12/23 Leo (newly dx) PMPS 443

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Lacie

Lacie

Member Since 2010
Leo was diagnosed with FD on 12/21/10 and put on Lantus 1.5u 2x per day after vet's office tests two weeks apart both showed his blood glucose around 385, with glucose in urine at 1,000mg each time and the usual FD symptoms. I was surprised at the dx, because his diet has consisted primarily of Innova EVO canned for the past three years since he came to live with me. But he had a difficult dental in October with five tooth extractions and some really awful gingivitis, plus he had been a stray who probably had a hard life before we met.

Our intro on the main board is here: viewtopic.php?f=28&t=32571

It's only our third day with the Lantus but I do have one question: is it normal for BG readings to get worse during the first week? The first two days I had PS numbers less than 400 just like at the vet's; then this morning we were way above 400 and nadir in the mid 300s. Could this be because he's still filling the shed? Or maybe he was just hungry this morning? He started yelling at me for food at 4 a.m. (usually he waits until 7).

If I just need to sit tight and let the first week go by, that's what I'll do. I have a Novamax meter and will test AMPS, PMPS, and both +7s if that seems like a good approach.

Thanks for any words of wisdom--I've been on a huge learning curve this past week.

EDIT: opened a new vial of strips between AMPS and +7. Guess I'd better do a control solution test before I go off and blame the cat! But the AMPS with the old strip is still his highest ever.
 
Re: 12/23 leo (newly dx) AMPS 440, +7 349 (w/question)

Welcome Leo and Lacie.
I think you do have to hold tight and wait for the first 5 days or so, for the shed to fill.
Others will be along to advise more and welcome you.
You are doing great so far, and it is a lot to learn.
Keep asking questions, and one day, you will be a pro.
I'm glad you found this board. It's awesome.
 
Re: 12/23 leo (newly dx) AMPS 440, +7 349 (w/question)

Lacie: A warm welcome to you and Leo into our family at LL!! I agree with Dyana..it takes a while for the shed to fill. For our Gracie, it was six cycles of high numbers before she showed any number under 200 and then another 10 cycles after that (of course, we started her low and ECID). Also as Dyana said, ask tons of questions because we're all here to help you and Leo. We have some dosing experts who can help you decide if his dose is correct once his shed fills. I'm impressed..alot of newbies don't even know to ask about the shed and looks like you are already getting the condo format down. We each do one condo per day so when you get his PMPS tonight, then just reopen this condo, on your FIRST post of the day, click "edit", and then take everything out of the subject line except "12/23 Leo"; then add his PMPS and if you have any questions put that after so it MIGHT look like this: 12/23 Leo PMPS 300 Dose ?? If you don't have any questions, then it will just have the date, his name, and his PMPS. As you get the other tests, just add as you have done above. Great job!!!
 
Re: 12/23 leo (newly dx) AMPS 440, +7 349 (w/question)

Well, hello, hello, hello!

you have indeed found the right place for you and leo.
and compliments on how ahead of the curve you are! took me forever to get avatar pic up, etc.
looks like we have a computer whiz as the newest member to the lantus family. :lol:

there are many here with much more experience and knowledge than i...we're in the "ask a lot of questions and inject a little humor" group...but i can tell you this:
Binks and i would not be together today if it weren't for the help, knowledge, and support so generously given us by the Lantus Forum.

took a week or two for us to see an effect after starting lantus...others will be along to answer your questions in more detail.
and there are no "silly" or "insignificant" questions...ask, and ye shall receive wisdom!

nice to have you here, Lacie!

celi & binks
 
Re: 12/23 leo (newly dx) AMPS 440, +7 349 (w/question)

Welcome Lacie and Leo.....

Yes, wonky numbers at the beginning as the shed fills and the body makes adjustments.

You are in the right place and questions are always welcome here.

Sounds like you and Leo are quick learners.

Lacie, you are doing a great job.
 
Re: 12/23 leo (newly dx) AMPS 440, +7 349 (w/question)

Hi Lacie,
Normally, dose is usually started at 1u BID so I just thought I'd mention it.

Here are some info for you to read on Lantus that will help you a great deal:
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers


Right now, you are filling the shed so just hold the dose for the first 5-7 days.
Below is the portion from the protocol about dosing:
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 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 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 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 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 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.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.


