2/9 Buzzy AMPS 201; 2.5U; +4 193; +8 128; PMPS 84 (another skip) dosing help (Promise to listen now)

toomanycats

toomanycats

Active Member
Hey all - all info is in my spreadsheet below.

Quick rundown:
Edit to add: Buzzy weighs 12 pounds
Started insulin (Lantus) 2/7
He eats canned low-carb food only now, but only transitioned to this 2.5 weeks ago; I'm switching him currently from DM to Fancy Feast, which is even a little lower in carbs

2.5 units was what I was told to start him on.
He had 2.5 units 2/7PM & 2.5 units 2/8AM before I got a gluose meter.
He read 109 at insulin time yesterday PM (2/8), so I did not shoot.
After 90 min (+food), he was still reading 120.

Here we are, it's morning time, it's insulin time, and here's his reading:
201

WWYD?
 
Well...I had to make a call as time was out and I needed to dose.
I decided to "trust my vet's dosing" and gave him the 2.5 units. I'll test throughout the day to see how he does.
Please don't hate on me too hard.
 
toomanycats said:
Well...I had to make a call as time was out and I needed to dose.
I decided to "trust my vet's dosing" and gave him the 2.5 units. I'll test throughout the day to see how he does.
Please don't hate on me too hard.
Click to expand...

Hi there :) Well done on checking BGs at home

2.5 units is a big starting dose for a kitty that weighs 12 lbs. My cat is 13 lbs and we started at 1 unit- held that for a few weeks until we needed to reduce it.
If you are able to grab some test during the cycle...maybe 2-5 hours after you give the shot so you can see how low the insulin ends up taking Buzzy's blood sugar that would be really helpful. Cats often show some lower numbers at night. It looks like you are also changing to a lower carb food...which can also lower blood sugar levels and in return insulin doses.
You have already had to skip a dose and ideally you want to try and give the insulin every 12 hours so it can build up in the system, you can read about the insulin depot here ...maybe giving a smaller dose would allow you to do so ...what do you think?

I am sure someone with more experience will be along soon to offer more advise.
 
Good Morning! Btw, what is your name?

First, let's get that title fixed up a bit. If you could please edit the title to make it look like our standard format: Like this:

2/9 Buzzy AMPS 201 - use the '?' mark drop down to add it
Then your question - help with dosing please...

It'll catch a lot of attention that way.

And as I believe we discussed yesterday 2.5 is too high of a starting dose! No one is going to hate you, but I thought we all agreed and discussed that your vet has used an old method to come up with that amount and it's too high. It would be much better if you could start with 1 unit - to see how Buzzy responds to the insulin.

Add that to the fact that you're transitioning him off of the DM - which is not low in carbs and in fact if you look at the ingredients has to much corn, wheat, etc. in it to in fact be a low carb - I think it's something like 13% which around here is considered a medium carb.

Please do test frequently today - keep posting those numbers and editing your condo - it'll push it back to the top each time you do that so that everyone who's on today and can help, will.

I personally had a very rough night (I've been sick with a nasty cold) and spent way too much time coughing and not enough time sleeping so I may not be on as much as I'd like today...
 
Welcome to the LBL forum! I'm linking your intro post from Health. (We link threads from the previous day to the current day. Unlike on Health, we start a new thread each day so your thread -- aka "condo" -- doesn't become impossibly long.)

No one is going to "hate" on you!! What I would ask is if you have a stockpile of strips and if you have high carb food at home. If you don't have any high carb food, do you have corn syrup (e.g., Karo), maple syrup, honey, etc? It sounds like the 2.5u dose was dropping Buzzy into lowish numbers. It's hard to know what effect the 2.5u will have and I want you to have the supplies you need should Buzzy drop lower than expected. Please get a test no later than +2. (Lantus onset, for most cats, is at around +2. If the +2 numbers is appreciably lower than your pre-shot test value, you may need to closely monitor your kitty's blood glucose.)

