17/28 Peter AMPS 455, +6 373, PMPS 332 clearing bounce?

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PeteandCourt

Member Since 2013
Hello! This is my first Condo, so please let me know if I'm not following proper protocol.

After struggling with Peter not wanting to eat (through about 7/22), then a few mornings with sorta low AMPS so I only shot .5, I am struggling to get on a "normal" track. Can some wise, experienced eyes please take a look at my SS and recommend a dosage change, if any? He is high today, and I'm thinking maybe a bounce from last night? But I am new at all of this, so maybe I need to be considering a dosage increase?

Thanks!

ETA: I hope that his lower PMPS means he's clearing the bounce...and that I'm understanding the idea of bounces correctly. :)
 
Re: 7/28 Peter AMPS 455, +4 353, +6 373, 1st Condo dose advi

Welcome to LantusLand, the greatest place you never wanted to be. :roll: :lol: Peter is lucky to have you for his bean. It looks like it's been quite a challenge between the poor appy, vomiting and diarrhea. I think you are absolutely correct that he is bouncing from the normal numbers (but lower than the liver is used to) last night. Lantus dosing is based on the nadir so that 67 says to stay at this dose.

Did the vet prescribe cyproheptadine AND mirtazapine for appy stimulant? Usually it's one or the other. We give cypro to Zener but just 1/32 or less of a pill at a time, in the mornings lately. Vets often prescribe more than is necessary. It would be good to know what other med he was prescribed. Is he still vomiting or having diarrhea? Was a UTI every confirmed?

You are doing a fantastic job with everything! :-D :-D
Liz, Zener's other mom (I sign my posts and Anne doesn't sign hers)
 
Re: 7/28 Peter AMPS 455, +4 353, +6 373, 1st Condo dose advi

First, I'd say yes, it looks like Peter is bouncing. You don't have enough data to really know how low he might have gone since you just recently put him back on low carb wet and don't have enough testing to know for sure, but you can probably figure that he went even lower overnight. Most cats do drop at night.

The protocol is to stay at the same dose for at least 3-5 days (6-10 cycles) but it looks like you've skipped some doses in the past two weeks as well as decreasing a full unit, increased .25u twice in 4 cycles, and then decreased .75 at AMPS and then went back up to 1.25 or 1 within just a short time.

Lantus is a depot insulin, and it takes time for the depot to fill and get any useful information from testing. Doses are based more on the nadir (the lowest reading in the cycle...where the Lantus is kicking in it's best) than they are on Pre-shot numbers.

From the Lantus Tight Regulation 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.

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.
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.

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.
Click to expand...

You might want to take a look at both the Tight Regulation protocol and the Start Low, Go Slow (SLGS) and decide which one is best for you, and then I'm sure the wonderful people here will be happy to share their knowledge and suggestions with you to help get Peter under better control.

Keep asking questions!! After reading the Sticky's at the top of this page, you might have a lot of them! Everyone here wants only the best for Peter and will always make his safety their first priority.

You sure have had a lot of challenges with Peter! I wish only the best for you both! You're in the right place though!!
 
Re: 7/28 Peter AMPS 455, +4 353, +6 373, 1st Condo dose advi

I want to echo Liz's question: Are you giving Peter both cypro and mirtazepine? If so, they cancel each other out. Mirtazepine has a serotinergic component where as cypro is anti-sertonergic. They shouldn't be prescribed together.

If you weren't home to do pre-shot tests, was someone else giving Peter his injections? When I travel, my cat sitter isn't able to test my cat. (She's a bit of a diva.) You might want to consider lowering the dose when no one is able to monitor so you know that your cat is safe.

I agree with Chris -- it looks like Peter is bouncing off of the 67 from last night. I would wait until you're sure the bounce has cleared before increasing. This dose has dropped Peter's numbers to 67. I'd want to see where his numbers settle at before an increase. Also, since many cats experience lower numbers at night, I'd encourage you to get at least a before bed test every night.
 
Re: 7/28 Peter AMPS 455, +4 353, +6 373, 1st Condo dose advi

Thanks everyone! His appy is totally normal since about 7/22 or so and we're back on low carb, eating great. Yes, he was on both cypro and mirtazapine, though the mirtazapine was only every 3 days. He was also on flagyl to address the diarrhea and, a bit earlier than that, another antibiotic for a confirmed UTI. Anyhow, he's been off all drugs (except Lantus, obviously oh and a probiotic) since 7/22. Love having his appy back!

With my work schedule this week I can get in a daytime +5 or +6 (over my lunch break), and I will be sure to get a before bed (PM +2 or +3). I will maybe do another Condo Monday or Tuesday and ask for a dose assessment then.
 
Re: 7/28 Peter AMPS 455, +4 353, +6 373, 1st Condo dose advi

Hey there!! Welcome to LL. Is your name Court?

We just do one condo per cat per day so if you want to copy and paste your question from the other condo into this one and then delete the other one, that would be AWESOME!!!

Thank you so much! You delete the other condo by clicking on the "x" in the text box and then clicking "yes".
 
Re: 7/28 Peter AMPS 455, +4 353, +6 373, 1st Condo dose advi

Hi Marje! Yes, I'm Court. I'm trying to delete the mistakenly-started Condo, but it's not giving me the "x" box. I will fight with it after dinner. In the meantime, nice to meet you and I've update the subject on this Condo with the PMPS #.

I do hope that the bounce is clearing and that tomorrow is uneventful. :)
 
Marje....I'm not getting the option to delete mine either for some reason...I know I've seen it before, but tonight, no matter what I do, it's not giving me the option.

I was looking in the FAQ's, it says this:
Please note that normal users cannot delete a post once someone has replied.
Click to expand...

Are Court and I going crazy?? (lack of sleep does that I hear)


Edited to add...when I posted this, the "x" is now available for this comment only, not prior ones...but I'm wondering if it'll still be available after someone else comments?
 
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