Alice AMPS 335, PMPS 115 Why? New to Lantus

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Julie and Alice

Julie and Alice

Member Since 2014
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Hi,
Todays Bgs are a mystery and concern to me. Alice has been on Lantus only a few days but looked steady in the fairly highs. Suddenly, just as about to increase from one unit to 1.5 her AMPS was lower than usual so after some pondering decided to just increase a tad. As there are no .25 markings on the syringe, I drew a fraction past the 1 unit but not to the 1.5. The days readings have taken me by surprise:
AMPS 335 (+3 -211) (+6 -212), PMPS 115. I delayed the shot by 40 minutes having let her eat and it was then PMPS 139, I gave 1 unit Lantus & (+2 -187). I've just realised that wont be clear on the SS as there are really 2 PMPS! I'll see if I can adjust it somehow.

I don't understand how she dropped this low. She had a good day, ate well this morning. Played again!! (Favourite pink mouse!). she became hungry about 2 hours before due to have shot. I gave her about 20 gms Hill's diabetic food one hour before shot was due to keep her happy but she was still hungry. I made her wait as told by vet to give most of food at insulin time. In future I will feed her if she asks.

What do I do now?? It's 11.30pm. How closely should I monitor her n the night? I'd really like to understand why the huge drop if anyone is able to cast any light on it.
Many thanks,
Juliana nailbite_smile
Ps. Am I doing this correctly? (New topic & linking this correctly to my first post?)
 
Hi Juliana, welcome to LL! I don't post daily condos for Nikki anymore but I do lurk around. Saturdays are sometimes a little quiet, especially as it's Easter weekend. Good job linking your condo and getting that PM +2 test in! Looks like Alice is getting some use out of that new dose. Generally it's recommended that newcomers don't shoot under 150 (or 180 on the Alphatrak you're using) but I think you are testing enough that it should be safe.

I'll leave the dosing advice for more experienced people, but I think since your +2 was higher than your PMPS, you can probably just leave a little food out for Alice and set an alarm to get a test in around +4. Lantus tends to give nice flat curves at lower numbers, so she shouldn't drop like she did on the other insulin.
 
wow, julie - what a surprise! and we thought she might need more insulin. clearly not at this point!

i'm glad you held the dose at 1.0u. now you're going to want to stay there for 6-10 cycles (shots) depending on what her numbers are.

i don't know why she dropped like that, but it's great you caught it. It may be that she's settling into the Lantus and now the depot is "filled" so it's "helping" with the dose you're injecting. I probably did a lousy job of describing it, but if you read the yellow starred sticky note on What is the Insulin Depot? it will make more sense. That's why we do usually wait for 5 days or so for a cat newly on Lantus to adjust before making a dose adjustment. We were just more concerned with Alice because of her background of DKA.

Cats puzzle us sometimes - ya just go with it and work with what they give us. As far as tonight goes, I see a +2 of 187 so she may be on her way up. I'd get a +3 if you can, and if it's still going up, she's likely bouncing (read the second post for an explanation of it). If she's significantly higher, go to bed! If she's dropped back down, you may need to keep checking, depending on what the number is.

So just stick with the 1.0u and let's see what she does. Don't be surprised if she goes really high tonight or tomorrow - even though she was in better numbers before on the Caninsulin, cats lose their "familiarity" with lower numbers fairly quickly and when they aren't used to lower numbers - even not dangerously low - the bounce can last 72 hrs or so.

While she's bouncing, don't increase the dose. You don't want to be overdosed when she clears it.

And yes - ya linked your condo just right and you're doing great with the posting. Thanks for all of that - it makes it easy for people to help you. Have a great evening!
 
Thanks Julie,

Should I keep trying to get her to feed? She's eaten but perhaps not as much as usual. Off to test again!

Nikki's Mom - just read the Dealing with low numbers - thanks for the link. I've saved it for future reference.

The vet actually rang me and advised that I still give the Lantus. I probably would have waited and then given a half unit for the night but she read the protocol & didn't seem to think she would go hypo. I'm not so sure. Yep - anxious again!

She's asleep now. I'm presuming that she would want to eat if going low?

Julianax
 
I can't recall what your home situation is, but if you can leave plenty of low carb food for her (her regular food) that she can get to, but no one else will eat, and her next number isn't lower, she should probably be fine.
 
you know, i should have thought harder before i commented about the dose. technically, you would hold the dose at 1.25u since she didn't "earn" a reduction, meaning she didn't go below 50 (80AT). So . . . even though you gave the 1.0u dose tonight based upon the preshot being lower than you expected, you might want to go back to 1.25u tomorrow morning and then stay there. We don't reduce or increase doses based upon the preshot, other than to do a one-time reduction if there are circumstances that call for it.

