3/10 - Gryphen and Alphyne dosing (looking for advice, please!)

Hi!

I'm wondering if anyone would have a few minutes to look over the spreadsheets for my girls, and let me know what you think? My vet rarely makes dosing changes...unless I keep on her (which I do).

I had fructosamine checked at the last vet visit, and she increased the dose for Alphyne, but not for Gryphen. She said Gryphen was in the 'controlled ' range based on her fructosamine number (268). I mentioned that controlled wasnt the goal!!

Gryphen appeared...to my vet...to be going into remission shortly after starting, and she had me down to 1 shot a day. That didnt work, at all, and now her numbers are back up and all over the place.

My vet wants me to do a curve next week (she seems adverse to those also, unless I push), and then we'll discuss dose changes again. But I would like to go in to that discussion with my own plan, since I don't feel she has one (at least not a good one). This is where I'm asking for advice. She had sent me 3 different protocols, and doesn't seem to follow any of them.

Don't get me wrong...I absolutely adore my vet. I just dont feel FD is her strong suit, and I'm not willing to keep playing this game with my girls' health.

Gryphen is on Lantus, .5U x 2, and Alphyne is on 2.5U x 2.

Thanks so much!

(I should note I will shoot the full dose under 200, as I'm getting more comfortable with my girls' numbers. They bounce horribly when I do a NS. 175 is where my comfort wears off. LOL!)

 

Hi!! Welcome to the forum

I am nowhere near to being qualified to give dosing advice (we have 2 months experience with FD), but my message should bump your post higher so that the "seniors" can come in as well

I looked at Gryphen and Alphyne SS, it is very nice that you manage to take a PS (preshot) measurement every time and in the same time it must take a loooooot of work to measure 2 cats in parallel, kudos to you

Dosing decisions are taken based on the lowest value in the cycle the kitties reach regardless the PS, maybe you can take some more middle cycle measurement to get a better understanding of what their bodies are doing. What we usually do is measure Chico at +2, this will most of the time let us know if it is an active cycle or a bounce cycle (if +2 value is the same or lower than the PS, it will most probably be an active cycle, if not -> bounce). If it is active then we know to measure at least +4 and +6 to understand how low he gets.

Having more values on the SS would be very helpful to anybody here giving dosing advice
Good luck

 

Thanks so much! I'll try to get some additional mid-cycle numbers. Luckily my girls are quite mellow, but two at once is definitely a challenge! I feel like I'm constantly feeding or poking. Ha!! Great info about what could be considered an 'active cycle'. MUCH appreciated!!

 

I can imagine, we have only one and it is so time consuming, with 2 i can only imagine. It is that much more difficult since both have different insulin needs.
With the +2 you will be able to understand which one will need more measuring during that cycle and if you are lucky enough they would be alternating haha

how do you convince them to get tested? Do you have them both on the testing place at once?

 

If following our SLGS for dosing, you would reduce the dose if they go below 90. Alphyne is oh so close tonight. Maybe in an hour. If not, hold the dose. Gryphen you would hold the dose too. Normally we hold for a week, then evaluate the dose. Unless she goes below 90 before then.

 

Alphyne is a foodie, so knowing she'll get fed after, she seeks me out for her test. Mornings are easier, too, since they both sleep on my bed. I just have to grab the testing stuff before they actually wake up and move around. Ha!

OH!!!! Below 90 reduce the dose! I was so freaked out with Alphyne dropping into that range tonight...I wasn't expecting it so she got a lot more pokes. She's at 113 this morning, so hopefully she's on the right path.

Their numbers are just so all over the place! I know that happens because all cats are different, but everyone says how Lantus is supposed to be a nice, flat curve, and I haven't seen that with my girls (yet).

Thank you both so much for your assistance and advice!!

