PMPS Dose Advice, Please. Dropped to 39 at +4

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Tricia Cinco(GA) & Harvey

Tricia Cinco(GA) & Harvey

Member Since 2011
Cinco has been doing much better this past week. We've got his numbers more consistent and coming down. We've had him at 1.5 for the past week or so. My husband gives him his shots and I'm asleep when he gets the AM shot. This morning his AMPS reading was 95 and Mark didn't give him any insulin at all as he was afraid it would make him hypo. I told him I thought he should have given a small dose, like .5 or .25. By the time I knew about it, it was already 4 hours past the usual shot time. Should we have given a token dose at that time? It is now 4.5 hours past dosing time. What should I do? I read in the protocol page that there are three options - reduce the dose, or feed and wait 1-2 hrs and test again, or split the dose. It seemed that the recommendation was to actually give the usual dose and monitor closely. I've briefed my husband on this for future reference, but what do we do now? Please advise.

https://spreadsheets.google.com/spr...gVSWwdEp4OWZpVXZCd05WV0taYmJRb1JmVXc&hl=en_US
 
Re: Need Dosing Advice, Please.

The headache is that if you shoot this late, your PM shot will be 12 hours from now. At this point, unless your schedule can accommodate this late of a shot, I'd skip.

FWIW, we usually don't recommend splitting the dose. Please take a look at Libby's post on handling low pre-shots.

I'd also suggest looking over when you need to take dose reductions. When numbers drop below 50, you need to reduce Cinco's dose. You shouldn't be waiting 3 cycles.

Also, could you take the "911" icon off. This isn't a emergency situation.
 
Re: Need Dosing Advice, Please.

Thank you, Mary. From the link you posted, it seems that my husband was ok in his choice. It's just so confusing when the protocol gives you several options. Based on his previous readings, I think giving a reduced dose is the best choice for Cinco in this situation in the future. When we tried it in the past, his +6 numbers were good, but not too low. I'm making my husband do more reading, so he understands that going from 1.5 to no shot is probably not the best idea. I'm just so afraid of making the wrong choice and undoing all the progress we've made.

Sienne, sorry if you feel I shouldn't have used 911. I wanted to be sure someone saw it and told me what to do, in case the advice was to give some insulin now. I'm still new at this, but boy am I learning a lot!
 
Re: Need Dosing Advice, Please.

Please listen to Sienne, she is great. Also, please read all of the stickys at the top, especially this one regarding dosing:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581
Your SS looks like you are changing your dose without gathering enough data, and no 12 hour curves. Please click on Stella's SS or any other to see what I am talking about. Also notice what a small change in Stella's dose did to her...a larger dose change will do a lot! I have data, so my 'mistakes' should hopefully not be repeated.

Please, don't beat yourself up...I am trying to assist... :smile: I am very grateful you and your husband are trying, and the best we can do is the best we can do...but please, get lots of data on your spreadsheet! ;-)
 
Re: Need Dosing Advice, Please.

Hello......just wanted to stop by and say hi....don't think I've stopped here before. You are doing great....there is a steep learning curve, so don't feel bad. I still go back and read the stickies....just to be sure I understand/remember what they tell me. I have just one suggestion....when making changes in dose (either increasing or decreasing) make the changes in increments of 0.25 units at a time......by making dose changes in 1/2 or full units, you may skip right over his purrfect dose.

Keep up the good work and don't worry about missing a shot. ;-)
 
Re: Need Dosing Advice, Please.

Just stopping in to say "Hi" and "Welcome" :-D to Cinco and his mom and dad.
I see some really nice numbers for him this past week. Good job.
Don't worry, there's a lot to learn. We're here to help and support you.

Lantus works best if you shoot the same dose consistantly. We usually try to shoot the same dose for at least 3 days (unless the cat goes too low) before we make an adjustment. Then, if we make an adjustment, we try to stay with that new dose for at least 3 days. And the adjustments are usually best done in 0.25 increments.

How would you feel about going with the 1.25 dose, and sticking with it consistantly (unless he goes too low) for a few days, and then letting us help you adjust from there, once we see how he does?

Let's see what others have to say, too.
 
Re: Need Dosing Advice, Please.

