Leah & Baby
Member Since 2015
Baby's AMPS dropped to 117 (has been steadily lowering over the course of the last week). Should I give him a micro dose or skip and see what happens?
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To shoot or not to shoot...
- Thread starter Leah & Baby
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What meter are you using? I'm going to assume it's a human meter vs an AlphaTrack unless you say otherwise. Also, are you following the Tight Regulation Protocol or Start Low Go Slow? This makes a difference with regard to when to shoot (or not) and when to reduce the dose.
I'm not sure why you're skipping doses at night. Lantus should be dosed every 12 hours. If you're nervous about Baby dropping low at night, one consideration is to reduce the dose so you're more comfortable shooting twice a day.
I'm not sure why you're skipping doses at night. Lantus should be dosed every 12 hours. If you're nervous about Baby dropping low at night, one consideration is to reduce the dose so you're more comfortable shooting twice a day.
Leah & Baby
Member Since 2015
Yes, it's a human meter, an Accu-chek Aviva. I don't know if I am following a particular protocol, but I have been checking him regularly, as you can see. I pay closest attention to what happens in the first few hours after food and injection to gauge how low he may go at nadir. At first, I was testing him at 12 hours, but when the AM numbers continued to drop, I figured that wasn't necessary.
His pre-treatment numbers were in the borderline range (200-250) and my vet didn't want to give insulin at that level, but his health was obviously suffering. We couldn't find any other underlying cause for the break from remission, so she prescribed 1x day .5u. The way he has responded in the 2 weeks he's been on insulin tells me that he doesn't need 2 shots. If I give him 2 shots a day at .5, I am fairly sure he would drop too low. I have tried to give .25, but find it nearly impossible to know if I am getting anything in him.
I am not a medical expert, but it appears to me that his body is healing and starting to work on it's own again.
His pre-treatment numbers were in the borderline range (200-250) and my vet didn't want to give insulin at that level, but his health was obviously suffering. We couldn't find any other underlying cause for the break from remission, so she prescribed 1x day .5u. The way he has responded in the 2 weeks he's been on insulin tells me that he doesn't need 2 shots. If I give him 2 shots a day at .5, I am fairly sure he would drop too low. I have tried to give .25, but find it nearly impossible to know if I am getting anything in him.
I am not a medical expert, but it appears to me that his body is healing and starting to work on it's own again.
BJM
Member Since 2010
We have 2 protocols for using Lantus which seem to work well in getting cats stable, regulated, and in some cases, off the insulin.
Tight Regulation is a research based protocol which has been successful in achieving diet-controlled status.
Start Low, Go Slow is a protocol for those who cannot do intensive testing, yet want to achieve optimal control safely. Some of these cats have gone into remission, too.
Tight Regulation is a research based protocol which has been successful in achieving diet-controlled status.
Start Low, Go Slow is a protocol for those who cannot do intensive testing, yet want to achieve optimal control safely. Some of these cats have gone into remission, too.
tiffmaxee
Member Since 2013
Measuring .25 is easier but not easy with syringes with .5 unit markings. I use the terumo and buy them from ADW. You cam make paper calipers to use as a guide, buy inexpensive ones for about $15 or count the drops in .5 and then divide in half. If you do the last suggestion, keep a syring filled with colored water as a guide to measure future doses.
I suspect you're right with respect to his pancreas waking up again. However, you need to give his pancreas as much support as possible while Baby gets back with the program.
We do encourage you to look at the two protocols and decide which best fits your cat and your lifestyle. With TR, which is the best researched of the two, you shoot lower numbers and use a drop below 50 -- although if Baby is out of remission or has been diagnosed for more than a year, numbers have to drop below 40 -- to signal a dose reduction (or your kitty has to be in normal numbers for a week to reduce the dose). You hold a given dose for 3 days if numbers are above 200 and for 5 days if below 200 before increasing the dose. SLGS uses 90 ad the dose reduction cut-off and you hold the dose for a week. There are longer explanations in the sticky notes. If you are feeding an entirely low carb canned food diet, you can use either TR or SLGS. If dry food is in the picture, you're limited to SLGS.
I'd encourage you to think about reducing Baby's dose and shooting twice a day. What Baby's spreadsheet (SS) tells me is that your AMPS numbers are higher because you're not shooting at night. If you were to shoot, I suspect you'd see a flatter cycle in both the AM and PM vs. numbers that are outside of the normal range during overnight and into the AM cycle. For those of us who are following TR, you'll see we shoot pretty much anything above 50. I suspect that sounds more than a bit anxiety provoking but numbers do not tank. Those of us who do shoot low have worked our way down to shooting low numbers. We have plenty of data that informs us how our cat responds.
