03/08 Shay AMPS 375 DOSING QUESTION

Hello! Shay's on his third day on Lantus having switched from PZI which he was on for 4-1/2 years. His amps was 375, so I gave him a fat 1 unit. I tested him at +4.5 and he was down to 277. I'm wondering how long it takes to build the shed and if I should up his dose to 1.5 or 2 starting tonight? He seems to be doing OK, but I know he's bummed about being high for days in a row. The PZI wasn't consistent, but atleast he spent the majority of his days in the 100-225 range. Thanks in advance for advice ....

 

Re: 03/08 Shay AMPS 375

Hi again! Glad to see you here in LL.

I can't give dosing advice, but you might want to edit your first post to say "dosing question" after the AMPS #. This way you should get more eyes on it. Also update your #s as the day goes on. You can either edit the subject line to add them, or you can do a reply to your initial post and just say "+4.5: 277" etc.

It took Buzz quite awhile to adjust to Lantus. If you look at my SS starting January 9 of this year (which is when we switched to Lantus) you will see that it was a good 3 weeks before we saw our first glimmer of hope, and then another week or so before we started to get consistent decent #s. I don't know how common this is but everyone here told me it might take some time and I should hang in there.

Have you read the protocol at all? It's usually best, especially at first, to consult with people here on your dosing questions, but I also recommend reading Tilly so you get an idea of where this information comes from. It can be found here: http://www.felinediabetes.com/FDMB/view ... f=9&t=1581 (apologies if you have already found and read it)

 

Re: 03/08 Shay AMPS 375

Hi Kate, I was looking at your profile and see that you feed Shay 1-1/2 hours before giving the insulin shot. I seem to remember from one of the instructionals (stickies) that feeding less than 2 hours before a shot will result in a "food spike": a high bg number. Maybe that's what's happening with Shay. See if any of the experts here will pick up on this (I am a relative newbie). I did everything wrong when I was first switched from PZI Vet to Lantus after almost 4 years on PZI Vet. Stu was prescribed too high a dose and I never questioned it because I didn't home test and had no idea what his numbers were. I took him down from 7 units bid to 5, then 4, and finally started over beginning with 1.5 units. It has taken a while, but Stu is having really good numbers lately. It will take a while for Shay's body to adjust to his dose and you may have to raise his dose very gradually and by very small amounts (.25 to .5 of a dose and then hold the new dose for 6 to 12 cycles (3 to six days). As Sarah suggests, put "dosing question" in your subject line. Then the experienced people will be along to help. Don't worry about your cat. Shay will be fine. You are way ahead of the game!
Ella

 

Hi there

please have a look at the stickie up above Insulin Depot AKA Storage Shed:
viewtopic.php?f=9&t=150

and yes the Tilly Protocol, the link Sarah mentioned, has been recently updated, please read thru it.

For tonight, it would help if you could do a +11 test, post your number, that gives an hour til PMPS time and hopefully you will have a bit more info by then.
Are you around this evening to gather a couple of spotchecks for the evening?
One thing with Lantus, you dont want to be dose hoping, you'll need to be patient and give each dose to settle in.

EDIT to ADD: yes what Ella is saying is true, with Lantus, you dont want to feed in the 2 hours before a preshot, you will see a food induced preshot number if food is given between +10 and +12 (preshot hour)

A good time to offer food is anywhere from +8 to +9 in both cycles, for the early mornings, many here use timed feeders set to dispense food at +9...if you work during the day, again, setting a timed feeder to +9, for example, will help..sometimes it helps with a hungry kitty by shot time, sometimes you can get away with a little bit of a treat. You'll learn this as you go.

 

Thank you all for your help. This is hard. I know I need to be patient, but I am just so nervous. I do not want Shay to go back to dka, losing weight, etc. He had such a horrible first year of being diabetic and it was so sad to watch my little man be miserable. Like I said, the PZI was not consistent, but it was effective at bringing him down. So, I'm hoping the Lantus will do the same once we figure out the appropriate dose.

