11/22 mikey PMPS 242 +2/256

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Re: 11/22 mikey amps 140 +2/190

just making sure i'm on target - you've got

amps 140
+1 172 (probably more like +1.5, right?)
+2 190

okay so my math is sketchy - 2 more hours would be your +4 - is that right?
 
Re: 11/22 mikey amps 140 +2/190

SSheet - Another way you can list those +12's and up is using 'comments' in that cell. Click on the cell then menu-> Insert/Comment. You'll get a box to type whatever into. You can remove the date/time by just deleting it. When you move to another cell, that cell with the comment will have a small orange triangle in the upper right corner. KT's spreadsheet is attached in my signature - I use comments for all sorts of data.

You're doing wonderful!!!
 
Re: 11/22 mikey amps 140 +2/190

i had no idea about the comments in the cells! awesome! i've seen the little orange triangles but didn't know what they were. thanks lyresa!
 
Re: 11/22 mikey amps 140 +4.5/164

i think at this point i'd get a test every 2-3 hours for the rest of this cycle, ending with a +11 so we can see what happens between that +11 and shot time.

great job collecting all that data!
 
Re: 11/22 mikey amps 140 +4.5/164

ok. will continue testing every 2-3 hours. I am so thankful to everyone who has been helping us and so fortunate to work from home so I was able to be here with Mikey all day/night.
 
Re: 11/22 mikey amps 140 +4.5/164

Jennifer,
You are doing a terrific job.

This is a "dosing question" for my education. I've been checking in on Jennifer's threads the past couple of days, and it is helping to understand the Lantus protocol somewhat, as well as what it is like to be a "newbie" with Lantus.

Regarding dose -
Had I been the only person online this morning, I would have (like you) asked her to stall for a little bit, and wait for a rising number, then shoot. But I don't understand why the dose remained at 1.5u? I would have, apparently incorrectly, suggested a dose of 1.0u. My reasoning -
Mikey doesn't have a "standard dose" yet. Prior to his fostering with Jenn, he was given 3u per shot, but haphazardly, no set schedule, no regular testing. Obviously not the right way to dose any insulin. Jenn started with a 1.5 dose. but has had a skipped shots, and a couple of "wait and shoot" shots, and a shot that was 5 hours late a couple days ago.

This mornng was a low PS. Yesterday he was flat, but higher all day. People have said that may have been "bouncing", but from what? He's only gone blue a couple of times, and he's had some really long surfs like on the 19th. I know there are not a bunch of tests that day, but the numbers he had on the 19th show an AMPS that was pink, and then what looks to be a slow decline for almost 30 hours, then a steep climb that ended up with a mid-cycle token dose shot. After that, a spike for some reason three hours later, then a drop for another unexplained reason 7 hours later (was that the nadir from the .5 token dose?), then an up down flattish (given variance) 8 hour ride, a food spike? at +2 yesterday morning. He goes down for another 10-13 hours, and gets 1.5 into a possibly rising number last night, but no surefire proof of that - (I understand you were guaranteed a rise due to feeding at that point). Then overnight, a decline/surf to this morning, another late shot, and a blue surf since then.

Again, I don't "get" how lantus works exactly. I know the nadir is more important than the PS's when determining dose. I know the curves are pretty much supposed to be flat. I don't get why 1.5 is still the right dose I guess. Can someone educate me? I also know that testing is encouraged, and that the more data you have, the more sense things make. But what does somebody who isn't at home all day and can't stay up all night do? I know with my job and my schedules, there's no way I would ever be able to effectively treat a kitty on Lantus. It just would be impossible. How do you all do it?

