12/30 Lee Lu - AMPS 444 (sigh), PMPS 482 (double sigh)

Status
Not open for further replies.
Ugh is right. Looks like numbers have been creeping up for a couple of weeks now. Hopefully that increase brings them back down and no more reds!
 
I did a 0.75u this AM, but really, the diff in the syringe between 0.50 and 1 is so small, so difficult to read. I'll probably creep her up to just under 1 over the next few days.
 
Please try to keep the .75 as consistent as possible for the next 3 days. I know it's hard to do those .25/.75 doses, but it's important to hold each dose for at least 6 cycles before changing again (unless they drop below 50) What I've done is bought some of those cheap reading glasses...it really helps to magnify the lines!

You could fill a syringe with some kind of colored liquid (grape juice works well) and use that to compare each shot to if it'll help.

I know making tiny changes may seem like it's taking forever to get anywhere, but it's really true that a drop too much can cause a lot of trouble, so we always want to give each dose at least 6 cycles to settle in and see what it does.

Come on now Lee Lu!..Work that juice!
 
good luck with the new dose!

For most cats, I find that increasing the dose by 0.25 units at a time works best, as long as you are able to test just in case it works better than expected. Sometimes I'll suggest decreasing by drops at a time, but increasing seems to have more impact when it's done by the full 0.25u - I think it's because it's enough of a change for them to notice that you changed something.

It looks like Lee Lu's last dose reduction didn't hold. That happens sometimes, especially when they have gotten a lot of reductions in fairly quick succession. Increasing is a good decision. 0.75u looks like it was a good dose for her before, but you might find that she'll need a tad more than that to snap back into place again. No worries, though, she's not far from her usual numbers so I think she'll get back there without too much drama.
 
Double ugh, PMPS 482!?!

Gave her the 0.75u shot even though I wanted to increase her dose ASAP. Still not sure what's going on with her. I keep going back to maybe the insulin is bad? The food the same, home life is the same, no new stresses, everything else is the same.
I will stick with this 0.75 dose for at least two more doses and if her AMPS test on the 1st (Thursday) is still in the 400s, I am going to increase. If it's in the 300s or under, I will hold the dose. I worry that staying in this high-level is going to cause her harm, is that reasonable to consider?
 
remember that your dosing decisions with Lantus are made on the low numbers - not the high. High numbers aren't good, but it's not going to do much damage in the short-run. You don't want to increase based upon high numbers. You want to increase based upon how low she gets. That's a hard concept for everyone to wrap their heads around, but it's how Lantus works, regardless of what dosing guidelines you use.

I agree with Libby that making dose increases in the 0.25u increments works better than skootching up. It's hard enough to measure 0.75 without trying to figure out a fat 0.75, but i'd do the best you can and then stick with it for 6 cycles.

What I always did when I wanted to figure out the dose was to look at the lowest numbers for the previous 3 days, then compare those lows to the dosing protocol (not sure if you're following TR?) and see what it suggested. On the fat 0.5u Lee Lu was getting nadirs in the blue 100's, so I'm highlighting the part below that I think applied to the increase that you did already today. Here's the TR dosing guidelines:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Now that you've increased, I'd watch the nadirs and then in 3 days, do another comparison (unless she goes below 50 first - then she gets a decrease.)

If you can only get one mid-cycle test, Amanda, probably the most helpful one is going to be the one right before you go to bed. I'm not sure how late that is in her cycle, but the night time cycle is so often low and that can often tell you a ton. In fact, if you have to make a choice, i'd choose getting one night cycle test over a curve during the day cycle.

I doubt that there is any problem with your insulin. She still has a curve and it can get her to the 100's. This looks pretty typical - i think she's just gotten used to being a little higher and you're having to give a little more insulin to move her back into better numbers. That's normal to have to adjust the dose. She'll get back on track before long!
 
Hi Amanda

The short time she's been in high numbers shouldn't affect her long term. The biggest concern is she is above renal threshold which means she is dumping sugar into her urine. Some diabetic cats are prone to UTI's because the sugar in the urine feeds the bacteria.

Hopefully, you will get her back to the dose she likes soon.
 
Thanks everyone! I think b/c I am not getting mid cycle data, all I have to react on is the AM and PM tests. So I will get more data to "react" to tomorrow on my day off :)

Question - the term "cycles" - is a cycle a full day or each dose? In other words, is 6 cycles = 6 shots or 12 shots?

I'm pretty much following relaxed lantus (I'm a transfer from the RL group!).
 
cycle = the time between shots, so 12 hours.

I wouldn't increase the dose again until you can get a mid-cycle test or two. Those red numbers are pretty uncharacteristic for her, so you want to be very sure that they are not bounces from some low number. Even just one mid-cycle test in each of a couple of different cycles can give a lot of information. Maybe a test when you get home today, or right before bed, or something like that. If it means waiting til the weekend before increasing, then so be it, it will be fine.

Also keep in mind that Lantus has a lovely phenomenon that we call New Dose Wonkiness. It's not unusual for the first few cycles of a dose increase to be higher than usual, though your dose increase was pretty small so this would seem like a pretty extreme reaction to a teeny increase. It's not impossible, though. That's why we suggest waiting a few days before increasing again.
 
Status
Not open for further replies.
Back
Top