4/11 Noxin AMPS 302, +11 86 :)

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beggargirl

Member Since 2011
I expected to see a high number this morning after pumping him full of food and treats after yesterdays stressful low numbers.

So this morning I am only giving him 1 unit, and hoping that agrees with him better.
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

Morning to you both and I want to say welcome to LL this is my first visit to you condo
Lisa and Do Lou
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

beggargirl said:
Good morning!

What does 'condo' mean?


Condo just means your daily forum entries. Tomorrow, you would do a new post, and link back to today's post. This way, people can go back and get up to speed on what's happening.

Welcome and good luck!

Jason
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

Welcome to LL. I was looking at Noxin's SS. Are you only shooting once a day? Lantus is based on 12/12 shots for cats.
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

Hi guys .. I also don't think I have been in Noxin's condo before .. Those were some nice blues and greens yesterday ... and a low pink start to today .. hope you guys have a great day!
 
Re: 4/11 Noxin AMPS 302, +3 151, +4 185

Barbara and tuffy said:
Welcome to LL. I was looking at Noxin's SS. Are you only shooting once a day? Lantus is based on 12/12 shots for cats.

Yes, the vet has me shooting once a day at 2.5 units. Unfortunately he recently started eating only his wet food (even though he has dry DM to snack on if he needs food/sugars), and saturday I didn't shoot him at all because of his preshot number. And yesterday despite a high preshot number, when I gave him his dose he went Low Fast.

Yesterday was scary, because at one shot a day we have been seeing his low at 12 hours after his shot. Instead he went into his greens right away, with 9 hours left to go down. The reason he is staying so even in the greens on his sheet yesterday, is because I was feeding him Temptations treats like crazy between glucometer readings, and gave him some carbohydrate high gravy wet food.

I only gave 1 unit this morning in hopes that that might not cause such a drastic drop. I am debating giving him another unit later today (so he gets two shots today), but am still wondering how to approach the topic with my vet, since she didn't like the idea of Noxin going to one unit twice a day.

I think a little later, when I get some more numbers I will ask about specific dosing advice.

Thank you Lisa, Jason, Barbara, and Peter for stopping in! I am a kinesiology student, so I have a pretty good grasp of the biology behind diabetes; though actually putting the theory behind it into practice is proving quite challenging! This has been confusing/stressful since we were diagnosed, and I really appreciate the help and support of this forum. I am SUPER glad I am doing home testing, or else Noxin probably would have gone hypo saturday or yesterday.

Sorry for the novel :mrgreen:
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

2.5 units is a rather high dose to start at - and Lantus indeed should be given twice per day every 12 hours. Your instincts here were spot on! I would say that you could have been flirting with danger there giving 2.5units as your vet prescribed and I think it is a VERY good thing that you have reduced to 1.0u at this stage..

Your Vet may be one who is not very familiar with long-acting insulins such as Lantus - but you are not the only one, many other vets before yours have prescribed initial doses of Lantus that were too high too, so don't feel too bad about yours. Your change to 1.0u was a good thing to do - right now. But you DO need to give it twice per day - an AM shot and a PM shot, 12 hours apart.

Please read the "stickies" in the Lantus group at the top - especially the ones about the Queensland / Tilly Protocol and review the paragraphs about initial dose!

Also please look at the Sticky post about equipping yourself with a 'HYPO KIT" - Hypos are uncommon on Lantus so don't panic - but we all have these kits, just in case! Hypo Kits can and do save lives - if the unexpected should happen...!!

I am sure others will be along soon with much more detailed advice but in the mean-time, WELCOME - this is the best place in the entire Universe that you could possibly come to, get help and advice with your kitty!

p.s. please, do not even dream of emulating the dosing that we are at, with our Sooty, he does not have regular Diabetes. (He has Acromegaly and needs WAY more insulin than diabetic cats!)
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

Thank you Perry. I am doing a lot of reading this week!

Noxin is now at +8 and down to 77. If he keeps going down (which he tends to until about +12), I don't know that I am comfortable giving him another unit.

How do I change my subject line? When I get readings closer to his +12 I want to ask for dosing advice.
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

To change your subject line, go to your first post in this thread, click on Edit at the bottom right, then go back up to your subject line and make your changes.

Here are the info links you should read - this insulin needs to be given EVERY 12 HOURS so you will have a more even curve. 77 at +8 is fine because you will find that your cat will rise by the +12 mark. Your dose is based on the LOWEST number during the 12hour cycle and 77 is just fine.

Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

Info how to handle if numbers are too low:

List of Hypo symptoms
How to treat HYPOS – They can kill! Print this out!
Jojo’s HYPO TOOLKIT
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

Hi, guys!! I just wanted to stop in and say hello and welcome!! I too had a vet that wanted me at one point to switch to once a day dosing, and it was a horrible idea that I'm glad I didn't go with. I'm no scientist, but let me try to explain WHY twice a day dosing is such a must... I'm someone who wants to make informed decisions and I know it always helps me to know the WHY when deciding what to do... especially when I've got a vet (who's supposed to be the expert, right???) telling me one thing and strangers on the internet telling me another. :cool: :cool:

Lantus is a depot insulin, which means that it is stored under the skin and drawn from in a time-release kind of way. We call the insulin storage the "shed." When you're first starting out, quite a bit of each shot is going to the shed (picture Noxin carting his little bag of insulin to a shed in your back yard and storing it there!), which is why it takes 5-7 days for you to really know what Lantus will do... because the insulin going to the shed is for later, leaving only a little insulin to be used for right now.

Once the shed is full, then each shot merely tops off the shed, with the bulk of the dose going to help Noxin battle his high BGs.

Here's the thing. Cats metabolize Lantus in 12 hours. So you give Noxin a shot in the morning, he takes some out to the shed, and then uses what is left. But then he doesn't get any at night. He'll pull what he can from the shed, but not enough to make a full amount of difference. So the numbers are higher. Then you give another shot the next day, but now even more of that shot has to go to the shed, which you depleted the cycle before. So, numbers less good... and you repeat this cycle for a week or two, and you're just constantly playing a catch up game trying to fill the shed... and suddenly, you'll get to the point where you're shooting a whole lot of expensive insulin in your cat and you're getting crappy results because the insulin isn't allowed to work the way the cat's body needs it to.

That, to me, is what is so upsetting about vet's telling people to dose once per day. You are asking someone to spend alot of money and effort to treat a cat, but are effectively sabotaging their chances of success from the get-go. Which then stresses out the pet owner because they are getting no results not because the insulin won't work, but because they are telling the owner to use it incorrectly.

I would encourage you to ask your vet about the "depot" aspect of Lantus and ask her to explain WHY she believes that once a day dosing is appropriate given it and the rate at which cats metabolize it. See if she can provide a reasonable answer. My guess is that the vet, like so many others, knows little or nothing about the mechanics of Lantus, but rather just heard that it's the latest greatest bees knees and is applying her prior knowledge of insulin to Lantus. The problem is that Lantus is fundamentally different than prior insulins (the only comparable insulin is Levemir, which is also pretty new), and those differences needed to be accounted for when creating a successful treatment plan.

We ultimately went with a different vet (the old one actually kicked me out for being non-compliant!), but many here have vets that are there for emergencies, vaccines, etc. only. My vets now are mostly supportive of what I'm doing, and neither would ever suggest once a day dosing.

If you are seeing nadirs at +12, I'd maybe suggest starting over at .5u BID. That will keep Noxin from going too low, and should allow the shed to fill with twice a day dosing. You can then go up from there if you need to.... slowly and safely.

I'm sorry... please know that folks here aren't trying to dog pile on you. We just have been in your shoes and we want what is best for you and for Noxin. While people can take many different approaches to treating this illness, there are a few things that make it next to impossible to regulate. You want Noxin regulated as soon as you can get him there, because that gives him the best chance of remission... which is the ultimate goal. Unfortunately, our experience (and science) strongly indicate that once a day feeding and dry food are two things that make it difficult, if not impossible to get there.

If you have any questions or concerns, feel free to PM any of us, and we're happy to answer! Hang in there!!
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

Thank you Gayle and Christie!

"If you are seeing nadirs at +12, I'd maybe suggest starting over at .5u BID. That will keep Noxin from going too low, and should allow the shed to fill with twice a day dosing. You can then go up from there if you need to.... slowly and safely. "

I think I may have to go lower than 1u if he keeps going down in the next few hours.

My vet actually originally recommended twice a day shots at 2units saying that twice a day was the best way to regulate a cat on lantus. Due to my reluctance and fear of him going hypo when I would not be there to monitor him, we decided to do a once a day 2.5unit shot until his BG curve. She had mentioned that I could get a monitor and do the curve at home. I called the vet after the curve and gave her my numbers, expecting to go lower and twice a day, but because of his late Nadir (I think) she wanted him to stay on once a day.