Below is info on a typical curve. Instead of getting a test at the same time - +7, try to catch some different ones, maybe a bit earlier and then a bit later next time:
How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

If you want to do a curve on any cycle, try to test every 2 or 3 hours and you will get an idea how Leo's doing on the dose.

The tests that are important to get every day would be the ps for am and pm and then try to get a before-bed test because some cats tend to go lower at nite, and if Leo has a plan to drop low one nite, it will be good to catch it before heading off to bed or you will be wondering how come he's so high the next morning.

When you do your curves and see his numbers staying high and flat, it could be that he may need to increase the dose once his shed is filled. The first few days, most of the insulin is going to fill his shed and then once that's topped up, Leo gets all of it. That's when you want to see his curves with a dip somewhere in that curve.

Anyways, just keep on testing and if you want someone to take a look at Leo's ss for opinions, just ask. Sometimes it's tough to see what's going on in the beginning.

I am sure you are feeling better now that you are noticing the changes in Leo, but don't worry about the food as most cats have much bigger appetites until they are regulated because their bodies just aren't capable of making use of the nutrients in the foods, so therefore hungry kitty.
Food links in case you don't have them:
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition


Keep asking questions.
To know the road ahead, ask the man coming back.
 
Re: 12/23 leo (newly dx) AMPS 440, +7 349 (w/question)

Welcome to Lantus Land!

I'm really not quite sure what to say since you've arrived with a spreadsheet (SS) already in place, familiarity with some of the language here... Oh well, I'll say it anyway: Read the starred sticky notes at the top of the Board. They contain an overwhelming amount of information -- especially if you follow all of the embedded links.

To respond to your question, some cats do experience higher numbers not only with staring Lantus but also whenever a dose is raised. In the latter case, we refer to this as "new dose wonkiness" (NDW). There is no explanation for why other than some cats do this. I would definitely stick with your current dose. It takes 5 - 7 days for the initial dose of Lantus to settle and for the shed to form.

Just to supplement Gayle's comment about dose, initial dose of Lantus can be determined by a formula: initial dose = 0.25 x ideal weight in kilograms. Given that you said at 12 lbs., Leo is on the thin side, using his current weight in the formula, his dose would be approx. 1.3u. Since this is based on a skinny kitty, 1.5u is certainly in the ballpark.

There is information in the Tight Regulation sticky that Gayle didn't copy that may also be useful:
WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR...

* Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.

* It will be necessary to test kitty's blood glucose levels multiple times per day.

* Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.

* Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).

* Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.

* Feed a high quality low carb canned or raw food diet.

* Feed small meals throughout the day. Some kitties adapt well to free feeding.
Click to expand...

As others have said, please ask questions. Also, visit our condos (it's what we call our daily thread -- one condo, per cat, per day) and take a look at our SSs. It's a great way to learn The people here are very generous with their time and their information. We're all here to help. Please post regularly and we'll do what we can to lend a hand.
 
Re: 12/23 leo (newly dx) AMPS 440, +7 349 (w/question)

Thanks everyone. The warmth and helpfulness of this community is amazing and wonderful.

I've looked at some of your SSs and will look at more. It's helpful to see what other kitties are up to.

Leo is happy and relaxed since starting Lantus. Don't want to get a false sense of security, but I have a good feeling about this.
 
Re: 12/23 leo (newly dx) AMPS 440, +7 349 (w/question)

Welcome Lacie and Leo. I hope you find this forum a great comfort as you go through the sugar dance with Leo. You'll find the people here have daily (who am I kidding - HOURLY, and even smaller intervals when you need them) experience with FD as opposed to a monthly visit with a professional - they'll be able to help you with whatever you need. They've been through it all.

Great start with your home-testing and spreadsheet setup.

Good luck with Leo!
 
If you get time in the next few days I would do a curve-- blood sugar readings every 2 hrs or so throughout day. That will give you a better idea of how your cat reacts to the insulin. Mine until recently hit her nadir at 3hrs past shot time which isn't typical for many cats. Lantus is an insulin that takes a lot of patience and time before you hit your groove, so try and be patient. :-)

Welcome to LL!
 
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