If you want to get attention to a question, you did the right thing -- you indicated you had a question in your subject line. You can also use the "?" icon. The convention is to use the "911" if there is a critical situation -- an overdose, presence of ketones, symptomatic hypoglycemia or some dire situation. The 911 will get people to drop everything and come running!

I agree with what the others have noted. Lantus works best if you are able to shoot the same dose over a period of several days barring the need for a dose adjustment. I like Dyana's suggestion to shoot 1.25u if your comfortable with that. If you think it will be easier to stick with 1.0u and if Cinco needs more insulin to add, that's fine, too.

Do you think you might be able to get a curve (testing every 2 hours) or a mini-curve (testing every 3 hours) sometime over the weekend? It will help you and us to know where Lantus onset and nadir are for Cinco.
 
Re: Need Dosing Advice, Please.

welcome to Lantus Land! I'm just chiming in to agree with the "pick a dose and collect data and then let us help you" thoughts. I would go with either 1 unit or 1.25 units and try to get some spot checks or a curve in the next couple of days. You're doing great at getting +6 tests, but we don't know for sure if +6 is Cinco's nadir so it would be good to get some other tests to see if maybe he is going even lower than the numbers you are catching. Good job, though!
 
Re: Need Dosing Advice, Please.

Hello! Just wanted to stop by and say hi and welcome!

If it feels overwhelming, you're normal. We've all been there before. If it doesn't feel overwhelming, then I want to know what drugs you're on. LOL!

You're getting some great advice. Baby steps!
 
Re: Need Dosing Advice, Please.

Wow, thanks everyone! It is very overwhelming. We have stuck with the 1.5 for some time. I know you aren't supposed to have knee-jerk reactions to low readings, but we can't seem to help ourselves. I do like the idea of trying 1.25 for a few days. We switched from the 1/2 ml syringes the vet prescribed to the 3/10 so we could be more accurate, but I still find it hard enough to do 1.5, let alone 1.25! My husband is better at it than I am. Any advice on getting that part right? There isn't a narrower syringe that would have smaller increments, is there?
I was planning to do a curve on Monday, as I'm not sure I can do the readings often enough tomorrow (Sunday) - I have too much other stuff going on. I will also try to vary when I take the readings some days - not just +6, or others in addition to the +6. I have read the stickies more than once, but each time I read them I retain a little more, so I'll keep reading them. I'll post again Monday when I've done the curve, unless I have a question in the meantime. Again, THANK YOU all for your help and support!!!!!
 
Re: Need Dosing Advice, Please.

Hello-

I noticed you went from 1.5 to .5 over night. I think this will cause a HUGE bounce over the next 3 days. I am no expert, but I feel if you think 1.5 made her nadir too low you should go to 1.25 or 1U and stick with it for 5 days solid. You need a very clear picture of the health of your kitty. I can't remember what the other suggested you start at...but start low and go slow. SLOW. ;-)

xoxo
 
Re: Need Dosing Advice, Please.

Mary and Stella said:
I am no expert, but I feel if you think 1.5 made her nadir too low you should go to 1.25 or 1U and stick with it for 5 days solid. You need a very clear picture of the health of your kitty. I can't remember what the other suggested you start at...but start low and go slow. SLOW. ;-)
Click to expand...
Just FYI, but most of us in the Lantus ISG don't follow the Start Low Go Slow method. Here is a link to SLGS. Here is a link to the Tight Regulation Protocol most of us follow here. We don't tend to hold doses for a week or two unless the numbers are in the range we want. ;-)

Cinco looks really good. :mrgreen:
 
Re: Need Dosing Advice, Please.

I stand corrected (I don't need to be right, I am a newbie trying to figure this all out). According to Tight Regulation, I believe the dose should only drop by .25 correct? I was just worried about a big swing like I gave Stella. Wouldn't like someone else to make my mistake! Good luck!
 
Re: Need Dosing Advice, Please.

Thanks, Mary and Libby. I told my husband, who does the shots, to go to 1.25 starting this morning, as had been recommended here. He was spooked by the low AMPS number, so he only shot .5. I tested several times today, and the numbers looked good. We decided to go to the 1.25 as long as his PMPS was over 150, which it was. I'll do a curve tomorrow, and we'll hold the dose for at least three days, barring any really scary low numbers. Then I'll do a mini curve - does that sound like a good plan?
 
