? Stalling - Should I shoot at 180 AMPS?

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TurkeyCat

TurkeyCat

Member Since 2016
Hi everyone, I am questioning whether I should shoot at a 180 AMPS about 2 hours after eating. He is currently on 3 U of Lantus BiD.

I know my spreadsheet has many holes - my vet explicitly requested that I stop testing as frequently but I've been doing AM/PM pre-shot tests given how dramatically Turkey's numbers have decreased since getting him off of the very high carb dry K/D.

If I do shoot, what might a good reduced dose be? Should I stall an hour? I just don't want to get him on a 12 hour cycle where I'm now doing his PM shot at 11:00 at night every night. Thanks in advance for any advice.
 
Lantus is dosed based up. The nadir, lowest point in the cycle. Not testing when nadir typically occurs at +4-7 usually can lead to missing a good dose or dropping too low the next cycle. So I disagree with your vet. What problems can be created from testing? I know a hypo can occur from not testing! Dropping from the food change has sent many cats OTJ quickly. Also, we don't feed for two hours before testing as food can influence the number. Since its been two hours it won't matter. Shooting a reduced dose won't guarantee you won't have an active cycle because lantus is a depot drug and the depot has already been built.

For those reasons I'm not going to give dosing advice. Even a reduced dose might lead to an active cycle. I will say if the shooting times aren't working for you then you could skip and shoot at whatever time you want to be your new time tonight. Just don't feed two hours before.
 
Thanks, @tiffmaxee - I think the vet's concern was that testing too frequently could cause stress which could artificially inflate glucose levels and bias readings upwards (she didn't say this explicitly but it's the only reason I could come up with). She supports home testing but not "daily curves" - she did ask that I run a curve 1 week after upping his dose to 3U BiD which is on the SS. He hit a green and then bounced a bit the next day but recovered quickly. She also asked that I spot check at +4 the first few days after increasing to 3U BiD and he was usually in the 200s.
 
Max gets stressed easily but not from my testing. I was so worried about that it took a long time to start. Sure glad I did because he often drops low at night. I get a surprise every now and then at amps. I'm glad your vet supports home testing. Mine does too. At the beginning I was seeing him twice a week at nadir. Then one day he handed me the needle. Giving a treat after each test made Max like tests, well almost. I used the same philosophy to get him to accept fluids. Tge first time he ran under tge bed. Now ge waits for his treat but he still doesn't like them. Trust me it won't inflate the numbers. Daily curves aren't necessary. I bad how many tests on the numbers I get each cycle.

So in an ideal world what timevdo you want to shoot?
 
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TBH, I don't think Turkey gets stressed from my testing either. He pretty much doesn't even react to it and gets way more freaked out when I have to pill him!

I'm OK with shooting 2x per day anywhere between 8 am/pm to 10:30 am/pm but I only got to the point of shooting at 10am because I've stalled a few times this past week - once from 8am to 9am then from 9am to 10am because his AMPS numbers have been lower than I've ever seen them. It's a good thing that his numbers have improved but it's been tough for me to make calls on how much to shoot and when.

I sent my vet the post-curve SS on Monday but haven't heard back from her yet. She is a really good vet otherwise and seems to know a lot about how to treat cats but communication isn't great.
 
You are going to have to get used to shooting lower numbers very soon due to the change in food you are feeding and giving insulin because normal is 50-120. The way to do that safely is to test so you can feed the curve if necessary.

I was appalled at the idea of following the advice of strangers instead of my vet when I first joined but eventually realized it was the right thing. I love my vet and he advises me in all other matters of which there are way too many. He never even discusses BG with me and has told me I manage diabetes as well as anyone he knows.
 
Home testing is less stressful than testing at the vet. My first vet (didn't last long though), when I first started said not to home test since it would stress my kitty. The first (and only) vet curve that was done my kitty was so stressed, he wouldn't eat, drink or anything. He lay in the litter box the whole time curled into a tight ball and ended up having a stress induce pancreatic attack from the vet stay. The curve did not work because of the stress. I started home testing right after that...AND changed vets.

Looking at your spreadsheet I am wondering about a few things. Why are you changing the doses so often? Lantus works best by having a consistent dose, unless the numbers drop too low then a reduction would be taken. Also on Sept 4 Turkey hit a 98 at AM +6 and yet the dose was increased that night. That makes no sense at all. Lantus is based on how low it gets the numbers not what the preshot is.
 
@Tuxedo Mom I've been changing the doses because the lower pre shot numbers have been making me nervous and I was afraid that at a lower starting point the Lantus would bring his nadir lower as well. I actually reduced his dose the morning he hit the 98 so the 3 units he got later that night was what he had been getting 2x daily for the past week. That is to say, the PM dose wasn't increased beyond anything he'd been getting for a week already - rather, the AM dose was reduced. I know that you're supposed to try and hold them at a constant dose with Lantus which is why I returned him back to his "regular" 3U that evening when I saw how high he was (probably bounce). I feel like I've been getting conflicting information, some saying that if their numbers seem lower they "earn a dose reduction" and others saying to hold doses steady.

Also ETA: @Tuxedo Mom your poor kitty's vet curve sounds awful :( I'm so glad mine knows that's not the best approach for the reasons you say!
 