If you are planning on feeding Buzzy Dr. Elsey's or another dry food, you are only able to use Start Low Go Slow (SLGS) as your dosing method. (Tight Regulation (TR) requires a low carb, canned food diet.) There are other options such as freeze dried or air dried raw food. Stella & Chewy's had freeze dried and ZiwiPeak has air dried raw. These are both low in carbs and have some of the "crunch" factor dry food addicts like. If you opt for either of those, TR becomes a possibility.

With SLGS, the starting dose if your cat is not on a low carb diet is 1.0u. If Buzzy is eating low carb, the starting dose is 0.5u. With TR, the starting dose is weight based (initial dose = ideal weight in kilograms x 0.25). The formula typically calculates out to around 1.0u give or take. Thus, a starting dose of 2.5u is aggressive. Depending on what Buzzy's numbers look like this cycle, you may want to reduce the dose.

Please look over the sticky notes at the top of the Board and let us know what questions you have. We're here to help.
 
Sorry, the titles confused the heck out of me & I was in a rush given it was shot time & didn't see stickies. I assume updating title with each measurement, etc. is the norm then too?

So, per the 2017 food chart, DM wet pate is 6% from carbs? and the Fancy Feast is 2% ...I know we said 2.5 was a high starting dose, but I didn't know what to do this morning, and time was of the essence, so my choices were: give nothing, make up my own dose, or go w/ my vet's dose... so I gave the 2.5 honestly "because nothing bad has happened with it the last 2 times" and bc my vet told me not to adjust the dose on my own at home right now and bc the literature I read did say 0.5 units per kg was in range, so I felt it was the "right" thing to do with my limited knowledge.

I guess the good thing is, 4 hours later, he's still at 193. I'll test him again in another 4.

I do have high-carb food, treats, and corn syrup all ready to go. I have to head out and buy more test strips now since I errored out through a bunch of them yesterday...oops.

I'm sorry you're feeling so poorly, Sue -- honestly, I feel you. I'm 21 weeks pregnant, recovering from the flu, and I have a 3-year-old kiddo running around, and I literally feel like I'm dying today :arghh: which is one reason why I am SO stressed about this... I'm running on fumes & feel like I just cannot handle this - but also I have no choice.
And it's super fun dragging myself out of bed at 5am every day - unfortunately, I have no choice bc I leave for work by 5:30am on weekdays, so to keep his insulin schedule, I have to do 5am on weekends too :(
 
You have a safe number @ + 4 !! I would suggest testing as much as possible today (if it’s possible) so that you can collect data on the nadir (low point). If you could get a +6 and +8 you will get valuable info. With only 3 days of insulin the depot is not filled up yet. When it does you should start to see the true effects of the Lantus. You have some of our experts helping you - so you are in good hands. Try not to stress (haha - I know), but try !
 
Oh...also just realizing I didn't see you ask about my name, sorry Sue - Lisa - it's Lisa! We spoke on FB as well :)
I posted that pic of my meter last night w/ the 109.
 
Agree with all. If your transitioning to lower carb food AND just started insulin (depot not established yet). The glucose can really plummet. Lower the insulin and it could be with lower carb food, diet controlled.
 
He's 128 at +8.

So, not sure what I'll do at dosing time...

My plan was:
if at close to 109 like last night, skip dose & lower dosage to 1u tomorrow.
if closer to 120, drop dose to 1.5u tonight (which is the 0.25u/kg dose).

But if he bounces back up, I'm not sure what I should do. If he's closer to where he was this AM - the 200s, do I do 2.5u again? Or should I just try 1.5u for now & call my vet tomorrow and basically say "I had no choice."
 
Was 2.5u what your vet recommended ?

It’s important to find a dose that you can shoot consistently every 12 hours.

as long as there are not any ketones present I think reducing to 1.5u is best.
 
