11/09 Frank AMPS >600, +2 376

Status
Not open for further replies.
Tina and Boozle

Tina and Boozle

Member Since 2013
Hello All!
Mr. Frank N. Stein switched from 10u Novolin N once daily to 1u Lantus BID today. His numbers are still not ideal, but they are consistent and so far tonight, the numbers are lower. It seems like, when his numbers are between 400 and some range over 600, that he feels good. Tonight he appears to feel as though he does not feel well. He acts like he is tired but he can't get comfortable. He is laying here, tossing and turning and moving from place to place. He usually fights us during bg sessions, but he is just kind of laying there and taking it. He was at 550 PPMS and at +3 360. He has been consistently high in the PM all week, while he was on the 10u of Novolin once a day. I'm curious, is it normal, even though his sugar levels are way lower tonight, for him to still feel like crap? He acts like he is hungry, but he ate two cans of friskies patte before his shot and we were told to try to keep food around the time of his shot.
 
welcome to Lantus Land!

I need to go back and read your previous threads to get caught up. My first question is have you checked for ketones today? That's important when you are decreasing the insulin dose, especially if he isn't feeling well.
 
Hello Tina and welcome to Lantus Land. I'm glad you were able to get switched over to Lantus. It's a depot type of insulin, so will take several days before you'll see the full effect of this dose. Make sure you read the sticky notes at the top of this forum. There is a lot to read and it can be overwhelming at first, but you'll get it. Feel free to keep asking questions. We've all been in your shoes and love to help.

For others who are reading, here are the links to some previous posts on Health:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=107363
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=107852
We include links to our previous posts, so people can catch up on what has been happening to our cats.

We've noticed that cats who have been in higher numbers for a while will not feel comfortable when they get into lower or more normal numbers. The longer Frank spends in good numbers, the more it'll feel normal for him. It's best to feed kitty several smaller meals, it's easier on the pancreas. So feeding at shot time is great, but you can also break food into smaller meals spread throughout the first half of the cycle. Some cats here are naturally grazers (mine is not) so that works too. Just make sure he doesn't have access to food for 2 hours before shot time as that can impact the preshot number.

Frank would have been high during the week with just one dose of Novolin a day as it's a shorter acting insulin and would have worn off by the PM. My Neko was originally on Caninsulin BID but it didn't last as long either and she was ravenous before dinner/shot time. Cats tend to be hungrier when their numbers are high.
 
wow tina, you've been on quite the roller-coaster for the last little while. i'm very glad the people on Main Health gave you good info to help you get to the Lantus and off of the dry food.

is he still having any dry food? last thing i saw you said he was getting a little bit of the dry Whiskas. We've had people document that a few kibbles, literally 4-5 crunchies, would raise their cat's BGs right through the following day. Frank was probably coping with that 10u dose because he had so many carbs in his food. which was a good thing if he was getting a high dose, but thankfully you've now learned to test so he doesn't need to stay sky high to stay safe.

it is a steep learning curve, but a couple of weeks into this you will have learned a ton about how Lantus works and how Frank works with it, and it won't seem so daunting. by the time you get it down, it becomes very routine. it will be the same for you.

i didn't see any mention of giving Frank treats after you test him on your previous posts (but there were a LOT of posts so i might have missed something!) we boiled chicken breasts, diced it small, like 1/2" cubes, froze most of it, kept 1/4 cup or so in the fridge and doled it out as treats after BG tests. that treat makes all the difference in how cats accept the testing. soothes their wounded dignity, you know! ;-)

i also didn't see if people suggested that now you have switched to Lantus, you want to test his BGs, then feed and shoot, all within a few minutes. with the Novolin i know you were feeding a little while before he got his shot, but it changes with Lantus. It works differently. Many of us test, fix the food and draw up the insulin into the syringe, then put the bowl down and while their face is buried in the dish, give the shot.

and because Lantus IS expensive, you want it to last as long as possible. There's good information & a video on the Lantus/Lev Info Proper Handling & Storage on how to take care of it.

