9/3 Jock PMBG 60 (skipped last night's shot)

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Re: 9/3 Jock AMPS 69 +5 126

Good number but keep in mind that HC wears off in 1-2 hours depending on the cat. So you will need to stay on top of his numbers because he could come back down.

It would be helpful if you could do a spreadsheet so we can look at his numbers since he has been FD since January. I don't know if you have ever shot this low before but we typically recommend when you are shooting low for the first time, that you post and ask for help and we can be watching for you.

I have to test my own kitty but will be back with some other info for you shortly.

Good job! And your name is?
 
Re: 9/3 Jock AMPS 69 +5 126

Good work, nice to see you over here. Keep testing as the HC does wear off. Yes, that 40 is definitely a decrease. Anytime a cat who has been dx for less than a year goes under 50 it is an automatic dose decrease. Humans adjust thier doses all the time without referring to their doctor. We do the same for our cats.

What increments were the dose increases done in? Generally we only increase by .25 u and wait 6 cycles to see the effect. Larger jumps in dose can result in a missed good dose and then a plunge in BG. Just what your reductin will be I'm not sure, getting a more complete history will help.
 
Re: 9/3 Jock AMPS 69 +5 126

I'll be testing every couple of hours for the rest of the day. Jock's never had numbers this low before on Lantus . . . he's never been lower than 225 since he switched from PZI (and that was last week, one week after upping his dose from 3u BID to 4).

My name is Scott, but my nickname since grade-school has been Tortoise (shortened to Tort). I'll answer to either of those, or even "hey you . . . middle-aged fat computer geek/cat lover with the beard". ;-) The "AWD" after my handle stands for "all-wheel drive". I love all things Subaru (and cats, and cooking, and food).

BTW, and this question is for anyone with knowledge/experience, given his readings for today (69 at breakfast, 72 at +2, 46 at +3, and 126 at +5 after some higher-carb food), should I back off from 4 units to 3 for his evening shot? I won't be able to talk to my vet until tomorrow morning. I plan to test again at +7, +9, and +12 (more frequently if his numbers head back down).

Thanks again, everyone.

Tort
 
Re: 9/3 Jock AMPS 69 +5 126

Ok...back with more info for you.

The vast majority of the members of this Insulin Support Group are using a dosing protocol that is based in clinical research and that has been published in leading veterinary journals. It is referred to as the Tight Regulation (TR) Protocol (or by Roomp-Rand/University of Queensland Protocol). They are the same. A modified version of the protocol and links to the formal versions are available in the Tight Regulation sticky. This approach will give Jock the best chance of going into remission or keeping his blood glucose numbers in a range that will prevent organ damage.

It is not mandatory that you follow this approach. However, you should be aware that most of us do and it is how we approach dosing decisions. As a result, we are very numbers oriented. It's great that you have already started home testing and we look forward to seeing a Spreadsheet soon.

This protocol was developed by lay people who are members of the German Diabetes-Katzen Forum. It has since been published in the Journal of Feline Medicine and Surgery. In other words, there is research to support the use of this dosing protocol. The majority of cats do very well on this protocol; some cats do not. Every cat is different (ECID). Also, results do not occur overnight. Lantus will teach you patience.

It is more time-consuming than most other protocols but still definitely doable if you work a regular full-time job. Many people here have challenging schedules.

Some important notes which I've modified since you've been at this awhile:
• Blood glucose levels should at least be checked at pre-shot and +2 and then additional spot checks. More monitoring may be needed if kitty is low.
• Learn the signs of and How to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
• Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
• Are you using U-100 3/10cc syringes with half units marked on the barrel for fine dosing?
• Are you feeding a high quality low carb canned or raw food diet?
• Are you feeding small meals throughout the day or some other method of feeding?

There is a steep learning curve but we are here to help you. Important information is contained in the Stickys at the top of the Forum and are also quick linked here for you:

New to the Group-provides great, basic information ....a must read first :-D
Tight Regulation Protocol - as discussed above
Proper Handling and Storage of Lantus/Levemir - very important as we store our insulin in the frig, do not shake, roll, warm, prefill syringes, etc.
Insulin Depot - discussion on how lantus/levemir work
Dealing with Low Preshots - very important to have on hand
How to Handle Low Numbers - also very important to have on hand

Unlike other types of insulin, Lantus and Levemir dosing is based on the nadir, or the lowest point of the cycle. Thus, you will need to test enough so you know when the nadir is. (The nadir can change.) In addition, it is important to know when Lantus or Lev “kick in” – their onset as well as how long the insulin is effective for your cat (duration). You can learn this by getting spot checks.

