10 June Tucker: AMPS 17.2 (310). Gave 2.5 units Lantus pen

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Tucker, Jun 9, 2018.

  1. Tucker

    Tucker Member

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    May 22, 2018
    After increasing his dose from 2.0 to 2.5 his BG is still up in the purple. Is this normal? He seems pretty happy but very hungry. Is it too early and his body is still adjusting to the extra Lantus or should we start thinking about an increase? Thank you
     
  2. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Feb 21, 2015
    Hi Patty,
    Tuckers SS is looking very much like a cat starting off on insulin and he is doing well.
    Are you going to do the tight regulation protocol?
    If so, we hold the dose for a minimum of three days (6cycles) before increasing.
    Read the tight regulation protocol which is at the top of this page in a yellow sticky.
    Have you been taking any reading in between the preshot? It is issential that you do if you are going to do the tight protocol and it is important as we can't see how low the insulin is taking the BSL.
    If Tucker's nadir has not gone under 200 (11) during the past three days you could increase to 2.75 units tomorrow?
    It would be helpful if you could keep the SS up to date all the time as anyone who is going to help you with dosing wil always look at the SS first. The colour is pink not actually purple:)

    You are doing really well. Your comments in the remarks column are great.
    Bron
     
  3. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    From Tucker's other thread on June 9:
    Hi There, I moved Tucker over to the Lantus forum but seem to have lost you over there. He has now had 5 doses of 2.5 units of Lantus and his numbers are still up in the 16+ range. He does seem happier (still starving and begging for food all of the time) but he is purring and more social. I know it seems weird but the two white balls on his face 'deflate' when he is not feeling well? Well, they are about half full. I was looking at other people's posts on the Lantus page and their numbers really move down during the cycle after a dose of Lantus. Tucker's seem to be always 16/17. At what point should we go higher on the Lantus? Thanks!

    Hi Patty
    If others do not respond, I continue to recommend a 6-dose regimen, then a change if needed. So I would give him 2.5 again at the next dose. If his BG is still in the 11.0 - 17.0 range during the nadir then bump him up to 3.0 units.

    I think he was at 4.0 units when we started, and there were not enough measurements then.

    You can always "tag" one of us by typing the "@" symbol, then our user name. @JeffJ or @Bron and Sheba

    You have really got the hang of it in my opinion. I think Tucker is lucky to have you.
     
  4. JeffJ

    JeffJ Well-Known Member

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    LOL - we basically responded in the same 3 minute period.
     
  5. Wendy&Neko

    Wendy&Neko Well-Known Member

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    It's hard to say if his BG is up in the purple without tests in the mid cycle. If you cannot get tests in the AM, it is essential to try to get some spot checks at night. My Neko earned her first reduction (by going under 50), starting the cycle at 430. By the next preshot time, she was back up in purple/pink. If I hadn't been testing mid cycle, I would have thought she needed a dose increase, but in fact she needed a decrease. I see only preshots on the 9th, so we have no idea what Tucker did yesterday.

    Regardless of which dosing method you want to follow, the increase would only be by 0.25 units, as you are seeing some numbers in the yellows. If you are following TR, you need to have 6 cycles with at least a preshot test and one other, before deciding if you should increase. Today is cycle 5 on this dose, but you only have one cycle with mid cycle data. With SLGS, you would wait a week, do a cureve then deicid if you needed to increase. In both cases, the increase would by to 2.75 units - if needed. It'll help us help you if you decide which dosing method you'd like to use, then put either TR or SLGS in the signature. That information in the signature also helps you by letting you know if the people giving suggestions have experience with that dosing method.
     
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  6. Tucker

    Tucker Member

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    May 22, 2018
    I just realised that I had been out yesterday afternoon and had not posted his +6 BG. Sorry, that was my mess up. I'll go pop it in now. (17.2) I just did Tucker's +6.5 bloods and it was 24.6! That was so high I re-tested and it was 24.2. I did a third test and it was 22.8............all of which are too high for a +6.5 to me, but I'm putting it out there to see what I should do next. He is doing that nauseated thing with his tongue but still ran for the fridge as soon as the BG test was finished. My husband thinks with that high of a BG result we should not give him much of a 'good boy treat' but I had been giving him a handful of cooked chicken breast each day after his test. What do you all think???
     
  7. Tucker

    Tucker Member

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    May 22, 2018
    Sorry! I did have a test for yesterday and have posted again with more info!
     
  8. Tucker

    Tucker Member

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    May 22, 2018
    Hi Jeff, Sorry I messed up with my spreadsheet and I've taken another +6.5 test with a result that concerns me. I'll try to remember the tag next time, had no idea about that.
     
