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Stalling need help AMPS 90
- Thread starter bbwyo
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Mandy & Rex (GA)
Member Since 2017
There is some information missing. It looks like you did not give insulin last night, correct? If you are following SLGS protocol, I would say to skip this morning. You can't monitor if she's outside.
CassAndGordy(GA)
Member Since 2016
Shooting an hour early can act like an increase with Lantus because its not an in/out insulin. (Similarly, shooting late can act as a decrease.)
If it were me, I'd reduce the dose by 0.25u to 0.75u (at least). Bev has some lime greens on the dose, which typically mean an automatic reduction.
Skipping is always an option too since it sounds like you may not be able to monitor today. Monitoring is key when you're not only new to an insulin, but also new to nicer numbers.
If it were me, I'd reduce the dose by 0.25u to 0.75u (at least). Bev has some lime greens on the dose, which typically mean an automatic reduction.
Skipping is always an option too since it sounds like you may not be able to monitor today. Monitoring is key when you're not only new to an insulin, but also new to nicer numbers.
Gill & George
Member Since 2015
I haven't visited before, Hello and Welcome,
Are you shooting once a day or twice a day? When you don't shoot any insulin, instead of leaving the box blank, could you put NS(no shot) in the box, that makes it clear that you skipped a shot.
Lantus works better with twice a day dosing, it usually doesn't have a long enough duration in cats to make once a day dosing effective. It does seem like 1u is too much of a dose for her. We usually look at what sort of numbers they were getting on a previous insulin when you make a swap to lantus. On Vetsulin 0.5u got her as low as 54, she may even have gone lower on that dose as you weren't doing much home testing at the time. This tells me that the 1u of lantus is too much of a dose for her, I'd look to taking her back to 0.5u or 0.25u of Lantus twice a day. (0.5u of lantus may see some lowish numbers, if you are unable to monitor closely for at least a few days when you make this change, I might err on the side of caution and dose 0.25u)
One other very important question,
Are you using the U100 syringes? (these are different from the U40 vetsulin syringes)
Are you shooting once a day or twice a day? When you don't shoot any insulin, instead of leaving the box blank, could you put NS(no shot) in the box, that makes it clear that you skipped a shot.
Lantus works better with twice a day dosing, it usually doesn't have a long enough duration in cats to make once a day dosing effective. It does seem like 1u is too much of a dose for her. We usually look at what sort of numbers they were getting on a previous insulin when you make a swap to lantus. On Vetsulin 0.5u got her as low as 54, she may even have gone lower on that dose as you weren't doing much home testing at the time. This tells me that the 1u of lantus is too much of a dose for her, I'd look to taking her back to 0.5u or 0.25u of Lantus twice a day. (0.5u of lantus may see some lowish numbers, if you are unable to monitor closely for at least a few days when you make this change, I might err on the side of caution and dose 0.25u)
One other very important question,
Are you using the U100 syringes? (these are different from the U40 vetsulin syringes)
bbwyo
Member Since 2017
I used the u-100 syringe yesterday for the first time. The days before I used the pen like a pen. I am dosing 1x a day. Have decided to skip today. I may test through out the day just for the data if I'm able. When you say Lantus does better w 2x day doses I don't understand because it looks like she was holding pretty good numbers (a little too high yes) but for the 24 hrs. and 2 days isn't much to go on I understand. The Lantus info says it was designed to be a 1x day dose. Just curious. I have read some of the Vet protocols and they have a protocol for 1x dose. As long as bg # are steady and in lower #'s what is the difference?
I know I need more data to make better decisions so will work towards that. I talked at length yesterday with the pharmacist who just couldn't say it was ok to use syringe w pen and I'm sure my Vet will be talking with him since she has never used the pens and always shot from a vial. You have to empathize with these professionals. The Pharmacist is trained to follow pharmaceutical companies directions for a med. The Vet has been trained to not use "anecdotal" info and to trust science. AND when the research hasn't been done and there is no scientific evidence they are bound to the science. I thank God for such a group as the FDMB.
My conversation with the Vet will go something like "I'm ok with anecdotal info when there is no science even though cats are not people. I may have to pony up the $$$ for a vial of Lantus just to get past all this. Health care is nuts.
