AMPS only; #s not changing w/ increases...Need PMPS?

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mstoney

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Sunshine diagnosed on 2/1/2010. Used Vetsulin up until 3/23 with limited results. Switched to Glargine at one dose daily on 3/24 (per vet). Numbers show little change w/ dosage increases. Concerned that: need PM dose? insulin not effective for my cat? bad bottle of insulin? still filling reservoir...gas tank...what is it? oh....storage shed? I need to be more patient (and not overshoot target)?

Here are my numbers:
3/24/2010 8:00a 2.0u New Insulin - glargine
11:07a 439
4:04p 434
10:34p 431
3/25/2010 8:00a 3.0u
4:28p 451
6:57p 435
11:22p 391
3/26/2010 8:30a 3.0u
10:48a 397
3/27/2010 8:00a 3.0u
2:25p 348
3/28/2010 8:00a 4.0u
10:32a 411
2:27p 357
5:58p 427
11:13p 388
3/29/2010 8:00a 4.0u
12:42p 397
6:08p 393
3/30/2010 8:00a 4.0u
8:37a 390
1:21p 353
7:46p 370
3/31/2010 7:30a 5.0u
7:37a 426
10:44a 388
9:16p 409
11:35p 377

What do you think? Compared to what I read tonight (first time on site), the units seem higher than most. Might I be increasing too fast and not waiting for insulin to stabilize at one level before moving to next? Will get your Google.doc ss and start the color chart.

Thanks for your input,
M. Stoney
 
welcome to Lantus Land!

I'm on my way to bed, but I'm sure others will chime in. What was Sunshine's dose on Vetsulin?

Lantus is a twice daily insulin for cats (in humans it is once a day, and many vets think that applies to cats, but cats' metabolisms are much faster than humans). We very, very rarely have a cat that will go on SID (once daily) dosing for a time, but that is only when they are on the smallest possible dose and are almost ready to go off insulin. I suggest you change to twice daily dosing, BUT not at the high dose you are on.

Yes, increasing from 2 units to 5 in one week is too fast. Instead of starting with 2 units once a day, I would suggest 1 unit twice a day, then following the dosing protocol here for any increases. If you can get the spreadsheet up and running (and also include any numbers you have from the last couple of weeks on Vetsulin), that will help us see if that is a good recommendation.

What is Sunshine eating? Any other medical considerations or complications that we should be aware of?
 
just wanted to say WELCOME! no expert here, but there are others that can help you out. You've found the best place to be for a kitty with FD.

Welcome aboard!
 
Hi, welcome to Lantus Land. I'm not a dosing expert,so I can't really give advice, but here are the basics.

The protocol we follow here is calls for 2 shots a day, 12 hours apart. Your increases are really a lot faster than we do w/ Lantus. It is usually a week in between increases and then only .25u or .5u not a full unit. It takes a cat several cycles (12 hour periods) for the dose to start showing in a cat. Also, for Lantus we set the dose by how low the BG gets during the cycle, not the preshot number. It is a lot different than using other insulins. You have to learn everything all over again. :roll:

Read all the stickies, the permanent posts at the top of the forum. Someone more experienced will be along soon.

Just saw that Libby had posted. She is great, you are in good hands. As Libby mentioned food is really important, FD cats need low carb food, but it can really drop the BG so you have to be especially careful with the insulin dose. Try to get a Profile set up too.It will get a lot of the questions people will ask answered all in one place.
 
It's been said, but it's pretty important so I'll repeat it..

Lantus is a twice a day insulin for cats. It gets most of it's effect from how it works over time with steady dosing 12 hours apart. Part of it's magic is that it builds up a shed (or reserve).. you are effectively making a reserve and then draining it each day and not really getting anywhere (as you have noticed by your AMPS tests).

The 5U dose can be quite dangerous.. although you aren't seeing changes in your once a day test, your cat could be dropping dangerously low during the day.. the rollercoaster your cat is on is very rough on her (assuming her with the pretty name of Sunshine :) ) and you obviously!

You are in the same boat that most of us were when we started.. I'll be the first one to admit I took my Nova for a wild ride before I knew what the heck I was doing. Even though we have a great vet, it's pretty tough for vets to stay up to date on the latest and greatest of every single disease out there. The good news is, you ended up here, and there's a lot of knowledgeable and helpful people that can help you (as they helped me) get on the right track.

Start over at 1U, twice a day (this is also a good time to switch to a low carb wet food only diet). And as you will hear over and over, the more information you get (by testing not only AMPS and PMPS, but as much as you can throughout the cycle), the faster you can get Sunshine under control.
 
Others have already noted some of the basics -- reading the stickys will help to familiarize you with the dosing protocol that we follow, the care and handling of Lantus, that dosing is based on the nadir, and not pre-shot numbers, etc. This is also a very test-oriented forum. As such having a spreadsheet will allow us to help you more effectively.

You can find the links for how to create both a spreadsheet and a profile in the Tech Support Forum. The profile contains information about medical history, food, etc. so we don't keep badgering you with the same questions.

I'd strongly encourage you to look at the sticky regarding the Tight Regulation Dosing Protocol. Dose increases are made in the amount of 0.25 to 0.50u. Increasing in 1.0u amounts is far too fast and vastly increases the likelihood that you will miss what is your optimal dose. It can also put your cat in a chronic rebound. As others have suggested, it may be most effective if you start over at 1.0u and shoot twice a day (12 hours apart).
 
Cats are not humans, but man, would I love to have a cat's metabolism! Would I ever be able to burn off some extra fat I have!

