2/22 Trixie, AMPS 151, +6 72 - Newbie Questions

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Amy&TrixieCat

Amy&TrixieCat

Member Since 2011
Hi-

I've only posted once before, but I have learned a ton from this group so far. Thank you! If it weren't for this group, I wouldn't know about home testing, and Trixie could have ended up in trouble the other day.

However, I still have lots of learnin' to do, so I have a few questions to see if I'm really starting to understand all this stuff.

Trixie's spreadsheet is in my signature, but there isn't a lot of data there just yet since we're new to this. She started on 1 unit BID on Jan 28. We tested her for the first time (at +6) a little over a week later. We initially didn't do the AMPS/PMPS thing because we were easing her into the whole routine of shots and testing. (She's actually been very helpful in making this all relatively easy for us.) Well, this past Sunday she gave us a 55 at +6, and that caught me off guard. We immediately called the vet, and started the AMPS/PMPS testing, but obviously it's only been a few days. Unfortunately we won't be able to do a full curve for a little over a week (I work retail...wacky hours.) All the info I do have is in her spreadsheet, though.

On the advice of our vet, we did not give her a shot Sunday evening (as you can see, she was 76 at +12). The vet said that as long as she's over 100, it's OK to shoot her full dose. I now wish we had her AMPS number for Sunday (and before), so we could see the trend better, but I can't go back and get it now. In any event, are the pre-shot numbers we got yesterday most likely a bounce (if I'm correctly understanding the concept of a bounce) because we skipped her shot Sunday evening? I know it's probably hard to tell that, since her pre-shot numbers from Sunday are missing, but her numbers for today are already lower than yesterday, so I wonder what tomorrow is going to hold if we continue with the 1 unit.

Does it look like she's heading towards a dose decrease? How are dose decreases determined? I've read the links, but am still a bit iffy on the info I've seen...any clarification would be appreciated. I assume decreasing her dose is better than repeatedly skipping doses, right?

I do have a phone call in to my vet to get further info, as well, but you all really know this stuff well! Thanks for any help/info/guidance!

Amy
 
Hi, Amy.. welcome to you & Trixie :YMHUG:
Great job on testing since learning the importance & Trixie is looking really great!!!
You are correct, shooting a reduced dose that you are comfortable with is very important, skipping shots does not work well with Lantus.
I do not give advice on exacts, etc. so please wait for others to come through who can advise you based on your situation. I just wanted to welcome you..
 
Thank you...and Trixie thanks you too! I'm pleasantly surprised at how good her numbers are looking. This is our first experience with feline diabetes...it has been overwhelming, but the information on this board has been invaluable. And I'm feeling far less stressed now that we're in the swing of pre-shot testing.
 
Amy: Welcome back and glad things are going so well with Trixie and you are now testing.

Gosh...your PS numbers are not that high; many of us have cats who, when they bounce, will go up into the high 200s, or into the 300s and some higher. So whether it is an actual bounce or it's just the end of her insulin and you aren't getting alot of carryover into the next cycle, I don't know and someone more experienced with that will have to answer. However, to answer your question on reductions, from the protocol:

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...

Because Trixie is a newly diagnosed diabetic (less than one year FD), then if she fell below 50, then you would reduce her dose by .25u.
You had a 55..so the protocol would say wait until she drops below 50 but you don't have alot of test data. If you follow the protocol and reduce her by .25u after she goes below 50 in a cycle and she does it again, then check with a dosing expert. Sometimes they go down the dosing ladder a little too fast and can't hold the reductions so you'll want to be sure you keep checking in with us on her reductions if she continues to fall below 50 after you reduce her. Clear as mud as Jill says? Of course, I have to stress again that it would also be good to have more data and find out where she is going after numbers like the 55 so you will know exactly how low she is going.
 
Welcome back!

Are you able to get any spot checks during the evening cycle? Many cats experience lower numbers at night. It's important to get at least a before bed test every night.

You might want to take a look at this post on how to handle low pre-shot numbers. Right now and until you have more test data, it's probably good to either skip a shot or shoot a reduced dose if Trixie's numbers are under 150. It may also be helpful to hang on to this post on managing low numbers.
 
+12 - 131. No shot tonight.

Just a brief update. I spoke with the vet this afternoon...twice, actually. The way my vet's office works was getting a little frustrating, because until today I was handed off to whichever vet happened to be on duty, and they've got quite a few. They all seem caring and pretty well-informed, but too many cooks...

