Pedro, new to Lantus (RVC trial, UK), low AMPS at 4.4 mmol (Alphatrak)

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KleineMue

KleineMue

Member Since 2014
Hello,

Pedro started on Lantus Wednesday morning and we picked him up from the Royal Veterinary Clinic and their feline diabetes remission trial with info to give him 2 units 12 hours apart. We didn't have a chance to do a curve yet, but will do that this weekend as in the moment it feels like everything is new. Lots more reading to be done about Lantus and data to be gathered for us to understand the way Lantus creates a depot and slowly releases.

He had a fairly low AMPS this morning, 4.4 mmol/l on an Alphatrak glucometer the clinic gave us. I just fed him his trial food (Purina DM) and will test him again shortly to see if that has done anything. If his numbers have gone up I reckon insulin would be ok, otherwise i will try and contact the clinic.

From the stickies above I understand one recommendation would be to lower the doses by 0.25 units? I am a bit worried because I will have to go to work shortly and only OH and Josie are staying home who might not be able to test him every 2 hours and miss if something is wrong... *overly and probably unnecessarily anxious*

Anyway, thought I say 'Hi!' and introduce us to the board.
Wibke & Pedro xx
 
Subsequent tests after breakfast were 4.7 and after a small portion of high carb food he is 4.6. Gaaaaaaah!! To inject or not to inject??
 
Hiya - I'm not an expert by any stretch, but if it were me, I wouldn't shoot this number for a couple of reasons.

1- you can't be sure what (if any) the food is having - it may kick in later and all will be fine......but you just can't tell
2- you're not around to monitor.

As the wise beans on here say - better too high for a day than too low for a moment!
 
Hi! I did read it and having had to make a decision before leaving I shot 1.75 units instead of the recommended 2, just texted OH to test him and give small portions of carb rich foods. Also emailing Ruth to see what her recommendation is for handling low numbers and also getting to know more about these new alphatrak numbers.

Will set up a new spreadsheet later when I'm home in about 3 hours. *sigh*

Thank you for getting back to us!!
xx
 
Welcome!

If Pedro was just started on Lantus this week, what insulin were you using prior to Wed?

If at all possible, could you migrate your spreadsheet over to the World Template so that the mmol/L measures are automatically converted to the format used in the US? The majority of us are in the US and use mg/dL to indicate blood glucose levels. Alternatively, you can multiply your numbers by 18 to convert -- but it's a lot of work! The link for the World template that we use is in the sticky note above.

If you're not going to be home, please make sure whoever is testing gets a +1 and +2 test to start. You've not shot this low before and we typically suggest extra caution if you're shooting lower numbers. With an AlphaTrack, you're very close to a dose reduction with the number you shot.
 
Hi Wibke

Make sure you get the spreadsheet fresh from here as the one you have been using doesn't have the US page which is the language most people around here speak. No extra work for you, you just enter in the world page and the results automatically go into the US page.

If you're going to use the Alphatrak please update your signature - there's quite a different between Alphatrak and human meter numbers and we wouldn't want anyone mistaking them, could be quite the disaster!

Could you let us know how much Pedro weighs and, if he's carrying some extra, what his ideal weight would be. Two units would be too high a starting dose for most kitties and this definitely seems to be the case for Pedro. A 4.4 on the Alphatrack would call for an immediate .25 reduction so don't go back to shooting 2 units. [ETA - Sienne is correct, it's not quite a reduction - there's an error on my guide that I hadn't noticed before! But I still wouldn't be going back up to 2 units being that low at AMPS chances are he was lower during the night] Depending on his weight I suspect the recommendation will be to reduce further than the 1.75 you shot today too.

There are better lower carb foods you could be giving Pedro too but changing while he's getting such low numbers could be dangerous so we'll worry about that later.

Welcome aboard :) we look forward to assisting you with the very gorgeous Pedro.
 
