1/27 Stu AMPS 306

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Ella & Rusty & Stu(GA)

Ella & Rusty & Stu(GA)

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yesterday's post: www.felinediabetes.com/FDMB/viewtopic.p ... 070#p39070

Hi All, Seems to be a pretty good BG number this morning, but I am indeed worried about yesterday's consistently and persistently high numbers. Please check Stu's SS and advise. I ordered the Walmart Relion Ultima online yesterday. When I receive it, probably early next week, I will try to do a full curve. I am still using the 4 unit bid dose (beginning the 4th day of 4 units bid), but I think that it is time to go down to about 1.5 and start over (Stu is a big cat). Will it be dangerous to drop the dosage so much at once, or should I continue to do it gradually?
Everyone has been so great. Thank you for your help and concern.
Ella
 
Ella & Stu said:
.....Please check Stu's SS and advise..... I am still using the 4 unit bid dose (beginning the 4th day of 4 units bid), but I think that it is time to go down to about 1.5 and start over (Stu is a big cat). Will it be dangerous to drop the dosage so much at once, or should I continue to do it gradually?
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Good morning Ella!
someone will come by to check ur question/concern today ok?
Other than that how is Stu feeling today?
 
Hi Ronnie & Luna, Thanks for your reply and for asking about Stu. He's doing great (he always seems to be doing fine, despite the numbers!).

Ella & Stu
 
As long as he's doing typical kitty things - and eating well with good litterbox action :lol: then these are excellent positive signs!
:dizcat
 
Do you happen to know what Stu's ideal weight is? If you look at the Tight Regulation Protocol, they give information about how to approximate a starting dose but you need to have ideal weight (0.25u per kg of the cat's ideal weight).

Are you checking for ketones? If not, I think whether or not to drop Stu's insulin dose to a starting point will depend on whether ketones are present. If you can pick up a box of Ketostix at any pharmacy, all you need to do is stalk Stu to the litterbox. You put the strip in his urine stream, wait 15 seconds, and compare the color on the strip to the guide on the tube.
 
Hi. At +6 his BG was 80. These numbers are similar to those of several days ago. Perhaps yesterday was atypical? Or just another indication that he is bouncing around without rhyme or reason? In any event, I will keep at it. Tested the other day for ketones and the test was negative. How often is one supposed to test? Stu is possessive about his litterbox! (he enjoys tending it and taking good care of it). As far as ideal weight goes, I can say that for the last 2 years or so his weight has been pretty even: between 15 and 15 1/2 lbs. "Ideal" weight might be a bit lower, but I believe he weighed 15 lbs. when he came to live with us (at age 4). At one point he had ballooned to almost 18 lbs (when he was about 6 years old), but we put him on a diet! I remember that shortly before he was diagnosed with diabetes, at age 8, he weighed 14 lbs., but we didn't keep regular records of such things then and my memory might be faulty. He is now 12 years old.
Thanks again,

Ella
 
Hi Ella. This is a tough question... what to do about the dose. Start over or decrease as you have been doing. I see that you had been up to 7 units bid and now are down to 4 units.

Stu's weight is somewhere around 15 lbs. and may have been 14 when first diagnosed. So, just for the heck of it, let's split the difference and say his ideal weight could be 14.5 lbs. That translates to 6.59 kg.
Using the Rand/Tilly protocol for figuring the dose: .25 units X 6.59 = 1.65 units would be the starting dose. Since that is too hard to measure I'd say 1.5 units should have been the starting dose. If you use 15 lbs. as his ideal weight it would be 1.75 units.

But you didn't start with this protocol and the other way to determine a dose is to take into account the previous insulin and dosage. This is where it gets muddy. With the numbers you have been getting, it does look like a pretty significant drop is happening at nadir which results in the liver panicking at the lower number and adding glygogen to the blood which raises the BG. And there you see the red/pink high number. So you want to convince or train the liver that these low numbers do not mean a desperate situation and that they are normal. After being diabetic for a while, the liver sees higher numbers as normal. You want to change that perception so the liver sees numbers between 50 - 100 as the new/correct normal.

I hope we can get some discussion on what would be the safest and best dose for Stu. I know I was giving my kitty 5 units of Vetsulin at first and dropped it all at once to 1 unit. My kitty did much better and then in a few weeks I switched to Levemir (similar to Lantus.)

You know your kitty the best and since he has not had ketones... you could try to start over with the beginning dose of 1.5 or 1.75 and work up to the correct dose. Or even start at 1.0 unit and work up if you need to. Those low drops you are getting and high bounces say too much insulin to me.

I hope some of this info helps put some stuff out there for you to consider. What do you think? You need to feel comfortable in what you are doing.
 
Re: 1/27 Stu AMPS 306 but PMPS 87!!!

Hi again. Wow. His PMPS is only 87 (+6 was 80). I think I'll begin immediately to drop the dose to 1.75, as CD suggests. On the comments on STu's Spreadsheet, which I added only a few minutes ago, I said that I will skip this evening's dose entirely. Is this wise?? Please adivse!

Ella

P.S. Stu is acting completely normal.
 
Hi again. Can you do another test now? It's been, what, about 30 minutes? This could tell you whether Stu is starting to go up or is still surfing along in the eighties or even dropping some more.
 
Hi. At PMPS +1 he was up to 105, so I decided to give 1.5 units of Lantus and to check him again later. I can check for a few more hours yet (until about midnight EST; it is now 8 P.M.). Was it OK to give the insulin? Tomorrow I'm going to start him off on 1.5 units and follow the Tilly protocall. By the way, he's still behaving normally. Many, many thanks for your help.
Ella
 
Ella & Stu said:
Hi. At PMPS +1 he was up to 105, so I decided to give 1.5 units of Lantus and to check him again later. I can check for a few more hours yet (until about midnight EST; it is now 8 P.M.). Was it OK to give the insulin? Tomorrow I'm going to start him off on 1.5 units and follow the Tilly protocall. By the way, he's still behaving normally. Many, many thanks for your help.
Ella
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Yai for shooting!! Yai for new dose!!

Now - u have shot an hour behind schedule, has anyone spoken to you about stalling and making up the time?
 
Yes, I would have said to go ahead and shoot the reduced dose. Good for you! I hope this starting over will really make a nice difference for Stu.
 
Great job! Sorry I bailed earlier -- had to go to work! CD was able to give you the input I was hoping someone would follow up with. I hope this dose starts to level things out for Stu. Be patient. It's going to take a while for Stu to get used to the new dose and to have his dose worked up to his optimal level.
 
Good!! Thanks again for your support. Yes, I do know that I will have to give tomorrow's morning shot later than usual and gradually work it back to the normal time. I gave the 1.5 units evening shot at 7:45 P.M., so I will give tomorrow's morning shot at 7:25 A.M. I'll get two more BG tests tonight (at about 9:45 and 11:45). Keep your collective fingers crossed that all will work out OK!
Stu thanks you, too

Ella
 
BG 144 at 10:30 P.M. I think it's safe to turn in for the night. My husband (the cat restrainer!) is exhausted and Stu is acting normally. See you all tomorrow, hopefully with good numbers to begin the Tilly protocall. Thank you all!

Ella
 
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