11/13 Beau (long night?) amps/386 +8/277 pmps/329 +2/202

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alicia.1771

alicia.1771

Member Since 2011
Yesterday 11/12/11 http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=56351

Last night Beau got his 1st shot of Lantus, the numbers were horrible he actually went up (pmps 405, +2/422, +3/408, +4/450). I was scared to get his amps this morning but was glad to see he came down to the pink :)

This morning I still had trouble with air bubble in the syringe so again not sure how accurate the 1u is because it's a fat 1.0 (almost ~1.25u) with a bubble on top to make up for the space difference.

Currently using U-100 UltiCare (3/10cc - 5/16" - 31Ga), may be need to switch back to U-100 Relion (3/10cc - 1/2" - 29Ga) or look into other options. What sizes of Monojects or other brands do most people here use?

@julie & punkin - where do you buy the Terumo?

How are we doing so far? I plan to get data at +2 increments for am-cycle, than either +2/+4 or +1/+3 for pm-cycle. Any recommendations?
 
Re: 11/13 Beau (new to Lantus) amps/386 +2/361

Welcome to Lantus Land Alicia and Beau! Looks to me like you are doing a great job! No advice here, just wanted to say hello.

And wow, what great notes you keep on your ss - I'm impressed!
 
Re: 11/13 Beau (new to Lantus) amps/386 +2/361

Morning...numbers are to be expected!!

Several of us get the U100, 31g, 3/10 cc, short needle, 1/2 unit markings Monojects at American Diabetes Wholesale Monojects You can go through mrrebates.com to the ADW site and get a rebate.

Here is the Terumo at ADW BUT I do not know if they are 1/2 unit markings...you'll have to call ADW: Terumo
 
Re: 11/13 Beau (new to Lantus) amps/386 +2/361

i just called there and left a message - they're closed on the weekends. the ones i currently get are from medivet, but they don't have 1/2 unit markings (punkin has acromegaly and has a high dose) - you want 1/2 unit markings.

you should expect that beau might be high for the first few days on lantus. lantus injects in as a liquid but forms a microprecipitate after it hits the body. the precipitate then dissolves slowly over time. this is one of the plusses of lantus, but it means that when you change doses there can be a delayed response. with an increase, you're building the "shed" or deposit, so we hold the dose for 6 shots to see what it's really doing once the shed is increased. when you decrease a dose, the shed keeps on giving until it's drained and is again in sync with the size of the dose.

this is the part of the Tight Regulation Protocol that applies to you right now:

WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
It will be necessary to test kitty's blood glucose levels multiple times per day.
Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
Feed a high quality low carb canned or raw food diet.
Feed small meals throughout the day. Some kitties adapt well to free feeding.


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 consecutive 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 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive 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 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

i saw on your ss you've got the directions on what to do if you see a lower than usual preshot value. because you're experienced, i don't think the directions you've got there apply to you. that's more appropriate for newbies. instead, there are starred stickies that we bump up (to get more attention) that would be more appropriate for you. you might bookmark this condo (see "bookmark this topic" at the bottom of this page) or bookmark the individual pages. the basic information also appears in the starred stickies at the top of the lantus forum, but these pages below are nice and clear.

New Dose Wonkiness
Don't Panic! How to Handle Low Numbers
Dealing with Low Preshots
 
Re: 11/13 Beau (new to Lantus) amps/386 +2/361 +4/312 +6/312

Thanks Julie for pointing that out. I updated my SS directions to more applicable to the Lantus protocol.

So far Beau's cruising in the low 300's, which isn't too bad compared to his high flat numbers in the last 3 days. I got his +4 and +6 which were both at 312. Wonder if he dipped any lower in between?
 
Re: 11/13 Beau (new to Lantus) amps/386 +2/361 +4/312 +6/312

I actually think I might classify Beau as a newbie in terms of using lantus. There is a great difference between the two insulins. I could be totally off here.....but that's just my thought.
 
Re: 11/13 Beau (new to Lantus) amps/386 +2/361 +4/312 +6/312

It looks to me like the instructions regarding pre-shot numbers and dose are the sliding scale for PZI or other insulin where dose is based on the pre-shot numbers. Lantus dosing is based on the nadir. With Lantus, you do what you can to stick with your dose unless there is a safety issue (e.g., a very low pre-shot number). At this point, I would agree with Marje -- you don't yet have data on how Beau responds to Lantus. As you gather data, you'll be able to shoot progressively lower numbers.

In the meantime, it's going to take a few more days for Beau to have developed a depot (aka "shed"). Once that happens, you'll be able to increase the dose. It's likely that you'll need to increase since Beau was on a higher dose of your previous insulin.
 
Re: 11/13 Beau (newbie) amps/386 +2/361 +4/312 +6/312 +8/277

We got a yellow!

amps - 386
+2 - 361
+4 - 312
+6 - 312
+8 - 277

Wonder if he is going to continue to drop...
 
Re: 11/13 Beau (newbie) amps/386 +2/361 +4/312 +6/312 +8/277

Welcome to LL! Very nice cycle, especially for the second one! Any chance of getting a picture of Beau?
Liz (Zener's other bean)
 
Hi Liz! Thanks for the reminder! I had tried to post a pic of Beau when I first joined, but I could not get the pic to fit the size requirement so was unable to upload the avatar. Determined to get Beau's cute face up, I spent almost an hour tonight and finally, voila!, I've got his picture up :)

Update on PM cycle:
amps - 386
+2 - 361
+4 - 312
+6 - 312
+8 - 277
+10 - 338
PMPS - 349
+2 - 202 :shock:

Hmmm...looks like it might be a long night for me. I still had a bit of trouble with the air bubble and residual insulin inside the syringe after injection, so tonight's dose is a more like 1.25u to make up for those issues. Time to get new syringes...
 
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