I personally want to get him on two shots a day. For the past few days he will only eat wet food; but I'm pretty sure he isn't eating close enough to the recommended amount for his size (21lbs). He's being a food snob, and it's frustrating. The numbers from last week that I gathered were from when he was on wet in the morning and dry at night, so now I'm trying to figure out what is going to be normal for him. :?
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

A housekeeping detail... We link our condos (i.e., daily threads) together. Here's Noxin's condo from yesterday:

I'm not sure Christie saw Libby's post from yesterday. Libby suggested shooting 1.25u BID. If you feel like this is too much, that's OK. You can always start at a lower dose. The initial dose of Lantus can be based on your cat's ideal weight:
initial dose = 0.25 x ideal weight in kilograms​
Based on this formula, if your cat is reasonably normal sized, initial dose is usually somewhere in the neighborhood of 1.0u BiD. Your vet suggesting that you start at 2.0u BID is a high initial dose. (It would mean your cat weighed about 17 lbs.) The information on starting dose is in the article I linked for you yesterday.

I do think Christie gave a great synopsis of what the problem is. By dosing once a day, Noxin isn't able to get the maximum benefit from Lantus.

In addition to the article I provided, there are also materials on the Health forum on how to "Convert a Vet." It's been a while since I looked at them so I don't know if they are relevant to your situation.

There is one 2008 study that did compare Lantus dosing either once a day vs. twice a day that found both dosing strategies were effective. However, and this is a HUGE however, the study was run with 6 non-diabetic cats. Obviously, this is a very small sample and the authors noted the need for the study to be replicated with diabetic cats. If your vet is basing her treatment on this article, there are clearly limitations to the study. The study was done to substantiate the long-acting nature of Lantus not that cats should be dosed x1/day.
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

How about getting at test at +11 and post it and ask for advice then? I agree with Gayle, the 77 is a beautiful number....and a lot can happen between now and PMPS. All of the same reasons that Christie gave you for shooting twice a day...the same reasons apply for shooting a consistent dose. I think we need to wait a bit and see where he is later, ok?

To add numbers or change your header...go to the first post of the thread, and click on edit...then change the subject line, and click on submit under the text box.
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

I didn't see Libby's recommedation from yesterday, Sienne. I certainly agree with that approach... just given the lower numbers seen today, I threw .5u out there as a conservative number to build from. I wasn't sure how much to attribute today's low numbers to the 2.5u shot yesterday a.m. when there was no shot last night.

Sienne and Libby are two folks whom I would trust with Willie's life... and have, literally! I would definitely defer to their suggestions... they completely know their stuff!
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

Sienne and Gabby said:
A housekeeping detail... We link our condos (i.e., daily threads) together. Here's Noxin's condo from yesterday:

Hmm. I linked it in my first sentence on my first post. When I link it I guess I should specify that it is his 'condo'? (Sorry, I'm still learning).

Sienne and Gabby said:
Based on this formula, if your cat is reasonably normal sized, initial dose is usually somewhere in the neighborhood of 1.0u BiD. Your vet suggesting that you start at 2.0u BID is a high initial dose. (It would mean your cat weighed about 17 lbs.)

Noxin is a big guy; He weighs 21lbs!
But at the moment even that 1u has taken him quite low. He may just need to learn to eat more of the wet food?

Laurie and Mr Tinkles said:
How about getting at test at +11 and post it and ask for advice then?

Thank you! I will do that. We are about an hour away from his +11 and he is at 79. We'll see how he is in a bit.

Thank you again!
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

Oh my. He is a big boy!! However, is that Noxin's ideal weight or is he, ummmmmm "fluffy?" But, you're right. His numbers are going impressively low.

The change in diet has clearly made a difference.
 
Re: 4/11 Noxin AMPS 302 Only gave 1 unit this morning

Dosing Advice Please

So I've been reading the links you all recommended on dosing and such. As far as finding a dose it says:

Using a weight based formula for determining a starting dose of Lantus or Levemir:
* the formula is 0.25 unit per kg of the cat's ideal weight


Noxin weighs 21lbs (9.5 kgs); His ideal weight? Maybe 15lbs (6.8 kgs).

Using a weight based formula for determining a starting dose of Lantus or Levemir:
* the formula is 0.25 unit per kg of the cat's ideal weight


So at current weight: 0.25 * 9.5 = 2.4 units; At potential ideal weight: 0.25 * 6.8 kgs = 1.7 units.

