12/29 Shane pre-AMPS +4 111, +6 342, +8 296

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Martica and Fred

Martica and Fred

Member Since 2010
Hi
Well don't know if my 0.75U was too much last night because I did a +4 check and he was already 111. So at 5am I went to the drugstore and bought more high carb food and gave him some more Nutrical, etc.

So he was

PMPS 314 gave 0.75U
+4 111
emergency carb eating
+6 342
+8 296

I have to leave now for work. I may be able to stop by at +12ish for a few seconds to do a shot, otherwise, it will be more like +13 (and deps on work stuff if I'm able to get away with those few extra minutes)

Anyway, what should I shoot? I think that 0.75 is too much. Don't know why he is still staying so low....should I go for 0.5, or even 0.25?

I've now been up 3 nights in a row worrying about him, can't do it one more night! I've also been giving him the lowest carb food like BG and Nat Var--at shot time, wondering if that's not having much of an effect--perhaps he can be diet controlled only at some point?

Anyway, Please give me your thoughts on next AMPS dose. Obviously, I'll see where he is but looks like he's probably going to keep dropping a bit
 
when i read your condo yesterday there were a couple of things that i thought might be helpful - one is that 111 is not a low number, definitely not an emergency or crisis. we normally are trying to push cats into the BG range for a non-diabetic cat, which is 50-120ish, and mostly under 100. i would not give high carbs to a car who was 111 unless i was trying to flatten out a curve and prevent the cat from bouncing - and that's not normally done for a cat that is still at the phase shane is in.

the goal of the protocol is to have the cats be in the 50-100 range. that's ultimately what you're aiming for with shane.

also, with lantus, we don't change the dose based upon preshot numbers unless the number is too low to shoot. dosing decisions are made by the lowest point of the cycle - and there's nothing in shane's numbers that says his dose is too high. in my opinion, your dose needs to stay the same for the 5 days or so that it takes to build the lantus shed. his doses so far have been 1.0, 1.5, 1.5, 2.0, 2.5, .75, .25, .75 - these changing doses (i realize one was a fur shot) but they are going to give you crazy wonky numbers and you won't be able to figure out anything.

it's a whole different mindset to use lantus than to use PZI. i think you'll be happy with it when you adjust. it's a good insulin but you'll have to re-learn some. everyone else changing insulins has had the same experience, so you're in good company! :YMHUG:

from the Tight Regulation Protocol sticky:

"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.
Click to expand...
 
oh, and here is his condo from yesterday. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=59582

we all sleep at night - don't worry, this will settle down and you won't feel like you have to stay up all night every night. i only wake up less than 1 night a month with punkin, and when i do, i set a cell phone alarm, wake up, test and go back to sleep in less than a couple of minutes.

are you saying you're only feeding him at preshot? most of us give our kitties something more in the first few hours of each cycle. i feed punkin 1 can of fancy feast with his shot and 1/2 can 3 hours later. 12 hours is probably too long for him to go without any food. if you're going to be gone you can either use a timed feeder or a catsickle (mix a can of food with some water, freeze it in a muffin pan or plastic dish) that can give him some food later. most of us (not everyone) don't feed after about +4.
 
What is a 'condo', by the way?

So at +12 he was 410...and I had left that higher carb food out and he ate it between +8 BG 296 and +12--which was really +13.5 because I couldn't leave work earlier.

So I gave him a 0.5+ U shot. I interpret this to be a 0.65 or 0.7, not quite a 0.75...although who knows cuz he's pretty hard to gauge that inbetween the half-unit marker. I did a drop less by making it a plus--so it's SLIGHTLY closer to being just above the .5 line. Does that make any sense?

When I used to shoot my soul kitty, Fred, with Lantus for 5 years, after several years I found that those teeny incremental changes were very powerful. Also, if the dose was too big then he would drop faster, earlier in the 12-hour cycle, and continue to drop. SO, seeing that Shane had a +4 of 111, I just didn't feel comfortable allowing him to drop for 8-10 more hours...so that's why I sort of went into semi-hypo mode.

And that's why I reduced it by an increment on him AMPS today. We'll see. he is SUCH a little guy--BONES--weighs 6 pounds something, maybe 6.5...I will now keep this .5+ dose for 5 or more days as the protocol suggests, assuming I don't get anything too low. As I mentioned in an earlier post, I know nothing about his history since I saved him from the shelter where he was DKA. So maybe this diaetes is a fluke and he'll go into remission?! (paws crossed). I also have no idea how old he is. I don't think he is a senior, everyone thought that at first.

This little guy is really difficult to test and shoot. His a little better with the ear test, but is very squirmy so not like I have a lot of time to do it, also his hair on his ears is a little more than fred's so I'm not getting the prick in everytime (I use a lancet pen, too afraid to poke with the lancet alone)

anyway, I know he's feeling better today, and even though he got a little up there in the ned, I know he was in a good range, for most of the past 48 hours now...whereas past week I think the poor little guy has been a rollercoaster. I think hopefully he will stabilize and we can gradually lower him. I'm not going to be aiming for getting him into the 50 range, more like the low 100s. I just feel better safer about that. For now we're not there really, but we just started!

And thanks Julie--yes all those crazy doses and the PZ were the VET--NOT me!!! (If you look on my spreadsheet at the comments on the right, you'll see that.)

