4/24, Cashew AMPS 290

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cashewsmomma

cashewsmomma

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hello hello!

Sorry, I have been MIA for the past week- had no computer/internet access and I just wanted to concentrate on getting a hold on things first. I started using a different ss that automatically converts world numbers to US so I am hoping this would help everyone looking at it...only problem is that there are some error messages showing up on US page, so please ignore. None of the data is lost it is just for some reason not formatted the same as before (sorry I am very lost when it comes to these things!)

SO just a quick re-cap:
Although I did not have many curves/spot checks done, Cashew was showing consistently high numbers despite dose increase (3u in AM and PM), I got a new meter and it showed slightly different (lower) readings. Because I did not feel good about having his dose increased further without enough data I decided to decrease it to 2 units (which I felt comfortable with) until I got enough data over the next few days (please see SS). Since then, I have increased him AM dose to 3.5 and PM to 2.5 and he seems to be doing MUCH better.

I know, he is in the yellows still but I think this is an improvement since he is not staying in the purples so much and leaning more towards the yellow. Also, his behaviour has improved even more so. Yesterday we stayed up till 1 am playing games!! And today he came up to me and started purring - you know how LONG it has been since I heard him purr?

Other changes: I started him on Felo wet food- i think this has helped with seeing decrease in bg levels, decrease in litterbox usage and water intake etc.

I have attached link from our previous 'condo' and I hope this works. I really apologize for not being able to update everyone sooner but it is finally the weekend and I thought I'd better sit down and put it out there.

If anyone happens to be browsing, please have a look at Cashew's data and let me know what you think. I am thinking of giving him another 4-5 days at current dose (3.5 u in AM and 2.5 in PM) and increasing it further. I am hoping to do another blood curve (PM) this weekend so I know how low he goes with the current dose. I don't think it is that bad if he remains in the yellows for the next few days...what do you think? Am I on the right track?

I think I may have ticked off the vets with this whole dosage situation, I just wanted to say I am NOT against dose increase I just think we need to increase very slowly and give more time for him to respond and heal right?

I just think about people on meds for example, from what I have seen everyone responds differently and given that you cannot dump meds into the system. sometimes it totally numbs out and doesn't respond other times it may respond asap but on a short-term level...aaah i know I am a little crazy with my analogies but I just want to see slow and steady improvement which I am currently seeing ( SO EXCITED!!!)

Your feedback would be much appreciate re: next dose changes...

love you all xoxoxoxo

i am already planning his OTJ party!! :lol:
 
First thing that JUMPED out at me was that you keep changing the dose, and you can't do that with Lantus or Lev - they don't work like that. You really need to stick with one dose because of the shed factor.
Just wondering how did you decide on those two values for dosing?

Sorry, I forgot to ask about increases and decreases in full units - following the protocol, you would be making only .25u or .5u changes.

If possible, you need to get in some tests at around mid cycle so that you can see if the dose is working or not; you may be getting lower numbers at mid cycle but you can't tell by just the ps numbers.
See below for info on what you may see when you do your curve
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.
 
hey gayle,

I have done two curves last week and getting midcycle numbers every other day since then. I am excited because I DO see a decrease in his bg levels which means he is responding to the insulin.

I know it looks like his dosing has been all over the place which is true in a way, we had been steadily increasing as per vet but the reason why I decreased to 2 units was because his first meter was faulty and I felt we were giving him too much insulin (this was discussed in my previous posts). I spoke to the vet last week who suggested since his lowest number was still pretty high (14 mmol/L x 18 = 252 mg/dL), we needed to increase even more. I explained to her that I did NOT feel comfortable increasing until I knew what was going on (hence the two curves last week....) I then increased his dose by 0.5 units in AM and PM and NOT the 1 unit dose suggested by vet.

As was suggested on the board here before, we need to give it at least 6 cycles before next dose change which is what I plan to do. I just thought I'd put his SS out there and see what everyone had to say.

