? 5/20 Dora AMPS 360

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Dora the Explorer, May 20, 2020.

  1. Dora the Explorer

    Dora the Explorer Member

    Joined:
    Apr 24, 2020
    Hi,

    This is more a longer term question than urgent. Dora is on 0.5 units of Lantus and is clinically doing well. She eats mainly fancy feast classics or Friskies pate, I feed her 3x/day after testing and a snack around 9-10pm (Weruva pouch).

    We have been keeping up on testing her as regularly as she will tolerate, she is being so good. We seem to be in a pattern of semi-high preshot readings and acceptable midday. Are we on the right track?

    Questions:
    1.At what level would we skip if we saw a low preshot reading?
    2.Does this dosage seem appropriate? It’s been a little over a week for her.
    3.The Lantus pen has a lot of air in it. Is that bad? No particles or cloudiness. We were told to gently roll the pen but I see the opposite here. Same with drawing back and pushing back into the pen. I couldn’t confirm on their site although it does say to inject air into the vial. How is the vial different from the pen?

    Thank you, as always, very grateful for your thoughtful advice!
     
  2. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    Can you please remove the GA and add the ? icon to your subject line. GA means a kitty has passed away. Thanks.
     
  3. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    It is okay if you end up with air bubbles in the pen. That does happen sometimes. As long as it's not cloudy it should be okay. You don't want to push insulin back into a pen because it is pressurized and the helps push the insulin down so you can draw it out with the syringe.

    Here is a good link for reading about taking care of you insulin.
    http://www.felinediabetes.com/FDMB/...info-proper-handling-drawing-fine-dosing.151/
     
  4. Dora the Explorer

    Dora the Explorer Member

    Joined:
    Apr 24, 2020
    Oh no! That was an accident. I’m on a phone - can’t find how to change the title?

    whew, I found it. Thank you!
     
    carfurby and Sonia & Leo like this.
  5. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    At first, if you get a Pre-shot number under 150, you should stall, don't feed and test again in 20-30 minutes. Use that time to post and make sure your subject line is really clear...like "STALLING! NEED HELP!!" usually works...LOL

    We want to see if that number goes up without the influence of food. If it does, that's a pretty good sign that the last shot is probably wearing off and it's OK to go ahead and shoot. We usually suggest getting a +1 and +2 at least the first few times you shoot a lower PS so if you need to intervene, you can do it early.

    As you gain experience and data, that "stall point" comes down. I'd shoot China if she was above 50 (she was on Tight Regulation)

    Before you go up, I'd like to see you getting a few more tests on the PM cycle. Most cats go lower at night so it's really important to test on the PM cycle too. You don't necessarily have to stay up all night, but try to get at least a +2 or +3 every night. A lot of us would drink a large glass of water in the evening so we "had to" get up in the middle of the night...and as long as you're up, you can grab a quick test!

    Without tests on the PM cycle, you're missing half the data on what's going on. That's like trying to figure out what the puzzle picture is when you only have pieces filled in on one side.

    The vial needs to have air pushed in to equalize the pressure so you can get the insulin out easier. The pens have their own mechanism to do that so you shouldn't insert more air. Most of the time by the time you've used some out of the pen, you're going to see some air but it won't hurt anything.
     
  6. Dora the Explorer

    Dora the Explorer Member

    Joined:
    Apr 24, 2020
    Hi -

    I’m getting a bit upset and apologize if I’m not properly sharing via an older post. I’m concerned that we were on the right track with Dora and something is wrong now. She started on 1 unit of Lantus and was switched to 1/2 when she has a reading of 71. She seemed to be stable until a few days ago when all of a sudden the insulin seems to be having no effect.

    I called the doctor yesterday and she had her tech call me back and say continue at the half and don’t test her again till Tuesday! What do I do? This is a new doctor for me. Dora has a bad experience at my regular vet and she gets feral when we go there. She’s very good for this new vet.

    She’s just been lying around a lot today so I checked her at +7 and she’s in the 400s! Am I suddenly doing the shots wrong? Did something happen to the insulin and it’s not working anymore? What is going on?

    I hate this helpless feeling. I trust everyone on here but at the same time how do I handle a vet who gives conflicting instructions?

    Dora is eating almost exclusively FF or Friskies pate. She has a few bites of dry low card food with her shots but way less than ever before. Should I contact the vet and tell her we tested against her advice and the level was even higher? What do I do?
     
