Monty 7/11 / AMPS 155 / PMPS 122 / Consistent skips or tokens

Tom & Monty

Tom & Monty

Member Since 2020
Glad that Monty's vomiting only lasted 1 cycle, yesterday he was perfect!

I have a question about dosing. The last 3 shoots have been skip, token token. I got a mid cycle reading yesterday on his token following a skip and he was at 115 (within healthy range on a pet meter).

Today he's at 155 which is another token, close to what SLGS would tell me to skip.

I'm comfortable injecting a token because most of the time Monty doesn't drop more than 40 points from pre-shoot. But what do need to change if nearly every shoot is a skip or token?

(I'm going to get a mid cycle tonight after PM shoot too)
 
Tom if you want to swap to TR you need to get at least one test in every pm shot. It is a more aggressive approach and one of the conditions is you need to be testing more.
For more information read the yellow sticky on the top of this forum.
 
One thing about Lantus is that you need to be consistent with the dosing...changing the amount from one time to the next isn't helping to build the depot. Lantus is a depot drug - meaning it takes time to build up in his system for best results. Please read the dosing methods at the top of this forum (SLGS or TR), select one and then determine a good dose for Monty - and stick with it for the number of cycles recommended in the dosing method information - typically 6 cycles is the minimum number of cycles before changing unless you have a pre-shot number of lower than 50 (for TR)...and I have to add I'm not familiar with AT2 tracker but I believe the no-shoot number may be 68? At any rate, about that, I'd change to a human meter as these dosing methods were written using human meters. Pet meters were not on the market when those protocols were written...so you may want to think about that. Here in the states the expense of pet meter strips is prohibitive and human meters/strips are much more affordable - so most of us use human meters.

I don't recommend skipping doses or changing the dose unless you've met the criteria in your dosing protocol for doing so (can't test, cat not eating, numbers are too low)...at that point you stall feeding, post for help and get guidance on next steps.

I hope this is helpful!
 
I've been following SLGS for over a week now and on his current dose of 0.25 many of the pre-shoot BGs are telling me to either skip, stall or token dose, particularly in the last few days.

I did a curve on his 0.5 dose last week and that told me to reduce, and now even the reduced dose of 0.25 isn't allowing me to be consistent on SLGS because of the low BGs before shoot which is why I'm considering switching to TR, I can't build the depot on this dose on SLGS.

I'll start getting some tests in as many nights as I'm able to before switching TR, also I'll get some +1 and +2 to see how he's rising before falling.
 
68 seems low for a no shoot on a pet meter no? The healthy blood glucose range for cats is 80 - 120, what's the benefit of shooting when he's already lower than the healthy range? Is it just depot maintenance at that point?
 
Actually different sources on Google are giving me wildly different healthy glucose levels.

The vetsulin website seems to quote the broadest healthy range at 44 to 147.
 
Another option could be to continue on SLGS but modify the thresholds to account for using a pet meter and knowing how Monty reacts to different doses.
 
The normal range we use here is 50 - 120 on a human meter. In all likelihood, the information on the Vetsulin page you noted are also for a human meter. The range for pet meters is a bit higher.

In part, how you look at the numbers depends on whether your goal is regulation or remission. If you want to keep your cat regulated, generally you're wanting to keep your cat below renal threshold (roughly 200 to 220 -- again on a human meter).

If your goal is remission, you want to see lots more green numbers. The dilemma is that with SLGS, you end up reducing if numbers drop below 90 whereas the reduction point with TR is 50. TR, because it's more aggressive, also requires careful monitoring during both the AM and PM cycles. It's fine to switch to TR. You might want to read through the dosing information and if you have questions, let us know.
 
I spoke to my vet on the phone just now and she's asked me not to inject below 9 (162) on my pet meter (AlphaTrak) for the next 3 days as she's concerned about a hypo.

I have a 10 minute chat with an internal medicine specialist booked this evening to get a second opinion on that.

I'm also going to buy a human meter as I'm curious how my AlphaTrak tests are converting to human test readings. I know the human meter will run lower but I'm curious how low and if I end up using TR then having the human meter will help.
 
PMPS came in at 122 (pet meter), well below a skip threshold for SLGS even ignoring that it would be lower on a human meter.

I'm going to skip tonight on the advice of both SLGS and my vet. I have the consultation with the internal medicine specialist in 1 hour.
 