But even the 1 unit shot today is keeping him quite low up to his potential next shot.


As far as giving him a second shot today, the sticky on "Data Ready to Shoot Low Numbers?" says:

My cat's pre-shot level was way below the usual value. Should I give the injection?

There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.


It is past +11 right now and he read at 86. He has been in the 70's and 80's for at least the past four hours. I am currently not comfortable giving him another shot right now, at any dose.
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

Here are a few things you should know about Noxin:

As you see on his spreadsheet he has been recieving one shot a day.

Numbers up until 04/08 are representative of him eating wet food in the morning and, when that is gone, eating dry Purina DM until the next morning.

From 04/09 'til today I have been leaving out wet food all day to free feed. He HAS NOT touched his dry food since then.

He is ALSO being a snob and not eating a great deal of wet food.

Those really nice green numbers you see on his spreadsheet yesterday are staying so nice and even BECAUSE I was pumping him full of Temptation treats and high carbohydrate wet food to keep him from crashing. I was testing him at least every half hour and feeding him. Once I got that 88 I let him be.
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

(What do you want us to call you? Somehow, Beggargirl doesn't seem quite right.)

I agree. I don't thing you're data ready to shoot an 86. I suspect if you did, you'd be a nervous wreck and up all night testing. And frankly, if I told you to shoot, I'd be committed to staying up all night with you! We don't tell anyone to "Shoot!" and then abandon them especially if there's any chance their cat will run into low numbers.

Here's what I would suggest. Skip tonight's shot. If you're concerned about numbers dropping too much, you can start giving a BID dose of 0.5u or even 0.75u beginning in the morning. (Do you have syringes that are in 0.5u increments?) We've had any number of people who have had to start over at a lower dose.

We do shoot low numbers but you've got to be data ready. Take a look at some of the subject lines and you'll see that once you're ready, you'll be able to shoot that 86. In the meantime, make sure you have a supply of strips and high carb food. It never hurts to be prepared!
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

I'm so sorry.... I don't think I caught your name!! :)

Thanks for the updated info... you are right! That is all very important info for our dosing advisors to know! I would have skipped the shot in your shoes as well. I think you definitely need to rethink the 2.5 as well... looks like the effects of wet food are big for Noxin!!

What foods have you tried so far, and have you tried any enticements to get him to eat more? I would suggest using fortiflora (a probiotic you can get either from the vet or amazon/ebay), bonito flakes (we buy catmando), or the dust from the bottom of the purebites bag. I know others use parmesan cheese as well.

You're doing great.... hang in there!
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

Sienne and Gabby said:
(What do you want us to call you? Somehow, Beggargirl doesn't seem quite right.)

I am Cherie by the way. Pleased to meet you. I'll look into changing my user name to something less impersonal.

Sienne and Gabby said:
I agree. I don't thing you're data ready to shoot an 86. I suspect if you did, you'd be a nervous wreck and up all night testing.

Amen. And his ears look SO SORE right now. I wouldn't have put up with me for this long...

Sienne and Gabby said:
Here's what I would suggest. Skip tonight's shot. If you're concerned about numbers dropping too much, you can start giving a BID dose of 0.5u or even 0.75u beginning in the morning. (Do you have syringes that are in 0.5u increments?) We've had any number of people who have had to start over at a lower dose.

I am concerned, and would like to shoot conservatively. 0.5u tomorrow it is. I have the day off, but after tomorrow I have to work and leave him at home alone right after I shoot; plus I'd be gone until right before he would need his second shot. Since I know he isn't eating on his own when he gets low enough that I'm concerned, I really want to play it safe.

I do not have syringes in 0.5u increments. I had asked the pharmacy for some when I bought them, but the clerk looked confused and said they didn't make them any smaller. I might stop by the Wal-Mart pharmacy some time to see if they have any. But right now I am BROKE until friday, so it will have to wait until then.

Sienne and Gabby said:
In the meantime, make sure you have a supply of strips and high carb food. It never hurts to be prepared!

Heck yes, and thank you SO MUCH.
It is really appreciated.
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

Christie & Willie said:
I'm so sorry.... I don't think I caught your name!! :)

Haha. I'm used to the internet being very impersonal. *waves* I'm Cherie. :) I'm going to look into changing my user name.

Christie & Willie said:
What foods have you tried so far, and have you tried any enticements to get him to eat more?