Hi Mue - good to see you made it over from the Health Forum. Welcome. I'm also not seeing any of the later data from Pedro. We are all rather data driven here so updating whatever tests you have will be a great help. When you change the spreadsheet, could you put a big line between the Caninsulin and Lantus data so when we know when he started Lantus? Thanks.

Starting doses of Lantus are based on cat's weight. We like to start at a lower number and work up to a good dose rather than start too high.

For those who want to follow Pedro's history:
His trip to the RVS Diabetic Remission Clinic
First post (he was on Caninsulin)
 
Hello, hello!!

Thank you all for your input!! Much, much appreciated!!

I just updated the spreadsheet with the the Lantus data by duplicating my old sheet and clearing the data to have a new sheet for the Lantus data, but I realise now my spreadsheet mistake because I deleted the U.S. sheet when I uploaded it to my google docs thinking I don't need it... *cough* Shall get a fresh sheet and update the Lantus data and insert the old CanInsulin sheet at the back for reference and archive purposes. ^_^ Quick note: the first two figures see 7.8 which was actually the calibration liquid and the 26.6 was me testing him in the car on our way home when we stopped at a service station.

Friday's numbers still feel erratic and I wonder if they are to do with him arriving home and settling back in, he started very high and dropped rather low at his nadir and I fed him some mid carb calorific food to help. Later he went to 12.7 mmol/l as pmps and then today a low low low day. OH kept a close eye on him and he seems to have reached his nadir just before, testing again in a moment. We keep feeding him small amounts of mid carb calorific foods to help him.

Besides the numbers he is perfectly happy and comfortable in himself, no sign of hypoglycaemia *touches wood* and other than being vocal about having low blood sugars he is unscathed from today's experience. *keeps touching wood*

Before Pedro entered the trail we used CanInsulin and also a human glucometer. He was a meagre "bag of bones" 3.2kg (all our boys have a rather large bone structure/skeleton, so this was really thin for him) when he was first diagnosed on 13 Nov and I am delighted that he now weighs 4kg (despite a fair amount of fur having been shaved off...) I don't think he carries any extra weight, rather the opposite. At his fittest a few years ago he weighed in at around 4.6kg, a lean muscly cat.

Will update my signature in a moment with the new information.

I will keep testing him throughout the night and tomorrow to get data and I will also email Ruth to consult with her.
When I just tested him he was up to 10.1 mmol/l on the Alphatrak, no doubt the work of the mid carb calorific foods. *sigh*

We have a bit of leeway (30mins) with the timing for his PMPS, ie not feeding him now until 9pm (last food intake at 7pm) means we do get a pmps at 9pm and can feed him and if need be inject although I am not sure if we should and if we do then maybe only 1.5 units if not lower.

Okey-dokey, back with more later!!
Wibke & Pedro x
 
Here is the quote from our TR protocol sticky regarding starting dose:
  • 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
Click to expand...
That would mean a starting dose of 1.oU for Pedro by his weight. I see he got to 2.7(49) today - that's too low even on a human glucometer. On an AlphaTrak, the reduction point is 3.8 (68). How about starting him over at 1.0U tonight?
 
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The other thing, Lantus is a depot based insulin, which means that it usually takes takes at least 6 cycles to be fully effective. You are just now seeing what this dose can do. I'd encourage you to read the Sticky Notes at the top of this forum. Did the Remission Clinic have any particular dosing protocol they want you to follow? We have two protocols, the Tight Regulation and Start Low Go Slow - people here are following one or the other. It helps to pick a dosing protocol so you can get help almost any time from us and eventually learn how to dose yourself, instead of waiting for an answer from the clinic.

One other note, after that low today, Pedro is probably going to bounce into higher numbers. Here's a description of what happens - check out the second post here. Basically it's his bodies reaction to those lower numbers. It's a very common reaction.
 
Just quickly: PMPS of 28.9, so fed him and then shot 1 unit. Will read the links above to prepare for his reaction to lower numbers and lower dosage.