I will be gathering more info to help me apply all the valuable info/assistance available here. Thank you for your care and concern.
I know I need more data to make better decisions so will work towards that. I talked at length yesterday with the pharmacist who just couldn't say it was ok to use syringe w pen and I'm sure my Vet will be talking with him since she has never used the pens and always shot from a vial. You have to empathize with these professionals. The Pharmacist is trained to follow pharmaceutical companies directions for a med. The Vet has been trained to not use "anecdotal" info and to trust science. AND when the research hasn't been done and there is no scientific evidence they are bound to the science. I thank God for such a group as the FDMB.
My conversation with the Vet will go something like "I'm ok with anecdotal info when there is no science even though cats are not people. I may have to pony up the $$$ for a vial of Lantus just to get past all this. Health care is nuts.
I will be gathering more info to help me apply all the valuable info/assistance available here. Thank you for your care and concern.
Gill & George
Member Since 2015
That's in humans, cat's have a faster metabolism and you don't get the duration, 12 hours gives you better glycaemic control.
You'll be better off using the syringe(with the 1/2unit markings), the pen will only let you dose in 1u steps, with a syringe you can micro dose and change the dose by small steps. take a look at this link for info on how to micro dose 0.25u or smaller , I think vet's sometimees doubt that we are able to accurately draw small doses, they don't believe it's possible.
Both dosing methods we use here see us changing the dose by 0.25u (up or down, depending on numbers), in my experience, usually (ie no underlying conditions), we either see kitties fail to hold a reduction, or see their BG's bottom out if they have been taken up too fast. (at worst this could see your kitty experience a symptomatic hypo and a visit to ER, saddly I have witnessed this remotely and the outcome is not always happy)
The TR protocol we follow is based on a published retrospective veterinary study. http://www.ncbi.nlm.nih.gov/pubmed/19592286
I followed TR with George, I have to say I'm a fan as it saw him go into remission after about 5months, he's still in remission now over a year later (anti jinx), my vet was also a bit circumspect of the board at first, I promised her that I would be careful and keep a close check on George, he's the only diabetic cat she's had go into remission, so she's now a fan of the board, and has referred some other clients to it.
Lantus is a depot insulin, so part of the shot you starts to get to work straight away, (onset typically around +2 for a cat), part of it remains in 'storage' for release later (the depot), the depot usually starts to come into play later in the cycle, and can even last into the next cycle, in some cases you may get depot action well beyond +12, and in situations like this when we are shooting on 12/12 schedule you may get some overlap, so you still have some depot action, as the next shot onsets. This, as your cat becomes regulated is what helps you achieve a flat curve that lantus is so famous for, take a look at the numbers on George's ss, you'll see that as he got regulated, he became super flat, we got good duration and overlap and his BG didn't vary by more than 20pts in a cycle.
Shooting once a day you aren't taking advantage of the depot/duration and overlap, that 47 yesterday at+1 tells me that 1u is too strong of a dose, when a kitty is overdosed on lantus, because the associated depot is also large you can see it hold the numbers down for longer as the depot drains. I suspect that as the depot drains, you may well see the numbers jump right up.
I want to clarify, that I would not recommend shooting 1u twice a day, I think that would be a mistake/risky. 0.5 units may be ok as long as you monitor closely. otherwise 0.25u would be a better option.
bbwyo
Member Since 2017
+++Update: I didn't shot this morning was out the door and couldn't watch. Headed home texted Vet who said go ahead and give regular dose. I tested when I got home and bg# was even lower than this morning. Texted info to Vet who just now got back to me 2:35 pm and said go ahead and give .5 unit now and then start with .5 unit 1x day. I understand we are not taking advantage of depot and will have to sort that out. Vet was on board with using syringe and lower dose. I really like my Vet and am trying to "bring her along". :-{ In my excitement I realize I forgot to test just now before I shot the .5 unit. Will be watching closely and ordering more syringes.
Also, How do I check someone else's spreadsheet? Will be reading links. Have read "shooting low" several times. Still absorbing.
