1/22 Josie AMPS 173 +6 132 PMPS 241

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eccentricfuzzyme

eccentricfuzzyme

Member Since 2011
Josies numbers have been all over the place lately, and regularily under 200 in the am, causing me to have to give her lowered dose.
I am going to shoot 2 this morning, and then try her at a few rounds at 2.5 if she is up tonight.

She is on her new food now, she here is hoping and praying it helps with her loose and stinky poops.
 
Re: 1/22 Josie AMPS 173 +6 132

The numbers are looking pretty good. Just remember that Lantus works best if you are not changing the dose all the time.
I think if you try to stick with the 2u dose for 4 cycles, let the shed fill and settle, you will be able to see where Josie's at and if the dose needs to go up or not.... base you dose changes on nadir, here are some of the guidelines on how to adjust the dose, OK?


"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.


Also, keep at the back of your mind that while you are giving insulin now, you are also giving Josie's pancreas some time to heal, to get healthier, so some decrease could be because she's getting better, and that's a good thing for sure.
 
Re: 1/22 Josie AMPS 173 +6 132

those guidlines confuse me because i thought you are supposed to hold for 4 cycles or whatever of clear shooting. the way josie is up and down, there is almost never 4 days in a row where she isnt too low for me to dose and leave in the morning, etc.
 
Re: 1/22 Josie AMPS 173 +6 132

Hi, eccentricfuzzyme and Gayle ~

eccentric, your numbers for Josie are looking better lately. Maybe the new food is helping Josie's numbers some, do you think? eccentric, I always learn from Gayle and think she gives really sound, common sense advice. If you can, I'd go with the 2.0U dosing as Gayle's suggested and try to stick with that dose AM & PM, since Lantus does seem to work best with consistent dosing. If you have to reduce a dose, then try to get back on schedule with the next dose and take a look at the following information from Jill on how to count cycles when you shoot a BCS (Big Chicken Sh*t) dose. But if you do back off to the 2.0U dosing, then you may be able to be more consistent. In a few days, you'll be able to see if that dose is high enough for Josie.

eccentric, this info by Jill on the Lantus TR board is helpful when you're not able to do consistent shots:
Counting Cycles - Edited to Add
"Notice the word "consecutive" is in bold.
con·sec·u·tive: adj. following one another in uninterrupted succession or order.

Because of the cumulative nature of Lantus and Levemir... stalling, shooting a reduced dose, shooting a BCS dose, skipping a shot, and fur shots can alter the effect on the insulin/depot on any given dose. If you have to do any of these things, the cycle count starts over. If you don't start over, you run the risk of kitty becoming over dose."

Hope this helps,
Eva
 
Re: 1/22 Josie AMPS 173 +6 132

Her pmps is 241. i am going to try her at the lower dose of 2 units for awhile and see if that keeps her from getting too low in the mornings.
 
Re: 1/22 Josie AMPS 173 +6 132

Marjorie and Gracie said:
Gayle's post cites the TR protocol which Angela is not following with Josie.

Please see Rebecca's post today regarding the Start Low Go Slow Protocol for those who cannot test as often.

Don't Go Too Fast with the Insulin
Click to expand...

The protocol is merely a starting point, a general guideline, and dosing is based on nadir if you are making any changes, no matter how relaxed you are with your style.

There's no big rule about the amount of testing to be done with TR; you can test at ps and bedtime for most of the week, then do a curve when you can, and that's pretty relaxed.
As Josie's eating dry food, it's already a deviation from the normal, but that's why this post is in the relaxed forum.
And Josie seems to be doing just fine with her relaxed protocol.

In general if you have BG all over the place and not sure what dose, you would want to step back/down and let the lesser dose settle, and after a few days, take stock of the kinds of BG you are getting.The general curve may well be higher, but it will also be alot smoother. It's at that point when you can think of upping the dose a wee bit to see if the stable curve stays but just drops a bit lower.