The yellow starred stickies on the top of this Lantus forum have the best info out there, i think. When you have time, take a peek and see what brings on questions.

and ask away. we all have been in your shoes and we get it. we'll do our best to teach you what you need to know to take care of frank safely and make him as healthy as possible.
 
good morning Tina,

How is Frank feeling today? I'm hoping you have had a chance to get a ketone test. I see that his numbers came down a bit overnight. :smile:
 
Welcome to Lantus Land!

It was wonderful that you brought Frank into your home and gave him a fighting chance! As overwhelming as the first few weeks of learning how to manage your kitty's diabetes can be, once you have the basics down, it becomes pretty routine and it creates an incredible bond between you and your cat. Frank was very lucky to have found you!!

Chances are that Frank was diabetic for quite some time before you found him. As a result, his body has become used to being in high numbers. In essence, the higher range has become his new "normal." When his BG levels are lower, it feels weird to him. However, the more time he does spend in those lower numbers, the more his body will readjust to being in a better range.

Lantus is a very different type of insulin than Novolin. I want to second the suggestion that you read over the starred, sticky notes at the top of the Board. They will help you to better understand how Lantus works and how to approach dosing.

Could you also put a note on your spreadsheet indicating when you switched from Novolin to Lantus? Like Wendy noted, it takes 5 - 7 days for the Lantus depot to form so it's helpful to know when you made the switch.

In one of your posts on Health, you mentioned that Frank's remaining teeth are a mess. Is there a plan in place regarding when the vet wants to do the extractions? There's a good chance that his dental situation is contributing to the high numbers although the antibiotics are probably helping. (What antibiotics are you giving him?)

Please let us know if you have questions. The people here are very generous with their time and knowledge and are very willing to help in whatever way we can.
 
Hi Tina :-D Good to see you made it over! Like Wendy and Sienne mentioned, Frank being in high numbers so long will make him feel 'weird' to be in the lower numbers. My guy always looked way perkier and was more playful in the high numbers and when they started to come down he acted tired and just 'off'. He is slowly coming around now though and his energy levels while he is in the lower bg's is much better. It takes some time for them to adjust, but they do, and it feels incredible to see the changes. I believe I mentioned before, but I also started him on Caninsulin and it is way different than using the Lantus. The stickies are great (I swear I still have to read through them everyday), and when anything seems 'muddy' just post your questions. Reading your posts is almost exactly like reading mine when I first got here, and Frank acts and sounds very similar to Twice. :lol: :-D
You are doing an amazing job Tina! Welcome to Lantus Land (LL) :-D
 
Thank you for all of the welcomes and information. Frank took an upward spike in bg this morning. He is doing okay, but of course, we could be looking better. I'll see if I can answer some of your questions:

Food - We were told not to change food and insulin at the same time. The goal is to go to wet food after we see what the insulin is doing for him. Right now, he gets 1/8 cup dry, high protein Whiskas, only in the morning. This may explain why he is over 500 this am. By this time next week, he should be starting his all canned diet. We are feeding him the canned Friskies Patte.

Ketones - He has been running astronomically high with no ketones present. I assumed, possibly incorrectly, that even lower numbers would reduce the chances that he would have ketone spillage, so I have not tested him. I have been wanting to test him since he had the >500 bg this morning, but I have not seen him pee yet.

Spreadsheet - I listed in the remarks for yesterday that we had changed his insulin.

Antibiotics - He finished a round of Clavamox recently. They gave him a shot at the vet at about 6:00pm Friday afternoon. I did not ask what it was. I just know it is a long acting antibiotic.

Teeth - We talked about his teeth Friday. We have not decided when, but we have decided that while he is in no condition now, it will be best for him to have them removed.

