10/11 Chester's +11=374, PMPS 385,+2=382

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Jaye and Chester

Jaye and Chester

Member Since 2010
Folks, this dose isn't working for Chester. I know he hasn't had the full 6 cycles on 1.25 but can this be considered a failed dose reduction. He's been SO high for days now... Wherever "wit's end" is, I'm at it. Was his last good dose truly 1.5?

viewtopic.php?f=9&t=27071
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

This could be the high before the break. I would say, if you don't see any better numbers tonight, then increase tomorrow morning. But will you be home to monitor him? Please wait for others to advise. I need to log off now, to get ready for tbp. I'm sorry, you're frustrated. You will get him better under control. Hang in there. Meanwhile, are you checking for ketones?
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

One of your cycles before the 1.25 was a fat 1.0, so I would think thats close enough to be 6 cycles.
Wait for other's to reply that are more experienced than me before you decide.


This is from the Lantus Protocols Sticky Lantus Protocols

"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.
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

But isn't this what I'm looking at?

--- If an attempted reduction fails, go right back up to the last good dose.
Click to expand...

His ketone level is 0.8. I don't like this...last time he was high it was 0.6. The guide says that this means his BG is over 300. Yes...we know that. I need to raise his dose tonight even if I have to stay home tomorrow to monitor him.

Is the protocol so rigid that I can't adjust it even if I feel he is in danger? Sorry...I'm frustrated and really, really scared.
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

I've been having a hard time getting my cats BG levels adjusted lower. She has been on Lantus since 9-27.
I have increased even after 2 cycles per the vets instructions.
I usually have high flat curves that day.
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

If he goes into ketoacidosis because I failed to get his BG down...I'll never forgive myself for that.
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

Took a nice long look at Chester's ss...it does seem like the 1.5u dose was a good dose for Chester, and I also agree with Ginger's mom that a fat 1u is close to a 1.25u dose. I also noticed that the last time he had that nice string of blues, he bounced for a few days, but he was able to get in an occasional high blue and yellow numbers on the 1.5u dose. This time around, he's not doing that quite so well, and his dose is 1.25u.
Now, I'm just wondering here....could there be something going on with Chester medically that could be cause these higher numbers?
How is the litterbox action? Could he be a bit constipated? Spot's numbers always went up when he was constipated and stayed there until he had a nice magical poo. Just a thought.

If it was me...and I was able to stay at home to monitor, I'd increase the dose to 1.5 tonight. He's been in those high numbers a few days now and you've got a trace of ketones. This is just my opinion and my observation, for what it's worth, so don't take it as an approval to increase. See what others have to say, and then make an educated decision as to what to do.
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

Jaye and Chester said:
But isn't this what I'm looking at?

--- If an attempted reduction fails, go right back up to the last good dose.
Click to expand...

His ketone level is 0.8. I don't like this...last time he was high it was 0.6. The guide says that this means his BG is over 300. Yes...we know that. I need to raise his dose tonight even if I have to stay home tomorrow to monitor him.

Is the protocol so rigid that I can't adjust it even if I feel he is in danger? Sorry...I'm frustrated and really, really scared.
Click to expand...

You are looking at the correct part of the protocol. There is no minimum time frame for holding a failed reduction - if it doesn't work, go back up.
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

I would increase tonight Jaye...can you get more liquid into him? Maybe make the food soupy so he will have more fluids?
Has he ever had problems with ketones in the past?
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

First, the last change you made was a dose increase. If you went from a skinny 1.25 to a full 1.25 - even a drop of insulin can have an effect. Even if we discount this change, you still went from a fat 1.0 to the current 1.25. This is an increase in dose, not a decrease. In addition, you've been tinkering with the dose. This can make numbers wonky. Let me summarize what I'm seeing you Chester's SS:
  • 10/1 AM 1.50
  • 10/1 PM 1.25
  • 10/2 AM 1.25
  • 10/2 PM 1.50
  • 10/3 AM 1.50 skinny
  • 10/3 PM 1.25
  • 10/6 AM 1.25 skinny
  • 10/7 AM 1.00 fat
  • 10/9 AM 1.25 skinny
  • 10/9 PM 1.25
In the past 11 days, what I'm seeing is that you've altered Chester's dose 10 times. Lantus really needs consistency to work well.

Are you using a Precision Xtra meter to measure ketone levels? If so, just as a matter of comparison, for most of us who use a Ketostix, to show a trace level on the Ketostix, you'd get a reading of 3.0 on the meter. Normal levels register up to 0.3 on the Precision meter.

I would add more water to Chester's food. That will help flush the ketones if you are worried. I'd also wait until later this cycle and we can evaluate closer to your PMPS what's going on and whether an increase is necessary.
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

Morning Jaye - Deb asked about Chester's poo. Many around here subscribe to the theory of Magic Poops. If a kitty gets a bit backed up, his numbers climb and then when he finally goes, his numbers drop a good bit. So we all root for good poops around here. If you aren't seeing some good evidence in the kitty box, maybe try some Miralax on him. And you said he had a good exam with your vet fairly recently, right? So you don't think anything else medically could be going on with him? I can testify to the increased efficiency of Lantus when you are consistent with dosing. It takes Shadow a good number of cycles to settle into her dose when it is changed and I've seen first hand how well the protocol works when followed closely. I can imagine that you feel quite panicky over Chester and perhaps that is why you tinker with his dose like you have but follow the advice given here and leave him on a dose for 6 cycles. That is only 3 days.

