3/9 Shay AMPS 374 (1.25), +5 285, +9 235

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kmskali

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Hi everyone, So, Shay's number are ridiculously high. He was never this high consistently when he was on PZI. I'm really trying not to be freaked out, but I just cannot keep him high as he does have a history of ketones. Please help! Last night his +9 was 305. He ate a small dinner at +9 and then I checked him at +12 (his pmps) which was 374 ... gave 1.25 units. I figured it would take a couple hours to see any movement, so I rechecked at +2.5 and he was at 475!!!! I re-checked at +5 and he was at 440. This morning at +9 he was at 370. I fed him a small breakfast and at +12 (amps) he was at 374 ... gave 1.25.

This is now his 4th day on Lantus ... his 7th dose. Shouldn't he be getting lower at this point if this dose is working? Do you think I should bump up to 1.5? FYI, his average dose on PZI was 2-2.5. Is there anyone else out there reading this that made the switch from PZI to Lantus? If so, what do you think? I'm leaning towards bumping up to 1.5 for the next 6 doses to see what happens. Should the shed be built by now?

His food schedule has been the same for the past 4 years ... feed at 5am/5pm ... shoot at 8am/8pm. I'm considering a change and here's what I'm thinking: Give a small meal at +9 (5am/5pm), shoot at 12/12, give a small snack at +6 (I could even give a small snack at +3 at night .. right before bed). This way, he's getting smaller, but more regular feedings. What are you thoughts?

Any advice would be greatly appreciated.
 
Re: 3/9 amps 374 PLEASE HELP!!!

ok, first take a deep breath and calm yourself down! :lol:

Can you add your kitties name to your subject line so we know who he is?

whats your schedule like today for this cycle?
if you're home, grab a couple of spotchecks, we'll have someone take a look at your info and spreadsheet thru the day, so take it easy and dont panic ok?

yes a snack at +3 is fine. smaller meals spreadout is very good. except after +10 :lol:

others with dosing experience will be along to advise.
 
Re: 3/9 Shay amps 374 PLEASE HELP!!!

by the way, nice job getting checks in last nite. :thumbup

will u be able to check for ketones today?
 
Re: 3/9 Shay amps 374 PLEASE HELP!!!

Yes ... man, if he gets ketones I am really going to be bummed. He hasn't had them in 4-1/2 years. We had a little talk at that time and decided it was just not a good idea to get those again. I am the expert, however, at giving sub-cutaneous fluids and getting him out of dka at home. I had to learn that after spending $7500 in emergency room visits during his first year post dx.

Are there people reading this that just haven't had success on Lantus after making the switch from PZI? Shay was on PZI for 4-1/2 years and never had ketones. His numbers were not perfect, but atleast I knew I could get him down into a good range within 1-2 hours post shot. Would it be better for me to change him to the Prozince instead of Lantus? Please help me to make sense of this ... I am going on 2 hours of sleep.
 
Re: 3/9 Shay amps 374 PLEASE HELP!!!

Hi Kate,

This is the hardest part. The Beginning. It will get better and the combined wisdom of the many people here who know the data so well will get Shay to a good place quickly.

Lantus is a different animal than PZI, so I think it takes a new way of thinking I never used anything but Lantus myself, so I am going on what I've seen people here say. But, when Lantus gets into gear and works, it works so well for so many kitties.

And I'll go do the no-ketones chant for you if that will help. :)
 
Re: 3/9 Shay amps 374 PLEASE HELP!!!

Might help you to read thru Jay/Frankie's thread, he just switched from PZI

viewtopic.php?f=9&t=8533

All I can tell you Kate, Lantus needs you to be patient, you need to give it a chance, I have heard it is very hard to be patient coming off PZI, and you will hear this often.

Hang in there ok? Remember, deep breath, calm and patience.
 
Re: 3/9 Shay AMPS 374 PLEASE HELP!!!

Thank you ... that will help. I chant it all the time, if not out loud, mentally. He was so sick and so sad during that time and it would break my heart to see him in that state. He's such a good boy :razz:
 
Re: 3/9 Shay AMPS 374 PLEASE HELP!!!

Are u ok now? A Little calmer? :-D

If you have a current spotcheck number please update your subject line

take it easy!
 
Re: 3/9 Shay AMPS 374 PLEASE HELP!!!

I won't be able to get a spotcheck until +5, but i'll let you know. Thanks for all your help. Any other people who have switched to Lantus ... please chime in. I'd love to head your thoughts. Especially those that had their kitties on PZI for years and then made the switch to Lantus.
 
Re: 3/9 Shay AMPS 374 PLEASE HELP!!!

Hi Kate:

Please remember to link your condo from the previous day to today's condo: viewtopic.php?f=9&t=8500

I think if you read the link to Frankie/Jay's condo, you will see a lot of responses from former PZI users.