When you get a chance, if you could please do a profile for Jock, it would be very appreciated. We have so many kitties in LL that it helps us to review any special needs, meds, issues, etc with Jock when giving you dosing advice. The profile is quick and easy access for us. Here is the link: Creating a Profile If you have any problems, please let me know.

You will also find a warm welcome and a community of people who are devoted to their cats and just as interested in yours and who will generously share their knowledge with you.
 
Re: 9/3 Jock AMPS 69 +5 126

It's getting a little confusing having posts in 3 forums, can you stick to one and direct replies to that. The Lantus TR forum is usually the busiest and you will probably get the fastest response here.

yes, reduction tonight, just what it is will depend on the rest of the cycle and getting more eyes on your condo.
 
Re: 9/3 Jock AMPS 69 +5 126

Welcome to Lantus Land.

To answer your question first, yes, you should reduce Jock's dose. When a cat that's within a year of diagnosis tests below 50, the dose is reduced by 0.25u if you are following the Tight Regulation protocol (well, any protocol for that matter). So, your dose tonight providing Jock doesn't bounce to the moon woul be 3.75u. The info on the protocol is linked below. I agree with Marje -- it would be help us to help you if you set up a spreadsheet for Jock.

The starred, sticky notes at the top of the board are a great introduction to Lantus. There's an overwhelming amount of information there so please don't hesitate to ask questions. We've seen a number of cats who have switched to Lantus from other insulin and have done remarkably well. I hope Jock ranks among them.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Kirsten Roomp from the German Lantus group and Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
You may want to pay particular attention to this post on handling low numbers. The information is also in the sticky note with a similar name.

Sorry -- Marje and I data dumped on you at the same time. Please do let us know how we can help. The people here are incredibly generous with their time and information. We'll do our best to lend a hand.
 
Re: 9/3 Jock AMPS 69 +5 126

Thanks, everyone. I'd already read some of those links, but with Jock's numbers being so high, I didn't expect an "oh crap, all of a sudden it's really low". I plan to continue updates on this thread only. If it makes more sense to lock the other threads, I'll do that (just let me know).
 
Re: 9/3 Jock AMPS 69 +5 126

You don't have to lock them. You can just go to them and link this condo and ask that any replies be made on this one. HOw does that sound?
 
Re: 9/3 Jock AMPS 69 +5 126

Marjorie and Gracie said:
You don't have to lock them. You can just go to them and link this condo and ask that any replies be made on this one. HOw does that sound?
Click to expand...

Done and done.

Thanks!
Tort
 
Re: 9/3 Jock AMPS 69 +5 126

Hrm. Bummer. Jock's BG is back down to 64 at +7.

Should I try to get more carbs into him, or ride it for another hour or two?

Thanks for any advice,
Tort
 
Re: 9/3 Jock AMPS 69 +5 126

I don't see Marje on the board right now, I feed a tsp. of LC just to keep him surfing and do another check in, well to be safe 30 minutes. If it were Tess I'd do an hour, but I know how she reacts. Too early in the dance to tell how Jock will react yet.
 
Re: 9/3 Jock AMPS 69 +5 126

Hi Tort! I just want to say welcome to Lantus Land to you and Jock! I'm glad you found your way over here.

I was wondering if you know Jock's usual nadir? and also what his weight is? Most cats have a nadir either around +3.5-4.5 or +5.5-6.5 or right around there. A few have late nadirs. Odds are that Jock will start going up now naturally. The LC is a good choice from this point forward unless he starts going further down or it's getting very close to shot time and he's still very low.

You did a great job getting him up.

Melanie & Racci
 
Re: 9/3 Jock AMPS 69 +5 126

MelanieAndRacci said:
I was wondering if you know Jock's usual nadir? and also what his weight is? Most cats have a nadir either around +3.5-4.5 or +5.5-6.5 or right around there. A few have late nadirs. Odds are that Jock will start going up now naturally. The LC is a good choice from this point forward unless he starts going further down or it's getting very close to shot time and he's still very low.
Click to expand...

