3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post here)

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KJ & Alfred

KJ & Alfred

Member Since 2013
Hello,
I really hope to keep up in this tight regulation group. This is my first day testing and I'm very nervous. I've put together Alfred's spreadsheet, including some additional information. Hoping I'm doing this right. I have called my vet a number of times and questioned the dose but they keep telling me keep it at 3U and just watch for signs of hypo. Thanks in advance for your advice, support, etc.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

Welcome to Lantus Land!! And you're catching on quickly.

This is the link to your introductory post on Health.

I'm not sure when your +5 was but I'd suggest another test, especially if it's around your +5.5. That 60 is bordering on dose reduction territory.

I haven't had a chance to read through your post on Health (which I'll do shortly) but how did your vet arrive at your starting dose? This looks to be a high starting dose especially since Alfred is transitioning himself to low carb, canned food.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

The vet gave us a starting dose of 2U and increased it to 3U last Friday after a BG curve performed at the vet's office. I have asked the main vet three of four times (and the other vet once this morning) about this dose and questioned them about things I've read here and elsewhere. Both vets have told me that this is the right dose for his body weight and that it "gives us plenty of room" but I'm scared. I sadly do not like either of these vets and have little confidence in them (even before I found this board!) but there are no other options in this small town.

ETA: The BG curve at the vet last week contained numbers ranging from 600-200-something, which is what prompted them to increase the dose. They only did 4 tests over the day, however. He was there from 8-4 and they told me the first dose wasn't until 9am, whereas we've been on a 7am/7pm schedule at home.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

Well you found the right place here!

And seem to be off to a great start. :thumbup
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

Ok, done skimming.

If Alfred's ideal weight is 10 lbs, his starting dose on Lantus would be 1.0u. (The formula is: initial dose = 0.25 x ideal weight in kilograms). I don't know what your vet meant by there being a lot of "play" in a 2.0u dose. Frankly, it's a lot less nerve wracking to start at a lower dose and work the dose upward than to start at a higher dose and have to work down because your cat is in low numbers. If it were me, I'd lower Alfred's dose. This is particularly important because you are changing the carb content of Alfred's diet. The carbs from the dry food have, in all likelihood, been offsetting the large dose of insulin, and 2.75u is a large starting dose of insulin for a cat Alfred's size.

You mentioned that you were concerned that Alfred wasn't eating enough. A 10 lb cat should be getting around 200 calories per day.

You also mentioned to feeling overwhelmed. That's pretty much how everyone feels at the beginning of this journey. It is completely overwhelming and there is a huge amount of information to absorb. That's the bad news. The good news is that we've all been in your shoes and we understand. We're also here to help you wade through. Please ask questions. The people here are incredibly generous with their time and their knowledge. Our only goal is to help you keep Alfred healthy and safe.

If you find your strips are getting pricey, the Walmart brand is manufactured by Arkray and are available at American Diabetes Wholesale. They are among the least expensive available.

What size lancet are you using? Initially, it helps to use a wider lancet (it gives you a bigger sized poke). It may be a bit more uncomfortable for Alfred but you won't have to give multiple pokes. The lower the gauge of the lancet, the wider the pin. So, a 28 gauge is probably what you want to use. As Alfred's ears begin to bleed more easily, you can switch to a 30 or 31 gauge.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

I will lower the dose.* I have wanted to from the first day I read information here (and did that calculation) but I was scared and confused that the vet repeatedly told me not to change the dose. I don't believe 10lbs is his ideal body weight. He has been closer to 12 lbs for several years and the recent weight loss is what prompted the vet visit that got us to the diagnosis.

Does anyone know how to calculate the calories in Friskies pate? I asked my vet but she said the information wasn't available online. I am feeding him the four flavors that come in the Costco pack (Turkey/Giblets, Salmon, OceanWhitefish, Mixed Grill). He has been eating this for years, but only as a supplement to dry food. He is completely off the dry food now.

I am using the lancets that came with the Accu-Check Compact Plus meter. I tried the lancet pen but had trouble hitting the correct spot, so am now using them solo. My small town pharmacy only has 31 and 33 lancets available currently. Maybe I should order others online? I'll run out of these soon anyway.

*But what should I lower it to???? Man, I wish I had a vet that I had some confidence in!!! This is so frustrating.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

Welcome to LL, KJ! I'm sorry that Alfred has diabetes but you are in the best place. Sienne suggested 1.0u. I would go with that. Quite often, just switching over to low carb wet food will have a big effect on blood glucose.

