11/25 Triton AMPS 429 - Increased Dose and Urine collection ?

Previous post: http://www.felinediabetes.com/FDMB/threads/11-24-triton-amps-482-3-303.222074/#post-2482592

Good Morning All!

This is Day #4 on Lantus! And his preshot number has gotten down which is a good thing. My little stubborn self decided to increase his dose by .50unit today hoping that he can be in the yellows or possibly blue.

I feel so worried now because that's not what is recommended especially since he is new with Lantus. I would appreciate any advice and how to make sure Triton stays safe. So far what I can think of is to test him through out the day. I am not sure what to do on his PM cycle now.

Also, I have not tested Triton for Ketones. Honestly, I have been trying to avoid it because I do not have a clue how I would be able to collect urine but I know it is necessary. Please provide suggestions or ideas on this because your girl has no clue!

 

Giselle -

I know how distressing those high numbers are. There are a couple of issues at play and I'm going to preface my comments by noting I've been out of town and not following what's been going on with Triton. Please forgive me if my comments have been discussed previously.

When switching from a short acting insulin like Vetsulin, you could have started at the same dose (2.25u) of Lantus or maybe a little less for safety's sake (e.g., 2.0u). So, you started out on an unintentionally low dose of Lantus. Hence, the less than lovely numbers.

With Lantus, it takes 5 - 7 days for the depot to form. Prior to that time, it's not surprising that Triton's numbers are high. Even if you opt to follow the Tight Regulation Protocol (TR) for your dosing strategy which is more aggressive than Start Low Go Slow (SLGS), you don't want to increase sooner than 5 - 7 days since you don't really know how Lantus will act since the depot hasn't stabilized. So, you've increased Triton's dose after 6 cycles (vs 10 - 14 cycle) which is considerably sooner than what's recommended. By increasing so soon, the depot has to recalibrate to the higher dose.

It looks like you are around to test. I would encourage you to read the sticky on dosing methods and make a choice over which method to follow. It looks like you test enough to follow TR and it doesn't look like Triton is getting any dry food so if you want the option of increasing doses sooner than a week, TR may be a good choice. At this point, though, please check before you raise a dose prematurely.

Also, unlike with Vetsulin, we look at how low Lantus gets the numbers (i.e., the nadir) not the pre-shot numbers. From that perspective, Triton has been in the 200s. Likely, the ugly numbers you're reacting to are bounces. So, please monitor carefully given the dose increase. Given that the nadirs are in the 200s, you would increase by 0.25u, not 0.5u. So, if you are set on increasing the dose, I would not increase by more than 0.25u.

As for ketone testing, I always stuck a ketone test strip in Gabby's urine stream whenever I caught her in the litter box. She wasn't shy! Other's have used a spoon or a ladle to do the same. I'm sure others will offer their suggestions, as well.

 

Sienne,

Thank you so much for your input.

So I did increase his dose prematurely...I had a gut feeling his does was low because he was doing alright with Vetsulin, on some days....

At this point, there is no going back and I gave him 2 units this morning. Should I continue to give him 2 units for 5-7 days? I promise to check before raising his dose.

I will have enough time to check him regularly (TR) until December 9th. I got a job offer! Excited but sad that I will not be around in the day to check on my tritty. My schedule might be from 7am-4pm. I will give him insulin at 5am/5pm. If my sister is around, she cant check him otherwise I will be doing some PM curves or on the weekends.

 

Congrats on the job!! So here's a surprise. We have a post on how to use TR and have a full time job! (We seen to have notes on everything!!!) I worked a full time job and used TR as do many people here. I would shoot at 5:00 which gave me enough time to get some early tests. (Gabby had an early nadir so the early tests were crucial for her.)

I would back the dose down by 0.25u (i.e., 1.75u). The only times we increase by 0.5u is if the nadirs are primarily above 300 or if the cat is above a 5.0u dose. By raising the dose in a systematic fashion, you don't run the risk of missing what can be a good dose. It's possible that too much insulin can look very much like non enough insulin which is hard to tease out. Could you also put a note in the comments section of your spreadsheet so we don't keep asking you about the dose changes. Thx.

 

Ok. I could decrease his insulin down to 1.75u but Triton is doing well today. He was at 169 around +5.5 today and we are at the vet for his check up and he was at 224 +6 with an alphatrak meter.