Other issues - Frank is also in tact and has FIV. He was in such bad shape, they recommended putting him down. I'm not that girl. As long as an animal is not suffering, or if there is a chance that we can get past the suffering to see a quality life, I have to see where things go. So, the plan is #1 Get him regulated and stable enough to have these major things done, #2 have the teeth removed, #3 remove his furry gems, and go from there. Alternatively, if his quality of life does not appear to be improving... well, you know... but we will cross that bridge when we get to it.
 
Oh, and
Treats - We give him a little taste, maybe a quarter teaspoon of his normal food. He would probably enjoy some diced chicken. That is a good idea.

Test/Feed/Shoot - We have been testing at 6am, feeding him and allowing him to almost finish. He has three teeth so it takes him a while. We give him his insulin at 6:30 while he licks his plate.

Stickies - I am working my way through them. There is a lot there! It is a great compilation of information, however. I've referred back to the things I have read a few times in the past 24 hours.

I think I answered all of your questions. If I missed anything, feel free to let me know.

Thank you again for all of the useful information.
 
That's great news regarding ketones! While lower numbers may lower the risk, the basic "recipe" for ketones is infection or inflammation (e.g., Frank's teeth) + not eating (doesn't sound like that's an issue) + not enough insulin. I'd suggest doing what you've been doing -- testing for ketones as often as you can.

While clavamox does have a longer acting, injectible form, I'd bet your vet gave Frank a shot of Convenia. It's not an antibiotic (AB) that many vets recommend. There are two reasons. It's pharmacological indication is for skin infections and because it's a long-acting injection, vets like to use it with cats because the caregivers don't have to pill the cat. Second, and this is the main issue, if you cat is allergic or has a reaction to Convenia, once it's in, you can't get it out. It lasts for well over 2 weeks.

One of the differences between Novolin and Lantus is when insulin onset falls. With Novolin, it's typically recommended that you have food on board before giving a shot. The onset is very quick. With Lantus, for most cats, onset is at around 2 hours. You have more time. Many of us test and once our kitty has started eating, give the shot. In fact, I shoot while Gabby's face is in her food. She doesn't even bother to stop eating (but, she's pretty food motivated).

Diced chicken is good as a treat. Lots of us use freeze dried chicken. It crumbles pretty easily which may make it easy for Frank to eat.

You might want to ask the vet about the possibility of taking care of Frank's teeth and neutering at the same time. That way, he'll have to be under anesthesia only once and it would be one less trip the the vet.
 
hi tina! hope you're having a good Sunday!

thanks for answering all the questions. i'm glad you got a negative ketone test this morning. ketones are serious, so it would be good for you to test him daily right now while he's in this transition phase.

regarding the food: i saw that people had told you earlier to slowly transition to canned low carb food, both to prevent stomach upset and so that the insulin dose wasn't suddenly too much after all the carbs were removed. that advice was good, but now the situation has changed.

now that you have dropped to 1u of Lantus, it's really important that the high carb dry food goes away. we need to get him out of those high numbers, and because of the way Lantus works (as a depot insulin) we can't just give him more insulin at the moment. can you finish making the transition today? just stop all the dry food? we really want to get rid of the dry so we can get him into lower numbers. it's a bit like a human diabetic trying to get regulated while insisting on eating candy and cake all day long.

a non-diabetic cat will test somewhere around 40ish, so you can imagine this 600ish doesn't feel good to him. although we can't guarantee this will immediately get rid of high numbers, removing the dry food is one thing you can control that will help infinitely. it might take a day or so to work the carbs out of his body, but then things should be improving.
 
mmm Tina - on Frank's ss it says that this afternoon he had a trace of ketones - is that correct? if so, it needs our attention. increasing water is one thing that will help - can you add water to his food, as much as he'll tolerate while still eating the food?

also about the food - if he's getting 2 cans of friskie's pate with his shot, you can spread it out a little bit so he's not starving in between. say 1.5 cans of food with his shot and the other 1/2 can at +2 or +3.

how much does he weigh? the 1u of lantus might not be enough. we usually start cats with a weight-based formula and take into account how much they were getting of any previous insulin.
 