In case you are interested, I'm including some spreadsheets of people using AT, whose cats went into remission. It'll give you an idea of both what normal AT numbers look like for those that kept testing after stopping insulin, as well as what cycles looked like when they shot low doses. Here are spreadsheets from Marcus, Suzanne used the PetTest which is s pet meter, and switched to a human meter during the OTJ trial for LT which makes an interesting comparison, Ninja also on SLGS, Tiny Sole - whose caregiver followed SLGS but test more than many people on TR. On the smaller doses, she also was shooting a lot lower.
 
Thanks these sheets are really helpful!

Having spoken with the internal medicine specialist in a video call, she said she isn't allowed to give dosing advice (legally) if she hasn't physically examined the cat. However, based on the recent numbers if my goal was regulation then his numbers are excellent. She said a lower dose after a few days of similar numbers to the ones I'm seeing now might be appropriate.

Her opinion is that it would be better to go to a lower dose and not keep depleting the depot with skips. Again, she wasn't allowed to give me specific numbers but seemed to hint that I should drop to 0.1 if I keep needing to skip because it would be hard to read a reliable nadir curve with an inconsistent depot and Monty's interday numbers are falling, "remarkably fast".
 
Tom, If you look at your SS, in the last 7 cycles you have 1 test during the cycles.
Just getting preshots is no good for dosing with lantus as it is dosed on the nadir not the preshot.
 
I understand that but the specialist was telling me that the cycle won't be a reliable indicator unless the dose is consistent.

If I'm skipping or token dosing because he's too low for a full dose then I ought to lower it to get consistency and then measure nadir. She wasn't concerned about lowering it to get that consistency as he's comfortably below the renal theshold and I can always increase it within a few days if it indicates he's too high.
 
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I look at it a bit differently. You're using an insulin that is long acting and the dosing is based on nadir, as Bron said. While I don't think this is the case with Monty, you should be aware that cats -- including mine -- could start a cycle with numbers in the 400s, drop to the 40s at nadir, and zoom back to the 400s at the next pre-shot. My point is that if you don't test somewhere around mid-cycle, you could be missing a number signaling a dose reduction. Our kitties are notorious for being unpredictable. And, frankly, what do you lose by getting the test?

Personally, I'd stick with the 0.1u dose. Your cat is not in numbers that are indicative of remission. the spreadsheets Wendy linked show lots more green.

One observation about how vets look at BG numbers that I've gleaned from being here a while. Most vets are very cautious about encouraging their clients to allow their kitty's to drop into "green" numbers. The reason is that most people do not home test and the vet isn't around 24/7 if a caregiver observes symptoms of hypoglycemia. The vet doesn't want the liability of a cat being on too high of a dose. By home testing, you have a great deal more control.
 
Sienne and Gabby (GA) said:
I look at it a bit differently. You're using an insulin that is long acting and the dosing is based on nadir, as Bron said. While I don't think this is the case with Monty, you should be aware that cats -- including mine -- could start a cycle with numbers in the 400s, drop to the 40s at nadir, and zoom back to the 400s at the next pre-shot. My point is that if you don't test somewhere around mid-cycle, you could be missing a number signaling a dose reduction. Our kitties are notorious for being unpredictable. And, frankly, what do you lose by getting the test?

Personally, I'd stick with the 0.1u dose. Your cat is not in numbers that are indicative of remission. the spreadsheets Wendy linked show lots more green.

One observation about how vets look at BG numbers that I've gleaned from being here a while. Most vets are very cautious about encouraging their clients to allow their kitty's to drop into "green" numbers. The reason is that most people do not home test and the vet isn't around 24/7 if a caregiver observes symptoms of hypoglycemia. The vet doesn't want the liability of a cat being on too high of a dose. By home testing, you have a great deal more control.
Click to expand...

Absolutely most people don't test according to the specialist, looking at Monty's sheet she said she's never seen more sophisticated care in her clinic patients.

Did you mean to say stick to 0.1 or did you mean 0.25? The suggestion from the specialist was to drop to 0.1 from 0.25.

As I'm about to mention in today's thread I just injected 0.1 at PMPS 137 and I intend to get a PM +3 and I may be able to get a +5 too. This will be the lowest BG I haven't skipped in PM.
 
I meant the 0.1u. I think you need to get comfortable with shooting "lower" numbers. (I'm putting it in quite since the pre-shot numbers you're seeing really aren't that low compared to where some the folks on this forum shoot.) You may need to increase but for now, hold the 0.1u dose so you're shooting twice a day on a consistent basis and can get a better feel for how this dose is working.
 
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