He seems to be doing much better with 2 unit dose but to be safe I could decrease it to 1.75u. Should I give him 1.75 for his PM cycle?

Thanks!

 

He is at 200 +9. Should I keep his new dose or go to 1.75u.

@Sienne and Gabby (GA)
@MrWorfMen's Mom

 

Given that lovely 169 mid cycle today, I'd be inclined to stay with the 2.0u dose even though normally that last increase would have been 0.25u instead of 0.5u. That said, you started the Lantus on a lower dose than what you'd been giving with the Vetsulin so I think the odds of you having skipped a good dose are small if present at all. I would stick to increases of 0.25u going forward though unless the numbers tell you otherwise.

 

Hi Linda!!

Yes, I completely agree to stick with .25u increases moving forward! I will definitely consult with you guys as well. Triton seems to do pretty good right now. Im so happy

 

I too would lean toward steady as she goes - meaning stick with the 2 units. I know you got a little ahead of yourself there by changing it too soon...but it does not appear - so far - to have done anything too major to his BG's. Lantus is a hormone, not a drug - so it takes time to work. The depot has to build up and then you'll see some changes happening. One thing I know about Lantus is that it loves consistency. Time of day and dosage amount - don't go bouncing around changing either one if it's within the realms of human possibility to stick to a rigid schedule and carefully carefully measure your dose every time.

If you have calipers, use them to be precise - if you don't, please consider getting some. I realize you're brand new at all of this - and it takes time to figure all of this stuff out - but if I had it to do over again those are two things I'd do - first.

Put another column in your SS for shot times - I did that -eventually. And try to stay within 15 minutes of that time.

And, CONGRATULATIONS on your new job! Exciting news! And you CAN manage a diabetic kitty and work too. It's being done as we speak by many members - I work fulltime - however I do it remotely from home - and I have to pop up all the time for timers that I set to remind me to test Luci. Heck I even have timers set to remind me to test/feed/shoot her - otherwise I can get distracted and forget to give the darn shot! It's a crazy life sometimes...

Enjoy the rest of your day!

 

I am really excited for my kitty and I on this new journey. He will have nothing but love and quality care!

Can you please provide me with links of what kind of caliper I should get?

 

How to use it?

 

Will this caliper work?

Digital Caliper, Adoric 0-6" Calipers Measuring Tool - Electronic Micrometer Caliper with Large LCD Screen, Auto-off Feature, Inch and Millimeter Conversion https://www.amazon.com/dp/B07DFFYCXS/ref=cm_sw_r_cp_api_i_Ate3DbAVEG41G

 

I bought this one: https://www.harborfreight.com/hand-...rs-micrometer/4-in-digital-caliper-63710.html

I like the smaller size, fits into Luci's kit easily.

I ordered a larger one from Amazon and it's just too big...

This is the one I have from Harbor Freight: Notice the little knob on the top? That's not visible on the one you sent me from Amazon - you'll want to be sure to have the knob - that's what locks the setting in place...otherwise it'll slide around and you'll have to reset it every time you use it...which can be a pain...


I forgot to mention, please ask @Marje and Gracie for help getting your syringes calibrated. She wrote the book on calipers and has a nice video that will be helpful.

 

Also make sure whatever you choose has a locking mechanism. The one you chose on Amazon doesn't have that feature. The one Sue suggested does. It's that little sliver knob on the top.

 

I agree with Sienne on 1.75 as your dose tonight. Not only did you increase before the depot was full, you also increased by a larger amount that the dosing methods suggest. The guidelines in the dosing methods are about safety. 2.0 units of Vetsulin got you to low blues. Going down to 1.75 gives a little margin of safety. At one time I did a comparison of kitties going from Vetsulin/Caninsulin to Lantus doses, and most ended up around the same good dose. But the odd one needed less Lantus.

For what it’s worth, Sienne was one of my mentors when I started here. I have listened to her for 7 years.

And one good practice for you, it’s a good idea to check your previous days post before shooting in the morning. Some of us are in different time zones and schedules and make comments late.

 

I am very reticent to suggest that you stick with an overly aggressive dose increase on top of a depot that is still in flux. That's my 2 cents. You are the one holding the syringe so it's your call.

 

Thank you all for your suggestions. I’ll give him 1.75u as supposed to 2u.