lovey 9/27 AMPS 434 +4 218 +6 259 +10 447

[lovey11]

Lovey had some hard stool and was crying out a little when defecating. She did pass several. I will call the vet. I put some extra water in her food. I got the ear to bleed for the first time at the +10.

9/27
This morning when I put the needle in Lovey cried out , she moved but I pushed the plunger all the way in. I didn't feel wet??

AMPS 434

+4 218

+6 259

+10 447

Big jump from +6 to +10
I took off today to do some more readings so I don't want a fur shot. I guess it wasn't a fur shot.

My new vet shaved some spots in the back and I have been using them. She thought absorption would be better for Lovey since she has a fat around neck. I used to do around the neck area with more skin. Does anyone use area just below neck?

Have a good Friday!

 

[julie & punkin (ga)]

Re: 9/25 Lovey's Numbers PMPS 409 + 7 393 ? Nervous

hi catherine! Here is the protocol regarding how to start using Lantus. It's a "depot" type of insulin, meaning that it builds up in the body. you don't usually see its full potential in the first few days:

Tight Regulation Protocol

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

earlier today Sienne posted this is your thread:

One of the more challenging differences between Lantus and ProZinc is that Lantus dosing is based on the nadir -- not on pre-shot values. Since you've been seeing some numbers that are under 200, you would want to increase in 0.25u increments. Typically, you want to give the first dose from 5 - 7 days before changing the dose. This allows the insulin depot to form. It looks like Lovey's numbers have been coming down as the depot is establishing itself.

it's hard to wait to see the dose "work" but it's the way Lantus works and it will help you build to an appropriate dose safely. try not to worry too much about the high numbers. as things settle in, they'll come down.

btw, you can go ahead and keep posting on the same "condo" or thread for one day. just add another post and it will bump up. if you go to your first post in the thread and click "edit" it will let you update/change the subject line to reflect your new question.

have a great rest of the evening!
julie

 

[Carl & Polly & Bob (GA)]

Re: 9/25 Lovey's Numbers PMPS 409 + 7 393 ? Nervous

Catherine,
Julie's right... Patience is required ;-)
Lovey's numbers will get better, and you'll get better results getting blood from her ears as time passes.

It's okay that you increased before the typical 5-7 days that the initial dose is held. On the Health forum, Jill said this yesterday

i'd like to offer a slightly different opinion based on the fact that lovey has been switched from pzi to lantus and the guidelines quoted throughout this thread so far apply to a newly diagnosed kitty... new to insulin use.

lovey has been on pzi since june. when switching to lantus from another insulin, ample consideration should be given to the dose on the prior insulin when determining a starting dose with lantus. the prior pzi dose of 1.75u only resulted in drops to the high 100s (AT meter). imho, lovey's initial starting dose of lantus was set too low.

"If the cat received another kind of insulin previously, the starting dose should be raised or lowered by taking this information into account. When selecting a starting dose, it is important to know that while Lantus and Levemir have a longer duration than other insulins, they also have a lower potency in most cats." [emphasis mine] http://www.tillydiabetes.net/en_6_protocol2.htm

catherine, if you can get a few mid-cycle spot checks today and tonight and you find lovey's numbers remaining high and flat, i wouldn't hesitate to increase the dose after 6 cycles on lantus. increasing by 0.25u is a cautious approach. increasing by 0.5u if nadirs are greater than 300 is a little more aggressive approach... one that requires frequent monitoring.

"The cat should be monitored closely on the first 3 days on Lantus/Levemir: do curves between the AM and PM-doses, e.g. AM pre-shot, +3 hours, +6 hours, +9 hours, PM pre-shot. Generally the starting dose is kept for 3 days. Test for ketones daily. 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). It is extremely rare that a cat will need to have its dose reduced in the first 3 days, *but if the cat falls below 50 mg/dl, reduce the dose." [emphasis mine] http://www.tillydiabetes.net/en_6_protocol2.htm *note: but if the cat falls below 50 mg/dl or 80 mg/dl on the AT meter, reduce the dose

fwiw, just my thoughts

To me, it sounds like Lovey could have been started on Lantus at more than 1.0u. You got lots of advice on several threads both here and on Health that suggested 1.0 or 1.25 to start. I know I suggested 1.0, but I tend to be conservative with Lantus since I didn't use it myself. So, dose-wise, you started conservatively. Upping the dose after three days would be aggressive. So you kind of did a little of both. ;-)

So, for the next three days, test as your schedule allows you to, and just try to be patient. Don't fret over the numbers. And ask any questions you think of.

 

[lovey11]

Re: 9/25 Lovey's Numbers PMPS 409 + 7 393 ? Nervous

Thanks for all your responses. I appreciate all your inputs and lending a ear.

 

[Sienne and Gabby (GA)]

Re: 9/25 Lovey's Numbers PMPS 409 + 7 393 ? Nervous

Jill's points are well taken. We can "fast track" Lovey provided you can get spot checks. If we do fast track, the dose would be evaluated and ostensibly raised after 4 cycles, rather than the usual 6 cycles.