Unfortunately, I don't know when his nadir usually hits. We've had such a hard time getting his numbers to come down (they were in the 400's when I started Lantus about 6 weeks ago at 1u BID, progressing up to 4u BID starting two weeks ago), so it was less about the "when" and more about "how high". He was profoundly diabetic when first diagnosed (624!), and we spent about six months fiddling with PZI and not making much progress; his curves were always spiky with PZI, and either way too low or too high . . . just couldn't find the right dosage. He currently weighs right around 15 lbs, and is about 1 lb or so underweight now (he's naturally a big boy).

I gave him a spoonful of some w/d canned that we had in the pantry after his last reading, and I'll be checking his BG again in about 30 minutes, so I don't think he's in danger of going terribly hypoglycemic, especially since I'm monitoring him so much today. Labor Day is a mixed blessing . . . I can be at home to monitor him, but on the downside, I can't really reach the vet until tomorrow morning. My gf keeps suggesting that we call the local emergency vet, but I've dealt with them in the past. We'll either get a "can't answer that over the phone", or they'll tell us to bring him in (which doesn't seem useful to me, given that they'll basically do what I'm doing at home: keep testing, and watch for a dive in numbers).

Thanks for the encouragement. Update coming shortly.

Tort
 
Re: 9/3 Jock AMPS 69 +5 126

Tort,

You've found the right place. Everyone here is extremely generous with their time and knowledge!

Amy & Ruby
 
Re: 9/3 Jock AMPS 69 +5 126

Sorry it took me so long to get back to you. My kitty needed some help with the litter box.

You can tell your gf that he is in no danger and an er is not at all necessary so please relax. I know it's scary the first time they hit low numbers but my Racci goes to the 30's sometimes with no ill effects, not that I want her to go that low, but I'm just saying we don't panic unless they are under 50 and only when we don't know if the cat will be able to handle that. Does he have any symptoms of hypo like nervousness, pacing, listlessness, not eating, acting strangely, etc?

I wanted to send this right away. Will be back with more but don't want either of you to worry.

Melanie & Racci
 
Re: 9/3 Jock AMPS 69 +5 126

Tort

Can you please update your subject line as you get new numbers and also, take just a few minutes to do the SS? We'd really appreciate that.

If he's at 64, he's at a very safe number.....since he's at +7, why don't you try to give him LC as Ann suggested if you haven't already? Then retest 30 mins after he eats and see if he is flattening out for you.

Here's why it is so important for us to see his Spreadsheet.....he could be overdosed if you took him up more than .25u at a time. Vets like to make big dose increases and when that happens, you can bypass the fitting dose.

I'm going to be away from the board for a bit but there are plenty of others who can watch out for his numbers, too. But it's better if you post them in the subject line so they can be caught quickly.....especially if he goes lower.
 
Re: 9/3 Jock AMPS 69 +5 126

My Racci started out on PZI also and had the same reaction to it. At one time she was up to 5U and she was in the upper 300's (never as high as Jock) but as hard to treat. When I changed to Lantus and to TR protocol and her diet she was able to come down to normal BG's most of the time or near them and a skinny 3u dose right now but constantly going down.

The prescription diets are okay but not the best you can feed him. You can do better both in nutrition and in lower carbs for less money with high quality name brand foods from the pet store. A lot of people use Wellness, Merritt (BG has only 2% carbs) and several other human quality foods, while others use cheaper but decent Fancy Feast or Friskies food (the pates are low carb).

We usually keep a lc, a mc, and a hc in the house as well as a karo or other syrup or honey as part of a hypo kit or just to steer the numbers if the cat is too high or too low. We just feed accordingly. Small frequent meals seem to be handled best.

Melanie & Racci
 
Re: 9/3 Jock AMPS 69 +5 126

Hi Tort, Welcome to Lantus Land! This is definitely the best place you never wanted to be. Let us know if you need any help setting up your spreadsheet.
 
Re: 9/3 Jock AMPS 69 +9 61

Tort, here is initial recap of what I saw in your posts today, let me know if I missed anything or got anything wrong? I can't give dosing advice but I wonder if Jock might drop lower tonight.

AMPS 96, shot 4U
+2 72
+3 46, fed HC
+5 126
+7 64
+9 61
 
Re: 9/3 Jock AMPS 69 +9 61

MelanieAndRacci said:
The prescription diets are okay but not the best you can feed him. You can do better both in nutrition and in lower carbs for less money with high quality name brand foods from the pet store. A lot of people use Wellness, Merritt (BG has only 2% carbs) and several other human quality foods, while others use cheaper but decent Fancy Feast or Friskies food (the pates are low carb).
Click to expand...

