8/30 Austin AMPS 135 (need advice)

[Tara and Austin (Aussie)]

Hi everyone- For those of you that helped me through this past weekend thank you all again (((((hugs)))))

I am now following the advice of everyone and doing AMPS and PMPS and before bed testing.

I'm pretty sure today is a residual effect from this Saturday. Austin got 4 units this Saturday, then nothing for PM and his numbers came back up nicely. Sunday I tested and shot 2 units AM & PM.
Today I tested AM and he is 135. That's low for him. With him fast the insulin has been working on his numbers and how LONG it lasts for him (he starts going back up at +11 & +12) I did not want to shot even 1 unit and see that number dip and dip and dip all day while I'm gone. I skipped this morning. I feel awful playing around with his units, and I realize he'll most likely have to start again and build up his shed. I guess I'm just wondering from those w/experience after a scary weekend with numbers in the 30's - the bounce up to higher numbers than a swing to the 100's - did I do the right thing not giving him anything this morning? What would you advise? I'm a bit lost.
I know my vet would say to just give him 3 units and "he is a big cat" - but no way am I going there again and then leaving the house.

As a disclaimer - I'll be reading the stickies and tight regulation all day! I just need to know how to get through this bump.
Thanks again!!!

 

[Roni and Moonie]

As you skipped a shot today, you will have to shoot tonite-
Our starting dose is 1.00 unit--Then if that doesnt work the dose is increased by 0.25U increments-
Looks like you have been dose hopping--You will Need Patience and consistancy while using lantus!
You cannot keep changing the dose and need to stick with one dose..
Get at leeast the amps & pmps--Can yon yu test when you co me home & Or Leave for work
On the days you are off, you should test at least at amps,+3,+6 pmps, and before bedtime--That's a mini curve-
See where he is tonite and ask for dosing help..

 

[Sienne and Gabby (GA)]

Tara:

I don't mean this to sound harsh but, IMHO you need to be testing more. Let's see what we can do to find a testing and shooting routine that works for your schedule. I would first encourage you to get more than a before bed test if you can't test during the day.

I don't think your AMPS is a "residual" from Saturday but it's very hard to say that with conviction since you have no tests during the day on Sunday and only one test last night. It's very hard to see patterns with limited data. Right now, we need as much data as you can collect in order to understand how Austin is responding to Lantus. Further, I know that no one here would be encouraging you to increase doses by 1.0u. It's too big of an increase -- we follow the protocol and usually increase in the amount of 0.25u.

If there's any way to move your shot time earlier so you can get a +2, that will help you to know where numbers are heading. If that's not possible, we'll work with what is feasible. Like Ronnie is suggesting, we need to find a dose you feel comfortable shooting consistently, twice a day. There are also other options besides skipping a shot but I think we need to figure out what dose you are comfortable with first.

 

[Tara and Austin (Aussie)]

Thanks for the responses. And you can be harsh - it's ok.
First off, I'd just like to reply I have been having patience and consistency for the last month. I'm not just saying to myself oh well he looks fine I'll skip a dose. I haven't been "dose hopping' until this weekend. I've been following the advice and guidance of my vet - He started on Lantus at the end of July and his numbers were not moving with any real consistency until about a week ago. I have been home testing with encouragement from my vet. I didn't change his dose because I felt like it this A.M. He almost went hypo this weekend and now it's a real fear for me. nailbite_smile
I started doing the AMPS and PMPS yesterday - with full understanding why I need to do that. Please cut me a little slack?

My schedule is to get up at 6am, AMPS at 630am, feed/shoot and go to work shortly thereafter. I usually get home between 6pm-630pm, and I can get a PMPS then as well. I can't really move it up 2 hours reasonably. I can get one before bed. I am comfortable shooting anything that's not going to send him into a 100 BG dive when he is at 135 in the morning. I did 3 tests on Sunday and 1 this morning.

 

[Sienne and Gabby (GA)]

No problem with slack!! The goal is to give you as much info and input as you need so you can make informed decisions. FWIW, most vets have great intentions -- they wouldn't be vets if they didn't like animals. It's a huge job to understand all of the diseases that effect every species of animal that a vet sees in his/her practice. For most vets, diabetes, let alone feline diabetes, is maybe 2 lectures in their training. Depending on how long it's been since your vet finished his/her training, Lantus may not have even been available.

