8/5 Lucky AMPS 366, +2 397, +4 307, +6 337 dose question

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jkluckycharms

jkluckycharms

Member Since 2012
This is my 1st full day doing testing, had a little scare yesterday with a low reading of 47 while on 2U lantus. Lowered his dose this morning to .5U. How long should I continue on this dose before I increase because he still has high numbers.
 
Hi, Jenny,

The short answer is: Give him the initial dose (0.5u or 1.0 -- whichever you choose) for at least a week UNLESS his BG at pre-shot is below 200 OR the cat is refusing to eat. (Test, Feed, Shoot in that order.) Give nothing if the BG is that low or he is on a hunger strike, but go ahead and take tests during the day.

It's important that the cat has food available after the shot and up until 2 hours prior to the shot time. If you want to, you can freeze half his daytime food and put the unfrozen part down in the morning for breakfast and the frozen part down when you leave for work.) If you can, try to keep him from eating for 2 hours before the Amps and Pmps tests UNLESS you are worried that his BG is getting low during that time. (If you aren't home at the time you need to pick up the food from the floor, don't worry about it. You can incorporate that part of the treatment later or not at all unless you find it's necessary.)

Also, test him at +6 as well as Amps and Pmps. Try to test at +6 in the middle of the night as often as you can stand it. If you can, test him at +1 and +2 and +10 and +11 as often as possible. Once you gather up all this data, you will have information to help in raising the dose, and you might even get an answer here that tells you that you can raise the dose before the 7 days at 0.5u is up. Post everyday (or every other day if that's all you can do), and use the question mark in your post if you want an answer to a specific question.

Don't worry about high numbers during this initial time. Most cats (who are otherwise healthy) are very resilient to high BGs, unlike dogs, and it takes a long time of having a high BG to really hurt a cat that is newly diagnosed. Unless you think your cat has had diabetes for a long time before he was diagnosed, try to relax while you are waiting to increase the dose.

You may wish to check out this link: http://binkyspage.tripod.com/SLGS.html until someone who is very experienced with dosing answers your questions. This is Binky's page explaining the Start Low/Go Slow approach to regulating diabetes in felines. It says in Step 2: "Don’t increase the dose until your cat has been on it for at least a week. If you have reason to be concerned about hypoglycemia, or if your cat won’t eat, do decrease the dose and contact your vet. Do test your cat’s urine frequently during the regulation process using Ketostix or Ketodiastix, and contact your vet immediately if the cat tests positive for ketones. Do be consistent in the timing and type of food. Do give the shots at about the same time every day." (By "about the same time" usually means within 15 minutes of the same time. Thirty (30) minutes past the time (or before the time) is too much, and if I missed by 30 minutes when I was new at this I would skip the shot, and give the next shot at the regular time in the evening or the next morning, unless I had posted about the problem and someone suggested differently.**** Test for ketones when you have to skip a shot either because of low BG or because you missed the time.)

It's fine to post here in TR even if you are using Start Low/Go Slow. Just remember that you have to evaluate -- as best you can -- what people on the board suggest that you do based on what you read in the Stickies at the top of all the posts and all the other information on this site. This is just the same as you have to evaluate what your vet tells you. If something seems scary or dangerous to you or you just aren't comfortable enough with this whole crazy FD thing to take someone's advice, don't. Wait, think about it, and read more answers until you feel like you know the right thing to do.

****The exception to this is, let's say you wish you were giving him the shot at 6:45 (or even 7:15) instead of 6:15, and you accidentally missed your 6:15 shot by almost 1/2 an hour AND you are committed to using 6:45 (or 7:15) for the future consistently. Test at 6:40 then feed and shoot (or wait until 7:10 and test, feed, then shoot).

If you want to give the shot a 1/2 an hour early, and make your new time 5:45, it's possible to do that, but not advisable. You might end up with a very low number about 2 hours later around 7:45, and if you are not there to catch it or stay with him that would be bad. However, 15 minutes early is okay. Then to get to 6:45 you can give the shot 15 minutes early at the next shot time or even the next day to get to the 6:45 time you wanted to use. It is best to be very consistent and not move the time around even by 15 minutes if at all possible, but it's just very difficult sometimes to keep the time exactly. (If you have daylight savings time in your area, you'll have to use this process of moving the shot time in 15 minute increments twice a year to adjust to the Time Change.)

I hope this isn't TMI at once! I had such trouble with shot times and incorporating all of this FD stuff into my busy life that I had to find out all the "exceptions" to everything I could.

Have a good day today!
 
Thanks Dale, that was very helpful information and I will keep him at the .5U till next weekend to see what his numbers look like. I was just nervous cause his number are in the 300s and that makes me want to up the dose but that's probably not the right thing to do. Not gonna do any more ear pricks till PMPS.
 