  9. Tucker

    Tucker Member

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    May 22, 2018
    Hi Bron, I messed up but have posted the results now. It's weird how many 17.2 readings I get...although today's +6.5 being 24, I wish I had another 17.2 to post. I was going to try to do the TG protocol, if I can manage to do it right.
     
  10. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Thanks for filling in the SS. It is really important to keep it up to date especially when you are getting dosing advice.
    Try and get an inbetween test in each cycle if you can because every cycle can be different.
    Yes, you should give Tucker a treat after every test. It doesn't need to be a big one.
    Also if you divide his food up into a couple of meals each cycle instead of one big meal, he won't be so hungry and then you can just give a small treat at each test time.

    Ok..can you put in your signature that you are going to do TR.....I forgot to mention to add that when I was telling you what to put in signature...sorry.
    Now that you have the inbetween BSLs you can increase to 2.75units tomorrow morning. Are you OK with drawing up the 2.75 in the syringe? You could use a practise syringe and draw up some cold tea or something coloured a few times to get some practise in with the dose. It's a good idea to keep a practise syringe to try with new doses, especially in the beginning.
    Don't worry about the higher BSL of 24. Just make sure he is drinking plenty of water when he is higher and test for ketones.

    You and Tucker are doing well. I understand your concern with the higher BSL but you can't rush FD..
     
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  11. Tucker

    Tucker Member

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    May 22, 2018
    I emailed our vet just now and thought since it is Sunday and the Queen's Birthday long weekend I may not hear back from her until Tuesday. She's a champ and already got back to me. She logged into the practice's computer and got Tucker's 'fructosamine' test from Friday. She says it shows that he has been very uncontrolled over the lasts couple of weeks with his BG all over the place.
     
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  12. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Let's have you follow Wendy's and Bron's advice to go to 2.75 in the next dose.

    "the Queen's Birthday long weekend I may not hear back from her until Tuesday"
    I'm impressed you have friends in high places! ....then I re-read the sentence.:D
     
    Last edited: Jun 9, 2018
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  13. Bron and Sheba

    Bron and Sheba Well-Known Member

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    She sounds very conscientious.
    The fructosamine test confirms what we can see with your testing, that Tucker is not yet regulated. But if you do the TR you are well on the way to getting that sorted out.
    The fructosamine test becomes redundant really when you are home testing the BSL as you have several tests a day which will give you an up to the minute state of his FD, whereas a fructosamine test is an overview of the last few weeks and while it tells you that he is unregulated it doesn't say if he has had good and bad BSL days, or if he is improving etc.. So from now on you don't really need to get that test unless you want to......it will save you money which can be spent elsewhere.
    Where are you buying your test strips? From the chemist is expensive. I always bought mine on eBay for half the price. Test strips is probably the biggest ongoing expense with FD. Just type in 'buy eBay blood glucose test strips......and add what yours are called'
     
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  14. Bron and Sheba

    Bron and Sheba Well-Known Member

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    @JeffJ
    Good one Jeff!
    We have direct lines here in Oz!
    :joyful::joyful::joyful::joyful::joyful::joyful::joyful::joyful:
     
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  15. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Thanks for filling in the spreadsheet numbers. One thing to note, it's usually more informative to get tests at different times in the cycles. As Tyler is showing today, +6 is not always the nadir. Not sure my Neko ever nadired at +6, more like +7 to +9 on Lantus. Which brings up a second point, nadirs can and do move around. If you think of the analogy of the spreadsheet as a jigsaw puzzle, it helps to put a few numbers in those sections of the spreadsheet that have a lot of white space.

    Our Queen's birthday holiday in Canada was a couple weeks ago. Course, that was for Queen Victoria.:p Pretty sure we don't have a direct line to her!
     
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  16. Tucker

    Tucker Member

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    May 22, 2018
    We sure do!!
    When I had Tucker at the vet she said she wanted to do a full panel as well as urine tests to make sure bladder, kidneys, pancreas and whatever else were doing ok. I was fine with it. She also had me bring my home test kit with me and when she drew the blood sample we compared her monitor with mine so we could see how far off they were (2 points). She says the other results said that his organs were doing fine at this point. He is healthy apart from having diabetes.
     
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  17. Bron and Sheba

    Bron and Sheba Well-Known Member

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    @Wendy&Neko
    Mmmmmmmm.......a direct line to Queen Victoria might be a bit of a stretch, even in this high tech age! ;)
     
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  18. Bron and Sheba

    Bron and Sheba Well-Known Member

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    I did the same with our vet in the early stages when I was freaking out about the numbers and there was a difference of 3 mmol. Just different meter variance but basically the same number really. So don't worry about that.
     