I've given him a few Fancy Feast flavours, and he has been eating some of the canned Purina DM. Both my cats have eaten dry for the first 8 years of their lives, so this is new for them. When I first gave him the DM he wouldn't eat it unless I mushed it up first with a bit of water added; and even then ... picky.

Crushing up a Temptations treat and sprinkling it on the food helped a little. I am just hoping he just needs time to get used to it. I will be trying other brands/flavours when I get more money. Right now I have a nice supply of Fancy Feast.

Thank you guys SO MUCH!
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

Walmart's brand, Relion, does come in half unit increments. You may need to ask if you can't find them. Some people have mentioned they could be located behind the counter. (There's no Walmart in Chicago so I'm noting what others have said.)

You can also order syringes on-line. I've gotten my through Hocks and I use their GNC brand.

When you have a chance, could you complete a Profile on Noxin? We won't have to continually bug you with info on health, food, etc.
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

Sienne and Gabby said:
When you have a chance, could you complete a Profile on Noxin? We won't have to continually bug you with info on health, food, etc.

Will do!
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

Hi Cherie, nice to meet you! If you don't want to change your user name, you could just add your name into your signature...just another option, it's entirely up to you. :smile:

It looks like you have a plan for tomorrow, it sounds good to me. Since you have gotten an answer to your dose question, can you remove it from your subject line? Thanks!
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

Cherie, I'm so glad you're working your way toward two shots daily. Noxin is going to do great. :-D
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

Hi, Cherie!! :)

Walmart does carry the right syringes. Write this down: U-100, 3/10cc, 5/16" needle. I went in and just told them I needed short needle syringes with 1/2 markings and it quickly devolved into me politely yelling at an employee who told me I should have really brought something written, with me informing her that if she was so incompetent she couldn't decipher basic clues about products sold in the pharmacy, I'd happily speak to the pharmacist who surely would have a clue. yeeeaaaahhhh..... you can guess how popular I am there!!

They cost around $14 for a box of 100. While you're there, I'd check out the special kitty brand. there are several varieties on the binky's chart that have acceptable carbs and there are several folks here who use them. They have a couple varieties in large cans that would be very economical for feeding multiple cats... like $0.50/can or so. Trying to find out how many carbs are in the pouches. Just gave willie one tonight for the first time, and I've got to figure out where to stash the leftovers.... I think he'd consider killing me in my sleep for it!! :shock: :shock:

I tend to go with very anonymous names on the internet too, and did when I first got here. I think if you're going to advise people on how to help their cat, it is just more polite to be on a first name basis. :lol: :lol: :lol: Plus, as you're quickly finding, we're a family around here!

EEKS!! Willie is staring at me, the open Special Kitty Pouch, his empty food bowl, then back at me. :shock: I should probably get on that....
 
Re: 4/11 Noxin AMPS 302, +11 86 DOSING ADVICE PLEASE :)

Hi, Cherie!! :)

Walmart does carry the right syringes. Write this down: U-100, 3/10cc, 5/16" needle. I went in and just told them I needed short needle syringes with 1/2 markings and it quickly devolved into me politely yelling at an employee who told me I should have really brought something written, with me informing her that if she was so incompetent she couldn't decipher basic clues about products sold in the pharmacy, I'd happily speak to the pharmacist who surely would have a clue. yeeeaaaahhhh..... you can guess how popular I am there!!

They cost around $14 for a box of 100. While you're there, I'd check out the special kitty brand. there are several varieties on the binky's chart that have acceptable carbs and there are several folks here who use them. They have a couple varieties in large cans that would be very economical for feeding multiple cats... like $0.50/can or so. Trying to find out how many carbs are in the pouches. Just gave willie one tonight for the first time, and I've got to figure out where to stash the leftovers.... I think he'd consider killing me in my sleep for it!! :shock: :shock:

I tend to go with very anonymous names on the internet too, and did when I first got here. I think if you're going to advise people on how to help their cat, it is just more polite to be on a first name basis. :lol: :lol: :lol: Plus, as you're quickly finding, we're a family around here!

EEKS!! Willie is staring at me, the open Special Kitty Pouch, his empty food bowl, then back at me. :shock: I should probably get on that....
 
Thank you Laurie,
I took that out of the subject line. :)

Thanks Kathy,
I have my fingers crossed.

Christie,
Thank you for the very specific info! I will have that written down when I go to ask at the pharmacy this time.
 
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