8/11 Tink AMPS 390, +3=246, increase to 2u

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JenM

JenM

Member Since 2013
Last condo viewtopic.php?f=9&t=123252

(Hope I'm doing this condo thing right. If not, let me know. :) )

After 5 cycles at 1.5u, I'm happy with the trend, but not the overall numbers. Increased to 2u this morning. This is my last day at home with him, but I can come home at lunch for a +6 if needed. Not ideal, but better than a hypo kitty.

I removed the 2am meal to see if it would reduce the higher AMPS (PMPS look much better than AM), but didn't seem to have any positive effect. Will keep it up a day or two and see. Tink seemed to have "dawn phenomenon" last time he was on the juice too... might just be something we have to deal with.

Someone asked about his teeth/gums in last condo. They are perfect. Vet was shocked that his teeth were SO NICE, given his age and having never had a dental. Nice pink gums, nice white teeth. No sign of decay and the vet said he didn't even need a cleaning.

ETA: Just realized I may have jumped the gun a smidge on the increase... I had 5-7 cycles stuck in my head, rather than days... but... looks like the protocol would suggest he increase after 6 cycles (so I only jumped the gun by one) given that he is getting high flat curves and is prone to ketones (originally in DKA when diagnosed).
 
yes, it's 5-7 full days at the starting dose when you start on Lantus. He got to 217 on the second full day, so quite a while before the full effects of the 1.5u dose would be seen. Right now he's had 5 cycles at 1.5u and one at 2.0u.

You also want to think in terms of 0.25u increases unless he is constantly having his nadirs over 300. Even the 0.25u increase will make a significant difference.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Click to expand...

After the first week on Lantus, then these are the guidelines used for deciding on increasing his dose:
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

eta: This has a good description of the way that Lantus works - that's pretty important to understand and a little different than non-depot insulins: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150. It's worth reading.
 
Hi there :cool:

I see Julie provided the info on safe increases (timings and amount) when using Lantus and the TR Protcol.
Although it may not seem like it, the TR Protocol is an aggressive method in itself. The modified version of the protocol we follow here is slightly more aggressive.
Keep in mind that due to the cumulative nature of Lantus a dose increase will likely take several cycles to settle in and show what it can do, or not do.

That being said I understand your concerns about avoiding ketones since he has a history of DKA. It's very important to monitor closely for ketones when starting oro switching to Lantus and even more so if your kitty has a history of DKA

Regarding PSs it's not at all uncommon for the AMPS to be higher than the PMPS - that was the case for us. On the road to OTJ the PMPSs went green beore the AMPSs did for my Black Kitty.

JenM said:
Someone asked about his teeth/gums in last condo. They are perfect. Vet was shocked that his teeth were SO NICE, given his age and having never had a dental. Nice pink gums, nice white teeth. No sign of decay and the vet said he didn't even need a cleaning.
Click to expand...
It was probably me who asked about his mouth. For BK this teeth and gums were his Achilles heel. Many kitties return from the falls because of infection from dental issues. Please keep in mind that the only way to thoroughly evaluate a kitties teeth, especially what may be going on under the gum line way in the back, is while they are under anesthesia.

Be patient. As long as all 5 Ps are present, sticking as close as you can to the guidelines offers the best chance for a favorable outcome. :cool:
 
Ok... so do you guys have suggestions then on dosing? Should I stick with 2u or bring it back down to 1.5 or 1.75?

Given the "Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles)." - I feel like he is very much described in that second sentence. Am I wrong?

I certainly dont want to put him at risk of hypo... but I dont want him sitting in ketone territory for a solid week either. His +5 was 164 on the 2u. He also eats at +5. Prior to today, the lowest we've seen is 217 since switching to Lantus. Should I dial it back for his PM dose? I have to go to work tomorrow - but like I said, I can come home to test at lunch if I really have to.
 
i'm not sure if you should decrease back to 1.5u or hold the 2.0u. i would've held the 1.5u dose longer. my interpretation of the "high flat curves" is to see all numbers over 300 - Tink got down in the low 200's on the second day. I don't think that description of "high flat curves" applies to him at this point. Maybe someone else can offer other insights on that.

if you choose to stay at the 2.0u, you've got to monitor carefully. You do anyway, but i'd be extra careful with it.
 
Ok, thanks. I hate things that are open to interpretation. :) My idea of "high" is generally anything over the low 200's... but you're probably correct on this one.

While I love the blue we're seeing... I am concerned that as the depot builds at this level, we might run into trouble. Unless I hear otherwise, I'll probably dial it back to 1.75u for tonights shot. While I can come home to test at +5 or +6 (or whenever), I can't be here to monitor him all day, after today - so that worries me a bit. Not sure what my daughter's schedule is this week - she might be home, which would be nice.
 
having someone else to help with testing is super! our son just graduated from college and was home one summer while punkin was diabetic. we were able to leave him in charge and take a quick trip. we still texted back and forth all day, but still, it was fabulous to get a break.

i hope your daughter can help.
 
Hi there :cool:

JenM said:
Ok... so do you guys have suggestions then on dosing? Should I stick with 2u or bring it back down to 1.5 or 1.75?

Given the "Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles)." - I feel like he is very much described in that second sentence. Am I wrong?
Click to expand...
Ketones suck, as all who have been there know.
My personal thoughts -If a kitty has a history of DKA less than 1 year behind him/her, extreme vigilance is a good idea. The transitional period as the insulins are switched can be a vulnerable time for kitties with a DKA past . Also, BGs don't need to be crazy high for ketones to develop. These are important considerations in Tinks case.
JenM said:
While I love the blue we're seeing... I am concerned that as the depot builds at this level, we might run into trouble.
Click to expand...
a valid concern also to be taken into consideration when making dosing decisions for Tink. Due to the cumulative nature of Lantus you will see the action of what you shoot at PS times later rather than sooner. Low numbers can sneak up on you. This is important because it's opposite of what you are accustomed to.

All things considered had you asked about increasing before shooting, I would have recommended at least completing 6 cycles and then go up 0.25u to 1.75u, but that's just my $0.02 :cool: Now, like Julie said, monitor closely if you decide to stick with the 2u

Check frequently for ketones during the transition; multiple times per day.
As long as there are no ketones and all Ps are present I recommend following the TR guidelines.

Until Tink gets enough cycles under his belt for you to gather enough data to see patterns in his reaction to Lantus and while you develop your Lantus instincts, you have to carefully navigate. Once you and Tink get the hang of Lantus I think you will like it very much.
 
Ok... I'm going to go with 1.75u tonight and hold this dose moving forward, which is a .25u increase from the 1.5 we started with. We completed 5 full cycles... with the 6th being 2u (probably not the best idea... but did give him a nice break at least).

Next time I'll re-read the protocol BEFORE making changes. :)

Although his "high/flat" cycle (as I would call it) may not be as high as I think... it does say OR have history of ketones... and he definitely has that. Albeit only once... but I'd like to keep it that way. It nearly took his life (I had made the decision, after several days of hospitalization, to euthanize that afternoon... but then he had a sparkle in his eye when I went to say goodbye).

This Lantus stuff definitely takes some getting used to... but I think it just might be what we need.
 
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