4/1/22- keykey- AMPS #498

keykey

keykey

Member Since 2022
Previous Posts: https://www.felinediabetes.com/FDMB/threads/3-31-keykey-amps-345.261411/#

Hey everybody! I'm new to the Lantus forums. I was posting on the main health forum but I was advised to come over here today. Thanks for everyone's help!

Just did my AMPS test (498) retested just to be sure (517). Fed her a little bit of the low carb fancy feast. Again, she's being picky and only eating a little right now, but I know she'll continue to graze at it over the next hour or so.

I did 0.5U yesterday morning. Idk how fast someone will advise me on what unit measurement I should do this morning, but I'm going to assume I should stick with the 0.5U? I hope I'm correct in that assumption.
 
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keykey said:
Previous Posts: https://www.felinediabetes.com/FDMB/threads/3-31-keykey-amps-345.261411/#

(Hope I did that right!)

Just did my AMPS test (498) retested just to be sure (517). Fed her a little bit of the low carb fancy feast. Again, she's being picky and only eating a little right now, but I know she'll continue to graze at it over the next hour or so.

I did 0.5U yesterday morning. Idk how fast someone will advise me on what unit measurement I should do this morning, but I'm going to assume I should stick with the 0.5U? I hope I'm correct in that assumption.
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You did it perfectly ,I don't know if Melissa is up yet
@FrostD but I would say go for the 0.5 units this morning

Oh one other thing go back to this post and say you are new to the lantus forum was posting on the main health forum
Add it above
Hope I did that right!)
 
Alright, 0.5U given at 8:40am (writing this time for my own future reference).

She just downed all the rest of her food. She walked away from it in the kitchen, because she wanted to sit by the front window and listen to all the birds. I put it in front of her and she's scarfing it down.

I'll test again in 1 hour.
 
keykey said:
Alright, 0.5U given at 8:40am (writing this time for my own future reference).

She just downed all the rest of her food. She walked away from it in the kitchen, because she wanted to sit by the front window and listen to all the birds. I put it in front of her and she's scarfing it down.

I'll test again in 1 hour.
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Great I'm glad she's a good eater , little piggy :p
 
About the dosing methods, since I know you're overwhelmed -

Start Low Go Slow key highlights:
  • You hold the dose for a week, then do a curve. Then decided whether to hold the dose, increase, or decrease. You still do the preshot testing, and whatever extra ones you can get
  • Reductions are earned any time she goes below 90
  • Target BG range is 90-150 ish
Tight Regulation key highlights:

  • Allows for faster increases...this really isn't an issue for you right now
  • Reductions are below 68 on a pet meter, below 50 on a human meter
  • Target BG range is 50-100 on human meter, 68-120 on pet meter. These are essentially non-diabetic numbers
  • Better chance of remission (honestly with her current dose and numbers I think you have a good shot at it, but it will take some hard work)
  • Testing: at minimum need the two preshots, plus one additional test each cycle . You're already doing this. But as you've seen, when they get into lower numbers, more testing is often required.
My recommendation is Tight Regulation because I think it gives you a very good chance at remission...you're essentially already doing it, just have to shoot those smaller doses/lower numbers. That said, it may mean some busy testing days and nights. And you'll have to get used to/comfortable with shooting those smaller doses.

There's also no harm in following SLGS for now until you get more comfortable with everything.
 
FrostD said:
About the dosing methods, since I know you're overwhelmed -

Start Low Go Slow key highlights:
  • You hold the dose for a week, then do a curve. Then decided whether to hold the dose, increase, or decrease. You still do the preshot testing, and whatever extra ones you can get
  • Reductions are earned any time she goes below 90
  • Target BG range is 90-150 ish
Tight Regulation key highlights:

  • Allows for faster increases...this really isn't an issue for you right now
  • Reductions are below 68 on a pet meter, below 50 on a human meter
  • Target BG range is 50-100 on human meter, 68-120 on pet meter. These are essentially non-diabetic numbers
  • Better chance of remission (honestly with her current dose and numbers I think you have a good shot at it, but it will take some hard work)
  • Testing: at minimum need the two preshots, plus one additional test each cycle . You're already doing this. But as you've seen, when they get into lower numbers, more testing is often required.
My recommendation is Tight Regulation because I think it gives you a very good chance at remission...you're essentially already doing it, just have to shoot those smaller doses/lower numbers. That said, it may mean some busy testing days and nights. And you'll have to get used to/comfortable with shooting those smaller doses.

