? 11/21 Cotton AMPS 142 Reduce dose?

CB Terri

CB Terri

Member Since 2020
https://felinediabetes.com/FDMB/thr...-shot-2-5-1st-day-lantus-looking-good.238865/

Due to late shot of +1.5 hours last night I was going to shoot late today by 1.25 hrs - but his BG before I fed this morning was 142 / 7.9. I read the sticky that advises no shot.
It seems that I read that a dose should be maintained for one week but I am thinking that 2.5 is too high, perhaps it should be reduced for PM shot?? Would it be better to reduce now at the outset than to have several skips, where he only started Lantus yesterday?
It seems the Lantus is much more effective for Cotton than Canninsulun ever dreamed of being!
 
Hi, have you given some thought to which dosing method you'd like to follow? SLGS or TR? I think you are now feeding Cotton canned food - no dry?
 
We do advise new members to skip the shot if the pre-shot reading is below 150. At least till the caregiver has data on how the kitty behaves on insulin. And 2.5 is a largish starting dose. Especially after the food transition.

I will ask @tiffmaxee to weigh in on the dosing, but you may want to hold the dose till Cotton actually earns a reduction by dropping below 90.
 
Bandit's Mom said:
We do advise new members to skip the shot if the pre-shot reading is below 150. At least till the caregiver has data on how the kitty behaves on insulin. And 2.5 is a largish starting dose. Especially after the food transition.

I will ask @tiffmaxee to weigh in on the dosing, but you may want to hold the dose till Cotton actually earns a reduction by dropping below 90.
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He had been on 3.5 u with the canninsulin so we were mulling how much to reduce the dose by - but I'm thinking maybe even 2 or 1.75 - lots of tests will need to be done. Poor Cottie's ears!
 
With Lantus dose changes are based on the nadir, not the PS. When you are new to low PS numbers, it is advised to stall and ask for help. Are you able to monitor today? Can you be off schedule? Do you have plenty of supplies to test and HC food if necessary? If you are up for shooting the 2.5 units this morning I can stay with you and help you. It is entirely your decision. If you are not comfortable, you can skip.
 
The idea is to get the cat into the blues and greens so the pancreas can heal. I know it's scary, but you can manage things with food. Like I said, you can skip if you need to today. You'll get another chance to shoot a blue number.
 
carfurby said:
With Lantus dose changes are based on the nadir, not the PS. When you are new to low PS numbers, it is advised to stall and ask for help. Are you able to monitor today? Can you be off schedule? Do you have plenty of supplies to test and HC food if necessary? If you are up for shooting the 2.5 units this morning I can stay with you and help you. It is entirely your decision. If you are not comfortable, you can skip.
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He has not been anywhere near 142 since he DX and with the canninsulin. I have about 40 strips and not expecting more for another week or so that I ordered on amazon, I just got this batch and no $$ to get more.
Not feeding him is very difficult with 5 other cats - he is fed in a separate but adjoining room to keep him out of their food/eat his own without them eating his. I will do what must be done but prefer not to stall.
He was already off schedule from last night by 1.5 hours so that was part of why I thought to go with the no shot.
Plus I am *extremely* uncomfortable with giving a shot with numbers so low according to his own short history of 500s /400s /300s, and TR is not my aim at this time/associated risks of hypo.
I have no vet in my area that is trustworthy if I was unable to reverse one, though I have HG food and glocose corn syrup (karo equivalent in Canada).
So honestly I would prefer him running high-ish till he is regulated.
All this said, I SOOO appreciate your willingness to stay with me if I had decided on the shot!
I will be testing every 2 hours again today to get a view of wth is going on :confused: and will update.
 
