11/7 Emmett AMPS 122 - what do I do?

Since it’s only day 2 of Lantus and his depot hasn’t built fully yet and he’s already seeing blue, I would cut his dose back to 2 units and go ahead and shoot as long as you are around to monitor/intervene. I’ve known you long enough to know you take great care of him. Are you home today?
 
Suzanne & Darcy said:
Since it’s only day 2 of Lantus and his depot hasn’t built fully yet and he’s already seeing blue, I would cut his dose back to 2 units and go ahead and shoot as long as you are around to monitor/intervene. I’ve known you long enough to know you take great care of him. Are you home today?
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Done. Thank you, Suzanne!

Yes, I’m home today. I’ll get a few more tests in today than I usually do to see how it goes.
 
And 2 units would be his new dose going forward for a little while as the depot builds further and unless it becomes apparent that he needs even less insulin based on numbers. We can increase in a few days if it seems too low, but he’s responding to the switch already!
 
Suzanne & Darcy said:
And 2 units would be his new dose going forward for a little while as the depot builds further and unless it becomes apparent that he needs even less insulin based on numbers. We can increase in a few days if it seems too low, but he’s responding to the switch already!
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Okay, sounds good. Thank you!!
 
113 @ +1

Side note: I called Emmett’s insurance and found out they will cover his medical supplies from any pharmacy, even without a script, as long as it’s a condition they already have covered (which it is). Which means I might switch back to the Freestyle Lite, provided Emmett can consistently stay under that meter’s upper limit (27 mmol). (Lately Emmett’s BG has frequently gone above that limit anyway, so maybe it was best I stuck with the AT3, which has an upper limit of 42/700).
 
Did you feed a little (tsp or two) of his regular LC food after that +1? Can you get another test at +2?
just confirming that these readings are on an AT3?
 
Angela & Cleo said:
Did you feed a little (tsp or two) of his regular LC food after that +1? Can you get another test at +2?
just confirming that these readings are on an AT3?
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I did not, but he got a couple treats (Stella and chewys freeze dried pellets). I absolutely will get another test at +2, which is also when I typically feed him again.

Correct, all readings are on an AT3. I currently do not have any test strips for a human meter.
 
KLD said:
113 @ +1

Side note: I called Emmett’s insurance and found out they will cover his medical supplies from any pharmacy, even without a script, as long as it’s a condition they already have covered (which it is). Which means I might switch back to the Freestyle Lite, provided Emmett can consistently stay under that meter’s upper limit (27 mmol). (Lately Emmett’s BG has frequently gone above that limit anyway, so maybe it was best I stuck with the AT3, which has an upper limit of 42/700).
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That’s great about the Freestyle test strips. I know you said they were really expensive without the insurance.
 
Suzanne & Darcy said:
That’s great about the Freestyle test strips. I know you said they were really expensive without the insurance.
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Yup, $70 for 100 for the freestyle lite or about $200 for 100 for the alpha trak (all of these prices would be before insurance pays their share). So it would be a pretty significant savings if I can switch back to the human meter.
 
166 @ +4

interesting interesting. I’ll test him again at +6, but are there any other times that would be good to test him today?
 
He is still doing really well. I would do the +6 if you want to, but then just take a break until later. If you get a +10 you can avoid any surprises at PMPS (not that I am expecting any necessarily.)

He has had a strong (but very much desired) initial reaction to the Lantus. That’s why I wanted you to cut his dose back a little - to make sure he would be safe. Every cat is different, but he went right to work with it. After a week, you can increase if the numbers warrant.
 
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Have you tested for ketones lately? As I recall he hasn’t had a problem with ketones before (even in the higher numbers.)
 
Suzanne & Darcy said:
He is still doing really well. I would do the +6 if you want to, but then just take a break until later. If you get a +10 you can avoid any surprises at PMPS (not that I am expecting any necessarily.)

