11/7 Leo AMPS 386 time for an increase - .25 or .50

[Susan Shropshire]

Leo has seen some improvement. He definitely seems to be feeling better and has a lot more energy. We were seeing some blues when we were at the 5.5 unit dose but haven't seen that since increasing to 6. I did get a 194 the other night for a PMPS and retested and got 229, so I did a reduced shot on him in case it was the 194. I did 5 units instead of the 6. The numbers stayed around what we normally see.

Today is day 5 of this dose (6 units). I'm just not sure why we haven't seen the blues like we did at 5.5. Since I am getting some yellows and a few lower yellows should I only increase by .25 unit?

Also, I know it says if his Pre-shot is 150 or less to not give an injection but between 150-200 to do a reduced shot. If it's right above 200 would I give his normal dose? And.... I know ECD but how quickly can it drop from say 250 to too low maybe in the 60s? I hate to keep getting up all during the night and checking it if I don't have to. I know I need at least 1 check during the night but if it's above 250 am I safe not rechecking it? It seems he is one that drops a little later in the cycle around +6 or +8 and I don't see a big jump from +8 to the pre-shot numbers.

@Wendy&Neko

 

[tiffmaxee]

He gets a .50 increase at this point. Proportionately .25 would be too small since he’s getting 6.0 now. The rule about if under 150 is for cats new to insulin which Leo is not. With TR you shoot 68+ when using the AT. What you are quoting are SLGS guidelines. If you get a lower number than used to irs best to stall, DON’T feed, recheck in 20-30 minutes. Post for dosing advice.

If your +2-3 test is not lower than the pmps you don’t need to get a later test unless starting a lot lower, under 200. Then if dropping get one more test. I’ve seen cats go from 250 to 60 do it is possible but usually those cats are very bouncy. It is an ECID thing. From what we have seen so far he’s not going low.

BTW there was no reason to shoot the one 5.0 after your last increase.

 

[Susan Shropshire]

He gets a .50 increase at this point. Proportionately .25 would be too small since he’s getting 6.0 now. The rule about if under 150 is for cats new to insulin which Leo is not. With TR you shoot 68+ when using the AT. What you are quoting are SLGS guidelines. If you get a lower number than used to irs best to stall, DON’T feed, recheck in 20-30 minutes. Post for dosing advice.

If your +2-3 test is not lower than the pmps you don’t need to get a later test unless starting a lot lower, under 200. Then if dropping get one more test. I’ve seen cats go from 250 to 60 do it is possible but usually those cats are very bouncy. It is an ECID thing. From what we have seen so far he’s not going low.

BTW there was no reason to shoot the one 5.0 after your last increase.

I did the 5.0 because the first test I did was 195. I’m still learning when to adjust.

So basically I give him an injection unless it’s close to 68? But not the full dose, correct? So like the SLGS directions but 68 instead of 150? At what number would I reduce instead of the full dose?

with Leo I don’t usually see the drop in numbers until at least +4 so should I do a +4 to check him instead of the +2?

 

[tiffmaxee]

Lantus typically onsets between +2-3. For me I also found Max would onset +2.5-3. So I would get a test at +3 now then to see if lower than the preshot. That’s because if there’s a big drop at onset it might cause a bounce.

You have yet to see a preshot under 200 so if you see one under 150, stall and retest in about 20 minutes and see if on the way up without food. Post for dosing advice if he drops. If the same or going up you shoot the full dose if you can monitor and have supplies. You would only shoot a lower dose if close to 68 and not coming up in his own once you have data again provided you can monitor and have plenty of supplies. The more time between 68-120 on an AT the better.

Until you are comfortable I suggest posting for dosing advice if 68-120 right now at amps or pmps. Stall and don’t feed.

 

[Wendy&Neko]

The great thing about Lantus (and Levemir) is that they are gentle insulins and do wonderfully when you shoot lower numbers. You get great flat cycles Unlike the other insulins, they aren't great at yanking numbers down, but instead good at keeping low numbers flat and low. A personal example about my cat, I loved shooting the 80's with Neko. For her that seemed to be her magic range. I'd get a cycle where she often didn't move more than 10 points the entire cycle. Now that was a human meter, but the idea is the same. Take a look at some other members posts, and see what happens when they shoot lower numbers.

