10/4/18, Kit, AMPS 115

C_Star

C_Star

Member Since 2018
Hi All,

I’m new so please forgive me if I make any newbie faux pas. I’ve read the ISG guidelines and stickies, and introduced myself in the main forum, so here goes… :)
....

My lil’ bud, Kit, was diagnosed with diabetes last month and he was started on on 2u Lantus BID under our vet’s supervision with testing twice a day on the AlphaTrak II.

My vet originally recommended the following dosing for Lantus:


“Our goal is to maintain blood glucose between 5.5–14 mmol (100 – 250)

1. Pre-insulin <4.5mmol (81) – Feed, no insulin, re-check the glucose in 1-2 hours

2. Pre-insulin 4.5 (81) – 7.2mmol (130) – Feed, reduce insulin by 50%, re-check in 1-2 hours

3. Pre-insulin 7.3 (131) – 12 (216)– No change, give insulin after feeding as per usual

4. Pre-insulin >12 (216)– No change, give insulin after feeding as per usual”​


Is that out-of-the-ordinary? Some FDMB members were concerned that at first I was advised to vary his dose so much. Some AMs I would give him 2u, and then nothing in the PM if his numbers didn’t warrant it, or vice versa.

Kit has been needing less insulin lately (see spreadsheet) so, on Monday, the vet recommended we drop him down to 0.5u BID and consistently give that dose (unless he’s below 4.5 (80) when we give no insulin.) Does that seem reasonable?
From reading this MB, I see that I should also be testing more frequently than my vet recommended.


My questions:

1. Is this system Tight Regulation Protocol? Or Start Low Go Slow? (And are those two mutually exclusive methods?) It kind of doesn’t look like either to me…


2. At what low number do I start to worry? As you can see in his spreadsheet, Kit sometimes has low numbers (once as low as 2.6 (47)) but he hasn’t had symptoms of hypoglycemia. From reading here, it seems like in that situation I would feed him something high-carb and stay home until he’s back into a safe number – but what range is safe? 4.5 (81)?


3. Is it ok for Kit to have a snack a couple of hours before his PMPS? Or will that throw off his readings? (Pre-DM, he would get several small measured meals throughout the day, so he’s not a fan of only getting 2 larger meals per day).


4. Can someone suggest some syringes? The ones I bought from the vet are 100u 3/10cc 30ml total capacity (orange cap). They’re ok, but since we’re doing a 0.5 unit dose, it’s super hard to draw such a small amount accurately. I’ve read that there are syringes with half unit marks but is there one with a narrower barrel so that it’s easier to be more precise? I’ve read that some of you use digital calipers, but even then, my dose is only about 2mm on the barrel and it’s so hard to be accurate even with a magnifying glass.


5. Do you have any tips that helped you in the beginning? Any secret hacks that made things easier?


Sorry for the barrage of questions! I just want to make sure I’m doing the best I can to keep my furry friend happy and healthy <3


Thank you all in advance – I really appreciate this amazing resource and support system! :)
 
Hiya C_Star! (What's your name? Should I call you C or Star?) Welcome to the best place you never wanted to be! I'm so glad you've found us! The depot insulins, Lantus, Basaglar, and Levemir are best given consistently, because any change in dose can disrupt the depot, which is what keeps our kitty's BGs level. You want to find a dose that you can give both AM and PM cycle, 12-hours apart. 2u is actually a pretty high starting dose for a new diabetic, as most kitties don't end up needing that much. I'm really glad your vet dropped the dose down to 0.5u, and that you're home-testing! That's so so important. Now to answer some of your questions.

