4/23 Meadow AMPS 500+

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Amber & Meadow

Amber & Meadow

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For those of you who are trying to help Meadow, I have finally set up the spreadsheet. Here's the link to the previous post viewtopic.php?f=9&t=12514. Will someone PLEASE give me some advice on going back to Lantus??? How much to start out with; when to give; when to test. I would like to start this tomorrow morning, but if I don't know what to do, I can't. Meadow's weight is 10.2lbs. Solid advice would be appreciated.
 
No problem. The housekeeping stuff will seem second nature in a couple of days.

How would you feel about starting over at 1.0u? The weight based starting dose would be approx. 1.0u. I think it would be prudent to start at a very safe dose given the presence of the Humulin N.

A couple of other things, as well. Are you testing for ketones? If not, please put a trip to the pharmacy on your "to do" list for the weekend. You want to purchase Ketostix.
Bayer-Ketostix-50.jpg

Given the high numbers that Meadow has been experiencing, it's important to test for ketones. Diabetic ketoacidosis (DKA) is dangerous and can be triggered by high numbers. Testing for urinary ketones is the best prevention you can do. Well, that and adding water to Meadow's food.

Also, please test regularly. You don't need to do a curve or test every hour but we will want to keep an eye on Meadow's numbers so we can decide how quickly the dose needs to be raised.

The other prevention item that we all keep is a hypo kit. Most importantly, please stock up on high carb food. Please read the sticky notes at the top of the board. The sticky on dosing is important as is the one entitled, New to the Group. The latter will give you a solid base for what we do here, what you will need to know and is a good reference point. It will also give you links to resources such as Janet & Binky's food charts so you know what foods to buy.

BTW, what are you feeding Meadow? (It will be helpful to complete a Profile -- it contains info about diet, medical history, etc.) The instructions are in the Tech Center where you found the spreadsheet instructions.
 
I agree that reducing the dose and starting over seems like a good idea. You had a glimpse of some better numbers when you started out on 2 units. There's not a lot of data from that time to know if that dose should have been held longer or increased. I wouldn't have increased by a whole unit at a time, with the numbers Meadow was getting then.

It may be that Meadow does need a higher dose, but the only safe way to be sure is to start over, check for ketones (which is necessary any time you're reducing insulin by that much), and monitoring. We'll know quickly whether we need to increase the dose or not, and we might move up the dosing scale faster than usual. We'll have to wait and see what the numbers tell us.

What do you think?
 
This sounds like a good idea. I have some Ketostix, but the vet told me they are unreliable. She tested for Ketones a month ago, and there weren't any. So I'll start out with 1 unit. How long do I need to wait after feeding her before giving the injection? Or do I need to give it before? Thanks for your help.
 
Literally, forget everything you know about other insulin. They are short or intermediate acting insulin and Lantus is long acting and it's mechanism of action is entirely different. You will hear us refer to the "shed" quite often. Lantus is a depot drug. Only Levemir is similar to the way Lantus works.

Most of us test, feed, then shoot. I shoot while Gabby's face is in her food bowl. Unlike N, it takes an hour or two for Lantus onset. You do not need to have food on board the way you do with N. Lantus also has a much longer duration and is much gentler. Please read the information on dosing. The sticky on the Tight Regulation Protocol has both the modified version of the Tilly and Rand protocols as well as links to both of the full dosing protocols. The first read through is usually confusing but if you stop by other condos, you will see how the protocol works.

The handling of Lantus is also very different from N. DO NOT shake, rattle, or roll Lantus. It is not a suspension the way N is. It is also far more fragile and you may start losing potency in as soon as 28 days. Some cats are able to use a vial or pen for a longer period of time. Some can't. Please look at the other sticky notes in the Announcement section at the top of the Board. There is a huge amount of information there that will help you get oriented.
 
Welcome to LL hopefully for keepsies ;). Great job getting a spreadsheet up and going.

As mentioned, read the stickies.. even better if you can read them every couple days, things take some time to sink in, there's a lot to wrap your brain around. Ask lots of questions.. and like it was mentioned.. Lantus takes a little while to build up it's magic.. so try to be as patient as possible.
 
A profile attached to your signature like you have done for your ss is very helpful to others who are trying to help you with Meadow; take a look at the profiles in my signature for Shadoe and for Oliver. You can see they are both entirely different, so any advice for them would have to take into consideration their uniqueness. Also, people won't have to keep asking you the same stuff over and over again!

Starting back to a dose of 1u is always a good idea because you may find that Meadow is getting too much insulin right now - better safe than sorry and that's why I started Oliver back at 1u when I adopted him.
When you read over the protocol in the link you were given, you will see that the first dose is usually held for a minimum of a week and those increases that may follow are only .25u or .5u. - only tiny bits, not an entire whole unit. Start LOW and go SLOW, that's the way you are going to find the right dose for Meadow.

I can't stress enough to test for ketones as often as you can when you are getting such high numbers; testing for ketones is NOT just a once a month thing. I try to test daily for Oliver with his constant high numbers, and also Shadoe when hers are high. If you get even a trace in your testing, post right away on the board. It's very important, ok?

Did anyone ask about food? It's important to get onto wet food and also low carb because that alone will help with Meadow's numbers. Shadoe used to eat mostly dry food, and I switched her to entirely wet food now. I have a civvie, Booboo, who eats only dry still, and if Shadoe got some of the dry in the past, her numbers went sky high; I keep the dry food out for Booboo only when I am around and it's covered when I am away. Food can make a big difference in the numbers. Many feed fancy feast or friskies wet canned food, or some others from the food list on this site.

I usually test, then prepare the bowl of food and also the shot, then put down the food and give the shot while Shadoe or Oliver are eating. They are used to getting shots at that time, and usually crouch down and be motionless for their shots in the scruff. The Lantus shot takes a bit to start working so if you tested Meadow at +2, you may even find the number the same as at ps or even higher, but that's OK; like had been said, it takes Lantus some time to kick in. See below for changes you may see when you test Meadow at different times after a shot.
How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

There's definitely lots for you to learn but don't worry; before you know it, half the stuff you will be doing automatically without a 2nd thought.

Be sure you ask every question you have; someone will have a reply for you.
 
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