5/20 Jack AMPS=346 ketones=0.5

[Jack & Mopem'sMom]

Jack was +3PM=274, +8PM=321, and now his AMPS is 346 w/0.5 ketones. I have to go out to work again today, so I stuck with the 4 units. I never seem to see any 'yellows' during the day lately; only a few when he first started the glargine (and I got all excited the 'new' insulin was going to work out great) He seems to have a small window after his PM shot that shows yellow lately, which is why I went to 4 and not 4.5 when I had to go to work, but he is still high most of the day. It seems like he will need to have at least one or two more dose increases. I have two questions:

1. Can I increase to 4.5 units on Sunday? (That would be 6 cycles on the 4 unit dose) I'll be home all day and can monitor him on Sunday, Monday, Tuesday since I'll be working from home those days. I know that was the original recommended switch dose by @Wendy&Neko and @Sienne and Gabby (GA) but I was a chicken once I saw those yellow numbers and went to 3 instead (yes, I'm an idiot)

2. Are there any cats, in your experience, that end up on different doses for AM and PM? I know the TR allows for different dosing amounts based on BG numbers and nadirs, but that requires tight food control, which is not happening any time soon with Mr PITA and his dry food addiction. That's why we are here in the anxiety ridden pool of misery of SLGS. I'm wondering if he could end up with a dose like 5 units in at the AM shot and 4.5 at the PM shot? OR does that mess too much with the depot? I guess I'm looking for a ray of hope...

PS to @Bandit's Mom - I heard from a tech at the vet clinic on the fluids; my vet is in today and should answer about the sodium chloride vs the lactated ringers fluids by tomorrow. I'll put that update in my daily post and in the original thread too. Thanks for your dose help yesterday as well.

Yesterday's thread: https://www.felinediabetes.com/FDMB/threads/5-19-jack-278-3pm-but-406-w-1-1ketones-amps-dose.263484/

 

[Bandit's Mom]

It's good to see his ketones are down.

1. Can I increase to 4.5 units on Sunday? (That would be 6 cycles on the 4 unit dose) I'll be home all day and can monitor him on Sunday, Monday, Tuesday since I'll be working from home those days. I know that was the original recommended switch dose by @Wendy&Neko and @Sienne and Gabby (GA) but I was a chicken once I saw those yellow numbers and went to 3 instead (yes, I'm an idiot)

I think this sounds good unless Wendy or Sienne suggest otherwise.

2. Are there any cats, in your experience, that end up on different doses for AM and PM? I know the TR allows for different dosing amounts based on BG numbers and nadirs, but that requires tight food control, which is not happening any time soon with Mr PITA and his dry food addiction. That's why we are here in the anxiety ridden pool of misery of SLGS. I'm wondering if he could end up with a dose like 5 units in at the AM shot and 4.5 at the PM shot? OR does that mess too much with the depot? I guess I'm looking for a ray of hope...

Lantus is a depot insulin which works well with consistent dosing. And dosing is based on nadirs - how low the dose takes the BG - and not based on preshots. Whether you follow SLGS or TR, the dosing is the same AM and PM and based on nadirs. TR is more aggressive and allows for more frequent dose changes than SLGS.

PS to @Bandit's Mom - I heard from a tech at the vet clinic on the fluids; my vet is in today and should answer about the sodium chloride vs the lactated ringers fluids by tomorrow. I'll put that update in my daily post and in the original thread too. Thanks for your dose help yesterday as well.

You need not put the put the update in the original thread. Putting it in today's is good enough.

 

[Wendy&Neko]

It's cycle 3 of this dose, too early to call the next dose.

In my time here, I have yet to see a cat successfully follow our dosing methods with different doses AM and PM. Not to say it's impossible, but I've see a lot of cat spreadsheets. Not sure why you'd want a lower dose at night. A shot often has impact on the following cycle, so it's not like you'd save them from going lower at night.

 

[Jack & Mopem'sMom]

It's cycle 3 of this dose, too early to call the next dose.

In my time here, I have yet to see a cat successfully follow our dosing methods with different doses AM and PM. Not to say it's impossible, but I've see a lot of cat spreadsheets. Not sure why you'd want a lower dose at night. A shot often has impact on the following cycle, so it's not like you'd save them from going lower at night.

OK, yes, I forgot the glargine impacts the next dose. I was thinking about the way ProZinc works and what I did with my other cat Mopem (he got into remission on the ProZinc and support from here). And thanks for your dose advice. I'll hold for now; looks like I may be out of the house for work on Sunday as well now anyway. Enjoy your weekend!

 

[Jack & Mopem'sMom]

It's good to see his ketones are down.


I think this sounds good unless Wendy or Sienne suggest otherwise.


Lantus is a depot insulin which works well with consistent dosing. And dosing is based on nadirs - how low the dose takes the BG - and not based on preshots. Whether you follow SLGS or TR, the dosing is the same AM and PM and based on nadirs. TR is more aggressive and allows for more frequent dose changes than SLGS.


You need not put the put the update in the original thread. Putting it in today's is good enough.

Yes, I am very happy about the ketones! And thanks for the reminder about Lantus and the nadirs...I get caught up in the numbers because of my other cat Mopem and his ProZinc dosing. Thanks again- have a great weekend!

 

[Jack & Mopem'sMom]

@Bandit's Mom - I just checked my email and this is what I got back from the vet tech:
"Dr. does not want you to do the lactated ringers all the time because the electrolytes can be transformed into sugar which is a problem with Jack being diabetic. However, since there are still ketones and the need for continued fluids, she recommends alternating between the lactated ringers and the sodium chloride. Next time you come in for fluids, we will dispense the ringers."

No mention about the kidneys, but I didn't offer a reason why I wanted clarification. I just said I forgot what she said (which is true) Vets get funny when you tell them you are getting (most times better) advice from people in a support group. I guess alternating would be OK? I'm actually hoping the increased insulin and lower BG #'s bring his ketones down to where I don't need any fluids beyond this coming week. Thanks again!

 

[Wendy&Neko]

Dr. does not want you to do the lactated ringers all the time because the electrolytes can be transformed into sugar which is a problem with Jack being diabetic. However, since there are still ketones and the need for continued fluids, she recommends alternating between the lactated ringers and the sodium chloride. Next time you come in for fluids, we will dispense the ringers

So the hundreds of cats on here who have had lactated ringers and not had their BG increase have been doing it wrong? In fact, some cats have their numbers go down with fluids. I liked to give Neko her lactated ringers when her numbers were naturally on the way up, and separated in location from the insulin shot location. Otherwise her numbers could go down.

Check out page 1087 in this paper. Specifically the quote in the section talking about treating a sick diabetic cat:

No published studies have compared the efficacy of different fluid types in sick diabetic cats, but 0.9% saline or lactated Ringer solutions are commonly recommended

 

[Jack & Mopem'sMom]

So the hundreds of cats on here who have had lactated ringers and not had their BG increase have been doing it wrong? In fact, some cats have their numbers go down with fluids. I liked to give Neko her lactated ringers when her numbers were naturally on the way up, and separated in location from the insulin shot location. Otherwise her numbers could go down.

Check out page 1087 in this paper. Specifically the quote in the section talking about treating a sick diabetic cat:

Thanks for the link. I'm going to read later after work and pass it on. It's very sad and more than that, frustrating and downright maddening that the veterinary community is so ignorant when it comes to things like this. I had the same trouble with the 'non-prescription diet' situation when my other cat was diagnosed. Thanks for this info!

 

[Sienne and Gabby (GA)]

Wendy said everything that I would have said!