10/11 Zeke AMPS=325; PMPS=352 (Increased to 1.5u)

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MrZ

MrZ

Member Since 2013
I'm sorry I keeping asking but you know I'm no expert on this and I can't find a vet that is an advocate for the Tight Regulation Protocol who I can contact to give me dosing advise. So I have to continue posting on the FDMB to get insulin adjustment advice. It seems that Zeke was doing much better earlier on so I have no idea if I'm suppose to just hold the dose at where he is now or increase.

Some on the board have advised to hold the dose at 1.25u because Zeke is getting good numbers and others have seemed to indicate that perhaps an increase is due. I'm very confused as to what I should do. Seems to me he was doing a lot better 9/12 through 9/17 on 1 unit than how he is doing now on 1.25. However, it kinda seems that his numbers are improving currently on the 1.25u as it's been three days since Zeke hit black; but on the otherhand he's also surfing in pink a lot and not hanging in the blues much (and hitting greens less often than in the past). I understand that things can change so perhaps I should really not pay too much attention to how he was doing a few weeks ago. All that matters is how he is doing now. However, I just seem to not be able to get a handle on interpreting his BG readings and the appropriate action to take. I'm fine with holding the dose at 1.25u but as he's been on this same dose for 11 days now, I just don't know if that's what I should do.

Please advise.
 
Re: 10/11 Zeke AMPS = 325; +3.5=335; +6=354 DOSE INCREASE

Dont apologise, this board is EXACTLY where you want to be to ask about dosing advice. Ask away! and of course read and re-read the stickies at the top of the forum. As time passes you will understand them better and understand the answers we give you!

Now your question on dose, if you look at the protocol (http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581) it says:
ncreasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 (blue green) before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 (yellow) increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 (pink red black)increase the dose by 0.5 unit.
Click to expand...

The fun bit is that your nadirs are all over the rainbow! You see a nice green one night and then he hits a black soon after. And repeat. He likes to be blue green at night and pink during the day. With those nice healthy blue greens at night it gives him time to heal and recover - so I would bear that in mind, his numbers are ok.

The problem is if you increase the dose that green could go under 50 which is too low which is why some people are saying dont increase. Others are thinking if you increase a little to say a fat 1.25 you might be able to sneak him down a bit more without dropping too low. Its up to you then , and you test a lot, so if you increase and he does drop too low you can always move him back up again.

However I do think you are stressing a little too much about the numbers ( I do it myself!!) . Tell me.. how is he feeling? hows his 5Ps? (peeing purring playing preening and pooping).

Wendy
 
Re: 10/11 Zeke AMPS = 325; +3.5=335; +6=354 DOSE INCREASE

I think he's feeling well. The 5 Ps are normal. You hit the head right on the head about his numbers not clearly falling in line with the prescribed dosing adjustments per the Protocol. That's what's giving me so much trouble in deciding what to do. When I look at his numbers since the increase to 1.25u, I see an initial worsening in that he's not surfing greens like he had been and he's hitting blacks much more frequently than he had before (and while having lower numbers with much more frequency back then too). However, now that I've held the 1.25u a while (and longer than generally prescribed by the Protocol) he's having fewer big swings and the blacks are coming less frequently. So, since (to me) it seems like I can't look to the protocol for clear guidance, I'm wondering if I should leave him on 1.25u and see if he will continue with decreased swinging and maybe he'll start having some surfs in yellow for a while as opposed to pink. Would that not be better than huge swings with very little greens anyway? I do realize that this course of action is philosophically contrary to the Protocol but as ECID is this something that perhaps is worth trying with Zeke? Of course, the tradeoff is that we may waste time and delay getting him regulated. Additionally, if I keep him on the 1.25u and he just stays in pinks then I’m not really doing him any favors nor helping him to improve and heal. And though yellows are not the ultimate goal either, it seems like it would be a move in the right direction.

In the past we have been testing quite often, however, due to personal circumstances it will be much harder to do so in the next couple of weeks. So, my concern is that if I increase the dose, Zeke might have dangerous dives and we won't be around to help guide his BGs back up. This is one of the major concerns that is driving my husband to persuade me to stop with the Tight Regulation Protocol (his concern for Zeke's immediate safety). He and I both want the same thing – what’s best for Zeke – but at this time we’re having a difference of opinion as to how exactly to achieve that.

If the majority feels that I should increase to 1.5u, I will do that. I’ll just have to figure out how to keep him safe.
 
Re: 10/11 Zeke AMPS = 325; +3.5=335; +6=354 DOSE INCREASE

Have you tried steering his numbers with food? It just seems he goes low at night and then bounces back higher in the daytime. It might be helpful to get some input from others who are used to "unique" cats like Zeke.

That being said, I'm not the one to ask about how you might try it and see if it makes any difference, so hopefully some of the more experienced members will have some ideas for you on what you can try
 
Feeling good is the most important thing!

The problem with flat yellow pink or above, is that the cat develops glucose toxicity and then you need to increase the dose just to keep him flat yellow, then just to keep flat pink.

By the way, Given his numbers and your description of his 5ps, I would consider him regulated as per the definition...

Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]
Click to expand...

