Differences between AM dosing and PM dosing.

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Linda and Tasha

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Is there a difference in the way a cat can metabolizes the insulin either based on eating & sleeping habits or just body chemistry given the same dose in the AM & PM? (I am aware of dawn phenomenon.)
My cat trends slightly higher numbers in the PM range with the same dose.
 
Re: Differences between AM dosing and PM dosing. No answers?

Linda and Tasha said:
Is there a difference in the way a cat can metabolizes the insulin either based on eating & sleeping habits or just body chemistry given the same dose in the AM & PM? (I am aware of dawn phenomenon.)
My cat trends slightly higher numbers in the PM range with the same dose.
i don't know the extent of a cat metabolizing insulin differently based on eating & sleeping habits or just body chemistry.

what i can tell you based on personal experience (been there, done that) as well as watching other caregivers give different doses at AM and PM shots... lantus doesn't seem to like it. lantus is all about consistent dosing for maximum effectiveness. using overlap and carryover to your advantage is how one achieves the shallow flat curves lantus is known for.
 
Re: Differences between AM dosing and PM dosing. No answers?

I'm a novice at this, but I can report that Stu's bedtime reading (usually at PMPS +4) is almost always higher than PMPS. I don't test after PMPS +4, but in the daytime hours his bg level always goes down after AMPS and the insulin shot. The fact that it usually goes up after the evening insulin shot and is always quite high (pink) just before AMPS suggests to me that his nighttime levels are higher. Maybe some night I'll stay up and test him ~O)
Ella
 
Re: Differences between AM dosing and PM dosing. No answers?

If you're looking for feedback on how cats metablize food and insulin, this might be a good topic to post in Think Tank. You'll probably get more responses there.
 
Re: Differences between AM dosing and PM dosing. No answers?

Based on about a year or so of playing around, I found that my Bailey does best on 2.6 units AM and 3.5 units PM. However, sometimes I still get a PM PS in the double digits.
 
Re: Differences between AM dosing and PM dosing. No answers?

Linda,

I can't tell you why, but my cat seems to be the exact opposite. She almost always goes green at PM+2. Given the same dose in am she as far as I can tell does'nt. I can't test during the week because of work, but when I test on the weekends she never does. I'm still trying to figure her out.

jan and sara
 
Re: Differences between AM dosing and PM dosing. No answers?

jan and sara said:
Linda,

I can't tell you why, but my cat seems to be the exact opposite. She almost always goes green at PM+2. Given the same dose in am she as far as I can tell does'nt. I can't test during the week because of work, but when I test on the weekends she never does. I'm still trying to figure her out.

jan and sara
In people (and I found out in cats too from another member) there is something called dawn phenomenon. A rise in BG in the early morning hours. Doesn't happen for everybody. Natures way to get you going with a little extra energy. Of course for a diabetic it isn't a great idea. In people who are non diabetic and I would assume animals too, normal insulin needs varies throughout the day and night. In a non diabetic, islet cells just makes insulin when needed, more at different times of the day then others. Different each day too depending on activity and food eaten. It is hard for me to believe that a truly flat line level of bg is really achievable with lantus using the same insulin am and pm for every cat. Some, maybe so. Cats are different and have different days too.
But... I am a newbie and am always being told differently. I know cats aren't people, but I know insulin and how it works. I have found so far that there is very little difference except the speed of metabolism is twice that in a cat to human. Everyone here will tell you differently so I'm not about ready to say I think it should be varied ever so slightly the amount for am and pm depending on your cats response to insulin. I pretty much listen to what everyone has to say and do what my gut tells me to do. I have been doing this with diabetes for 19 years. No one person has all the answers and I found that you do what ever it takes to make things work for you.
 
Larry and Kitties said:
Based on about a year or so of playing around, I found that my Bailey does best on 2.6 units AM and 3.5 units PM.