Re: Need Dosing Advice, Please.

Just to clarify... it looks like your husband shot 1.5, then got spooked and shot .5, you are now suggesting you will try 1.25 and hold for 3 days, right?

I think if 1.5 spooked you, then 1.25 sounds like a good plan. Again, I am new and have made many mistakes. In your position I would try to get a safe dose to hold to gather data. It seems to be 1.25 is a safe dose according to what info you have given...again...I am new...and it is always up to YOU! ;-) Good Luck!
 
Re: Need Dosing Advice, Please.

keep testing - it looks like Cinco is on a mission. He might not stay on 1.25 for long...
 
Re: Need Dosing Advice, Please.

Mary, 1.5 was the dose we were holding at, but because the AMPS was only 112, my husband was afraid to shoot 1.5. Since I told him he should not have skipped a dose completely the day before, he felt .5 was a good dose. Fortunately, it turned out well. I'm working on getting him to read more of the stickies and not just rely on me to tell him what they say. Anyway, we want to get to a "good" dose, and since several other posters recommended going from 1.5 to 1.25, that's what we decided to do. I feel like we are close to the "purrfect" dose, and want to do the right thing. Libby, you are right that Cinco seems to be playing along well - I'm loving the numbers we've been getting the past few days, and he is doing so well.
 
Need Dosing Advice, Please

Another question: We started Cinco on 1.25 last night, and today I'm doing a curve. His AMPS was 233. His +2 was 81 and his +4 is 39. According to the protocol, anything below 50 earns a dose reduction. Does that mean we should shoot 1.0 tonight? Also, should I give him a little HC food now, based on that number? Or should I take it again in 30 minutes to see if it goes lower? He had his usual BG test treat of 1/2 slice of deli thin turkey. Thanks for your help.

https://spreadsheets.google.com/spr...gVSWwdEp4OWZpVXZCd05WV0taYmJRb1JmVXc&hl=en_US
 
Re: Need Dosing Advice, Please.

It's me (the NON expert) This just happened to someone, and it turned out to be a bad read. If this happens in the future, do two BG tests to see if it is appropriate. This response will bump you up. 'edit' your post title click the '?' mark and Put ??? before and after the title. When someone gives you the answer you need, re-edit the title to take off all of the question marks and change your condo title.

Good luck!
 
Re: Need Dosing Advice, Please.

Another question: We started Cinco on 1.25 last night, and today I'm doing a curve. His AMPS was 233. His +2 was 81 and his +4 is 39. According to the protocol, anything below 50 earns a dose reduction. Does that mean we should shoot 1.0 tonight? Also, should I give him a little HC food now, based on that number? Or should I take it again in 30 minutes to see if it goes lower? He had his usual BG test treat of 1/2 slice of deli thin turkey. Thanks for your help.
Click to expand...

You need to give HC asap! Anything below 50 would be a serious situation. Give HC with karo and retest in 15 minutes and let us know! You want to get Cinco out of the 30's immediately!
 
Need Dosing Advice, Please

Don't think he's hypo. No symptoms, and this is the second time he's ever tested with that number. Tested him againn 25 minutes later and he was up to 68. Of course, he was also pretty ticked off at me for sticking him again so soon, so that might have raised the number!
 
Re: Need Dosing Advice, Please.

Don't think he's hypo. No symptoms, and this is the second time he's ever tested with that number. Tested him again 25 minutes later and he was up to 68. Of course, he was also pretty ticked off at me for sticking him again so soon, so that might have raised the number! Will test again in 20 minutes, if he'll let me. Do you still think I should give him some HC?
 
Re: Need Dosing Advice, Please.

There are many cats who don't show symptoms with hypo. You really don't want them down that low. Once Tarragon drops below 50, I start with MC and test every 15 minutes. If he hits 40, we go to the HC and karo/honey.
 
PMPS Dosing Advice,Please

Tested again at +5 (50 minutes after BG39 and 30 minutes after BG68) and he's up to 75. Had to bribe him with more turkey. I am still wondering if, as the protocol says, that has earned him another reduction? Since we just dropped him .25 to 1.25, should we just stay with that for at least 3 days? Also, we'll be going out this evening right after he gets his PM shot, and will be gone for about 5 hours. Should we still shoot 1.25, after these low numbers today?

https://spreadsheets.google.com/spr...gVSWwdEp4OWZpVXZCd05WV0taYmJRb1JmVXc&hl=en_US
 
Re: Need Dosing Advice, Please.

