? 12/13 Mr. Pants AMPS 144 +2 119 +2.5 101 +5 136 PMPS 214

Zach Pool

Zach Pool

Member
Ailish’s Brother said:
Hey, I’m new to this whole thing and still trying to understand all the different approaches, what are the behavioral changes you see that lead you to change the dose?

Hope Mr. Pants is feeling better today!
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It boils down to energy levels at the end of the day. Lethargy, sleeping all day vs. following me around and overall activity. He was in the mid 200s for a while a earlier this year and his coat became less vibrant and soft. When he feels good his fur looks fluffy and vibrant. I have a Siamese female that is pretty rude to everyone, including him, and if he is feeling really good he will put her in her place or chase her around. He is very talkative when feeling his best. He is a scavenger as well so when he isn't licking the food dishes for remnants of food or scouring the kitchen for something to eat, I know he doesnt feel as good as he could. He stalled out this morning in the 140's...I like him in the 160 ish to 100 range. That's where his clinical symptoms look the best. I don't think that .25u is enough for him. At least right now. I've noticed that reducing his insulin right away typically results in subsequent hyperglycemia and reduced activity. I think my answer here is holding the .4u dose and delaying the shot until his BGs begin climbing and make it over 160 mg/dl. That is NOT what I have done this morning however. I imagine I will regret it this evening.
Thanks for your concern by the way. He was out of bed before me talking about needing fed this morning so I think we'll stay in range both biochemically and clinically, today.
 
Zach Pool said:
He stalled out this morning in the 140's...I like him in the 160 ish to 100 range. That's where his clinical symptoms look the best. I don't think that .25u is enough for him. At least right now. I've noticed that reducing his insulin right away typically results in subsequent hyperglycemia and reduced activity. I think my answer here is holding the .4u dose and delaying the shot until his BGs begin climbing and make it over 160 mg/dl. That is NOT what I have done this morning however. I imagine I will regret it this evening.
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Nice start this morning, you see how the high didn’t last, and he came down all cycle? To me, that’s a bounce break. Had he stayed up high, and continued that way for additional cycles, that would be more so a sign of not enough insulin. You really don’t need to delay a shot until he gets above 160, especially when you see that he has nadired already and considering that meter variance business ;). Take a look at some of the cycles where you have shot similar numbers.

In what way do you think you’ll regret it? I just want to understand so I can help. If you’d like to start a new post on how his cycle is going, I’ll be around today.
 
Zach Pool said:
It boils down to energy levels at the end of the day. Lethargy, sleeping all day vs. following me around and overall activity. He was in the mid 200s for a while a earlier this year and his coat became less vibrant and soft. When he feels good his fur looks fluffy and vibrant. I have a Siamese female that is pretty rude to everyone, including him, and if he is feeling really good he will put her in her place or chase her around. He is very talkative when feeling his best. He is a scavenger as well so when he isn't licking the food dishes for remnants of food or scouring the kitchen for something to eat, I know he doesnt feel as good as he could. He stalled out this morning in the 140's...I like him in the 160 ish to 100 range. That's where his clinical symptoms look the best. I don't think that .25u is enough for him. At least right now. I've noticed that reducing his insulin right away typically results in subsequent hyperglycemia and reduced activity. I think my answer here is holding the .4u dose and delaying the shot until his BGs begin climbing and make it over 160 mg/dl. That is NOT what I have done this morning however. I imagine I will regret it this evening.
Thanks for your concern by the way. He was out of bed before me talking about needing fed this morning so I think we'll stay in range both biochemically and clinically, today.
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I feel you on those signs. It sucks to see your little friend not acting like their best selfs. I’m going through that with my cat right now and am trying to find the best balance to help her.

I hope you and Mr. Paint find a balance that works for you and lets you both have some consistency.

I’ve got a question since you’ve been dealing with this for five years, was there ever a time you just kept him on a stable dose, or has it always moved around?
 