I am not surprised by that. I haven't done it yet, but I may sweeten her PM shot by a drop. Tasha is on such small amounts of insulin. Lately (except for today) her numbers haven't been that tight. Today except for her AMPS which was in the blue, everything else has been green. If I see it trending up in the evening I may consider doing it.
 
Re: Differences between AM dosing and PM dosing. No answers?

Larry and Kitties said:
Based on about a year or so of playing around, I found that my Bailey does best on 2.6 units AM and 3.5 units PM. However, sometimes I still get a PM PS in the double digits.
might the above statement have something to do with the following statement?

Re: Suggestions for being late on evening shot when going out.
by Larry and Kitties » Sun Feb 21, 2010 10:59 am

I have four cats on Lantus and not infrequently give their shots at 4:30 AM and 8:30 PM. They are usually a little high at 8:30 PM though.


link: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=6975&p=69970#p69970

we all know a late shot can be equivalent to a dose reduction. increasing the PM shot in this case only serves to give the PM shot a little boost to help overcome the higher numbers due to the shot being four hours late, yes?

without the benefit of being able to view these 4 cats spreadsheets, it's possible/probable the shed/insulin depot could overfloweth when shots are given on time... causing an occasional ps number in the double digits.

just my thoughts...
 
Larry and Kitties said:
Bailey gets the double digits when I am on a 12/12 hr 2.5/3.5 schedule. I do not count the long/short schedule as being normal
for purposes of this discussion and given the cumulative nature of lantus, the 12/12 schedule would have to be consistent.
i'm sorry if i misunderstood your post. i took "and not infrequently give their shots at 4:30 AM and 8:30 PM." to mean being off schedule was more the norm in your household than being on a consistent 12/12 schedule.
 
I think if you would like to see the results of consistent dosing, take a look at some of the condos. Kitty and Kathy would be an excellent example of a well regulated curve.
 
Sienne and Gabby said:
I think if you would like to see the results of consistent dosing, take a look at some of the condos. Kitty and Kathy would be an excellent example of a well regulated curve.
I think you have to do what ever works for you. One size does not fit all. Even what may work for most does not mean it will work that way for everyone. Just look at the differences of spreadsheets with the same insulin doses in different cats. Replacing insulin is only part of diabetes. There is no accounting for how a cat's pancreas will react differently at different times.There are also other hormones involved too. That is why we don't change for a single high number. Sometimes it just happens. Of course it is a great idea to start out with what works best for everyone and then if it doesn't work for you you have to make it work.
 
The question I would ask is this: Even if our cats' BG curves differ from day to night--and I think for many they do--why is is desirable to have the curve be the same day and night? Perhaps it is a natural biorhythm that makes them differ and the thing to do would be to find a single dose that give you numbers in a good range both day and night, even if those ranges are not identical.

I also think that the people here who help out do that under some clearly stated conditions. One of them is that you follow the protocol. It doesn't make anyone a bad person not to follow the protocol. And following the protocol is not a guarantee of success. But I do think it is unfair to come to the forum for help from volunteers if you don't want to play by the stated rules. I don't mean to sound harsh. This is just my personal opinion.

There is always room for discussion and all ideas should be revisited and made to stand the test of time and new information. But that seems more the stuff of Think Tank, not for the forum of people who are signed onto the protocol.
 
You are absolutely right. However, I do think you try to apply the protocol that has the research evidence to back it up first. And by that I would include consistently accurate dosing, being attentive to the influence of food on BG, and all of the other concerns that people have raised in your condo. If, despite your best systematic effort to have the protocol work, there are still discrepancies, then a more customized approach is needed. There are people here who have highly customized plans -- including one cat that is on TID dosing. I honestly don't think you are there yet.
 