Thanks, and sorry for butting in again,
Carl
 
Re: 11/22 mikey amps 140 +4.5/164

you're not butting in Carl, but i'm not sure i can answer your question. what i can say is that we change doses based upon the nadir - so we're looking for a test that shows less than 50. the lowest test on the ss is a 125 - that doesn't look like a dose that's too much.

there's also more caution because mikey had a trace of ketones yesterday - and perhaps a greater commitment to not skip a dose so that some insulin is getting in and we don't get into another ketone situation.

i'm going to also guess on 11/20 with the delay, then .5u dose, then skipped evening dose, it really throws things off. you need that consistency to see what the insulin is doing in mikey's body. i probably shouldn't have said anything about a bounce - laurie knows much more than me, was one of the people teaching me when i came on, in fact. i was trying to predict when perhaps i shouldn't have.

i'm sure someone more experienced than me will have a better answer. to me, the testing of the last couple of days is giving the information needed to make an assessment of the dose. if it's too much, testing will tell us.

edited to correct my mistake - mikey had a trace of ketones yesterday and has no history of DKA. my error.
 
Re: 11/22 mikey amps 140 +4.5/164

I don't think anyone is certain whether Mikey had an episode of DKA. However, he was showing at least trace ketones yesterday. I would be very reticent to reduce a dose of insulin in a cat that is showing some evidence of ketones.

For better or worse, we've been treating 1.5u as Mikey's dose. The basic "rule" with Lantus is that consistency is key. This means consistency with shot times and with dose. There has been some tinkering/slip ups with the dose but I think Jenn is on track. Mikey's cycle this morning is certainly an indication that good things are happening. (Although, that's the benefit of 20/20 hindsight.)

What I was seeing is that there is the high likelihood of bounces. When Mikey dropped to a blue number, like on 11/16, there was a bounce into higher numbers. With Lantus, we wait out the bounces to see how the numbers settle. Based on those blues, it looks to me like the 1.5u was a good dose -- at least for the time being.
 
Re: 11/22 mikey amps 140 +4.5/164

Hi Carl,

Lantus is a slow acting insulin. When you shoot a dose of Lantus, you aren't shooting it at the PS number, you are shooting at a number 3-4 hours down the road.
It needs consistency in timing (12/12) and in dose. Dose hoping causes wonky numbers.
That all being the case it can take some time, which varies from cat to cat, to get the shed and the dosing amount established.
Mikey flirting with ketones adds another layer of concern as not enough insuliin could spell trouble.
 
Re: 11/22 mikey amps 140 +4.5/164

so tonight I am going to do his PMPS at 12:20 and based on the BG shoot 1.5u? I have been posting the BG # prior to shooting, should I do that tonight as well? Is it necessary to get another BG between now and 12:20?
 
Re: 11/22 mikey amps 140 +4.5/164

I might get a +10 or +11. (I'd want to know whether your PMPS is a dropping number.)

A small housekeeping suggestion. Please try to keep your most recent number in your subject line (if not the numbers from the entire cycle). Since you're new, several of us have been keeping an eye on Mikey's condo. Having the recent numbers there let's us know that he's not in trouble.
 
Re: 11/22 mikey amps 140 +4.5/164

From the TR protocol:
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.


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.
Click to expand...

I recommend you get a +11, to give you clue where Mikey is going.
 
Re: 11/22 mikey amps 140 +8/158

ok. I will get a +11 and post and then see from there. I am hoping/assuming someone will be online? Again, I apologize for all my housekeeping issues and if I repeat questions. It is A LOT of information for me to take in (along with having to work and take care of 15 other cats). I have made Mikey my priority BUT I can't completely get lost in your site as I would like to or I'm going to get fired and my kitties are going to get really mad at me ;-) They are definitely attention seekers and with Mikey here I need to make sure I am giving them the attention they need as well.
 
Re: 11/22 mikey amps 140 +8/158

Jenn:

I'll be around as 12:20 your time is 10:20 mine but did you shoot at 12:20 this morning? If you did and you want to get back to 11, you could shoot at 12 tonight. Please let me know so I'll know what time to be looking for your +11 :-D

It's really, really important that you post a +11 so you give me time. I think one of the best ways for you to keep track of when you need to poke him is to set your phone alarm so you don't miss important tests. I wanted
you to post a +11 this morning but we got a +8 (I think) and then your PS ;-) ;-) However....you did awesome today and so did Mikey. YAY!!!