The 1.25 might be too much. Let's see what others have to say.

Last night J.D. went to 38 and I gave him a little 5% FF (Chunky Turkey) and he came up for me. It depends on how carb sensitive your kitty is.
 
Re: Need Dosing Advice, Please.

You've been using this same Subject line for a couple of days now. How about changing the Subject line in your first post to something like "PMPS Dose Advice, Please" just to get fresh eyes on the condo.

OR, you can open a new condo each day, like most of us do. If you open a new condo, you'll copy and paste the link to this condo to the first post of the new one, so people can easily browse back to this one to see what's been going on in the past. You will need to use the URL button to copy and paste the link in order for it to be/stay clickable.
 
Re: Need Dosing Advice, Please.

Normally, you want to be careful about taking two reductions back to back as a full shed can affect the next 2-3 cycles. The low numbers yesterday morning were most likely from a full shed from the 1.50u dose. However, shooting .5u yesterday morning should have drained the shed a bit.

So this might be a "real" number today. I think it would be good to fix your subject line as suggested and do as we all do for daily posting and ask for dosing help so others can weigh in.

Also....our girl has been in the 20s with no sign of a hypo. So please take any number under 40 seriously ;-) :-D
 
PMPS Dose Advice, Please.

Thanks, Dyana and Marjorie. Still very new to this and not familiar with the way to do it. I was wondering about that. I will try to remember to open a new "condo" tomorrow. I appreciate all the help. I will keep watching for more posts today so we know what to shoot this evening. We shoot between 5:30 and 6:00 pm Pacific time.

https://spreadsheets.google.com/spr...gVSWwdEp4OWZpVXZCd05WV0taYmJRb1JmVXc&hl=en_US
 
Re: Need Dosing Advice, Please.

:lol: i loved bonnie's comment that if you weren't overwhelmed to tell us what drugs you're on . . . truly - she's right. all of it is overwhelming and we'll do our best to help you understand it one step at a time. it does get easier!

personally, i'd assume the 39 was correct. might not be, but none of us has a perfect glucosemeter, and you're basically just going to trust what you read on it and act on that. checking it again is fine, but if you're not going to check it again, assume it's correct. most of the time what you're looking for is a trend, anyway. that 39 was a low enough number to stand up a pay attention.

here's the skinny on it - lantus is a slower, longer-acting, gentler insulin, and we've seen a number of kitties on here who drop below 40, which is a hypoglycemic range, but have no symptoms. it almost seems like they don't have symptoms til they're 20ish or below. by then it's serious. a cat can live for a long time with too high of blood sugar, but their little brains can't go one minute with zero sugar. so you always want to rely on the numbers rather than the behavior when you're looking at a possible hypo. far better for you to send cinco soaring too high with karo syrup or high carb food than to let him get too low. Punkin's gone too low several times and the only sign i've ever seen is that he might act really hungry.

just for the future (it's all one great big old learning adventure here, so never beat yourself up after the fact) go ahead and print out these two stickies. they're current and will lead you through what to do if you have a low number at shot time, or if you drop into low numbers during the cycle.

How to Handle Low Numbers

Dealing with Low Pre-shot Numbers

you're doing just great - keep on asking questions!!! feel free to keep editing the first post in a condo and putting any questions in there, too. we just edit away on these every day! :lol:
 
Re: Need Dosing Advice, Please.

Most of our cats are asymptomatic when they are in low numbers because we deal with the low numbers immediately. Please review the post on how to handle low numbers that Julie linked. You need to test frequently and give HC food if numbers drop below 50. We use HC food to steer the numbers and we test every 15 - 30 min. to make sure the numbers are staying where they need to be.

As for dose, I'd reduce to 1.0u. I think you're going to need to keep an eye on Cinco's BG numbers. I think your kitty is on a mission!!

I do need to ask a housekeeping favor. Please start a new condo every day. And, just as importantly, please edit your subject line so the numbers your getting when you test are visible. (You need to edit your first post in the thread/condo.) Since this is an older condo, I would not have stopped by again if you hadn't sent me a PM. For those of us that read most of the posts on the Board, having the numbers visible let's us know if there's something that requires attention.
 
