Dosing Question/reaction to dosing change

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Maresydotes

Maresydotes

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I have been trying to check Missy more often, now that my back allows me to bend over without pain :mrgreen: She has been hangin in the 200s AMPS and 300s PPMS for the most part, lately, so I increased her dose by .25 on 9/30. There was not much response, although I do realize I haven't gotten much data mid-cycle. I waited until 10/5 for her to settle in to the dose and then I did a curve. It was pretty flat, staying in the 200s the entire day. I decided that I would go up to 4.50 units....and did that today. I checked her at + 4 1/2 and she was at 64, checked her again a couple minutes later, in case I made an error and she was 74 then. I just checked her at +5 1/2 and she is at 77 (and had a tsp. of food. )
She hasn't been acting hypoglycemic, she is doing her normal routine and is bright eyed and engaged. Is this a "normal" response to a dose increase?
I didn't see anything change in numbers on the last dose increase......although in fairness, I didn't check mid-cycle. I guess I won't be skipping mid-cycle tests anymore, given todays response. :roll: It is going to be interesting to see where she is PPMS.
Any thoughts?
Thanks,
Mares and Miss
 
Numbers that low are actually "normal" (non-diabetic). If she hasn't been that low before you may see a "bounce" - a sudden spike into much higher numbers that may take a day or so to clear. Without visible symptoms of hypo you shouldn't worry unless you see numbers under.50. It looks like she's headed up so you're probably fine, but you may want to check again in half an hour or so to make sure it's noy just a food spike.
 
Hi Mares,

The first thing I want to say is I'm so glad your back is feeling better and that it will allow you the opportunity to test more often. Also, good for you for posting, your gut is usually right!

Really at this point I just want to make a few observations for you to consider and then give you a few options in how to proceed safely.

It is almost impossible for anyone to give you responsible advice without more information. As mentioned above, those day time and night time spot checks will become an invaluable part of your toolbox in making any kinds of decisions. Are you able to do that and would it be possible to run a curve maybe on the weekends? (the one you did on 10/5 was GREAT....with more data, we could tell if this was a bounce or if she truly was flat...but without it, we just don't know. That makes deciding about an increase, a risky proposition).

An important thing to keep in mind with Lantus is.....it's only about 10% about the AMPS and the PMPS and about 90% about the nadir (or the peak) of the insulin. It's those throughout the cycle checks that will give you the best picture of how the insulin is working for Missy and where her nadir is. I have a hunch that lower numbers are happening during the day and they're just not being captured.

With that having been said.....I am concerned with the dose you are on without data. 4.5 units twice a day is A LOT of insulin for most cats. I cannot say with any certainty that it's the wrong dose, but I can say it's not a conservative dose with the small amount of data available, which potentially makes it a dangerous dose (especially considering she dropped to 64 today with the very first installment).

From my perspective, the the safest option is to "start over" by starting low and going slow; following the Tight Regulation Protocol to the "t". It would be important to test mid cycle sporadically, both during the day and night if possible and to curve once a week if you can. There are a lot of people over on the Lantus board that will guide you every step of the way. We'll help to figure out how to fit a routine, into your individual schedule, because we all have to live a bit too!

Does this sound like something you would and could do?
 
I also have concerns about taking a cat up as much as you did at one time. I also agree with Jessica that I would take her back down and follow the protocol with her; never increase by more than .25u if her nadir is under 300. Give her six cycles to settle into a dose when you raise. Her high numbers could be too much insulin....it sometimes looks the same.

I'm also worried about her 64 today which is like a 34 on a human meter. She definitely needs to be brought back down in dose from the 4.5u.

I know you posted in Lantus ISG a few days ago I believe. I think it would be a good idea for you to stay over there where alot of experienced eyes using lantus can help out.

Good luck!
 
mares, i'm just wondering - on missy's ss it says you started a new lantus pen on oct 5th. how old was the lantus you were using? because if it was more than a month or so old, especially if it was your original lantus from the beginning of the spreadsheet, you may have had higher doses coming because the lantus was not effective anymore.

that might explain why the sudden drop in BG today. i'm thinking she got a shot of good lantus.

does that sound like a possible explanation for her drop today?

you probably are going to need to keep an eye on her tonight and make sure that if she goes below 80 on the AT that you bring her up. use tiny amounts of gravy from a high carb canned catfood - you can post here and someone will help you through it. often on lantus we don't see dramatic hypoglycemic symptoms when they go low. seems like it's usually mental confusion in the cat. we still treat it.

you should probably print out this link in case you need it: Shooting & Handling Low Numbers

i would also encourage you to keep posting on the lantus forum. that way people can get to know your kitty and situation and help you.
 
Marjorie,
I increased her from 4.25 to 4.5. I waited over a week and did the curve before I bumped her to 4.5. I thought increasing seemed reasonable, as all her numbers were in the 200s on the curve....and most of the few mid-day checks I did were in the 200s, also. In the past, I had increased her a larger amount, on the advice of my vet, but after getting feedback here and reading the protocol, I decided I would NOT do that again.
I DO realize I need to get more data.......

Julie,
This is first time I have used a pen. I was using vials and I threw them out after 28 days plus or minus a few. The date on the prescription label of the last vial says to stop using it on Oct. 4, so I think I am ok there. I would rather err on the side of caution and stop using it, even though some people in here say you can use it longer. But, is it possible that the pen concentration is somewhat different than the vial concentration? I wouldn't think so, but I have read posts where some people think the pens from Turkey via Canada work better.

