26/04 Frankie AMPS 10.4

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Sue484

Sue484

Member Since 2015
Hi. After consistently being high forever, Frankie's dose was increased to 5 units of Lantus twice a day. Last night he was 28.6. I woke up at 2.30am and he was 13.6 and this morning 10.4. I only gave him half a dose as my vet said below 15 do a half dose. Was that right? I'm having problems setting my spreadsheet up but will do ASAP.
 
Here's Sue's message with US numbers also, Elise:

"Hi. After consistently being high forever, Frankie's dose was increased to 5 units of Lantus twice a day. Last night he was 515/28.6. I woke up at 2.30am and he was 245/13.6 and this morning 187/10.4. I only gave him half a dose as my vet said below 270/15 do a half dose. Was that right? I'm having problems setting my spreadsheet up but will do ASAP."

Sue and Elise; to convert 'World' numbers to US numbers you (grab calculator and) multiply by 18.
 
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Sue,
Can I just clarify:
Was he 515/28.6 immediately prior to his evening insulin shot? (5 units Lantus given)
And then 187/10.4 immediately prior to this morning's shot? (2.5 units Lantus given?)
It may be that his blood glucose was still falling at that point.

How long ago did you give this morning's shot?
 
That does not sound right. How long has Frankie been on Lantus? That is a really high dose if just starting. Lantus works best when you find a dose that you can give twice a day. You need to get a ss up so the dosing advisors can help you find the right starting dose. If I'm right that you are new with lantus I"m glad you gave a half dose. It might be the right dose even. I wish I could start your ss for you but I needed help myself. Hopefully later today someone will help. It's 1:17 in the mornings here but east coast people will be around in a few hours.

I'm glad you are testing at home. The cut offs for the Alpha are different than for the human meters so it is important to add it to your signature. Until you do that be sure to mention it when you ask for advice. The Alpha reads about 30% highet than the human meters.
 
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He's been on Lantus since the start of March after being on Caninsulin for a year. He started on 3 units twice a day and was upped to 4 units twice a day after two weeks. His numbers were still high 20's early 30's. I only started on 5 units on Friday. I have the shot 2.5 hours ago and his blood is now 16.0
 
That helps as I see Frankie has been diabetic for a year. Shooting a 187 is fine. You wouldn't shoot anything under 68. She needs to decide if she is following TR of SLGS protocol. I'm fading so I need to go to bed. I was concerned at the high dose if this was a newbie. I still suspect this will be too high a dose but will have to leave that to advisors. I would at least needs ss with enough data to be of any help. I would get a +2 or +3.
 
Sue, I'm sure someone will be able to help you with your SS later.
Meanwhile you can list the blood glucose results you get. There's a bit of jargon that I'll explain...
The test prior to the morning insulin shot is referred to as 'AMPS' (am pre-shot test). And the test prior to the evening insulin shot is 'PMPS' (pm pre-shot test). We then say how many hours after the AMPS/PMPS a test was done. If one hour after we call it '+1', if 2 hours later '+2' etc. That's because we're all in different time zones and the 'hours' system' is 'universal'.

So, the data we have so far is:

25/04
PMPS: 515/28.6, 5 units
+8.5, 245/13.6

26/04
AMPS: 187/10.4, 2.5 units
+ 2.5, 288/16
+4.5, 507/28.2.
.
 
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Hi Sue,

That was quite a big jump up in 2.5 hours (from 10.4 to 16). I'm wondering if Frankie had actually dropped lower than that 10.4... How long after the evening shot did you get that 13.6?
 
Sue484 said:
That [13.6] was 8.5 hours after evening shot.
Click to expand...

Hmmm... It'll be interesting to see if the blood glucose is still on the rise, or whether this morning's shot is starting to bring it down.
It may be that whatever happened between the 13.6 and and this morning's 10.4 has triggered a bounce. And if the numbers continue upwards then that could certainly point to that.
I know you got a test at +2.5. Is it possible to get another one at around +3.5 - +4...?

Bouncing can be triggered by the blood glucose dropping too fast or too low. "Too low" doesn't necessarily mean 'dangerously low' (ie hypo territory); it can also be triggered if the blood glucose is dropping lower than the cat's current comfort level. Cats that have been in high numbers for a time can get used to that, and they can need to 're-learn' what is normal.

I'm also wondering whether the jump up in numbers this morning could be caused by a food spike. (Is Frankie on the Royal Canin diabetic food? I'm not sure of the carb content of that and will go and look it up.....)
.
 
+4.5 the reading is 28.2. He had one pouch of Royal Canin diabetic and a few Purina DM kibbles before his shot this morning.
 