Hi Sandy - yes, well...actually, my vet originally wanted to start him on 3u, but I told her that I was more comfortable with 2.5u, so she "signed off" on that.

I think you're right - I'm going to be less anxious w/ the 1.5 and if it's not enough, we'll know soon enough, right?

So I think my plan will be if he keeps dropping to where he was last night, I'll skip tonight & do 1.5 tomorrow
And, if he comes back up before tonight's dose, I'll do 1.5 tonight & stick w/ 1.5 til we get more data.
 
He was drinking an excessive amount of water, urinating a lot, and he lost weight - I could feel his spine, and that wasn't normal, so I took him into the vet. That was Jan 24. He'd lost 3 pounds over the course of about 4-6 weeks.
They did a LOT of tests, including urine & fructosamine tests & dx-ed him diabetic then. That's when we changed his diet to the Purina DM Wet Pate food only for 2 weeks - at that point, no insulin. He was also on antibiotics for a UTI (which he still has, unfortunately)
I brought him back in this past Friday, the 7th, for a re-check, and they did the fructosamine & spot glucose test again & said he had improved, but not enough, so that's why we started insulin. I also at that point told them I wanted to change him over to Fancy Feast (mostly for financial reasons but also bc it's even lower-carb).

I don't think my vet is bad... she encouraged home glucose testing, she encouraged me to get a single Lantus pen and pull from that pen with a syringe... but her dosing was definitely different than what I've seen here. The paperwork she gave me even has instructions for adjusting dosing at home, but she did tell me not to do that right now. (Edit to add: but I'm gonna anyways 'cus I can't get ahold of anyone, so they leave me no choice)

Their protocol is for him to come back in weekly for fructosamine & spot glucose tests til he's regulated, but I think i'm going to push back on that now that I'm home testing. I just don't see a reason for it.
He's supposed to go back in this coming Friday for a urine culture, fructosamine, & spot glucose test, but I think I'm going to ask if we can hold off til Friday the 21st and then just do the urine culture & a spot glucose test only so I can compare my meter w/ theirs... Opinions on that welcome, though!
Just...finances, ya know... and also his stress levels!...and mine
 
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I should add - they made clear he wasn't in crisis. Like, he needs changes, but he's not got any neuropathy or anything like that.

My last diabetic cat (a foster cat) was SOOOooo sick by the time he got treatment - he could barely walk. And he made a miraculous recovery! But, with him, we didn't home test at all...they just did glucose curves in the office a couple of times & we just gave him his insulin (I want to say it was like 2 units) with food every 12 hours til he went into remission. So this is a whole new world this testing thing.

And my mom says with HER diabetic cat they were still doing urine glucose testing only. That was over a decade ago though.
 
Sooo y'all are right & my vet's an idiot.
His bgc just read 84 at PMPS; did a re-test on same blood to be sure (79), so obviously NOT giving insulin & holy crap can you imagine if I gave him 2.5 units right now? He'd die.
I'll test him again in a couple of hours. He IS eating mostly bc he'd kill me if I didn't let him eat right now, and I figure we're starting from ground zero now bc clearly...cleeeaarrly my vet's dose is wrong.

Soooo...who wants to help me craft a plan for tomorrow morning? Because I'm 100% ready now to NOT follow my vet.
If he's back at 200 tomorrow, should I try just 1 unit? Or 0.5 unit?
WWYD?

And what should I tell my vet RE: the weekly appointment she wants me to come in for (fructosamine & bgc spot check)? My plan was to cancel this Friday's but go next Friday (bc he does also apparently still have a UTI so they want to do a urine culture) and say NO fructosamine since I'm home testing but do 1 spot check with both theirs and my meters so we could compare meters -- or should I go ahead and do those two things THIS Friday?
 
I'd make sure whatever you decide regarding the vet visit, to take your data you've gathered with you. You definitely want to get the UTI treated, but if this recent appointment is just a spot check say no thank you. The BG reading they get will be affected by stress from being at the vets, so all you do is continue receiving dosing advice based on bad/inaccurate data.