I planned on taking him off the dry this morning, but since I was told to withhold insulin if he was <300, and I didn't want to skip insulin at a 285, I decided to give him his insulin anyway and leave the dry. That didn't work out so hot today so, since I am home to monitor tomorrow, I am going to take the dry out and watch him.

The doc told us to add water to his food and we keep forgetting. I added about 1/2 a cup to his meal tonight. When he came to me, he was severely dehydrated and we fed him blended/watered down food for two days prior to taking him to the vet. We probably should have taken him to the vet that day, but my guess was he was just starving (which was technically true) and if we could get food/water in him, he would be fine. Anyway, he doesn't care if we water it down. I probably could have added more, but I didn't want to push it.

Last time I weighed, he was 7.6 lbs.

Tuesday, I will be gone all day. I have school on Tuesdays and Thursdays all day. I have someone who can look in on him and call me if there is a problem, but I am going to be at least 45 minutes away, this Tuesday. I'll probably be taking his bg in the morning, but if you don't see any updates until after 4:00pm, that's why.
 
the line for new people using Lantus, and posting here, is to not shoot under 150, although once you are hometesting, have learned how your cat responds to insulin and if you are home to monitor, we decrease that number. we try to get to that point as quickly as is safe, for the benefit of the cat. experienced people who know their cat might shoot in the 50's and 60's. you aren't ready to do that yet, however, so 150 is a good cut-off line for you.

from the Lantus & Lev: Shooting & Handing Low Numbers yellow starred sticky - it is found at the top of the this forum.

Our motto in the Tight Regulation Insulin Support Group is "Shoot Low to Stay Low". We follow a Tight Regulation Protocol with Lantus or Levemir not a "Start Low - Go Slow" (SLGS) method because research has shown "significantly higher remission rates are observed if good glycaemic control was achieved soon after diagnosis: 84% for cats started on the protocol within 6 months of diagnosis went into remission, and only 35% for cats that began more than 6 months after diagnosis". Not all kitties will reach remission. However, a tight regulation protocol can help towards controlling kitty's diabetes.

When following the Tight Regulation Protocol, you'll want to become data ready, learn to safely shoot preshot numbers between 50mg/dL - 150mg/dL, and how to manage curves with low numbers. Scroll down to learn how to "Shoot Low to Stay Low" safely by "BECOMING DATA READY", learning "HOW TO DEAL WITH LOW PRESHOT NUMBERS", and "HOW TO HANDLE LOW NUMBERS". Ask any questions you may have in your daily thread. The first few times kitty presents you with low numbers can be scary for most caregivers. Please post for guidance and support.
Click to expand...

cats have the unique ability to have their pancreas heal and for them to become diet-controlled diabetics (ie, they don't need insulin.) Our goal with Tight Reg is to get cats' blood glucose back into normal range (less than 120) and hold it there so that the pancreas can heal. the protocol we follow is designed to safely do that. a newly diagnosed kitty has the best chance of remission, although we've seen cats go off even after 2 years.

i'm glad you're removing the dry. we can figure out a good way to handle Tuesday on Monday evening! it's hard to plan ahead on some of this, although food is our main tactic against low numbers. some people use a timed feeder (we used the PetSafe 5 Compartment from Petco), some people mix cat food with water and freeze in ice cube trays, then as they thaw out kitty can eat them. would either of those things work for you? are you gone every tuesday and thursday like that?