The trick with Lantus and Lev, with TR or relaxed, is to let the dose settle. only then can you see how your cat reacts and the sort of BG you see.
 
It's important to note that Angela moved to the Relaxed forum because she was not able to take care of her family and test as much. Jill provided her with info on SLGS so she would not have to
change the doses as often but could let Josie stay at a dose a little longer.

She is not able to feed canned food because of her other cats and having to be gone all day.
 
Good Morning, Angela and Everyone ~

Angela, I've been calling you eccentric (love "eccentricfuzzyme", by the way), so I'm glad Marjorie told us your name. Hello to you and Josie! I see that you've backed off a bit to the 2.0U dose which I think could be a good dose for you to be able to do consistent AM & PM dosing. And you're gathering some good bg data to get a feel for how low you'd be comfortable shooting the 2.0U dose in the mornings. Of course, you need to shoot a dose that you're comfortable with and that you feel will keep Josie safe when you can't be around to test.

When our 15-year-old cat Willie was diagnosed with steroid-induced diabetes in 2007, she'd always been a free feeder on dry cat food. We made the decision to leave her on dry food, although we switched to lower carb EVO and Wellness CORE. Willie did go into remission and remained that way for the rest of her life, but steroid-induced diabetes is a different form of diabetes. Guess what I'm saying is that we make the best decisions we can about foods for our dear, individual cats and for our particular situations. Angela, how's Josie doing so far on her new Nature's Variety Instinct food?

And please don't shoot me, everyone, but I'd like to respectfully and gently suggest that either a modified version of Tight Regulation Protocol or the Start Low Go Slow Approach can work well for us if we're not following Tight Regulation to the letter. I like the guidelines that Tight Regulation provides even if you need to stay with a dose longer to keep your cat safe and to have more time to test for nadirs. With Lantus or any other insulin and the protocol that goes with it, we need to make it work for our cats, ourselves, our schedules, our work, our lives.

Angela, wishing you continued good bg numbers for Josie at the 2.0U dose. Have a great day!

Eva
 
Thanks for all the info everyone.
I have her 2 units again last night, but this morning she is below 150 again, at 132. I cannot delay her shot, or stay home to watch her, so is it better to give a dose of .5 or 1 unit, or to give nothing at all?
Please advise.
 
Re: 1/22 Josie AMPS 173 +6 132 PMPS 241 PLEASE ADVISE- DOSE

Eva- Josie seems to be doing well on the new food. I guess it will take a few weeks to know for sure, but so far so good. No poops in the liviving room, and the smell of her litter box is certaintly not so horrendous as it was before.
 
Re: 1/22 Josie AMPS 173 +6 132 PMPS 241 PLEASE ADVISE- DOSE

Hi, Angela ~

Josie's keeping you on your toes, huh? What dose are you comfortable shooting this morning? The 1.0U or the .50U? If it were me, I wouldn't want to skip the shot entirely, but I'd want to shoot a reduced dose, too, since you're not going to be there to test.

I think this is a comfort level call for you, Angela. I get very nervous when I have to be away, too, when there's a low morning number.

Eva
 
Re: 1/22 Josie AMPS 173 +6 132 PMPS 241 PLEASE ADVISE- DOSE

i dont know, i dont know which dose is better or safer for her. is the 1 unit more likely to make her go dangerously low? but then again it is also closer to her normal dose so it may keep her more steady, right?
 
Re: 1/22 Josie AMPS 173 +6 132 PMPS 241 PLEASE ADVISE- DOSE

Nice amps, but since you aren't going to be around to watch her, if she was mine I would want to give her at least a token dose of .5u, that at least will give her a little bit to counteract the food spikes from eating. In fact with as low as she is going on you all the time before her next shot, I might be tempted to take her clear back to .5 b.i.d and hold her there for a few days and see where she settles into that and then if not enough to slowly raise off that. But that is just me, I think it is easier to start at the bottom and work up to the right dose, than try to come down to the right dose.