I've never used PZ and know nothing about it--I requested that the vet use Lantus and they switched him over. The vet knew nothing about Lantus but I gave him the medical lit to review on how to dose and requested that he start at 0.5...which as you can see from my spreadsheet he did for ONE DOSE ONLY, then started bumping it up ridiculously high and based on NO numbers except one-only +6 test. So I"m pretty sure that Shane was hypo-ing everyday and then somogying, since when I removed him from the vet on WEd he was 39 an hour after I got him home. :(

Also, because he is literally skin and bones, I am going to be feeding him more frequently with smaller portions. Julie, no--the VET was ONLY feeding him at preshot, then starving him the rest of the 12 hours when he was likely hypoing from the awful huge doses. I'm feeding as noted on my spreadsheet, basically smaller portions frequently. We are not in a cycle /pattern yet, this is only the 3rd day he's been mine!

But also, one of the things I noticed with my Fred was that if he had a high number at PS---like in the 400s, then I would NOT feed him for a few hours, and because he had eaten midcycle he was not starving---then I would feed himi once the L started taking effect, for Fred that might be 3-4 hours after the shot. That seemed to keep the curve flat and lower. If I feed him on a 450 PS, for example, he might bump up to well 600 or more from the food, but the Lantus wouldn't kick in for several hours or more...and by that point he had been high and the Lantus dose was only SO powerful and so would keep the flat curve at a higher level than if I'd just waited a few hours for him to drop a bit before he ate again.

So I'm very experienced with some of the nuances of Lantus. I was on this board from 2005 to 2010, less so in the last year probably. I don't think I ever did the lantus-only group, only posted in the main board. However, this whole 'shed' concept is new too me, I don't recall every reading about it or having it be mentioned to me before. I knew about the overlap effect, but anyway, there is still lots to learn and I'm certianly feeling a little overwhelmed and underconfident since I'm a little rusty, it's been a year since I've been doing this on a daily basis.

Thank you all for all your help and feedback.
 
sorry just noticed all my many typos. Trying to type fast and no time to proofread because I have so much to do and this little boy has left me behind in all my work this week!
 
hello martica! i hope shane is settling in nicely.
you mentioned lowering the dose. you might be able to get away with the reduction if shane isn't throwing ketones. have you had a chance to get a ketone test yet? if he's throwing even trace ketones i strongly urge you to take the dose back up right away.
 
oh i'm sorry i didn't see your answer sooner today.

you've been through so much! shane too! it was good of you to adopt him when he was in a crisis.

a condo is just the thread we post every day. think of Lantus Land like a neighborhood and each cat has a condominium.

the "typical" lantus curve is illustrated here:

Example of a typical Lantus 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.
Click to expand...

of course every cat is different - the testing will reveal how shane responds to lantus and what his curve will look like.

you'll remember more as you go! people will help you - so feel free to ask as many questions as come up. hopefully shane will settle in nicely and do well on the lantus!

see you tomorrow!
 
Hi Julie and Jill
thank you--well I never to be able to catch him in the act of peeing, or if do, can't get there in time with the stick. I have ordered that Precision Xtra meter off ebay, so that should come soon and I'll be able to track ketones.

Well that is a nice little curve, I found that it didn't really affect Fred that way, he often peaked very late, and I guess a lot has to do with when they eat and how much they eat when they do.

I've backtracked on the dose a bit because his 200 point drops in the first 4 hours at 2 different BG numbers were just too drastic for me--especially during the overnight hours. Three whole nights this week I was up all night dealing with curves or whatever and I just have so much work to do that I won't last if that keeps going on, so I'm aiming for a gradual lowering. He was good all day yesterday--in the 200s and that on the 0.5+ shot...for the even he was still low--242 I think...but I just couldn't risk a 200 pouint drop while I was supposed to be sleeping, so I dropped the dose in a teeny increment--to 0.5- (or .25 or .3 ish) This held him in the 300s during that 12 hour phase, and even while eating about 7 oz of Merrick turducken, plus a few chicken treats. So I think the good news is that that amount is still too small but not inadequate because he didn't spike into something crazy. I'm also noticing that the lowest carb food really keeps him down...wondering if eventually this might be that diet control will be enough?

So over the last half of last-nights cycle he was still dropping on that teeny dose, not much and not enough, but it still was having an effect. And he even nibbled a bit. But that tells me that I'm close. So for today's AMPS shot he was 343 and I've given him 0.5 exactly plus food at shot time.

I can tell he's feeling great, his poops are good now, quite solid and he's very active and purring and furr looks better. He doesn't drink much water on his own, but I am putting it in his food as well. He's ok with that--thankfully he doesn't seem to be a picky eater! Today I was able to give the shot with only a slight growl but no real protest--thank goodness--the other night it was a nightmare and took me 30 minutes of trying before I had to go ask downstairs in my bldg and ask for help.

My biggest issue at the moment is trying to get blood out of the ear...It's not easy but the little guy is fairly patient. I never had problem with Fred, part of the problem is the firmness under the ear, it's hard to flatten his ear enough for some reason, it has a little fold in the back part.

anyway, overall I think we're both feeling good about things! Last night he mingled wiith me and the other cats in the living room. He played a teeny bit (first time he's played) and only growled a bit at the other cats. He also hung out and slept on the sofa and a sideboard, so nice that he's feeling more relaxed. Other than that I'm keeping him in the bedroom and if I'm in there he comes out and hangs out on the bed, but when I'm not, he found a place in the closet that he likes.

Poor little guy has had an awful last month, if not longer. I keep telling him, he's going to live a life of luxury now and get all the food and love he wants!
 
Hi, Martica ~

"Poor little guy has had an awful last month, if not longer. I keep telling him, he's going to live a life of luxury now and get all the food and love he wants!" -- How wonderfully sweet to read this, Martica! You and Shane have come such a long way already...thanks for taking in that precious little furguy.

Eva
 
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