I understand. It sounds like skipping is what you need to do today. You'll get another chance to shoot blue numbers when you are ready. He will most likely go up after a while with no insulin. So you may not need to test all day. You can save some strips if he keeps going up. You'll be able to shoot at his normal shot time tonight with the skip.
 
carfurby said:
I understand. It sounds like skipping is what you need to do today. You'll get another chance to shoot blue numbers when you are ready. He will most likely go up after a while with no insulin. So you may not need to test all day. You can save some strips if he keeps going up. You'll be able to shoot at his normal shot time tonight with the skip.
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Okay, maybe two tests then in between the AMPS and PMPS.
 
You should probably test now. I think it's been about an hour since you would have shot if you shot this morning. Then you'll be able to see if you need another test.
 
He tested at 1
carfurby said:
You should probably test now. I think it's been about an hour since you would have shot if you shot this morning. Then you'll be able to see if you need another test.
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18.9 / 340 - he did get breakfast at 8am.

And my damned spreadsheet keeps going to "View Only"!! I cleared the app cache and I am logged into my google and am the only person with full permissions. Restarting the phone worked earlier - but not this time. Arghhhh.
 
It looks like he will go up from a combination of the skipped shot and a bounce. I'd say you don't need to test again until the second half of the cycle. That will give you an idea of if he's coming back down on his own by PMPS time.
 
What exactly is a 'bounce' please? I have read the term multiple times here at FDMB but don't understand the mechanics od it. Is there a thread describing how it works?
carfurby said:
It looks like he will go up from a combination of the skipped shot and a bounce. I'd say you don't need to test again until the second half of the cycle. That will give you an idea of if he's coming back down on his own by PMPS time.
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I'm not sure if there's a thread about a bounce. A bounce is when the cats numbers go back up suddenly after dropping down. It can be from dropping into numbers the cat is not used to or dropping really fast. The cat's liver panics if it sees numbers it is not used to and releases hormones (I can't remember what it is called) to get the BG back up. That is why we work toward getting the numbers down to normal numbers. Eventually the cat's body gets used to normal numbers and doesn't panic. I hope that helps.
 
I just read your previous condo. I don’t think this is too high a dose. Normal numbers on a human meter are 50-120. You just got a really good first response to Lantus and as you can see duration will be longer than your previous insulin. When you get a number under 200 next time, stall, don’t feed, and retest in 20 minutes. The bg just might go up enough to shoot. If you feed then there’s no point in stalling because the test would be food influenced. Once you have more data the no shot number will be reduced. It’s good to get a test an hour before shot time at first to see if he’s going back up by shot time.
 
tiffmaxee said:
I just read your previous condo. I don’t think this is too high a dose. Normal numbers on a human meter are 50-120. You just got a really good first response to Lantus and as you can see duration will be longer than your previous insulin. When you get a number under 200 next time, stall, don’t feed, and retest in 20 minutes. The bg just might go up enough to shoot. If you feed then there’s no point in stalling because the test would be food influenced. Once you have more data the no shot number will be reduced. It’s good to get a test an hour before shot time at first to see if he’s going back up by shot time.
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My fear is that where after 12 hours it was so low *compared* to what he had on Canninsulun, it frightens me to think of giving him another full dose - it dropped him by over 10 points in 12 hours, and if he's at 7.9 at the END of a 12 hour cycle he can't drop 10 from that or he'd end the next 12 hour cycle at 0 wouldn't he?
Realizing that Lantus acts differently and over a longer period, there must be something I am still missing in my understanding. If they are at a normal-ish range (like say he was at a 6.5) then we would not shoot, right? Or it would mean to get to that general range and stay there, a lower dose eould be appropriate?
I apologize for all the questions, I am not doubting your experience but I need to understand why I am doing things to keep on top of them.
 
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I think if he had hit 7.9 at the nadir I eould get this, but hitting that at the end of the cycle has my mind messed up.
 
tiffmaxee said:
Have you read the yellow sticky on how Lantus works? What happens on one cycle doesn’t mean the same on the next. We are all scared at first shooting lower numbers than we are used to. If it is suggested, that person will stay with you until safe, even if that means for the entire cycle. If not possible someone else will take over.
Read this one.
https://felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/
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I have read it a couple of times but will read it again, I must be missing something important.
 
