NEED DOSE HELP PLS... PMPS 401, +1 446, +4 416, +8 358

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Sarah and Simba

Sarah and Simba

Member Since 2011
I'm so pissed.

First the vet tech tells me that any phone consultations will be $25. I said that's unreasonable, and left it at that.

She'd asked me to call her at 4pm so that we could decide based on his values how much insulin to give. We went over the numbers and at first she said 'let's do .5units glargine, then she changed her mind and said 'don't do a dose, I want to see if he levels off around 10'.

Well now he's f'ing 22.3

Is this normal in the beginning? Should I look for a new vet?

She's currently busy dealing with an emergency and there's no one picking up the phone.

GRR!
 
Re: Value sky high after vet recommended NO DOSE

Thanks, I'll pass that to her. She does seem to be having trouble.
I just heard back from her after repeated calls, gave 1u glargine
 
Re: Value sky high after vet recommended NO DOSE

Hi Sarah and welcome to FDMB

I know some people are having problems with the spreadsheet.
Try this link and see if you can get it going. You need to follow the instructions that are in the tech that I am posting below as well. I hope it works.

Enter the Canadian values in the world tab and your numbers will convert to the US.


https://spreadsheets0.google.com/ccc?pl ... l=en#gid=0
This link is not working.

Instructions
 
Re: Value sky high after vet recommended NO DOSE

I really hate to do this to you, but rather than using the spreadsheet template you're using, can you use the World template? It will automatically convert the numbers into the US format that the majority of us use and, we won't have to sit with a calculator in hand to help with your numbers.

Just out of curiosity, when you got that red number, did you re-test? It's a big jump in the space of an hour, although with having skipped at least one shot, it's possible. You might want to think about keeping the dose at 1.0u for the next 5 - 7 days based on the data you have from yesterday.

Please take a few minutes to read the starred, sticky notes at the top of the Board. They will help to orient you to this forum and to using Lantus. Like Beth (Blue) pointed out, there are materials that your vet may find helpful, as well.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in German and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
Please let us know if you have questions. Everyone is here to help.
 
Re: Value sky high after vet recommended NO DOSE

Thanks for the links, I'll certainly wade through all the info. I've just been doing this for 3 days and I desperately need a break.
I did double-check the test. I did two tests - one from right ear and one from left. (Indicated by R ear | L ear on ss)

I've also figured out the world converter, have attached to sig :)
I have to figure out a better way to make notes in it though, it's understandably not recognizing some of my value+notes
I got it from here: https://spreadsheets.google.com/ccc?key ... l=en#gid=0
Posted by Sue and Oliver in This Thread

The jump was actually 2.5 hours. sorry if my ss isn't clear. Doing the best I can.

Thanks everybody
 
Re: Value sky high after vet recommended NO DOSE

Wow you figured out that World spreadsheet in record time compared to me :lol: Great job.

You can manually colour in the cells when you put notes. On my MAC - I press Ctrl + Enter and it goes to another line within the same cell. Not sure how to do it on a PC. But you still have to colour the cell manually on both the Cdn/World and US tabs. I don't bother to colour the Cdn tab - just the US.

And what ever you do, do not tell your vet about this spreadsheet ohmygod_smile
 
Re: Value sky high after vet recommended NO DOSE

.... too late. I already told her! She has a link! why shouldn't she know?

Also, since I hear your are Miss Techy Guru... how do I make it so that if I add a row in world, it will also add a row (complete with notes) in US tab?

Right now my ss has notes in the world, but not the US... I added a row so that the values would convert properlly

Thanks :)
Sarah.
 
Re: Value sky high after vet recommended NO DOSE

Take a look at Gabby's SS. It will show you one way to note if you are shooting on some time other than the hour. If you just keep typing in a cell, the text wraps. Like Karrie said, you will need to manually adjust the color if you have more than one line of text. I'd also try to widen the AMPS column and see if the values show up. You do need to enter the values on the World side vs. the US. Something like the "HI" may not convert since it's not numbers and I'm guessing the conversion rules are based on numbers.

We may need to get Randi/Max, who did the latest version of the World template to answer your question if Karrie can't.