Please keep your suggestions coming!! and thank you so much for taking the time out to look at his SS
 
The comment I made about changing the dose too often was due to your saying you gave a different dose at am and pm:
If anyone happens to be browsing, please have a look at Cashew's data and let me know what you think. I am thinking of giving him another 4-5 days at current dose (3.5 u in AM and 2.5 in PM) and increasing it further. I am hoping to do another blood curve (PM) this weekend so I know how low he goes with the current dose. I don't think it is that bad if he remains in the yellows for the next few days...what do you think? Am I on the right track?
Click to expand...

Your ss says different than your post, so I wanted to make sure you are keeping the dose the same for 6 shots in a row, and not reducing the pm dose and then raising the next am dose.
You need to stick to just the one dose, whatever that may be - 2.5 or 3 or even 2.
 
Hey,

Okay, sorry I misunderstood. When I spoke to the vet last she said it was fine to have him at 3 u in the AM and 2 in the PM for now until I had more data and then increase.

Now, that I have more data I felt comfortable increasing (therefore the 0.5 unit increase) so I did this for both AM/PM. I am not sure if I was to leave AM at 3 units and increase PM dose to 2.5 and then 3.0 units...the vet says it doesn't make a difference with the insulin I am using and strongly suggested a full unit increase.

I am really confused now, am I doing something wrong? Cashew has been on a different dose in the AM than PM before (as per vet's instructions)... nailbite_smile
 
The protocol followed on this board does not seem to go along with what your vet is telling you to do.
Please ensure you read all the Sticky notes at the top of the main screen, especially the one that talks about the SHED.
viewtopic.php?f=9&t=150

By your changing the dose am and pm, you are slowing the progress for Cashew.
Think of a gas tank, one of my favorite visuals.
With Lantus, you MUST have a FULL spare tank of gas (Lantus) before any of it gets used to help Cashew.
So, on the first shot, most of it goes to the spare tank, the shed, that's just under Cashew's skin, and teeny bit goes to Cashew. The 2nd shot, alot of it goes to the shed but a bit more goes to Cashew.
When you first start out and have NO SHED, you need to stick with the SAME dose for 5 days or so because you need that full spare tank of gas, or insulin. As soon as it's full, the WHOLE shot goes to help Cashew.
Now, what you are doing, is filling the tank, then using some of the tank, filling the tank more, then using from the tank. Cashew's tank, or shed, is never getting filled.

You want to stick to ONE DOSE for 6 consecutive shots, no changing. There are some cats that don't really react to the change of dose until that 6th shot, it takes them that long to react, so stick to one dose.

Your dose changes are based on nadir, or a number around mid cycle, and not on your ps numbers. Once you have more numbers near the mid point, between shots, you will be able to see if the dose you are on is working.
 
Gayle is correct. The Tight Regulation Protocol that we use to guide dosing is based on providing the same dose twice a day, 12 hours apart. Lantus is an insulin that likes consistency because it is a depot medication (or what we refer to as having a "shed"). My best guess is that your vet, like many vets, is less familiar with Lantus than other insulin. Most of the other available insulin (with Levemir the notable exception) are short or intermediate acting insulin and allow you to slide doses based on pre-shot numbers. Lantus is long acting and dosing is based on the nadir and doesn't utilize a sliding dose. Thus, dosing is based on the same dose at each time. (Think about what would happen with blood pressure if you took a different amount of your anti-hypertensive medication at each dose.)

I would encourage you to take a look at the sticky that pertains to the Tight Regulation Protocol and print out the links to the actual protocols and supporting materials. You may want to share these materials with your vet and discuss dosing strategy in light of the research. If you look at the SS of the members here, you will note that we all shoot the same amount of Lantus at AM and PM times. It will make it very difficult for us to help you with dosing if you are giving differing amounts of insulin at shot time since there will be no way to know which shot is influencing BG levels in what way.
 
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