  19. Tucker

    Tucker Member

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    May 22, 2018
    Hi Bron, I had bought 100 strips from National Pharmacies last month and they were appx 50.00. I just took your advice and checked ebay here in Australia and it came up 35.00 with free shipping for the same amount. Double checked the expiration date and there is plenty of time on them. Not quite 50% off, but enough to matter. Thanks for the tip!
     
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  20. Tucker

    Tucker Member

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    May 22, 2018
    PMPS was 16.9 so we increased him to 2.75 units. His behaviour did improve during the day however, with purrs and more social behaviour etc. I need to edit this a bit. My husband gave the shot and he says he thinks he gave a 2.5 and a 'touch' but he cannot see how anyone is able to do a 2.75--the amount is just too hard to see on the syringe. So he has asked me to re-post it as 2.50.
     
    Last edited: Jun 10, 2018
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  21. Bron and Sheba

    Bron and Sheba Well-Known Member

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    With TR you hold the dose for at least 6 cycles (3 days) before increasing the dose, as it can take that long for the depot to fill up and to show how far that dose can bring down the BSL. So really you should have waited until tomorrow morning to increase.
    However now that you have, if I were you, I would get at least two tests in this cycle to see how he goes with this dose.
    Try a +3 and maybe a +5 or 6 depending on what the +3 is. If he is still dropping at +6 you will need to keep testing until he stops dropping.
    Here is information on a depot
    http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/
    Thanks for posting the PMPS promptly.
     
  22. Tucker

    Tucker Member

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    May 22, 2018
    Hi Bron, I think we overlapped with our posts. I have shown my husband the photos of the mark lines for the .25 increases on the syringe but he doesn't think he is going to be able to be accurate with them at all. At the moment he says he gave Tucker 2.5 (and a smidge) but doesn't think it is enough to have made a difference. Does that make any sense at all? Tucker just ate a huge dinner and is actually interacting with our other kitties, so that's a plus. I'll go ahead and do some extra blood tests tonight just to be sure though.
     
  23. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Patty, I have just seen your edited post where you added that your DH (husband) thinks he gave 2.5 plus a touch and found it difficult to do 2.75.
    Do you have a magnifying glass? I always used one whenever I drew up any insulin.
    When you get the syringes with the 1/2 unit markings you might find it easier, but I always used the syringes with only the 1 unit markings (except when someone gave me some 1/2 unit ones after their cat had gone to the rainbow bridge)....
    There is a ruler which can be used to get an accurate amount....I will try and locate it.....but I always just eyeballed it.. try it on a test syringe as you will be using small increases all the time.
    When we give a bit more than say 2.5 we call it a '2.5 fat dose', or if we give a bit less than say a 2.5 dose we call it a 'skinny 2.5 dose' but these are only used when you have pretty much reached the correct dose and might need to fine tune it.

    It will be fine so don't stress about it. Does your DH give all the doses? Do you think he could try practising drawing up 2.75 units with black coffee or some other dark liquid and then keep that syringe filled with the correct dose to check the insulin dose against....does that make sense? Then hopefully he will be able to give the 2.75 dose in the morning.
    It does take time to learn to draw up the smaller amounts....he has obviously been doing a great job to get this far.........practise makes perfect;)
    We can all only do our best and we don't judge anyone....we are just here to help......and we all understand how stressful it is in the beginning. Tucker is a very lucky boy to have you both!
    Bron
     
  24. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Feb 21, 2015
    I have just written a PM to someone @Tara & Ivana here in Oz who used the insulin ruler. She doesn't post often now but hopefully she will see the PM and reply.
     
  25. Tucker

    Tucker Member

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    May 22, 2018
    Thanks Bron. He says it would have been a 2.5 fat dose. The vet gave us 100 syringes that are all one unit measurements, so getting it to a have unit is tricky enough! Can't imagine being accurate to the qtr dose!
     
  26. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Feb 21, 2015
    Patty, Can you change the SS PMPS dose to 2.5F please and over in the remarks column just say what has happened and why it is 2.5F, so that anyone looking at the SS will understand what has happened please and why 2.5F is written there. Thanks.
     
  27. LizzieInTexas

    LizzieInTexas Well-Known Member

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  28. Bron and Sheba

    Bron and Sheba Well-Known Member

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  29. Tucker

    Tucker Member

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    May 22, 2018
    Silly question here. I was looking at the box of syringes the vet gave me and they are BD Ultra-Fine #326103 and I found them online in Australia. When I looked up the item number there was a drop down list of various sizes. I was not sure what exactly I was looking for but wondering if they don't actually sell the same size BD but with the .50 or even .25 markings on the syringe. This is the link to what I was looking at:
    https://www.medshop.com.au/products/bd-ultra-fine-insulin-syringes

    Can you decipher them for me?? Thank you for your support.
     