It sounds like your schedule is pretty tight. There's probably not much of an option in terms of shot time. That's good information for us to know. If the best you can get during the work week is an AMPS, that's fine. Try to get as much data as you can during the PM cycle and on weekends and holidays. The better you can read Austin's subtle signs and the numbers, the more confidence you will have when you're shooting and have to leave. I'd also make a pitch for a timed feeder since it doesn't sound like you can dash home during the day. Knowing that food is available and that Austin will eat on his own is also a confidence builder.

I'm going to suggest that you drop the dose to no more than 1.5u. In fact, going back to 1.0u is an option, as well. This will give you the opportunity to gradually raise the dose and see how Austin responds. In addition, it lowers the risk for getting numbers that make you nervous. I'm sure some others will be by to take a look and make some suggestions. You can weigh the information and decide how you want to proceed.

 

[Pat+Raja+Shadow (GA)]

Hi Tara! Here is the link to yesterday's Condo for Austin: viewtopic.php?f=9&t=23624
We include this so that everyone can just click and see what transpired the day before...
Sounds as if you have a pretty tight schedule during the work week. I guess there isn't a way to juggle the time of the preshots.

In yesterday's condo I asked:

When was Austin diagnosed and
Did you start right away on Lantus?
Does Austin have any other medical problems besides the FD and neuropathy? And meds?
And Sienne asked what happened between the 21st and the 28th ...I guess because there were some missing days there on the SS.

It is great that you are home testing and I think everyone agrees that Austin does not need the prescribed dose that he has been on for all this time. Now we have to find a dose that you are comfortable with and one that works for bringing his BGs to healing numbers. Sienne had great suggestions for you to think about...
It would be helpful to us if you could fill in the blanks by answering those questions above, okay?
Hoping you will check back throughout the day, okay? :razz:

 

[Tara and Austin (Aussie)]

Now that I am at work (with a much more functional computer) its much easier for me to check in.

Questions-
When was Austin diagnosed? He was diagnosed 7/25 when I brought him to the kitty ER for hind leg weakness. Looking back however, we adopted him about 2.5 years ago. He has always been an overweight cat with warnings from the shelter that he may develop diabetes. Of course he was also allowed to graze on dry food there all day (and with his previous owners). We put him on a wet food diet and he's gone from 27 lbs to a little over 20 lbs. His blood work bgs at regular vet visits was always high but due to stress and him generally acting like a "well cat" - he was never diagnosed with anything and more than likely allowed to live with high BGs for a long time. One vet that I started with said that 250 may be his "normal" while another disagrees. This is frustrating. The internal medicine vet that was there when I took him to the ER for neuropathy is my new vet. She also has this message board, along with a Sugar cats website as part of her website and signature. This lead me to believe she had a lot of knowledge on FD. I still think she is great, but now perhaps just to busy to really be able to focus on Austin - along with me getting spotty numbers - the whole picture is probably not represented.

Did you start right away on Lantus? Yes, he received 1 unit that night - wanted to get him on a regular 12/12 dosing cycle so he skipped the morning and we started 1 unit regularly at 630pm Monday July 26th.

Does Austin have any other medical problems besides the FD and neuropathy? And meds? No other meds - he is doing pretty well with his health for a 9-ish year old overweight cat with a few teeth. No ketones, his organs look good, no crystals, etc. He's been X-ray'd recently and had a battery in January and as well as July when we brought him in.

And Sienne asked what happened between the 21st and the 28th ...I guess because there were some missing days there on the SS.
Between the 21st - 28th I wasn't testing and was blissfully shooting away at 3 units 2X per day. I did his curve on Saturday - my vet is usually in Tues and I report my numbers. She was out on vacation until Thursday so I reported on the 26th what I got. She said looks good, lets up to 4 units AM, keep 3 units PM. She said it will take about a week to settle so check back the first weekend of September with curve numbers. I shot the 4 unit dose on Saturday thinking I would need a week -- checked back in 2 hours and freaked at the 39.