Here is Dr. Lisa's food chart. It has virtually every food and the content.
Liz, Zener's other mom
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

Thank you all for replying. And yes, there was a suggestion of 1U (reading comprehension not my strong suit today, obviously ;-) )

So I did another test just now at +6 and it was 61. Happy to report at least his ears are bleeding and I'm only having to stick him once each time. *knock wood*
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

carbs and calories in canned food

Welcome to LL.
I'm so sorry Alfred has diabetes.. But, you have found the very best spot to be! I've included a link to the canned food list with carbohydrates and calories for quite a few foods. Take good care my dear, ask lots of questions, you'll find there's someone here who has an answer to most any question you may have. Oliver and I have been guided by everyone here since his diagnosis last Sept.
Try to relax a little. If Sienne told you to start with 1 unit, you are good to go with that!

If you have a question, put a question mark in the first post of your daily condo. There's a little circle right next to the question mark ---click in there and it'll put the question mark in your post. It will help people to know you have a question and they'll be in to help you .
again welcome! hugs to you and scritches to Alfred
mary and oliver
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

Welcome! Congratulatons on successful testing! Looks like you have some beautiful numbers right off the bat - yay! Since you're in the lower ranges, be sure to keep testing and be very diligent. Looks like Alfred could easily dip too low (below 50), which is why we test! There is a sticky at the top of the forum for handling low numbers and low pre-shots. Be sure to get a hypo kit together with high carb food, Karo, syrup or honey and always have plenty of supplies onhand (test strips, lancets, kitty treats and treats for yourself, too!). We're here with you so please keep posting numbers and ask all the questions you need!
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

Thank you. I have poured over this site since the initial diagnosis, and while overwhelming, I do recognize there is some tremendously helpful information (and people!) here. I'm very grateful. I have assembled a hypo kit and a good supply of all "the new normal" stuff as well as a folder of articles and information. I will keep testing today and as much as I can tomorrow. I have to go out of town Thursday and am fingers crossed that my husband will be able to take over without too much stress to either him or the cat!
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

In response to your question about what to lower Alfred's dose to:
Sienne said:
If Alfred's ideal weight is 10 lbs, his starting dose on Lantus would be 1.0u. (The formula is: initial dose = 0.25 x ideal weight in kilograms).
Click to expand...
There is a newer list of carbs and calories in canned food. Janet & Binky's had been the standard list for years. However, it hadn't been updated, Lisa Pierson, DVM is a vet with an interest in feline nutrition. She recently updated the food list. The Classic Pate varieties (I think that's what you said you're feeding) run about 6 - 9% carb (we consider low carb below 10% although, many of us feed about 5%) and around 171 - 187 calories per 5.5oz can.

If you haven't done so already, I'd suggest you pick up some cans of gravy-based, HC food. (This is any food that says it has gravy. I'm more familiar with Fancy Feast. Their Gravy Lovers or roasted or marinated varieties all have "gravy." It's the gravy that has the carbs.) We use this to steer low numbers if it's necessary. Most of us also keep a supply of Karo/corn syrup, honey, maple syrup, etc. if numbers are low. All of this is part of a "hypo kit."

Don't be too hard on your vet. Most vets get about one lecture on diabetes when their in vet school and it's for all species of animals. They can't be experts on everything. All we do here is pay attention to one condition in one species -- feline diabetes. A friend of mine who's an MD, PhD who was visiting and saw how this Board responds and the expertise here noted that it's possible to be an expert in one area. You have a tremendous amount of pooled expertise here because we eat, breathe, and sleep feline diabetes. Rather than be annoyed with your vet, work to get him on the same page with you. I have a great vet. She also understands that I know more about Gabby's diabetes than she does. We don't do in-office curves because Gabby is incredibly stressed at the vet's office. I refuse to have fructosamine levels run because I have more data from testing than what an average of 2 - 3 weeks of numbers could ever provide. I don't buy prescription food because the commercially available canned foods are of better quality and lower in carbs. And, I brought them the Tight Regulation protocol which is what they now encourage all of their clients to use if their cat is on Lantus. We work collaboratively. She also understands the I will do research and I don't blithely accept what she says because, "She's the vet." We're partners in my kitty's care.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60 (first post here)

Thank you, Sienne. Should I use Alfred's previous weight of 12 lbs (that's where he had been for many years) as the ideal weight in that calculation? He was down to 10lbs when I took him in 2/21 and had gained 3oz when weighed on 2/26.

I do have some Friskies with gravy which are 19% carbs, I believe for when the numbers are low as well as the bottle of corn syrup in the hypo kit.

