8/7Alley AMPS 319; +3259, +297 (dose too high or low?)

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Kerri B., Aug 7, 2018.

  1. Kerri B.

    Kerri B. New Member

    Joined:
    Jul 16, 2018
    Looking for some advice about Alley's numbers this last week post dose increase. On 8/1 the vet increased her dose from 1 to 1.5 U. I got excited because we had our first blue the next morning, but she's been all over the place since then. Today her AMPS was especially high (note: all of the pink AMPS have occurred on days where Alley vomited/hairballed (different than a vomit, no?); today she hairballed early morning, and then vomited her mid-morning snack almost immediately. I haven't been able to test for ketones yet, but I have strips at the ready and am standing by.

    Based on her numbers, I'm wondering if she needs more insulin, of if it's possible that the .5 increase was too much for her and she needs 1.25 instead? At 1unit she was almost entirely in the yellow, but she was pretty consistent day to day. Thoughts?
     
  2. Kerri B.

    Kerri B. New Member

    Joined:
    Jul 16, 2018
    Coming up on pm shot. Any thoughts on dosage?
     
  3. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Are you following Tight Regulation or Start Low Go Slow as your dosing method. Suggestions may vary based on the answer,

    Any chance of getting some night time tests, even before bed? They might explain the morning pinks. How about holding the dose, getting a later test tonight, and then deciding?
     
    Kerri B. likes this.
  4. Kerri B.

    Kerri B. New Member

    Joined:
    Jul 16, 2018
    Thanks for your reply and suggestions. I honestly don't know if I'm doing TR or Start Low Go Slow--I guess the latter? I was waiting to get vet confirmation for the first dose increase, but now I'm not so sure waiting was the right call. I'm diligent with testing throughout the day, though when the vet saw my chart last week, he didn't think all of the tests were necessary. I'm keen to try the TR protocol, especially if that means getting Alley at the right dose and stabilized again. I'll reread to make sure I've got it down. I thought we were moving in the right direction, but now if feels like we're starting from scratch :/

    I'll hold the dose tonight and test before bed. Related, I just managed to test ketones (negative, yay!)...I never thought I'd be so excited to catch cat pee, but here we are.
     
    Sonia & Leo likes this.
  5. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Negative ketones is great!

    Many cats go lower at night. We dose based on howmlow the dose is taking the cat, hence the need to see what is happening then.
     
    Kerri B. likes this.
  6. Kerri B.

    Kerri B. New Member

    Joined:
    Jul 16, 2018
    Update and questions: I bumped Alley up to 1.75 last night, got a couple pm tests in, then she vomited with hairballs early am. I expected amps to be sky high as they’ve been post-puke, but were average for her at 247. Today went from +5 112 to +7 71 and now I’m getting a little nervous. Gave her snacks after both, she’s not super ravenous but she’s eaten. I’ll test again at +8.

    What I’m concerned about is:

    1. Should I be on the lookout for a hypo today given how fast she dropped? Maybe that’s fine at peak?
    2. Or perhaps a bounce in the next few days?
    3. What’s the shootable PMPS number tonight, and how will I know whether or not to stay the course at 1.75u? The TR protocol variables for this part confuse me.

    Any suggestions or reassurance seasoned veterans can offer as we dip into the green for the first time would be super helpful. Thanks a million. We’re kinda new here
     
  7. Kerri B.

    Kerri B. New Member

    Joined:
    Jul 16, 2018
    Got nervous +7.5 91. That feels better.
     
  8. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    First, congrats on the first green! That's great progress. :D When you first see them in green, it can be helpful to give a spoon or two of their regular low carb food. That can help them surf, or hang out in those healing green numbers. How is Alley feeling?

    If you want to follow TR, please put TR in your signature. That way people will know how to help you. With TR you don't decrease until you see a number under 50, so you would hold the course. If you were following SLGS, you would reduce because she went under 90.

    There's a decent chance she'll bounce, but no guarantees. ECID - each cat is different. In the beginning, Neko was 100% going to bounce. :rolleyes: It's possible some of the morning pinks you have been seeing have been bounces from her going green overnight. Today is a good day to gather data and learn about Alley on Lantus.

    As for how low to shoot, again if following TR, we suggest that if you get a preshot number under 150, you stop, do not feed, and post here for help. There are several options you can choose, which are situation dependant. If you do get an under 150, I would create a new post for today (which we suggest a new post daily anyway) with a subject line something like "help with preshot, first time under 150".

    Make sure you have a good supply of test strips, and some high carb canned food or karo around, just in case you need it. As long as we are monitoring and can feed, we can bring them up out of low numbers. Cats usually don't show hypo symptoms at under 50, though again ECID. My non diabetic cat tested in the 40's, we just don't want cats on insulin to go that low.
     
  9. Kerri B.

    Kerri B. New Member

    Joined:
    Jul 16, 2018
    Thank you thank you thank you!! This is all super helpful. Green feels like progress but is also terrifying for a newb. When I got the 71 at +7, I gave Alley a snack; by +7.5 she was up to 91. She's been a little sluggish today, but seems pretty content, grooming, napping, getting irritated with ear pricks, etc.

    In your opinion, do you think it would have been ok to hold Alley at the 1.5 for a bit longer? I'm only asking as want to make sure I'm going about this the right way, and being so new at reading her numbers and analyzing her SS, I haven't yet built up my confidence with this whole thing. Alley was solid yellow for her first week and I'm kicking myself for waiting for the vet to tell me what to do. In any case...

    I'll reach out with a new post if the PMPS number goes low. Meanwhile, I'm hypo ready with HC food and sugar solution, and will grab extra strips today. Thank you again for your suggestions. I can't tell you what a tremendous relief it is navigating this whole thing with such knowledgeable people who just get it.
     
  10. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I think you were right to increase to 1.75 units. Whether your end goal is regulation or possibly eventually remission after that, you want them to see green numbers. 1.5 units doesn't look like it was doing it.
     
    Kerri B. likes this.
  11. Kerri B.

    Kerri B. New Member

    Joined:
    Jul 16, 2018
    Quick update: PMPS was high, so I guess Alley is a bouncer. Started to come down last night, AMPS within her normal range, so hoping we'll trend down again like yesterday to see some blues and greens.

    Side note, the goal is absolutely remission...I have an international move planned for December that I hadn't even considered Alley might not be able to come along for...keeping in mind the stress of travel and high elevation (we'll be in the Andes) will be tough on her little body in the best of circumstances, I'm trying to do what I can to get her stabilized and off insulin to help increase the odds that we can stay together. Fingers and paws crossed
     

Share This Page