He has had a strong (but very much desired) initial reaction to the Lantus. That’s why I wanted you to cut his dose back a little - to make sure he would be safe. Every cat is different, but he went right to work with it. After a week, you can increase if the numbers warrant.
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Okay sounds good. I appreciate all your help with Emmett
 
Suzanne & Darcy said:
Have you tested for ketones lately? As I recall he hasn’t had a problem with ketones before (even in the higher numbers.)
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It’s been a few days. Not sure if I put his last test in his spreadsheet or not. But yeah the only time he was positive was when the vet tested him when he was first diagnosed. He’s always been negative when I’ve tested him. I’m trying to get another test since I haven’t tested him since switching to Lantus, but I keep missing him in the litter box lol
 
274 @ +6

Ah well, he had a good morning at least.

Am I still giving him 2 units this evening?
 
If you haven't already, take a read through this Sticky Note:
Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers
I wouldn't have suggested dropping all the way down to 2.0 units. A temporary reduced dose is one of the ways to handle lower numbers as per the Sticky Note. It gives you a chance to gather data.

Shooting lower numbers is what you eventually want to do all the time. With Lantus, that typically means nice and flat. I loved shooting Neko in the 80's, cause she wouldn't move more than 10 points the entire time.

Regarding the Freestyle Lite - go for it! You don't really care if Emmett is above 27 and just reading "Hi", that still means his numbers are "too high". Save the money for more kitty treats. Have you ever checked eBay for test strips? Some good savings to be had.
 
I have a few reasons for what I said. First, K is not a newbie and can handle low numbers. Next, some cats have an initial stronger reaction to a change in insulin but then that reaction fizzles out. Not sure that is what we are seeing though. Next, it was just blues, not greens Emmett saw. Though it could be argued they might have been on the Freestyle. And lastly, the method of going to a similar Lantus dose from Prozinc has seen lots of successful experiments. Going down to 2.5 might be OK, but 2.0 seems like a big drop.

One thing that's hard to tell with the back half of the AM cycle is whether this is a bounce from such a long stretch in blues (almost 12 hours :cool:), or just a sign of too little insulin this cycle. Or both.
 
This is all very good information, thank you to you all. Emmett is so unpredictable that I think what to do with lower numbers is not always easy. At least with prozinc, there are times I drop the dose significantly and it was still too much, and times it was too little. Hopefully after this first week we’ll be able to get a better sense.

All in all though, I think Lantus is going to do a much better job at giving him a flatter curve.
 
Agree. And she always does a good job handling his numbers.
Wendy&Neko said:
One thing that's hard to tell with the back half of the AM cycle is whether this is a bounce from such a long stretch in blues (almost 12 hours :cool:), or just a sign of too little insulin this cycle. Or both.
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I was speculating on this as well.
 
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Wendy&Neko said:

Regarding the Freestyle Lite - go for it! You don't really care if Emmett is above 27 and just reading "Hi", that still means his numbers are "too high". Save the money for more kitty treats. Have you ever checked eBay for test strips? Some good savings to be had.
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just in terms of this second half, honestly, he has insurance so at the end of the day his medical costs aren’t really breaking the bank lol. But I far preferred how quick the freestyle lite is, and you’re right, high is high. On the other hand, his vet doesn’t like when I use the human meter.
 
KLD said:
On the other hand, his vet doesn’t like when I use the human meter.
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My Vet had the same position at first. But he also felt that testing often wasn't necessary either. So we came to a compromise that when he wanted a curve I would do it on the AT2 and that I would double check the human meter "lows" with the AT2 meter. The rest of the time he had no issues with what meter I used or how often I tested.
FWIW, he no longer opines on dosing or meter choice since he said I have a "remarkable" handle on FD. I give the credit to FDMB and now he refers newly diagnosed patients to this board. :kiss:
 
