Re: 3/2 Frank AMPS 447, +7.5 421 Need Help

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Delma and Frank

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yep, should have not increased yesterdays 156 PMPS dosage. Even though it was on the low side, 156, I should not have decreased dosage. It's bounced up high today as I thought it might be with the dosage decrease. Since it was somewhat low at 156, I was afraid to keep dosage same because I feared it would bring Franks BG too low as I slept.
Hoping for better times.........
 
Re: 3/2 Frank AMPS 447

Hi Delma,

I just wanted to stop in to say hi. I was looking at your ss and wondering how you decide to change doses. Forgive me if I am forgetting your story, but was Frank just diagnosed recently?
 
Re: 3/2 Frank AMPS 447

It's also very likely that the dose changes are causing the fluctuation in numbers.

Given the trace ketones, can you try to get another ketone test in today?
 
Sorry if the following is confusing but at this point I am becoming rather overwhelmed.

Frank was diagnosed 1 1/2 yrs ago. When he was first diagnosed, he was up to 8 units humilin just not responding well. Next was vetsulin. When I increased insulin to get to an acceptable BG, the BG would go to low….like it does now on Lantus.
It took a LONG time but he finally was doing somewhat OK on Vetsulin until the vet said it would not be available anymore. This is the reason for the switch to lantus.

He is constantly looking at my hands for food so I upped his daily food portion a bit.( a quarter can more of FF) It seems that one step up in dosage and his BG goes to low so I thought maybe the extra carbs might even help with his dosage.

His dosage range recently isn’t all that much…it ranges from 2U to 2.5U with a drop to 1.75U once when he was low and I was scared to give same dosage. Another time I dropped to 1.75U but I can not really see what I was thinking by looking at my SS.

I determine dosage by looking at charts that tell me increase if BG is “this” or “that”. However fear factors into this and if BGs or the AMPS or PMPS is too low it scares me.
When I noticed ketones I increased the dosage.

I am so overwhelmed at trying to figure this all out. I am stressed out with worry for Frank. I need help.
 
Re: 3/2 Frank AMPS 447

Delma,

If you put "Help" into your subject line or something similar, the people here with the most experience will come by, look and comment. I can't really help much myself except to say I think your solution MAY lie in a more consistent dosing, which I know can sound scary, but it does seem to work for people.

Hope you get the advice you need soon.
 
Re: 3/2 Frank AMPS 447

Delma said:
His dosage range recently isn’t all that much…it ranges from 2U to 2.5U with a drop to 1.75U once when he was low and I was scared to give same dosage. Another time I dropped to 1.75U but I can not really see what I was thinking by looking at my SS.

You would be surprised how much even a drop of insulin can effect the numbers. I can tell you from my personal experience that changing the dose too quickly will set you up for all sorts of crazy numbers. Sami is now officially OTJ, but if you check out her SS you will see what was happening when I was changing the dose often. You will need to look at the TrueResults tab to see when Sami first got started on Lantus. Once I was consistent on dosing Sami's BG also started to stabilize.

So that said, I have to agree with Lydia and Sienne that your fluctuation in dose might be part of the problem.

I totally understand not feeling comfortable with shooting a low number but also from person experience at some point you need to take the plunge and shot a lower number or you will never get to those nice green numbers. The first time I freaked out with a lower then expected number I skipped the shot and Sami's BG skyrocketed. The next time I was determined to stick with the plan, but Sami was already in the normal range so I did decrease her dose by .25 units. But no matter what you have to feel comfortable with the dose you are giving.
 
Re: 3/2 Frank AMPS 447

hi delma. lantus dosing is different from some of the other insulins. lantus like consistency... both in dose and shot schedule. as little as a drop (more or less) of lantus can make an unwanted difference. what you want to do is pick a dose and stick with it for at least 3 days. please read all the stickies (starred posts) at the top of this forum. the "LANTUS & LEVEMIR: TIGHT REGULATION PROTOCOLS" sticky will give you an idea of how lantus should be used: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581.

please continue to check for ketones and ask any questions you may have...
 
thanks for your responses. I'll stick to 2.5 for 3 cycles...is this a good plan since he has trace ketones?

I worry about the ketones...how long can this be ok for?

Can not believe Frank was just giving himself a bath at near 500 BG.
 
3 days = 6 cycles so you'll want to hold the dose for 3 days. However, since Frank is experiencing trace ketones PLEASE post here every day. Sometimes when ketones are a factor we recommend increasing the dose a little faster than that.

Keep getting ketone tests whenever you can, and get lots of BG tests too. If the ketones go above Trace, let us know. 2.5 units MIGHT prove to be too much - it looks like it has brought Frank into lower numbers in the past, so if that starts happening again then we might want to go back to 2.25. You don't have to hold the dose for three whole days if he is going low. We'll help you if you open a new thread (we call them condos) for Fred every day.

Has anyone pointed you to the protocol we follow? It is in this sticky, along with some general dosing guidelines: viewtopic.php?f=9&t=1581 You don't have to do it by yourself, though, there are lots of people here who can help.
 
Delma, You are very right to be concerned. Please test every single time he pees. If the ketones go above trace, he will need to go to the vet. Remember that the urine you are testing is several hours old so it could be something that happened earlier that caused it, however, I can not see why he is throwing ketones at the numbers you are getting unless perhaps he is sick or running an infection. Can you do a skin test on him, where you pull the skin up over the shoulders and let go.. you want the skin to snap back into place, not slide back.
 
Hi Delma,

Just want to let you know - you are in the right place. My guy started on Vetsulin and I made the choice to switch to Lev(essentially the same as lantus). At first I was making way too frequent changes. With the help from folks here, we have made great progress and I can tell you- consistency and giving Frank time to adjust to changes will really make the difference. I've seen that Pedro can take about a week to settle into a dose change. However ECID-

Hang in there-
 
Re: 3/2 Frank AMPS 447, +7.5 421, PMPS 334 Need Help

Libby and Lucy said:
Delma, how is Frank's appetite? Same as usual, or more, or less? Action in the litterbox?

Frank has a good appetite...although he is watching my hands like he wants more food, even after he just ate...but he doesn't persist with it. I feed him 1 1/2 can lc ff 2x/day. Regarding the litterbox: I have 2 other kitties and it's hard to tell about pees. But he's the same as he's been---- I know he pees 1 or 2 times overnight and I see him pee at least 1 during the day. Poops are another story, he is a constipated cat for a long time now. I give him 1/4 tsp miralax 2x/day. This helps him but he doesn't poop every day, maybe an average of every 3 days.
 
and I see on your spreadsheet that Frank got a much better PMPS, and negative ketones! Good news all around. Keep checking ketones whenever you can, since he seems to be prone to them you'll want to stay on top of that.
 
Carolyn and Spot said:
Delma, You are very right to be concerned. Please test every single time he pees. If the ketones go above trace, he will need to go to the vet. Remember that the urine you are testing is several hours old so it could be something that happened earlier that caused it, however, I can not see why he is throwing ketones at the numbers you are getting unless perhaps he is sick or running an infection. Can you do a skin test on him, where you pull the skin up over the shoulders and let go.. you want the skin to snap back into place, not slide back.

I also wondered why he showed ketones with BGs in 300s or less.

Frank's skin seems to snap a bit then slide...is this a hydration test?
 
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