Finally, one of them took charge of Trixie's case today, and I really like her. She is very pleased, yet somewhat concerned, over Trixie's numbers. She's not comfortable with the lower numbers, so she gave me a new "no shoot" number of 170. Basically, she wants to see how Trixie does on one 1unit dose a day, which I guess is why she decided on the 170. I know that's not the way Lantus is meant to work, so I mentioned the possibility of perhaps doing 1/2 unit BID. She was concerned about us trying to eyeball the half unit with our current syringes, and apparently she would have to special order the syringes with the 1/2 unit markings. (Is that the case? I'm so new to all of this.) So, before we go down the 1/2 unit BID path, she wanted to see how Trixie's numbers do on 1 unit, once a day.

Originally, she was thinking we would wait until after Trixie's fructosamine on Friday to begin creeping her dose down, but after doing a little thinking about the information I gave her earlier in the afternoon, she called back an hour later to say she wasn't comfortable waiting until then. Since she's taken such a strong interest in Trixie's case, I'm following her advice, even though I do feel slightly conflicted about shooting only once a day. We'll continue testing her "on schedule" - AMPS, +6, PMPS for several days, and the vet wants us to touch base again on Thursday (unless her numbers really skyrocket, in which case we'll be in touch sooner); at that point we'll make the judgement call about the fructosamine on Friday. She also wants us to do a curve once Trixie's settled into 1 dose a day.

Any thoughts? I can never have too much information. Thanks!

Amy
 
Hi Sienne and Celi--

Thanks...and it looks like we were writing at the same time!

That's interesting that cats can experience lower numbers at night. Do you know why that is? Yes, I'm sure we can do a spot check before going to bed (although I did promise her no more ear sticks today...)

Thanks for the links, as well. I have read, and re-read them several times (and I'll definitely re-read them again), yet I still feel like I'm in "absorbing all the information" mode.

Your suggestion of skipping her shot if she's under 150 makes me feel more secure about not giving her her shot this evening. It's funny, I'm nervous about giving the shot because I'm eternally worried about her going hypo, and I'm nervous about not giving the shot because I'm hoping she's on a path to remission...what a roller coaster.

Amy
 
Nope. The vet is incorrect. The Walmart brand, Relion, comes in half units as do any number of brands. I use the GNP brand syringe from Hocks. (FDMB gets a commission if you order by clicking the green box above.) This is their house brand. If you order by mail, you don't need a prescription for syringes.

I suspect you're going to see less than optimal numbers giving insulin only once a day. Lantus is a twice a day dose in felines. Given that a cat's metabolism is much faster than a humans, cat's require BID dosing. If you look at Gabby's SS, way back when we first started this adventure, my vet told me to switch to once-a-day dosing. I skipped one shot then ignored her. (Look at 8/22/09.) The other problem that is going to occur is that you will be depleting the depot (i.e., the shed) by dosing this way. I understand you're wanting to keep the peace with your vet but just be aware that this is not the optimal approach.

You may want to print out a copy of this journal article for your vet. It includes the formal version of the dosing protocol we use and specifies twice a day dosing.
 

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Thank you for the syringe info. I thought it seemed odd that 1/2 unit syringes would need to be special ordered. I'm glad this particular vet has taken charge of Trixie's case because she is willing to talk and work with me, but I think they're not used to having an owner who is so involved.

I will definitely share that article with my vet, as well. I've read so much about Lantus that it does go against my grain to shoot only once a day. I think my vet suspects that Trixie is being well-controlled by her diet change, and that's part of her reasoning behind the once-a-day test. I do see it as just a test, though, and if it fails, we certainly won't continue with it. The vet wants to touch base again on Thursday, so it will be a brief test...and it will be briefer if Trixie's numbers shoot up.

I'm also a bit confused, because if we don't shoot numbers below 150, then by default we're (probably) on a once a day schedule. I guess the next day or so will be the true test for it, since tonight was a no-shoot night.

So much information, so much to learn....
 
Actually, one last memory that popped into my head...lots of information swirling around in my head today. I can't believe I forgot this one.

The main reason my vet wanted to try the once-a-day dosing with Trixie is because we skipped her evening shot on Sunday, and her AMPS on Monday was still only 162. Granted her +12 on Sunday was 76, and her +12 today was 131, so I'm sure we'll see a higher number than 162 tomorrow. But that's what prompted the vet to suggest a trial of once-a-day dosing. Tomorrow's AMPS will be interesting.

Amy
 
Often when we see that a person is skipping shots routinely, we suggest lowering the dose so you can shoot BID -- exactly what you asked your vet about. Once you have sufficient data, shooting below 150 is not a problem. In fact, one of the goals of tight regulation is that you can shoot low. Once a cat is better regulated, Lantus has a flat curve.

The other thing to be aware of is that many vets will recommend keeping a cat in higher numbers than we typically encourage. Our goal is for our kitties to be in normal numbers -- 50 - 120. Most vets will consider a cat in good numbers if they are below 200.

It is also entirely possible that Trixie is responding very well to the change in diet. The best way to know this is to keep testing.
 
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