 

Haha, you're so lucky, Chico never stays in bed if we get up, it's enough one of us to make any move that he leaves immediately ))

Alphyne is doing sooo well on the 2.5 dose, even though i understand the pressure you were under i feel so sorry that you decided to give her the reduced dose. As @Wendy&Neko said their nadir has to go under 90 in order to decrease, Alphyne was so close but she still didn't go, in my (beginner's) opinion, based on yesterday's cycle only it is a good dose for her healing pancreas i am sure you will have the chance to get there and i am sure people on the forum will help guide you to make safe decisions for your kitties

Lantus's mechanism likes consistency, changing doses often will not give you the flat curve you strive for, that is why it is important to learn how to safely shoot at lower PS than you are used to. We follow TR with Chico, we have to lower dose if BG value is <50 nailbiting and a few days ago we gave Chico the same dose of insulin as usually when he was 74 at the PMPS (08/03 on the SS), it was nerve-wracking but with the guidance of experienced people we decided it was safe to shoot and as well we got advice on how to keep him in safe values after the shot

It is difficult to say yet if their numbers are all over the place or not because there is not enough data to read their progress, nonetheless i would say their numbers look standard when you will have more data filled in i am sure people will be able to advise you on dosing and if you want i can try to help you make more sense of the numbers, at least in a simplified beginners understanding.

You are doing a colossal job at managing 2 not 1 diabetic cats

 

Thanks so much! I only read the replies to the post after I tested/shot this morning, so I might have done differently if I had read them first. That's the problem with testing/shooting right when I get up, I guess!

Honestly, between the advice here and the advice from my vet, I'm not really following any protocol right now. My vet can't even decide on one, I don't think. I did insist that we do the SLGS doing for increases, though...my vet wanted to go up full units with my girls, and I wouldn't do it (plus Gryphen actually needed a decrease, not an increase). I had read enough to know that a .25U increase was acceptable, so I got my vet to agree. I cant imagine what would have happened if we raised Alphyne to 3 units! I need to read the guideline for SLGS again and try to get a better handle on it. Thank goodness people here are so great and helpful! I know my vet is trying, but...

You can see the numbers in the spreadsheet notes that my vet gave for reducing doses, so I tried to follow that, although this morning I had too much anxiety to even follow that. I knew Alphyne needed something, but I panicked. I'm much better at shooting under 200, but the closer to 100 we get, the more I panic. I had a diabetic cat 20 years ago, before any kind of home testing, and he went hypo once. I think that is always in the back of my mind, which is why I panic. We don't have an emergency vet here, which makes it worse.

Not going to lie...I am juggling 4 cats (thankfully only 2 sugarcats), and between trying to find a food everyone will eat (still a work in progress - one is very stubborn), and making sure no one eats what they aren't supposed to, and the testing, and the fluctuating numbers, and freaking out that someone is only hacking up a hairball and not going hypo, and testing for ketones, and panicking about every little thing...it is a struggle. I know I'll get there, but yikes...

Thank you again, very much!! It helps to know I'm not alone in this.

 

Don't worry, i am not giving dosing advice anyway, next time when you get a low PS value you stall without feeding and post on the forum with a question mark in front and write that you are stalling. If even like this nobody answers quickly enough, you can go on the main forum page and see who is available and you can tag them. you tag by adding the "@" sign in front of the person's nickname. It takes time to get used to shooting at lower values, we have all been there, trust me. The good thing is that we get better at it with time.

Our vet had 0 (zero) experience with diabetic cats, thank God for this forum, otherwise i would still be drowning in information without having any idea of what we are doing

Take it slowly from yesterday's cycle, it looks like Alphyne will give you a bit more work for now then Gryphen. Try to always measure both cats at +2 and decide how to go on with the measurement from there. The more information the SS will have the easier it will be for people to give advice. You chose one protocol and stick to it, i believe this is the main rule. This forum recommends 2 protocols for Lantus users: TR, the protocol we are using with Chico requires much more monitoring and pushes the cats much lower in the BG range than the SLGS, for that reason i believe it is probably better for you to stick to SLGS for a while not to add too much on your plate.

The biggest benefit from choosing a protocol this forum is recommending is the fact that almost any time you can get some advice from someone experienced who has a diabetic cat at home, real life experience unlike vet experience (which in our case was no experience at all). Plus it is rare that you can find a vet that you can call any time of the day to receive some dosing or feeding advice, when your cat is too low in BG.

4 cats from which one a picky eater? you are an angel with nerves of steel Good luck and plenty of patience, it will get easier

 

Of course the picky eater is not diabetic. Ha! So when she gets fed I have to make sure to pick up any leftovers right away or everyone else gets in to that food. I am trying to transition to all wet, but Lena (picky) snubs just about eveything. Gryphen throws up if she doesn't eat for several hours (always has) so Dr. Elsey's stays out, too.

