10/12 Ginger pmps 337, +4 343

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Re: 10/12 Ginger AMPS 459

Good morning Lori and Ginger.....


Hoping Ginger's numbers come down a bit for you. You are doing such a great job w/her. You had mentioned in one of your previous condos about having a hard time w/ear pokes.....I was doing great w/that until lately (when I first joined, it took me a week to get that technique down)...now one of her ears is just being stubborn w/giving me some blood. Boy is she getting irritated w/me. Hoping that issue got resolved for you.

It seems that everything goes in cycles w/our kitties.

Have a great day.
 
Re: 10/12 Ginger AMPS 459

oh bless, can see your frustration (picked up your comments on evokats thread)

few things jump out at me.
it's early days and lantus takes time to build it's shed (and can take longer in some than others)

as i highlighted in a link to evokat-if your nadir is consistently above 300 you can increase by .5u.(this is barring anyone else advising you otherwise because of other complications)

whats the canned special kitty? lower in carbs?

you need as much info gathering as possible here. Record all behaviours-so peeing, pooping, preening, playfulness (and 1 more i can't remember).Your looking for pieces of the jigsaw at the mo. try not to get too downhearted your doing everything right.

oh and record how much water ginger is having if you can (i'd measure an amount out at start of day and measure again 24 hrs later for the difference)I also added a little water to luckys food as she was a tad dehydrated.
keep checking for keytones (sorry if saying suck eggs)

the sugar dance is a marathon not a sprint but i can understand your concern withthese numbers, but really your doing a great job.

do you warm gingers ear before poking? i used a rice sock, popped in microwave for 20 secs, pop under her ear for a few secs with my finger over the top of her ear before poking. this expands the blood vessels and gives you a better chance. i also found using the rice sock as a firm surface when pricking the ear helped heaps. (sorry bout typing have a small being attached to me so doing 1 handed :mrgreen: )

hang in there and keep asking q's and venting any frustration here-lots of support :mrgreen:
 
Re: 10/12 Ginger AMPS 459

There are some Lantus people who have used PZI and I hope they will stop by and give you their thoughts on why they switched. I am thinking that since Ginger started on the ABs on the 8th, there might be be some BG influence from the infection still. It does take time for it to work.
Did you get the probiotics yet?
Is she still okay with taking the meds? (Maybe make a note on your SS for when you started it as a reminder)
How long did your vet want her to be on them?
 
Re: 10/12 Ginger AMPS 459

sorry to see such a high number for ginger today, I know it's frustrating seeing those numbers so I'll be hoping that she comes down for you!!
 
Re: 10/12 Ginger AMPS 459

Lori, I can totally understand your frustration, really. Spot was on N from the day he was dx'd at the end of July of 2008 until 3/4/2009 and his numbers were very seldom out of the 400-over 500 range. I do have to agree with the others, tho and say that you should really give the Lantus a little more time to work. I also wish that your DH would change his mind in regards to the dentals. Mouth issues will definately cause BG's to raise...usually when Spot's numbers start to raise, I know he is either having problems with his teeth or getting sick (once he had a UTI and the other time his stomach quite "churning" due to stress related issues). Since Spot has been dx'd with FD, he has had at least 5 dentals.

So, I hope things start to look better for you and Ginger today.
 
Re: 10/12 Ginger AMPS 459, +3 369

Thanks everyone.

I have added the link to Gingers Profile to my signature.
I could not get the code to work per the instructions, so started from scratch to cause me less stress. lol

I also added the link to the story of the Kittens we Rescued (Ginger was one of them)
 
Re: 10/12 Ginger AMPS 459, +3 369

Good luck to you! Things will get better. I too hope that you can get in the dentals. With Mannie we are in twice a year - since his DX, his needs in that area rose quite a bit. He alwasy had the cleanest healthiest mouth - not since the DX. He does so much better numebrs wise when the mouth is healthy. Also yes on giving Lantus time to work.

I hope that Ginger's numbers come down today - the +3 is encouraging.
 
Re: 10/12 Ginger AMPS 459

Pat+Raja+Shadow said:
There are some Lantus people who have used PZI and I hope they will stop by and give you their thoughts on why they switched. I am thinking that since Ginger started on the ABs on the 8th, there might be be some BG influence from the infection still. It does take time for it to work.
Did you get the probiotics yet?
Is she still okay with taking the meds? (Maybe make a note on your SS for when you started it as a reminder)
How long did your vet want her to be on them?
Click to expand...

No on the Probiotics. What was that called again?
She got a little diarrhea probably from the amoxicillin, so I am reducing her dose today.
It is liquid and the vet said to give to her until gone.
I have added that info to the spreadsheet.
 
