2/11 Phobos - AMPS 454 - when will there be a difference?

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Raechel

Raechel

Member Since 2015
I bumped up Phobos' dose to 2 units yesterday morning. His numbers were all really high yesterday. I'm assuming I should see a difference in his numbers, but how soon after increasing his dose?

Also, I'm noticing that I'm getting bubbles every time I draw up a needle. Is this normal? There's usually at least one good sized bubble. I flick the needle until it rises, but it doesn't look like it actually expels even when I squirt out a drop or two of the Lantus. Am I doing something wrong?

Thanks!
 
Hi Raechel,
When you first start out to follow the protocol, sometimes (often) it will take a while to see results. That's why we compare feline diabetes to a marathon, rather than to a sprint. Does Phobos have any other health issues (teeth; infections; chronic conditions?). Often when these are resolved the blood-glucose will settle down. But sometimes you just have to plug along. Phobos clearly hasn't reached a dose that will have an effect on his numbers. Lantus is a "depot" insulin that leaves some of itself as a "reserve" in the cat's body. We call this the "shed". Every time you change the dose, the shed needs to recalibrate itself so that the size of the shed will compliment the size of the dose. This recalibration can take a few cycles (and, when beginning Lantus it takes about a week for the shed to establish itself, so some of the insulin is going into establishing the shed, rather than going straight to work on the blood glucose). When blood glucose numbers go up (instead of down) after you have increased the dose, this is a temporary phenomenon we call New Dose Wonkiness (NDW). It usually only lasts for a cycle or two. The shed is recalibrating itself to the new dose.

Bubbles: 1) work the plunger back and forth to loosen it up. 2) push the plunger all the way in to expel any air in the barrel of the syringe. 3) still holding the plunger all the way in, insert the needle into the insulin vial or pen. 4) slowly draw about 1 unit more insulin than your dose. 5) remove the syringe from the insulin vial. 6) flick the bubbles to the top and try to get them into one large bubble. 7) center the bubble (as best you can) under the needle. 8) with a quick, deft, pull-and-push of the plunger, expel the air bubble. 9) twist (rather than push) the plunger until you arrive at your dose (twisting is slower and more accurate than trying to push the plunger).

Good luck, and welcome to L&L!

Ella & Rusty
 
When we had problems with bubbles, I'd pull up China's dose and before trying to remove the small bubbles, I'd draw MORE air into the syringe so there was a bigger air bubble...then I'd tap the syringe so the smaller bubbles would go to the top (into the bigger bubble)...then it seems to be easier to expel the whole "big"air bubble.

Sometimes you just have to keep playing with it until you find something that works though! I know at the price of insulin, it's really hard to see even a drop or two "wasted"

Good luck with the dosecrease!
 
Thank you both for your replies! I've read through all the stickies for information, but there's so much that it doesn't always stick and make sense, so I appreciate you both going through my questions.
Ella - Thank you for the detailed explanation. No, he doesn't have any other health issues that we're aware of. So, hopefully, after yesterday's NDW, we should at least see some lowering of his numbers, right? Today's already looking better, so that's a relief. As for the bubbles, that's pretty much what I've been doing, but I'll try pushing the air out faster and see if that makes a difference.
Chris - That's a different way of dealing with the bubbles! Makes sense to me that a bigger bubble would be easier to dispel, since you're not trying to center it under the needle. I'll definitely give it a try.
 
Hopefully, you'll start to see Phobos' numbers getting out of the higher ranges soon. I do suspect, though, the descent into yellows today may trigger a bounce. Phobos' dropped almost 250 points by +6 and that big of a drop for a kitty that's been used to hanging out in the 400s and 500s could easily cause a bounce. I you notice on your SS, every time Phobos drops into the 200s, the numbers spike back up for several cycles. Be patient! If it occurs, you'll want to let the bounce clear before another increase.
 
Hi there :cool:

Looks like the 2u is showing some action!
Hang in there and hang in here - patience will prevail :cat:

eta - if you are not already doing so be sure and test Phobos urine daily for the presence of ketones :cool:
 
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One kind of funny thing about diabetic cats and Lantus, at least, is that sometimes it seems like you go up in dose but you don't really see the BGs come down much until you hit a sweet spot in the dose and suddenly, the whole range of blood sugar will drop. You just want to be methodical and follow the protocol and keep increasing on time. Don't linger on a dose that's not getting him into greens. He'll get there!

If you want help figuring out if it's time to increase, just ask. Sometimes it's hard to tell when you're new if a cat is high because they are in a bounce or if it's because they need more insulin. If you want more of an explanation about a bounce, take a peek here.

If you are happy with your testing schedule, carry on, but if you'd like to test a little less while he's high, you probably could. One thing you can see that Sienne was referring to - notice that your yellow streak today was almost exactly 3 days after the last yellow streak. A bounce can last as long as 3 days - which is what Phobos just did. So he got into the 200's 3 days ago, his body reacted to it as being "too low" for what it's gotten used to, and it sent him back high. He stayed in high numbers, bobbling around some, but still being mostly high, and then when it cleared he got back into the 200's again.

What this tells you is that this dose is capable of getting him at least into the 200's. Since you just increased to 2.0u you want to give it the full 6 cycles before you increase again. Unless you see some lower numbers when he clears the next bounce, you'd want to hold this the 6 cycles and then increase by 0.25u - I've bolded the part below that would apply to Phobos at this phase right now. If he goes lower in the next 3 cycles at 2.0, then this might change.

Hang in there! It gets infinitely easier and you'll see more progress before long.

The TR Protocol 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.
 
Thank you to the rest of you that gave me encouragement and information. Yesterday's numbers were slightly promising, so that was nice to see. Of course, today he bounced, but I'll go ahead and keep holding at this dose for a bit and see if the higher numbers will clear. How will I know he's done with a bounce?

I finally found some ketone test strips today, so I have them on hand. What's the best way to test, though? I rarely see him head to the litter box, so it'll be hard to catch him. And, he squats real low.
 
Here are some Urine Testing Tips

Bounces can take up to 6 cycles to clear, so you just watch for the numbers to start coming back down and staying there. Some cats will "wobble" a bit before they actually clear the bounce

My personal opinion is that you could go ahead and take him up to 2.25 ...This may be a bit of a bounce off the yellow's, but he's still running pretty high. You test enough to keep him safe.

Maybe give him another cycle and see if he comes back down, but you don't want to hold a dose too long that's not getting them where you want them to be or you'll risk developing glucose toxicity.
 
tomorrow will be the 3rd day after the last streak of yellow numbers. He should clear this bounce either tonight or tomorrow. If he hasn't shown you some green by tomorrow at pmps, I'd increase the dose by 0.25u.

you'll get the hang of seeing what it looks like when a bounce clears before long. It can take a while to figure it out. Most of the time when a bounce clears the BGs will end up somewhere near the range they were in that caused the bounce.

by the way, would you start a new post when you post again? We suggest people do a new thread (or condo) daily so that the current information easily found.
 
I do what Chris does with the sucking in a little air after I've drawn the dose and I never end up with air bubbles in the final product
 
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