New- Dosing Advice- AMPS 231, PMPS 143

Status
Not open for further replies.
mococo

mococo

Member Since 2011
Hi

We are still relatively new to the whole ball game (dx late jan/early feb of this year) and I have some questions about dosing.

A little background as I'm not a frequent poster:
-I've read a great deal of the information in the stickies, and I feel a little silly to say this, but I just "got" the protocol -for tight regulation about 2 weeks ago (the lights finally turned on), which is why when we went up from 1un to 1.5, we went up the whole .5 at once, and this time we are going up in .25un.
-We have a very very supportive vet who is open to discourse.
-We are on wet food, fed BID (ff gluten free, I've been tracking the flavors in the ss to see if there is any link to changes in sugar), and this has been encouraging slow, steady, and much needed weight loss.
-We do test, and have made it a more regular habit, and we're increasing our spot checks, we do as many curves as we can get. The BF just finished grad school, and I am a performer with a day job, so our schedules are loopy, and we don't have as bountiful a ss as many of the folks here, but we have made it more of a priority.

So this all finally leads to my question- our vet is aiming for numbers in the low 100s (aren't we all). She started him on 1un, bumped to 1.5, and now to 2. However I noticed that his curve is more like a climb the last time we were able to do a full one. I unfortunately don't have the previous ones we did on the ss back in Feb (we were less organized), but when he was on 1un, his curves were high, but they looked more like the one we saw on 3.20.

I want to make sure that we aren't bumping his insulin too quickly, and to make sure that we are aware of potential side effects of changes in insulin can have. We are prepped for hypo (we have syrup and instructions on the kitty shelf), but I feel a little uncertain about what else to expect and if what we are seeing now is normal.

Thanks so much.
 
Re: New- Dosing Advice- AMPS 231

Welcome to Lantus Land!

It does seem like you have the basics of a spreadsheet (SS), home testing, and food in place. I'm glad the protocol "clicked."

I'm assuming that D'Artagnan is your kitty's name? A Lantus "curve" is characteristically flat. You will see this more and more as your cat become increasingly more regulated. If your cat's BG is in the 50 - 120 (i.e., normal) range, the resulting curve will be flat.

Referring back to the protocol, doses are increased by 0.25u when the nadir is typically below 300. If you increase by 0.5u, there's always the chance that you will miss a good dose. You can increase the dose as soon at after 3 days (6 cycles) if the nadir is above 200. If it is below 200 (i.e., "blue" or "green"), you can hold the dose for 5 days (10 cycles) before increasing. Obviously, you can reduce the dose once the reduction (i.e., a drop below 50) is earned.

Please let us know if you have questions. I hope you'll post regularly so we can see how your kitty is progressing.
 
Re: New- Dosing Advice- AMPS 231

You are correct on the name, nicknames are plentiful around here though since the bf doesn't speak french.

Just to make sure I've got this right:

We should hold at 1.75un for 10 doses, and then move up to the 2un the vet reco'd.

However if he's surfing blue and green on 1.75un in the 10 doses, we don't need to bump up to the 2.

Does that all sound correct?

Thanks for the help with this!!!
 
hi there!

welcome to Lantus Land!
Sienne's info is good,
here a link to the PROTOCOL STICKY used here.
Plus check out the other starred stickies floating around and at the top.
Oh I see you have read these - good!

Keep us posted if you can on your kitty. Even if you don't post daily, once a week or couple times is ok, keep your spreadsheet up to date to.
Best of luck to you!
 
"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 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 cycles).
Each subsequent dose is held for a minimum of 3 days (6 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.

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

Reducing the dose...
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.
A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.
Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

Using a weight based formula for determining a starting dose of Lantus or Levemir:
the formula is 0.25 unit per kg of the cat's ideal weight
if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
Online Calculator for Converting Pounds to Kilograms

There are circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines.
Click to expand...

you can't really just say "i'm gonna hold the dose for 10 cycles and then increase" because it depends on what happens during those 10 cycles what you do . . . where are the nadir numbers on that dose?

i've basically kept posting here, asking when the numbers seem too high or flat to find out if i need to increase the dose, or if they drop down to less than 50 then you need to decrease the dose. we also started at the same time and i've had to reread the stickies about 100 times - each time i get something new "fixed" in my head. i'd encourage you to post daily or every other day so that people can help you.
 
Status
Not open for further replies.
Back
Top