You're doing great for having only 3 days under your belt. This whole ordeal is completely overwhelming at the beginning. Just let us know how we can help.
 
Re: Value sky high after vet recommended NO DOSE

Sarah
I am sorry you are having such problems with the ss. Google I think was being fussy and I myself have been having problems with the link.
The ss that you got going is not the world one that I made. I just checked the link in tech and it is working now. Maybe a bit slow to load but finally it opened.
here is the link again, click on world and follow instructions.
Please make sur you have google already opened, it makes it easier.
All the cells in the us are linked to the world so you should not have to add for the notes.

viewtopic.php?f=6&t=18207
 
Re: Value sky high after vet recommended NO DOSE

Hi, Thanks Sienne. That's how I wanted to do time-specific notes (ie: +3.5) But if I do this on the world tab, the value won't convert to the US tab; as you mention the conversion is based solely on numbers.

So what I'm thinking to do is manually add a row underneath with time values when needed. I'll have to add them manually to each tab because I don't know how to automate the formula, and I have a feeling it'd be a pain to do it in google docs. (Basically I don't know how to automatically apply the logic to the entire row at once instead of one cell at a time, plus I'd have to add the row manually in US anyway). If it becomes a huge issue for me I'll ask in TECH.

Thanks muchly :smile:
Sarah
 
Re: Value sky high after vet recommended NO DOSE

Sarah --

See Randi's note -- I think you may have missed it. If you're still having problems, drop a PM to Randi.
 
Re: Value sky high after vet recommended NO DOSE

I think she was referring to Randi and Max :lol:

I only add notes to the US spreadsheet - none on the canadian that I recall. I started showing my vet and it caused all kinds of problems. And I ended up having to start a new one that she couldn't see and was needlessly stressed. They don't know how to dose lantus according to the protocol (consistent dosing, dosing based on nadir, not preshot numbers which mean little with lantus). A number of vets seem to think we test too much and just don't believe how cats can react to lantus when shown. They don't want to see. You may be one of the lucky ones but they are few and far between. I'm trying to find a vet comfortable with tight regulation vs blind shooting and keeping them above 9.0. Thats just not okay with me. Their schooling on feline diabetes is outdated. probably because they aren't used to educated owners, or worry about liability and making us high maintenance. What is easier for their practice is not best for our cats.
 
Re: Value sky high after vet recommended NO DOSE

hi, guys! it's a huge learning curve in the beginning...you're doing great!

celi & binks
 
Re: Value sky high after vet recommended NO DOSE

Welcome to Lantus Land, Sarah and Simba! You are doing great with the steep learning curve. When in doubt about anything, ask questions and someone will be along to help you.

Ella & Rusty
 
Re: Value sky high after vet recommended NO DOSE

Thanks everybody for your warm welcome!

Karri, my vet actually does believe in reading numbers, and says she's more comfortable with long-acting glargine than with other insulins... so maybe I'm just freaking out, but.. anyway.

She has the link to the old SS, the first one in my sig.. I just started the second one so that US'ers know what I'm up to as well .. so she doesn't HAVE to have updated and current information if it does cause a problem.

What's interesting is she expressly told me not to worry about adjusting insulin dose, that she would look at the numbers and make the call... a 'don't worry your pretty little head' scenario.

So when the vet tech told me I'd be charged for each of those phone calls, it makes me think THAT's why she doesn't want me adjusting the insulin.. that it's more about her pocketbook than about my cat.

He's still high tonight. I gave him 1u at 6:30pm and it looks like he's just starting to come down. I may need advice on what dose to give him in at 6:30am. The doc suggested 2u originally, but the 2units + toronto insulin yesterday aft put me in 'freakout mode' when his numbers went really-not-that-low at all. lol. He might be alright with 2u afterall, if you consider just how high his numbers were to start + the high ketones.

Sarah.
 
Re: Value sky high after vet recommended NO DOSE

Hi Sarah, sorry you are off to such a rough start.

When starting Lantus it can take several days for the shed to build up so you will not be seeing the full effect of the dose until then. You just need to grit you teeth and keep with it until then with a consistent dose. Every time the dose is changed w/ Lantus it effects the shed and it needs to either refill or drain before you can tell how the new dose is working. So changing the dose frequently is not a good idea. Also Lantus doses are determined by the lowest number , the nadir, not the preshot number.