Christie & Maverick said:
Nice start this morning, you see how the high didn’t last, and he came down all cycle? To me, that’s a bounce break. Had he stayed up high, and continued that way for additional cycles, that would be more so a sign of not enough insulin. You really don’t need to delay a shot until he gets above 160, especially when you see that he has nadired already and considering that meter variance business ;). Take a look at some of the cycles where you have shot similar numbers.

In what way do you think you’ll regret it? I just want to understand so I can help. If you’d like to start a new post on how his cycle is going, I’ll be around today.
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Well his nadir was literally right before his shot....he then stayed there for 30 minutes after his meal and gave me a reading of 140, 30 minutes after he ate. And to speak on high numbers through additional cycles...he did have high numbers through 4 cycles before I increased his dose last night. Ever increasingly high numbers before I decided to bump it up. All the way from the low 200s to nearly 300. Know thy cat right? I've seen this happen a million times. Whether it be from reductions or a vet telling me he doesn't need insulin. I don't see how rising nadirs and rising curve numbers are going to change with a lower dose. I did look at the chart you linked with higher preshot numbers clearing and going green. I don't recall the chart reflected a steady rise in numbers over the course of four cycles. Also its for a different cat on a considerably larger dose (I would say close to a large as a dose gets). So knowing that all cats metabolize this stuff differently Im not sure that chart is necessarily a game changer for me.
Dose goes lower....numbers go higher....dose stays the same...numbers continue rising. I cant wrap my mind around that leading to lower numbers. When he got his dental done this year he was given steroidal medications, gabapentin, covenia, amoxicillin, and another antibiotic he was allergic to. His BGs have been wonky ever since. He has in the past got into high carb food or even white bread and ice cream bowls that have been left out. I've always been able to get him back to consistent 100-160 numbers (which is what his body likes), but not after all the meds. I think it was the steroids.
The idea of waiting to give him a dose until his numbers start rising is to offset the insulin depot time from the shot prior so that it does not have the same effect. Waiting to give the shot should have that effect. The protocol that has been most effective for me for the last 5 years is to take a reduction after I notice I need one....e.g the following cycle. Truthfully, I think I came down too fast. I don't think I should have went from .5- to .25. I think he would be best suited coming down a little slower....Which I think can be achieved by delaying the shot until his numbers begin moving and taking the reductions on the following cycle.
 
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Ailish’s Brother said:
I feel you on those signs. It sucks to see your little friend not acting like their best selfs. I’m going through that with my cat right now and am trying to find the best balance to help her.

I hope you and Mr. Paint find a balance that works for you and lets you both have some consistency.

I’ve got a question since you’ve been dealing with this for five years, was there ever a time you just kept him on a stable dose, or has it always moved around?
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For the vast majority of his time as a diabetic cat he has been on less than .5u BID. I typically get him to a place where he is essentially getting .25u BID or even half that. Essentially such a small dose that I have to hold the syringe up to the sliding glass door to see that there is even insulin inside it lol. He will fluctuate between 90-100 for a nadir and typically hit 150-170 pre meal.
 
Christie & Maverick said:
Nice start this morning, you see how the high didn’t last, and he came down all cycle? To me, that’s a bounce break. Had he stayed up high, and continued that way for additional cycles, that would be more so a sign of not enough insulin. You really don’t need to delay a shot until he gets above 160, especially when you see that he has nadired already and considering that meter variance business ;). Take a look at some of the cycles where you have shot similar numbers.

In what way do you think you’ll regret it? I just want to understand so I can help. If you’d like to start a new post on how his cycle is going, I’ll be around today.
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Having had some time to look at that chart you linked again I would say that it seems to me like complete chaos. Quite frankly it looks like where my chart was headed while I was following TR in late November. This cat looks to me to be going super low and bouncing....going super low....then bouncing...going super low then bouncing. No offense but that is literally exactly what I was speculating that was happening to MY cat before I started taking reductions when I would normally instead of following TR. If you look at my chart you'll see that the reductions that I took in spite of being told NOT to take them has led to much better numbers than the chart you have referenced.
 
