1/26 Terra AMPS>600;+3 416 +7 401 PMPS 296 +3 315

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KarenAmelia

Member Since 2012
Terra AMPS>600;+3 416 +7 401 PMPS 296 +3 315

I'm posting with some trepidation because I flat out ignored folks' advice not to increase dose. I know that some people get peeved if their advice is ignored; I want to say that I REALLY appreciate the guidance here and couldn't do without it, so don't write me off! My reasoning (which I share in all humility - and am certainly open to feedback):

Terra appeared to bounce on 1/24 and I held her dose steady for 4 cycles after the big bounce ( I know I should've held for 72 hours or 6 cycles, but she'd been on that dose for some time). Last night was her ninth cycle on that dose, so going slow. She pegged the meter this morning and I reasoned that, looking at her numbers over the past couple days, it wasn't the start of another bounce. Possibly she was responding to too little insulin , not too much. So I upped the dose to 3.0 this morning. If it weren't for the 1 hour late shot last night which is reputed to equal a reduction in dose, she could've been a candidate for increase according to the protocol.

She's been kind of low today: sleeping a lot and drinking a lot. Not active as she has been intermittently over the past weeks. She wouldn't eat anything but some bits of boiled chicken and some chicken liver. Negative ketones: I tested late in the afternoon.

Now her numbers are kind of wacky: an apparent nadir at +12, so tomorrow will be interesting to observe. Unfortunately I'm going to be gone much of the day and won't be able to test mid-cycle. Seems like tonight will be important to get some indication of what's happening.
 
Re: 1/26 Terra AMPS>600;+3 416 +7 401 PMPS 296

aw...we don't write anyone off here! :-D

I'm no help with dosing input, but I surely like that pm number better than the am one!

now, Miss Terra...
please eat your food!

celi
 
Re: 1/26 Terra AMPS>600;+3 416 +7 401 PMPS 296

Karen: I'm so glad to see you posting again. You do not need to have any trepidation in doing so. We are all learning.

Due to the cumulative shed action of lantus/levemir, you would typically not see the effects of a dose the same cycle in which it's given as one dose builds upon the next. Because stalling (accidentally or otherwise) acts like a dose reduction, those effects combined with Terra's foray into dry food coulc be the reason you saw the AMPS of 600 (or it could be #2 below) and her high numbers today. Dosing for lantus/levemir is not done based on the pre-shot but on the nadir with some consideration given to pre-shot. I know the high PS worried you this morning and you did what you thought was best for Terra.

Here is why I am concerned about you increasing her dose this morning: you could have a couple issues brewing here:
(1) a dry food "high" clearing--we know dry food raises the BG and keeps it elevated for a time and then numbers *can* drop quickly once the effects have worn off.

(2) a bounce clearing (and for some reason, *some* cats go high right before they clear a bounce)--many of our kitties are champion divers when clearing a bounce.....not to scare you but they *can* go from 300 to 40 back to 300 in the course of one cycle. And as I noted above, it sometimes starts with a high PS, AND

(3) the effects of insulin she *might* not need once her shed fills.

I add the asterisks because ECID and we just don't know what Terra will do....we don't yet have enough data to see a pattern.

Why do we start counting cycles again when we skip a shot, stall, shoot a reduced dose, etc? Because of the cumulative effect on the shed from one dose building on the next and we need time to see what those effects are in order to keep her safe.

Jill's post last night is extremely important. The TR protocol is relatively fast-paced. In order to follow the TR protocol for safety, the following requisites exist:
  • 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.
  • Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
  • Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
  • 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.
Click to expand...

If it's not possible to do this, then for Terra's safety and your sanity, a slower approach and different protocol, Start Low Go Slow, is warranted.

Terra was not past the 72 hours of possible bounce last night or this morning when you increased her dose. Everyone forgets to give a shot or is late for one...it happens. But if you had shot on time, this morning would have been her sixth
cycle in the bounce as her 128 was the a.m. cycle of 1/23. So it would have been best to hold her through today's a.m. cycle as she was not post bounce yet. A kitty can have five high cycles and then come down.