I hope things start to smooth out soon.
 
Re: Value sky high after vet recommended NO DOSE

Thanks Ann, smooth would be good! Love the info on shed, I saw that in the links Sienne shared. It's so hard to grit teeth! I just want him to be betterz :YMSIGH:

Sorry sienne, I didn't see your post. Toronto insulin is a humulin insulin, sorry I don't know what term it's more commonly known by
 
Re: Value sky high after vet recommended NO DOSE

Sienne and Gabby said:
Sarah --
What's "toronto insulin?"
Click to expand...
According to a friend of mine who is a phamacist, Toronto insulin is made by Novolin and is very fast acting. He thinks it is only available in Canada.
He says it is faster acting than humulin and just as harsh.
In his opinion, it is to fast acting (lasts about 2 - 4 hours in humans) and harsh for a cat.
He says it is typically used for humans along with a long acting insulin such as lantus when BG is very high after meals.
That's all I know about it. Hope that helps.
 
Re: ... NO DOSE PMPS 401, +1 446, +3 430, +4 416, +6 382, +9

Wow, thanks Noreen! That's exactly what the vet wanted for him.

Based on how high his bg is and how at risk he is for ketones, do you guys think I should consider doing 2 units 4 hrs from now despite shed anxieties?

The vet originally wanted to start him on 2 units, and it looks like 2 units really did good things for him 3/9/11 ... what brought him down right away, as Noreen indicates, was the toronto insulin, but what kept him blue was the lantus...

Maybe 1.5units?

I know everyone cautions no more than 1unit but since Lantus is so different and Simba did so well on 2units last time, I'm hoping to get some educated guesses based on his stats. Here's his chart

He hasn't been drinking much, but he's not dehydrated. (good skin reaction)

Edits: I am adding some water to his food, so that may account for his lessened drinking.
He's weak, a little listless. I pick him up and there's little resistance, when under normal conditions you can definitely feel him tense.

Thanks everybody, I hope there's someone online this time of night :)

Sarah.
(GBTB But will check in)
 
Re: ... NO DOSE PMPS 401, +1 446, +3 430, +4 416, +6 382, +8

Hi Sarah. Welcome to Lantus Land.
I'll be online for a bit.
Sorry, but I'm not comfortable giving dosing advice.
I'm still confused about the shed myself.
 
Re: ... NO DOSE PMPS 401, +1 446, +3 430, +4 416, +6 382, +8

Thanks, nice to know I'm not alone, anyhow :D
Never did make it back to bed. Will do a +9 reading. So tired.
 
Re: ... NO DOSE PMPS 401, +1 446, +3 430, +4 416, +6 382, +8

Sarah said:
Thanks, nice to know I'm not alone, anyhow :D
Never did make it back to bed. Will do a +9 reading. So tired.
Click to expand...
I was up til 5:30 am the other night testing.
I put a pot of coffee on at 3am.
You'll do fine.
What part of Canada are you in? I'm in Alberta.
 
Re: ... NO DOSE PMPS 401, +1 446, +3 430, +4 416, +6 382, +8

Sarah...I'm also not comfy giving you dosing suggestions. I would suggest you change your subject line to "NEED DOSE HELP PLS"; it's probably going to be awhile before anyone who can provide you with some dosing suggestions will be on. Sorry.....
 
That's ok. I was afraid that might happen. Thanks for the tip on changing the subject line :razz: I need all the help I can get!

Actually, I do have another question.

When I put to my vet that I'd heard that if cats go hypo they should get High Carb food she looked at me like I was crazy and said "but cats don't use carbohydrates for energy, that doesn't make sense... but if you can send me the literature, I'd love to learn something new"...

So does anyone have any literature on why to give HC to hypo cats?

Thanks for all the support and kindness,
Sarah.
 
Op, sorry noreen (I keep missing posts)!
I'm in Toronto... well, GTA. (Greater Toronto Area)

I took a few days off work - I have no idea how I'm going to do this when I have to be at work. :?
 