Hopefully that creates a little history.

 

[CD and BigMac]

What a good mommy bean you are to Austin, with your difficult work schedule and you are so willing to home-test. This is a great thing for your kitty. I've met people out there in the world that don't want to test at all because it is too much trouble. :sad:

Everyone here really loves to help and as you are seeing, more info the better. We are nutty and you can't overload us with info, hee, hee.

It does look like Austin's needs have changed for the amount of Lantus he needs right now. It's possible that the perfect dose for him could have been skipped over due to the larger increases. As Sienne said, we try to increase only by .25u at a time to make sure that we don't miss the best dose and zoom up too fast. My vet did that with my kitty, she kept raising the dose by 1 unit and it turns out that my kitty needed 1/10th the dose! Ten times too much, oh my! I'm not saying that is what is going on with you... only that this is what happened to me. The vet didn't happen to catch the low numbers and only saw high bounce numbers so she would give more insulin.

Anyway I agree with Sienne that starting with 1.5 or even 1.0 units and working up (as needed) is much safer for Austin and for your work schedule. I hope this is the beginning of a great adventure down the dosing ladder for you and Austin.

P.S. Hugs to you for rescuing him from a shelter! He's a lucky kitty.

 

[Janice & Johnny]

Hi Tara,

I was in a similar situation when Johnny was diagnosed. We were told to start him out at 2u and it was too much for him. We ended up skipping shots because he was too low to shoot confidently and hemming/hawing over every pre-shot number and I was a mess. Then, because of the inconsistency with shots, we were getting inconsistent numbers. The people here really armed us with the information we needed to make the best decision for Johnny and for us. We lowered to 1u and we felt so much more at ease (literally, it was immediately like a weight was lifted off), knowing that his numbers would be driving reductions/increases and it wasn't going to be as scary as just pulling a number out of the air (what I feel like our vet did). The "what-ifs" were greatly decreased, too, in my mind. We've pretty much cut the vet out of our dosing plans (not that she tried to stay involved). I figured we were losing traction with waiting for feedback all the time and she didn't exactly seem as knowledgeable (or friendly or supportive) as the people here. Plus, the last time I checked in with her was a week after dx. She said he might need a reduction soon. The fact that she still possibly thinks we are shooting 2u three months later confirms for me that we made the right decision for Johnny.

It sounds like Austin was really lucky to find you! That's awesome that he's lost so much weight in your care. You can do this, too. Once you find a plan you are comfortable with, it will all become a comfortable part of your routine and not so overwhelming and stressful.

Glad you found us.

 

[Pat+Raja+Shadow (GA)]

Thank you for all that information Tara...as CD said, we love information! And numbers!! :razz:
When you get in tonight and test him, maybe update the number here and tell us what hour it is.(from what you said it will be the PMPS time that you are able to test...
Testing during the evening would be good to fill in the SS with data and definitely a before bedtime check.
A +1 if his PM number is low is always important to do, and a +2/3 or so would help see how he is doing.
Think about what Sienne said earlier:

.....I'm going to suggest that you drop the dose to no more than 1.5u. In fact, going back to 1.0u is an option, as well. This will give you the opportunity to gradually raise the dose and see how Austin responds. In addition, it lowers the risk for getting numbers that make you nervous. I'm sure some others will be by to take a look and make some suggestions. You can weigh the information and decide how you want to proceed.

Maybe talk back and forth tonight when you get home...and come up with a safe dose for now....ok?
Doing a great job!!! The home testing is the best step...you are empowered when you can check the numbers at any time, right? :razz:

 

[Libby and Lucy]

I like the idea of lowering the dose a bit. That should give you numbers that you can shoot every 12 hours. The numbers will probably be a little higher than they are now, but that's ok, that will give us a chance to clear out all the extra insulin that may still be in his system from the 4 units, and see where he is now and get a fresh start. I agree that it's too early in the game for you to have to deal with a preshot of 135. That time will come, but we want you to be comfortable when that happens.

How about 1.5 units? It's only a little bit less, but can give you some breathing room with the numbers.