It was fine that you reduced, i don't mean that, but i mean that following the protocol would mean that you would return to 1.25u tomorrow morning. What do you think about that?

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

Please do not let yourself become complacent or blasé about drops into the 20s or 30s.
If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
Please ask for advice.

If anyone suggests otherwise, they are putting your cat at risk! Our kitties are not just numbers. They are living beings who trust us to look out for them. The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive.

Keeping YOUR cat safe is the #1 priority of the FDMB.
Let's keep all our kitties in the Lantus Tight Regulation ISG safe by suggesting and taking appropriate reductions.
Click to expand...
 
Hi Julie,
I've just tested again (+4 hours) she's gone back down to 5.6 which I reckon must be 100.8 (x by 18). I'll put it on SS.
She was sleeping, not asking for food, but I've taken her some Hill's diabetic wet food & she's eaten. Would her higher carb Royal Canin Chicken & rice be better?
I'm seriously worried now that she hasn't reached the bottom. When should I retest? I think it will probably go up quickly now because of the food but I'm thinking later in the night. I will lwave food out but will she get up to eat it?
Juliana
 
darn. well the thing is we don't have any idea when her nadir is yet. so the safe thing to do is going to be for you to get up in another hour and test her again. we just want her to bottom out and start back up.

i'm sorry for the bad news. when we know her patterns it will be easier and you won't always need to do this, but if there is any way you can tonight, i would. i always slept on the living room sofa with the lights on, with my cell phone alarm set when i needed to recheck punkin.

awfully great numbers for her, though!! it's very good for her body, just rough on you.
 
Ok! I haven't gone to bed yet anyway. I wouldn't dare leave her. She looks fine. The worry ing thing is, when she went this low after a day at the vets & on Caninsulin she begged for food. Should I keep feeding her? I guess so if she'll eat it (talking to myself now!). I'm so dog-gone tired & feel sick in the stomach now! I have some Glucogel (fast-acting Dextrose gel) how much would I give if necessary & at what number?

Sorry to bother you, I'm so pleased you are around at the mo!
Juliana
 
:-D i've been sewing all afternoon and looked at the clock and thought "shot time for east coast people" and thought i'd check in. I see several other experienced folks are on right now too.

you don't need to intervene with carbs until she drops below 80. i'm not familiar with the Glucogel. What most of us do is to pop open a can of high carb cat food with gravy (nom nom nom) put the lid back on and squeeze out about a teaspoon of gravy. kitties mostly love it. If you don't have high carb gravy cat food, you can put in a drop of karo syrup (corn syrup), pancake syrup, maple syrup, or the Glucogel (it ought to have directions on it) and then you wait for the carbs to take effect.

Once you've done that, then post and ask for help. Also take a look at the "how to handle low numbers" sticky and look at the section that applies mid-cycle (not the section that applies to preshot numbers.)

Edited to correct for Alpha Trak meter numbers.
 
ok thanks.

By the way, her dose of Lantus was only 1 unit anyway. Her AMPS today was lower than normal which I didn't understand but wondered if it was to do with her overlap but I still increased the .25 (instead of .5). Ten mins to testing time!

Thanks for looking in.
Juliana (actually Julie!)x
 
BG gone up to 126 - after all the food she ate I thought it might have spiked more!
The Glucogel btw is for humans & it says 'Swollow the whole tube'! (25grams of gel) Hopefully she wont need it but if so I'll try a teaspoon!
Do you (or anyone around) think hourly is ok to test or more frequently at the moment? I cant remember when the expected nadir is normally, was it around 6 hours?
Juliana
 
it can be anywhere from about +3 to +8 - it's so hard to say until we see what she actually does. by the "manual" it's about +6, but it varies tremendously from cat to cat.

i think you're probably ok to go to bed, though, if you want. One of the things you're looking at is the speed of the drop - she's basically holding steady tonight. ya gotta sleep at some point. although if you're nervous, you could recheck her in another hour.

remember, unless she's below 80 AT you don't need to do anything.
 
Is this still the effects of the food at +4 & +5 or is it past the nadir now?? I'm guessing its safe to leave her for a couple of hours now at 10.3 (about 184).

Thanks for supportx
 
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