The w/d canned was just some leftover from before Jock was diagnosed. He's been doing well on the "good" Fancy Feast varieties, and the other two kitties in the house have been switched from w/d dry to Evo dry (with occasional canned food, plus whatever canned leftovers Jock might leave them).

I took another BG reading (and updated the subject line on the first post as suggested), and he seems to be hanging out in the 60's for now. I'm not as worried about him going hypo today as we're nine hours in and dinner time is approaching.

Another update in an hour or two, and I'll try to get a spreadsheet together with his curves from the last couple of weeks plus today's (numerous) readings.

Thanks again, everyone.
Tort
 
Re: 9/3 Jock AMPS 69 +9 61

Leslie and Jasper said:
Tort, here is initial recap of what I saw in your posts today, let me know if I missed anything or got anything wrong? I can't give dosing advice but I wonder if Jock might drop lower tonight.

AMPS 96, shot 4U
+2 72
+3 46, fed HC
+5 126
+7 64
+9 61
Click to expand...

I don't have the glucometer next to me at the moment, but those numbers appear correct except for the first one; his AMPS was 69.
 
Re: 9/3 Jock AMPS 69 +9 61

Thanks for doing the SS.. The link in your signature works.

You are going to hate me for this :-D but it would be better To have every single number you have for him...even when he was on PZI, if at all possible, but the priority is to at least have all his lantus numbers and doses on it. Sorry! But there isn't enough for us to go on here but it's a great start :-D and I really appreciate you getting the SS started.

Even though he's at +9, please don't wait mo than an hour to test him. Lantus is a depot insulin and one dose builds upon the next so you get a cumulative nature and the depot can get quite large and drive numbers down low for long periods of time.
 
Re: 9/3 Jock PMPS 61

Marjorie and Gracie said:
Thanks for doing the SS.. The link in your signature works.

You are going to hate me for this :-D but it would be better To have every single number you have for him...even when he was on PZI, if at all possible, but the priority is to at least have all his lantus numbers and doses on it. Sorry! But there isn't enough for us to go on here but it's a great start :-D and I really appreciate you getting the SS started.

Even though he's at +9, please don't wait mo than an hour to test him. Lantus is a depot insulin and one dose builds upon the next so you get a cumulative nature and the depot can get quite large and drive numbers down low for long periods of time.
Click to expand...

I'll have to get info on the older glucose curves from the vet tomorrow, and will post it up as soon as I can.

I didn't see your post right away, so I took a reading at +11, and PMPS (just about 30 minutes ago). +11 was 62, and PMPS was 60. Now I'm not quite sure what to do, as I can't talk to the vet until tomorrow morning. I get the concept of the depot, but do I skip his post-meal shot (and risk emptying the depot completely)? A lower dosage after dinner? Or check BG again after his dinner kicks in (his normal LC food) and decide based on that?

Thanks,
Tort
 
Re: 9/3 Jock PMPS 62

Hi Tort,

Did you feed him already? What I usually like to do is delay a short time to see if she will come up by herself. Since he ate already it will be a food number and unreliable because he could come down again as soon as it wears off and with a full depot he could go very low again. At this point, there are a few ways to go:

You can skip the shot and start him off clean in the morning with the new dose. He will not be as emptied as you think and you can shoot early but you would also have to remember that whatever time you shoot, you will have to shoot the pm shot 12 hours from then and it will be your new time.

You can shoot now and you will have to check on him all night and have a hypo kit ready just in case. You would need to commit to staying up all night and need one of the dosing pros to stay up with you to help you through it just in case. We do this all the time and if someone is can they will so it's up to you. Don't forget the lantus doesn't take effect for about 2 hours usually and he may have come up by then.

The other option is a chicken shot or a reduced dose for one night only just to get him through the night without draining his shed.

Whatever you do now is going to change your time if you are already past his shot time because you will have to shoot 12 hours from that time again for the pm shot except the 1st option.
Let us know.

Also Please put in your subject line now: Dosing Advice Shot Due

Melanie & Racci
 
Re: 9/3 Jock PMPS 62

Thanks for the quick response. I think I'm going to skip tonight's shot and consult with my vet in the morning. I was already sleep-deprived last night, and don't think I can manage another short night.