Since it doesn't look like right now remission and diet controlled is going to be your primary goal, you aren't going to want her to run as low at preshots. Because you are not going to be able to monitor her or stall shots. So we need to find a dose for her that will keep her high enough for you to be comfortable giving insulin and yet keep her in good numbers and well regulated as well.

Kind of start her over with the SLGS (Start Low, Go Slow). It doesn't look like she was ever started low, looks like you started her out at 3u..so I would restart her at .5u hold until you can get in a curve, or enough random spot checks to flesh out the picture and then see where you need to go from there.

Mel, Maxwell, Musette & The Fur Gang
 
Re: 1/22 Josie AMPS 173 +6 132 PMPS 241 PLEASE ADVISE- DOSE

MommaOfMuse said:
Nice amps, but since you aren't going to be around to watch her, if she was mine I would want to give her at least a token dose of .5u, that at least will give her a little bit to counteract the food spikes from eating. In fact with as low as she is going on you all the time before her next shot, I might be tempted to take her clear back to .5 b.i.d and hold her there for a few days and see where she settles into that and then if not enough to slowly raise off that. But that is just me, I think it is easier to start at the bottom and work up to the right dose, than try to come down to the right dose.

Kind of start her over with the SLGS (Start Low, Go Slow). It doesn't look like she was ever started low, looks like you started her out at 3u..so I would restart her at .5u hold until you can get in a curve, or enough random spot checks to flesh out the picture and then see where you need to go from there.

Mel, Maxwell, Musette & The Fur Gang
Click to expand...

I ended up giving her somewhere between .75 and 1 unit.

I have taken her back to 1.5 in the past and started raising before. She just jumps around so much it makes it very hard.
she bounces so much and so easily, that i am afraid on a lower dose she will end up having that problem even more/still
 
Angela,

I have the Queen of the bouncy girls...Musette will bounce at a sneeze, if you don't believe me, look at her spreadsheet...But I didn't really start making progress with her until I took her back to 1u and held that until all that bouncing around cleared, then slowly raising her to 1.25u, now I'm having to wait all her bouncing out again. :roll: But I know she will stop bouncing eventually. What I'm saying is I didn't start really getting Musette under control until I hand cuffed myself to a dose until she decide to stop boucing like a rubber ball. Some kitties just take longer to settle into a dose, Musette is one of them and Josie looks like another one.

Instead of the standard 3-5 days to settle it takes Musette more like 2-3 weeks. I know it is hard not to want to react to those high bounce numbers with more insulin..I want to do it too, especially since my little girl has already survived DKA once before I adopted her and was head back there when DCIN pulled her from being put to sleep. So those high numbers scares me too. But sometimes throwing more insulin at those high numbers just adds to the continuing bounce..it can come from not only super low numbers but from those sudden drops ( over 100 pts in an hour).

As much as we all want our cats in those normal numbers as quickly as possible sometimes if you aren't going to be around much to test and watch it is better to get the curve to smooth out first then slowly go up in dose to let the bgs to come down smoother.

But ultimately you have to go with a dose you are comfortable shooting. As my vet told me once I can only make a suggestion but ultimately it is your hand on the syringe.

Mel, Maxwell, Musette & The Fur Gang
 
so should i go to 1.5, then 1? or just straight to 1 or lower?
the vet started her on 3 units than moved it to 4 units after 2 weeks when she was first diagnosed.
but i wasnt home testing then.
if you jsut hold it for weeks at a low dose, and change nothing else, will the bouncing clear on its own eventually? how? why?
 
You can do it either way but where she is going so low that you are skipping shots just about every other shot, I would personally go to either 1u or .5 which ever you are more comfortable with. And hold that for 3-5 days or longer if she is still bouncing.

