9/3 Zeke - AMPS 225;+2=87;+2.5 ~56;+3~66;+3.6~74;+4 94

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Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

By the way - tonight you may see a bounce - a surge in glucose numbers due to compensatory hormones releasing a stored form of glucose from the unusual low. This may take as much as 72 hours to clear.

If he is way high tonight, you may choose to shoot through the bounce, ie give the 1.5 that took him low, then take the reduction. He got so low, though, I'd suggest patience if you see those high numbers and just wait it out.
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

BJM said:
I'd go with 0.5 to help the shed drain faster

I'm a little fuzzy on the way the shed works. Are you saying reduce by 0.5 (i.e.: decrease more than the protocol calls for and shoot 1u) so that Zeke uses the extra insulin he has stored in the shed? So what happens is that because I'd be injecting less insulin, his body would instinctively take from the shed (the insulin storage) to make up the difference now that his body's gotten "used" to the "higher" insulin levels it's been experiencing?
Does shed = depot?
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

MrZ said:
...I'm a little fuzzy on the way the shed works. Are you saying reduce by 0.5 (i.e.: decrease more than the protocol calls for and shoot 1u) so that Zeke uses the extra insulin he has stored in the shed?
Yes. It takes about 3 full days to stabilize at a dose change. Letting it drain a little more tonight, may reduce the chances of another cycle like this one where you have to test, feed, wait, repeat. He went very low.

MrZ said:
So what happens is that because I'd be injecting less insulin, his body would instinctively take from the shed (the insulin storage) to make up the difference now that his body's gotten "used" to the "higher" insulin levels it's been experiencing?
Does shed = depot?
Not an instinct. Lantus has an acidic pH; the body is more neutral. When the 2 come in contact, Lantus makes little crystals. These slowly dissolve. The crystals Lantus makes (aka depot or shed) keep dissolving. You just aren't adding as much back in.
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

Think of liquid pouring into a funnel.

Too slowly and it runs right through.
Too fast and it overflows.

A little fast, then back off, and it makes a stable pool with liquid going in and out at the same rate.

Speed up a bit then level off - the pool is bigger.
Slow down a bit then level off - the pool is smaller.
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

Thanks BJ. You explained everything so well. Additionally, you've made it quite clear (thank you) that the situation this morning was seriously dangerous. I will definitely play it safe and reduce to 1u tonight with an increase back up to 1.25u tomorrow morning barring any <80 numbers tonight. I don't want to push my luck and definitely want to keep Zekey safe. But only by the grace of God did the situation this morning not take a very dire turn. I figured at some point I'd have to deal with low numbers but I didn't expect that to happen so soon. I'm praying I do right by Zekey and get him safely through this process.

Thank you to you, Ann, Carl, Wendy and Sienne for helping me today, as well as Deb and others who've provided advice or information since the minute I joined this MB.

- Laura
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

BJM said:
The protocol says 0.25.

I'd go with 0.5 to help the shed drain faster, just because I don't stay up well (sleep disorder).
- You might then go to the 0.25 reduction tomorrow, unless you want to work down to shooting low to stay low more cautiously.

BJ,when you say "...,unless you want to work down to shooting low to stay low more cautiously"? Do you mean do not increase up to 1.25 but stay on 1 and see how it goes?
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

work down to shooting low to stay low more cautiously"? Do you mean do not increase up to 1.25 but stay on 1 and see how it goes?

I don't think that's what she meant. After our cats have been on Lantus for awhile, and we have enough data to see how they react (both to insulin and food) instead of having a "no shot" blood glucose number of 200, we start working our way down

The goal is to learn how to go ahead and give insulin when they're number is lower than that (shoot low) so that they're numbers stay in those healing 50-120's (to stay low)

We want them to spend as much time in those healing numbers as possible to give their pancreas a chance to heal....if you look at China's spreadsheet, you'll see where I've given insulin even when she's been under 100 a few times.....and in the low 100's even more.

That's where the data you've been collecting on your spreadsheet really comes in handy. You want to get to the point where you can "shoot low numbers to stay low"

From what I've read (and looking at your spreadsheet), the recommendation is to reduce to 1 unit tonight (to drain the shed a little), and then go back up to 1.25 and then hold it for the 3-5 days to see how it goes. IF he dropped below 80 again during that 3-5 days, you'd want to reduce even further in future cycles....down to 1 unit every cycle for 3-5 days and see how it goes...and IF another number <80 reduce another .25 to .75 units...hold again

Is that any clearer?
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

Wow, what a day! You did great.