Just to clarify...
You delay the shot at some points? I'm hoping that you are aware that early or late shots have an effect on the depot. An early shot functions like a dose increase whereas a late shot acts like a dose reduction. For today, delaying your shot time AND taking a dose reduction is essentially a double reduction. (Maybe not literally a double reduction but I suspect you get the idea.) You likely have a 30 minute window with the time factor but that's not the case for all cats. Just like some cats are exquisitely sensitive to carbs, some cats are very sensitive to the timing of their shot.

The other "rule" besides not basing your dose on the pre-shot numbers is that Lantus likes consistency. This refers to consistency both with the dose and with when you are administering insulin. The depot needs time to stabilize. Back-to-back dose changes, frequent changes in the timing of your shots can give you wonky numbers. I don't feel like I've seen enough evidence on your spreadsheet to know exactly what is influencing your cat's numbers. If you can grit your teeth and stick with SLGS for a few weeks, we will be able to get a better handle on what's going on. On the other hand, if you're convinced you have all the data you need to manage your cat's diabetes, stick with what you're doing. The downside is we may never know if one of the established dosing methods would be more effective.
 
Zach Pool said:
Well his nadir was literally right before his shot....he then stayed there for 30 minutes after his meal and gave me a reading of 140, 30 minutes after he ate. And to speak on high numbers through additional cycles...he did have high numbers through 4 cycles before I increased his dose last night. Ever increasingly high numbers before I decided to bump it up. All the way from the low 200s to nearly 300.
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Bounce breaking cycles will often have later nadirs, which may actually have been before your preshot, but from the tests we see, yes his nadir was around preshot. Having a one higher yellow in each of those 3 cycles does not mean he’s high to where an increase is warranted. Had he hit 290s and stayed there for several cycles, then yes I would say he had high numbers. Yesterday and day before +1s were more than 20% meter variance, so I’d call those food bumps. He came down nicely thereafter when insulin dose kicked in around +2 ish. As I said before, not every cycle is going to look exactly the same, and at the risk of using another broad statement which I know you love :), insulin is a hormone, not a drug, so the way a cat responds may vary from cycle to cycle since there are variables involved in how the cat metabolizes the insulin.
 
Zach Pool said:
Having had some time to look at that chart you linked again I would say that it seems to me like complete chaos. Quite frankly it looks like where my chart was headed while I was following TR in late November. This cat looks to me to be going super low and bouncing....going super low....then bouncing...going super low then bouncing. No offense but that is literally exactly what I was speculating that was happening to MY cat before I started taking reductions when I would normally instead of following TR. If you look at my chart you'll see that the reductions that I took in spite of being told NOT to take them has led to much better numbers than the chart you have referenced.
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No offence taken. That cat was previously in remission and has come back, so arguably quite a bit more bouncy plus there are other considerations. The purpose of sharing that cat’s SS was to offer what I saw as a cat who often clearly shows a high before a break. Why is that helpful? Well, if you see this type of pattern, you can watch for the bounce breaking instead of saying the cat is high based on one higher yellow preshot and increase the dose because you think the dose isn’t working. Does that make sense?
 
Sienne and Gabby (GA) said:
Just to clarify...
You delay the shot at some points? I'm hoping that you are aware that early or late shots have an effect on the depot. An early shot functions like a dose increase whereas a late shot acts like a dose reduction. For today, delaying your shot time AND taking a dose reduction is essentially a double reduction. (Maybe not literally a double reduction but I suspect you get the idea.) You likely have a 30 minute window with the time factor but that's not the case for all cats. Just like some cats are exquisitely sensitive to carbs, some cats are very sensitive to the timing of their shot.