I hope this helps explain our reasoning for you holding the dose. And now what should you do?

IMHO, if it were my kitty, I'd first decide which protocol I want to follow. If it's TR, then we ask you follow the requisites and especially remove the dry food because it is difficult to make dosing suggestions if we don't know which numbers are influenced by dry food....in fact, we are not able to do it as a matter of safety.

If you proceed with the TR protocol, I would also be thinking about taking her dose back down to 2.5u for consistency and let six cycles play out to see what she will do. She might need an increase but until we factor out some of those variables, we won't know.

It's a lot to absorb so please let me know if I've confused you or if you have questions. I"m sure others will also have some great thoughts.
 
Re: 1/26 Terra AMPS>600;+3 416 +7 401 PMPS 296

I just wanted to come on and lend my support. I'm a confirmed control freak. Anyone in my life can attest to that. It can be very hard to read some of the advice that's given here and consent to follow it when it seems opposite of what you would think is logical. However, I came to realize that, even though I know a lot about diabetes from being in the medical field, having had gestational diabetes myself, and having a father with diabetes, I knew ABSOLUTELY NOTHING about feline diabetes. There is nothing logical about it. There is no guarantee that if you do "A" that "B" will happen. It is damned frustrating. As hard as it was for me, I put my Champers into the extremely experienced hands of Jill, Sienne, Libby, Marje, and a bunch of others on this board and I've never regretted it. Is it hard for me to take advice when I don't understand the reasoning? Oh, yes!!! But I just keep asking questions until I understand the rationale and then I make up my own mind as to what path I want to choose. The advice here is only given; you don't have to take it. No one will harass you about that!!! Since I've been on this board, almost a year, I've never seen anyone get bad advice. I guess what I'm trying to say is that you can trust the advice you're given here by these experienced people. They truly want nothing more than for your kitty to go OTJ. It took about a month or two before Champ started acting like he felt well again. I just followed the protocol to the letter and every day he got better and better. I can now honestly say, though Champ is still on insulin, he's back to his old self again, just way sweeter!! We're all here for you, trust me!! We've all been where you are, trust me!! It will get better, trust me!!

I'll check in every time I see Terra's condo. I want to see how everything goes with you.
 
Re: 1/26 Terra AMPS>600;+3 416 +7 401 PMPS 296

Hi Karen! I am relatively new here myself so I don't give advice on dosing, I just wanted to say hello and that I know how it must have felt to see that 600 :shock: :? confused_cat When I first got here I too raised the dose on my cat out of impatience and a desire to be doing something about her numbers! I ended up backing it down on the advice of people here and discovered that they were right about what was best for Bailey.

Good job getting rid of the dry food - makes a big difference! That PMPS looks like she might be starting to clear her bounce, it is a good idea to monitor closely tonight. No one here is writing you off!
 
Re: 1/26 Terra AMPS>600;+3 416 +7 401 PMPS 296

Karen: just caught the PMPS and also reread your comment about apparent nadir at +12. No....I don't think so...this is what clearing a bounce looks like.

Can you do some extra monitoring tonight? I'd be absolutely sure to get a +2. If the +2 is not about the same as the PMPS, then you might see an active cycle tonight.
 
Re: 1/26 Terra AMPS>600;+3 416 +7 401 PMPS 296

I think Marje's point is well taken. This could be that Terra experienced a high before a break in her numbers.
 
Re: 1/26 Terra AMPS>600;+3 416 +7 401 PMPS 296

Maybe Terra isn't a candidate for the tight regulation, given her unpredictability and stubbornness about diet. I'll check out the other Lantus forum and see if that may be where I need to be posting. I probably should have her checked out for other possible complicating factors that would affect her appetite, but I don't want to put both of us through extensive and expensive testing. Maybe in that sense, there is an ongoing unknown which isn't conducive to the tight regulation.
 
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