  7. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    A lot of vets don't understand hometesting. You don't need to call the vet back and tell her you tested more than she said. A lot of people here adopt the smile and nod method of dealing with the vet if the vet won't work with them on hometesting. That means just smile and not when the vet says don't test very much and then test as much as you need to in order to keep Dora safe. From looking at her SS it looks like what you are seeing is bouncing, which is a perfectly normal part of the process. Bouncing happens when the cat drops into number their body is not used to or drops really fast. If you look at the 19th you see that 170. If you follow the numbers after that, they go up at PMPS and at AMPS the following morning. That is a bounce. It looks like on the 20th Dora started to clear the bounce and then bounced back up to 444. Some cats will have a secondary bounce like that. Since you didn't get any tests after the 391 at AMPS on the 21st you don't know how low she went. It looks like she did come down some and is bouncing again with the 421 today. That is one reason it's not a good idea to not test.

    Have you decided if you are going to follow TR or SLGS? That will make a difference in what dose advice you get. It looks like you need more testing to see how low Dora is really going on this dose. I know the high numbers can freak you out, but remember dosing is based on the nadir (how low the dose takes her). You should always get the PS test and at least one more test each cycle. A lot of people get a before going to sleep test for the PM cycle. Then we can help you adjust the dose to get Dora in better numbers and get her feeling better. Hang in there. It takes time.
     
  8. Dora the Explorer

    Dora the Explorer Member

    Joined:
    Apr 24, 2020
    Thanks very much! I’m not totally clear on SLGS but I think that’s us since Dora can have a few bites of her Tiki Cat dry occasionally. I’m not as worried about not telling the vet that we test a lot as I am about adjusting a dose without talking to her and then having a problem and having to admit it. I’m ok with more testing and will definitely do. How long would I expect this to last if it’s a “bounce” and is it dangerous for her to stay high? She as 450 when diagnosed.

    Other than moping she seems fine. Eats, plays, and since her very first shot she has lost her obsession with drinking. Her coat is sleek and free of dandruff now.

    My other cat is near the end - took her for a blood check yesterday and she was sent home without as she is so sick with abdominal growths that nothing will matter - and Dora is my youngest. It’s so frustrating!
     
  9. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    I'm so sorry about your other cat. I hope you can make her as comfortable as possible. It's never easy. :bighug::bighug::bighug:

    It sounds like Dora is already showing improvement. It does sound like SLGS is what you need. Can you add that to your signature so people won't keep asking you?

    With SLGS you need to do a curve once a week to see what her nadir is so you can adjust the dose if needed. The higher numbers are not ideal, but I don't think they're as bad with just bouncing vs. staying high all of the time. You can't rush bringing them down. As you follow SLGS and increase the dose, Dora will get into lower numbers and her body will get used to them and eventually the bouncing will settle down. It's hard to say how long a bounce will last because every cat is different. After PMPS test tonight, it is a good idea to get a +2 to see if it looks like she will come down tonight. If you are able to adjust your schedule, it is a good idea to get a +10ish or +11ish test before AMPS so you'll know if she's going up or down at AMPS. I was able to adjust my schedule to do that with Furball and found it very helpful.
     
  10. Dora the Explorer

    Dora the Explorer Member

    Joined:
    Apr 24, 2020
    Ohh I have SLGS in the spreadsheet where it asked me to put it. I’ll add to the signature. Should I be increasing her dose with these higher numbers? This is what makes me nervous. Will check her again after her night shot to see. Poor thing had a couple of days off. How do the ears survive this? Thank you
     
  11. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    Are you putting Neosporin with pain relief on her ears? A lot of people use the to help the ears heal. I put just the tiniest dab on Furball's ears after a test. If you put too much, it may keep a blood drop from forming. If you know you're done testing for the night, you can put more on the ear for the night.

    You'll need to do a curve to see what her nadir is before you make any dose increases. Can you do a curve tomorrow? A curve is normally a test every 2 hours.
     
  12. Dora the Explorer

    Dora the Explorer Member

    Joined:
    Apr 24, 2020
    Yes to Neosporin. I put it on after as of now. Her ears look fine, not really too scabby. I just think after months of this they won’t look so good. Not sure about a curve tomorrow. Maybe Monday since I’m supposed to check in with the vet on Tuesday. It also drives me crazy that the vet has her tech call back. I have another vet that I’m so comfortable with for my other pets and just wish Dora would go there without freaking out. She starts with that guttural growl even before she comes out of her carrier.
     

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