Need help regulating dosage please.

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Robyn & Mika

Robyn & Mika

Member Since 2011
Hello again my new found best friends! I have been gathering information all day. Sorry to post it here, but I still can't get the spreadsheet to work, probably because I have an iPad. Here are Mika's stats:

12 year old male Siamese, over weight at 17.3 pounds. Has not lost any weight since being diagnosed. Has not been tested for any additional underlying health problems like acromalgy (sorry about spelling.) Does not appear to have any characteristics of acromalgy. Started eating, drinking, sleeping, and peeing a lot. Took him to the vet on 7/15/11. Vet took blood and urine. Called me on 7/20/11 to tell me Mika had diabetes. Blood glucose was 470, and fructosamine was 536. Vet started him on lantus BID 3 units the next day (7/21/11.). Lantus is being administered using u-100 bg insulin syringes.

7/29/11 - blood glucose curve performed at the vet's office:
6:30 am - food
7:00 am - 3 units of insulin
8:30 am - bg 459
11:00 am - bg 431
1:00 pm - bg 453
3:00 pm - bg 490

Vet upped bid to 5 units

Second bg curve I performed at home using an alphatrak meter and strips. Drew blood using a one touch delica lancet, 33 gauge.

8/5/11:

6:30 am - food
7:00 am - 5 units lantus
8:04 am - bg 411
10:40 am - bg 371
12:50 pm - bg 383
2:55 pm - bg 388
6:30 pm food
7:00 pm 5 units lantus

Took results of bg curve to the vet the next day. Vet upped lantus dosage to 7 units bid.

Third bg curve I performed at home on Saturday, 8/20/11:

6:30 AM – Food
7:00 AM – 7 units of Lantus
8:35 AM – 371
10:50 AM – 275
1:00 PM – 335
3:00 PM – 334
5:00 PM – 319
6:30 PM – Food
7:00 PM – 333 (right before 7 units of Lantus)

At this point I noticed Mika had slowed down on eating, drinking, and peeing so much. Transmitted above bg results to vet on Monday, 8/22/11. Vet called and told me to up the lantis to 8 units bid. Monday, 8/22/11, is when I actively became involved in this website as I had doubts to the extreme amounts of insulin Mika was being prescribed by the vet. After much reading, I lowered his Lantus dosage to 3 units bid on Tueday, 8/23/11, night. After additional conversation with members, we lowered the dosage to 1.5 units (based on Rand protocol) on Thursday, 8/25/11, night. Last night I took his bg right before food and insulin and it was 376 at 5:30 pm. Today, I gave him 1.5 units at 7:00AM and tested his BG at 11:00AM, it was 347. He appears to hit his napir 4 hours after his dose of insulin. I leave all this information in your good hands and look to your for any advice you may be willing to provide regarding getting him regulated and possibly OTJ. I have the following questions:

On the excel spreadsheet, what does AMPS and PMPS stand for? I assume AM and PM insulin dosage?
Am I correct in increasing his dosage based on his napir 6 - 7 days after I changed the last dosage?
How often should I test his bg's and at what time of the day?
When should I test for Ketones? Only when his bg is high? How high? Above 400?

Thank you all so much! I really appreciate the help. As of today, Mika is mildly eating, drinking, peeing, and sleeping to much. Not as much when he was first diagnosed, but still not his usual self.
 
You really are going to need a spreadsheet and you're right, they are impossible to do on an iPad. For some reason, the Google doc won't let you enter info (or I haven't figured out how to do it).

AM/PMPS = AM or PM Pre-Shot. It's the test before your shoot. The "U" column is the units of insulin you inject. We don't use hours on the clock. We are all in different time zones. As a result, we count time from when you give your shot. If you give your shot at 7:00, then 9:00 is your +2.

Most of us test, feed, and shoot all within a few minutes of each other. You do not need to feed 30 min. prior to your shot. Lantus onset is generally around 2 hours after the injection.

Since you have already been using Lantus for over a month, you do not need to hold a dose for more than 3 days (6 cycles). Dose changes are based on the nadir -- and if the nadir is over 200, then the dose is increased by 0.25u after 3 days.

I would suggest getting a mini-curve (testing every 3 hours) or a full curve (testing every 2 hours) both over a 12-hour period so you have some idea of when Mika is experiencing Lantus onset and when the nadir occurs.