Could you remove the 911 icon? We try to only use that when the situation is life threatening and it looks like Zeke is completely safe now. You can use the ? icon if you want dosing advice.
Liz
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

As I'm a newbie, should I go back to posting on the main forum or can I stay here on the Tight Regulation forum?

As I'm using an AlphaTrak, when analyzing Zeke's BGs against the SS should I adjustment the ranges in the SS (for my info) so that Green is 1-129, Blue is 130-229, Yellow is 230-329, etc (ie: add 30 to all)?

If so, the target is 80-129 (very good regulation), right?

We're not anywhere near this point but: After at lease 7 days that his BGs have consistently been in the normal range 80 - 129mg/dL, I can then consider reducing 0.25, correct?

BTW - Zeke tends to get very sleepy within about an hour after a shot, is this typical?

Lastly, is it possible to save my preference to see (in my posts) the most current postings first (in descending order)? I know I can change during a session, but it reverts back to ascending when I refresh or have to log back in due to timing out.
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

I meant if you wanted to just keep the 0.5 reduction for a bit, get stable first, learn a bit more and get some confidence, then dive in and work more towards making dose adjustments following the Tight Regulation protocol and shooting low to stay low.

If you're able to be home a lot and want a good chance at getting him off the insulin, following the Tight Regulation protocol and posting in this forum is where you want to be. There have been quite a few cats who've successfully done that in this forum.
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

As I'm a newbie, should I go back to posting on the main forum or can I stay here on the Tight Regulation forum?

You're in the right place! Right here with the rest of us Lantus users!!

As I'm using an AlphaTrak, when analyzing Zeke's BGs against the SS should I adjustment the ranges in the SS (for my info) so that Green is 1-129, Blue is 130-229, Yellow is 230-329, etc (ie: add 30 to all)?

Not necessary. You've got that you're using the AlphaTrak in your signature as well as in the remarks on your spreadsheet. We get pretty good about checking BUT if you think you're getting advice that doesn't sound right for the Alpha, make sure to remind us!! The majority of us do use the Relion (or other human meter) so we tend to get "used to" giving advice on the glucose levels we're more used to seeing. I saw that you'd also been using the Relion....it'll be easier if you decide on ONE as your "primary" and use that one for everything unless the other one has a problem.

If so, the target is 80-129 (very good regulation), right?

80-150 I believe. It's 50-120 for the human meters

We're not anywhere near this point but: After at lease 7 days that his BGs have consistently been under 130mg/dL, then I can consider reducing 0.25, correct?

ANY time you get a number below 80 (on the Alpha) you decrease by .25...no matter what the other numbers are. You're right, it's too soon to think about reducing at this point unless you get one of those low numbers. Keep doing your home testing and we'll be here to help advise you as we see the trends he's showing us

BTW - Zeke tends to get very sleepy within about an hour after a shot, is this typical?

Cat's normal lives revolve around hunt, kill, eat, preen, sleep....so the "sleepiness" is much more likely due to being fed after shots

The one thing I'll add is that since you had those low numbers yesterday, remember, the highs you're seeing are a "bounce". It can take up to 72 hours for a bounce to clear, so just hold that 1.25 dose and let's see where he is in a few days. Of course if you're ever concerned about a number (whether low or high), please ask!

Now, for a bit of "housekeeping". Here in the Lantus Forum, we post once/day.(we call them "condos"). Each day, give the date, cats name, and the AMPS reading in the subject line. As the day goes on, you just go back to that day's condo and "edit" the subject line with the latest results. If you also have a question, on that first post, tick the ? icon (in the icons above the Subject line) and it'll let us know you also have a question. And if you get a low number like you did yesterday, don't hesitate to use the 911 to get eyes on your condo fast! You can always go back and remove the 911 or the ? when it's appropriate.

The rest of your condo can include things like the WCR (Whole Cat Report) Things you can include are thinks like how he's "feeling"...the 5 P's, peeing, pooping, purring, preening, playing in combination with his appetite are the clinical signs that give us the WCR

Welcome to Lantus Land!!
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak. (maybe print and highlight those?)

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers.
(May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Re: AMPS 225; +2 = 87 +2.5 ~56; +3~66; +3.3~88; (AT); +3.6~

Lastly, is it possible to save my preference to see (in my posts) the most current postings first (in descending order)? I know I can change during a session, but it reverts back to ascending when I refresh or have to log back in due to timing out.

Go to the "User Control Panel" and go to the "Board Preferences" tab. On the left is "Edit display options". The bottom "set" of options is "Display post order direction:"...switch it to Descending and "submit"....it should then keep the last post listed first.
 
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