Most definitely you need 2 shots a day of insulin for a cat.
With Lantus, you need to pick a time that is good for you, AM and PM. It looks like 8am is good for you, so if 8pm is also good for you, then that's the time of your shots.
The 12hours apart rule is VERY important; if you give the shot before 8, it's like a dose increase, if you give the shot after 8, it's like a dose decrease.

You are correct about the gas tank, the shed; it's got to be filled before you are going to see some results. If your dose is 1u, those first few shots are going into the shed and not helping a cat, so that's why you MUST stick with the same dose for 6-10 cycles (3-5 days of 2 shots a day) before deciding if the dose is good enough. There ARE some cats who take that entire 6 shots before their shed is filled and changes are seen in the numbers, so the waiting is hard but necessary.

It looks like you have been giving one shot in the am, then testing regularly. Awesome that you are testing - the numbers that matter most will be the ones in the middle of the shots.
If your shots are 8am and 8pm, you NEED to see what is happening at times like +3 and +6 and +9 hours after each shot. The number at ps is important to know where the cat is before the shot because some cats may be so low that the full shot may not be given, but in your case, you don't have that worry yet.
The area you are looking at right now is in the mid point - after the shot, you will see the numbers go down, down, and then the numbers go up, up as you get closer to the next shot time. That number, nadir, around +6 or so, will tell you when to change the dose and by how much. If you follow the protocol, you will definitely see results, but no rushing. Hold that first dose of 1.0u for a full 5 days, 10 shots. Then look at the numbers you have gathered and decide on the increase. All following doses do not need to be held for so long - just 3 days or 6 shots are needed for each dose.
http://www.tillydiabetes.net/en_6_protocol2.htm

Now, you have been giving a shot, most of it is going into the shed, then you don't give a shot 12 hrs later so the tiny bit that went to the shed gets used and you are right back at square one again. You got nowhere! That may explain part of the reason you are not seeing results.

What you have though, is a great routine that just needs another shot stuck into the evening and a couple more tests after that pm shot, and you are off to the races.

That dose of 5 most likely is too high. There is no way of knowing without starting lower and working your way back up with 2 shots a day, 12 hours apart. You should hold that first dose of 1u for 10 shots or 5days. After that time, you will increase to 1.25u or 1.5u, depending on what kind of numbers you got around that +6 time.
You are really going to need that spreadsheet because it's very clear to see how things are going with the numbers. You can take a look at the two spreadsheets I have in my signature to see how it helps to visualize how your cat is doing; my two are quite different, and the sheets help.
I am guessing at the starting dose but most times, it's best to start at 1u and build up from there.

The others will have very good info and directions for you.
I am sure that once you are all set up and into a good routine, you are going to see great results.
 
You are all amazing! Thanks so much for getting me (and Sunny) on the right track. An updated spreadsheet and profile are attached. One more question:
Do shots have to be 2 hours before she eats? I believe that's what I read somewhere.
Thanks again, fellow travelers on this medical journey. Really appreciate it. MDS
 

Attachments

What you want to see at ps time is a pure number that is NOT affected by foods, and some cats have their numbers go way up after they eat.
You see often that others are told to test in 15min but do NOT feed because they need to see if the numbers are rising on their own, and not because of food.
Think of feeding HC or LC. If a cat is low, you are to feed some HC and it brings their number up to a safer area, right?

That's why you don't want to give any food or have any eating for the 2 hrs before each shot. That way the food should be out of the system to the point where your ps number will not be colored by foods.

So 2 hrs before each shot, lift the foods. And don't give in to those pity looks and whining and sucking up. Look away! Be strong!
 
Usually we get the preshot test (give yourself 15 to 30 minutes before the shot to get it all done) , feed and then shoot. I think what you are referring to is that we do not allow them to eat during the 2 hours before the preshot test. That is because we do not want the food to effect the test. Feeding after the test and before the shot makes sure your cat eats when it is getting insulin. If no food the BG can drop drastically once the insulin kicks in.
 
Gayle and Shadoe said:
So 2 hrs before each shot, lift the foods. And don't give in to those pity looks and whining and sucking up. Look away! Be strong!

Or do what I do and pretend to be sleeping! :)

Great that you got a SS together.. buuut (yeah, we're not easy to please are we :) ).. Sienne gave a link above you should follow, to learn how to set up a google ss. The great thing about doing it that way is that we can see it when you update, instead of having to download and open and not everyone has the ability to read xls files on their computer/phones.

Looks like you've been getting in a fair amount of testing.. it won't take us much nagging at all to get you up to the insane amounts most of us consider normal :).
 
Spreadsheet Template and Instructions

I think it's the right link to get you started. With the google ss, you can access it from anyplace to update, and others have the ability to see the ss anytime. If you add the link to your signature, it's available to everyone from any of your posts.
 
I agree with Gayle's note about using the Google spreadsheet. Not everyone here has Excel and you don't need to have the software on your computer to use the Google documents.
 
Wow! All you night people. :-D

I just want to say welcome and offer a little pat on the back for all that testing you are doing. That's great and as I learned, testing is THE key to unleashing the powers of Lantus, so you are halfway there. The other half will come along, I'm sure.

Others have said it but I'll chime in with a YES to the twice a day shots.

As for the feeding and shots, most of us test, feed and shoot all at basically the same time. We used to test, feed Basil up on a desk with his dish inside a flower pot to keep his head raised, and shoot while he was eating. He never seemed to mind. The purpose of the flower pot was to make it a little easier to tent the skin for the shot. (I say "used to" because Basil is in remission as of March 3!!)

Best of luck and looking forward to tracking your kitty's progress.
 
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