Yes, bouncing will smooth out if you hold a dose and change nothing else. There are two things that cause bouncing...Too much insulin or lower numbers than what the body is use to, it doesn't have be super low hypo numbers either. But a good example is Musette's body got to thinking that 400+ was her normal blood sugar, so when she started getting insulin even a very low dose of .5u she would bounce sky high when her body reached 300s..but once her shed was full on that .5u and her body got use to going into the 300s her curve became high and flat, but she still wasn't going low enough at her nadir and her preshots were still way to high..so we went up to 1u, again now she didn't bounce in the 300s anymore she bounced in the 200s, but would go skyhigh when she did bounce, again I had to wait her out but slowly her body learned that she wasn't going to hypo in the 200s, now I've raised her dose again and she is bouncing again but now it comes after the 100s and double digits. Because she is now going in normal numbers on this dose this is probably her ideal dose, once she stops bouncing again.

Mel, Maxwell, Musette & The Fur Gang
 
It is very dangerous to give long lasting insulins at varying doses without very closely monitoring the blood glucose. When properly used, long-lasting insulins have a low incidence of hypos. Proper use without more intensive testing is to give low doses, give several days for the dosage to "settle in" and then if the blood glucose is still too high, increase by a small amount. Start low, go slow (SLGS). Short term hyperglycemia (high blood glucose) won't kill your cat, but a hypo incident sure can.

We've got someone on Health right now who had their vet (!) increase the dose of a long lasting insulin from one unit to 4 units (!) and the cat had a severe and expensive hypoglycemic episode with seizures. The owners are now terrified and the cat my lose its home or its life.

Yes, I am trying to scare you but also reduce stress on you and your cat. Please be careful.

Best,
Rebecca
 
Angela, a comment on not being able to feed canned because of multiple cats. My cats are barn cats and so get lots of protein but they (& local feral cats) have access to a room of my house via a pet door where I keep dry food out all the time. This room provides protection from predators and bad weather but also provides food when hunting is poor. I can't leave food out for the ferals as we have a real skunk and coyote problem.

Feeding dry food really wreaked havoc on my one of my cat's blood sugar and his irritable bowel syndrome. I buy premium dry foods and was very happy with Taste of the Wild as far as blood sugars went but Buck's IBS was getting worse. I switched to Innova Evo that makes Taste of the Wild look cheap! But, wow, it really is a good food and it goes a long way. Feeding 7 cats on a pretty regular basis, I go through a 30 lb ($40) bag approximately every 3 weeks. Expensive but worth it.

If you have to feed dry, so be it. Please consider trying Innova Evo though as it is the lowest carbohydrate dry food on the market.

Best,
Rebecca
 
Since you are not aiming for OTJ, and are feeding dry and not able to test alot, how about aiming for numbers to stay under 240, the highest. That way you are not harming Josie's organs. For the low end, you know you are OK with above 50. Depending on the curve you get from Josie, you could aim for the general 100 to 200 zone, and now just find a dose that fits in that slot.

That way, it's not going so high as to do damage to organs, and it's not going so low as to worry you when away and possibly causing hypo type harm to Josie in your absence.
 
Rebecca said:
Angela, a comment on not being able to feed canned because of multiple cats. My cats are barn cats and so get lots of protein but they (& local feral cats) have access to a room of my house via a pet door where I keep dry food out all the time. This room provides protection from predators and bad weather but also provides food when hunting is poor. I can't leave food out for the ferals as we have a real skunk and coyote problem.

Feeding dry food really wreaked havoc on my one of my cat's blood sugar and his irritable bowel syndrome. I buy premium dry foods and was very happy with Taste of the Wild as far as blood sugars went but Buck's IBS was getting worse. I switched to Innova Evo that makes Taste of the Wild look cheap! But, wow, it really is a good food and it goes a long way. Feeding 7 cats on a pretty regular basis, I go through a 30 lb ($40) bag approximately every 3 weeks. Expensive but worth it.

If you have to feed dry, so be it. Please consider trying Innova Evo though as it is the lowest carbohydrate dry food on the market.

Best,
Rebecca
Click to expand...


