8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice please.

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Christianna

Member Since 2014
I had been posting on Relaxed Lantus but had a suggestion to come over to TR for help in getting Noodle's numbers down. Could experienced members look at Noodle's spreadsheet and tell me what I need to do to help him, or what I'm doing wrong. He's only been on Lantus 5 weeks and I'm just a ball of confusion :? Thank you!

Christi
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Hi Christi and welcome to Lantus Land. Are you interested in following the Tight Regulation Protocol? I'm going to make comments on Noodle based on the idea that you are interested in doing that. It is the only scientific published research shown to help diabetic cats get into remission. Is that your goal with Noodle? We have some people here who just want to get their cats into better regulation. Either goal is fine, it just helps us to help you if we know what your goals are with Noodle.

First, if you are following TR, you need to get at least four tests during the day. Two each at preshot, and one in each other cycle. You don't have a lot of tests at night. We recommend a "before bed" test as a good one. Many cats (like my Neko) really prefer to go low at night. Those night time tests will catch that, and also tell you if Noodle is bouncing or just needs more insulin. I suspect the latter but we'll need the tests to know.

With the type of numbers that I see for Noodle, you should hold each dose for 6 cycles, as long as you are seeing nadirs in the 200s, then increase by .25 units. You slow down the increases when you start to see blue. Also, there is no need to fatten the dose at this point. Some cats don't need fat and skinny doses, and those that do only need it when they are seeing green.

So for now, I'd stick with the current dose for a total of 6 cycles, and then increase by .25U, unless you see blue. Here's the relevant part of the protocol on increases:
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...
5 weeks is still early in the game. You will get there. It just requires patience, not my strong suite. :lol:
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Hi christi! I want to add my welcome to Lantus Land! It is overwhelming to most everyone in the beginning, but it will get easier. We can teach you what you need to know to help Noodle.

Lantus and Levemir are both excellent choices for cats. If you have Lantus I'd keep using it. We usually suggest people give a solid 6 months before deciding to try another insulin. I used Lantus for 2.5 years with punkin.

At this point I would encourage you to get at least 1 test in the pm cycle because so many cats go lower at night. If Jill's suggestion of a big glass of water isn't your first choice, LOL, would your schedule allow you to move your shot time earlier? I shot punkin at 7 am/pm so I could get pm cycle tests in.

I agree with Wendy about increasing by quarter units at this phase. I'd give 4 more shots at the fat 1.5, then increase, unless you see green numbers before then.

I'd encourage you to post daily if you can and ask lots of questions. If you think it's time for an increase in dose, we can look at Noodles ss and help you decide.

Heehee and i'd love to hear the story of your sweet boy's name!
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Hi, Christi and welcome to Lantus Land!

Jill has provided you with some great information and explanations. I agree -- Noodle's spreadsheet (SS) looks like there's not enough insulin on board. I did notice that you "fattened" the dose yesterday. For most cats whose nadirs are outside of normal blood glucose range, it's recommended that you adjust the dose by 0.25u. Adding or subtracting a drop or so of insulin makes sense if you are needing to zero in on what is a "good" dose. Noodle isn't there yet.

Given that you just adjusted the dose, like Wendy suggested, I would not change anything now. Hold the fat 1.5u dose for a total of 6 cycles and let's see how Noodle does.

FWIW, Lantus and Levemir are both long-acting, depot types of insulin. They act in much the same way even though they are different from a pharmacologic point of view. Five weeks on Lantus isn't enough time to determine how well the insulin is working. Given that it looks like Noodle needs more insulin, if this were my kitty, I'd give the Lantus longer in order to evaluate how well it's working.
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Hi Wendy and Neko,
Thanks so much for your response. I really appreciate your advice and clarifying those things for me. I really want to get Noodle into remission if that is possible. Both vets said they think he's had diabetes for a "long time." :sad: I need to go update my spreadsheet. I think I'm almost done with the 6 cycles 0f 1.50 U. I really didn't understand the thing about "fat" doses but I do now. What a dolt :shock:
I am so grateful for your information. I have really been floundering around out here and think I really belong on this forum. I will make getting a minimum of 4 tests a day a priority for Noodle. My vet wants AMPS, +4, +8, and PMPS but it seems to me like that leaves an awful lot of the time uncovered, like at night. So I will concentrate on those. One lady who responded over on the "relaxed Lantus" forum said it might be a good idea to fill in my spreadsheet with random tests at varying hours because the nadir wanders so I'll try to do that too.
Thanks again. I really appreciate the help.