Gingers Mommy (Lori) said:
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.
Click to expand...
Be consistent, get some numbers for the folks here to work with and let's see what happens over the following 6 cycles. And remember that dose changes are based on nadirs and not preshot numbers, which is the routine for some of the previous insulins you've used. We wouldn't worry like we do if we didn't love these kitties so much and you wouldn't be here if you didn't love Chester so much so take a deep breath, commit to following the protocol and post often with your numbers. You don't have to make all these decisions on your own. The people here want to help you if you'll listen to their recommendations.
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

My vet wants me to check his numbers tonight pre-shot and probably give him some fluids after that. I can do that...I give my CRF cat fluids every night so it's not a problem for me. He's isolated today, so I can (hopefully) get an idea of the poop.

I understand the thing about the consistency...truly I do. But I really have to stress that I'm totally not confident that my skinny 1.25 and my fat 1.0 weren't the same, or my full 1.25, for that matter. I would venture that anything that had skinny or fat in front of it were all essentially the same dose. I can't see those markings well, even with the magnifying glass (which for some reason makes it blurry for me) so, although it looks like I've been bouncing all over the place, virtually all of those were essentially 1.25, which I thought was my last good dose...but maybe it was the 1.5.

And if I go by the above paragraph, Chester has had 16 cycles on the 1.25 with no more than literally two drops on either side of it for variation, which is what I probably would get just trying to shoot the same number daily if I couldn't get the blasted bubbles out.

It's the ketones that are scaring me. I don't want even a tiny little ketone if possible! His eyes aren't bright...he feels blah...and I'm praying that he's alive when I get home.

Of course, I could come home and find him with a pre-shot of 120....one never knows what to expect!
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

there have been many valid points already mentioned in this thread, but we definitely don't want ketones getting any worse.

the modified version of the tight regulation protocol many of us have followed allows for a deviation from the norm when ketones are present:

There are some circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines.
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

the tight regulation protocol somewhat addresses the presence of ketones in phase 1:

Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours).
http://www.tillydiabetes.net/en_6_protocol2.htm

since a small amount of ketones are present and if you're available to monitor, if it were me, i would go ahead and increase the dose to 1.5u tonight because i have a ketone prone cat... barring anything unusual happening between now and then. however, you mentioned giving fluids tonight. it should be noted some caregivers have noticed a glucose lowering effect after receiving sub-q fluids. i haven't noticed this happening with my own kitty, but some kitties have reacted to fluids. just something to be aware of if you're increasing the dose + administering sub-q fluids...
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

I'm also thinking that this part of the protocol might apply to Chester's case...but I'd be afraid to increase by a whole 0.5....feel safer at .25.

However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU.
Click to expand...
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

no advice here...you've got the wise ones helping you out...just want to say good luck and hang in there!

celi & binks
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

hi,
couple of things i've noted-it's not obvious why you reduced on several of your reductions as there's no test showing a bg of under 50. this is the 'magic' number in a newly diagnosed kitty that your looking for.

as for increasing by .5u this is usually aimed at when yur working up to your ideal dose. you got this a while back and are working down, so for now stick with .25u increases.

Totally agree with deb and jill, increase cos of keytones (and keep monitoring them closely).

good luck :mrgreen:
 
Re: NOT WORKING! 10/11 Chester's AMPS 447

Several people told me that, because I use the AlphaTrak meter and it consistantly runs 30-40 points higher than human meters (particularly the ReliOn) then my cutoff for a dose reduction was 80. If Chester get a 50 on an AlphaTrak, it would be almost non-measurable on a human meter.
 
Re: 10/11 Chester's AMPS 447, +11=374

My plan of action for tonight is.....

Chester will get an increase to 1.5. After dinner I'll give him fluids and then wait a bit and recheck for ketones (he'll probably save me one of those ghastly expensive ketone strips after fluids...he'll surely have to pee then).

No poops in the litterbox today and he was isolated. I don't have Miralax, but my other cat is on Lactulose...I can give him some of that.

Will watch him like a hawk tonight and hubby is taking off work tomorrow to watch him and test him.
 
Re: 10/11 Chester's +11=374, PMPS 385

That Lactulose....the sugar content? Hmmm;....something is ringing in the back of my bean brain....
did you give it to him yet? Hold off if you can for a minute...unless you already gave it to him....
 
Re: 10/11 Chester's +11=374, PMPS 385

It sounds like a good plan. I was hoping that Jill would weigh in.

I didn't realize that Chester was constipated - sorry if I missed that. That could be contributing to higher numbers.

