8/26 Tillman AMPS 455, +9 497

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Hi Allison - I haven't dropped in yet and welcomed you to Lantus Land. You sure have a lot on your hands with Tillman. What you could be experiencing today is something called New Dose Wonkiness. It lasts up to a couple of cycles then resolves.

I don't use R, but I'll see if someone is around who can provide advice on it.
 
Normally you don't want to give R if it looks like NDW but with his situation and the fact that he is late in the cycle and you are past nadir, I think I'd give it. I will leave it up to you as to amount since you've been doing that on your own but the 2u seemed to work fine last night. If you are going to give the R, I'd be sure and monitor.

Sound good?
 
Allison, we're thinking of "fast-tracking" Tillman with his Lantus dose. Right now, it appears the Lantus dose isn't sufficient to keep him in good numbers and it's taking daily use of R to get him down. We don't want to be too hasty with it, though, and overshoot a good Lantus dose, but we want to get him to a point where the Lantus dose is doing 99% of the job and you're not using R all the time.

So . . . if you can keep this in mind and keep it in front of us - the idea is to give 4 shots total at this dose and then re-evaluate how low it's getting him and decide if he should have an increase with the 5th cycle. For right now, that means late Wednesday night we'd look at how low he's getting with the L and decide if he should have another increase on Thursday morning. You'll have to let us know if you can monitor and when a dose increase would work for you, but lingering too long at a dose that isn't doing the job isn't helpful.

What happens when a cat has gotten used to high numbers is they develop Glucose Toxicity. All that means is that his body has gotten used to high numbers and considers them normal. It just takes a little more insulin to overcome that, but we want to do this safely.

how does all of that sound to you?
 
julie & punkin (ga) said:
Allison, we're thinking of "fast-tracking" Tillman with his Lantus dose. Right now, it appears the Lantus dose isn't sufficient to keep him in good numbers and it's taking daily use of R to get him down. We don't want to be too hasty with it, though, and overshoot a good Lantus dose, but we want to get him to a point where the Lantus dose is doing 99% of the job and you're not using R all the time.

So . . . if you can keep this in mind and keep it in front of us - the idea is to give 4 shots total at this dose and then re-evaluate how low it's getting him and decide if he should have an increase with the 5th cycle. For right now, that means late Wednesday night we'd look at how low he's getting with the L and decide if he should have another increase on Thursday morning. You'll have to let us know if you can monitor and when a dose increase would work for you, but lingering too long at a dose that isn't doing the job isn't helpful.

What happens when a cat has gotten used to high numbers is they develop Glucose Toxicity. All that means is that his body has gotten used to high numbers and considers them normal. It just takes a little more insulin to overcome that, but we want to do this safely.

how does all of that sound to you?
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Thanks everyone! I'm doing 0.5U R increments and testing every hour until I get him in the 250-300 range. Hopefully then the Lantus will be kicking in and can grab on to that number. I'm not sure if he dropped last night during the night and that caused the spike this morning, or the Lantus is just not lasting the full 12, but hopefully this will prevent a possible drop that I'm missing in the night. He got the 2.75U at PM normal time. Unfortunately, I could only do AMPS/PMPS test tomorrow, then I could do PM tests up to +6. If you think this is sufficient, let me know. So would this mean 3.0U tomorrow AM?
 
He's only had 2 shots at 2.75, and the fastest we would typically move up is 4 shots at each dose. Tillman isn't looking typical, but with you being gone tomorrow, i would hesitate to increase so quickly in the morning. The way Lantus works it can take a few cycles to see the dose's effects. I think you should probably hold the 2.75u tomorrow morning and we can revisit the dose tomorrow night.

It looks like you shoot about 6:30 in the eastern time zone. Is that right?

I'm curious what your vet's directions were about using R? None of us have ever seen it used hourly like this. Typically, we give an R shot, timing it to avoid the Lantus nadir, and then wait. Cats are each different, but many will show the first effects of the R beginning in about an hour and by the 3rd of 4th hr after the shot the effects are gone.
 
Allison, I want to point out that on 8/12 you gave R multiple times hourly, in a situation similar to tonight. The next day following no morning shot of Lantus, it looks like he was somewhere below 120 in the morning. Because of that, I'd be cautious on continuing to give R tonight, knowing that you won't be able to monitor him tomorrow.

