Frankie is back

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Jay

Jay

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Looks as if we are going to be spending time here again.

The switch from PZI Vet to Lantus just began 22 mintues ago.

I havent updated our profile in a long time, however, we have been using PZI Vet in varying doses, most recently 3.2 untis bid, for the past 4 1/2 years since his diagnosis (wow, I thought its was doomsday when he was diagnosed)

We try as best we can to keep him between 175 and 235 on both sides of the curve AM and PM preshots, on average. I just gave him 1 Unit, (PM PS 5PM EST was 275 and fully expect (I will be spot checking tonite) his numbers to be high as a kite)

Other then GoLow, GoSlow any advice on what we can expect (other then high numbers early on)

Jay

Joined: Mon Jan 18, 2010 10:26 am
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Hi there

welcome to the Lantus forum!

I'd suggest starting with the information stickies up above (all threads with the "star" icon)

you will prob need a spreadsheet, u can find instructions here along with other info on Lantus
New to the Group stickie:

viewtopic.php?f=9&t=157

Can u tell us what your schedule is like? Lantus works best on a 12/12 schedule, so if you shot tonight at 5pm, you would shoot the morning at 5am.
Lantus is not based on preshot numbers, but rather the nadir. You'll also want to shoot consistently (edit spellcheck), so no dose hoping.
As you gather your data for your spreadsheet (spotchecks thru each cycle (AM and PM) others will be able to offer feedback on how Lantus is working for your cat.

See the link above, for an example of a typical curve.

So tonight's PMPS was 275, are there any other health issues with Frankie? What does he eat?

Do you have any past numbers from PZI? The most recent would be fine.

If you can stick around, others will be by thru the evening to offer feedback and suggestions.
But in the meantime, read up on the stickies up above, check other kitties threads/condos here, have a look at some spreadsheets and ask any questions you might have.
 
Yes-- forget everything about PZI, as lantus is totally different--We Welcome you first, and second you need to set up a spreadsheet to record Frankie's numbers through the day--AMPS, PMPS, and any spot checks during the day & night--Please read the stickys on the top of the page, as things may have changed some in the last few years..Lantus lasts longer & we are consistant with the does(no dose hopping) unless the bg numbers call for it--Make like you are a newbie & read those articles, it will make a world of diffference--
Welcome to lantus land
 
Welcome to the two of you. This is a wonderful neighborhood.
A Roni said - lantus is a whole new game and a really great one. It does take some adjusting for you too - not just Frankie. Especially the concept that dose is based on the nadir not preshot. Took some getting use to for me but I couldn't be happier with the results.
 
welcome Jay and Frankie!

You've already gotten good advice. If you'll post here every day, especially at first, we'll help you get Frankie's dose figured out. If he was on a higher dose of PZI, then 1 unit of Lantus might not do much. We do increases according to the protocol, but in some cases we'll move a little faster if needed (especially knowing that his PZI dose was higher).
 
Libby and Lucy said:
welcome Jay and Frankie!

You've already gotten good advice. If you'll post here every day, especially at first, we'll help you get Frankie's dose figured out. If he was on a higher dose of PZI, then 1 unit of Lantus might not do much. We do increases according to the protocol, but in some cases we'll move a little faster if needed (especially knowing that his PZI dose was higher).
Click to expand...


I dont believe in settling a dose. If his numbers are high, we up the dose every day till I get a dose that will control the rise of his sugar level and bring his number down
 
Ronnie & Luna said:
Hi there

welcome to the Lantus forum!

I'd suggest starting with the information stickies up above (all threads with the "star" icon)

you will prob need a spreadsheet, u can find instructions here along with other info on Lantus
New to the Group stickie:

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=157

Can u tell us what your schedule is like? Lantus works best on a 12/12 schedule, so if you shot tonight at 5pm, you would shoot the morning at 5am.
Lantus is not based on preshot numbers, but rather the nadir. You'll also want to shoot constantly, so no dose hoping.
As you gather your data for your spreadsheet (spotchecks thru each cycle (AM and PM) others will be able to offer feedback on how Lantus is working for your cat.

See the link above, for an example of a typical curve.

So tonight's PMPS was 275, are there any other health issues with Frankie? What does he eat?

Do you have any past numbers from PZI? The most recent would be fine.

If you can stick around, others will be by thru the evening to offer feedback and suggestions.
But in the meantime, read up on the stickies up above, check other kitties threads/condos here, have a look at some spreadsheets and ask any questions you might have.
Click to expand...

Frankie has no other health issues (other then he lovingly annoying, he's cat go figure)
I feed them both CHubby is my civie
FF Beef Feast
FF Chopped Grill Feast
FF Turkey and Giblets Feast
FF Salmon (not oftern)
FF OceanWhite Fish (not often)

Once in a while, I'd sprinkle a little EVO on his food, if he is on the border of a BG that I knew was safe to give him a dose. In other words, for example, if it were very late in the cycle, and he was at 190 (I would try and catch him at 225 and give him a dose that was my safe number 225 and rising) It would bring him up quicker, so I could get a dose into him and leave my apartment to get on with my life.
The last time I checked Janet and Binky's food chart (years ago) they were all under 5% carbs

Assume I'm a newbie.