There's also no harm in following SLGS for now until you get more comfortable with everything.
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If I'm understanding this correctly (and please correct me if I'm not)...the main difference between these two is with SLGS you pick a dose and give it for a week, and based off the data over the week you either increase or decrease the insulin...

and with TR you give a certain amount, you test more frequently in one day (than you would with SLGS), and based off that one day's data you change your units given based on that?, is that what you mean by faster increases?

I've been re-reading your bullet points, and clicked through to the pages and read them on this site, but for the life of me I'm not sure that I get it.

She's at 199 right now. Reflected in sheet.
 
keykey said:
If I'm understanding this correctly (and please correct me if I'm not)...the main difference between these two is with SLGS you pick a dose and give it for a week, and based off the data over the week you either increase or decrease the insulin...

and with TR you give a certain amount, you test more frequently in one day (than you would with SLGS), and based off that one day's data you change your units given based on that?, is that what you mean by faster increases?

I've been re-reading your bullet points, and clicked through to the pages and read them on this site, but for the life of me I'm not sure that I get it.

She's at 199 right now. Reflected in sheet.
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The main differences are the target BG range (hence the difference in required testing for safety), speed of increases, and the reduction point (SLGS = 90 regardless of meter, TR = 50 on human, 68 on pet).

Mostly correct - with TR you hold the dose anywhere from 6-10 cycles, or 3-5 days (the specific guidance is laid out in the dosing sticky). So cats in higher numbers can increase as often as every 6 cycles, but when you are seeing low numbers you hold for at least 5 days. So no, it's not just based on a single day of data.

With the numbers keykey is seeing, I suspect at a consistent dose of 0.5U she'll be seeing green nadirs - so you'd be holding this dose regardless. I suspect you'll be getting a reduction before an increase is even part of the conversation.

For most people, the choice comes down to lifestyle and desired BG range. Some people are away for work and not comfortable letting them go as low as 50/68 when they cannot be home. Some people have health conditions that make nighttime testing and broken sleep very difficult (and sometimes impossible). So you have to weigh what you as a caregiver can handle, as well as your desires for keykey.
 
FrostD said:
The main differences are the target BG range (hence the difference in required testing for safety), speed of increases, and the reduction point (SLGS = 90 regardless of meter, TR = 50 on human, 68 on pet).

Mostly correct - with TR you hold the dose anywhere from 6-10 cycles, or 3-5 days (the specific guidance is laid out in the dosing sticky). So cats in higher numbers can increase as often as every 6 cycles, but when you are seeing low numbers you hold for at least 5 days. So no, it's not just based on a single day of data.

With the numbers keykey is seeing, I suspect at a consistent dose of 0.5U she'll be seeing green nadirs - so you'd be holding this dose regardless. I suspect you'll be getting a reduction before an increase is even part of the conversation.

For most people, the choice comes down to lifestyle and desired BG range. Some people are away for work and not comfortable letting them go as low as 50/68 when they cannot be home. Some people have health conditions that make nighttime testing and broken sleep very difficult (and sometimes impossible). So you have to weigh what you as a caregiver can handle, as well as your desires for keykey.
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I’m currently a full-time student doing online classes from home, so I have the opportunity to be at home throughout the day and test often with her. I’m also willing to work with my sleep schedule, her testing regimen and dosing method, if there’s a chance of achieving remission.

