01/26 Emmy AMPS 172 3u Lantus - Adjust?

Hi,

Emmy has been on 3u Lantus since being diagnosed a month ago. Yesterday we were recovering from a missed shot, so her numbers are high on SS; this morning she tested 172 and I double-checked and got 150. I am using ALPHA TRAK. Since it's been 12 hours, should I give her normal 3u or adjust down a little?

Thanks
Judy&Emmy

 

Good morning, and welcome to Lantus Land!

Unfortunately, I don't have very much dosing advice to give you, and I'm not familiar with the Alpha Trak monitor. I hope that someone comes by very soon to help you.

 

Judy:

Lantus dosing is based on the nadir (the lowest point in the cycle) not on the pre-shot number. That said, are you going to be around to monitor this morning? Do you have a supply of strips and high carb food if needed? To be perfectly honest, with the amount of BG test data on Emmy's SS, I'm not entirely comfortable telling you to shoot. You want to do your best to get at least one test per cycle (AM and PM cycles) in addition to your pre-shot tests. Does Emmy have a history of ketones?

 

Hi, thanks for responding. No ketones. I think I don't understand how insulin works and I did just go back and read the Insulin link on the website. Will it lower her BG from where it is now? That's what I keep thinking but I think I am wrong. I have strips and high carb food, karo syrup, etc. My concern is we are part of the "historic storm" on the East Coast and it might not be easy to get her out to a vet later today. So I think I will not shoot until I talk to my vet.

Thanks again.

 

It may/probably will lower her BG from where it is now. This is where those mid-cycle tests come in...it gives you an idea of how Emmy responds to insulin. EVery cycle is different, but the more you test, the more information you have that will give you a good idea of how Emmy responds. One very important thing to keep in mind is that every cat is different in how they respond. We have seen some cats go from 400 to 40 and back to 400 in one twelve hour cycle; we've seen other cats barely move during a 12 hours cycle; we've seen the same cat do completely different things from cycle to cycle. So getting those mid-cycle tests will really help show you how Emmy works the insulin.

I think you are wise to hold off on shooting for now. Eventually you will feel comfortable shooting lower numbers, and you will learn how to steer the numbers with food...and we are more than happy to help you with that! But it is a good idea to gather a little more data first. Please keep asking questions!!

I'm in Central NJ and also about to get hit with the "historic" storm...not very happy about that at all. Stay safe!!

 

I do think you have a couple options. One is, if you haven't fed her, stall and see if she comes up. How long you stall depends on how flexible your schedule is. We usually grt back on schedule by shooting early 15 mins each cycle or 30 mins once a day until back on our normal time. If you stall, again, don't feed, check her every 20-30 mins and shoot when she starts to rise.

You could also shoot half a dose so she gets some insulin. Depending on full her depot is, she might still come down and so the effect of shooting w reduced dosr might be seen later in the cycle.

Either of those options work for you?

Edited to add: choosing either option above requires you test. If you shoot, you would need to get a +1 and +2 to start.

 

Judy --

Did your vet give you any instructions on how often or when to test? Most vets don't. They tend to be surprised when we home test. In many cases, when they discover we're home testing, it seems like the party line that many of them get in vet school is that if your test too often, your cat will hate you. That's really not what the vast majority of us have found. As long as you provide a reward (i.e., treats, food) when you test, you may find that Emma is sitting and waiting for you or comes when you call her to her test spot.

That said, it's very, very important to get some spot checks and/or an occasional curve. You need to know when onset and nadir occur for your cat. Most of our kitties refuse to read the "rule" book when it comes to how insulin should work -- in other words, nadir isn't always at the midpoint of the cycle. The more data you get, the more confident you will be with respect to how Emma responds. I'd encourage you to take a look at other members' spreadsheets. You'll see some wide variations in how people test and it will give you an idea of what others do.