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Crikey, that does look like a bounce!
Here's a recap of the data so far (from last night and this morning).

25/04
PMPS: 515/28.6, 5 units
+8.5, 245/13.6

(bounce triggered somewhere between this last test and the AMPS...?)

26/04
AMPS: 187/10.4, 2.5 units
+ 2.5, 288/16
+4.5, 507/28.2
+7, 579/32.2
+8, 588/32.7
 
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Seems like Frankie's numbers are levelling out now, Sue.

That does look like a bounce to me (possibly 'aided and abetted' by the Royal Canin food).

If it is bouncing, then it may be that lowering the insulin dose could help level things out.
I don't use Lantus and so can't advise on Lantus dosing (I use PZI insulin).
I'm hoping that some experienced Lantus folks will be able to give you some advice on dosage soon.

And regarding food, most of us just feed our cats ordinary low carb wet food. The prescription foods are pricey and tend to be too high in carbohydrate.
We recommend that cats are fed a wet/canned diet that has less than 10% of calories from carbohydrates. However, reducing the carb content of the diet can reduce the blood glucose quite a bit in some cats, so (assuming you might want to switch foods) it may be best not to do this at the same time as working out what the current insulin dose is doing for Frankie. Sometimes it's better to do one thing at a time... Alternatively, it might be possible to change the food if you also reduce the insulin at the same time; but only if you are able to monitor the effect on Frankie's blood glucose. Let's see what others think...

You may get more eyes on this thread if you edit your title to include something like 'dosing advice needed' (and there is also a little '?' icon you can add if you want). To edit your subject line just look at the top right hand corner of your first message and you'll see 'thread tools'. If you click on that you'll get the option to edit your title.

FYI: There is a fledgling list of suitable UK foods (if you want to switch). It's not exhaustive but it is a pretty long list and is growing. It's currently still in the draft stage. This post tells you how to access it: Food Forum, Anyone?


Eliz
 
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I am under the RVC so they say to stay on this dose and food for five days and do a curve. 3 and 4 units were too low for him so we need to give this time for his body to adjust. I work full time and leave straight after his morning dose and am back just before his evening dose. After the curve I will bring the food subject up.
 
Hi I came back after about 4 hours sleep to see how things are going. You would want to read the SLGS protocol based on your testing. I understand that you are gone all day but there are ways to make things easier for you. If you can get a +1 or +2 before you leave for work it will give you an idea ow what might happen while you are away. Many use auto feeders set throughout the first 6 or 7 hours as small meals seem to help level them out. If you can get a +2 at night and one before bed that would help and ideally some mod cycles at night. Those night cycles helped me realize that Max was dropping at night and triggering bounces which could have led to him getting too much insulin. Many cats like my Max drop lowest at night even though he gets fed at the same points. That is why I was up at 1:30 a.m. When I saw your post.
 
I can't do a +1 in the mornings as I leave straight after his dose at 7am. I can do the evenings though. Plus I have several cats, so doubt he would get to the feeder in time with his legs.
 
Hello and welcome from another person who uses the mmol/L readings.:) Getting that spreadsheet set up will really help us help you.

Are you part of the RVC remission trial? My understanding is that they like to have you follow their food and dosing suggestions. If not, the two things that I'd recommend changing are the food and how dose increases are done. Feeding low carb wet food is the best thing for diabetic cats. We use autofeeders here to spread out the meals if you are gone during the day. Or multiple feeders if multiple cats, or just leaving several bowls out with watered down wet food to keep it moist. However, I'd only change to all wet food when you can carefully monitor. We had one member here that thought her cat wasn't getting any dry food, decided to remove it from the rest of her cats diet, and her cat went from 5.5 units to zero in a couple of very long days of monitoring to keep him safe.

Next is dosing - we make dosing decisions for Lantus (and Levemir) based on how low a particular dose can take a kitty. For doses under 5 units, that means increases of .25 units most of the time. If following the Tight Regulation Protocol, then increases can be as high as .5U if nadirs (low points) are above 16.1/300. With dose increases of 1 unit at a time, it's easy to bypass a good dose. Even on doses above 5 units, we don't increase by more than .5 unit at a time.

It is possible that Frankie is just one of those cats that needs more insulin. Was he tested for acromegaly by the RVC? My Neko has acromegaly and got up to 8.75 units. Research by the people at RVC shows that 20-25% of all diabetic cats have acromegaly.
 