I checked both girls at +2 this, and Alphy is down to 80! Gryphen is also down, so looks like they are both 'active'. (You have no idea how much I appreciated that tidbit!) Yes, Alphy will definitely be keeping me on my toes...wasn't expecting it to be her! LOL!!

I ran out of strips this morning, and my Chewy order doesn't arrive until tomorrow, so I ran to the vet this morning and picked up some extras. I'm all set for lots of poking! Fingers crossed!!

 

Let me tag some people to look at your spread sheet,

Alphyne went already under 90 so you should feed her a bit of food to keep her from falling any lower.

@JaxBenji @Wendy&Neko @Bandit's Mom @Gill & George @Butters & Lyla
@JanetNJ
@Hercule's mum

 

Let's see if someone will be online to help you with advice

 

For now you can describe the types of food you have for them with % carbs

We differentiate Low carb (LC) <10%
Medium carb (MC) 11-16%
High carb (HC) >16%

 

I have the following on hand:
FF pates (multiple flavors) all LC
Tiki Cat LC
Dr. Elsey's LC
Young Again LC
Orijen (most likely) MC
Friskies Treats (definitely) HC

 

Do you know the % of carbs? you can use this link to calculate % carbs, just pay attention we care about caloric distribution of carbs

 

Did you feed Alphyne anything? i would recommend measuring her again at +3

 

Dr. Elsey's is out all the time, but I just put it in front of her and she ate a few nuggets. She's acting ok. Just tested her again (+3) and she's at 77.

Looks like the Orijen is 23%, so HC.

 

Don't get me wrong, 80 is not low on its own, it is low for a +2 considering that usually cats on Lantus nadir at around +6. It is nice she has flattened out Maybe the lower dose was not such a bad decision on your side If it was Chico i would check him at +4 again just to be sure he is flattened out.

 

Will do!

Right? That's why I freak out...I dont expect her numbers to go down so fast. Leave it to my cat to be the exception rather than the rule! Ha!!

Thank you so much!

 

You are more than welcome,

the tagging function sometimes doesn't work so i am not certain the people that are tagged received a notification about it, i really hope someone will see it and will advice you on Alphyne's next dose. In my opinion if you would decide to follow SLGS then a dose decrease would be appropriate but i am not sure what her new dose should be. I believe that the low values you see today are most probably caused by the depot (which is the specific of Lantus) which is being still filled as for the dose of 2.5

 

If I get weird numbers for the PM, I will stall and post again.

Thanks again...I appreciate you!!

 

Hi, I was out. Just saw the tags. When did Alphyne eat last and what?

 

Hi! She ate about a tsp of Dr. Elsey's at +3. I will test her again in about 15 minutes.

She is behaving normally; currently sleeping in my closet, as per usual.

 

77 is a normal BG on the AT2. But feed her a little LC with every test to keep her surfing. You intervene with higher carbs only when numbers dip below 68 on the AT.

 

Great!

She's at 84 right now.

I have a security camera on the food, so I can see who is eating and when. Looks like she may have found 1 or 2 nuggets of Orijen on the floor from my other cat (did I mention she's a foodie? Ha!) But that's a guess, since I'm trying to switch everyone to Dr. Elsey's, and the Orijen is mixed with that.

The non-diabetic cats are fed on a table...looks like I need to check the floor to see if anything fell!!

Thanks for all the input! Fingers crossed for the PM shot!!

 

Alphyne has a very nice green cycle she is flattened out
@Bandit's Mom if i understand correctly bobjoh should decrease the dose from 2.5U for the PM cycle for Alphyne, would you be able to help them?

 

Yes, with that drop below 90 today, she has earned a reduction to 2.25U.

 

So, even if I get a low number, like a PM of 113 again, I do 2.25? I'm nervous! LOL!

 

I believe the right way to do it is if the value is lower than what you are used to and you still want to shoot the fool dose you have to be able to follow her more often until you make sure she is in safe numbers and doesn't drop anymore. I believe the best is for you to create a new thread with today's date and maybe measure half an hour before your shot time and if the value is too low write on the forum and ask if you can shoot the reduced dose of 2.25 - put the question mark and tag people. The half an hour pre shot would give you some time to receive an answer and you could measure a second time to see if the value keeps on dropping or rises. This information would require different intervention from your side after shooting: if the value is still dropping then you would have to make more effort to keep her above 90.