You'll find that people here can answer questions fairly quickly, most of the time. so if you are faced with a number and are uncertain what to do, you can post here and add a ? icon to your post title or put "advice needed" in the subject line - anything like that to catch people's attention.

btw, tomorrow would you start a new post (we call them condos, for kitty condos)? we do one new post per day, then keep editing the subject line of the first post to keep it updated. the format we use allows us to scan and see if anyone needs help right away. we also add a link to the previous day's post so that a person helping you can go back and read to see what happened, or any advice given, the day before.

keep testing for ketones. if there's any more than a trace you'll want vet help.

according to the weight-based formula, this is probably a good starting dose for him. it takes about 5 days for the insulin depot to form (it actually builds up in the body). the fact that he was down to 285 this morning is really good.

You're doing great - there is a ton to learn. hang in there and it gets infinitely easier!!
 
Between now and Tuesday, leaving out the frozen cubes is probably my only option. He is extremely, as you said earlier, food motivated. You don't think he will try to eat the frozen cubes and hurt his teeth, do you?

I leave the house at about 8:30 Tuesday and Thursday mornings and I don't get home until 3:30-3:45 in the afternoon. I am generally about ten minutes away, but tomorrow we have a field trip in Charlotte, which is 45 minutes away. I didn't go to work today so I could monitor him, but I am generally working every other Sunday during the semester and I am gone from about 11pm until, most times 7 or 8pm. We have one more field trip this semester where I will be more than ten minutes away from home. Other than that, I am generally home doing homework, so I can keep an eye on him.

I'm wondering now about his level of activity. We have other cats in house and he is a stray with FIV. We foster for the humane society so we have large kitty kennels in one room. We keep a large cage in the living room where we spend most of our time. He is allowed out for a while a few times a day, but while he is acclimating to the environment, he stays between the large enclosure in the evenings and the large cage while we are awake. I don't think where he is makes much of a difference though because he isn't extremely active when he is out. I'm wondering if his level of activity plays any part in this.
 
Hi Tina!!

On the food, cats usually won't eat what they can't smell, and when it's frozen, it doesn't have much of a smell. As it thaws, the smell increases, so generally, they won't eat it when it's frozen.

ECID though, but I'd think if he did try to eat it and it hurt, he'd stop
 
thank you for doing another ketone test tonight. i'm glad it was negative.

are you able to cut out the dry food now?

i think i'd go with the catsickles (frozen cat food) then. i would think, depending on how hungry he is, he wouldn't hurt himself to eat it.

what time are you giving shots? i'm thinking if you have to leave at 8:30am, if he's getting his shots by 6:30 you could get a +2 before leaving. the +2 can act as an indicator as to what is coming in that cycle.

also, do you have high carb canned cat food? the gravy kind is what you need to keep on hand in case he gets low numbers, or if you need to leave some out.

i think if i were you, tomorrow i'd make cubes of both the gravy HC canned cat food and the regular pate low carb canned cat food. then you'll be ready if you need to leave them out when you go on tuesday morning.
 
btw, you don't have to test every hour when he's high. only if it looks like he's going into low numbers (headed under 50). you'll go broke trying to pay for the strips! i suspect you could wait for your next test until preshot in the morning, then maybe every 3 hrs or so.

thanks for fostering kitties! and thanks for your big heart with Frank. it's great that you're willing to take him in and take care of him. :YMHUG:
 
He gets his shots at 6:30 every morning already, so that is definitely doable. I have HC food in the pantry and kayro by his enclosure. We haven't been close to needing it, thankfully. I am only testing as frequently as I am because I want a good set of data to present to the vet, since his insulin has changed. With the exception of the one time I gave him the rouge shot last week, we are used to him reading HI (>600 on our meter) in the evenings so despite the high numbers, at least he is below that threshold. First experience trying to give him insulin by myself this morning. Wish me luck. :lol: We did good with a plate in front of him last night so... I am thinking it'll work out just fine. He is starting to fight less at bg time, unless he is exceptionally hungry, and he is barely noticing the shots.
 
Hi and Welcome Tina and Frank.

Good luck giving the dose ;-)

You can start a new condo (thread) for today, with the new AMPS number.
 
Status
Not open for further replies.
Back
Top