Re: Need Dosing Advice, Please.

Again, thanks to you all. I am trying to learn the best way to communicate and take advantage of all the help available. Just so you know, I've received the stickies on Hypo and Low Numbers numerous times and have printed and read them several times. I just find it a little confusing, because in one place it says if the number drops below 40, reduce the dose, and in another it says not to react to a single reading (except if it's a possible hypo), but to base changes on at least 6 cycles.

Please, is there a sticky on posting protocol? If not, I think someone needs to create one for dummies like me. Info like: 1)What is a condo? 2)Start a new topic every day. 3)What do the icons at the top mean and when to use them, etc. 4) Post numbers in subject line. That might save all you veterans from having to explain it to each of us as we fumble along. I looked for some guidance when I first started posting but couldn't find any.



https://spreadsheets.google.com/spr...gVSWwdEp4OWZpVXZCd05WV0taYmJRb1JmVXc&hl=en_US
 
:-D I think I asked that same question when I was new... the one about not changing doses for 6 cycles.
I use that guidance for when INCREASING the dose.
Reductions should be taken as SOON as they are indicated. In this case, 39 says reduce the dose now.

A 'condo' is your thread. My kitty is OTJ (off the juice - in remission - not using insulin) therefore I do not have a condo or thread. But I'm visiting your home/condo. :lol:

I believe there is a glossary of these crazy terms... I will try to find the link for you. I'll be right back.

P.S. Welcome to Lantus and FDMB! (Feline Diabetes Message Board)

EDIT: Here is the link to the Slang Glossary: Lantus Slang dictionary
 
Is it hard to process all the info you get, and it's a ton of reading!!!
I just find it a little confusing, because in one place it says if the number drops below 40, reduce the dose, and in another it says not to react to a single reading (except if it's a possible hypo), but to base changes on at least 6 cycles.
Click to expand...

Both of these statements are true...if Cinco drops below 40, that could be a possible hypo and you would reduce the dose. That is an earned reduction. But you can't react to a single reading (say, a 55) and you need to just keep on the current dose for at least 6 cycles. Does that make sense when it's put altogether?!! You don't know how many times I had to read and reread things to get them in order in my head. It can be difficult!!

There is a sticky that includes the info about only having one condo a day, etc. I'll see if I can find it.

And just for a bit of info....I know a lot of people use karo for their kitties, but I found that using HC for numbers under 40, and MC for numbers above 40-60 is all Champ requires. It will help you to find out what Cinco needs by experimenting. The next time he gets to the 40 or 50s, give him about a tablespoon of something like a 16% carb food (Friskies shredded beef in gravy is a good one) and then check his BG again in 15 minutes AFTER HE FINISHES EATING. Make a note of what food you fed and how much you fed in the remarks section of his SS so you have something to reference when you need to remember how many points this increased him. Just experiment with different percentages with different BGs and see what you get!!
 
Found the sticky about condos. It's at the very beginning of the sticky called "New to the Group?...Please read"

*** First stop ***
Lantus & Levemir: Info, Proper Handling, & Storage


*** Daily Threads & Posting Instructions ***


Please start one new thread each day. This will keep all your questions, comments, and replies in one place.
Start your daily thread with the date, kitty's name, and AMPS
Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
Click to expand...
 
Thanks, Patty and CD. I ended up not giving Cinco any HC, because his number was up already above 60 the next time I tested him. The turkey I gave him when I was testing him at +4 must have been enough to bring it up. I'd noticed that before when he was low, too. I read in one of the stickies that just giving them their normal food can often raise the BG enough. If it had been lower than 39, I wouldn't have stopped to ask, but would have given him HC right away. That was his third time testing that low, and the other times I did give the HC. This time his numbers had been consistently lower, so I wasn't as scared by it as I was the first time it happened at home. The second time it happened was at the vet, and he hadn't been fed in over 6 hours, so just giving him some of his regular food brought him up.
 
and that's the great thing - because every cat is different, every "mistake" we make with our own cats tells us more about what works and doesn't work with our kitters.

you're doing just great! there's a lot to learn - and we all know it starts out very confusing, but it gets easier every day. pretty soon it's almost routine - hard to imagine when you're at the beginning of the ride!
 
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