Also thank you for helping me try not to be too upset with my vet. You are right in that they cannot possibly be experts in every area. I just had a very bad experience with them in the past with my other cat, so I'm pre-disposed to question everything they say and generally feel like they just don't care. It's unfortunate at times like these to live in such a small town without any other options. But I'm bolstered by knowing how many of you have done such research and have such experience I can tap into. It is a whole new world dealing with an illness with a pet and realizing that I can't just roll into the vet and have them "take care of everything". It's okay...I am willing to pick up the slack on this one. Alfred is a pretty sweet little kitty who occupies a large part of my heart. He's worth it.

Guess that's likely why all of us are here, right? :smile:
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

Just stopping in to say "welcome"...you're doing an awesome job. This is the best place for you and Alfred to be...the wealth of knowledge and emotional support is amazing - we're really one big family who spans the entire globe!

Keep posting as many questions as you need. And, when you feel comfortable, pop into condos (threads) for other kitties here...it will help you see what we're all up to and about.

Have a great evening and again, welcome aboard!
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

Hi KJ and Alfred and welcome to Lantus Land.

You have received tons of great information already, so I won't burden you with more. But I do want to say that we also live in a small town in a rural area and have found that it is best to deal with Feline Diabetes with the help of this Board, while going to the vet for the other things. The cumulative knowledge here is awesome. And there is always someone around to help at all hours of the day and night.

You have found a good place for Alfred. I second Sienne's advice to get one of the Arkray meters and strips from American Diabetes Wholesale. They have the best prices and they ship right away. They also have good package deals on the Arkrays. I buy all of Rusty's diabetes supplies (meter, strips, syringes, lancets) at ADW.

Good luck, post often, and whenever you have a question or a problem, post it in your daily "condo" (LL slang for the thread you start each day) and call attention to the fact that there is a question by using the ? in the subject line.

Ella & Rusty
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

The dose would be 1.25u if you opt to use Alfred's 12lb weight as his ideal weight. It's really up to you. There's no hard and fast rule here.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

I know many of you are in a later time zone, so I'll pose the question now. Should I skip the evening shot if his numbers stay down here? The last test was at +8 and was 54. I will, of course, test again. My vet said don't dose if he's below 125. If I skip, when should I test again? Do I have to get up in the night?
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

I haven't a clue what time zone Alaska is in. Marje/Gracie is usually around for the late shift. She's on Pacific time.

We usually suggest that if you're new to Lantus, that you post and ask for help if you have a pre-shot that's below 150. If you look at the sticky on Shooting & Handling Low Numbers, you'll see you have options besides skipping a dose with a low pre-shot.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

Hi KJ and welcome to you and Alfred!

I'm closer to your time zone and am usually on at night. How long ago was his +8? If you haven't gotten to +9 yet, please grab a test at that time. If you are past +9, grab a +10 and post it and I will look for you.

I'd like to look at his SS. Typically we ask that if you get a 150 or less, that you post and ask for help. He could shoot up between +8 and PMPS so let's just see where he lands.

He's very, very handsome! Where in AK do you live? I lived in Fairbanks as a child, then Moved to Anchorage after I got my M.S. degree. Met my hubby there and then moved back to Fairbanks but we've travelled all over the State.

See you in a few minutes....and again, I will watch for your next test.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

I just wanted to come say Hello and welcome. Alfred is very handsome...
That's such a nice bright picture.
You've found the best place to be and the best help there is!
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

Yes, Alaska is one hour earlier than Pacific time.
Thanks, Marje. We are at +10 in about 15 minutes, so I'll go see if I can't give him another test and update here shortly.

Also, we are in Homer, but have lived in Denali Park area and Anchorage for many years. It's a lovely state.

ETA: Okay, we're back and the +10 is 77.
I'm so happy I am finally doing this testing! Last night I was a wreck and couldn't get enough blood for one test and today I've had 7 relatively easy tests.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

I was watching for you but got stuck on another condo. Sorry!

Let's give him a break until PMPS. I'd suggest you post a +11.75 so we have a bit of time to discuss it. Let's see if he bounces or not.

Great job on the tests!

Oh yes...we've been to Homer many times. Love AK but had enough of the snow and cold.

See you soon. Let me know if you have any questions.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

One other question ... Have you decided if you are going to change doses and, if so, 1u or 1.25u?

I always recommend that you scroll back to your last post and read forward from there. Sometimes we cross post and you can miss something important.....when we are working lower numbers, it becomes very fast paced and you don't want to miss anything :-D
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

I hear you on the snow and cold! I'm lucky enough to travel often so I can escape all that winter from time to time.

But back on topic, I will wait until +11.75 (which will be about 8:45pm Pacific Time). I was definitely planning to lower the dosage. I was planning on 1.25U based on the fact that he was 12 lbs for so many year and has already gained a tiny bit of weight back from the 10lbs he was at diagnosis.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

Sounds great. I will be up still to help you. Normally I'm up until midnight if things are quiet and later if they are not :-D

See you soon!
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

Small world. My grandparents lived in Homer. I spent one summer there in High School.

