AMPS 70 +2=123 Newly Regulated-low BG-dosage help

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MelanieAndRacci

MelanieAndRacci

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Hi, Racci and I are returning members of this board. I'm not sure yet if our old info is still here or not. I'm not sure of my old password or user name and have to search my files still. She's on Lantus Glargine 4.5U bid (after being on PZI for about 1.5 yrs), has diabetic neuropathy for which she takes methyl B12 3mg sublingual tab 1x daily and has asthma ( Flovent inhalant 220 1puff bid).

Racci is newly regulated after a long hard battle to get her there. The 4.5U bid dose keeps Racci usually between 167 and 280 bg. She's been on this dose for about 2 weeks. The 4U dose had her above 300 at the 12 hour test so this dose has kept her much better regulated and I thought we were okay. The last couple of days she has been getting lower and lower though. Today at the 12 hour test she was only 70 BG! I was afraid to give her reg dose so gave treats & waited 2 hours. She was still only 123! BTW, no signs of hypo. I still was afraid to give such a large dose so gave 2.5U finally but am wondering what you would have done? Did I do right or should I have let her go without her dose at all? Given her regular dose?

I will be watching her and worried all day even at the reduced dose and will test every few hours until she's over 200 but what should I do next time? I'm hoping she goes up naturally before it takes effect since she is always slow in reacting to it but I also worry that I ruined her good streak by not giving her enough. I've been told by all that Lantus is very different than PZI so feel inexperienced because of that.

I'd appreciate your help. PS: I have a current chart but it's not online, it's written. I need to start a new online one and try to find my old one at google.

Thanks,

Melanie & Racci
 
Hi Melanie,

I'm new to Lantus myself, my Suzie is on 3.5IU, I can't give you any dose advice, but I just want to tell you I understand the nail-biting and not sure what to do. Someone with the right experience will surely come along to tell you what to do for the future, but my instinct is to re-assure you and say "when in doubt, do the safe thing", I am sure the good folks here in LL can help you get back on track !

Hope someone comes along soon who can help you better than I can.

Meanwhile, look at the Lantus sticky, it helped me a lot, it explains about how Lantus builds up a "shed", and how it works in general, you might find some further re-assuring info in there. My feeling is that since she was reacting nicely to Lantus, you'll be able to get her back on track.

Hang in there!

Maria & Suzie
 
Hi Maria,
Thanks for your reply. Was Suzie on a different insulin first also? Which one? Suzie's a cutie. Is she a calico also? These photos are so small. :)

I'm about to test Racci again to see where she's at now. I made her stay here with me so I could watch her more easily and she's sleeping on my ottoman right next to me doing fine. I just hate the thought of letting her get back over 300 again! It's been such a long time getting her to this point.

I'll check out the Lantus facts. I might be able to learn the difference between it and pzi there. Thanks. I know my vet said that larger doses are common with Lantus & hearing that you're also using a high one is reassuring. My vet is a cat specialist and seems good but she tries to talk me out of testing too often because she claims that Lantus doesn't need a lot of testing like the other insulins do, which I don't get. She would rather I give the regular dose all the time which I think is dangerous - our only point of difference. She knows I do what I feel is best anyway though and she is the one who finally got Racci on the correct insulin and dose so I do trust to a certain extent but when it comes to my baby's safety, I don't like to take chances.

BTW, I forgot to say that Racci is 13 1/2.

I hope someone in the know can give advice soon so I know what to do with her next shot if i have a problem. Thanks again.

Melanie & Racci
 
Melanie!!! Where have you been? I remember you from PZI and we never heard from you after you moved. How have you been? I see that you've switched to Lantus. When did you do that? We switched Blackie to Lantus in March and Sarah & Buzz came on Lantus in January I think.

Once you get your spreadsheet up so we can see your numbers, others here will be sure to help. Please feel free to look at our spreadsheet so you can see how Blackie's bgs & doses have changed.

I'm so glad you are here. Welcome back!
 
Hi Melanie, welcome!

I agree with Maria, a good place to start is to read the stickies. The Tight Regulation Protocols sticky and the Data Ready to Shoot Lower Numbers are the most relevant right now. Then get your spreadsheet up and running and post your numbers here, and we'lll help you interpret what you're seeing. It's hard to interpret without a spreadsheet, though, or at least the last several days' numbers.
 
Hi Melanie,

Yes Suzie is a calico, "colors three" :smile: In many cultures they are considered lucky cats. Anyway, that's my excuse for "rubbing" her a lot... for luck... She is 15. I've seen cats on here that are 20 & 21 (I salute them!)

Suzie is a first-timer on any kind of insuline. In hindsight, I think her diabetes may have been missed/mis-diagnosed for up to 2 years. Everyone tells me Lantus is a good thing, smoother and easier to work with.