Wendy
 
you've gotten some good advice. i'd get a +2 and see where he's headed tonight. Wendy's right, if you look at the night time cycle, overall, it's pretty good. he's taking about 72 hrs to clear each bounce, hitting a green and taking off again. he's just a bouncy guy and he will eventually settle down.

perhaps it will help your husband to know that this is the only published protocol to treat diabetic cats. the Tight Regulation does give a cat the best chance at having their pancreas heal and going off of insulin - which of course, everyone wants. it's an intensive investment, but for some people it's a very short time that they do it. some cats don't go off, of course, but holding a cat's blood sugar in normal ranges keeps a cat as healthy as possible. i think vet's don't come out in support of it because it does require home testing and most people won't do it - doesn't mean that it isn't the best option out there.
 
laura, i just saw your other post with lots of people's experiences with their diabetic cats on it and a little more about your own situation.

i also think this board saved my punkin's life. we started punkin on Prozinc but when the vet switched Punkin to Lantus, he didn't tell us to switch syringes from a u-40 syringe (Prozinc) to a u-100 syringe (Lantus.) That difference meant that Punkin was getting 2.5x the dose that we thought. The people here realized this and presented us with a few options to figure out what dose punkin really needed. as it turned out, he had acromegaly - which probably saved his life with that high dose he was really getting.

anyway, the point is that people here do feline diabetes 24/7 every day of the year. some have been doing it for many, many years and seen every possible spreadsheet there is to see. vets are fantastic people - i adored my vet - but i realized that any individual vet simply doesn't treat many diabetic cats. they just don't have the depth of experience that you'll find here.

i've seen many people think their cats were overdosed and want to start over again. if they followed the protocol in increasing doses, i haven't seen any situation where the cat actually was overdosed. the cats that are overdosed are the ones who had their doses increased by entire units at a time. Zeke's dose of 1.25-1.5units is a very average dose for a cat.

the post Marje linked for you on Glucose Toxicity is one that i wrote a while back. I think it is a very real concern - we see it regularly that cats that sit in high numbers too long seem often to need a higher dose to get back under control. Holding a dose too long or restarting from the beginning just seems to slow down the process.

the other comment that someone made is a great question - if you don't follow this protocol with Zeke, what's your husband's plan? there isn't another published one to use. here is the actual Lantus (Glargine) study that was published:

Intensive Glucose Control is Safe and Effective in Diabetic Cats Using Home Monitoring and Treatment with Glargine
i hope you can convince him that this truly is Zeke's best option.
 
I'm glad you increased to 1.5u. For a newly dx cat, unless you are really just fine tuning, it's best to increase in increments of .25u if nadirs are below 300.

Great job!!! Come on down Zeke!
 
I know you're probably not awake yet, so I'll post on here for now.

Good luck with the dose increase, and I hope that it'll help to bring his #s down for you. One thing to always keep in mind is that whenever you change the dose, and/or sometimes the food amount, or the food, the #s may bounce. I know that it'll be frustrating to see, especially in the beginning. Trust me, we've all been there. Just continue to work with him, and in time you'll begin to see improvements. You're both doing a wonderful job. Hang in there, Laura! :YMHUG:
 
Hi Laura

Just dropping in to say hi to you and Zeke. Hope both are doing well this morning. I see that you are from Houston....I'm in Houston as well. I have to say that you are really doing a great job with Zeke....this diabetes dance sure can be challenging....for both the bean and the kitty.

Its good that you are asking the questions about the protocol here in LantusLand...its the best way to learn it and then try to apply it to your specific situation. While I have a wonderfully supportive Vet at Meyerland Animal Clinic he couldn't openly endorse the protocol....and I didn't really expect him to do so....I think its a liablity issue for them. So I would ask my questions here. And got lots and lots and lots of feedback.

While my Curry(GA) wasn't as bouncy as Zeke, it was challenging to try and figure out dosing sometimes for her. She would be fine and all of the sudden her numbers would start to increase....then I would increase the dose....sometimes what I was seeing just didn't make sense.

I did notice her numbers increasing during this time of the year....Ragweed season in Houston can be awful for the beans and the kitties. Just a thought.

Hope Zeke's numbers start to come down and level out for you. Please keeping asking questions. Please take care of yourself during this sugar dance with your boy.

We are all rooting for Zeke!!
Tena, Curry(GA), Zeke and Sidney
 
I gotta ask what may be a dumb question. How old is your Lantus? Please make sure there are no "floaties." Have you accidentally left the insulin out of the refrigerator for any length of time or has it gotten inadvertently knocked around? Sometimes when you see wonky numbers, it's a matter of the insulin being toasty. I've actually gotten a bad pen on an occasion or two.
 
The potency of the insulin is something I'd previously posted about. We have kept ours in the refridge - on a sturdy shelf, in a glass for added stability and reduced risk of being knocked over - taking it out only for about the minute or so it takes us to fill the syringe. The vial is just shy of 9 weeks and is clear with no particles. We've been told it can keep for six months if handled with care and shows no signs of cloudiness or particles. His numbers have improved some, so for now we'll continue using the vial unless advised otherwise.


Thank you everyone for the support. We'll just keep moving forward and hope to see his numbers improve.
 
If we're getting decent results at least through a portion of Zeke's daily cycle (typically at night), can we rule out the possibility that the insulin needs to be replaced?
 
usually with dead insulin you don't see a curve. zeke just wants to provide his all night long. so yes, to my eyes, looking at his night cycles, i think his insulin is working. if only he'd do that during the day instead of at night! ;-)
 
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