CB Terri said:
I think if he had hit 7.9 at the nadir I eould get this, but hitting that at the end of the cycle has my mind messed up.
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Here’s the problem. We have no idea when he dropped or how low because there aren’t any night tests. With Lantus the +2 is important. If it’s lower than the pretest you need more tests on that cycle. We need to determine when he hits the nadir, the low point. We don’t know if he was still coming down or hit nadir and was in the way back up. Random tests through the cycles will give us necessary data to shoot. Many cats drop at night. If we don’t have any tests between +4-8 we won’t know.
 
I just tested a 22.4 - I think that's what it was, my short-term memory since my stroke has gone to shite. I will check the meter again for the 4th time because my damned spreadsheet keeps going to View Only every time I have a number to enter.

Also reading the depot sticky I read something about 'carryover' that sounds like what may be going on.
 
Let me jump in and see if I can help with some of the confusion. Apologies if I make it worse!!

A cat that is "regulated" is a kitty that is spending most of the time in normal or close to normal numbers -- or at least below renal threshold (i.e., below about 220 on a human meter). A cat that's tightly regulated is, as Elise noted, spending time in the 50 - 120 range. So, when you say you want Cotton to be in regulated numbers, I think you're referring to a different range than how we use the term.

Whether you choose fo follow TR or SLGS, ultimately you want to want to be shooting progressively lower numbers. Everyone is apprehensive about shooting low. It can be scary. No one would expect you to shoot low numbers from day 1. Think about where your comfort level is and then as you gain confidence and know how your cat responds to Lantus, aim to shoot lower numbers in a step-by-step way. Most people make the assumption that if you were to shoot low, your cat's numbers would bottom out. That's likely true with Caninsulin. It's not typically the case with Lantus. Because Lantus is a depot insulin and isn't as potent at Caninsulin or Novolin, we rarely see numbers that we can't steer with food if you shoot low. I would shoot any number over 50. I'm sure that sounds terrifying to you! What may help is to understand that the ideal Lantus cycle is flat. Take a look at Max's spreadsheet. Elise would routinely shoot low numbers and what you see are very pretty flat cycles. The basic mantra with Lantus is "shoot low to stay low." If you look at the sticky on shooting and handling low numbers, while it primarily applies to TR, there's also a section on being data ready. You want to be able to know when onset and nadir fall in order to tackle shooting lower numbers. Cotton hasn't been on Lantus long enough for you to have accumulated that knowledge.

I also agree with Elise that having more PM cycle tests would help you to get a better handle on how Cotton is responding to Lantus. It's not uncommon for a cat that's switched insulin to have a marked initial response. That's likely where that blue number came from. It's going to take 5 - 7 days for the Lantus depot to form and stabilize. That doesn't mean you get a pass, though. Many cats like to spend time in lower numbers at night. Getting a before bed test every night will help you go to sleep knowing that your cat is in safe numbers. In addition, if you don't test at night, you may miss a dose reduction and, just as importantly, you're missing half of your data. (If it's not obvious, we're pretty numbers obsessed.)
 
Sienne and Gabby (GA) said:
Let me jump in and see if I can help with some of the confusion. Apologies if I make it worse!!

A cat that is "regulated" is a kitty that is spending most of the time in normal or close to normal numbers -- or at least below renal threshold (i.e., below about 220 on a human meter). A cat that's tightly regulated is, as Elise noted, spending time in the 50 - 120 range. So, when you say you want Cotton to be in regulated numbers, I think you're referring to a different range than how we use the term.