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Are you following either protocol? I don't think so. Please read the stickies on SLGS and TR. Both require you to shoot the same dose every 12 hours. They differ as to how often to increase and when to reduce. You need to stick with a dose you can shoot every 12 hours long enough to see where it takes you. Take a look at some spreadsheets. Often when we shoot lower preshots they remain flat. To be able to do that you need enough data.
 
TurkeyCat said:
@Tuxedo Mom I've been changing the doses because the lower pre shot numbers have been making me nervous and I was afraid that at a lower starting point the Lantus would bring his nadir lower as well. I actually reduced his dose the morning he hit the 98 so the 3 units he got later that night was what he had been getting 2x daily for the past week. That is to say, the PM dose wasn't increased beyond anything he'd been getting for a week already - rather, the AM dose was reduced. I know that you're supposed to try and hold them at a constant dose with Lantus which is why I returned him back to his "regular" 3U that evening when I saw how high he was (probably bounce). I feel like I've been getting conflicting information, some saying that if their numbers seem lower they "earn a dose reduction" and others saying to hold doses steady.

Also ETA: @Tuxedo Mom your poor kitty's vet curve sounds awful :( I'm so glad mine knows that's not the best approach for the reasons you say!
Click to expand...

Dose changes are based on what type of protocol you are following. The SLGS (start low go slow) approach uses 90 on a human meter as a dose reduction level, Dose reductions would be done in increments of 1/4 unit. You would hold this does for a week ..unless the numbers drop below 90 and then do a curve to see what sort of dose adjustments would be needed:

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

The TR (tight regulation) uses 50 on a human meter as the point where a dose reduction would be done. Dose reductions would be done in increments of 1/4 unit. With TR you hold the dose for 3 days before making any dose adjustments...unless the numbers drop to 50 or below.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/


In either case you need to look at how low a dose brings your kitty, not at what the preshot levels are.



ETA The more data you have the clearer the "picture" becomes
 
@tiffmaxee I'd read through the SLGS protocol and was (trying) to follow that - I also was going off of this advice, specifically the 2nd and 3rd points

How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
 
Ok. Please add SLGS in your signature and then we won't keep asking you. The stall/no shot numbers go down when you have enough data. With SLGS you need to do a curve every 7 days. Since you do have data for three months you will need to get used to shooting lower numbers if you want to get Turkey regulated I think. At least that is what I would do because lantus doesn't work well when dosing is changed so often.
 
Thanks, everyone - I know it must be annoying to coach inexperienced/confused people through all of this! I agree, @tiffmaxee that I'll have to get used to shooting at lower numbers to keep him regulated - he was very high this morning so the halved dose yesterday morning definitely is affecting him today. I guess 3U is his dose for now and I'll keep it constant regardless of the pre-shot numbers for a while?
 
TurkeyCat said:
Thanks, everyone - I know it must be annoying to coach inexperienced/confused people through all of this! I agree, @tiffmaxee that I'll have to get used to shooting at lower numbers to keep him regulated - he was very high this morning so the halved dose yesterday morning definitely is affecting him today. I guess 3U is his dose for now and I'll keep it constant regardless of the pre-shot numbers for a while?
Click to expand...

Well, that depends. You need to base your dose on the nadir, the lowest point in the cycle. We have all been newbies and don't mind coaching at all. That's why we all are here. Test when you can and put your results in the subject box. Ask for dosing advice if you are unsure. Since lantus is a depot drug it needs changing consistency. I suspect we may find that 3 units is too much but the only way to find out is to shoot it, test, and see if Turkey drops under 50. If that happens you reduce by .25 the next dose. You will keep him safe by feeding and testing. I know it's scary. I just had a scare this morning's BG with preshot test in the 40's. Hang in there. It will get easier I promise.
 
Welcome to the group!

Just a quick question - is Turkey still eating DM dry? If so, the dry food is approximately 18% carb. In other words, this is high carb food. Low carb would be below 10% and most of us give our cats food that is considerably less with regard to the carb content. Will Turkey eat canned food? As Elise (Tiffmaxie) noted, there are some cats that go into remission with a change to low carb, canned food.

If you're following SLGS (which is the protocol you have to follow if your kitty is eating dry food), dose changes are made in 0.25u increments. Increases of more than 0.5u, even with the Tight Regulation Protocol, do not give you the opportunity to evaluate the effectiveness of the dose and it's very easy to bypass what could be a good dose if the increases are too large.

Please let us know if you have questions. We're here to help.
 
No advice, I'm one of the new folks who is regularly helped by the folks here. Oh yeah, I do have one little piece of advice, the folks here have a world of experience that they freely share, and are amazing coaches! Take them up on the help whenever you can!
Just wanted to say Welcome!:bighug:
 
@Sienne and Gabby (GA) yes, he's still on the DM dry which is about half of the carbs of the KD dry he'd been on! His numbers were completely out of control with the KD! I have tried getting him on wet and he just won't have it. I have samples of the Young Again Mature Health coming to me so hopefully he'll like that and we'll reduce the carb intake even further. Thanks for all of the advice thus far, everyone :)
 
It you've not already seen it, Dr. Lisa's site on feline nutrition has information on transitioning a stubborn kitty from dry to canned food. I know this is difficult for some cats -- they're dry food addicts! Keep in mind, if he likes the Young Again, you'll need to monitor carefully. The carbs in the DM are propping up Turkey's numbers and even with a HC food, he's still seeing some blue nadirs. His numbers could drop considerably with a lower carb food.
 
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