Angela & Cleo said:
My Vet had the same position at first. But he also felt that testing often wasn't necessary either. So we came to a compromise that when he wanted a curve I would do it on the AT2 and that I would double check the human meter "lows" with the AT2 meter. The rest of the time he had no issues with what meter I used or how often I tested.
FWIW, he no longer opines on dosing or meter choice since he said I have a "remarkable" handle on FD. I give the credit to FDMB and now he refers newly diagnosed patients to this board. :kiss:
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Yeah my vet likes that I test a lot because she trusts I have a good handle on managing him, but I had to reassure her the human meter was fine back when I briefly used it. I don’t necessarily agree with his vet on everything—when I told her I was ready to switch his insulin because he was constantly in the 20’s (mmol/L), she told me that was normal. Hard disagree on that one lol. I think it would be insane to tell a human diabetic frequent 20s are normal, so I don’t think it’s normal for a cat either.

(that being said, she was all for me switching to Lantus because it’s her preferred insulin, and Emmett was originally diagnosed by a different vet at the same clinic).
 
KLD said:
On the other hand, his vet doesn’t like when I use the human meter.
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Back in the day when I started, no one used the AT. Not even the vets. Then the company making the AT's started marketing heavily to vets. My vet used to use the Onetouch - we used to compare notes on best/cheapest places to buy test strips. When she got her first AT in, she said to me "I don't suppose you want to switch?". Got it in one!
 
Wendy&Neko said:
Back in the day when I started, no one used the AT. Not even the vets. Then the company making the AT's started marketing heavily to vets. My vet used to use the Onetouch - we used to compare notes on best/cheapest places to buy test strips. When she got her first AT in, she said to me "I don't suppose you want to switch?". Got it in one!
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My vet says the only human meter she trusts is the Aviva, which happens to be the one a family member of mine uses. I’ve compared it to my freestyle lite and saw no real difference.
 
Suzanne & Darcy said:
I see that PMPS. I hope it’s not one of Emmett’s famous bounces. :confused:
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I got some conflicting advice on doses and panicked and went back up lol. Hoping that wasn’t the wrong choice, but he’s back in the red anyway so hopefully not. I do wonder if it’s a bounce, all things considered. Its Emmett so we’re not allowed to have nice things haha
 
KLD said:
I got some conflicting advice on doses and panicked and went back up lol. Hoping that wasn’t the wrong choice, but he’s back in the red anyway so hopefully not. I do wonder if it’s a bounce, all things considered. Its Emmett so we’re not allowed to have nice things haha
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It’s all good!
 
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Suzanne & Darcy said:
Emmett is doing well. He’s still a bouncer, but he’s not staying up too long. I am happy to see how well he’s doing.
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Yeah, the bounces are still annoying, but at least they are not as extreme, and I can see the preshot numbers generally trending lower than they used to be. I’m still not sure if 2.75 is the right dose for him (what with the bouncing and varying preshot numbers) but I guess time will tell with that one.
 
KLD said:
Yeah, the bounces are still annoying, but at least they are not as extreme, and I can see the preshot numbers generally trending lower than they used to be. I’m still not sure if 2.75 is the right dose for him (what with the bouncing and varying preshot numbers) but I guess time will tell with that one.
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Yep. He needs more time. On November 13 it will have been 7 days on 2.75 and you will see if he needs an increase- based on nadirs. I think his preshot numbers will continue to come down over time.
 
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FYI, not all cats on Lantus nadir at +6. If you can mix up that mid cycle test a bit on days you can, that would help. Cycle where they are breaking a bounce, like yesterday, the nadir can be later.
 
Wendy&Neko said:
FYI, not all cats on Lantus nadir at +6. If you can mix up that mid cycle test a bit on days you can, that would help. Cycle where they are breaking a bounce, like yesterday, the nadir can be later.
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Yeah, I want to get some more tests in for the reasons you said (some of his preshot numbers have been slightly lower than the +6 which I’m not used to seeing haha). Yesterday I was away all day at an event from right after the AM +6 until the PM +4… I was concerned my mom, who was watching him, wasn’t even going to be able to get the PMPS, but she managed in the end.
 
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