Feeburt AMPS 415 pmps 397

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Shelly and Spaceman

Shelly and Spaceman

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Crazy Feeburt.
Here is a run down of the last few cycles.
LAst night pmps was 441. Actually that was his +11 but I decided not to wait to shoot. so at +5 I check him and he is 485. WTH? I decide to let it ride and get up super early to check him. (lucky for me I have never gone back to a regular sleep schedule after losing Cosmo) So I get up at +10.5 and he had dropped a little. 415. So I decide that this is high enough and shoot him early again. So now at +4 he is down to 356. Finally getting some response. Looking forward to the pmps. Please be pink! please be pink! please be pink! I'm not asking for much...not even yellow...just pink!

Ok...got pink...just barely but it is pink.
 
Re: Feeburt AMPS 415

Shelly:

I think you are approaching Lantus like it's PZI. First, shooting early, especially as early as you are shooting, is like a dose increase. Are you doing this because you need to get back on schedule? When you shoot 90 min. early, are you then shooting 12 hours later? Generally, with Lantus, we try to not move shot times by more than 30 min. per day (either all in one cycle or 15 min. per cycle) due to the effect on the shed. The early shots will effect overlap and it will be difficult to tell how this dose is working. It may be somewhat less of an issue with high numbers, but as Feeburt's numbers improve, you need to keep issues relevant to the shed in mind. Also, remember that Lantus dosing is based on nadir, not on pre-shot numbers. We get PS values for reasons related to safety, not for the purpose of dose adjustment.

A couple of housekeeping items:
  • When you have a chance, can you complete a profile on Feeburt? The instructions are in the Tech Forum. We won't plague you with questions about his medical history, food, etc, if you have a profile attached to your signature.
  • Please remember to link your previous condo to your first post of the day. Just cut and past the url from that condo into your current condo.
  • Include Feeburt's date of diagnosis in your signature.
 
Re: Feeburt AMPS 415

Hi Shelly,

Not sure why the baytril but if Feeburt has an active infection, that's not helping his numbers, and it could take days for it to clear. Also of note is your increases. What Sienne said is true. I'm an ex PZI user so I well know your frustration but you've got to be sooooo patient with Lantus. It takes days for a dose to settle, and you can't increase your dose based on preshots or you'll end up in huge trouble. Some rules of thumb for you:

1. You'll get him there. No panicking over high numbers. If you are ketone testing, he's gonna be fine, and you are doing a great job. I know it doesn't feel that way but Lantus is a challenge for us ex pzi-ers because we're so used shooting more to overcome high numbers.

2. Dose increases are generally done in .25u increases. You can easily miss your correct dose on Lantus. .25u increases can often mean the difference between pink and yellow, you'd be surprised. Take a peek in other Lantus condos and see where they started and what their numbers looked like. Every cat truly is different, so you'll see vast differences, but the truth is, most cats start out looking just like Feeburt. :)

3. An early shot is akin to a dose increase. Lantus can have a 14hour duration or more, so shooting early can make your progress hard to read, unlike PZI which is pretty much completely toast by +10 to +12

4. Dose increases and decreases are made by nadir rather than preshot values. Rebound will be a factor, especially in early weeks of treatment, so if you are basing a dose increase off a rebound number (preshot), you could skip right past optimum dose. We tend to recommend holding a dose for 10 cycles, 8 at a minimum, to make sure all rebound is cleared and the dose increase is made upon "true" numbers.

So.. why lantus over pzi? Many of us ask that question because we all have had the horror of looking at terrible numbers and being told to hold the dose. Several reasons: high remission rate, cat feels better without that steep V curve, it's a shoot and go insulin (every 12 hours, no worrying about intervening with a dose failure at +9), cat can spend more hours in good numbers when shed is full (allowing pancreas to heal faster).

So.. patience patience patience. Let the insulin do its job. He'll get there! :)

My recommendation: hold 2u a minimum of 10 doses. Let's see what happens when infection clears and this dose stabilizes. If you don't already have syringes with 1/2u markings, you'll want to pick them up so you can measure 1/4u increases.


PS: don't forget to read the stickies.. and Jill's writeup about NDW (new dose wonkiness) which can make a new dose appear to be an utter failure for several cycles.
 
Re: Feeburt AMPS 415

Hi Shelly

sounds like good feedback here, I gotta agree with the patience as well, it's sooo hard to be patient, and most of us hate that darn word!


But it's true, Lantus requires good-old-yet-silly-but-brings-results-patience...hang in there Shelly, Feeburt will get it! cat_pet_icon
 
Re: Feeburt AMPS 415

carolyn and cheryl both make excellent points. however, when kitty is throwing numbers like feeburt has protocol allows for the initial starting dose to be raised within the first 24 - 48 hours.

Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier
(after 24-48 hours).
http://www.tillydiabetes.net/en_6_protocol2.htm

shooting an hour or two early is definitely equivalent to a dose increase. it can be an effective tool when used occasionally. howwever, you don't want to shoot early on back to back cycles. that's when it can become counterproductive and could come back to bite you for the reasons already mentioned.

subsequent increases:
doses are increased in increments of
--- 0.25u when nadirs are more than 200, but less than 300
--- 0.5u when nadirs are more than 300

Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose).
http://www.tillydiabetes.net/en_6_protocol2.htm

be patient and please continue to check for ketones often. he'll get there...
 
Re: Feeburt AMPS 415

Ok...so I'm not crazy. I thought that I read that .5u dose increases were fine if he had high nadirs. thanks...I was feeling a little shitty. But I will hold on to this dose a while and at 12 hour intervals.
 
Re: Feeburt AMPS 415

just a head's up... we've seen numbers come down abruptly once baytril has cleared an infection.
keep your eyes open and watch for it.
 
Re: Feeburt AMPS 415

ShellyandCosmo(GA)andFeeburt said:
Ok...so I'm not crazy. I thought that I read that .5u dose increases were fine if he had high nadirs. thanks...I was feeling a little shitty. But I will hold on to this dose a while and at 12 hour intervals.
Click to expand...


OMG I'm so sorry Shelly, I didn't mean to make you feel badly! I just wanted you to be prepared for what your brain was going to do to you when you continued seeing those numbers. Learning Lantus is hard enough, but it's 10x harder when you're a former PZI user. (((hugs))) I'm sorry :sad:
 
Thanks to Feeburt for being the inspiration for this really helpful conversation! As an ex PZI user, I (and Stu) have learned a great deal. Good luck Shelly and Feeburt!

Ella & Stu
 
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