  30. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Feb 21, 2015
    There is no such thing as a silly question here!
    No, what you are looking at is the different volume sizes of the syringes that go with different insulin. They are not the individual markings of the units.
    The two that are suitable for Lantus is the one you have and the one below it
    328822. Both are 0.3ml syringes.
    The others are not for Lantus insulin and would give you the wrong dose.
    To get the 1/2 unit marking syringes you will need to order from O/S from that link I gave you above. They will take about a week.

    ETA: how did the +3 BSL go?
     
  31. Tucker

    Tucker Member

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    May 22, 2018
    I did a +3 and it was 16. Then I did a +7 and it was 13.1. I gave Tucker some chicken after his tests.
     
  32. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Dont' feel bad. I have been dosing Leo for 3 years and I still have a hard time with doses between the syringe lines.

    I feel that consistency is more important. If I give him a fat 2.5 dose, then he gets repeats of that same dose. Also I do not try to get the bubble out anymore. The bubble in my syringes is from the area by the tip of the plunger, so it is always the same.

    You're doing great Patty. A lot of owners do not go all the way down this learning path. But once you do, then it really becomes routine. And you will end up with a healthier Tucker in the long run.:bighug:
     
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  33. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Jul 25, 2016
    I agree. What we did here, because both hubby and I shoot, was filled a syringe with colored water and used it as a template. I have since moved to using the calipers which I find easier on the small(er) dosing (0.25, 0.50).
     
  34. Tucker

    Tucker Member

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    May 22, 2018
    Thank you for the support and suggestions. We are doing our best but it's still a bit daunting and distressing that he was diagnosed the end of March and he is still all over the place. So far, this is his only health issue (that we know of) but the longer it takes us on this learning curve and the longer it takes us to get him stable the higher the risk of other issues developing...so we sort of feel like we have failed our boy. His afternoon BG test was done at +8 today and was 17.1. I'm happy he has been out of the 20's today but it's still not great. He is acting like his normal self today :). Very purry and when we were lopping a tree out the back he was right in there curious and underfoot! I've noticed him taking some extra drinks and he is begging for more food, even though I gave him a little less at breakfast so he could have lunch after his afternoon BG test.
     
  35. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Feb 21, 2015
    @Tucker
    You have certainly NOT failed your boy. You are doing everything you can for him. You are going above and beyond what a lot of people would do so please don't beat yourselves up about it. :bighug:
    Most cats take some time to get regulated. It doesn't usually happen in a few weeks. Have a look at some of the other cats SS and you will see this is true. Of course there are a few lucky ones that fall into line early but most take a while.
    Tucker is getting insulin and the correct food and he has a loving family so he is well on the way.
    I truly know how frustrating it is when you are doing everything right and you are not getting the numbers you want. But they will come. While you are waiting put on some patience pants.......we all own multiple pairs;)
    Keep on with the regime and try and get tests inbetween all cycles at different times if possible.
    Bron
     
  36. Tucker

    Tucker Member

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    May 22, 2018
    11 June PMPS 16.1 so shot 2.75.
     
  37. Tucker

    Tucker Member

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    May 22, 2018
    Thank you, Bron. Sorry to be so needy, but I am feeling rather needy these days.
     
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  38. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Feb 21, 2015
    You aren't needy...you are just new to all this and it is confusing.
    I remember when I was starting out the second time after Sheba slipped out of remission...before I found FDMB....my sister came to visit me and all I talked about for three hours was how worried I was about Sheba's high BSLs!

    Let's see what he does with this cycle. Stick with the 3.75 units *****(ETA typo mistake should have read stick with 2.75 units) for 3 days unless he drops under 2.9
    There are eyes watching you.
     
    Last edited: Jun 11, 2018
    Reason for edit: Correct typo mistake
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  39. Tucker

    Tucker Member

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    May 22, 2018
    11 June PM +6 = 13.1 He's been very social and happy tonight.
     
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  40. JeffJ

    JeffJ Well-Known Member

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    "Stick with the 3.75 units "
    She meant 2.75, it was a simple typo.

    You are doing good with this. Keep up the spirit, and keep up the testing.

    We are easing up into the proper dose in 0.25 increments. If we jumped directly to 4.0 units, it would cause lots of bounces. And it makes it hard to adjust the dose. Once Tucker gets into the correct dosage range - he will be regulated. Also he will drink less water and with luck - he will also not crave food all the time.
     