What do yo mean when you say
Dose is based on the Nadir? Do you mean the size of the dose or the time to give it to him
"shoot constantly"
"no dose hoping"

I live alone and have to leave my apartment to get on with my life, and work. Keep that in mind. I'm not around all day, every day. The faster I find a dose that will work for him that I know he will be safe after giving him that dose. The better. I need a dose that I can "shoot, go and not worry" I have too much grey already.

Jay
 
Jay said:
Libby and Lucy said:
I dont believe in settling a dose. If his numbers are high, we up the dose every day till I get a dose that will control the rise of his sugar level and bring his number down
Click to expand...
Click to expand...

That's where you need to let go of everything you learned on PZI (trust me, it's hard, I remember!). Please read this sticky: viewtopic.php?f=9&t=150 this explains the overlap concept that Lantus and Levemir are based on. Settling time of at least 3 days is really necessary with Lantus, or you can end up way over dose and the numbers will just get higher.

It is also very common to see *higher* numbers the second day of a dose increase, but that doesn't mean the dose increase isn't working. That phenomenon is observed in our protocol, and is seen with most (not all) of the cats here.

from http://www.tillydiabetes.net/en_6_protocol2.htm
Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations.
 
sorry I meant shoot consistently, meaning holding the dose. Please read the stickie )with the "star" icon) on how lantus works
Lantus dosing is not based on preshot readings.

The Tilly Protocol:
viewtopic.php?f=9&t=1581


from the stickie: New to the Group:


Learn how YOUR kitty is responding to insulin:
Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir - the lowest point in the cycle
Duration - when the insulin is strongest or works the hardest
How to do a Curve

Example of a typical curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
 
Libby and Lucy said:
Jay said:
Libby and Lucy said:
I dont believe in settling a dose. If his numbers are high, we up the dose every day till I get a dose that will control the rise of his sugar level and bring his number down
Click to expand...
Click to expand...

That's where you need to let go of everything you learned on PZI (trust me, it's hard, I remember!). Please read this sticky: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=150 this explains the overlap concept that Lantus and Levemir are based on. Settling time of at least 3 days is really necessary with Lantus, or you can end up way over dose and the numbers will just get higher.

It is also very common to see *higher* numbers the second day of a dose increase, but that doesn't mean the dose increase isn't working. That phenomenon is observed in our protocol, and is seen with most (not all) of the cats here.

from http://www.tillydiabetes.net/en_6_protocol2.htm
Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations.
Click to expand...


Now you know why we are back. We had PZI Vet and his dosing on cruise control. I test, feed, shoot and get out of here.
 
I'm now totally confused

The dose is based on the nadir? (there wont be any if I hold this dose, his BG will be a str8 line up) If the nadir is the lowest number over a 12 plus hour cycle, how does one then determine from that a dose amount. I have in the past with PZI been able to catch his numbers rising, and dose him when I knew the 3.0 units of PZI I was giving him was a. safe without bringing him too low b.still some effectiveness to the previous dose (overlap)

By the way I have to learn how to use this message board, the old one was at least at this point more user friendly.

Jay

Ronnie & Luna said:
sorry I meant shoot consistently, meaning holding the dose. Please read the stickie )with the "star" icon) on how lantus works
Lantus dosing is not based on preshot readings.

The Tilly Protocol:
viewtopic.php?f=9&t=1581


from the stickie: New to the Group:


Learn how YOUR kitty is responding to insulin:
Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir - the lowest point in the cycle
Duration - when the insulin is strongest or works the hardest
How to do a Curve

Example of a typical curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
Click to expand...
 
Hi Jay and welcome to the Lantus ISG.

I think a lot of your questions will be answered if you take a look at the information in the dosing sticky. The sticky contains the link to the formal version of the Lantus/Levemir (Tilly) Dosing Protocol as well as a briefer, modified version that we use here.

Lantus dosing does change -- it can be a "flat" curve but doses are adjusted. That adjustment is, however, based on the nadir and not pre-shot values. We test before shooting in order to insure that it's safe to shoot but the AMPS and PMPS values are not what determines whether a dose is raised or lowered.
 
Sienne and Gabby said:
Hi Jay and welcome to the Lantus ISG.

I think a lot of your questions will be answered if you take a look at the information in the dosing sticky. The sticky contains the link to the formal version of the Lantus/Levemir (Tilly) Dosing Protocol as well as a briefer, modified version that we use here.