Never mind what your vet says, test a lot !!!! Everyone here tells me to, so that we can see what happens as the cat adjusts to Lantus (esp when the cat is starting out) and what not to do with Lantus (I am sure you have seen it in the sticky) is to "dose hop", it needs time to take effect, but as the cat's body adjusts to it, fluctuations can happen.

Look at my Suzie today, started out with a 210, nice, non-scary, I was thinking "great, today will be a smooth day like yesterday" and when I tested her at +4, she had dropped to 54 (yikes !) I mean, nice number, but that's quite a drop, and unexpected too. Now that I think about it, she has not eaten much today, so that's probably why. So much for me getting anything else done today, scratch all plans, am now on "cat watch".

Look at Suzie's spreadsheet and you can see why it's wortwhile to test, she's thrown some unexpected numbers at times. You are paying for those strips, not your vet, so just test away, it will re-assure you, and help others help you better. (but don't test more than Racci's ears can take ! ;-) )

Get that spreadsheet set up (a bit of a stressful effort I know, when you are worried about the cat and just trying to get stuff done), but then we all (peeping toms that we are) can look at it, and people who are far more knowledgeable than me can give you some good advice !


Best of luck!

Maria & Suzie
 
Welcome Melanie!

People are giving you good suggestions. The reason a spreadsheet will be helpful is to see how Racci's numbers look as well as to know how you got to your current dose. There are considerable differences between Lantus and PZI. Lantus dosing is based on the nadir of the cycle and the the pre-shot level. In addition, Lantus is a depot-type (we refer to this as a "shed") medication which allows for longer duration and overlap between shots. PZI is a shorter acting type of insulin compared with Lantus. While you can certainly get low numbers with Lantus, we have had very few cats experience a symptomatic hypoglycemic episode with Lantus.
 
Good Morning!

I'm sorry I couldn't reply sooner. I tried twice last night and typed out these long replies and both times I lost them! I was so frustrated that I gave up for the night. I had to play with the computer a bit and hopefully it's working ok now. :)

Ele! It's great to talk to you! I had a crazy move and terrible winter. Sorry for disappearing. First they lost our stuff and we got most of it after a month, some of it never showed up. Had to do repairs on the new house, buy furniture, paint, etc. Calli (15) adjusted fine as usual but also as usual, my little sugarkit, Racci (13.5) did not and weeks of comforting and coaxing her out of the closet were spent. Then we got snowed in most of the winter with sporadic electricity, etc. Racci developed the neuropathy and I was sick with bronchitis all winter. Computer setup was just low on the list. lol.

I think Calicoes may be lucky for us Maria, but not for them, poor things with diabetes and asthma. lol. I consider getting Racci lucky for me. She's the sweetest most affectionate creature I've ever known and a gift that Calli gave me. :)

I did read the Lantus info and Libby, you were right about the tight regulation chapter. It was very helpful! I still don't quite get the way it works but saw it for myself in Racci's numbers yesterday.

Sienne, isn't PZI's dose based on the nadir and pre-shot also?

It turned out that giving the low dose at +2 was the right thing to do. Racci ended the night with a PMPS 160 at +13 and I gave her a regular dose of 4.5U. She's due for her AMPS in an hour so we'll see how that worked out. I'll let you know what it is after her shot.

Thank you all for your replies and help! It sure feels good to have someone to discuss it with again!

Melanie & Racci
 
Hi Melanie,
This is the protocol that we have been following since our switch: http://www.tillydiabetes.net/en_6_protocol2.htm It's also in the tight regulation sticky. It really helped me to have these rules to follow for dose increases and decreases.

I would like to make a suggestion for your postings. Because LL is so busy, they have a few guidelines for posting. Post once a day and put in your subject line the date, kitty name and bg number. WCR means Whole Cat Report so we know how your kitty is feeling. And put in a link for the previous day's posting. You'll want to do a new post each day. Each post is called a condo.

I'm really glad you're here and look forward to seeing your posts.
 
Melanie! I was so happy to see your name on LL! It's great to see you back and to hear that all is well (though it sounds like it took awhile to get there). I still laugh when I think about you testing on the airplane bathroom; that is one of my favorite FD stories. :mrgreen:

I'm sorry I can't give you any dosing advice, but people here are wonderful for both support and advice. I think you will find this to be a great home away from home. Ele's given you good tips on posting; there is so much traffic here that we don't want you to get overlooked. I'm eager to see how Racci does on Lantus; it looks like she's off to a great start.
 
Hi Ele,
Sorry I haven't posted. Things have been crazy here and Racci has remained in very low numbers so I have been crazed watching and testing her. One of the cats peed on the floor near their box and I have been freaked over that too. Calli had an upsetting day too though so I don't know who it was but it scares me since Racci has been near 100 consistently. To top it off, I was ready to do Racci's chart and water spilled on her book with the log and the ink ran and now I have to search my computer and online and hope I can find old charts but all my new info is lost!!!!!! I can just scream! I am always so careful to write it all down and it's gone!