Just to tweek Dale's information a bit. You hold the initial dose for 5 - 7 days. A lot will depend on where Lucky's numbers are.

Have you thought about whether you are planning on following the Tight Regulation Protocol? You can read about what's involved in the linked sticky note. The majority of people here follow TR since it has an admirable track record for getting cats into remission. There are also people here who follow the Start Low Go Slow (SLGS) approach that Dale mentioned.

It takes a little while for the insulin depot to form. You want to give your initial dose time, hence the wait.
 
Hi! Welcome to lantus land...This could just be a food spike..if Lucky ate after is shot..
The insulin does start to take effect after +3, so you should see some movement then,,
The Stickys at top of the main page have lots of info--So far so good with Lucky..Let's see where he goes tonite! Good job both of you! :-D
 
Re: 8/5 Lucky PMPS 412, +2 415, +4 399

will check again +6. Thanks Roni and Moonie - were thankful for the support.
 
This is Lucky's story as I understand it:

Meter: Relion Micro

Food: Only FF Classics (even before diagnosis he was eating this for quite a while).

Dose: Now is 0.5u (Was 2.0 before that)

Lucky was getting 2.0 units bid (2x per day) from 7/25 in the evening to 7/28 at evening shot. He vomited that night after the shot. He ate again and held it down. On the morning of 7/29 he vomited before his shot, and Jenny did not give the shot. He went to the vet that day, and his BG was 517. That evening Jenny gave him 2.0 per the vet. The next morning she gave him 1.0 per the vet until 8/2. The morning of 8/2 his BG was 577 at the vet's office, and he had a dental done with one extraction and a cleaning. The vet told Jenny to go back to 2.0, and she did on the evening of 8/2 until yesterday evening (8/4). She did not give him a shot on the evening of 8/4 because his +7 was only 47. This morning she gave him 0.5 units, and also this evening.

Shot time is 6:15 am EST
Lucky is getting antibiotics - clindamycin hcl - 3ml every 24 hours given at 6:00am from 8/3 am until the am of 8/10.
He had a dental on Thursday 8/2 - it involved a cleaning and extraction of 1 tooth.
He is taking pain medication for the tooth - buprenex ampule - .5ml every 12 hours given at 5:45 am / pm

He had low potassium on both earlier blood tests on 7/23 and 7/29 he was given 5ml of potassium supplement on 7/30 and 2.5 ml on 8/1, but when he was tested prior to his dental he had a low-normal potassium level. So, the potassium supplement was discontinued.

He was checked for pancreatitis on 7/29, and it was negative.

Jenny, is that all right?
 
Re: 8/5 Lucky PMPS 412, +2 415, +4 399, +6 356 question

That's right Dale. Except I gave him 1U of lantus tonight in hopes of bringing the bs down; however, he had less of a drop than when on the .5U. Can't quite understand that but I did notice a few air bubbles in my solostar pen tonight since I've been using the syringes for dosing. Is this normal or a problem? I won't increase his dose anymore until he levels out or do you think I should go back to the .5U.
 
Jenny,

Dose: If he were mine, I would use one unit as long as I could test him on the +1, +2 and +6 for every day and every night, i.e., you don't have to go anywhere, ever, at a particular time or for more than a couple of hours at a time. If you see a shot time number that is a lot higher than what it is at +2 get ready to test every 15 to 30 minutes around +2.5. What I would worry about is that he has 5 more days of the antibiotics, and his infection may still be there somewhat. If so it can be keeping his BG higher or even just the fact that his body is still recovering from it in some way could be affecting BG. Kitty's BG may naturally come down more over the next 5 days, and you will need to catch another low BG, use the High Carb food and/or maple syrup to bring it up, etc.

Please get some HC food tomorrow at the store -- like Fancy Feast in Gravy. It's better to use it than syrup until you absolutely have to use syrup because the HC isn't working well enough.

You saw less of a drop tonight. Yes, Lantus is very special. The fact that you saw that tonight doesn't mean you won't see good results in the future. Lantus is not like the fast acting insulins. It creates a depot or shed under the skin. This builds up until the shed is "full," and then the cat uses that shed. I don't understand it very well, but the object is to get a more gentle drop in the first part of the cycle and a more gentle rise at the end. The curve is more "flat" or "mild" than with fast acting insulins.

If the shed isn't "full" then the insulin doesn't have as strong an effect on the BG. That could be the reason you saw a smaller drop. If the shed is too full, the effect is more severe. Maybe the shed isn't full or maybe your dose is too low. You don't know yet.