Sienne and Gabby said:
You are absolutely right. However, I do think you try to apply the protocol that has the research evidence to back it up first. And by that I would include consistently accurate dosing, being attentive to the influence of food on BG, and all of the other concerns that people have raised in your condo. If, despite your best systematic effort to have the protocol work, there are still discrepancies, then a more customized approach is needed. There are people here who have highly customized plans -- including one cat that is on TID dosing. I honestly don't think you are there yet.
I did not mean to imply that I was there yet. I was talking in the broader sense. I have very little control over how Tasha eats. I am lucky if I can get her to eat at all. That is the most challenging part for us. She always seems to want to eat about an hour before her AMPS. That seems to be the only time of day she is interested in food. It is very frustrating. I currently am giving her what I call a 0++ (which is between a fat 0 and a .1) at a 12 hour interval. I see no reason to change it at the moment. She does trend a bit higher in the evening, but not enough so to make any kind of change. I have learned through my daughter's diabetes that it takes time to establish any real patterns. One or 2 bg test means little. I put this question up for discussion to see what others are doing and to find out the kind of patterns they are getting. I have only been doing this for a month, but I can see a lot of parallels to human diabetes. I am learning what I can use and what I must discard from what I have learned over the past 19 years. Asking about this helps me make a more informed choice for Tasha when the time comes if a choice must be made.
 
I am brand new to this, so still overwhelmed by it all. But my cat is on Lantus, and she started her first week (last week) on one unit morning and night. After a day at the vets last Saturday for a glucose curve her numbers were still really high. So the vet had me double her dose to 2 units morning and night, which I was concerned about. Her morning dose seems to go OK, but after her evening dose, she consumes a ton of water almost as if I was raising her glucose level. I am so confused and concerned. Any ideas?
 
Hi Sarshsmom!

You should probably start a new thread with this question in it because it is likely to get lost here. I'll try to go start a new thread pointing people here so they can start helping you!
 
actually the question is flawed, hence any answer is is of no consequence. i checked your SS just added up the past 11 days and it breaks down to 4 times your PMPS was higher than AMPS, 3 times it was lower than AMPS and 4 times it was the same as AMPS (BG's within a couple of numbers of each other like 171 vs 186 or 139 vs 144 are called the same number in feline diabetes). your cat is not running higher numbers in PM's vs AM's.
 
jojo and bunny said:
actually the question is flawed, hence any answer is is of no consequence. i checked your SS just added up the past 11 days and it breaks down to 4 times your PMPS was higher than AMPS, 3 times it was lower than AMPS and 4 times it was the same as AMPS (BG's within a couple of numbers of each other like 171 vs 186 or 139 vs 144 are called the same number in feline diabetes). your cat is not running higher numbers in PM's vs AM's.
It is not enormously higher that is true. That is why I didn't change anything. I just see a trend. Also there were different amounts of food intake. She eats much less (often nothing) after the second shot. You will also note their were some dose changes and that plays into it too. Also some rebounds from lows at the AMPS +3 . You are not looking at the entire picture.
 
Linda:

Just as an FYI since you are new to the Board, Jojo is probably the most experienced person on this Board (note in her sig line that she's been a member since 2000). In addition, she is an exceptionally skilled vet tech. With only a handful of other members, she is among the few who can and does look at the whole picture. She'[s not infallible, but we don't refer to her as NostraJojo without reason.
 
Sienne and Gabby said:
Linda:

Just as an FYI since you are new to the Board, Jojo is probably the most experienced person on this Board (note in her sig line that she's been a member since 2000). In addition, she is an exceptionally skilled vet tech. With only a handful of other members, she is among the few who can and does look at the whole picture. She'[s not infallible, but we don't refer to her as NostraJojo without reason.
That is good to know. I have been dealing with diabetes for 19 years. Of course not in a cat. I ask these things to become better educated and to make better choices for Tasha. One thing I have learned with my daughter is that one size does not fit all. From looking at other spread sheets, it is easy to see that this holds true here too. When it comes to diabetes in humans I consider myself an expert. Better then many of the diabetes educators I have come across.I became one by questioning everything I was told and finding out how things worked on my own. I certainly don't think I'm an expert when it comes to kitties. I do intend to learn as much as I possibly can, but as you said, no one is infallible, my self included. If I don't question, I will never learn.
 
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