3/19 Chester AMPS 61 (!!??!!)

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MaryB & Chester

MaryB & Chester

Member Since 2012
Chester's bouncing all over the place. Our vet has me working on a sliding scale for his low numbers. We both know that's not really how Lantus works, but it seems preferable to skipping shots altogether. Anything over 200 gets a standard 2.5 U dose. Anything between 175-200 gets 2.0 U and anything from 150-175 gets 1.5 U. Anything below 150 doesn't get a shot at this point. Then I bring him back up to his regular dose 0.5 U at a time.

So last night at PMPS, he gave me a 300+. OK. Fine. This morning, he's reading 61. 61? How low did he get overnight? But he seems fine. Happy, bright-eyed and bushy tailed (as my dad would say). No shot this morning, that's for sure!

I wonder sometimes if he's cycling long...
 
The only real problem with dosing on a sliding scale with Lantus or Levemir is that it isn't the shot that you are giving that is effecting that days BGs, it is a cumlative effect from the shots before it.

Perhaps Lantus just isn't the best insulin for him if he seems to need a sliding scale. Have you ever considered talking to your vet about switching him over to Prozinc? That way you could use the same sliding scale that seems to be working for him and not have to worry about the cumlative effect of the shed coming into play, as well as if you use the conversion chart and your same U100 syringes you can make smaller adjustments more easily.

Just something to think about...Lantus isn't always the perfect insulin for every cat, I know it wasn't for Autumn, she does much better on Levemir. But if you already think Chester is cycling longer on Lantus then Levemir wouldn't be the way to go..since it tends to have an even longer cycle. But Prozinc might be something to consider.

Mel, Maxwell, Autumn & The Fur Gang
 
How would you suggest handling numbers like
AMPS: 338
PMPS: 143
AMPS: 491
PMPS: 151
AMPS: 493
PMPS: 110

I know I need more in-between data than I have. Still working with my husband to get regular lunch tests. Some days, one of us remembers...The in-between data I do have so far kinda indicates that, when he gets his shot, he's getting down to regular numbers. I think that means we don't increase the dose yet. Still waiting to hear back from the vet about our mini-curve. I just don't know how best to handle numbers like he's giving me.

I'm not sure I really want to switch insulin...unless that's what's best for Chester. I keep thinking the Lantus will settle in and start giving us nice bell-shaped curves that we can work with.
 
The only problem that I see with waiting for the Lantus to settle and give you that nice bell-shaped curve is the sliding scale. It doesn't give any one dose time to settle and be able to give you a typical Lantus curve.

Think of it like a funnel where you want to find a nice steady stream of water going into the top of the funnel so that the level of water at the top of the funnel stays even and the flow of the water coming out to bottom of the funnel is also staying at the same velocity. But when you use a sliding scale with Lantus sometimes that water going in is big stream and sometimes its just a trickle, and the same with the water coming out of the bottom of the funnel. You are constantly building and draining the shed so it can't settle and tell you what the true dose is that Chester needs.

Mel, Maxwell, Autumn & The Fur Gang
 
So what should I do with those low numbers? I know some people shoot low to stay low, but I'm really not sure about that When 2.5 U can bring him from 400+ down to double digits, I'm not comfortable giving him the same 2.5 U when he's at 130+. I guess that's my anxiety creeping back up. Especially at night. I take medication in the evenings that makes me sleep VERY soundly, so I wouldn't have any idea if he was in trouble until I woke up, which might be too late. Maybe if he can switch cycles and give me high numbers at night, then low in the morning so someone can be awake to monitor him all day...I wish I had more confidence in my vet. I wish I could be home to monitor and test Chester whenever I wanted...

I don't know how you guys manage this. I know I'm being stubborn and fearful. I don't know how to get over that.
 
MbMinx said:
So what should I do with those low numbers? I know some people shoot low to stay low, but I'm really not sure about that When 2.5 U can bring him from 400+ down to double digits, I'm not comfortable giving him the same 2.5 U when he's at 130+. I guess that's my anxiety creeping back up. Especially at night. I take medication in the evenings that makes me sleep VERY soundly, so I wouldn't have any idea if he was in trouble until I woke up, which might be too late. Maybe if he can switch cycles and give me high numbers at night, then low in the morning so someone can be awake to monitor him all day...I wish I had more confidence in my vet. I wish I could be home to monitor and test Chester whenever I wanted...

I don't know how you guys manage this. I know I'm being stubborn and fearful. I don't know how to get over that.
Click to expand...

Hi MB,

I went with the stall approach and waited an hour or so to see if the BG was rising and generally that let me shoot at +13 or +14.
Granted that wouldn't work for me if Jez was low in the am cause I shoot right before I leave for the office....but I was lucky enough that she tends to run high in the morning. And maybe you could test right before you go to bed to try to get a bit more data. You say you sleep really soundly because of your medication, but if you can hear the alarm - maybe occasionally set it to catch a +5 or 6 at night -that's the equivalent of doing it during the day. I do weekend curves and its made me feel a lot more comfortable in terms of having a good sense of how my cat reacts to Lantus.....but you really don't have any curves up there at all to tell you what happens over the hours after Chester gets his shot.

Good luck whatever you do,

Em
 
Are you using the Young Again Zero Carb dry? I saw it noted on your spreadsheet but not sure if you are still using it. I used it too to get my stubborn cat into remission (she's afraid of wet food... long story...and no I don't recommend it over wet). I know there are not many of us on the board who have personally used this product so thought I would chime in. When I switched to YAZC in mid-December, Ninja went from needing 4.5 units of Lantus down to .25 within 12 days. I had to reduce her dose daily to keep up with the rapid drop (see our spreadsheet below -- around mid December). Her last dose of insulin was Feb 9 and she continues in remission (BG of 66 today). Vet appointment last week and Ninja got the all-clear.

This YAZC is the only dry commercial cat food (in my experience) to metabolize as a low carb food in a cat's body. At least that was my personal experience (not sure of anyone else). I tried Evo dry low carb prior to the YACZ and BGs stayed high. But as soon as I switched, the BGs fell as though I was transitioning Ninja to wet.

In any case, I am wondering if the switch to YAZC (if you are still using it) resulted in a reduced need for insulin, and the 2.5 units is just too much for your cat now (BGs swinging from high to low). When you switched to Young Again Zero Carb on Jan 17 from the Young Again 50/22 variety (the 50/22 does not help to lower BGs according to the manufacturer and is more like traditional dry food), you were giving 2 units of insulin. Now you are giving 2.5 units. Again, my experience in switching was that I needed significantly less not more. I am not making any recommendation here, and would defer to more experienced guidance on dose. Just relating my personal experience with YAZC and the need for rapid reduction in dose - and wondering if this could be a factor in the BG volatility.
 
I am feeding YAZC, in addition to Chester's daily cans of Friskies.
We increased the dosage because, in my vet's opinion, Chester's nadir number was still too high. Now he's just bouncing around like a rubber ball. We want to get some more mid-cycle tests...We got a morning shot today (500+!) so i asked my husband to do a couple of +4 & +8 tests. Probably need to get some early-cycle and late-cycle tests, too.
 
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