  41. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    "11 June PM +6 = 13.1"
    This may be a typo on your spreadsheet - maybe you meant to put it on the June 11 line, and not on the June 10 line.
     
  42. Tucker

    Tucker Member

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    May 22, 2018
    I had to double check it as well, last night his pre-bed BG was the same as tonight, 13.1. I put it as a +6 because we fed him just before 6pm and I tested him just before midnight. I'll go back and double check my spreadsheet in case there is a typo there. Thanks for keeping track of me!
     
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  43. Tara & Ivana

    Tara & Ivana Well-Known Member

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    Aug 20, 2015
    Hi Patty! Bron has tagged me in your post as I used to use the insulin ruler when my girl was on the juice. Bron has linked the actual ruler PDF file above, and I have found another post where I was explaining how to use it to someone, so have a look at that here. It really does make drawing up small doses super-easy, and also consistent as sometimes the printed lines on the syringes can vary batch to batch. Let me know if you need any more advice :)
     
  44. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Feb 21, 2015
    @Tucker @JeffJ
    Yikes! thanks for picking up the typo Jeff. I have edited the post to correct the mistake.
    Bron
     
  45. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    No problem, easy to see the typo then fix it.

    Tucker is progressing nicely. He will probably start to get regulated in the next 2-3 dosage increases.
     
  46. Tucker

    Tucker Member

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    May 22, 2018
    Thank you for this, I'm not seeing the link with the explanation? I'm not the best at this computer jazz....
     
  47. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Feb 21, 2015
    '
    Click on the light blue word 'here' in Tara's post and that should put you through to the thread about the ruler
     
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  48. Tucker

    Tucker Member

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    May 22, 2018
    +6 was 17.2 and PMPS was 16.1 so shot 2.75 Lantus.
     
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  49. Tucker

    Tucker Member

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    May 22, 2018
    Ok, so this is an issue. I did a PM +6 BG test and it came up 8.2. This was unusually low so I did it again immediately and it came up 18.3. So I did another test and it came up 14. So, what do I actually record? A variance is expected, but this seems ridiculous and I'm not sure what to do.
     
  50. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    I would toss out the low value and go with the 14.0 value. The first strip could have been bad. Or maybe the sample was not great.

    Your notes says Tucker still doesn't like BG tests. If you have not done the "treat conditioning" this would be a good time to start. Just give treats and no testing on a towel in the kitchen. Leo thinks it is now a "special spot" since he always gets a food reward there.
     
  51. Tucker

    Tucker Member

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    May 22, 2018
    Hi Jeff, I've done the treat conditioning with Tucker......maybe he is a slow learner?? They also say that the edges of the ears have few nerve endings so it shouldn't really hurt but he yelps when the test is done. It makes me feel terrible to cause him pain-but it really does seem to hurt him.
     
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  52. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Sorry to hear that Tucker is ALSO a slow learner. Leo was too. It took a long time to train him. Now we are almost at the third year. So Leo has gotten used to it. He does shake his head after the test though.

    I would say that the ears do have nerves, but this is no more painful than pulling a drop out of our fingers. Irritating but not horrible. It's unfortunate but there is no real better method. Some very few people pull the test thru their cat's paws.
     
  53. Tucker

    Tucker Member

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    May 22, 2018
    I'm hoping he comes around. Our vet did tell me there is a device that you can put on their backs which allows BG scans without having to stick them multiple times. She described it as a pad you put onto their backs once, and it lasts a couple of weeks. The initial pad is about $100 and then the replaceable attachment is $100. She said it is good for the early days after diagnosis when lots of monitoring needs to be done.
     
  54. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Yeah, but you would have to shave him and keep him shaved. He would be walking around for a week with his poor head hanging low because none of the other kittehs are shaved. With Leo, he would probably pull it off. We do have one member using it, but I can't remember who. They had BG readings every 2 hours....and we thought they were staying up 24 hours a day!
     
  55. Bron and Sheba

    Bron and Sheba Well-Known Member

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    Feb 21, 2015
    @Tucker
    This alphatrak device you mention above has been available in Australia for almost 18 months. As far as I am aware it is mainly used in the first few weeks of FD. Vets seem to think that after that the cat will be fine and only need the checking BSL every so often!
    @Girlie's mom used one in the beginning. There have been a couple of other Aussies who used it, but I can't recall who. Someone said the cat found it irritating but I can't think who that was either.
    However you are already testing so really it would be a bit of a waste of money and as the alphatrak numbers are a bit different to the human meter numbers you will have to get your mind around that as well.
    I'd save my money for something else more pressing ;)
     

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