? 2/25/18 - Luci AMPS 270 - Dose Advice please. 2+193, 7+ 197

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Sue and Luci, Feb 25, 2018.

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  1. Sue and Luci

    Sue and Luci Well-Known Member

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    I've been thinking about contacting the vet to see if he has any suggestions on what to do about Luci's high numbers. Each time I've increased her Lantus to 1.75 we end up with numbers that are way too low. I'm perplexed about what to do next? She's on a low carb diet - FF pate and freeze dried salmon are her stables. An occasional treat is string cheese (DH gives that to her at night)...other than that - the only time she gets anything remotely MC or HC is when we have one of those hypoglycemic episodes.

    She looks and acts great. Her old spunky self. She's regained her weight. Would a different kind of insulin make any difference?

    So what to do? I don't think these numbers are very good. I can't seem to figure out when her nadir happens because she's all over the map. I keep trying to find a pattern - but there doesn't seem to be one. It can't be healthy for her system to continue with these high numbers - when and how are we ever going to get her back into a normal range? We've been testing and treating Luci for two months and there has been very little change in the numbers - occasionally a very high number and occasionally a very low number...but never a steady settling in of any number any time...

    What can we do to get off this roller coaster of ups and downs...and start working her toward a better number?
     
  2. Juliet

    Juliet Guest

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    Sep 8, 2017
    Can you try somewhere in between. Like a fat 1.5?
     
  3. Mandy & Rex

    Mandy & Rex Well-Known Member

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  4. Sue and Luci

    Sue and Luci Well-Known Member

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  5. Sue and Luci

    Sue and Luci Well-Known Member

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    I'm certainly willing to try that - I asked the other day about increasing the insulin just a tad...but was told that is for long term diabetic cats and I shouldn't do that with Luci...I'm in a quandry of what exactly to do with Luci...I'm just frustrated at her eractic numbers...would like to see some stabilization...
     
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  6. Juliet

    Juliet Guest

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    They’ll see it if tagged. I know the feeling. Silver just earned a reduction then failed it.
     
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  7. Sue and Luci

    Sue and Luci Well-Known Member

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    Sounds a lot like Luci - she earns a reduction from 1.75 x2 but can't get her numbers to go anywhere near 100 when she's on 1.5...so frustrating.. :(
     
  8. Mandy & Rex

    Mandy & Rex Well-Known Member

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    As soon as the pros log in, they will see a notification that they were tagged and will come over to read your condo and see your questions.
     
  9. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    You could try a fat 1.5 u as Juliet suggested. I hear you about the frustrations of having a bouncy cat! Have a look at my guy's SS - two years after diagnosis and on his third insulin. :confused:
     
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  10. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Oct 2, 2017
    The numbers you are seeing aren't that bad, all things considered, she's seeing a lot of blues and most of the rest is low yellows. I know you've been giving insulin since November, but you've only really had the reins in your hand since January, because you've been monitoring and following a method since then.

    I don't think people understand or appreciate the length of time it can take to achieve regulation. I know I didn't! The vets make it sound like we just give insulin, play around with the dose a bit and a few weeks after diagnosis, voila! And if that doesn't work for your kitty, they must be a hard to manage diabetic and will never be regulated. Neither of those are accurate. It takes some cats longer than others, that's all. Some are more difficult, but I think it's way to soon to make that call for Luci, you are for all intents and purposes less than 2 months in. Look at Asia's SS in the beginning. My vet labeled her a "brittle diabetic", well he wouldn't call her that now!

    As far as waffling between doses, you have a few options from what I see, and hopefully the others will weigh in when they see the tags:

    • You can increase again, and decrease again if it's earned and keep doing that, it may work out eventually as cats change, it may work out better for Luci if you try to steer with food.

    • Another thing I've had success with when this happen to Asia, but this is just my observation and not something written as a rule, is what I call a kick in the pants dose. You know 1.75 is probably too much, and 1.5 doesn't seem to be enough, but you increase to 1.75 and shoot that for a cycle or two to bring the numbers back to some reasonable preshot and then reduce to 1.5 and see if it sticks when it has the momentum of a nice preshot. I think some people call something similar to this "shooting through the bounce", but that's when they don't reduce right away because the preshot number after the reduction is earned is too high, for example your pm 2/21 cycle. You will still likely deal with some lower numbers than you want to see, Luci is bouncy, the more blues and greens she sees, the better she will get used to them and not bounce as much (hopefully). You would have to very closely monitor to try either of these techniques because when a bounce breaks, and it can be somewhat unpredictable, they gain a lot of momentum and you will likely see lime greens if it gets ahead of you.

    • Lastly, you could do an in between dose. It's generally not recommended because it just gets tricky and it's harder to know what to increase or decrease the next time, it's somewhat difficult to do consistently without calipers and is just a pain to keep up with. If you use calipers for dosing, it's easier to get more precise measurements. I would recommend you try calipers if you haven't, I found some syringes so wildly different from other in the same lot, I was shooting what I thought was 1.5 units and sometimes it ended up being closer to 2 because of the inconsistently printed lines. That can certainly mess with the numbers you see and add to your frustration. Asia got something looking more like regulation when I switched to using calipers (it's a row marked in her SS in October 2017 if you want to see the before and after).
    One more handy bit from the first bullet item, if you know or can learn when Luci's onset is (how long it takes for the insulin to kick in after you give a shot), you might be able to steer with food and get ahead of those lime green drops. Find her onset, you are missing a lot of +1 data and I think onset might be sooner than you think it is, it could even be +.5, you won't know until you figure it out. If it's pretty early in the cycle, you might want to feed higher carbs at your preshot meals and see if that helps any.