Christi
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Hi Julie and Punkin,
Thanks so much for the warm welcome and the advice! I am especially glad to hear that at least 6 months is a reasonable trial for Lantus before giving up Probably you saw in my earlier posts that I was about to jump ship on the Lantus and try Levemir. I got 2 opinions from 2 different vets (one for Levemir and one to stay on the Lantus.) Even worse, an interim vet I saw when my vet was having knee replacement surgery was pushing Vetsulin and I mean PUSHING. When I dared tell him what I had read about it on this forum, well, our relationship went down from there. I knew I had to find someone who would at least work with me, not dictate to me :-x So I really feel that the experiences of the members on this forum will really help Noodle and I'm so grateful for that.
Quick story on Noodle's name. We adopted him from a shelter and his name there was FatCat. We really didn't like that particularly (plus, he wasn't even fat!) We pondered all the way home what to call him. Well, of course he was really wired sniffing all around the house and that afternoon, without thinking, I went to answer the phone right before we sat down to dinner. I had mushroom stroganoff simmering on the stove and a big bowl of wide egg noodles on the counter, ready to serve. Well, in the 2 minutes I was out of the room, kitty jumped up on the counter and right into that big bowl of noodles. He had them in his hair, hanging off his ears, wrapped around his tail. What a mess! But we laughed so hard! So we really thought NOODLE is a perfect name for him. Somehow it just fit. I can tell you that cleaning him up with that sticky pasta was no small task. But he was SO good, like a big happy baby. So that is how the name Noodle came to be :-D
I'm going to try to gradually move Noodle's shot time so I can get more PM tests in. By the way--a question--my vet gave me a handout to read on Lantus and it said that in some cases Lantus could be shot at +10. Have you ever heard of this? I thought it was to be done every 12 hours firm. My vet mentioned overlap but I was overwhelmed with so much info that day I didn't think to ask for clarification.
Thanks so much for all your help and advice!

Christi
P.S. Did I remember to mention that we ordered out for a pizza on the night of the Noodle escapade? ;-)
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Julie,

Just noticed your sweet kitty's picture. His face could be a twin for Noodle!

Christi
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Hi Sienne and Gabby,
Thank you so much for the warm welcome! I appreciate, too, your encouragement on staying with the Lantus for quite a while longer. I had made up my mind to beg my preferred vet for Levemir but he agrees with everyone here so I'm glad I didn't after all. (Noodle has had to be under temporary care of an interim vet while I'm staying for a month with my mom who broke her hip. Our own vet is 4 hours away and I had to have someone on board in case of an emergency.) It's been hard to handle this in the temporary situation so I'm turning more and more often to this forum and am really confident in the advice I'm getting. Everyone here on TR is united on a good course of action and that really takes some of the stress off!
Thanks so very much for answering my post and for your very helpful input.

Christi
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Hi Christi - cute story on Noodles name! Neko's a bit of a carb fanatic too. With her, it's bread products (banana bread, muffins, baguette). None of us know how long our cats were diabetic before we had the diagnosis. I suspect Neko had been diabetic longer too, although she wasn't drinking or peeing a lot, she was ravenous for a while.

BTW, when I first started out with Neko, I was doing the fat and skinny dosing thing too. :oops: Not a good idea for Neko, as it turns out she has a high dose condition and .5U changes were more appropriate at the time. Course now that she's back on smaller doses and getting greens, I'm back to fat and skinny dosing. :lol:

Moving your shot schedule earlier if you can, is a great idea. One of the tests that's quite valuable on Lantus is the +2 test. If you can get this before bed, it's a great indicator of how the cycle will go. Typically, if the +2 is the same as the PS, you will have a normal Lantus cycle. A +2 that is significantly lower than the PS means an active cycle and getting a later test in the cycle is a good idea. A +2 that is higher than the PS means you can get a good sleep.

Random tests do help give a good overall picture of what is happening on a dose. Big white spaces on the spreadsheet with no tests could mean you are missing data. Some cats are fairly predictable with the nadir, and others are not (like Neko).

We recommend that you stick to tests 12 hours apart. There are some cases when kitty is really high and you can move the shot up a bit, but more like one hour instead of two. There are also some kitties that don't get very good duration from an insulin that can benefit from less time between shots. But that sort of schedule is really hard on the caregivers. Once you get towards a good dose, the duration will get better.
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Here on this forum we do diabetes 24/7/365. We get how feline diabetes works and we work all the time with lantus and lev both. Ask any questions and hopefully we'll have the answer.

There are circumstances where one shot at +10 might be appropriate. That vet understands lantus more than most. Lantus has around a 12+ hour cycle in most cats. It onsets, meaning you begin to see it take effect about 2 hours after the shot. Once it takes effect it lasts about 12 more hours. We give shots 12 hours apart, meaning that the effect of shot A is lasting after you have given shot B. Ideally, that helps flatten out the rise and fall of blood sugar throughout the cycle. When a cat is near the right dose, they might only move a few points in the whole cycle.

Shooting at +10 increases the amount of time that shot A and shot B overlap, which can be very helpful in certain circumstances. You must be careful doing it, however, because it essentially behaves like a temporary dose increase. You also wouldn't do back to back 10 hour cycles unless you really understand the implications of it.

For everyone starting out, we follow the protocol guidelines first. For many cats, that's all that is needed. If a cat needs more, then we start thinking of which alternate methods might help with that cat's issue. For noodle, for now, we'll start with getting him to the right dose per the protocol guidelines- evaluating his blood sugar numbers every 6 cycles and deciding if he should have an increase or if you should hold the dose. If you think you want to increase, let us look first and help you decide.

Love the story of his name! And how cool he looks like my sweet punkin. I have more pics of him in the profile in my signature line. He was the best cat ever!
 
Re: 8/25 Noodle AMPS 282, +5 304, PMPS 262 Dose advice ple

Oh yeah, and there are no dumb questions. Following someone's lead on dosing isn't dumb and doesn't make you a dolt. There are different phases of dosing and Noodle will get to the fat/skinny phase, he's just not there yet.
 
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