The 2 units were prescribed by RVC. Emailing Ruth (our vet at RVC) and ask for clarification. ^_^

x
 
Looks like he is definitely bouncing. Bouncing can take 6 cycles to clear, so it's time for patience. Just hold the same dose. Lantus works best when you use the same dose for a while (unless they earn a reduction). I forgot to ask, any history of ketones for Pedro?

I'm curious what sort of protocol they use at RVC. What was his highest dose of Caninsulin? I did some searching of kitties who switched from Caninsulin to Lantus, and some needed less and some needed more Lantus than Caninsulin so it's hard to say what Pedro will need. He may need to go up in dose, but the protocols we use say to hold the initial dose for 5-7 days, unless they earn a reduction. From the TR protocol sticky:

"General" Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive 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 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive 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.
Click to expand...
 
Shall get a fresh sheet and update the Lantus data and insert the old CanInsulin sheet at the back for reference and archive purposes.
Click to expand...
Yes definitely on the new spreadsheet and then post the US numbers in his condo otherwise everyone has to get out their calculators to work out what's what. Even though I'm in Australia even I still think in American on the numbers.

To clarify - Wendy meant hold the new dose of 1 unit. As you are able to get plenty of tests I would highly recommend the tight regulation protocol for Pedro.
 
Woke up at around 1.30am lying on my side and Pedro perched on top of my shoulder, purring into my ear. ^_^ Promptly tested him (27.1/488) and again just now, a couple hours later (28.2/508). Read up about 'bouncing' and have my 'patience pants' on while Mr Liver is sending my cats into dizzy sugary heights. *sigh* Does a 'cycle' last 12 or 24 hours? EDIT: just read up, a cycle is 12 hours, so hopefully in a couple days we can see an improvement of the numbers again.

The shooting protocol as advised by RVC was a starting dose of 2 units (which he started with on Wednesday morning at the clinic, I collected him Thursday afternoon), to definitely do a curve towards the middle or end of next week and to have him checked over by our local veterinary surgery at that time, and then to bring him back to the clinic on 19 January for a 2 day stay for them to run curves and examine him.

Considering all that has happened over the past 24 hours I will write Ruth at the RVC an email to update her on Pedro's development and also inform her of the change of dose. I wonder how she arrived at 2 units in the first place and I wonder if his blood sugars were raised due to the stress of the car journey (4 hours, no mean feat) and settling into the clinic? He was on 1.75 units of CanInsulin before that and they continued to give him that at the clinic for the first couple days while they examined him to see if he would be able to join the trial. When he got the all clear (except for a tiny nodule on his liver and slightly diluted wee which she said might mean he could develop kidney problems at some stage in his life) they started him on Lantus Wednesday morning.

I guess by now we have a build up of the depot and the Lantus started working to full effect and his numbers were already coming down a bit on Friday evening (12.7/229) and then went even lower Saturday morning. Going by everything I have since read on this thread thanks to your contributions and replies and the links you posted we have now halved the original dose to 1 unit and will hopefully hold this for the recommended duration before doing any further changes, unless the numbers tell us otherwise. :)

I uploaded a new spreadsheet (link is Pedro's name below) with the US numbers and also the old CanInsulin spreadsheet added for reference. We used a human glucometer for the CanInsulin spreadsheet and since starting the Lantus we are using an Alphatrak2 glucometer. I have yet to resume my full working schedule of the new year and I hope we can manage a tightly regulated shooting schedule. I will be in work most days though, so most testing will be evening time. We also have to bring his shooting time back up as we shifted it to a holiday suitable 9am/9pm. Hoping to bring it back to 8am/8pm.

Shame about that green string of numbers, I believe this would be a fine flat curve for a healthy cat. Maybe we are lucky and he might get there. ^_^
Wibke x
 
Great job on the spreadsheet :) Shame about driving 4 hours for a curve you can do yourself - is it part of the trial that you have to maybe they would be just as happy accessing your spreadsheet? You can send them the link.

Doh - just got the low battery alert on the computer and the powers out so I'd better shut up shop in case I need it later :eek:
 
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