Makoto AMPS (409), +6 (137)

[Si am cat mom]

It's been an interesting 24 hours....
I was feeling better about his numbers yesterday since we started seeing values hanging out in the 200s and then some 100s midday, but I messed up last night. His PMPS was (265) which is where it had been trending , but then I think I shot though or missed shooting so... his +5 was (354) and then he woke up in the 400s (AMPS 409!) which is where we originally started - this is his first week on the Lantus. I was pretty discouraged about it all. Thankfully, he leveled out again today his +6 this afternoon was (137).
Anyways, I was wondering if this bouncing is typical in the beginning with such a small dose? I hate seeing 400s then 100s in the same day...he seemed more tired today and that was different. Almost like last night was harder on him. I know that it can take a week or so before you start seeing changes in the values, so maybe that is what this is - the timing fits. I just felt more at ease when it seemed like he was sliding down the scale not falling.
He seems pretty happy when he is in the 220-249 range...makes me wonder if that will be his happy place. Anyways, we are wrapping up his BG curve tonight and checking back in with the Dr. tomorrow but I am not feeling confident about making any changes right now :/

 

[Sue and Luci]

Which protocol are you following?

Bouncing is very common in the beginning. Let's hope that those 200's aren't the 'happy place' for Makoto. He needs to find a way to lower numbers for his health.

Based on which protocol you're following and his food (is he eating any dry food)? then you can decide whether to increase or not - on TR it's faster increasing, more testing and no dry food; on SLGS it's slower increases - have you read the stickies about the differences?

 

[Si am cat mom]

Fixed the signature
I'd take stable 200s right now over the occasional 400s. No dry food- poultry based Blue Buffalo Wilderness and the grain- free Purina Beyond so far. He was used to those so I just stopped buying the salmon, tune and/or whitefish. I read the differences and I'm just not comfortable with the TR. I work 12 hour shifts on overnights usually. I am just worried I would tweak something one day and get in trouble overnight since I am not around to check another BG. It's been 8 days on the Lantus and I was thinking of increasing the dose 1/4 dose, so 1.25 U. We will pow wow with his vet tomorrow, but I don't think I'd go higher even if he says otherwise for now. I'm just super nervous.

 

[Crista & Ming]

Woo go Makoto! I see all of his numbers as a win, honestly. He went up but came back down quite quickly. Bouncing can last for up to 6 cycles and Ming is an expert at bouncing...

Is there a reason why you need to speak with the vet besides running by for his opinion on Makoto's dose? I'm not saying don't work with your vet but I find it... difficult sometimes to work with both a vet and what's recommended here on FDMB. Of course, we will help you as much as we can and won't stop. But it is especially hard to juggle advice from the vet and advice from FDMB. Ultimately, it should be your decision what you think is best for Makoto. Many of us just go to our vets for non-diabetic related issues and just give very brief summaries if what's going on with our cat's diabetic-wise.

I would increase whenever you're ready to 1.25u. I also wouldn't increase beyond 0.25u based on his numbers and what I've seen work here on FDMB, especially if you're not always home.

Edit: I went to read the SLGS guidelines again and since Makoto's had some numbers/nadirs under 150, holding 1u seems like the way to go. I'm not too good at all the nuances of SLGS so let's see what other members say.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

 

[Sienne and Gabby (GA)]

If you think the needle went in one side and out the other or if Makoto moved, etc., we refer to that as a "fur shot." It falls into the category of life happens. I would, however, put a note in with the dose that it may be a fur shot or put a note in the comments section of your spreadsheet. If you think you did give a fur shot, one way to sort of figure it out is that Lantus has a unique odor -- it smells like bandaids. Also, never ever give a second shot. Even if you saw the insulin squire across the room, do NOT give another shot. You have no way to know if any insulin got where it's supposed to go so there would be a good chance. your would overdose your kitty.

Bounces are unrelated to the amount of the insulin dose. They are more related to how low numbers drop, the range of numbers. your cat is used to, or how fast a drop occurs. If you gave a fur shot, the high AMPS today is likely a reflection of not enough insulin and not a bounce. If Makoto seems like he feels good in the 200 - 250 range, I hope he gets unhappy with it soon and gets happy in blues and greens! If you talk to a human diabetic, they will sometimes mention that in the beginning of treatment, they felt lousy when their numbers were first in a good range and they felt better when their numbers were higher It took a while of experiencing better numbers before good numbers felt normal.

It looks to me like Makoto needs a dose increase to 1.25u whenever you're ready to increase the dose.