Thank you for the link on shooting and handling low numbers. I have been cruising around the board for a while and reading all that stuff....I printed up the info on handling hypos and built my little hypo 'kit' up for her. She was very low once before in March and scared me to death. But that time you could definitely tell something was going on. She seems ok today....

Well, I need to go check on her. I want to see where she is right now. Thank you all so much. I am happy to take in all the advise you can give me.....and I WILL get more data!!! :sad:
 
Yippee!!! She is 142 now! HUGE SIGH OF RELIEF I will continue to monitor her and do you think I would be wise to back her down to 4.25 for tonight?
 
Well,she was well up tonight at PPMS.(243) I gave her a skinny 4.25 and will check her later...past my normal bedtime, but want to make sure she is ok. I get kind of intense over my kitties and I was pretty spun up tonight. (and she looks at me like "what's up, Ma?") She is snoring in the recliner right now, so I think we are good for the night.
Thank you, thank you , thank you for your input! It sure helps!!
 
Hi Mares,
Just a few more thoughts here and then I would encourage you to begin a new thread each day on the Lantus board. You'll see over there how we put the date, what our AMPS OR PMPS are, and anything else we may see during the day that would be important in a header. PLEASE MAKE SURE, when you post your numbers...that you put ALPHATRAK meter behind them .

I just want to make sure you understand why I want you to post the type of meter and want to make sure you understand that the ALPHATRAK meter is different than the human meter, so the numbers you are seeing don't correlate to most of the numbers posted in the Stickies. I do not know what the conversion is, but someone will can easily give you that info. If you're not already, you need to become VERY FAMILIAR with the conversion. As Marje mentioned last night...that 64 on your ALPHA METER.....is like 34 on the ones most of us are using and that's definitely a critical value.

I think 4.25 is still too much insulin. I would start over at 2.5 Units immediately. That's the recommended starting dose for a 22lb cat. If you can hold that dose for 5-7 days, post each day your information, update your spreadsheet daily, and get mid-cycle tests and a curve or two....you will find you have more than enough info to make educated decisions and more than enough info to let others help you at any time, day or night.

My main goal here is to make sure Missy stays safe. I think fate intervened when you posted yesterday....If you've already shot the 4.25 again this morning....please watch her very closely, please know the conversion and please have your HYPO TOOL kit as referenced above ready in case she falls again.
 
Jessica And Boo,
I love Boo's name. Boo is actually a nickname DH gave Missy. :smile:
I like your suggestions with one caveat. I plan on doing more testing...just posted the last ones on her spreadsheet. So, hopefully I will have some good data in a week or so. I will have a bit of trouble doing the PM tests, as I have MS and fatigue issues, but I will try to do a few. I can see how they are important, esp since she generally does not have food out in the night....unless she has some left over from the PM shot time.
My one caveat about your suggestion is dropping her dose so much so fast. Wouldn't she bounce WAY high if I did that? I am nervous about it. I don't want to stress her body more than I already have. Even dropping her down to 4 units last night caused her to go rather high this am.Wouldn't it be better to back her down, gradually?
I really would like your opinion on that. You have much more experience with this......
Do you think I am ready to post on the Lantus board? I really don't have data to back me up....maybe I should give it a week and return with information in hand. :oops:
Thank you for following up with me today. I appreciate your concern for my fur kid!
Mares and Miss ( and civvie brother Phoenix)
 
Hi Mares....I've been hoping you would stop back in ;-) ;-)

I would not worry one bit about dropping her down to 2.5....I would be much more concerned if you didn't. Hypoglycemia (low) is way more dangerous than hyperglycemia (high numbers). I'm very glad you are open to this suggestion because hypoglycemia is a real possibility at the current dose. Someone today over at Lantus confirmed that the Alpha Trak reads about 30 points higher than the human meter....so I'm going to repeat what was said earlier...that 64 two nights ago was really a 34, which is a very dangerous zone to be in. Someone was looking out for Missy for sure....

Her body will adjust to the drop just fine and I also think you're going to see some wonkiness anyway for the next few days just because of the dose changes from 4.5, to 4.0 to 4.25....you're right on target with picking up on that.

And an absolute YES to posting over on Lantus, especially if you take the plunge and "start-over". That is their specialty and they will guide you each step of the way. You went into remission so fast before, that you didn't really get to experience what happens. Take a peak tonight at how people post each morning and evening, what the subject lines say, the information they give (numbers, foods, etc,) and what their thoughts and concerns are.

All of this is a process and part of that process is for us to see Missy every day and to look at her numbers every day. We need and very much want to get to know her and to help her. We all started at the beginning, so I think if you treat this experience that way, as a new beginning.....Missy will be safe, and you will be oh so supported.

I'm going to reiterate that I would 100%, without a doubt, shoot 2.5 and plan on holding that dose for 5-7 days. Spot check as often as you can, always test before you shoot, run a curve or two in the upcoming days (you may consider waiting a few to let the wonkiness settle) and post each morning and each night.

You're doing a great job Mares and Missy is lucky to have someone so willing to be an active participant in her disease... Big HUGS to you and I'll see you over at Lantus for PMPS OK?
 
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