Good luck

 

Hi! I'm not going to chime in on dosing at all, you are in excellent hands already and I can't add anything to that.

However, I notice you are using the AlphaTrak monitor and with testing 2 cats, the cost must be ratcheting up. You'll probably also start getting comments about that too so I'm sharing my experience. I recently converted to human meter and I'm deciding between the Freestyle Lite and the Novamax. I still have trouble consistently getting enough blood after a month so I like the smallest blood quantity.

Freestyle Lite - strips have same design as the AT strips with "zipwick" - you get the blood on the side of the strip instead of the middle. Note the strips are not interchangeable between monitors. Monitor also needs minimum blood 0.3 microL. Strips cost around half of the AT strips.

Novamax - I got this as a ketone meter and discovered it also works as a BG meter, you just buy different strips. BG strips are even cheaper, around half of the Freestyle Lite strips. What I like about these strips is you can see the blood sucked up into the meter.

You definitely have your hands full so I imagine this might be one extra thing too many, but something to keep in mind when you feel a bit more in control! I'm in awe of you managing 4 cats, I am struggling with just 2.

Good luck!

 

Will do!! Thanks!!

 

Yes, the AT2 strips are definitely straining my wallet. I do have the Relion Prime, which I got at the recommendation of this group. Unfortunately, it erred on me...a lot...and I was getting weird numbers that made no sense to me (ex: a 186 and 115 on AT2 were both 122 on the RP). So, for now Im sucking it up and dealing with the wallet drain. I hope to switch back to the RP once my girls quit bouncing all over!! It would definitely be more cost effective to switch while they are bouncing, but I may not handle the additional strain well. Ha!! Thank you for the suggestion!!

 

I didn't mention...I first had a Relion Prime and a Truemetrix. I didn't get on with either of them!! I feel like Goldilocks...and also completely relate to the comment about additional strain. I was a slow convert because of that! Good luck!

 

I'm glad to hear it wasn't just me with the RP....ha! I'll definitely check out the ones you mentioned, too...I do enjoy buying things for myself occasionally, which hasn't happened lately due to FD supplies!!

 

I believe you were correct...she's back up to 384 at +10. Boooooooooo!!

 

At least like that you won’t feel uncomfortable shooting the fool dose

starting the new dose you might get lower preshots still, just try to post here for advice before instead of giving smaller dose. The smaller preshot means that lantus does its job and keeps the kitty flat, we want that

Let’s see how will Alphyne do with the new dose and don’t fortget to try some +5 or +6 for Gryphen as well to find out how low he goes

 

Yep, back to 2.5U. No panic issues when her BG is up that high. My poor girl...she bounces hard.

I will definitely check in before reducing again!!

Thanks again! Fingers crossed!!

 

Alphyne's new dose is 2.25 units. She earned a reduction by going under 90. Remember, we dose based on how low the dose takes the cat, not the high bounces. And today's greens were from the 2.5 unit depot. Gryphen's dose remains at 0.5 units, she hasn't gone under 90.

In future, could you start a new post for new day with a link to the old one. Otherwise your post can get overlooked if they stale dated cause people won't know to look at old posts for things happening.

 

I just posted a new thread, because I was pretty sure I misunderstood that!

Thanks for clarifying!! I'll delete the new post!

 

As @Bandit's Mom said you can decrease to 2.25 due to the drop from today.

The higher value you see now is not a bounce, it is a loss of duration from the reduced dose. If you look at the spreadsheet a lot of times when you gave a reduced dose their next preshot was increased, for example 2/3 and 3/3 morning preshot was higher after not giving her any insulin in the evening.

A bounce happens when kittys BG goes much lower then the body is used to, that a "defense" mechanism kicks in and increases their BG for from 1 up to next 6 cycles. If you want to see a typical bounce, you can check Chico's spreadsheet on the 9.03 AM cycle. Chico spent in the previous cycle 12 hours in green values, which was a first for him, so his body kicked in and raised his BG for next cycle to values it felt were "safe" until the mechanism calmed down and let Chico go back down in the PM cycle.

As soon as you will have a bit more information on your spreadsheet i am sure you will start seeing the difference as well

 

I appreciate you (all)...so much new terminology to learn!!

 

Don't delete the new post, everybody creates new posts here every day, even when it is a day without any events

 

For when you will find time, here is the Official Lantus slang dictionary

 

Thank you!!!!