We do encourage you to look at the two protocols and decide which best fits your cat and your lifestyle. With TR, which is the best researched of the two, you shoot lower numbers and use a drop below 50 -- although if Baby is out of remission or has been diagnosed for more than a year, numbers have to drop below 40 -- to signal a dose reduction (or your kitty has to be in normal numbers for a week to reduce the dose). You hold a given dose for 3 days if numbers are above 200 and for 5 days if below 200 before increasing the dose. SLGS uses 90 ad the dose reduction cut-off and you hold the dose for a week. There are longer explanations in the sticky notes. If you are feeding an entirely low carb canned food diet, you can use either TR or SLGS. If dry food is in the picture, you're limited to SLGS.
I'd encourage you to think about reducing Baby's dose and shooting twice a day. What Baby's spreadsheet (SS) tells me is that your AMPS numbers are higher because you're not shooting at night. If you were to shoot, I suspect you'd see a flatter cycle in both the AM and PM vs. numbers that are outside of the normal range during overnight and into the AM cycle. For those of us who are following TR, you'll see we shoot pretty much anything above 50. I suspect that sounds more than a bit anxiety provoking but numbers do not tank. Those of us who do shoot low have worked our way down to shooting low numbers. We have plenty of data that informs us how our cat responds.
Leah & Baby
Member Since 2015
The vet steered me away from anything lower than .5, citing the difficulty in measuring. Lowering the dose means going to .25u, which as I said, I have found difficult to do. I have read about how to do it, but putting it into action is a different story.
And how do I deal with the consistent drop in AMPS numbers? Today was the second day he started at a low number, one at which I am not comfortable shooting. You say with the TR, you shoot anything above 50. That would make me extremely nervous and I'm not sure I want to go out on that ledge. Judging by Baby's drops at +3-+6' I would not want to shoot at any lower than probably 130. Yesterday, with no shot, he even dropped slighty at +2.
I think this is an oddball case. He had been out of remission for 18 months. For two months while we looked for a cause, his pre-treatment numbers never went above 270, and were mostly in the 230 range. My gut was telling me there was something setting this off, but blood panel and urine didn't show anything.
Then, in the short term of two weeks of the smallest doses of insulin, his BG is back in the normal range and holding for the second day with no shot.
FYI- Changing his diet to all-wet high protein/low carb during his initial bout was highly instrumental in getting him into remission. His diet is not an issue, for certain.
I have to admit I have a slippery memory sometimes, but I am recalling that he went through a similar brief relapse between initial diagnoses and remission. He slipped into needing insulin again for a very brief period, then stabilized. Perhaps something sets him off, like an infection, and he needs relief to heal.
And how do I deal with the consistent drop in AMPS numbers? Today was the second day he started at a low number, one at which I am not comfortable shooting. You say with the TR, you shoot anything above 50. That would make me extremely nervous and I'm not sure I want to go out on that ledge. Judging by Baby's drops at +3-+6' I would not want to shoot at any lower than probably 130. Yesterday, with no shot, he even dropped slighty at +2.
I think this is an oddball case. He had been out of remission for 18 months. For two months while we looked for a cause, his pre-treatment numbers never went above 270, and were mostly in the 230 range. My gut was telling me there was something setting this off, but blood panel and urine didn't show anything.
Then, in the short term of two weeks of the smallest doses of insulin, his BG is back in the normal range and holding for the second day with no shot.
FYI- Changing his diet to all-wet high protein/low carb during his initial bout was highly instrumental in getting him into remission. His diet is not an issue, for certain.
I have to admit I have a slippery memory sometimes, but I am recalling that he went through a similar brief relapse between initial diagnoses and remission. He slipped into needing insulin again for a very brief period, then stabilized. Perhaps something sets him off, like an infection, and he needs relief to heal.
julie & punkin (ga)
Member Since 2011
We encourage people to practice, maybe with a used syringe, on drawing up those tiny doses until you can do it fairly consistently. It doesn't matter if your 0.25u is the same as someone else's 0.25u. What matters is that you can reduce from the 0.5u you've been shooting and that you can replicate the dose again.
The reason that people are encouraging you to try a smaller dose that you can give twice a day is that Lantus only lasts about 12 hours in a cat's body. For some cats it's as little as 8 hrs. If you're only shooting once a day that leave a lot of hours without any insulin helping keep his blood sugar controlled.
That said, he does look pretty good and even his morning numbers aren't bad. They still are hovering on the border of normal/diabetic though. Everything under 120 is considered normal, although for remission to stick most of the time the cat needs to be under 100 for most all of their tests.
It doesn't look like he'll need insulin very long but I'd encourage you to give him some for as long as he needs it, until his blood sugar is under 100 and staying there.
