? 9/11 Wes AMPS 144, +5 90, AMPS 115 Contour One high-dose kitty flying suddenly low

[Jen & Westley]

We have been on a real high dose journey, following our vet's protocol, and so I know the numbers aren't as fulsome (we were following what the vet asked for), but we've gotten on the preshot regimen, and after a high number last night, got a really low one this morning. We still shot, though it was borderline and probably we should have reduced though I monitored him closely and gave him a bit of bonus lc food at +5. I tested at +5, and tried my best at +7, but my partner usually does the testing and I got so many errors on my meter and Wes was getting riled so I stopped. Now tonight, another low PS.

Other variables:
- we opened a new bottle of insulin last night (I know now this was a bad idea at night) possibly our bottle wasn't good anymore, though it was only 1.5 months old and had never been left out.
- Kitty has a UTI and got a Covenia shot today (I know, not the preferred antibiotic -- last time we had to do oral antibiotics he was vomiting and lethargic and all went to hell).

I'm assuming we just skip this PM shot, following 4.4 in the FAQ? We did give him his first meal (roughly 40% of food), and can retest in a couple of hours to see how things are going. It feels strange to not even give a reduced dose, but obviously we don't want to put him in danger.

We're totally new to greens, and haven't spent much time in the blues. I'm also not sure how to proceed dosing going forward. I will talk to the vet in the morning, but it will be after the timing for the AM dose.

 

[Wendy&Neko]

I'm going to add the link to your post in Feline Health, for a bit more background for people: https://felinediabetes.com/FDMB/threads/introduction-wes.293756/

It's really hard for us to guide you on dosing, when you are following the vet's suggestions for dosing and testing. Not to say we can't help, just that I wouldn't be as confident in dose suggestions.

In the previous post, we suggested that you test at different times. There's a reason for that and it's based on looking at hundreds of cat's BG spreadsheets, and for me maybe even more than a hundred of those with high doses. You've only done one curve where he was is OK numbers, and his nadir then was not at +5, but later. +6 is more typical for Lantus, but for many higher dose cats, the nadir tends to be even later. What we are trying to do is figure out how low a dose is taking the cat, cause here we adjust doses based on how low the dose takes the cat.

We're totally new to greens, and haven't spent much time in the blues.

At least, the testing you've done hasn't shown much time in greens or blues. I've seen plenty of spreadsheets where cats start high to begin the cycle, then dive down to greens, then zoom back up at the end of the cycle. Or go green at night and bounce during the day - the girl in my avatar specialized in that one. Her nadirs on Lantus tended to be in the +7-+9 range, though could be even later.

I'm glad you've started preshot testing - as today has shown you why we say to test before the shot to make sure it's safe to shoot. For a cat for whom you have lots of blood sugar data, and if you are following one of our dosing methods, both your AM and PM preshots would be safe to shoot if you could monitor. But not yet, you aren't there yet. Just letting you know what could happen in the future.

 

[Wendy&Neko]

If you've only been using Lantus since July, and it stayed in the fridge, then it's likely not the reason for lower numbers. People here have vials last for 5-6 months. Convenia shot wouldn't work that fast to fix a UTI. What is more likely the cause of lower numbers is getting rid of kibble and putting him on an all low carb wet diet. It takes a few days for the impact of the kibbles in the system to wear off, so that's about the timing.

Since you have changed diet, I would reduce his dose a bit, maybe 10 units, and keep up the monitoring. Changing to an all wet food diet can make a big difference in amount of insulin needed.

Normal with our SLGS dosing method, you wouldn't reduce the dose unless he went below 90 (5.0), which he did not.

 

[Jen & Westley]

Thanks so much @Wendy&Neko, I know it's not easy when we don't have all the data on hand. I need to keep practising my testing skills more now that my partner is back at work so that I can get more nadir numbers.

For the least couple weeks Wes was getting very little kibble 4-10 a day total (gradual decrease), but I have read some cats have a strong response to it, so maybe!