5 minutes.

Since you skipped the shot, you can change the "amps" in the Subject Line of your first post to "AMBG". AMPS means that you shot the insulin. So, his shot tonight will most likely be at +24.

I think Clyde needs more treats and more praise, so that he learns to allow you to get those mid-cycle tests and curves. With more data, we can help you to adjust the dose.
 
Hi,

Cini and I do test/feed/shoot, but that all happens in the space of 10 to 15 minutes tops.

Waiting an hour after feeding to shoot does seem odd since Lantus doesn't take effect right away. So it's not like as soon as you get the insulin in him you're going to see results.

Lantus dosage is not determined by the AM/PM blood glucose reading's either. Dosage is determined by the lowest reading (nadir) you get for that day. So if kitty had a BG of 500 at shot time but a BG of 50 as the nadir that day, you would then decrease the dose of insulin.

Not shooting at 65 today was a good decision. Me personally, I would have not fed, stalled 30 mins, and then taken another BG reading to see if he was going up. But, if you had already fed him an hour beforehand you would have had no way of knowing if the increase was from the food or from the previous injection wearing off.
 
Re: 1/18/12 Clyde AMBG 65 but have ????'s

Can I just say Clyde & I love you guys?! Thanks for responding. Clyde's vet is not up to date, he keeps telling me to get that +6 number & that will determine his dosage. But when I replied back doesn't Lantus work differently, dose is determined by his Nadir? He looked at me as if as I had 3 eyes. He didn't know what Nadir was. So my 3.5 dose could be to much for him. He does weigh 17lbs, he's a big boy.
My big problem is determining his nadir. The test strips are draining the wallet so to speak, another reason why I'm conservative on testing. I'm using a Relion confirm meter. What would be my best approach to determine the right dose? I'm not going to consult w/ the Vet. In other situations he's been very helpful, plus affordable. I hate to drop him.....but maybe for Clyde's sake.....
 
Many of the people here rely on their vet for pretty much everything other than diabetes management. My vet leaves me alone when it comes to dosing. I've sent her the link to Gabby's SS so she can keep an eye on things but she never has questioned what I'm doing. We had a discussion about food (she wanted me to feed DM) and when I pointed out I could get better quality food that was lower in carbs she backed off because she realized I knew what I was talking about.

Your vet isn't entirely wrong about the +6. For many cats, the nadir is at +6. Your vet not knowing what you meant by nadir, well, that's a whole other kettle of fish. You do need to get spot checks. Even if you're testing only once during each cycle in addition to your pre-shot tests, that's fine. You can test at various times to "fill in the blanks" on your SS. I'd sooner see you do that and save up on strips for time when Clyde's numbers are running lower and you really do need to test frequently to make sure his numbers are where they need to be.
 
hi richey! great to see you and clyde checking in! i'm seconding dyana & sienne's comments about his dose. looking at his spreadsheet his preshot numbers range from 65 to 400+ - if you had a "good" dose you would see more consistency. it's never exact, but you might "almost always" have a preshot in the 200's and "almost always" have a nadir somewhere mid-cycle that was less than 100 - something like that. if you click on the link to punkin's ss in my signature you'll see what i mean. despite have acromegaly, punkin is fairly well-regulated and in the range i'm wanting him in - but the consistency of the numbers throughout the cycle is the part that i'm wanting to point out to you.

what it looks like with clyde is that he's bouncing. the dose is bringing him down low (might not be hypoglycemic, but there's no way to know what the low is) and then his liver lets loose with stored sugars and counterregulatory hormones that sends his body sky high. that starts to clear and he starts coming down, then boom, it repeats. if you scroll down on this link there's a description in there with more info about how a bounce works: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012

the information melissa gave you will hopefully help you be able to get in some more tests. i would worry a little bit that dose is too high, just guessing i would think it is, but i'm just guessing.
 
Julie. I'm thinking he's getting to much juice, any suggestions as far as dropping the dosage down too? Or anyone for that matter. His PMPS # was 451. So he is definitely bouncing.
 
i can't even guess, richey. wish i could, but typically we would say that unless a cat goes under 50, we wouldn't reduce. when we did reduce we would do it in increments of .25units. HOWEVER, it's not following the protocol at all, but just responding to your particular situation, i guess if i were you i would probably drop it tonight by some - how much over he is, i just don't know. my guess is you could anticipate another high number by this evening, based upon the patterns you've been seeing plus a skipped shot this morning. i think i'd reduce anyway and then try to get a mid-cycle test to see what's happening.

we may have missed his ideal dose by increasing by 1units there at the beginning. back in september when he started, if your spreadsheet really starts when he started on lantus, he was only 8 doses on 1unit and then increased to 2units. normally we would say a minimum of 10 cycles (doses) to start with before changing the dose at all, then only changing it by .25unit and allowing each dose change to settle in for at least 6 cycles before changing it again, unless the cat went below 50. so he could actually be way overdose, but i don't just want to say drop back to 1 unit and start again. if you want to even consider doing a drastic change like that, i'd want to get some people with more experience than me laying out options for you.

it's really a mental mind-switch to change from humulin dosing to lantus dosing, because lantus dosing is all based upon the lowest point in each cycle.