Re: 10/12 Ginger AMPS 459, +3 369

I sent an email to my vet regarding the decision on switching to PZI that said:

I have not made up my mind yet about switching Ginger’s insulin, but I wondered which protocol you prefer with the use of PZI.
"Start Low - Go Slow" Protocol
“Tight Regulation” Protocol

Ginger is only on her 16th day of Lantus with the "Start Low - Go Slow" Protocol , and all the information I have read, its way too soon to expect her to be close to being regulated and we cannot know if it will work unless we stay with the protocol long enough to see.
I am though concerned how much these high numbers are hurting her.
I am also concerned of Dr. Hodgkins statement “When a diabetic cat is consuming low carb foods instead of high carb foods, the liver resumes its ability to make enough glucose to meet the brain’s needs, and hypo signs DO NOT OCCUR. Low carbohydrate-feed cats have tremendous resistance to hypo signs because their livers work to keep this problem from occurring.”
This statement was found at this site. http://yourdiabeticcat.com/faq.html
From what I have read, that statement is not always true.
Low carb canned foods do help preventing hypo, but do not totally prevent that from happening.
 
Re: 10/12 Ginger AMPS 459, +3 369

A lot of people use Fortiflora. http://www.amazon.com/FortiFlora-FELINE ... B00164YL22 It might be available at your pet shop...but I ordered it from Amazon myself. It is a probiotic that is used a few hours after giving the ABs. So, not at the same time.
Sometimes with the ABs, they do get diarrhea and this replaces the friendly bacteria that is necessary for good intestinal health. (the ABs wipe out all bacteria, good and bad and that is why we should take the probitocs when on ABs.)

There are some active cultures in plain yogurt but this Fortiflors is convenient to use on top of their food. Most kitties really like it and I use it for my two occasionally even when they are not on ABs.
 
Re: 10/12 Ginger AMPS 459, +3 369 and PZI switch thoughts

Thank you.

What is the stuff to sprinkle on the wet food that attracts cats to eat?
 
Re: 10/12 Ginger AMPS 459, +3 369 and PZI switch thoughts

Gingers Mommy (Lori) said:
Thank you.

What is the stuff to sprinkle on the wet food that attracts cats to eat?
Click to expand...
The same FortiFlora that was mentioned above. We use it only for that purpose (and never mind if its a probiotic too...)
 
Re: 10/12 Ginger AMPS 459, +3 369

Gingers Mommy (Lori) said:
I sent an email to my vet regarding the decision on switching to PZI that said:

I have not made up my mind yet about switching Ginger’s insulin, but I wondered which protocol you prefer with the use of PZI.
"Start Low - Go Slow" Protocol: http://www.diabeticcatcare.com/protocol.htm Preferred by DR. REBECCA PRICE
“Tight Regulation” Protocol: http://www.diabeticcatcare.com/protocol.htm Preferred by DR. ELIZABETH M. HODGKINS

Ginger is only on her 16th day of Lantus with the "Start Low - Go Slow" Protocol , and all the information I have read, its way too soon to expect her to be close to being regulated and we cannot know if it will work unless we stay with the protocol long enough to see.
I am though concerned how much these high numbers are hurting her.
I am also concerned of Dr. Hodgkins statement “When a diabetic cat is consuming low carb foods instead of high carb foods, the liver resumes its ability to make enough glucose to meet the brain’s needs, and hypo signs DO NOT OCCUR. Low carbohydrate-feed cats have tremendous resistance to hypo signs because their livers work to keep this problem from occurring.”
This statement was found at this site. http://yourdiabeticcat.com/faq.html
From what I have read, that statement is not always true.
Low carb canned foods do help preventing hypo, but do not totally prevent that from happening.
Click to expand...

hi lori. i have to admit, i'm a little confused. i'm not really sure what dosing method you're following. :-D

the Start Low, Go Slow (SLGS) method would have you holding each dose for at least a week, if not more... unless the numbers dropped low enough to warrant a decrease in dose.
SLGS method: http://binkyspage.tripod.com/SLGS.html

the Tight Regulation Protocol which most of us have been following in this group for the past few years generally would have you holding each dose for a total of 6 cycles (there are exceptions) and increasing the dose by 0.25u if nadirs were over 200, but less than 300 OR the dose would be increased by 0.5u if nadirs were over 300.

given your frustration with ginger's numbers, would you be interested in following the tight regulation protocol?
guidelines can be found here: STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOLS

we've been very successful using the tight regulation protocol for several years now.

i noticed ginger is being treated for a UTI. glad you caught it! ANY infection will make it very, very difficult to regulate ginger. my own kitty was OTJ for almost 3 years before needing a dental put her right back on the juice! all she ended up having was a good cleaning. there were no extractions. i'm still kicking myself for not paying more attention to what was going on in her mouth! :roll:


about a switch to pzi... i've never used it. i'm sure others who have will stop by to offer their thoughts.
 