I had a discussion with my first vet and it was not pleasant and he showed that his knowledge of diabetes was a about a decade behind the current research (i.e. vesulin was designed for cats....ummm, no), so I haven't mentioned Smudge at all to them (he's still treating a few of my other animals) and I found another vet for Smudge and her diabetes treatment. Now I have a vet with an open dialog who is willing to research so she supports the advice I'm getting here on the boards. If you find a vet willing to work with you, it's so much easier.
 
OK so I'll keep the appointment but say do the urine culture so we can treat the UTI only since, yes, I want that treated. But, I'll decline fructosamine & bgc spot check & yes I plan to call the vet tomorrow and give them a piece of my mind RE: what their dosing would've done to my cat...........

But -- to make sure it doesn't get lost in the shuffle -- what do I do tomorrow morning?

0.5u?
1u?

And no-shoot if under 200 still? Or use 150 as my no-shoot number?
 
I'd suggest you read over the dosing methods sticky. If you opt for Tight Regulation (TR) the initial dose is based on Buzzy's weight (initial dose = ideal weight in kilograms x 0.25). This usually calculates out to somewhere in the neighborhood of 1.0u. If you prefer Start Low Go Slow (SLGS) the starting dose would be 0.5u. The two approaches also differ in terms of when you take a dose reduction - if numbers drop below 50 with TR and below 90 with SLGS. You hold a dose for a minimum of 3 days with TR and for a week with SLGS.

Are you comfortable with dropping the dose as far back as either of the dosing methods suggest?

The "no shoot" number is a misnomer. If you get a lower number than you're comfortable shooting, post and ask for help. You want to find a dose that you can reliably shoot every 12 hours. Because Lantus is a depot insulin, if you skip, give a fur shot, shoot off schedule, or change a dose, it has an effect on the depot. Every time you mess with the depot, it takes several cycles for it to stabilize. Skipping has the most impact on the depot although sometimes, it's the safest alternative. With TR, you ask for help at 150 and with SLGS at 200.

Is Buzzy still taking antibiotics for the UTI? If Buzzy hasn't been on antibiotics for at least a week, getting a culture and sensitivity for the UTI is fine. If antibiotics are still in his system, you run the risk of a false negative culture.
 
toomanycats said:
do the urine culture so we can treat the UTI
Click to expand...

Is he currently on antibiotics? If he is, the culture won't be valid. He would need to be off the AB for at least a week. In the future, if the vet thinks there's a UTI, have him do the culture first and then go ahead and start a broad spectrum AB....if the culture comes back showing the AB isn't going to be effective, they can change it then without losing any "treatment" time.

toomanycats said:
And no-shoot if under 200 still? Or use 150 as my no-shoot number?
Click to expand...

Since you're still so new to insulin and testing, I'd stick with 200, especially if you can't be there to test. If you're home and can test, you could start at 150. As I explained on FB, it's not really a "no shot" number....I like to call it a "stall point" where you'd want to stall, DON'T feed and test again in 20-30 minutes. Use that time to post for help and make sure your subject line is really clear...like "STALLING..NEED HELP!!" so you get help ASAP. You can edit your subject line later after you have someone's attention.

I think I'd also start over with a much smaller dose like .5 to 1U while you're gathering data and learning more about how Buzzy reacts to both insulin and food.

You can always increase the dose in a few days if 1U isn't enough (depending on which dosing method you decide to use)
 
He will have been off of the antibiotics for 1 week by this Friday.

Oh man I don't know which method to choose...
I have some limitations...
The biggest hurdle is going to be that it will not be possible to test his blood glucose between his AM and PM doses 3 days a week (Tuesday, Wednesday, Thursday) as I will be at work - over an hour from home. (Edit to add: I will def test before insulin, just can't test at +anything in between.)