The other "rule" besides not basing your dose on the pre-shot numbers is that Lantus likes consistency. This refers to consistency both with the dose and with when you are administering insulin. The depot needs time to stabilize. Back-to-back dose changes, frequent changes in the timing of your shots can give you wonky numbers. I don't feel like I've seen enough evidence on your spreadsheet to know exactly what is influencing your cat's numbers. If you can grit your teeth and stick with SLGS for a few weeks, we will be able to get a better handle on what's going on. On the other hand, if you're convinced you have all the data you need to manage your cat's diabetes, stick with what you're doing. The downside is we may never know if one of the established dosing methods would be more effective.
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The reductions were actually being taken according to SLGS...He was dipping under 90. Did you look at the chart? and yes Im aware that delaying the shot acts as a dose reduction. Typically I don't delay the shot AND reduce it, I reduced it based on a suggestion I got here. I increased it based on the parameter of increasing the dose if you have a nadir over 150. I had a nadir of 145. It wasn't just pre shot numbers that were rising either. It was literally every test at any given hour including the nadir over the course of four cycles.
 
Christie & Maverick said:
No offence taken. That cat was previously in remission and has come back, so arguably quite a bit more bouncy plus there are other considerations. The purpose of sharing that cat’s SS was to offer what I saw as a cat who often clearly shows a high before a break. Why is that helpful? Well, if you see this type of pattern, you can watch for the bounce breaking instead of saying the cat is high based on one higher yellow preshot and increase the dose because you think the dose isn’t working. Does that make sense?
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It would if it were based off of one pre shot number...but it was based off of literally every test of every hour including the nadirs over the course of four cycles so...Once again all the nadirs were rising...all the numbers in every test...and then I got a nadir of 145 which is 5 mg/dl away from meeting the parameters from a dose increase. The only difference is that I wasn't going to wait a week to do a curve.
 
Christie & Maverick said:
Bounce breaking cycles will often have later nadirs, which may actually have been before your preshot, but from the tests we see, yes his nadir was around preshot. Having a one higher yellow in each of those 3 cycles does not mean he’s high to where an increase is warranted. Had he hit 290s and stayed there for several cycles, then yes I would say he had high numbers. Yesterday and day before +1s were more than 20% meter variance, so I’d call those food bumps. He came down nicely thereafter when insulin dose kicked in around +2 ish. As I said before, not every cycle is going to look exactly the same, and at the risk of using another broad statement which I know you love :), insulin is a hormone, not a drug, so the way a cat responds may vary from cycle to cycle since there are variables involved in how the cat metabolizes the insulin.
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You dont think it had anything to do with the increase in insulin? Seems pretty coincidental. Just saying.
 
Christie & Maverick said:
No offence taken. That cat was previously in remission and has come back, so arguably quite a bit more bouncy plus there are other considerations. The purpose of sharing that cat’s SS was to offer what I saw as a cat who often clearly shows a high before a break. Why is that helpful? Well, if you see this type of pattern, you can watch for the bounce breaking instead of saying the cat is high based on one higher yellow preshot and increase the dose because you think the dose isn’t working. Does that make sense?
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Were sticking with .25u regardless. We are back on schedule with it. So we will see what it does.
 
Christie & Maverick said:
No offence taken. That cat was previously in remission and has come back, so arguably quite a bit more bouncy plus there are other considerations. The purpose of sharing that cat’s SS was to offer what I saw as a cat who often clearly shows a high before a break. Why is that helpful? Well, if you see this type of pattern, you can watch for the bounce breaking instead of saying the cat is high based on one higher yellow preshot and increase the dose because you think the dose isn’t working. Does that make sense?
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Food for thought, also....Dont know how accurate this source is but in reference to depot times being 14- 16 hours in humans it may be beneficial to ponder this article or its validity . Being that SOME cats may metabolize Lantus so quickly that it doesn't even act as a long lasting insulin. So the depot times may be even shorter and every cat may be different.

https://veterinarypartner.vin.com/doc/?id=4952157
 
Zach Pool said:
Food for thought, also....Dont know how accurate this source is but in reference to depot times being 14- 16 hours in humans it may be beneficial to ponder this article or its validity . Being that SOME cats may metabolize Lantus so quickly that it doesn't even act as a long lasting insulin. So the depot times may be even shorter and every cat may be different.

https://veterinarypartner.vin.com/doc/?id=4952157
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I already said the number of subsequent cycles a depot can affect varies based on many factors but you are getting duration and depot mixed up and they are very, very different. They cannot be used interchangeably.