Re: 10/12 Ginger AMPS 459, +3 369 and PZI switch thoughts

Jill & Alex:
The protocol does not state to hold each dose for a whole week.
It states to hold the dose for 3-5 days (6-10 cycles)


Other than the 1st 2 days of confusion, I have been going by the Start Low, Go Slow protocol except I have done .25 increases rather than the .50 increase because most people have suggested it is safer. I also didnt want her nadirs to jump down too fast, because it makes her feel worse than having the high flat curves.

Start Low, Go Slow protocol:

--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) tell you unless the numbers otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).

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.

~Today her curves this afternoon have been in the 300's rather the 400's, so I feel a little better.~
 
Re: 10/12 Ginger AMPS 459, +3 369, +6 391, +9 357

Hi Lori...can you put a link to where it was that you found that SLGS Protocol that you quoted? Thanks.

The freeze-dried chicken is what I use from Pure Bites. Halo and other companies make them too. I have been ordering the 1.4oz bags online since they are not sold locally. My two really love it sprinkles on top of their food. It's only one ingredient so it is a great tempter for them. :mrgreen:
 
Re: 10/12 Ginger AMPS 459, +3 369, +6 391, +9 357

its in the sticky link that Jill and Alex posted. (the message right above mine)
Its also at the top of the Lantus forum.
 
Re: 10/12 Ginger AMPS 459, +3 369, +6 391, +9 357

let's see if we can clear up the confusion...

the Start Low, Go Slow method can be found here: http://binkyspage.tripod.com/SLGS.html

Five Steps to Regulation:

Step 1. Start at a low dose of PZI, Lantus, or Levemir insulin, as recommended by your vet. (Note: Humulin and Novolin Lente and Ultralente, two insulins with good track records in cats, have been discontinued by the manufacturers.) A conservative starting dose is 1.0-2.0 units, twice per day. If your cat’s blood glucose was less than 400 mg/dl (22.1 mmol/L) at diagnosis, or if your cat is on a low-carbohydrate diet, the starting dose should be only 0.5-1.0 units twice per day. Fast-acting insulins such as Humulin Regular, Humulin 70/30, and Humulin N (NPH) are not suitable starting insulins for cats, in the experience of FDMB members because of the high risk of hypoglycemia; Humulin N may be appropriate later on if you discover that longer-acting insulins cause problems for your cat. Vetsulin, also known as Caninsulin, is less harsh than Humulin N, but still appears to carry a risk of hypoglycemia, particularly for cats who are not meal-fed high-carbohydrate food, so please be aware of the risks.

Step 2. Don’t increase the dose until your cat has been on it for at least a week. If you have reason to be concerned about hypoglycemia, or if your cat won’t eat, do decrease the dose and contact your vet. Do test your cat’s urine frequently during the regulation process using Ketostix or Ketodiastix, and contact your vet immediately if the cat tests positive for ketones. Do be consistent in the timing and type of food. Do give the shots at about the same time every day.

Step 3. After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve (blood glucose tests every 2 hours, starting at shot time and continuing until the next shot). Follow the cat’s normal feeding schedule during the curve. The curve should be evaluated by someone experienced at interpreting feline blood glucose curves, in order to check for signs of rebound and other possible problems. If no rebound is present, follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):

a) If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
b) If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
c) If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.

Step 4. Repeat the cycle of curving and waiting 1-2 weeks. As your cat’s blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don’t increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don’t be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat’s blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Step 5. Once you can no longer increase the dose without the cat dropping below 90 mg/dl (5.0 mmol/L) at the lowest point, evaluate the duration of the insulin’s action. If your cat’s preshot blood glucose values are still consistently above 350 mg/dl (19.3 mmol/L), or if your cat’s blood glucose usually returns to preshot values more than an hour before the next shot is due, ask your vet about longer-duration insulins or possible adjustments to your cat’s food or feeding schedule.

That’s it — 5 steps! These steps are general guidelines that work for the majority of cats. Because every cat is different and exceptional situations may arise, your cat’s progress should be closely monitored by someone with experience regulating feline diabetics.


the tight regulation protocol can be found here: STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOLS.

the "modified" version of the tight regulation protocol is as follows...

Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"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.


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.



when following the tight regulation protocol, you would want to increase the dose by 0.5u after 3 consecutive days (6 cycles/3 days) if nadirs are greater than 300.


hope this helps...
 
Re: 10/12 Ginger AMPS 459, +3 369, +6 391, +9 357

Jill,
Ok, I think I understand now how the confusion happened.
I was following the "modified version" stated in your sticky rather than the regular one.

Its a little late now to go back, so I am going to continue to follow that version since her numbers have been so high.
Thank you for the input and clearing up the confusion.

Except for the AMPS reading of 459, her numbers all day have been in the 300's, so that is better than all the reds yesterday.
:smile:

Lori
 
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