EVO is what i just took her off. it made her stool very loose, she lost control of it several times and pooped outside the box, and it stunk so bad the entire house reeked the second she dropped it, haha.
that is why i switched in the first place.
 
Hi, Angela ~

You're getting lots of very good advice here. I think it's got to be so much harder trying to find the right dose when you have started on a higher dose and are working your way down the dosing scale, Angela as you're doing now for Josie. To me, it's easier when you start at a lower dose and gradually, steadily, in smaller increments work your way up so you don't bypass a dose that will work well for Josie. Some of the best advice I've been given on FDMB has been to back off to a dose that I could give consistently in the AM & PM... a member, Pam, recommended that to me in 2007 and several members, Sienne & Marjorie & Julie, in 2011. Okay, so I'm a slower learner :-D ...it's been great advice (thanks,guys)!

And, Angela, if you go down to a lower dose now with Josie, I think you'll be far more comfortable and less worried when you need to be away and can't be there to test her. I think Mel has suggested taking Josie's dose down to .5 or 1.0U which sounds like a good plan to me. As you've seen this morning, the 2.0U dose that we'd suggested you go down to is still too high for you to be able to do consistent AM & PM dosing without having to reduce or skip a dose.

Hope you're having a good day, Angela.

Eva
 
Eva & Butters & 5 Others said:
And please don't shoot me, everyone, but I'd like to respectfully and gently suggest that either a modified version of Tight Regulation Protocol or the Start Low Go Slow Approach can work well for us if we're not following Tight Regulation to the letter. I like the guidelines that Tight Regulation provides even if you need to stay with a dose longer to keep your cat safe and to have more time to test for nadirs. With Lantus or any other insulin and the protocol that goes with it, we need to make it work for our cats, ourselves, our schedules, our work, our lives.
Click to expand...

yes, we need to make things work for us, but we have a responsibility to do it safely.

the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats comes with requisites:

REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

  • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
    Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
    More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet.
  • Feed small meals throughout the day. Some kitties adapt well to free feeding.


these are not my requisites. they (and more) come from the protocol itself: http://www.tillydiabetes.net/en_6_protocol2.htm. these requisites serve as built-in safeguards for the cat. failure to adhere to these requisites results in creating a potential risk. recommending dose adjustments based on the guidelines in the TR Protocol when a caregiver has chosen to not follow the protocol... well, let's just say it could be dangerous.

practicing TR safely involves a commitment to the requisites listed above. not everyone can or wants to commit themselves to this kind of regiment. that's fine. it doesn't mean they can't have a healthy and regulated cat. it doesn't mean their kitty will never go OTJ. there have been many Lantus kitties who have gone OTJ following the SLGS Approach. many.

here's a little "SLGS Dosing Guidelines Cheat Sheet for Lantus Users" i recently prepared for a few others:

Starting Dose
  • 1u – 2u twice per day if kitty’s glucose was higher than 400mg/dL at diagnosis OR if cat is not on a wet low carb diet
  • 0.5u – 1u twice per day if kitty’s glucose was less than 400mg/dL at diagnosis OR if the cat has been switched to a wet low carb diet

Hold the dose for at least a week
  • unless your cat won’t eat or you suspect hypoglycemia
  • test often for ketones
  • be consistent in timing and type of food
  • shoot every 12 hours

After 1 – 2 weeks at a given dose perform a 12 hour curve, testing every 2 hours
  • if nadirs are more than 150, increase by 0.25 unit
  • if nadirs are between 90 and 149, maintain the same dose
  • if nadirs are below 90, decrease the dose by 0.25 unit

Lather, Rinse, and Repeat!


as you can see, SLGS is similar to the TR Protocol in that it recommends Lantus dose adjustments be made in small increments. the biggest difference is in holding the dose longer (as you mentioned above)... which takes those who don't want to/can't test as frequently as the TR Protocol requires into consideration. seems like a win - win to me! :mrgreen:
 
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