The one thing that holds me back from doing everything I can, is really budgeting all of these expenses. The insulin, syringes, and new food have done quite a deal on my fixed budget. At the moment, I’m focused on picking up more test strips/buying that cheap meter you all mentioned at Walmart.

I had her blood work/urine analysis emailed to me, and I’ll upload it once I have a chance today to go it and kind of remove all the really specific personal information (rather not upload that to the internet lol). I did ask and check on the urine report, about ketones, and the report does list it as negative. This test was done on 3/22/2022, the day of her diagnosis. I’m not sure how often ketones need to be tested for while giving insulin? Let me know because if it is something I have to do as frequently as the test strips, it’ll be something I’ll need to budget for and pick up asap.
 
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I hope I'm posting these images/her blood work-urine analysis, correctly.
 

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FrostD said:
The vet didn't say anything about all those elevated values in the CBC? Even the note says consider occult hemolytic or blood loss disease. Didn't mention it?
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He didn't mention it to me, no. That was the one thing I saw when reading it myself (for the first time today) that really caught my eye. Again, I'm kind of a novice to this stuff, but a quick google search tells me that means she may be losing red blood cells faster than she can create them?

Also, I can read that comment, but what values are you looking at specifically that are related to that comment? Is it all the ones in hematology that are highlighted red?
 
keykey said:
He didn't mention it to me, no. That was the one thing I saw when reading it myself (for the first time today) that really caught my eye. Again, I'm kind of a novice to this stuff, but a quick google search tells me that means she may be losing red blood cells faster than she can create them?

Also, I can read that comment, but what values are you looking at specifically that are related to that comment? Is it all the ones in hematology that are highlighted red?
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Yes, all the ones highlighted in red. And yes, your Google is correct - at first I was thinking regenerative anemia, but the RBC and hematocrit are fine. So whatever is happening she has a lot more new red blood cells than normal.

Suzanne is much better at reading labs, I'm sure she'll be around sometime tonight or tomorrow to take a look
 
Hello and welcome to you and sweet Keykey. I just did a quick scan of your previous posts, but not sure I saw you describe how you discovered Keykey was diabetic. What were the symptoms? Any other medical conditions worth mentioning? How are Keykey's gums/teeth?

Like Melissa, I'm wondering about the CBC/Hematology values and wondering what your vet said. The higher reticulocytes (new red blood cells) can indicate a bleed or other reason the body is busily making new red blood cells. But hematocrit is nice and high, so not anaemic. Just a bit of a mystery. The MCV is higher because of the higher proportion of red blood cells that tend to be larger, so that's not a worry. If my vet saw odd numbers, she recommended a second blood work test a couple weeks later just to see if it was a testing oddity.

Chemistry values are not unusual for a new diabetic.

By the way, there is a labs tab on the spreadsheet. If you have the time and interest, it's good to put your lab results there. I really liked doing that so I could see trends over time. I even have done lab spreadsheets for the non diabetic cats.
 
Wendy&Neko said:
Hello and welcome to you and sweet Keykey. I just did a quick scan of your previous posts, but not sure I saw you describe how you discovered Keykey was diabetic. What were the symptoms? Any other medical conditions worth mentioning? How are Keykey's gums/teeth?

Like Melissa, I'm wondering about the CBC/Hematology values and wondering what your vet said. The higher reticulocytes (new red blood cells) can indicate a bleed or other reason the body is busily making new red blood cells. But hematocrit is nice and high, so not anaemic. Just a bit of a mystery. The MCV is higher because of the higher proportion of red blood cells that tend to be larger, so that's not a worry. If my vet saw odd numbers, she recommended a second blood work test a couple weeks later just to see if it was a testing oddity.

Chemistry values are not unusual for a new diabetic.