i totally get the budget issues, of course. this little diabetes party is expensive. unfortunately any way you go with lantus you really need to know how low the cat is going on a particular dose, and it's only the mid-cycle tests that tells that. it's simply the only way to keep a kitter safe while on insulin. there are some folks who will help with $$ issues if that's what's preventing you from being able to check mid-cycle. i can try to connect you there if that is helpful.

not trying to evade your question, but without seeing anything in between i truly don't know. i think of the spreadsheet as being like a jigsaw puzzle. the preshot numbers are like the edge pieces, but the mid-cycle tests give us the picture itself. does that make sense?

what are you thinking you might like to do?
 
ok, just did a test, +3, & he's at 317 now from 451pmps. I'm gonna try ,starting tomorrow am, reducing his dose to 2.5ml and go from there. I'll try to get some midcyles in the pm cuz during the day im working. I can try on the weekend for midcylces after am shot. I'll see where is #'s are going.
 
Hi Richey. That's actually a pretty decent drop for that +3 tonight. I would b gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv (sorry, that was J.D. typing :roll: ) I would probably set an alarm or something to get at +5 tonight, and see where he is going from there.
I like Julie's analogy of a jig saw puzzle and the test results at the shot times are just the edges of the entire picture.
I was thinking something simuliar not too long ago. I was thinking about the saying of not judging a book by it's cover (it's what's inside that's interesting) when my cat had a 369 pre-shot test and the following pre-shot test was a 390. Well, guess what, his +6 happened to be a 29 :shock: So, it's really what happens between those PS tests that matters.

Good luck getting some more strips. I know how tight money is, and save wherever I can.

Also, I am fine with taking my cat to the vet for his blood work check ups and his vacinations, and what not, but my vet says "I am a PZI Man!" and pounds his chest, and he admits I am his only client using Lantus (well, Levemir), so we just don't discuss dosing. He knows I'm doing okay, with the bouncy boy I have.

Also, also, I work long hours during the week, so I set alarms to try to get up during the night at the time I think my cat's nadir is, test, and then go right back to bed. And then, I try to get more like regular curves done when I have a day off.

Best of luck to you.
 
Hi there!

You have received some excellent recommendations today. FWIW I too suspect he may be on too high a dose.

One thing I'll add regarding nadir - it can change over time. So random tests will go a long way to help you determine nadir .

Are you testing his urine for ketones?
 
Yes, you guys rock! I'm so happy I have the support. I asked the vet about testing my "Lil Beansy" for ketones & he got very angry & said to me "Clyde is not a sick cat, there is no need to test him. If I felt I need to do that, I would have done it already", unquote! Alrighty then, no, I haven't checked.
Anywho, I started Clydey on 2.5ml this morning, we'll go from there & check his #'s when I get home later.
 
You don't need your vet to test for ketones. You can purchase Ketostix at any pharmacy. They cost around $15 and it's the best prevention you can buy. You grab a strip when Clyde is in the litter box and dip the end of the strip with the litmus paper into his urine stream. Wait 15 seconds and compare the color of the paper with the guide on the container. That's it -- that's a ketone test. If the results are more than "trace" it's a trip to the vet/ER.
 
Consistency is the key here. Remember to stay on the 2.5 units for at least 6 cycles (3 days) before changing it again, unless Clyde earns a reduction in dose before then by having a reading that is 50 or lower.

As for the Vet's comment above. It may be time to part ways and find another Vet that's a little more open minded about Feline Diabetes and the role of the owner in caring for the pet.
 
For more encouragement, the ketone test is cheap (that $15 box will have 50 test strips), noninvasive (just a minor loss of dignity), and potentially life and money saving (the earlier you catch a problem, the less intensive care that should be needed). I would also start to question the motives of a vet that would discourage this type of home test.
 
Thanks Cathy, will do. As far as the vet, yes, I've been struggling with that decision. I do ( to myself, blame him for Clyde's sugar. Ever since he was given Steriods for a eye condition, the diabetes appeared) He said it was transient but it never left.
 
hi richie - i see others have the same thought.

it'll take a few cycles for clyde's shed to reduce and "match" the new reduced dose. i agree with cathy's advice to hold it for 6 cycles and see what it does.

it's not uncommon for a cat to develop diabetes from steroids, but so unfortunate. i finally left our vet after one too many mistakes with punkin. we'd been with him for at least 20 years, and i really liked him personally, but i decided i had to do what was best for punkin. it was hard to do and took me 9 months of waffling to get it done.

hope you keep checking in with us so we can help you get clyde figured out!
 
Hi Richie:

Welcome to you and Clyde. My pals here in LL have given you some awesome advice and information. I just wanted to welcome you.

My baby girl, Gracie, was also dx'd with diabetes after steroid eye drops. She was 4. Vet also said it was transient and wanted me to hold off on insulin and see if she would come down. The wonderful people
here told me to get started. Good thing I did....it was not transient.

This is the best place you never wanted to be and we're here to help you so keep the questions coming. And hope you can grab some ketostix soon....all pharmacies carry them. It's worthwhile to check every day
when his numbers are high.....

Good job today. And as Dyana suggested, please do keep an eye on his numbers tonight...he is dropping kinda fast. It's important to note that a dose can affect several subsequent cycles. Why important? Because
even though you decreased tonight, you could still see some active cycles over the next day or so.
 
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