 

[Si am cat mom]

Woo go Makoto! I see all of his numbers as a win, honestly. He went up but came back down quite quickly. Bouncing can last for up to 6 cycles and Ming is an expert at bouncing...

Is there a reason why you need to speak with the vet besides running by for his opinion on Makoto's dose? I'm not saying don't work with your vet but I find it... difficult sometimes to work with both a vet and what's recommended here on FDMB. Of course, we will help you as much as we can and won't stop. But it is especially hard to juggle advice from the vet and advice from FDMB. Ultimately, it should be your decision what you think is best for Makoto. Many of us just go to our vets for non-diabetic related issues and just give very brief summaries if what's going on with our cat's diabetic-wise.

I would increase whenever you're ready to 1.25u. I also wouldn't increase beyond 0.25u based on his numbers and what I've seen work here on FDMB, especially if you're not always home.

Edit: I went to read the SLGS guidelines again and since Makoto's had some numbers/nadirs under 150, holding 1u seems like the way to go. I'm not too good at all the nuances of SLGS so let's see what other members say.

I was maybe thinking of holding through this week since he has started to have some movement in his numbers just recently...
I just wanted to show the vet our curve data and possible get an ultrasound scheduled. He's had elevated liver enzymes over the past few years. When I worked in veterinary medicine, we would just take an Xray or look with the ultrasound probe- can't now. I want to work it up and make sure I'm not ignoring something. I'm not 100% following the vets advice- hell...he was the one who mentioned the prescription diet and feeding every 12 hours -which was not the way to start this journey.
I think I'm just so anxious about this diagnosis that I am trying to get all the information and hear all the options just so later I'm not regretting things.

 

[Sienne and Gabby (GA)]

Had you ever considered supplements? Denamarin, milk thistle, and SAMe are all supplements for liver support.

One point for your consideration -- Holding a dose that isn't bringing Makoto into normal range numbers can end up causing glucose toxicity. You don't want Makoto treating a higher range of numbers as "normal." Ultimately, it makes it harder to get the numbers to come down into a better range and it can add to bounciness.

 

[Si am cat mom]

If you think the needle went in one side and out the other or if Makoto moved, etc., we refer to that as a "fur shot." It falls into the category of life happens. I would, however, put a note in with the dose that it may be a fur shot or put a note in the comments section of your spreadsheet. If you think you did give a fur shot, one way to sort of figure it out is that Lantus has a unique odor -- it smells like bandaids. Also, never ever give a second shot. Even if you saw the insulin squire across the room, do NOT give another shot. You have no way to know if any insulin got where it's supposed to go so there would be a good chance. your would overdose your kitty.

Bounces are unrelated to the amount of the insulin dose. They are more related to how low numbers drop, the range of numbers. your cat is used to, or how fast a drop occurs. If you gave a fur shot, the high AMPS today is likely a reflection of not enough insulin and not a bounce. If Makoto seems like he feels good in the 200 - 250 range, I hope he gets unhappy with it soon and gets happy in blues and greens! If you talk to a human diabetic, they will sometimes mention that in the beginning of treatment, they felt lousy when their numbers were first in a good range and they felt better when their numbers were higher It took a while of experiencing better numbers before good numbers felt normal.

It looks to me like Makoto needs a dose increase to 1.25u whenever you're ready to increase the dose.

not sure how to put notes on- so I will look at that. That 400 this AM just threw me a bit, but I did not give another shot.
I did try and sniff out the fur shot but didn't smell anything - he definitely jumped and I did freak out. We recently got different syringes- 31g with shorter needle ( 5/16) so I will see if the newer ones feel better to both of us.
I am nervous about an increase- I feel like I don't have enough information- especially since I just now started getting varied results and I wasn't checking enough for the first 3-4 days of his insulin so... we'll see.

Thank you everyone for all of your help !!! We do appreciate it

 

[Si am cat mom]

Had you ever considered supplements? Denamarin, milk thistle, and SAMe are all supplements for liver support.

One point for your consideration -- Holding a dose that isn't bringing Makoto into normal range numbers can end up causing glucose toxicity. You don't want Makoto treating a higher range of numbers as "normal." Ultimately, it makes it harder to get the numbers to come down into a better range and it can add to bounciness.

I think I will revisit the supplements. We had tried Denamarin before and I think he got sick- unrelated to this and I just stopped it because he wasn't eating/ acting normally. Good idea and great point about the long term point of all these injections. I definitely don't want him to stall out here.

 

[Sienne and Gabby (GA)]

I'm not all that well versed on supplements. I never had to use them with Gabby. If you want to consider them, I'd suggest posting here and on Health with a question about liver supplements in your subject line.