By the way, there is a labs tab on the spreadsheet. If you have the time and interest, it's good to put your lab results there. I really liked doing that so I could see trends over time. I even have done lab spreadsheets for the non diabetic cats.
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I noticed that she was drinking a lot of water, which I knew to be a concerning sign. This prompted me to take her into the vet. The only concerning things I saw were the drinking and the increased urination in accordance with. At the vet, he mentioned that she had normal tartar on her teeth, but that was something we could focus on later after dealing with the diabetes. Other than everything just listed, she has always been (or at least appeared to be in) good health. She's always been an indoor kitty, cat naps frequently...she's usually quite playful and adventurous around the house, her personality has pretty much never changed since she was a kitten. However, since being on insulin she seems less like herself. More tired and not as interactive. I'm beginning to wonder if her playful-like personality was always driven by high blood sugar?

The vet literally said nothing to me other than other than the diabetes, everything looked fine. He told me to give insulin and come back in a couple of weeks to test the blood again. I don't really have the funds to take her back right now (to be honest, I didn't have the funds to take her in the first place). I'm also considering a new vet because I'm not too pleased with this current one (I'm too tired to detail their mistakes again, they're in my previous posts).

I will definitely take a look at uploading labwork onto the lab tabs portion of this site when I have the chance. It will have to wait for the moment, because I've been seriously neglecting my school work this week while I've been anxiously trying to learn all about this stuff. School work is due Sunday so I kind of have to prioritize my worries for the next couple of days.
 
She's at 199 as of 7:25pm. I gave her her a 0.5U insulin shot this morning at 8:40am, so I'm approaching my PMPS reading soon.

If that reading is at or around 200, would I be safe in giving her another 0.5U tonight? I skipped the last two nights, mostly because I was afraid of low numbers...but with two days of data now I'm able to look at see how her numbers spike back up by the time morning breakfast rolls around. Giving that second shot would keep those numbers steady throughout the night/early morning just like they do from breakfast till evening, right?

I'm becoming more confident with everyone's help here. I have the gravy food in case she starts dipping too low, and I'll be up again quite late so I can monitor for a few good hours past the evening shot.
 
keykey said:
He told me to give insulin and come back in a couple of weeks to test the blood again
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Sounds like your vet agrees with the second blood work to see if the numbers were one time or a trend. You would only need to get the CBC done, which is slightly cheaper, and maybe the vet tech could do the draw, plus no consult. Which would make the overall cheaper.

Have you made a decision on dosing method yet? Our answer for tonight varies based on that. Once you decide, if you could put either TR or SLGS in the signature, we'll stop asking. ;)
 
Wendy&Neko said:
Sounds like your vet agrees with the second blood work to see if the numbers were one time or a trend. You would only need to get the CBC done, which is slightly cheaper, and maybe the vet tech could do the draw, plus no consult. Which would make the overall cheaper.

Have you made a decision on dosing method yet? Our answer for tonight varies based on that. Once you decide, if you could put either TR or SLGS in the signature, we'll stop asking. ;)
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You have me confused. If you change the dosing on SLGS around every week, and you change the dosing with TR every 3-5 days like you said, wouldn't it be the same either way as to what I do tonight?

*EDIT: Her PMPS is 179, and I retested again and got 197.
 
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I think that was a good call.

I'm sure Wendy will be back around, but she may have been considering that we sometimes do temporary reduced/token doses (10-59% of the normal dose) for lower than usual preshots and/or when under 200. It's basically what I've been guiding you with the past few shots without saying it outright. I know you have trouble measuring those smaller doses anyway

The other factor is likelihood of going under 90. She came down nicely today, it's reasonable to think you'll probably see greens tonight. But youre prepared!
 
FrostD said:
I think that was a good call.

I'm sure Wendy will be back around, but she may have been considering that we sometimes do temporary reduced/token doses (10-59% of the normal dose) for lower than usual preshots and/or when under 200. It's basically what I've been guiding you with the past few shots without saying it outright. I know you have trouble measuring those smaller doses anyway

The other factor is likelihood of going under 90. She came down nicely today, it's reasonable to think you'll probably see greens tonight. But youre prepared!
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Yeah, that image you posted (I believe it was you) of the syringe with the very small measurement increments, my syringe looks nothing like that.
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That first black line is where the plunger rests when it's fully depressed, and the first line is that 0.5U. It's really hard to judge anything like a 0.25 or God forbid a 0.10 measurement. It's literally like, you pull the plunger back, you're already at 0.5u.
 