While R typically only lasts about 4 hours, the next cycle after it's given can sometimes be quite a bit lower overall.

it would be a good idea for him to have access to food while you're gone tomorrow. canned low carb will be fine all day. if someone is able to check him during the day, i sure think that would be a good idea.

If you need help in the morning, post before you shoot. Amy, Sienne and Dyana are in your time zone and might be on to give you a hand.
 
Hi there :cool:

Just peeked at Tillmans ss - Ouch!

Could he be in pain?

I have not seen an R dosing strategy like the one your vet has recommended.
did he explain this strategy/protocol to you?

The method I'm familiar with -
give R at PS time, along with Lantus or sometime after nadir - converging nadirs can cause fast drops to the lowlands and should be avoided.
In the first case the idea is the R will keep BG in check until Lantus onset. R duration is around 4 hours, Lantus onset in general is around 3-4 hours. In the second case giving an R bolus after nadir can help make for a better PS if a kitty has a pattern of Lantus duration problems , aka BIPO (big insulin poop out).
It's like a relay - R sprints the baton to Lantus and Lantus has an easier time with the cycle.

It's critical to learn you kittys response to R (how much R moves BGs how far and fast), as well as the R nadir and R cycle duration.
This way you avoid coinciding nadirs.

Allison and Tillman said:
I'm not sure if he dropped last night during the night and that caused the spike this morning,
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get some PM+10s and +11s. They will be very revealing and go a long way in assisting you in making the best dosing decisions. It also will help those who are willing to help you do so.

fighting back ketones at home is an aggressive process and it follows that monitoring should be equally as aggressive, for safeteys sake.
urine should be tested for ketones 2x per day and noted on the ss. anything over trace requires a call to your vet.
check for the 5 Ps (peeing, pooping, preening, playing and purring) daily and please provide a WCR (whole cat report) daily.
 
Thanks everyone for the replies! I just typed a LONGGGGGGG response, with explanation for the regular protocol that got deleted when I hit submit, because I obviously got signed out! ARGH! :evil: I promise I will retype it tomorrow and get the information to you!!! I just don't have time tonight to retype it all again! cat(2)_steam

But, basically he's super high again today.

I'm thinking "giving R at PS time, along with Lantus" that Sandy mentioned....sounds like it might be a good option?? I did have to do that tonight, because he is in the danger-zone here in the reds all day.
 
Allison and Tillman said:
I just typed a LONGGGGGGG response, with explanation for the regular protocol that got deleted when I hit submit, because I obviously got signed out! ARGH! :evil:
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I feel your pain - I'm the slowest messiest typist and take quite a bit of time to write a post - after losing a few posts because of my slowness I realized if I hit 'preview' periodically while I'm composing I don't get signed out. Or. I sometimes compose my post in Word and then copy and paste when I'm ready to post.

Allison and Tillman said:
I'm thinking "giving R at PS time, along with Lantus" that Sandy mentioned....
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That's good however you need to find out Tillmans response to R (how much R moves BGs how far and fast), as well as the R nadir and R cycle duration.
Please get at least a +2 and +4 tonight. It is the only way to determine what effect, if any, this R dose has on a PS of 457 and will serve as valuable a guide in future dosing decisions.
 
Sandy and Black Kitty said:
I feel your pain - I'm the slowest messiest typist and take quite a bit of time to write a post - after losing a few posts because of my slowness I realized if I hit 'preview' periodically while I'm composing I don't get signed out. Or. I sometimes compose my post in Word and then copy and paste when I'm ready to post.
Click to expand...

Thankfully, I'm a quick typist, but compiling all my thoughts takes me forever!! Then, you finally get it all together and down, and POOF! :oops: Will try out one of your tricks for sure next time!!! :smile:

Allison and Tillman said:
I'm thinking "giving R at PS time, along with Lantus" that Sandy mentioned....
Click to expand...
That's good however you need to find out Tillmans response to R (how much R moves BGs how far and fast), as well as the R nadir and R cycle duration.
Please get at least a +2 and +4 tonight. It is the only way to determine what effect, if any, this R dose has on a PS of 457 and will serve as valuable a guide in future dosing decisions.[/quote]

When given the full 2.0U R in the past, he drops about an avg of 60 points in 2 hours, and it seems when really high he gets about 4-6 hours duration, the lower numbers it seems to give him closer to 6-8 duration. He was 389 +2 tonight.
 
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