Your cat's shed was full or overflowing yesterday, and as you saw, you have to be very vigilant when the shed is overflowing. This is part of the reason for the "don't shoot" advice for a cat whose shot time BG is under 200. You don't know when the shed is full until you have been collecting data for quite a while. Also, some cats drop super fast in the first part of the cycle and have their lowest point, "nadir," at +4. Others have nadir at +8. Average is probably +6. If you don't know which kind of cat you have, you don't know when to expect the lowest point. What you don't want is to have the lowest point at a time you don't expect it AND have it be a very low number -- that's what happened to you: a 47 at +7. (Now, it may be that a cat can be an early nadir cat and then change to be a late nadir cat or an average cat or vice versa. I don't know.)

Additionally, some cats have a more gentle curve and others have a deeper curve with Lantus. That could have something to so with what you saw tonight. You can't predict how low your cat will go on a particular dose without collecting data for several weeks or even months sometimes.

If your cat had a much lower BG at shot time, I would say that was why. I'll mention this now because you may see that happen again when your average BG gets much lower. When the cat has a BG of 500, Lantus could bring him down 200 points in a couple of hours. That's ok because 300 isn't a dangerous level in terms of hypo-glycemia, and he probably won't go below 100 at any point (probably). (Three hundred is not so great if you are trying to avoid the damaging effects of diabetes, though.) You won't want to shoot below 200 for a while. However, to explain it better -- Assuming you are not overdosing the cat, if the cat's BG is 200 when you give the shot, the drop in the first two hours is usually less dramatic and even less so if the cat is at 100. (This does not mean that the BG won't go below 50 at some point in the cycle. A drop of 50 or 75 points at +2 when the cat was at 200 at shot time is cause for concern about how low he might go. A drop of 25 points in the first two hours if the cat was at 100 at shot time is also scary. Both mean you need to watch out for a hypo.)

Finally, there is the bounce effect that can make it hard to predict how low the cat will go. For example, your cat had a BG of 47 yesterday. It shot all the way up to 417 before it started coming back down. If your cat is a bouncer whose liver gets involved time and time again, you may have a full shed and shoot the perfect dose of insulin for the first time without knowing it. The BG may come down even lower than you have ever seen it before despite the fact that the cat was way up in the 300s at shot time. The liver might have suddenly failed to dump glucose. It can surprise someone who has been logging the BG for months if the cat has been bouncing over and over.

The bouncing happens because the liver has a glucose store for emergencies, and it will add extra glucose to the system if the BG is much lower than usual. The BG could be way above the normal range and yet the liver panic is triggered just because the BG was far lower than it used to be (250 as opposed to 450 for example). Suddenly, the liver may stop releasing glucose, and the BG goes down and just keeps going. If you have a full shed and have given a full dose of insulin when this happens, the BG can get down below 50 even though it was much higher than the normal range just hours earlier.

Bubbles: Oh, yes, they drive me crazy. You don't want bubbles in the pen. After you withdraw a dose with the syringe, hold the pen so the rubber stopper is at the top and turn the little gauge on the end to about 1 unit, and then push it in. This will push most of the air out unless you have tons of tiny bubbles. I sometimes try to get a bigger bubble out by withdrawing it with a syringe.

Please don't shake your pen or drop it or do anything to cause bubbles. Air in the insulin will break it down and many tiny bubbles is much worse than one big one. The more surface area available with many tiny bubbles will break the insulin down more and faster. There is no reason to shake Lantus or roll it between your fingers like you would with other insulins, and shaking it will cause lots of tiny bubbles. Some people even keep their insulin in the main refrigerator and not the door to avoid shaking the pen.

As far as bubbles in the syringe, I get them all the time. I waste a lot of insulin. Hold the syringe with the needle pointing at the ceiling, of course. Then, after trying to get the bubble up to the top of the barrel without flicking the barrel too hard, push the plunger to push the bubble out. Insulin will go everywhere. I can't push it gently enough, and I sometimes shoot all the insulin out of the barrel. Very irritating. I understand that some brands of syringes are worse about this than others. Some people on here have a techniques to get them out of the syringes, but I can't seem do it right. Do a search for "bubbles syringes," if you like. I hope you have more luck than I do.

You aren't shooting into a vein, so a few little bubbles won't do anything to your cat, but a big bubble does make a difference when you are giving very small doses to a cat. I assume humans don't lose that much space in the barrel to the bubble to make any real difference in the dose.

Have a good night.
 
Thanks Dale
That explained alot. I'll go back to the .5U today as long as bs indicates. No more 1U unless after the 5-7 days indicates a need for a slight increase. This is all just very scary to me and I feel like I'm hurting him if I shoot to little or to much. I guess I'll get the hang of it . . . someday. Have a good day.
 
Shooting too little is waaaay better than too much. In the beginning I, too, felt that I was hurting Max if I didn't get his BG down asap, but now I realize it was much better that it stayed high until I got the hang of this. Their bodies can handle the high BG for a while just fine. I would never have forgiven myself if he hypo'd, and I didn't catch it -- and who can afford the vet bill even if you do catch it!?!
 
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