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keykey said:
Yeah, that image you posted (I believe it was you) of the syringe with the very small measurement increments, my syringe looks nothing like that.
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That first black line is where the plunger rests when it's fully depressed, and the first line is that 0.5U. It's really hard to judge anything like a 0.25 or God forbid a 0.10 measurement. It's literally like, you pull the plunger back, you're already at 0.5u.
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Ah yep, it's a real pain they don't make smaller dose pet syringes to make life easier...but I suppose most vets tend to do whole unit increases (and youve already seen the issues with that...)
 
I would start with a +2 tonight. She may drop a bit after the shot due to long duration and that's ok, but her onset appears to be around +2 (I'm considering yesterday and today's +1 as meter variance, but we'll see).

No harm in a +1, just trying to get you some breaks
 
FrostD said:
I would start with a +2 tonight. She may drop a bit after the shot due to long duration and that's ok, but her onset appears to be around +2 (I'm considering yesterday and today's +1 as meter variance, but we'll see).

No harm in a +1, just trying to get you some breaks
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Paranoia of doing something wrong had me testing again at +1. 202 was the reading.
Real quick, as this has been something on my mind but I keep forgetting to ask...is there a specific way I can clean her ear when I'm testing? Like taking one of those cotton makeup remover pads and some hydrogen peroxide or something to just keep that area clean? What's the right way of going about that?

My other question is, her left ear just DOES NOT BLEED. It's weird. I've been getting her readings off her right ear, but I'm getting kind of apprehensive of just going to town on her one ear. Is there any trick or tips I could use to get a reading out of her left ear? Also, my testing strips kind of requires more than just the "ballpoint size" amount of blood to draw a reading. It took me a while to figure it out, but the blood almost has to wrap around the unit and feed into this little square window, and then it gets the reading.

I'm providing a picture for reference: What I'm talking about is is that little orange square on the tip. It doesn't just start reading by putting the white part on the blood, it has to kind of "fill up" the orange square, and the bottom one is one that I just tested with. You can see it's filled.

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Is this normal? Looking at the video examples I feel like this is weird. Shouldn't it be just like, a very little amount touches the strip and you get a reading? I burned through a few of these things before I figured it out.
 

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keykey said:
You have me confused. If you change the dosing on SLGS around every week, and you change the dosing with TR every 3-5 days like you said, wouldn't it be the same either way as to what I do tonight?
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The directions for what to shoot if you see lower numbers at preshot vary by dosing method. People following TR, who are posting on this forum, are encouraged to shoot everything over 150. Under 150 it is suggested they post here for help as to what to do. People following SLGS follow a more conservative process initially for shooting lower numbers.

Sorry, no help on the test strips. I've never seen any like that. There are some suggestions on ear care in this post: Testing and Shooting Tips
 
Mr Kitty definitely has a "better ear". Best you can do is keep poking the "bad ear" though so it forms the extra capillaries over time.

To be honest I've never cleaned the ear unless I happened to really scratch it with the lancet or something else weird happened. Even then I just wiped with warm water. Have to be careful with antiseptic sort of stuff because it can actually kill off the healing cells.

As for the amount of blood - I just googled your manual and it says 0.5uL, which is the same as my ReliOn. In the pic below, the part with the hole goes into the meter. The other side is what draws the blood up, and yes the whole part that's black has to fill up with blood
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keykey said:
It's really hard to judge anything like a 0.25 or God forbid a 0.10 measurement. It's literally like, you pull the plunger back, you're already at 0.5u.
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You can pick up U-100 syringes from Walmart. Their RelliOn brand 30 unit (0.33 cc) syinges come with half unit markings. $12.58 for a box of 100.

Either box

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a lot of them don't realize they DO come with half unit markings!) I would check them anyway before you leave the store
 
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