In regards to the feeding schedule in relation to the dosing: yes, we feed Shay about 3 hours prior to insulin. We've been doing this for years and I do know about the food spike. The food spike for Shay usually occurs at about 1/2 hour to 1 hour after eating. We are then waiting another 1-1/2 to 2 hours more before testing and giving insulin. One thing that was mentioned on this board is that the dose determination is based on the nadir and not the pre-shot. Is this true? If so, the food spike shouldn't make too much of a difference. We can work with a new schedule if this is necessary. It's challenging because of my work schedule. But, my husband and I can team up to make this happen. Let me know your thoughts.

I'm confused about this statement: "you dont want to feed in the 2 hours before a preshot, you will see a food induced preshot number if food is given between +10 and +12 (preshot hour). A good time to offer food is anywhere from +8 to +9 in both cycles." Right now, Shay is getting fed at 5am and 5pm and getting his shots at 8am and 8pm. That is at +9, so wouldn't that work?

I'll have my husband test tonight prior to eating ... that will be at +9. I'll record the numbers later tonight. He tested at +5 and he was at 277 (down almost 100 points from his amps). He received a fat 1 unit this morning.

BTW, Shay has gone through 3 timed feeders and broken all three. He is INSANE when it comes to food! So, unfortunately, the timed feeder will not work for us. He's a rascally one!

 

We totally understand how you feel and why you're worried about the transition and how it might make him feel. Some people here use the insulin R to help bring #s down. I know Carolyn is one of those people; I'm going to ask her to stop by and weigh in on this because I don't know anything about giving R or if it would fit your situation.

Yes, Lantus dosing is based on nadir rather than on PS.

It should be fine to feed him at +9, since that is outside of the 2 hour window. It also sounds as though you have the timing of Shay's food spike pretty well nailed down, so you might have some leeway on the timing if you truly do know that it's between 1/2 hour and 1 hour that it affects him. I would say you are fine to stick with the feeding at +9. Does he only eat twice a day, then? Just wondering if the feeding will affect his nadir, but that wouldn't be the case if he is eating 2 meals a day, each at +9.

 

Yes that works fine! That is a +9 which is just right.
This chart below may be useful for you to see what is typically expected during any given cycle. (you'll find it in the NEW TO THE GROUP stickie up above) please note, this is an example of a curve, it does not mean you have to test every hour, if you look at some other kitties spreadsheets, you'll see a variety of examples of when others test the most, the most common is a +3 and a +6, as you get the hang of it, you will see your kitties patterns thru your spotchecks

Learn how YOUR kitty is responding to insulin:
Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir - the lowest point in the cycle
Duration - when the insulin is strongest or works the hardest

Example of a typical curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

 

Yes, Shay only gets fed 2 x day .... 5am and 5pm. He gets snacks at shot time, either a bit of cooked chicken or a little bit of shredded cheese, nothing that would really throw his numbers off.

 

Welcome Kate.

A quick question: How much PZI were you giving Shay? The initial dose of Lantus is based on ideal weight (dose = 0.25 x ideal weight in kg). However, in the case of a switch from another insulin, the previous dose is taken into account. Could you also let us know what Shay's ideal weight is?

I think one of the reasons that most of us test, feed, then shoot is that Lantus typically has a slower speed of onset than other insulin. As a result, you don't need to have food on board in quite the same way as with other insulin. Generally, with shorter acting insulin, it's very important to feed first. Lantus will begin to take effect after about 2 hours.

With respect to your question about building a shed, it takes roughly 5 - 7 days before you will see much action from Lantus. If you could respond to the question about your previous dosing with PZI, that may help with respect to dosing Lantus.

The other thing to please keep in mind is that as you've read, Lantus dosing is based on nadir. We get pre-shot tests to make sure that it's safe to give a shot. Otherwise, it is important to get spot checks, especially at mid-cycle. Many of us work and can't run home to test. Evenings and weekends become the time to gather these data. How Lantus is used is very different than PZI. There are a number of former PZI users on this forum who will be able to help you navigate the differences in using Lantus. Basically, you will need to forget everything you are used to when it comes to dosing. In fact, please do not change Shay's dose. You have already made several dose changes, fortunately in the lowering direction. One of the things that Lantus likes is consistency. Once the shed is built, doses are typically held for 3 - 5 days unless numbers dictate otherwise.