Sarah said:
I took a few days off work - I have no idea how I'm going to do this when I have to be at work. :?
Click to expand...
You figure out a shot time 12 hours apart that works with your schedule.
You get spot checks when you can, and test more on the weekend or when you're not at work.
It does get easier.
 
Thanks, I do believe it gets easier - I'm just stressed because my schedule is wonky and I'd love to be here more often for nadir tests, but I'm not sure I'll be able to.
 
I'm not to sure on the science behind the carbs but it sure makes the glucose skyrocket if given in large amounts! Which is why they only need a little, just to get the glucose up. I can look about for a better explaination, I'm new at this myself. I believe I read about it on Dr. Lisas website. Let me go browse and I'll try and get you something concrete.

While your at work you just do the best you can. Take tests in the middle of the night if you have to (or in my case day while I'm asleep) and make sure to get one right before you leave for work and then as soon as you get home. It's a little nervewracking, I know. It's what I have to do myself because I can't take a day off from work. I even have to work a 12 hour shift this weekend and thats going to be really nervewracking.

ETA: Ah, try reading this. Might make things a little clearer. Probably something to do with the glycemic index and glycemic load of the carbs. :3 I hope that helps.
 
Is there someone who lives close who could do readings for you? My parents are getting home from vacation so I'm hoping they'll be able to ease the load a bit for me when they get back
PS: would love any info on HC for hypo you come across, thank you :)
 
My mom actually is going to help me out a bit, but she can't really be there in the middle of the night for his PM nadir. She is however going to check his blood and give him his PM dose for me on the day I work 12 hours. Kinda hard to find someone to kitty sit while I'm working since it's a midnight shift.

Hopefully your parents can help you out :3

Oh and did you see the link I added? Might help about the carb question. I know theres a sticky about Hypos on here, but it doesn't have much of a why the HC food works the way it does.
 
yay for moms!
gbtb.. but I don't think I'll sleep. I'm so torn about this dose.
The vet originally wanted to go with 2u, and by his latest (though incomplete) curve, it looks like she was right.
If anyone can help with advice, please post and I'll check back no later than 6am.. but probably intermittantly depending on how well I sleep!

Thanks everybody :)
Sarah.
(and Simba, who has been dozing in my lap since his last reading :smile: )
 
hi Sarah

when you have a chance update your spreadsheet for the evening cycle thursday night.
you'll want to look thru the links Sienne provided, especially the protocol followed here.
you don't really want to be changing doses too soon, take time to collect your data - the nadir checks will be important (+5/+6)

if noone is around this morning, I would suggest stick to the 1u, see how the cycle goes, I think you said you were home for a few days...so those spotchecks will be important in order to see how this dose is working, it's not going to be instant, and a lot of patience is needed.
and do keep checking for ketones when you can.

if you see this in time, try not to feed in the 2 hours before shot time, as food can influence (spike up) your preshot number.
 
Thanks Ronnie. Incidentally he's fast asleep- no food for this guy! I agree that 1u for analysis purposes is better. We'll see what vet says after the fact.
Thx again, will dose in 30 min
S
 
PLEASE answer Miriam's question about ketones. Trace amounts are not an emergency -- just add water to Simba's food and test for ketones as often as possible. If you start to notice an acetone/alcohol smell on Simba's breath or if the reading is more than trace, you need to get Simba to your vet or an ER immediately. Diabetic ketoacidosis (DKA) can be life threatening if not properly treated. Before you panic, check the expiration date on the box and test yourself. Make sure you are not misreading the color coding for Simba by comparing it to the reading you get.

Your vet is confusing what cats need for their diet vs. overall metabolism. Cats are obligate carnivores. They do not need anything other than protein and certain vitamins and minerals in their diet. Cats in the wild get this from prey and whatever is in the stomach contents of their prey. However, ALL food is metabolically converted to glucose in order for the body to function. I would remind your vet what is done in the clinic for a cat who is hypoglycemic -- they give IV dextrose (a sugar solution). We're just giving an oral version of HC/sugar or a simple sugar (e.g., Karo).

The Toronto insulin you describe sounds like Humulin R (or "R"). It's a bolus insulin that no one would ever use for overall diabetes management.
 
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