Beautiful place. In the summer. Doubt if I could make it through the long dark winter. nailbite_smile

We spent some long evenings snagging flounder somewhere around there. We went fishing about everywhere.

And it is so small, I might have run into Marje if she was in town? ;-)
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

Welcome to LL, KJ and Alfred! Congrats on finding this board and for successfully poking the ear and drawing blood! I think once you get the hang of the pokes, it makes almost everything sooooo much easier! :-D GREAT numbers today and here's to hoping that Alfred likes that 1.25u!! Have a great day/night!!!
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

So at +11:45 we got a 74. I had given him about a Tbsp. of FF at about +9.5 that I forgot to mention earlier.

Thoughts on the PM shot and anymore testing tonight?
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

I'm assuming he's never had ketones, right?

I'm not a fan of skipping, typically, but I just don't think you have the data to shoot this number even with a reduced dose of 1.25u. He's had a pretty high dose and so his depot is probably large which means even if you shoot a reduced dose, he might come back down. We don't really know how he reacts to foods.

If he's never had ketones and he's healthy, I'd probably skip and start over tomorrow with 1.25u. However, if you can afford to stall, you could wait until he zooms up and then shoot 1.25u.

Normally if one of us advises you to shoot a low number, we commit to staying up with you...all night if necessary. But I'm working tomorrow and I can't stay up with you tonight.

What do you think?
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

I read the sticky about shooting with low numbers and am trying to understand the depot but I'm still a bit confused.

Marje and Gracie said:
He's had a pretty high dose and so his depot is probably large which means even if you shoot a reduced dose, he might come back down.
Click to expand...
I don't really know what this means.

That said, my very-newbie and nervous inclination is to skip tonight and start over in the morning with the 1.25u. I fully understand that you can't stay up with me. I'm not sure I can stay up with me. ;-) I haven't slept more than a few hours a night for the past 10 days.

If I do opt to skip, do I need to keep testing tonight or can I wait until early tomorrow?

ETA: Also, my vet did say to skip the shot if he was lower than 125 at shot time.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

Let me try to explain because the depot is one of those difficult concepts to grasp. Here is a great post by Libby on the Lantus and Levemir Depot.

Short course is these insulins, by different means, build a depot so the first several shots you give go towards establishing the depot and then the cat starts using the insulin in the shot you give. However, when the dose gets to be too much and they don't need all that you are giving in the injection, the depot overfills like a bucket that has too much water and then the BG drops. It takes a while to drain that depot and a depot from a larger dose can affect up to six subsequent cycles...although most cats it's probably more like 3-4.

So alot of times, if you have a larger depot, even if you reduce the dose, you don't see the depot draining much the cycle you reduce....it's seen more in subsequent cycles.

If we don't shoot, we refer to it as AMBG or, in this instance PMBG. You count hours since his last shot so +12 is 12 hours from his last shot. I'd check him again at +14 and if he's gone up alot, Id get some sleep. If he hasn't, set an alarm and check him at +17. The caveat is if you test him at +14 and he's going down....then test hourly until he's going back up. But I doubt that will happen...very unlikely. He can't hypo if you didn't give him a shot.

So feed him a good meal, skip the shot, check at +14 and go from there. You can adjust your shot time in the morning if you want to pick a new one and then shoot 1.25u. Do not be surprised or worried if he goes up high tonight, ok? He will come back down in the next few cycles when his dose is correct.

Any questions? BTW, there will be a time that you will shoot low and need to get alot of tests at night. It's our commitment to stay up with you....low numbers alone can be scary so we put on the coffee and have a pj party :-D

I will check back with you in a few minutes....ask any questions you have.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

Marje - you are giving me so much good information and support, I am eternally grateful! Thank you for that explanation of the depot. I read it aloud to my husband so we could both understand. We're going to follow your suggestions and test again at +14 and hope we can all get some sleep. We will do whatever it takes, however.
 
Re: 3/5 Alfred AMPS-176, +2-130, +5-60, +8-54 (first post he

It's tough being new....such an info dump but you will get it fast. We are here to answer your questions so all you have to do is let us know you have them. We want to help you get Alfred in remission as quickly and safely as possible.

I'm going to subscribe to your condo. So...if you get a test that worries you, just post and it will send me an email and I will pop on. Ok? It's no big deal...I do it alot and I go back to sleep.

I work tomorrow but will be around tomorrow night. Dyana and Sienne are usually on in the mornings if you have any dosing question but we also have lots of experienced members who can help, too.

Get some sleep while you can.... :-D Ni Ni!
 
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