I'll get info on Jock's past curves and post them into the spreadsheet tomorrow.

Thanks again to everyone who helped me out today. Going to go crash now.

Tort
 
Re: 9/3 Jock PMPS 62

Sorry you've had to wait, but I've been dealing w/ Tess's shot and meal.

Since Jock is so new to Lantus and has been low all day , I think you would be much better off skipping tonight. It won't totally drain the shed, but you will be at a better place to continue. Melanie is right, if you shoot you will be up all night and probably faced w/ the same conundrum in the morning. Also since you are already an hour past his shot time you will have tho follow that new schedule. you can adjust it over the next few days though.

With your stall already , a BCS (Big Chicken Sh##) shot isn't appropriate. We usually either stall or BCS, not both as shooting late also has the effect of a reduction.
 
Re: 9/3 Jock PMPS 62

I think that's best for tonight Tort. Since you are skipping, this is your opportunity to change his shot time if your are interested in doing so also. :smile:

I have to take care of Racci's shot time now also. Have a great night. Will talk to you tomorrow.

Melanie & Racci
 
Re: 9/3 Jock PMPS 62

Please read and perhaps print out the TR stickies and take them to you vet. It sounds like you dose was moved directly from 3u to 4u. That is a very big jump for Lantus. Check again in the morning before you contact your vet and I hope some of the dosing gurus will have some advice for you. Unfortunately without more data , peeps here can be reluctant to advise.

Many vets are turning to Lantus because of recent articles, but haven' had the experience to fully understand the differences to other insulins. Here we live w/ it 24/7 and know it inside and out. You have access to the original studies in the stickies. You vet may find them useful as well.
 
Re: 9/3 Jock PMPS 62

Tort

I'm also sorry...that was right when we do fluids for one cat and then shoot Gracie. If you did not give insulin, then it would be PMBG not PMPS.
 
Re: 9/4 Jock AMPS 102 (skipped last night's shot)

Marjorie and Gracie said:
Tort

I'm also sorry...that was right when we do fluids for one cat and then shoot Gracie. If you did not give insulin, then it would be PMBG not PMPS.
Click to expand...
Oops, sorry about that. New to the forum and the acronyms . . .

Jock's morning BG reading was 102 after skipping last night's shot. I spoke with the vet, and she wants me to go ahead and give 3u, and spot check him a couple of times throughout the day (around noon, and again around 2:00 or 3:00). Should I just change the subject line for this thread to AMPS 102, and keep this thread alive, or is it customary to create a new thread? (again, sorry, n00b)

Thanks,
Tort
 
Re: 9/4 Jock AMPS 102 (skipped last night's shot)

Hi guys .. Don't think I've been in Jocks condo before, so welcome from us! To answer your question about the threads, yes, we do usually start a new one each day, with a link to the previous day's thread in it .. that makes it easy for anyone to go back and recheck what happened ..

I'm not usually one to give advice, especially since I don't know Jocks history, but 3u on an amps number of 102 without much data collecting seems kind of risky in my opinion, but others will be here soon enough to give you a definite answer .. You might want to change this title to "dose question" It will get more eyes on it!

Have a great day guys!
 
Re: 9/4 Jock AMPS 102 (skipped last night's shot)

Good Morning Tort!

Its customary to start a new thread for the day with a link to the day before on top.

Example:

Yesterday: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=78407
Then either a line with his numbers copied from the day before or go on with your whole cat report and whatever you want to talk about for the day. I like to also put the day before's bg numbers.

I think 3u is too large a dose for Jock and that is why he went too low yesterday, low enough that he could not have a second shot! In fact he is still at a nice low number. I would use the dose you were given by Sienne or was it Marje, last night. I believe that was 2.75 if you have syringes with half lines. Do you? You also earned that decrease with your low numbers.

Melanie & Racci
 
Re: 9/4 Jock AMPS 102 (skipped last night's shot)

Melanie,

Thanks; I'll start a new thread and link back here.

I can't thank everyone enough for all the support yesterday. As I'd said, Jock seemed to be somewhat Lantus "resistant", and it wasn't until he had been on 4u for a week that we saw numbers come down out of the 300/400's. Another week passed on 4u, then yesterday's curve started in the double digits, which was both surprising (and scary).

I'm fortunate that I have a boss that loves cats, and I'm a computer geek, so I can work from home to keep an eye on the old man.

Tort
 
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