7/13 Mary AMPS 265, +6 290, PMPS 300, +6 273

[Lisa & Mary]

Mary sends smoochies to everyone!

She had a recheck at the vet on Wednesday and all her liver values, electrolytes and CBC are back to normal and she was very perky and smoochy. Her keytone uring strip was negative this evening.

 

[Marje and Gracie]

Re: 7/13 Mary AMPS 265, +6 290, PMPS 300

Hi Lisa....smoothies back to Mary who needs a dosecrease ;-)

I think you've held this dose a little too long and she needs to Go back up to 1u. She saw some nice numbers on that dose.

 

[Lisa & Mary]

Re: 7/13 Mary AMPS 265, +6 290, PMPS 300

When I had her on 1u she was going low and I was having to give her honey to keep her above 50

 

[Marje and Gracie]

Re: 7/13 Mary AMPS 265, +6 290, PMPS 300

She was in totally normal numbers and A little extra LC or MC might have done the trick? Both times, she came up very quickly and kept going up.

You can't be afraid of low numbers and shooting low (above 50). She is a cat now prone to DKA and it is best for you to try and keep her in normal numbers as much as possible...she's too high now.

Remember that as long as you are testing and can use food to bring her up, you are in control. We're also here to help you if she goes low and it worries you...there is usually always someone around to walk you through low numbers.

 

[Venita]

Re: 7/13 Mary AMPS 265, +6 290, PMPS 300

Hi Lisa....smoothies back to Mary who needs a dosecrease ;-)

I wish the folks on FDMB would find two separate terms for dose decrease and dose increase. Using the same term for opposite actions can be very confusing. (My first thought when I read this was "why does Mary need a dose decrease?") Separate terms would take only three more key strokes and result in much greater clarity.

You can't be afraid of ... shooting low (above 50).

Although I agree that Mary needs more insulin, especially as a $5K DKA survivor, I do disagree with advising Lisa that it is OK to shoot at a number as low as 51 mg/dl. I do not believe that Mary is data ready to be shot numbers that low. (I seldom believe any cat should be given insulin at a number that low and usually cringe when I see it done.)

 

[Sienne and Gabby (GA)]

You might want to remove the OTJ icon from your post!

I'm going to advocate for a position between what Marje and Venita have suggested. I have no problem with shooting numbers above 50. With long acting insulin, such as Lantus or Lev, once you are data ready, shooting low is not a cringe-worthy behavior. However, most caregivers are initially and understandably nervous shooting green numbers the first few times. In order to become data ready, you want to be able to shoot progressively lower numbers so you do have the data to inform your decision.

As far as "dosecrease," it generally means a dose increase although it has been used in the context of a reduction. At least that how the term is used on this Lantus board.

I want to encourage you to not decrease your dose just because you're seeing green numbers. Given Mary's history of DKA, you do not want numbers to be sitting in higher ranges. While ketones can develop in lower ranges, they are more likely to develop in higher ranges. Even though you may not be following the Tight Regulation protocol, I do think you need to be aggressive, at least initially, in order to get Mary's numbers into a better range in order to minimize the risk of ketones developing. We are happy to coach you if you are nervous when you are seeing green numbers. Mary needs to be spending more time in a normal BG range and you're not seeing that yet.

 

[Lisa & Mary]

One thing I hadn't made clear on my spreadsheet was that I had nudged up the dose but not the full 0.25 increase to 1u. I fixed that and did bump it up again this morning to ~0.9.

The other thing I've been doing over te last week is to try to switch her over to a lower carb food as I discovered that the FF classics had more carbs in than I'd relalised. Venita provided some more up to date info and the flavours she liked were 5.45-9%. I stopped giving her the 9% one and have been focussing on the ~6% flavours that she liked. At 1u (and 1 can FF BID) she was going low and at +8-9 would have gone below 40 if I hadn't intervened with honey but at 0.75 she was going too high. I left the dose at 0.75 and started mixing in lower carb foods to see if that would get her to good control. It hasn't and I was confused about that but I just realised that I hadn't been taking into account the calorie levels and the really low % carb foods I had been experimenting with had much higher calories than FF so the absolute carb levels were similar.

So I think I need to go back to FF 1 can BID, increase the dose back up to 1u tonight and then adjust the amount of FF to 1.25-1.5 cans BID so she doesn't go too low like she did before. I wish Lantus came in different strengths so we could do more precise doses on our cats.

 

[Marje and Gracie]

Re: 7/13 Mary AMPS 265, +6 290, PMPS 300

I wish the folks on FDMB would find two separate terms for dose decrease and dose increase. Using the same term for opposite actions can be very confusing. (My first thought when I read this was "why does Mary need a dose decrease?") Separate terms would take only three more key strokes and result in much greater clarity.

I couldn't agree more, Venita. That's why when I mean an increase, I say "dosecrease" and when I mean a decrease, I say "reduction". However, I understand that not everyone reads all my posts to know that ;-) :lol: :lol: :lol:

You can't be afraid of ... shooting low (above 50).

Although I agree that Mary needs more insulin, especially as a $5K DKA survivor, I do disagree with advising Lisa that it is OK to shoot at a number as low as 51 mg/dl. I do not believe that Mary is data ready to be shot numbers that low. (I seldom believe any cat should be given insulin at a number that low and usually cringe when I see it done.)

Aahh....but I didn't advise her to shoot 50 NOW. I usually put the "50" in there otherwise someone might want to shoot a 45. We help caregivers learn to shoot low gradually but the first thing is to get them over the anxiety of seeing low numbers and shooting lower and lower.