I also have to get out the door within 30 min of his AM dose, so stalling in the AM is not going to be something I can necessarily do. I'll have to make a call on my own, I imagine, most of the time...

I also have questions -- with the doses needing to be 12 hours apart, like...how do you not get into a slippery slope? My timeline is TIGHT in the morning... I can't stall for 30 minutes and then have to dose him at 5:30AM every day, it has to be at 5/5:15 or not at all basically...

That said,he's 12 pounds, so that's like 1.35, and I'm not super confident in my ability to pull quarter doses right now, so I'd probably ask we round down to 1 unit. Like literally I just cannot get my syringe to move that little idk how y'all do it, but then both protocols call for that ability...so idk

I'm also just not comfortable poking him so frequently...I'm just not...his poor ears are torn UP, and it's only been like 2 days, and we're both miserable... I'm like literally losing my mind.
 
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You can start on SLGS and change to TR later if you want to. As long as we know which one you're using, we can advise you better.

It WILL get easier to test. It's always hard at first because their ears aren't used to it and we feel sorry for them (they are our babies!!)

A little Neosporin with pain relief ointment (not cream) can help heal those little pokies faster. I know it's hard right now, but I tested China over 16,000 times and unless you were right on top of her looking for it, you couldn't tell.
 
I'm pretty sure I already stupidly used the generic version of neosporin, and I'd call it a cream... idk there's different versions? ugh. Well. That happened; I'll get the right thing tomorrow. I'm also using a 26-gague lancet, but I'll likely switch to 30 eventually.

I still think I fall somewhere in the middle here...but I lean towards TR because we've caught his diabetes, we think, within 1-2 months of it even starting, and that gives us a good chance at remission on TR
But I still would prefer to start at 1u instead of 1.25 (or 1.35...). Except for the part, of course, where I just simply won't be able to test so much due to being at work.
I can do SOME between-dose testing tomorrow (but not at the exact increments mentioned in the sticky) & definitely Friday, but I'm in the office Tues, Wed, Thurs :\

And, gosh, I mean who knows - it's possible he won't even be above 200 tomorrow AM, and I'll have to make a quick, on-my-own judgement call yet again... because doesn't delaying just lead to a slippery slope? If he's not above 200 tomorrow AM, I think I'd have to just skip so as to keep the 12-hour schedule a possibility...
 
OK as I look at more charts, etc. I'm getting so confused...

It looks like, eventually, you're giving them insulin even when their pre-shot numbers are pretty low -- like I'm seeing people giving insulin even when under 100.
Obviously that indicates "stable on this dosage," but how do you know when to do that??...to be giving insulin even when it's that low??
I'm so lost...

So if he's 150 tomorrow AM (I can be home to test), do I give him the 1u? And then as long as his mid-day tests don't drop below 50 & he comes back up to at least 150 by PMPS, I give 1u again?

...the last 2 day he's just ...kept dropping. Sigh.
 
toomanycats said:
because doesn't delaying just lead to a slippery slope?
Click to expand...

Not necessarily.....if you have to stall, you can work your way back to your chosen shot time by adjusting the times 15 minutes per cycle or 30 minutes per day. So if you stalled for 30 minutes in the morning, the following morning you could make the 30 minute adjustment back to your chosen shot time or shoot the PM dose 15 minutes early and the next AM dose 15 minutes earlier so you'd be back to your chosen shot time either way
 
I just switched my baby over to Levemir and am also working my way through a lot of the same things you are.

The main thing is you get to shoot lower numbers once the depot is fully established and once you have lots and lots of data to know how your baby responds to the insulin..

Im not there yet, and neither are you, so for now I'd follow the advice on this board, not shoot under 200, and start with a much lower dose than what your vet said.

This is a marathon and we're both in the first mile, just getting started, which means nothing is stable, nor is it going to be.

Sounds like slow is going to work best right now while you start, which is starting the dose low (. 5U) and staying for 7 days then seeing what happens.

I'm having to learn patience too.
 
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