  1. Your vet's protocol is neither Start Low Go Slow (SLGS) nor Tight Regulation (TR). These depot insulins are dosed based on how low the dose takes your kitty, not on the preshot numbers. This protocol seems like it would fit more with an in-and-out insulin like Vetsulin (Caninsulin in Canada), which is quicker acting, shorter lasting, and dosed based on preshot numbers.
  2. Your safe numbers depend on what meter you're using. You'll notice the protocols are written with human meter ranges in mind. The AlphaTrak runs a bit higher than human meters. I never remember the full normal range for it, but the "take action" number on the AT is 68. Anything under that number needs to be addressed, whether via a higher carb food or honey/Karo syrup to bring the numbers back up into normal range. So your 47 would definitely be a situation where you'd feed higher carb and/or honey or Karo syrup to bring those numbers up ASAP. HERE is an article about treating hypos, please print this out and keep it handy for those situations. With both protocols, low numbers (or limes on your spreadsheet) would earn an immediate reduction in dose. Please remember that a kitty can be pretty dangerously low and have little to no outward signs or symptoms of a hypo event. That's why testing is so important!
  3. My vet tried the "only feed 2 meals a day with insulin" route with us as well, but we've found that many kitties do much better with multiple meals a day. It can help the pancreas get to work and actually lower BGs. The only hard and fast rule is no food 2 hours before your preshot numbers. You don't want those numbers to be food-influenced. My buddy Lou eats 4 times during each cycle (PS, +3, +6, and +9). I know other kitties feed mostly in the beginning of a cycle, and some at other times. You'll figure out through trial and error what works best for Kit.
  4. I personally use the CarePoint Vet U100 syringes with half-unit markings that I get from ADWDiabetes.com. But now that I say that, I see you are in Canada (in my favorite city!!), and I don't think ADW delivers there. I feel like I've heard BD and Monoject are popular in Canada, but I'm sure some of our Canadian members will be along to give you their favorites.
  5. Gosh, I feel like an old hack, because I feel like I should have some hot tips, but I can't think of anything specifically, haha. This is a stressful process, but you've already done something super helpful by finding us and joining the board. Do NOT be afraid to ask questions, even ones you think are stupid. We love questions and we are here to help! I don't have any real tips, but just remember that this entire process can be extremely stressful. While you're bond with your sugar kitty will grow immensely, you can run yourself ragged or make yourself sick worrying or stressing. So remember to take care of you during this process and make sure you give yourself downtime to relax and decompress. You are important too!
So definitely read over the TR and SLGS protocols again (I still constantly find new things when I read) and decide which one suits your situation best. I'm also noticing that Kit is currently eating Royal Canin Renal Support E food, which actually has 21% carbs! Feeding wet food is the best, but you want to keep carbs under 10%. We have a food list HERE that you can review foods for the protein, fat, carbs and phosphorus content. Please be aware though, that switching to low carb food can lower Kit's insulin dose needs.

Whew! That's a lot of information, so I'll stop there. :cool: I'm sure others will come along and add their two cents. Again welcome to L&L Land! I look forward to getting to know you and Kit!
 
Looking at your spreadsheet, Kit has not had an abnormal BG reading since the 10th of Sept. which suggests he is well regulated and possibly very close to remission. As a rule, we do not suggest just withdrawing insulin and continue to provide pancreatic support in gradually decreasing doses. Those tiny doses are nothing short of a PIA to draw up but they can lead to a much stronger remission. The caveat is that this also requires you give insulin at lower BG levels to keep Kit's BG in lower normal range. Lantus is better at holding a low BG level than it is at lowering a high BG.

That said, your dosing as per your vet's instructions makes it hard to even suggest where his proper dose might be at this time using either TR or SLGS. If I had to guess, I'd say 0.5u max and possibly less. Lantus needs dosing consistency and with the doses missed and changing, there is no way to tell just how much of a depot Kit still has in his system. Normal readings on the AT meter are 3.9 to 8.3 mmol. IDEXX labs norms are 4.0 to 9.7mmol.

If you are considering changing to a lower carb diet and you work full time and are unable to monitor during the day, you might want to consider starting an OTJ trial when you introduce the new diet and test Kit AM and PM when you would normally but don't give him any insulin unless his BG is above normal range and if you do find it's above normal, then I would post for advice about how much insulin to give. If Kit remains in normal BG range for a period of 14 consecutive days, without insulin, then he is considered in remission. The odd reading over normal does not necessarily mean he needs insulin and that is another reason I suggest you post for help. Even if you have to start insulin again, it will give you a clean slate to determine dosing. Diet changes can have a major impact on insulin requirements so I would be very cautious about dosing given Kit's current BG readings.

As for syringes, I'm in Canada and used the BD U100, 3/10cc, 8mm, 31 gauge with half unit markings. I have yet to see any other brand available in my area of Toronto. I think there is one member who orders Monojects through his pharmacy in the Halton area.
 
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