The way Lantus works is that when a person shoots a lower number, the blood sugar doesn't necessarily drop. Shooting a 60 might mean that for the next 12 hours the cat stays around 60. When you shoot a higher number, even 150, there will likely be a drop in the middle of the cycle. That's simply not true in a cat that's nearing OTJ. It's logical to apply what you have experienced at a higher number to a lower number, but that's not how Lantus works. Take a look at this thread, where it's discussed a little more thoroughly, and especially look at the spreadsheets that are linked for you to see how it does work.
With a kitty out of remission, typically you have to be more aggressive with dosing to get them back in remission and especially, to have it "stick" this time. I'd try to give 0.25u twice a day without skipping any shots if I were you. Of course that means you have to check him in the pm cycle, but if your goal is to get him back in remission and have him stay there, that's probably your best chance. He may be able to hold these 115ish number for a while without insulin, but that's not the same as giving his pancrease enough support to let it heal, go into remission again, and then for him to stay diet-controlled.
The reason that people are encouraging you to try a smaller dose that you can give twice a day is that Lantus only lasts about 12 hours in a cat's body. For some cats it's as little as 8 hrs. If you're only shooting once a day that leave a lot of hours without any insulin helping keep his blood sugar controlled.
That said, he does look pretty good and even his morning numbers aren't bad. They still are hovering on the border of normal/diabetic though. Everything under 120 is considered normal, although for remission to stick most of the time the cat needs to be under 100 for most all of their tests.
It doesn't look like he'll need insulin very long but I'd encourage you to give him some for as long as he needs it, until his blood sugar is under 100 and staying there.
The way Lantus works is that when a person shoots a lower number, the blood sugar doesn't necessarily drop. Shooting a 60 might mean that for the next 12 hours the cat stays around 60. When you shoot a higher number, even 150, there will likely be a drop in the middle of the cycle. That's simply not true in a cat that's nearing OTJ. It's logical to apply what you have experienced at a higher number to a lower number, but that's not how Lantus works. Take a look at this thread, where it's discussed a little more thoroughly, and especially look at the spreadsheets that are linked for you to see how it does work.
With a kitty out of remission, typically you have to be more aggressive with dosing to get them back in remission and especially, to have it "stick" this time. I'd try to give 0.25u twice a day without skipping any shots if I were you. Of course that means you have to check him in the pm cycle, but if your goal is to get him back in remission and have him stay there, that's probably your best chance. He may be able to hold these 115ish number for a while without insulin, but that's not the same as giving his pancrease enough support to let it heal, go into remission again, and then for him to stay diet-controlled.
julie & punkin (ga)
Member Since 2011
There are photos of small doses here: http://www.felinediabetes.com/FDMB/threads/lantus-levemir-new-to-the-group-please-read.18139/
Leah & Baby
Member Since 2015
From what I observe on the SS examples, I can see that the drop is not as dramatic when you shoot at a lower number. Not logical, but I am willing to give it a try. And looking at the photos of the small doses, I think my "skinny .5" is close to a .25. I think I will wait until tomorrow morning to try the 2 x .5 so that I can monitor better in the post- shot period.
Thank you for all of the support and benefit of your experience.
Thank you for all of the support and benefit of your experience.
Leah & Baby
Member Since 2015
Hmmm, just did a + 2 reading and he's at 102. Aren't they supposed to go up after they eat if there's no shot? Mystery cat.
Leah & Baby
Member Since 2015
Meant to type 2 x .25, not .5.
BJM
Member Since 2010
And if he's ready to go off the juice, you may find that firmly pushing in the plunger, inserting it into the Lantus, and relaxing the pressure draws up just a tiny drop that could work.
Some folks also use calipers to measure the dose, particularly since syringes aren't always marked consistently. It can help to use a free-standing magnifier or if you wear glasses, clip on magnifiers, to see better.
Some folks also use calipers to measure the dose, particularly since syringes aren't always marked consistently. It can help to use a free-standing magnifier or if you wear glasses, clip on magnifiers, to see better.
julie & punkin (ga)
Member Since 2011
That "vacuum" method that BJM is describing will draw up less than a 0.1u dose, so I'd save that one for later and try the 0.25u twice a day first.
Good ideas about the magnifier - you can also stack 2 pair of reading glasses on your nose to see better if you need help.
You're welcome - it really helps to have people with experience explain it all because there is lots here that is counter-intuitive: New Dose Wonkiness and Bouncing are 2 other things that don't make sense until someone explains it.
Good ideas about the magnifier - you can also stack 2 pair of reading glasses on your nose to see better if you need help.
You're welcome - it really helps to have people with experience explain it all because there is lots here that is counter-intuitive: New Dose Wonkiness and Bouncing are 2 other things that don't make sense until someone explains it.
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