    On 2/21, I'm curious what the +1 was. Let's pretend it was 100, that's a pretty fast and steep drop, 100 and you know she can keep dropping a bit for those first 3-4 hours. So you see that big drop right away and instead of waiting for the lime green lottery to come at +2, you try to head it off with higher carb food at +1 and slow her down. I know you tried to do it when you saw the 84, but it was too late then, the +1 could have been a game changer. If you can do this successfully, for a time, the 1.75 dose might work out to keep her in greens and blues longer and quell some of the bouncing. Sometimes cats are bent to earn a reduction and there is nothing you can do about it, but you won't know the difference without some more experimenting.

    If it were me in your situation, I'd try option one first and experiment steering with food before you try the others. Get some more opinions and see what you think about it all before deciding.
     
  11. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    Hi there :cool:

    A couple questions-

    How did you discover Luci was diabetic?

    What % carbs are you feeding?
     
  12. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Change your subject line to include the ? prefix, and add something like "dose advice" to the text. That should get eyes of people who are experienced and feel comfortable giving such advice (and are around).

    Some cats are harder than others to regulate. It took Neko over a year to ditch the red in her SS. :rolleyes: Some cats are just bouncier than others. Roll with it.:bighug: I used bounce days to do something for me and ease off on the testing.

    Luci doesn't seem to hold her reductions very well. One thing you might think about doing is the 3 under 50 (or once under 40) rule before giving her a reduction. Hopefully that way she'll spend more time in green and not freak out every time she sees it. More green is the path to regulation. I also like Stacy's idea of feeding her some food around +1 or +2 if you see those fast drops happening. What are her normal feeding times? Maybe she's one of those that needs small mini meals early in the cycle to giver her fresh carbs on board when she onsets.

    The nadir is the lowest point in any given cycle. For some cats it's the same time each cycle, for others it's not. When Neko was on Lantus, her nadir was reliably between +3.5 and +13. :rolleyes: But I learned her patterns which helped me pinpoint the likely times. And those patterns aren't just one cycle at a time, but action over several cycles.
     
  13. Sue and Luci

    Sue and Luci Well-Known Member

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    Luci was drinking a lot of water and peeing a lot - so we took her to the vet and he did a blood test - her glucose came back at 374. He said she was diabetic. That was around November 4 in Michigan. I bought a home testing kit and Novalin N insulin with the vet script. However, her numbers were always less than 200 so I posted here (FDMB) and was told not to give insulin as long as it was under 200. So we held off until January 4 - and she'd lost too much weight in my estimation - took her to a different vet here in Florida and he prescribed Lantus x 2 per day, 2 units. FDMB said that's too high - start lower - so we've been working our way up dose wise since early January.

    Luci's diet is primarily Fancy Feast Pate - around 4 or 5% carbs if I'm recalling correctly. I've checked the Food Chart for other foods and have set them aside (HC or MC) for the emergency kit when her BG drops too low. She eats freeze dried chicken or salmon as a treat. Luci is a grazer and eats often. She gets fed after every BG test and along with every insulin shot - at shot time she gets about 1/3 to 1/2 can of FF pate; at testing times she gets another spoonful of pate and/or freeze dried salmon (lately, since we're working on a bag of salmon).
     
  14. Sue and Luci

    Sue and Luci Well-Known Member

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    We've only been giving Lantus since January - because we had a script for Novalin N and I was told by this group not to give insulin until she tested above 200...I wasn't testing very often because she was rarely above 200...and if she was it wasn't by much. So we were cautious...
     
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  15. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    Luci eats with every injection and every BG test - she gets a food reward - and sometimes in between when she's begging...so I try to keep the portion sizes down to a teaspoon or two...injection time feeding is 1/3 to 1/2 can of FF pate - her diet staple. Otherwise it's a few pieces of freeze dried salmon. She's a member of the clean plate club and eats everything in her dish. So she is already getting mini meals frequently...hope that's helpful.
     
  16. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    Our vet sent me an email today asking how Luci's numbers were doing - interesting because I was thinking of contacting him! Psychic? Anyway I sent her spreadsheet to him and this was his response:
    They are still high. I don't understand why you went back to 1.5 units
    Other than telling him that she was in a nosedive on two occasions from 1.75 - any other suggestions for my response?
     
  17. Wendy&Neko

    Wendy&Neko Well-Known Member

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    I see a new Luci pic. :)

    You can tell him you are thinking of increasing back to 1.75 units. She isn't holding reductions, try three times under 50 as I suggested above.
     
  18. Sue and Luci

    Sue and Luci Well-Known Member

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    Yes, Luci was looking so cute today - waiting by the doorwall to go out...just had to snap a new glam shot of my girl. :)
     
  19. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    So just to clarify - starting tomorrow on her AMPS or this evening on the PMPS?? - if she's still in the yellow or high blues, I'm going to go back to 1.75, test at 1+ to see if she's dropping significantly and feed her a little high carb food to stave off further big drops. If the addition of a teaspoon or so of high carb FF Gravy Lovers food will keep her from getting hypoglycemic then maybe she'll start to be more comfortable in the high greens - correct?

    I've been so worried about sending her blood glucose soaring I'm very careful not to feed her anything other than low carb foods.
     
  20. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    At your convenience. You've held the dose longer than you need to. After a reduction and the bounce is cleared, they should be seeing green again or it's a failed reduction. Yesterday was cycle 6 on this dose and no green.
     
  21. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    Ok then we'll start with our next PM dose - and get a 1+ to make sure she isn't going to hyper-respond tonight. Typically she waits a day or 3 before she starts to decline - and I'll be sure to get those 1+ over the next few cycles to try to catch the big drop early on - and will be waiting with FF Gravy Lover's in hand - that'll be a special treat for her - and she gobbles it up!

    Stay tuned :)

    And thank you for your advice! :bighug::bighug:
     
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