LINK TO YESTERDAY’s CONDO
 
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Zach Pool said:
What's the difference between duration and depot?
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You might have noticed I’ve moved all the posts to a new thread; please remember....each and every day, we start a new thread. One per cat per day.

To answer your question, duration is the length of time ONE shot is effective and continues to lower blood glucose during the cycle. Duration can vary by cat for many reasons: the way the shot was administered, the food which was fed (amount and time during cycle), absorption rate (which can vary as much as 50% between cycles), etc. You might also want to read about carryover and overlap which relate to duration and are not to be confused with depot.

Instead of reinventing the wheel on explaining depot, you can read it from the Sticky discussion.
 
Zach Pool said:
It would if it were based off of one pre shot number...but it was based off of literally every test of every hour including the nadirs over the course of four cycles so...Once again all the nadirs were rising...all the numbers in every test...and then I got a nadir of 145 which is 5 mg/dl away from meeting the parameters from a dose increase. The only difference is that I wasn't going to wait a week to do a curve.
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By my count, in the past 5 cycles you’ve had 4 cycles with nadirs under 150. The goal with SLGS is to have nadirs in the 90-149 range. That may mean preshots won’t be. And you want to evaluate based on the cycles and nadirs over the course of 7 days on a dose before deciding whether to increase, not just one nadir.
 
pretty sure I hit higher doses the last two doses. I was in a crazy rush last couple of days and my not have got my mark correct. Pushing the plunger didn't feel the same. I think he has had a little over .25u the last two cycles. Looks like he's bouncing now.:banghead::banghead::banghead:
 
Those smaller and in between lines doses are definitely a challenge. What I do is I draw up a little more than I need so in your case a little bit over the 0.5u line, then I open my fridge door and use the fridge light as a back drop so I can see the lines better, then I gently twist the plunger to squeeze out a few drops until I can see it’s halfway between 0.5u and the zero. I find it easier to see the insulin levels in relation to the lines with the fridge light as I am squeezing out the drops.
 
Christie & Maverick said:
Those smaller and in between lines doses are definitely a challenge. What I do is I draw up a little more than I need so in your case a little bit over the 0.5u line, then I open my fridge door and use the fridge light as a back drop so I can see the lines better, then I gently twist the plunger to squeeze out a few drops until I can see it’s halfway between 0.5u and the zero. I find it easier to see the insulin levels in relation to the lines with the fridge light as I am squeezing out the drops.
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Thats exactly what I do except for I also use a razor blade to mark the plunger, which I have come to find out is the same width as .5u lol. Its the most consistent thing to use on these pathetic syringes haha. His BGs are totally ridiculous now.
 
Christie & Maverick said:
Those smaller and in between lines doses are definitely a challenge. What I do is I draw up a little more than I need so in your case a little bit over the 0.5u line, then I open my fridge door and use the fridge light as a back drop so I can see the lines better, then I gently twist the plunger to squeeze out a few drops until I can see it’s halfway between 0.5u and the zero. I find it easier to see the insulin levels in relation to the lines with the fridge light as I am squeezing out the drops.
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Now I'm struggling to decide if I want to just continue getting the same dose as the last two wonky ones I shot or try to get it a little lower and closer to an actual .25u
 
Don’t forget about the high before the break. Let’s see if he’s breaking another bounce from the 101 yesterday. If you’d like to start another post for today to continue the discussion, that would be great :)
 
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