On this forum, we suggest that if you get a number below 150 for preshot, you do not feed, and post for help. There are several options for what you can do, one of which is to shoot the full dose. As you gather more data on shooting low, it'll become easier to do. I'll admit the first few times can be nerve wracking. An aside, I'd screw up the courage to shoot low the first few times, then Neko would immediately bounce.

With dose between 5 and 10 units, we typically increase by 0.5 units at a time, unless you are trying to tweak a good dose that is already giving you some greens.

'm just not sure why we haven't seen the blues like we did at 5.5.

I have a suspicion that Leo is seeing some insulin resistance. I can't remember if I've mentioned this to you before, but when a cat gets to 6 units dose, we suggest they get them tested for a couple secondary endocrine conditions that can be the source of insulin resistance. Those conditions are acromegaly, caused by a benign tumour on the pituitary gland - one in four diabetic cats has it, and IAA or insulin auto antibodies, which are sort of like an allergic reaction to the injected insulin. My girl had both those conditions. To test for them, the vet draws blood and sends it to Michigan State University.

Here is the link to your last post here, for continuity: https://felinediabetes.com/FDMB/threads/11-5-leo-pmps-195-or-229-reduce-shot.255114/

 

[Susan Shropshire]

The great thing about Lantus (and Levemir) is that they are gentle insulins and do wonderfully when you shoot lower numbers. You get great flat cycles Unlike the other insulins, they aren't great at yanking numbers down, but instead good at keeping low numbers flat and low. A personal example about my cat, I loved shooting the 80's with Neko. For her that seemed to be her magic range. I'd get a cycle where she often didn't move more than 10 points the entire cycle. Now that was a human meter, but the idea is the same. Take a look at some other members posts, and see what happens when they shoot lower numbers.

On this forum, we suggest that if you get a number below 150 for preshot, you do not feed, and post for help. There are several options for what you can do, one of which is to shoot the full dose. As you gather more data on shooting low, it'll become easier to do. I'll admit the first few times can be nerve wracking. An aside, I'd screw up the courage to shoot low the first few times, then Neko would immediately bounce.

With dose between 5 and 10 units, we typically increase by 0.5 units at a time, unless you are trying to tweak a good dose that is already giving you some greens.

I have a suspicion that Leo is seeing some insulin resistance. I can't remember if I've mentioned this to you before, but when a cat gets to 6 units dose, we suggest they get them tested for a couple secondary endocrine conditions that can be the source of insulin resistance. Those conditions are acromegaly, caused by a benign tumour on the pituitary gland - one in four diabetic cats has it, and IAA or insulin auto antibodies, which are sort of like an allergic reaction to the injected insulin. My girl had both those conditions. To test for them, the vet draws blood and sends it to Michigan State University.

Here is the link to your last post here, for continuity: https://felinediabetes.com/FDMB/threads/11-5-leo-pmps-195-or-229-reduce-shot.255114/

At his last vet visit they did an ultrasound and said they saw a 2cm x 2cm mass on his pancreas. I don’t know much I trust they person doing the ultrasound. She also does ultrasounds for pregnancy and comes into the clinic by appointment for animals. The vet said it could be a number of things from an abscess (we did an antibiotic) to a benign mass to cancer. There really wasn’t anything further he wanted to do except re- ultrasound after a month to see if it had grown or was even still there. I didn’t see a need to redo the ultrasound since there was no treatment and Leo is doing great other than high BC. He eats great and has energy. We have now changed to a new vet so I will talk with her about what she might want to do. He did have pancreatitis and I did read that sometimes the inflamed area of the pancreas can look like a mass. This same person did an ultrasound on another kitty of mine for a heart condition and X-rays showed 2 masses in her lung and the person couldn’t find those masses on the ultrasound.