Carl: in reality, 140 is not that low of an AMPS. It's low for Mikey, yes. But many of us in LL shoot much lower than that. We wouldn't want Jenn shooting low without alot more data so we let her stall until he had a rise. Also, a kitty who is used to higher numbers can bounce off blue numbers....he doesn't have to be green to bounce. We are happy you are asking questions because you might know more which ones to ask and that helps Jennifer learn as well. There is a typical lantus curve, which I sent Jennifer in yesterday's condo I believe. However, that doesn't mean every cat will adhere to it....ECID. So while the goal is to have him flat, he might be sometimes and other times he might not be. A truly regulated cat on lantus should be flat.
 
Re: 11/22 mikey amps 140 +8/158

marjorie, it'll be an hour earlier here so i'll no doubt be checking in tonight too.

jennifer, we truly all understand how much there is to absorb. never worry about asking too much. i know at one point i said "sorry to be so dense, but . . .? " and i think most of us feel that way. seemed to me that until i needed that particular bit of information for punkin, i couldn't absorb it. anyway, ask away. then ask again. you'll get it. you're doing great! :YMHUG:

and 15 cats?!? :shock: and one of them diabetic? you're an angel.
 
Re: 11/22 mikey amps 140 +8/158

OK. My +11 is at 11pm my time, then I post the BG# and wait to here the next step...

I can shoot at 12midnight. I know I wanted to be at 11/11 but I just want to do what's best for him right now, as long as that is ok I would prefer to do 12midnight and get back to 11.

yes, Julie 15, ALL rescues. I actually almost brought 3 more with me from FL 2 weeks ago when I came back to NY. I was (am) a HUGE volunteer at the Florida Humane Society in Pompano Beach, FL. I have done many fosters, 911 rescues. pulls from animal control, trap and returns, adoptions, cleaning cages, administering meds. tackling ringworm, etc. but a diabetic cat, Mikey is my first. I took on the challenge when I briefly spoke to Jenn J w/ DCIN in an online cross post I came across. She informed me on how you all work together to get cats OTJ and I was fascinated. I have seen first hand how many cats get put down for the most ridiculous reasons (mostly medical) so I saw this opportunity as a way to learn and educate others once I have the knowledge. I once had a lady tell me she would rather put her cat down for peeing on her bed then leave it in a cage at our shelter for adoption. And let me just add the shelter I was at is gorgeous! Like a 9,000 sq. foot home in key west.
 
Re: 11/22 mikey amps 140 +8/158

Ok so we'll look for a number at +11 (11 pm Jenn's time, 9 pm mine, 8 pm Julie's).

That would be great, Julie. You all did super today. Me....still fighting this durn cold and worked today. I can probably be up until Mikey's +2 if Jenn shoots at 12 am. We can discuss when we get the +11.

Thanks!!
 
Re: 11/22 mikey amps 140 +8/158

Nice job today, Jennifer! You're doing great, don't worry about the housekeeping issues and asking questions over and over....it's overwhelming, we've all been there and we understand. Ask as many questions as you need to, how ever many times as necessary. It will get easier, I promise!

Moving the time back to midnight tonight, and then working back to 11 gradually sounds fine....15 minutes per shot or 30 minutes once a day.

Were you able to get a ketone test today? (Just call me the ketone test pest! :lol: )

Julie...thanks for helping Jennifer out today....and it's fine that you guessed he was bouncing, and he very well could have been! I wasn't trying to tell you not to speculate, I was just giving you my perspective, and the reasons for it. :YMHUG:
 
Re: 11/22 mikey amps 140 +8/158

I have not caught him peeing since this morning. :( I keep checking and had him by himself in the bathroom for an hour, nothing
 
Re: 11/22 mikey amps 140 +8/158

I know you've been busy, and they can be sneaky pee-ers! ;-) Just get one when you can...I'm hoping for a negative test next time!
 