It's more important to test for ketones when numbers are over 300 BUT if your cat has a history of ketones or has had DKA (diabetic ketoacidosis), I would test at least once a day.
 
this starred sticky at the top of the Lantus forum is your new best friend. it lays out how we dose our cats - you'll want explanations to understand it, but it's the basis. this is what sienne's referring to:

Lantus and Levemir - Tight Regulation Protocol

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

yes, dosing is based mostly upon the nadir. don't count on it being at +4 all the time - sometimes they stay constant for a while, but sometimes the nadir moves around. you want to get in as much testing as you can bear (and afford) to do. i tested about every 3 hours while awake til i felt i had a grasp of how punkin "works."

sienne's answered all your questions so i'll just add the "good job" to getting all the information gathered and posted here. it definitely helps.

i wish vets would come here for dosing help! :lol: you wouldn't believe what a change you can see with tiny .25 insulin adjustments on the lantus. a 2unit dose change is like a sledgehammer!
 
I bought an app for iPad to allow me to edit my google spreadsheet. It's called "Documents; Mobile Office".

Truthfully, it's not the greatest and I do most of my spreadsheet work on a desktop, but it works in a pinch.

If I was exclusively using the iPad for inputs and updates, I would do a more thorough search on Google, asking for "apps that allowed editing and syncing of Google Docs (specifically excel) on iPad". these programs allow you to pull the spreadsheet down, make the necessary changes and then it syncs with the Google doc page. They're out there and you may have to pay for it...but I know you will find this site soooo much more helpful if you can get your spreadsheet up and running - it really is essential.
 
Hmmmm I'm on an iPad right now and I can update my spreadsheet on it, In fact I updated Leo's numbers on it just 2 minutes ago. I don't have any apps for it.

Good luck with Mika!
 
Welcome to LL. One thing I noticed in your first post, you are using an Alpha Track? They are calibrated to read about 30 points higher than the human meters most of us use. So in most of our recommendations you will add 30 to the numbers advised. I know it can get confusing, but most of the studies were done using the human meters and the strips are a whole lot cheaper.

Unless you have invested in a lot of strips for the AT, you may want to get a new meter. Most meters cost less than $10 and you will save more than that on one box of strips. We do a lot of testing and strips get to be the most expensive part of FD.

Many here use the Walmart Relion meter ($9) and strips are about $20 for a box of 50. You can get even better deals online. Many of us shop at ADW
 
Julie, I can access an see your spreadsheet on my iPad, so obviously it can be done. When I try to download the spreadsheet it only loads the column headings and won't let me input anything. I will get it figured out. Did it work for you when you downloaded the spreadsheet from google the first time, and did you download it directly onto your iPad?

Ann, thanks for the great advice on the testing meter and strips. The one I am using is a loaner from the vet, so I will definitely purchase the one you recommendnalong with the strips.

Mika has slid back into his old ways, sleeping, eating, drinking, and peeing too much. His bg's are still in the high 300's. This morning was his sixth shot at 1.5u, so going to increase to 2u tonight based on the protocol. This is nerve wrecking :shock:
 
are his nadirs in the 300's? the nadir determines the size of the increase. if the lowest point is over 300, increase by .5, if the lowest points in the previous few cycles are less than 300, increase by .25.

it's tracy that said she could use it on an ipad. i use a little netbook all the time. not perfect, but it's what i have. you can send her a personal message and ask her directly for help - that's probably going to get you the quickest answer. look at the right side under her avatar and see where it says "pm" - click there.

hang in there - you'll get him regulated. it just takes a while of increasing to find the "just right" dose to turn it around. it is a little tense at first but it gets much, much easier. hugs!
 
We don't actually download the SS. We work on it online using our browser, for your iPad it's Safari, right? To used it you must have a Google account (free) and be logged into it. Once you get the SS set up you will actually have 2 addresses for it,
  • - one to share w/ others that is read only it will start like this https://spreadsheets.google.com/pub?key=………………….
    - For the address that you will use to edit the SS the pub should be ccc (colors are just to help explain.)

How far have you gotten in setting up the SS?
 
Negative for Ketones!! Yippee!! I managed to download the spreadsheet on a desktop, so now I can get Mika's spreadsheet going. Numbers are still in the high three hundreds, but I noticed that they don't fluctuate as much any more. Used to start in the 400's, go down to high 200's, back into 300's when he was on 8 units of lantus. Now that we started over at 1.5 units (just upped to 2 units last night), his numbers hover in the mid-300's.
 
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