4/7 Jake AMPS 91 - Advice?

[Lydia & Sid & Jake(GA)]

I'm not sure what to do about Jake's readings over the past few days. In the 7+ years that he has been diabetic, I would occasionally hometest but not on a regular basis. Since Nov 2009, he has been on Lantus. In Dec 2009 his fructosamine was 343.

Last Saturday (4-3) I took him to the vet for a glucose check and he was at 68. I am now checking him 2-3 times a day as my work schedule allows. I got very scared because he was showing no signs of hypo but acting normal. Now that I've been checking him on a regular basis, I finally created his spreadsheet and it appears his numbers are high one day and low the next without any real pattern that I can determine.

Jake has basically stopped eating on his own or he doesn't eat enough and he is down to 8.8 pounds. I syringe feed him 1 can divided into two feedings each day. He either gets Newman organic turkey, Hills A/D, or 9 lives turkey and giblets. It doesn't matter what he is offered, he doesn't seem to want to eat it on his own but he is very good about accepting syringe feedings. He is 19 and now on amlodopine (1/4 of 2.5 mg once per day) since March 2009. I hate to think that we are taking a downward slide, so any thoughts or recommendations are appreciated.

 

[Monique & Spooky]

Hi Lydia,

Great job on getting a spreadsheet set up and some testing. Since there is not much information I can gather from the Spreadsheet, I can't give you much help. During the time you were giving insulin everyday but not measuring BG what dose were you giving? Did you always give the same dose?

Since you just started measuring you have changed the dose several times between nothing and 1.5U, Lantus doesn't do well with that type of dosing, better is to find a dose that you can give every 12 hours that doesn't make the BG go to low but keeps it nice and steady in a "good range".

It seems like around 1U might be a good dose, but with Jake's poor eating it could be some days to much. In your situation I would try to give a dose of .5U every 12 hours and test as much as you possibly can (I know work gets in the way) ALWAYS test before giving insulin (AMPS & PMPS) those shouldn't be left blank on the spreadsheet! Then test whenever you can, before you leave the house, when you come home, and as many times as you can in the evening before bed. Try to do that for several days on that dose and see if you can get some staeady numbers.

If using the Alphatrack you want to be abouve 70, if you measure below 70 at anytime you need to reduce your insulin dose. If after a few days on a steady dose his BG remains to high (nothing under 200) you can raise the dose up a quater unit (.75U) every 12 hours.

These fluctuations you are getting are possibly due to what we call bouncing after a cycle where Jake had lower BG his liver has responded by releasing glucose and hormones to protect him from dropping lower, those then cause the readings some hours later to be much higher. Many cats have this going on and the best way to uncover it and manage it is by testing as much as possible to determine the pattern and adjust the dose accordingly.

Check out the information at the top of the forum about Lantus and the dosing protocol there is a lot of good explainations there. At Jake's age it is going to be a challenge and his other health problems complicate things, your goal is to keep him safe (avoid hypo) and limit the damage being done by prolonged high BG, his organs are fragile and probably somewhat failing due to his age. In human years Jake is approaching 100! Congratulations on keeping so well all these years!

 

[Lydia & Sid & Jake(GA)]

Thank you for the response.
Typically Jake had received 1.5 u twice per day.
After your comment, I looked back at the SS and realized I had filled out the spreadsheet incorrectly by putting the values for PMPS in the 11+ column so I corrected that because I have checked his level before the pm dosing.
If there was no AMPS reading, it was because I couldn't get enough blood (and wasted several strips) and did not have time to keep trying before I had to leave for work. I have more time in the evening to try to get a reading. Just yesterday I found a good spot on his ear that bleeds very well so I was able to get AMPS readings yesterday and today. I reasoned that if his level was high >300 the night before, I could give him 1 unit. Last evening, I gave him 1.5 (his usual dose) because he was at 362.

As for the inconsistent dosing, my vet advised me that if his reading is low <200 to give 0 units so I did that on the 3 times his readings were <157.
I agree with you about the problems with giving 0 units. The problem is that during the week days, there is no way I can check him before 12+ because I work 11 hours every day. I cannot go home and check him ever because I also commute an hour each way. So, I have to let him run a little high during the day rather than risk him going too low and no one there to check on him. I hate that but I don't have a choice.

I think going forward, if his reading is <200 at PMPS, I will give him 0.5 units and check him a couple of times before bed. However if his reading is < 200 at AMPS, I would be concerned and hesitate to give him anything.