Re: 11/22 mikey amps 140 +8/158

Rescue_Cat.jpg


best picture i could find - kinda backwards, but perhaps one of yours will rescue you from a shower someday! :lol:

one of my friends adopted a cat from a rescue group on Sunday and i met Frankie last night. ohmygosh - sweetest cat ever. a 6 mo old boy who was rescued with his 3 siblings and mom from living in a barn without care. all of my cats have been homeless - 3 from the humane society, one abandoned in a grocery store parking lot, one dumped in a creek that went through our campus. i'm appalled at how some people treat pets like they are disposible. it makes me furious. so kudos to you for opening your home to all these kitters.

so if you're east coast we must be close to your +11 right now.
 
Re: 11/22 mikey amps 140 +8/158

We cross posted. Good..he's coming up slowly. Looks like you can plan to shoot 1.5u at PMPSat 12 but don't feed and post before you shoot if he comes back down.
 
Re: 11/22 mikey amps 140 +11/191

Julie :lol: :lol: :lol: :lol: :lol: girl...you been having a bit of wine? It was +11, not amps :lol: :lol: :lol: love ya.

We'll both be back in an hour, Jenn. Remember....if he keeps going up, then shoot 1.5u on time. If he falls back down, don't feed (and tell DF not to feed ;-) ) and post...we'll be waiting.

So...is his +11 198 or 191?
 
Re: 11/22 mikey amps 140 +11/191

cute picture Julie!

I will test PMPS if 191 or over I can shoot 1.5u. If lower than 191, his +11, I need to post the PMPS first to get advice. DF knows now, ;-)
 
Re: 11/22 mikey amps 140 +11/191

Juile...I should have known it was a test...from the supreme teacher.

Standing by Jenn.
 
Re: 11/22 mikey AMPS 140 +11/191 PMPS 242

Jennifer:

what a day and you learned a lot!!! Super job!! you had lots of good folks on your condo today helping out. Big thanks to Julie and Laurie.

My last "waking" test of Gracie is at midnight my time which is MIkey's +2. I try to get everything done so that as soon as I test and feed at midnight, I can hit the sack for an hour or so. If you could please test
Mikey just a few minutes before his +2 (your 2am) then I'll check in right before I go to bed. Julie may still be up, too, but I just want to be sure he's getting a food spike and we let you know what to do and
when to test next.

Sound ok? Good job instructing DF :lol: :lol:

I'll be back at your +2.
 
Re: 11/22 mikey AMPS 140 +11/191 PMPS 242

I will test in 2 hours which is about (a little earlier for Marjorie )2am my time.

And yes, thanks again for all your help!
 
Re: 11/22 mikey AMPS 140 +11/191 PMPS 242

Thank you so much. I got zero sleep last night and am dragging tonight so I want to get in bed as soon as I test my baby girl.....I think I'm gonna be up and down with her tonight....think/hope she is headed for green..she's been surfing flat, lower blue the last several hours.

I'm so excited Mikey is back on track....now we just need to see a neg ketone test!!!! SUPER!!
 
Re: 11/22 mikey AMPS 140 +11/191 PMPS 242

i love a recap . . . so we've got

amps 140
+1 172
+2 190
+5 164
+8 158
+11 191
pmps 242

that's a pretty nice curve today.

i think mikey's doing great. you doing ok with getting blood for the tests and everything, jennifer?
 
Re: 11/22 mikey AMPS 140 +11/191 PMPS 242

at +2 (a few minutes early, taken at 1:48am) 256
 
Hey Jennifer...thanks so much for checking him a little early. So he has a tiny food spike going. Nice of Julie to give us that little synopsis curve.

Looks like today he had a late nadir. Not sure when you are headed for bed but I'd definitely get a bedtime test and then get one as soon as you get up in the morning.
If he's still coasting in the mid 200s, I'd get a +11 in the morning. If he's higher, you might just want to get a +10.

Remember....if he's above 200 at AMPS....just go ahead and shoot the 1.5u. You can shoot at 11:45 tomorrow morning to try and move him back on his schedule and 11:30 tomorrow night.

Does that all sound ok? You're doing awesome. And please let us know if you get a ketone test.

Sleep well.
 
looking good!

i'm headed for bed too - don't think you're going to need help tonight.

just fyi - a lot of us set cell phone alarms and sleep inbetween doing these kind of checks. i hope you're not totally exhausted! sleep well tonight!
 
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