At any rate thank you for your last post with the links. I wanted to verify some things. The protocol was very helpful and agrees with what her vet has been telling me as well only has much more info that I needed. When I post, am I supposed to post only once per day? Does this mean I should post in the evening after I have all the figures or the next day with the figures so it is complete?

Maybe I'm panicing over nothing since according to the protocol Racci should be at these low numbers all the time if she's tightly regulated? I'm just not used to seeing these kind of numbers consistently and especially at 12 and 14 hours. I'm about to give insulin at +14 now when I test again!

Hi Sarah! It's good to talk to you! It's funny but on the airplane, the hard part was the kitty litter, not the testing & shot. LOL. The testing went smooth as can be but turning around in that tine spot with a little disposable kitty pan, setting it up, filling it and then emptying it was murder!!! lol.

Melanie & Racci
 
Ho welcome back to LL!

Bummer about losing your data! But, it happened so you can now let it go, breath deeply and start a whole new SS (spreadsheet.)

I can't advise on dose but I can answer a couple of questions about how the board is set up. We set up a new Condo each day , but you can post to it as as often as you want. Usually the Subject is " today's date cat's name AMPS~#" If you want to change how the subject reads on the list in the forum, go back to your first post , click edit, and add info put in a question, ask for help, etc. If you just change the subject in a reply that you add to the condo it won't show up on the list, only on that post within your condo. We often go in and edit that first post subject w/ the PMPS # or other tests when things are changing. Advisors can see at a glance who needs help that way.
 
Hi Ann,
Thanks for the reply. I just got Racci's new sheet up so at least that is up and I found her old online ss from June to September 09 so I think I will post an additional link to that one just for history. I'm just really bummed out though because the old one was pzi, not lantus and she was all over the place on that. It doesn't really tell how she's been doing lately. Once I get the other link up I think I'll put up a new post the correct way so Racci and I will have our first real condo or should I wait for more data from today? She's had only 2 tests and isn't going to get one for a while because I know she won't change much for another couple of hours.

Thanks!

Melanie & Racci
 
Hi Melanie,

This is going to be a housekeeping post... and I apologize for being a little direct.

1 condo (thread) per cat per day - we've been recycling this condo since Wednesday.
Post title should be Date-Cat Name - AMPS number or whatever else number for that day.
So... new day, new post (and you link the condo for the day before)

Also... stick to the same dose. From your SS, I think you are dose hopping. For the time being, pick a dose. Others, including myself, have changed from another insulin and we've had to bleach and brain and start the learning curve all over again, but we're all here to help you. However, pls remember that Lantus doesn't work like the other insulins and that this insulin likes things to be consistent -dose and time of shot.

I hope this helps and welcome again!
 
Just a thought about your missing data...

By any chance, does your meter store your test data? Mine will store numbers for at least a week, maybe 2.
 
Hi Helene,

I appreciate the directness. I'll change the post on the next message. I just didn't want to lose it. I'm having trouble typing today (I have RSD so some days are difficult for me).

I havve started jumping a little with her new low numbers out of fear of giving such a high dose. you're right. I need to go back to the 4u where she was safe but not that low or be brave and watch very carefully and keep her on 4.5. I just don't know what to do. At 4.5, she is at the numbers consistently that she should be according to the tight regulation page. It's scary though. She has never been there before and someone peed on the fllor and I don't know if it was her so I'm worried. Can anyone advise?

Calli was also upset because she ran and hid and was crying so it could have been her too. I just don't know which way to go. It could have been Calli and not Racci but if it was Racci, it could be a sign of hypo. What do you think?

Sienne, thanks for the good suggestion. I thought of that too and tried it but my meter has wrong date and time on it so it is very confusing and it also does this stupid averaging thing in between each test so i have to be really careful to get the right numbers. Will have to attempt it on a good day when I'm feeling really sharp. I kept making mistakes the other night. I was too tired.

Please excuse all my typos today. Thanks!

Melanie & Racci
 
MelanieAndRacci said:
I havve started jumping a little with her new low numbers out of fear of giving such a high dose. you're right. I need to go back to the 4u where she was safe but not that low or be brave and watch very carefully and keep her on 4.5. I just don't know what to do. At 4.5, she is at the numbers consistently that she should be according to the tight regulation page. It's scary though. She has never been there before and someone peed on the fllor and I don't know if it was her so I'm worried. Can anyone advise?
Click to expand...

What I would do is pick one of your doses (probably the 4.0 units) and hold it for a few days, and get as many spot checks as you can. The insulin usually shows most of its action in the middle of the cycle, so we don't know if Racci is going low or staying high or what. The +1 and +2 tests are showing a food spike and a little of the natural rise that occurs as the earlier dose is wearing off before the new dose kicks in. We need to see some tests between +3 and +7 to know what is really happening. Then you'll know for sure whether the dose is too much, too little, or just right. It looks like she is really close, if not at, her perfect dose for now, so let's be sure.
 
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