AMPS 290/+2=116/+4=51/+6=86 ...

My first attempt at curving Woody every 2 hours. So far, it seems he really dropped FAST after I gave him 3 units of Lantus. Is this normal? So far, does 3 units look like the right dose? Too high? He has neuropathy now and I am trying to better regulate him.
I will post full curve later but NEED ADVICE on what to shoot at +12! THANKS ALL!
BTW, what is a vine and what is a condo??? I'm a newbie

 

Hello Ellen and Woody

Welcome to lantus/levemir land. A condo is this thread you have posted (woody's home) most of us post daily so others can get to know our cats and give the best tailored advice. Especially good for newbies because often you don't even know that there's a question that needs answering at this point. Sending vines originated from a typo years ago when someone was sending good vibes. It stuck and we now have vines for everything

I would encourage you to read the stickies (the threads stuck to the top of this forum) to learn more about Lantus, particularly the ones about how to handle your Lantus and how to deal with low numbers - that one is a good one to print out and keep handy too.

Well done on getting Woody's first curve. It does show that Woody is getting too much insulin. To help us decide on a more appropriate dose can you please provide a bit more information as follows:

What and when (in relation to his shot times) is Woody fed and have you changed his diet at all since diagnosis?
How much does he weigh and if this is not his ideal weight how much should he weigh?
When was he diagnosed?
When was he started on lantus and how have his doses been adjusted so far?

For diabetic neuropathy you want to get Woody zobaline tablets (methyl B12). They have no taste you just crush one per day on top of his food. These tablets are designed specifically for diabetic cats and, combined with regulation, work wonders and often result in complete recovery from the neuropathy.

You will be wanting to set up a spreadsheet for Woody's BG results and attach it to your signature - see the tech forum for instructions. The spreadsheet is a marvelous way to keep track of Woody's progress and is necessary so you can receive appropriate advice.

 

I found your first post back in September of 2013. You were starting with 1u of Lantus at that point. I think Serryn is assuming you just started insulin when she's suggesting the dose might be too high - if he'd just begun on insulin then yes, but since you've had him on Lantus for 18ish months now, it might not be too large of a dose.

It would be helpful to have more information - one essential bit in addition to what Serryn asked above is about the meter. Are those numbers you've reported using a human glucometer or an AlphaTrak or other pet glucometer. If you are following the Start Low Go Slow method of dose adjusting, you would decrease the dose because he went below 90. If you are following the Tight Regulation Protocol's dosing then the dose is reduced if a cat goes below 40 - both of those figures are for a human glucometer. Pet glucometers read about 30-40% higher.

If you can give us a little more info we can give you a hand figuring out how to move ahead with Woody.

 

Hello and welcome to this forum. Woody is a very handsome cat.

It will really help us help you if you can get that spreadsheet set up. The instructions are here. Don't worry too much about going all the way back to 2013, even just getting the data in for March will be a great help to us.

 

Hi all you good people. We free feed Woody low carb (<- 6%) wet food only. No dry. I let him feed himself through the curve and he was especially hungry during his 51 nadir period. I use an Accucheck human glucometer. I recently validated it against my vet's meter and mine was maybe 10 points higher than their read. He is about 14-15 pounds and at ideal weight. I am from the old school where we based our doses on the pre-shot BG, so I have been moving him between 2 and 3 units every 12 hours (2 if he is 200-ish, 2.5 at mid 250-ish, 3 at high 200's or higher. Sometimes fat 3 or 3.5 if in the 300s).
It is really hard for me to grasp the depot concept and how to work with Lantus. I will post the latest numbers for all on a new thread. I'd really appreciate if you can take a look and give advice for what to shoot at +12.
Ellen

 

You don't need to start a new thread. With the number of people here, one a day is enough. You can change the subject line or add a question there if you have a new question.

Without the spreadsheet, it's hard to give dosing advice, but I think I'd try 2.75 units and stick to it for a while as the 3 units seems a bit much. There are no syringes with .25U markings. You just have to use the ones with half unit markings and eyeball it. It helps to fill and old syringe with colored liquid (juice, tea) so you can replicated what you use for 2.75U.

Many vets who are used to the older insulins are used to dosing on the preshot. Moving the dose around for Lantus can get you some wonky numbers. With Lantus and Levemir we dose according to how low the dose can take a cat. That means holding the same dose for at least 6 cycles, unless he gets a nadir lower than we want.

 

It can be a real adjustment for people to get used to dosing based upon the low point in the cycle instead of the preshot.

There is a great information post at the top of this forum about the insulin depot that occurs with Lantus and Levemir. These insulins sort of slow release in the body...so much so that if a cat has been on, for example, a dose of 2 units for the past few days and the dose is reduced to 1.75u tonight, the depot from the 2u dose is still influencing blood sugar for the next 2-3 days. You may be unknowingly contributing to the wild swings in his blood sugar by changing his dose all the time. This is also behind our reliance on the spreadsheets that everyone is mentioning. Because of this depot action we look at tests in the context of previous dose changes. The spreadsheets are a really important tool with these long-lasting insulins.

Lantus has the ability to cause flat cycles if it's dosed right. Take a look at some of today's subject lines. People post tests as they get them. You'll notice several that have basically flat cycles. A cat feels better when they don't have wildly swinging blood sugar.

I'd encourage you to post daily or when you can for a while to learn a little more on how Lantus works best.

 

From Other condo

Without having more data, I wouldn't shoot 3 units again. We don't know if he dropped below 50 today and it looks like he may very well have. Looks like these are today's numbers?

AMPS 290. Gave 3 units Lantus/+2= 116/+4=51/ +6=86/ +8=161/ +10=303!

Can you shoot again in 12 hours or how flexible is your schedule? You can adjust shots 15 minutes per cycle or 30 minutes per day, so being off by 30 minutes right now isn't too hard to recover from

 

So does a change of .25 units make a difference? I shot Woody 2.75 tonight at 360 BG after I gave him 3 at 290 BG this AM and he dropped too low (51). I do have the U 100 syringes with the half units, so I can read approx. 2.75.
THANK YOU!!!
Ellen

 

Woody was 360 at +12 hours tonight and I gave him 2.75 units, which is the best dose I could glean out of all members' good advice. Basically, I needed to reduce the dose to flatten out his BG reaction a bit. But does a .25 unit reduction really make a difference??? He ate lots at BG of 51 and that probably added to his spike upwards to end at +12= 360.

 

If you already shot 2.75, you may have an exciting night. If his depot is over-full, decreasing by .25 tonight may not keep him from going below 50 on tonight's cycle.

Without knowing how much you've been shooting over the past several days, it's really hard to know what he might do

If what you fed at +4 when he went to 51 was his regular low carb food, it probably didn't have much to do with his high number tonight. It's much more likely it's a bounce from the low number today

If Woody were mine, I'd make sure to get a +2 tonight to see how fast he's dropping (he may not..he may continue to climb since we don't know how bouncy he is) and let us know what you get

 

Yes, 0.25u changes in dose can make a significant change in blood sugar.

 

Woody's AMPS was 294 and I am giving him 2.75. I definitely think this reduction helped (yesterday I gave 3 units at 290 and he had a low of 51 or lower), as he still had food in his dish this AM. If he had dropped to 50 or lower in the night, he would have been ravenous and eaten all his food and then woken me up. So I think I am slowly getting the picture.
I have to go to a brunch but can test him again at +5 today. Once my houseguest is gone, I will dive into the spreadsheet. THANK YOU EVERYONE!