When you say "shooting once a day doesn't let you take advantage of the depot/duration overlap. Does this mean that even though numbers may stay even there just isn't a "reserve"?
Gill & George
Member Since 2015
Click on the link in the signature of the members.
I would recommend you start by getting a +1 tonight, seeing as you don't know what you actually shot, you may well have shot a low number, better safe than sorry.
bbwyo
Member Since 2017
Ill get a +1 (good idea) at 3:30 in a few minutes. I will not dose again until in the morning and then .5 cu. Still on the 1x daily. This will change but for now ....will do as the Vet says until I can prove otherwise. It's all really new right now with the change over. Watching closely. Thanks for the comments.
Tricia Cinco(GA) & Harvey
Member Since 2011
By "watching", I hope you mean you will be testing regularly. Since we don't know for sure when your kitty's onset is and don't know if that 65 is higher or lower than she was preshot, I'd recommend another test at +2, and go from there.
I can't see any reason why you should waste the money to buy a vial when a pen is much more economical, especially with a kitty on such a low dose. Has your vet ever looked at a pen? If you show him/her the cartridge, it looks just like the vial where you put the syringe in. Same thing, smaller package.
Marvin's Mom - Nat
Member Since 2017
You may find that kitty will keep you busy with active and low number the next few days. It's good that you are reducing the dose, as I am sure others mentioned the starting dose would be .25 AM and PM (.5 for the day). See how it goes, .5 all at once may still be too high, separated by 12hrs maybe easier on her system. Just saying 
Looks like she is in good hands
Looks like she is in good hands
Gill & George
Member Since 2015
Glad you tested.
Given what you were dosing on the previous insulin, 0.5u may also be too hefty of a dose to give in one shot, it !ay see her drop significantly, think you need to keep on your toes with this one over the next few hours of it were me I would test hourly, you may find yourself needing to steer this cycle with high carb food to keep her safe. Remember under 50 is the point at which you must take action to avoid a hypo, with that 67 early on you are not far of that. Time to be cautious especially as there's not much data on how she responds to insulin.
Please shout for help if you need it, by editing the title appropriately to catch folks attention, you can use the ?prefix, or the 911 should things get hairy.
I'm calling it a night it's past midnight for me, good luck
bbwyo
Member Since 2017
Thanks to all. We have had a very very normal afternoon, active communicative, bright eyes. I just did another check +6 and still 65. I'm wondering if my monitor is broken. When switched to all wet lc food I started feeding her a small meal of 0 carb around bedtime (I tested before food). She finished that off and is bathing. I really don't know what to think. So glad Vet was so supportive and dropped dose. We will see how it goes. I will check on her through the night. If we had been on this longer and I had a better idea of how all this is working with her I wouldn't be concerned. She's curled up sleeping peacefully...so different than how she was on the Vetsulin. Gill thanks for checking in so often and following along. It's kind of lonely out here with a sugar cat. I'm surprised how many people don't take this on seriously.
bbwyo
Member Since 2017
Yes. I didn't know what to expect from Vet and had a frustrated moment there. I was afraid she might contact the Pharmacist who had to tell me no it wasn't a good idea to use a syringe BUT our Vet came through and was very supportive.By "watching", I hope you mean you will be testing regularly. Since we don't know for sure when your kitty's onset is and don't know if that 65 is higher or lower than she was preshot, I'd recommend another test at +2, and go from there.
I can't see any reason why you should waste the money to buy a vial when a pen is much more economical, especially with a kitty on such a low dose. Has your vet ever looked at a pen? If you show him/her the cartridge, it looks just like the vial where you put the syringe in. Same thing, smaller package.
Marvin's Mom - Nat
Member Since 2017
65 is still a bit low, well for me it would be. You may want to feed him a bit of MC, are you up a bit longer to monitor or heading off to bed?
Red & Rover (GA)
Member Since 2016
You could test your own BG as a control.
Tricia Cinco(GA) & Harvey
Member Since 2011
Testing yourself is a good option. I could be entirely possible that she is surfing, though.
We find it easier to catch up on what has happened if you put it in the comments section, to the right of the BG columns. You can use the wrap text icon to get it to all fit. Look at other people's spreadsheets to see how it looks.
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