 

I'll be honest, I don't have the stomach for all this testing. Her poor ears have little poke scabs all over them although she is relatively tolerant. And I just lanced my finger and I'm here to say it does indeed hurt ;-)

She just tested at 337 after I fed her and gave her 2u. I wish now I had given her the three. I asked the question this morning because when I joined everyone seemed so upset about her "high" dose of 3u as if she was going to be thrown into hypoglycemia at any moment. I sincerely appreciate all the advice and moral support but honestly, this Board just scares the hell out of me most of the time. I don't want to be adjusting her dose all the time and I don't want to be walking around afraid she's going to keel over any minute from hypoglycemia. I am not denying the probability of it happening but perhaps because I'm new I'm more freaked out now than I was before I joined.

Please -- I do really appreciate all of your advice and time on our behalf. I'm going to work on not panicking every time something unexpected happens.

Thank you all very much!
Judy & Emmy

 

Judy

Lantus doesn't work by adjusting the dose all the time. It needs time to settle and the depot to establish. If you look at other SSs, you'll see members holding doses. Yes, sometimes they need to be changed but changing very often doesn't help the depot.

I don't think anyone was trying to scare you about the 3u dose. We have a lot of experience with starting doses and with vets starting cats too high and increasing too fast without letting the dose settle. The average 10 lb cat would have a starting dosr of 1u and many of the csts fall into that range but the larger the ideal weight, the larger the starting dose.

This morning, I offered two options. One was to stall, test, and as soon as she started to rise, shoot. The other option was to shoot a reduced dose and I told you the downside of that. I was watching your thread and would have been happy to discuss with you and asked for your thoughts.

Are you testing more than your SS shows because with just two tests a day, her ears should not be full of scabs. Are you poking just along the edge of the ear? If you warm her ear, rub it a little, do a gentle poke in the edge to just get a tiny drop, and then compress the poke spot, she shouldn't get scabs. Gracie has never had scabs or bruises and we test a lot. I think one thing that helps is I bought a pack of baby washcloths and when I go to test, I take a cold, damp on. I then immediately compress the poke spot when done testing and the cold cloth stops the bleeding and helps prevent bruising.

What size lancet are you using? Usually new members start larger, like 28g, and then as the ear learns to bleed, go to a smaller, e.g. 30g, lancet. Perhaps you might find help in this post on Testing and Shooting Tips.

We test to keep them safe. when the depot gets full and they are ready for a reduction, they can go lower and testing let's you know when it's time to reduce the dose. I'm not trying to scare you of a hypo but just trying to reinforce the need to test. You don't have to test as often as some of us do; we are just suggesting a mid cycle test during the day and before bed at night unless you shoot a number lower than you have before.

If you are testing and feeding, then you are in control.

 

Hi - thanks Marje - I have no idea what size lancet - they came with the AlphaTrak. I know you aren't trying to scare anyone about hypo. I think the stress I have is that I don't know yet what to do with the data I'm collecting. And I come from a background (astronomical research) where there's never enough data - MORE DATA PLEASE! That's a joke.

Emmy runs as soon as I get a drop so I haven't been able to do any "after" ear care. She also appears to be a good little bleeder - so she takes off across the room with some blood coagulating and ends up with a yucky (that's a technical term). Maybe a scab isn't the right word.
++
Okay, I will try the mid-cycle test when I am home (I work from home a few times a week, but not every day) and one before bed. I'm assuming that what is useful is a pattern that would be built up over a week or two? If I don't try to react to each shot, it would help. So half-way through on days I'm home (+6) and before bed (maybe +3)?

Thanks
Judy&Emmy

 

I'm not sure what size lancet comes with the AT; my guess would be a larger one but you can also buy them at Walmart pretty cheap just so you know what you are using or read the info that came with the meter; it should hopefully state what the gauge is.

It takes a long time to learn what to do with the data you collect. That's why we are here; we've looked at hundreds of SSs and we have some members that are excellent at interpreting the patterns and the data. Our goal is to teach you what the data means but first you have to have data.

Emmy needs to learn that she doesn't leave until you allow her to leave. That will allow you to compress the ear and put some Neosporin ointment with pain relief on them. That will also help with the scabs and keeping the ears soft. Many members put a nice coat of the Neosporin with PR on the ears at night after the last test.