Please continue to ask questions.

 

Thanks everyone! The average dose for Shay on PZI was 2 units BID. He was on a sliding scale depending on his preshot number and was extremely sensitive to the PZI insulin. He would be at 350 for his amps and then I'd give him 2.75 units of PZI and he would go down to 60 within 4 hours. He would stay in a good range the majority of the day and then shoot way back up. That was one thing I didn't like about the PZI ... the crazy spikes. I have been told that Lantus should show more consistency with numbers and that once we determine a good dose for him, he will be staying fairly consistent all day long. That sounds wonderful! I am being patient and hopeful and will keep you all posted.

In regards to determining the dose according to his weight and what his average dose was for PZI, are you thinking that Shay should be getting a larger dose of Lantus? I have a gut feeling that he is going to be good at 1.5-1.75, but I am being patient with this initial dose of 1 to wait for the shed to build and then re-evaluate on Wednesday.

The feeding/dosing schedule is a realy tricky one! I was starting to think that the +9 feeding was a good idea, but now I see what you are saying about how the insulin takes 2 hours of so to start taking effect. On one hand, feeding at +9, I won't necessarily see the problem from the typcial curve where you have to consider the food spike in the +1(because his food spike will be happening at +10 to +11). But then the insulin will be wearing off so much at +10 and +11 and THEN I give his next shot and we have to wait another 2 hours to see the new dose of insulin taking effect? Hmmmmmmm ... this is a real dilemma.

I will be able to get spotchecks on Shay most days at +5. So, I'll be able to always do amps and pmps and 6-7 days will be able to get the +5. This will be truly helpful as we get established.

Thanks again to all of you for your wonderful advice and support!!!

 

Hi there,
Sarah asked me to stop by. Hang in there, you'll have to be verrrrrrry patient for the numbers to come down.. which is very hard for us ex-pzi'ers.. he'll get there and you'll be very happy you've got him on Lantus!

I can see you got some pretty good swings on PZI so you won't need R for him. We reserve that for kitties who are stuck in the 400-500s permanently

 

Thanks for explaining when R is used, Carolyn. Now it will be easier for me to keep my big mouth shut.

 

I tend to think the 1.0u is a good place to start although it's certainly possible that you could go a little higher. Based on what you said about the wild swings on PZI, probably a start low, go slow approach would not be a bad thing to insure you don't miss the optimal dose of Lantus. I've asked some others to stop by to see what they think of 1.0u as a good starting dose.

As far as the feeding situation, most of us try to give smaller, more frequent meals. If you're able to spot check at +5, you could also consider leaving a mini-meal or snack at that time. It helps to keep metabolism stoked while not overloading the pancreas. The other thing that I do is make "catsickles." I mix canned food with water so it's soupy and freeze it in ice cube trays. I leave a few cubes out if I'm going to be away for several hours as well as leaving some out overnight. Gabby will sometimes eat the cubes while still frozen but most of the time, they get to room temp and she has fresh food.

 

Welcome to lantusland.... where more patience than you ever thought you'd need is required :lol: . I'm kidding, but patience is a still important.

I support all that was said above:
- shed takes 5 to 7 days to build
- lantus is not like PZI so you'll need a broom to remove all the pzi cobwebs from your brain - been there, done that and you'll likely freak when you have to shoot a low number.
- consistent dosing with lantus (timing 12/12 and dose)
- small snacks are better than meals
- better to have more food at onset than at actual shooting time.
- you'll need as a minimum 3 tests daily including: AMPS, PMPS and bedtime check; more tests are better, but you don't need to join anonymous testaholics.
- post daily, visit others and ask lots of questions!!!

again, welcome

 

Hi Kate!

Shay is already seeing a good response (this pattern is very typical of cats who are new to Lantus, in fact it is better than many cats in the beginning!). Usually we hold the starting dose for 10 cycles, but since Shay was on a higher dose of PZI, the protocol gives us some leeway to increase after 6 cycles. That would mean that you hold the 1 unit dose through tonight, then you can increase to 1.25 in the morning if you want. Then we'll hold the 1.25 for at least 3 days. Sound good?