? 7/6 Tasha AMPS 111; +13 114; +18 121; +23 197; dosing advice needed

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stacia

stacia

Member Since 2014
This is only day 3 on Lantus. She started Clavamox for a likely UTI last night. And she was barely over 200 at PMPS.

She was fairly flat yesterday but a lot of that may have been stress from the visit to the vet.

I can stall a bit but I don't think it will make much difference and I'm still not comfortable shooting when she's really low. Help?
 
I am new, so I don't feel comfortable giving advise. Gonna bump this so maybe someone with experience can help.

:bighug:

Did you retest after the stall?
 
I just retested an hour later and she's only up to 114. I decided to skip. Maybe we need to decrease her dose? If anything, seems she should be running high with a UTI and antibiotics.
 
stacia said:
I just retested an hour later and she's only up to 114. I decided to skip. Maybe we need to decrease her dose? If anything, seems she should be running high with a UTI and antibiotics.
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In theory, she hasn't earned a reduction on either slgs (below 90) or on TR(below 50)

Have you decides which method you were going to follow?
How able are you to monitor midcycle numbers? this will be a factor in your decision.


That +13 (rather than +1, because you skipped) shows she was staying flat and it would have probably been ok to shoot, with Lantus you have a few hours before onset, so, unlike prozinc which is a faster acting insulin, you have more time to get food into kitty and help them surf along, also because lantus typically yields flatter curves we are looking at how low the dose has taken kitty, the amps is less 'important', with that in mind it would be very helpful for you to get into the habit of getting at least one test in the evening cycle as well, many will get a +1 or +2 and a before bed test, getting that sort of data on a daily basis will really help you when it comes to making dosing decisions, as it will give you a good idea where the cycle is heading. As it stands this morning we have no idea what Tasha has been up to last night, she may have dropped into green or she may have just been surfing along nicely in the blues all evening.

Typically those of us following TR, once we have become data ready, will shoot anything over 50, it's early days on Lantus for you yet, so skipping was a valid choice.

You may find that having skipped the shot that her numbers will zoom up, if you find that happens, and as she has a possible uti, you may want to consider shooting two back to back 18hr cycles, so that you don't have her numbers run too high.
here's how that would work
if you shoot on a 7am/7pm schedule
7am skip
1pm shoot
7pm skip
7am tomorrow, back on schedule.
 
I've been looking at other daily posts and I've seen that people shoot at 50. Coming from Prozinc, it makes me shudder, though I realize there's a big difference in how the insulin works. I'm trying to make that mental shift.

We're generally able to monitor her during the day but I'm so completely overwhelmed right now (we just moved, her UTI...) that I wonder if it's possible to start SLGS and then change to TR down the road? Or are we better to hop right on it immediately? I want to do what's best for her but I'm trying to be realistic about where I am right now as well.

Let's do an 18-hr today, which would mean getting her at 1:30. And we can certainly add a pre-bed test, that would get her around +2 or +3 in the evenings.

Thank you for explaining - I feel like we're starting all over again. Only instead of peeing all over the carpets, she's peeing blood. And we're living out of boxes.
 
stacia said:
that I wonder if it's possible to start SLGS and then change to TR down the road
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Absolutely, you can start SLGS and switch when you feel like you can handle it. There are lots of us that started on ProZinc and switched to Lantus and it does take some getting used to as with ProZinc you are dosing in regards to the pre=shot number with consideration of the nadir and with Lantus you are dosing by the nadir. I had to learn to turn my ProZinc brain off. You will get there. And welcome to L & L. Keep asking questions as that is how we all learned.
 
That's great news about being able to switch methods. I'd feel better if we can collect a little more data first, monitor other kitties' days first, etc. It's also nice to know I'm not the only one stuck with Prozinc brain. (And am I the only one whose autocorrect insists that should be Prozac instead of Prozinc? Like there aren't enough problems going on here.)

We'll get there. She's much more chill about it than I am, thankfully.
 
stacia said:
(And am I the only one whose autocorrect insists that should be Prozac instead of Prozinc?
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LOL

Sounds like a lot is going on for poor Tasha, perhaps the stress of the move has triggered the UTI, hope that settles down soon and the AB work their magic.

As Bobbie already said there is no problem switching to TR down the road when you feel you and Tasha are ready.

Hopefully you'll get a number that you feel is shootable by +18.

Below are the guidelines for SLGS and your options depending on what number you get. As you are just starting out with Lantus the bit in pink should be your guide, then as you gather more data, you would look to lowering those preshots. If in doubt post up.

How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus and Levemir users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:
  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near usual preshot numbers:
  • Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, your goal is to achieve flat numbers that are greater than 90, so there is no need to push a cat into numbers lower than that.
 
She's only at 121 now, which is +18. She's just coasting along, having a grand day. I don't want to shoot that low.
 
Ok, that's how I was reading the protocol (and my gut) so thanks for the reassurance. She just wants more chicky treats. We'll try again this evening. She's such a little punk. <3
 
Given that she is still surfing along in blue I am wondering if maybe a reduction to 0.25u may make sense, especially if she is still in blue by pmps. Though technically she didn't earn it, ideally it would be good to be on a dose that you could shoot BID while still following slgs. She wasn't on much prozinc after all.

I'll see if some others could look in and offer their opinions.
 
I would appreciate that, Gill. Especially since that antibiotic and infection should, theoretically, be boosting her.
 
I'm about to head of to bed now, hopefully someone else will stop by before your pmps, when they log in.

If she is high enough for you to shoot but between 150 and 200 then perhaps a reduced dose of 0.25u would make more sense.
If she is in the high yellows or pinks, then you could stick with the 0,5u, skipping this morning will have drained the depot somewhat so hopefully that should keep excitement to the minimum.

Try to get a test in at +11 and if it looks like she is still running low post up for dose advice for pmps.
 
Will do. Thanks for all the help today, Gill. I really appreciate it. Good night to you and George!

ETA: The vet called and her urinalysis didn't indicate a UTI. We're going to run the course of antibiotics and see what happens. He said it could be stress from the move or possible kidney stones? He'll update our regular vet tomorrow and I might check in with her since she has more of Tasha's history, see if she agrees with that assessment.
 
stacia said:
Will do. Thanks for all the help today, Gill. I really appreciate it. Good night to you and George!

ETA: The vet called and her urinalysis didn't indicate a UTI. We're going to run the course of antibiotics and see what happens. He said it could be stress from the move or possible kidney stones? He'll update our regular vet tomorrow and I might check in with her since she has more of Tasha's history, see if she agrees with that assessment.
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My pleasure,
Hope it's nothing serious. Sending lots of vines for sweet Tasha.
 
We're at +23 and 197.

Do I give her the assigned 0.5u or reduce her, since so far that seems to be riding her too high for subsequent shots? However, we originally shot too high Monday morning and that should be out of her system now.

Updating spreadsheet with the 197 and then title.
 
I like Gill's idea of trying the reduced dose tonight. You do want to get to a dose you can give twice a day, but you will also have to get used to shooting lower numbers with Lantus. We'll let you get there gradually though. ;)
 
I feel a lot better about that reduced dose. And as I collect more numbers and see what she does, I'm more than happy to raise it. I'll get her after dinner. Thanks.
 
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