Whether you choose fo follow TR or SLGS, ultimately you want to want to be shooting progressively lower numbers. Everyone is apprehensive about shooting low. It can be scary. No one would expect you to shoot low numbers from day 1. Think about where your comfort level is and then as you gain confidence and know how your cat responds to Lantus, aim to shoot lower numbers in a step-by-step way. Most people make the assumption that if you were to shoot low, your cat's numbers would bottom out. That's likely true with Caninsulin. It's not typically the case with Lantus. Because Lantus is a depot insulin and isn't as potent at Caninsulin or Novolin, we rarely see numbers that we can't steer with food if you shoot low. I would shoot any number over 50. I'm sure that sounds terrifying to you! What may help is to understand that the ideal Lantus cycle is flat. Take a look at Max's spreadsheet. Elise would routinely shoot low numbers and what you see are very pretty flat cycles. The basic mantra with Lantus is "shoot low to stay low." If you look at the sticky on shooting and handling low numbers, while it primarily applies to TR, there's also a section on being data ready. You want to be able to know when onset and nadir fall in order to tackle shooting lower numbers. Cotton hasn't been on Lantus long enough for you to have accumulated that knowledge.

I also agree with Elise that having more PM cycle tests would help you to get a better handle on how Cotton is responding to Lantus. It's not uncommon for a cat that's switched insulin to have a marked initial response. That's likely where that blue number came from. It's going to take 5 - 7 days for the Lantus depot to form and stabilize. That doesn't mean you get a pass, though. Many cats like to spend time in lower numbers at night. Getting a before bed test every night will help you go to sleep knowing that your cat is in safe numbers. In addition, if you don't test at night, you may miss a dose reduction and, just as importantly, you're missing half of your data. (If it's not obvious, we're pretty numbers obsessed.)
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Hello Sienne and Gabby :)
The reason that I shot late last night was that his numbers kept going down and yes it IS scary - I was scared to give him insulin until I knew they had stopped dropping. I have only been at this for three weeks total, and today is only my second day shooting Lantus.

I know folks understand that dear lives are in our hands - for me it is very difficult to speak to people that I am only just meeting online, and do things because I'm told to, without any chance to build experience and trust. Documents are one thing, but as I've read, ECID.
**Yet** I can see by looking through the members' spreadsheets, experiences posted and Forum stickies, that I have clearly come to the ~ best ~ resource I could ever hope to find. :joyful: My vet is no help with my cats, diagnosing one that didn't have diabetes with diabetes (and prescribing her 2 units teice a day of canninsulin with no mention of getting a meter or testing till I suggested it), and not diagnosing the other that DID have diabetes - I discovered Cotton was by testing him because he was drinking a lot and constantly hungry.
I also lost another cat with this vet 13 years ago so trust is thin with me. Had I not had some sense I would have two of my 6 feline furkids dead now instead of one with hope for a good life and the other returned to full health after a yet undiagnosed week of not eating and constant oral syringe injections of liquid food and electrolytes.
I will do bedtime tests each night in addition to random ones till he settles and there is more data. My funds are limited on test strips but I have about 35 left right now and more on order and shipped.
 
If there were a way for you to go over the border and get a Relion meter and strips, they would be less expensive. While Canadians get a break on the cost of insulin, you don't have some of the options we do in the US for strips. I would find deals on Amazon and Ebay (I used a Bayer Contour meter since there wasn't a Walmart anywhere near where I lived.)

Many vets do not get well schooled on feline diabetes. Usually their unit on diabetes covers all species and if their practice isn't busy with cats, they are not especially knowledgeable. FWIW, we've had vets on the board who didn't know how to use Lantus and came here to learn how to manage their diabetic cat.
 
I totally understand your hesitation in trusting total strangers. I felt the same way at first but also had a vet that I trusted. Stick around and you will soon see it’s safe to do so. I also encourage you to try and follow SLGS as written until you feel comfortable.
 
I forgot to mention that I ended up listening to people here and my vet handled everything else. I did send him the spreadsheet every few weeks.
 
If I had listened to my vets, my cat would be dead right now on 2U. They thought I was the crazy cat lady control freak but I am glad I did not listen to them and tested Djoko more often than they recommended it. Take your time and you will see. No rush.
 
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