On days you work in the office, perhaps you could grab an out the door test before you leave and in the door test when you get home. When you are home, rotate it....some days get a +5, others a +6, etc. And a +2 or before bed test at night. Sounds great and that gives us some idea of what she's doing. Sometimes the patterns come out fairly quickly, sometimes not as quickly. It depends on whether she's bouncing or not bouncing. What we look for, and what we try to teach new members to look for is her (1)onset....when does she onset from the current shot; many cats onset around +2 on lantus; (2) nadir.....when is the peak action of the insulin (i.e. the lowest number in the cycle); this is variable according to the cat and can change; some cats nadir early, some late, some around mid-cycle; and (3) duration.....how long does one shot last her. 10 hours? 12 hours? 14 hours? Does she get any carryover which means one shot lasts longer than 12 hours and carries over into the next cycle or overlap....is one shot just waning as the next one onsets.

 

Now that explanation I understand! Thank you - I will print it out and keep it as a timetable.

 

Hi Judy,

I just want to offer a little encouragement. Being hit with the diagnosis of a diabetic cat can be pretty intimidating. Most people start out without testing, then become aware that there's the potential for problems if they don't test.

We'll help you learn what you need to know. Just keep asking questions - there's a lot to learn but once you've got the hang of things it becomes very routine and easy. After a couple of weeks of testing, i was testing punkin while talking on the phone and realized that I had Made It. You'll get there too. I think being nervous and worried comes partially from not knowing or understanding what is likely to happen next. The more you know, the less nerve-wracking it all becomes.

Hang in there - you've found people who can teach you. You'll feel more comfortable before you know it.

 

Judy, Check the gauge of the lancet you are using and make sure it s on the highest settings so that it doesn't go through her ear. When I first started testing Sami I thought the same thing, but now I use 33 gauge lancets and I always make sure that it is the highest setting, plus I use Relion Micro BG Meter so I only need the smallest amount of blood. Hope that helps.

 

Thanks Julie.

 

Thanks, I think I just don't have the hang of it yet. I am free-handing the lancet and I'm just getting 45 degree angle under control. I am going to need more by Wednesday!

Thank you

 

Wow, I don't think I could free hand. Have you tried the lancet device? I like using it because it is quick and I can sort of place it on the ear by looking at the hole where the lancet pokes out. Sometimes I do miss entirely, but most of the time I am spot on. It is so much harder in the winter because Sami's ears are cold and the blood isn't flowing as well through them. I try to warm them up a bit with my hands, breath, or a warm paper towel before I poke her.

 

I have a lancet device but I have read here that the noise scares the cats? How was yours with it? We are doing better - I am learning to be less assertive and milking more. Thanks!

 

Sami seems to be fine with the device. It works much better for us than trying to prick by hand.

 

Thanks - I'll try it tonight

 

I only used a lancet device. someone told me to click it around punkin's ears to help him get desensitized to the noise, but it never bothered him. honestly, i think the freehanding sounds a little intimidating to me!

One little trick for helping get the blood to well up when you use a lancet device: it said with my directions to press the clear cap firmly against the ear for 5-10 seconds, then click the release thing that pokes, and continue to have it pressed against the ear. The blood will come right up and you'll have plenty to test with.

 

Thanks for the tip - I have the bits ready to practice but I need to go get an orange ;-). The vet showed me how to do it just using a syringe so I guess I didn't know enough to be intimidated freehanding it. I promised her I would do a curve this weekend so I will really get a chance to come up to speed with the lancet device. I don't see any new scabs on her ears so I must be getting a little better at it (I'm not sure she shares that opinion.)

Thanks,
Judy&Emmy

 

i'm sure you're getting better at all of it! the whole thing is a bit intimidating at first but it gets infinitely easier with practice. Poor punkin, i learned doing it on him - we kinda scarred his left ear learning, then switched to his right ear and used it for the rest of his life. I'm not sure if anyone suggested using Neosporin with Pain Relief ointment on miss Emmy's ears. If not, that stuff is awesome for taking out the owie. I tried it on my foot where the cats ran across me and scratched it - it's amazing! I put it on punkin's ear every night and by morning they looked perfect. No one would ever know that his ear got tested.

If you could get a test this evening around +4, maybe, that might be very revealing. Cats often have their lowest numbers at night and tonight was the lowest pm preshot that you've had. Since Lantus dosing is based upon how LOW a kitty gets on a dose, those pm cycle tests can be really important.