Lantus dosing does change -- it can be a "flat" curve but doses are adjusted. That adjustment is, however, based on the nadir and not pre-shot values. We test before shooting in order to insure that it's safe to shoot but the AMPS and PMPS values are not what determines whether a dose is raised or lowered.
Click to expand...


I'm still at a loss.

How does one determine a dose at some point in the future based on the lowest number of a 12 hour cycle.

The protocol reads like you needed have gone to med school to be able to understand.

Can someone explain to me in "plain english" not FDMB Broadese, how you can use the Nadir to determine a dosing level, maybe 6, 8. or when ever he is in a safe bg range. later after the lowest reading.
 
Lantus does not work instantly. It isn't like an asthma inhaler. It has its major effect some number of hours after the shot. The dose you want to give your cat is based on the lowest BG numbers you see in a set of cycles.

EVERY cycle will have a nadir, because nadir just means lowest point. Even a very flat curve will have a lowest point. It might not be LOW, but it will be the lowest in that 12 hour cycle.

Dose hopping based on a reading or two is a terrible idea because:

1) Meters are not 100% accurate and test results can vary by 10 to 20%.

2) BG numbers can go UP in response to having been very low some number of hours before or the cycle before. So, you see a high number, up your dose and what you are really doing is giving too much insulin because your last dose was enough to give a very low number that maybe you didn't see.

3) Cats take time to settle in on a dose. You can look at almost any spreadsheet here and see that.

Lantus, as I understand it, works its magic when you are in an equilibrium situation. It may teeter around a bit until you see things settle, but when they do, that's when it's working for your cat.

There are people here who will help you when you need help. Even in the middle of the night. They don't ask you to pay for their services, but they do ask that you read the information (probably more than once) here, follow the routine of a spreadsheet and daily condo, and keep an open mind. It's an amazing group and I say this as a recent beneficiary of the wisdom of this community.

Best of luck and hope to see you here!
 
Lydia and Basil said:
Lantus does not work instantly. It isn't like an asthma inhaler. It has its major effect some number of hours after the shot. The dose you want to give your cat is based on the lowest BG numbers you see in a set of cycles.

Ie.. you bqse a dose on the lowest nubmer?
Assume a target of 60
If his Nadir is 120 at +6 (in an ideal world, rarely happens that the nadir is attained at plus 6) then based on your comment above one should raise the dose slightly
IF his Nadir is 60 at + 6, then you have his dose regardless of what his PS are? Is that what you are suggesting?
The former then requires "dose hopping" increasing or decreasing the dose based on the Nadir. Afterall we do want to get our sugar babies down to 60...right?

EVERY cycle will have a nadir, because nadir just means lowest point. Even a very flat curve will have a lowest point. It might not be LOW, but it will be the lowest in that 12 hour cycle.

Again,. a high Nadir, assume (I'm just picking random numbers here) 180, then based on that Nadir you should increase the dose, which is contary to holding the dose constant? (Dose Hopping) Right.
If one were to hold the dose constant then, at a Nadir of 180, how can one ever get a cat below the renal threshold of 175 and avoid sugar spill into his urine.

Dose hopping based on a reading or two is a terrible idea because:
its been 5 years of testing, albeit with PZI Vet, not a few pokes, and at least 10,000 strips and countless of vials of insulin.

1) Meters are not 100% accurate and test results can vary by 10 to 20%.
Given, however regardless of the varying results its far better to test, then not to. The above is an argument that a vet once gave me, trying to talk me out of testing.

2) BG numbers can go UP in response to having been very low some number of hours before or the cycle before. So, you see a high number, up your dose and what you are really doing is giving too much insulin because your last dose was enough to give a very low number that maybe you didn't see.

3) Cats take time to settle in on a dose. You can look at almost any spreadsheet here and see that.

When he was diagnosed 5 years ago, I waited far too long at ineffective doses waiting for it to "settle" the net effect being that we lost the window of opportunity to create a situation with an effective dose that he could produce his own insulin. Given the effect of waiting for those ineffective doses to settle, Frankie's glucose toxicity during that time, destroyed his ability for his body to produce beta cells which is where the insulin is produced.
Frankie is living proof of that, and old timers here who remember my old posts will attest to my willingness to allow "his dose to settle" and now he is still after 5 years insulin dependant.


Lantus, as I understand it, works its magic when you are in an equilibrium situation. )
I have no clue what an "equilibrium state is" although by definition its balance.
If he is balanced, his bg, regardless of food, food type or when hsi BG would range between 60-120 or normal. As we all know, thats not the definition of what a "Diabetic" is.
It may teeter around a bit until you see things settle, but when they do, that's when it's working for your cat.

There are people here who will help you when you need help. Even in the middle of the night. They don't ask you to pay for their services, but they do ask that you read the information (probably more than once) here, follow the routine of a spreadsheet and daily condo, and keep an open mind. It's an amazing group and I say this as a recent beneficiary of the wisdom of this community.

Best of luck and hope to see you here!
Click to expand...
 
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