What I would like to suggest is that you practice with some of the dosing. If you're finding it hard to read the syringe, given the need for consistency, the best thing to do is to practice. I'd expel the desired amount of insulin (use water or something other than Lantus) on wax paper so you can see the bead of liquid. I use the marks on the syringe in relation to the plunger to keep my dose consistent. Just keep at it until you feel like you're able to measure the same amount consistently.
 
Re: 10/11 Chester's +11=374, PMPS 385

Pat+Raja+Shadow said:
That Lactulose....the sugar content? Hmmm;....something is ringing in the back of my bean brain....
did you give it to him yet? Hold off if you can for a minute...unless you already gave it to him....
Click to expand...

Oh, no! I think you might be right...sugar! Eeeegaaaadddsss! And yes, I gave it to him at 6:00 (which was +.5) Jeeeezzzz.... What else can go wrong tonight (oops...fingers crossed and knocking on wood).

I'm on my way to Walgreens and I'll pick up some Miralax. I'm not sure if Chester is constipated or not because we've go so many and haven't been checking him poop particularly until today...which he hasn't done.

Would the sugar in the lactulose have made its presence known yet? It's now +2 (1.5 hours later) and he's only marginally higher than his pmps which I would expect for this time after the shot.

I'm guessing I probably shouldn't add the Miralax after already dosing the Lactulose though. Any idea on the amount I should use for a 10 lb. cat?
 
I've seen some cats affected by lactulose, and others not at all. I guess you'll just have to wait and see.

Good luck with the dosecrease!
 
I would not give Miralax in addition to the Lactulose.

You can give 1/8 to 1/4 teaspoon of the Miralax mixed into food and be sure to add water to the food.

If you're not sure if Chester is constipated, rather than jumping to laxatives, maybe adding a little oil to his food to see if that greases the skids, so to speak, might be a better first step. If you have tuna packed in oil or sardines, that would probably work fine. Just pour off a little of the oil and add it to Chester's food. If you don't have that in the house, a little bit of vegetable oil would be fine. Other's have used pumpkin puree as a means of adding fiber.
 
Yeah, no more for tonight IMHO. Do buy the Miralax and have it on hand for next time. I use 1/4 teaspoon and mix it with the food....adding more water to the food. The added liquid is important. What I usually have lots of success with is adding the Miralax to tuna oil...

You could even give him some tuna oil tonight if you have some. The oil is good to help move things along and they usually need no prompting to enjoy that treat.
If they haven't gone in a day or two the numbers can sometimes go higher. Not to mention the other issues with constipation, it is good to try to keep an eye on the frequency of the LB action.
Some people didn't notice any BG rise with that Lactulose (I think some vets recommend it) so maybe you will not see any yourself. It's all good data anyway.

So, welcome to the Magical Poops Club...some of us are members..LOL...we wait for the magic to happen!
 
Okay...bought it but won't use it tonight. I'll use a little oil after his fluids if he hasn't pooped yet. Honestly didn't know you could still get tuna in oil.

I have a chronically constipated FIV cat....one poop a week if we're lucky...who is on lactulose 2 ml bid and I don't think it's working well at all. Her stool is infrequent and hard when she has them (and sometimes soft behind the hard...pretty disgusting to have the poopers and hard poopers at the same time). Now I'm wondering if the Miralax might not be good for her as well. It says it has a softener for times like last night when it's really hard for her to poop.

My, my....what a lovely conversation to have! :-D
 
I'd check with your vet before using the Miralax with an FIV kitty who you know is constipated. Miralax acts by drawing water into the colon. It sounds like it would be fine with your other kitty but there are also some conditions where it's not indicated.
 
Yup...I'll check with them. She doesn't have any other symptoms of FIV yet, besides the constipation. Might be just what we need for her.

Just gave Chester some fluids...he took them like a man. :)
 
:lol: There is a lot of talk about poop in this forum. After all, it IS so important.
Do add a lot more water when you give Miralax.
That's why I say to add it maybe to the tuna oil. It does help things move along. And if they do not move their bowels, they can get impacted. Not a good experience for anyone.....
I usually buy the tuna in water too, but now I have the special cans w/oil for them too!

I agree that you should check with your vet about using it for her....

You wouldn't believe what goes on around here!! DH scoops it sometimes and announces that here was poops. I always ask if it was Raja or Shadow. He always says he isn't sure. sigh. We go through the entire conversation all over again. (A mother notices the difference between her babies poops. One is healthy an puffy, the other is tight little balls from the little Miss Smarty Pants.) :lol: I keep track on my SS.

Oh yes, it is important. (and sometimes the numbers do come down after some LB action too!)
As Sienne said, we don't know that he IS having a problem, but it doesn't hurt to go through the motions. And it will definitely be good for them all now that you have it. :mrgreen:
 
Haven't done the oil yet (will with his bedtime snack) but we're seeing our first yellow in DAYS. Granted, it's a high yellow..but a cheerful, sunny yellow! Whether it's the higher dose (so fast?) or the fluids...don't know.
 
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