You really do need to forget everything you knew about how to use insulin when you switch to Lantus. Lantus' pharmacology is very different than PZI or shorter acting insulin. First and foremost, you are not basing doses on pre-shot numbers. You are basing your dosing on the nadir -- hence the importance of getting spot checks. If you base dosing on pre-shot, you will run the risk of a hypoglycemic crisis since the effects of Lantus are cumulative. Especially this early in your use, it takes roughly 5 - 7 days to build the shed. During this time, the full amount of Lantus that you are giving is not available for use -- some is used to create the depot or "shed." This is why there is overlap between doses and you get longer duration from Lantus. It is also why you are strongly discouraged from taking an aggressive approach to dosing at this point even though you are experienced with insulin and FD. (See the previously noted condo if you want a lot of people trying to explain why aggressive dosing is such a bad idea at this stage.)

It is very good to know that Shay is prone to ketones. I'm presuming you are testing for ketones and I'd encourage you to do so on a daily basis. I think you should begin to see the numbers breaking soon. Please be patient. It will happen.
 
Re: 3/9 Shay AMPS 374 PLEASE HELP!!!

Hi Kate:
I second everything Sienne said.
Lots of information was posted yesterday re: PZI and Lantus.
Although we understand your frustration, pls be patient.
Keep an eye on the ketones and keep us updated.
 
Re: 3/9 Shay AMPS 374 PLEASE HELP!!!

Hi Kate! I switched from PZI to Lantus and what I told you the other day is true (and what everyone else has said here): it is HARD to switch. As Sienne said, the two insulins are very different. It is, in some ways, more difficult than your first insulin, because while you know more about FD now than you did then, you have to relearn everything all over AND you feel like you should just go back to the old insulin (or its new equivalent, in the case of ProZinc).

Buzz is prone to ketones, too, and I was really worried about her developing them in the early days of her Lantus use. She didn't, and I got sub-q fluids just in case (you're ahead of me on this; I couldn't even give them). I know the worry of DKA/ketones introduces another scary element to staying in high numbers. I can't tell you what to do, but I can say that I am really happy that I stuck with Lantus. It took awhile for Buzz to settle in, and people here can attest to how much I whined every day about "I'm afraid Lantus isn't working! I'm afraid she will be the one kitty that it doesn't work for and then I will have lost a month and we will be nowhere except in the 400s and I will have to start all over with ProZinc and I will feel so guilty!" They pretty much dragged me kicking and screaming into waiting it out. They were so patient and understanding about how hard it is.

The thing about a switch is that it's still a new insulin. Sure, you could go to the vet and get ProZinc (which I thought seriously about doing more than once). You would understand how it works better than you do Lantus, but you will still have to start over. ProZinc's action is similar to that of PZI, but it is not identical. If you want to read about experiences people are having with ProZinc, check out Gator and H's posts in PZI, or any of the other newer folks over there (they are all using ProZinc). You will most likely still be fiddling around with the dose on ProZinc, and Shay may still spend time in high #s while you are figuring it out.

We will absolutely support you no matter what decision you make. It's your kitty and your life and you need to do what you think is best for your situation. I really, really, really encourage you to stick it out with Lantus. From my own experience, it has evened out her cycles; she had wild swings galore on PZI, and that was the only thing with which I was dissatisfied (on Idexx). It is 2 months today that Buzz has been on Lantus, and she is down from an initial dose of 1.5u BID to 0.3u BID. And that's just her; there are lots of examples of success here.

Vent here when you need to, and understand that you WILL have frustrations and you WILL need to be patient. I finally told myself that I was giving Lantus 1 month, and I was going to be committed to it for that month. I wasn't going to waffle every day about "should I go to ProZinc, should I stick with Lantus, should I jump off a bridge?" That's not to say I didn't get frustrated and impatient. I did, every day. But I just kept telling myself that all the nice people couldn't be wrong, that things WOULD turn around.

Hang in there, okay? It will be okay. :)
 
Re: 3/9 Shay AMPS 374 PLEASE HELP!!!

Thank you all ... you really are wonderful! Just got a spotcheck on Shay at +5 and he's at 284. That's 100 down from his amps, so I am pleased. It appears that he is building his shed, but also using some to bring his numbers down. I will keep him at the 1.25 for the next 5 cycles and see how things go. I'll keep you posted.
 
Re: 3/9 Shay AMPS 374 PLEASE HELP!!!

That's great to hear that Shay's numbers are coming down.

Now I'm going to be the nasty housekeeper...

When you have a chance, please update Shay's SS. Many of us open a condo and then open the SS (yes, we do keep an eye on you!!) so it's very helpful if you keep things up to date. (It's particularly important if you have a question. It's much harder to try to sort through all of the numbers if they are in separate posts within your condo than on a lovely, color coded SS.)

If you post and ask for help, remember to edit the subject line of your first post to remove the request once you've received the help you need. A yell for help will bring people running. (For example, I inadvertently clicked on a candle icon yesterday and Gabby's condo was flooded with people checking to make sure she was OK. People here really do care.) Also, it's helpful to update your subject line from your initial post of the day with Shay's BG numbers as you accumulate them throughout the day. The line will only hold a fixed amount of information so you may not be able to list all of your testing. Dividing it by AM and PM is fine.
 
Re: 3/9 Shay AMPS 374 PLEASE HELP!!!

Thanks for coaching me on the protocol ... I have updated my ss and will continue to do so throughout the day. I will work on getting getter about the subject lines ... definitely takes some pract.

Again, you all are a real blessing and we are lucky to have each other as support as we sort through this crazy world of diabetes!
 
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