Sue484 said:
I am under the RVC
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Hi Sue,

There are a couple of other members here who are involved in the RVC trial. Cassandra's kitty, Angel, went into remission and is still doing well. Sarah is a new member here and her kitty, Edgar, has only recently started on the trial. Are you in S/E England?

Eliz
 
tiffmaxee said:
The Alpha reads about 30% lower than the human meters.
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Hi guys, someone correct me if I'm wrong (or doing this backwards), but I always thought the Alpha Trak read 20-30% higher than the human meters. The following quote is from Roomp & Rand:

"If a serum chemistry analyzer or plasma-equivalent meter calibrated for cats is used (eg, AlphaTRAK from Abbott Animal Health), increase the target blood glucose concentration by about 1 mmol/L, 18 mg/dL, or adapt the normal range reported for cats as the target nadir glucose concentration (eg, change 3–4 to 4–5 mmol/L, change 54–72 to 72–90 mg/dL)."
 
Hi. yes I'm in London. I'm not part of the trial as they only take newly diagnosed, uncomplicated cases. I did ask and was told he was not suitable. He is under the RVC for his heart and was also referred there because my vet thought he was insulin resistant. He has has the test for acromegaly which came back negative and also a CT scan. There is no underlying health concern. At the moment, they are looking at food as that is the only reason left apart from him being a kitty that needs a lot of insulin. I am hopeful that his feeding regime and dose is on the right road because of lis low ish number this morning. I have just tested him before his meal for his evening shot and it is now 29.4. Let's see what the 5 units do tonight. I will certainly test at +2, before bed, if I wake up in the night and +11.
 
Thanks for all your help and advice. I was a state when he was first diagnosed but soon adjusted. Now I get in a state when his numbers go low!!!!
 
Sue484 said:
Now I get in a state when his numbers go low!!!!
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Haha! I remember that feeling so well.... Lower numbers can come as a shock when you're used to only seeing really high ones! But you will soon learn to get more comfortable with them, and indeed to welcome them... ;)

Sue, since you're in London you may be interested in this thread (no advice here at all, it's social stuff...):
London and S/E England Lunch, Anyone?
.
 
Good to hear on the acro test results! One less thing to worry about. Other common reasons for needing more insulin, besides food, are needing a dental, hyperthyroidism, and heart issues. Sounds like he's had recent blood work.

Frankie's AMPS number this morning was encouraging. Over time and with more data you'll be able to shoot full dose into lower numbers, with help from people here. But we also suggest people new here show caution around 15.0 (around 200 on human meter). Half dose today was fine to do, but it probably contributing to his numbers today.
 
H. Looks interesting. I have a few things coming up but will speak to the other half and see if we can make any dates. I will have to be back for 6pm though to inject Rom and Frankie.
 
Ella & Rusty & Stu(GA) said:
Hi guys, someone correct me if I'm wrong (or doing this backwards), but I always thought the Alpha Trak read 20-30% higher than the human meters. The following quote is from Roomp & Rand:

"If a serum chemistry analyzer or plasma-equivalent meter calibrated for cats is used (eg, AlphaTRAK from Abbott Animal Health), increase the target blood glucose concentration by about 1 mmol/L, 18 mg/dL, or adapt the normal range reported for cats as the target nadir glucose concentration (eg, change 3–4 to 4–5 mmol/L, change 54–72 to 72–90 mg/dL)."
Click to expand...
OMG, thank you for catching that typo. Another reason that it was smart to refrain from making suggestions. :oops: Sorry.
 
tiffmaxee said:
OMG, thank you for catching that typo. Another reason that it was smart to refrain from making suggestions. :oops: Sorry.
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(((Elise))), no need to be sorry. Crikey, you needed sleep. Be kind to yourself, girl!!!
I missed something yesterday (and have done so many, many, many times (more than I care to remember actually...). I usually blame it on 'blonde moments' but it's probably unfair to blame my hair.....:rolleyes: However, the beauty of this place is that it is public and therefore peer-reviewed. So someone else will pick up whatever we miss.
...Loving this forum..... :cat:
.
 
just want to add my welcome!

You'll find that more people will be able to help you if you get the spreadsheet going and "speak" in US numbers. This forum has members from around the world and those two things serve as our "common language."

I'd second the suggestion to put AT in your signature line - preferably the first item since it is extremely important for anyone helping you to see it. Many people also add it to the name of the spreadsheet when it's made, so your spreadsheet could be called "Frankie - AT". You'll find it infinitely cheaper to get a human glucometer instead - the strips are perhaps 1/4 the cost as those of an AT.

Glad you're here! Keep asking questions and we'll be glad to help you learn how Lantus works and see how to use it with your sweet little Frankie!
 
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