? AMPS 96 - insulin yes or no?

Unfortunately I forgot Bojangles #s to post so you may not be able to answer. Yesterday AMPS was 111, gave .5u. Lowest number was 61 at +4. Half a unit seems to lower numbers by 30-40 points. Should I attempt a .5 dose when her number is 96? I did give less than .5 this morning as I didn't want to drop her too low. Probably about .25 dose. Should I have given anything when she's under 100?

 

Hi,

Did you give the shot? And if so, are you going to be around to monitor your kitty's blood glucose?
(That 96 is a normal blood glucose number.)

Eliz

 

Only a token dose. About .25 as I thought it was a good number. Yes, I'll be with her.

 

Okey dokey.
She may be just fine. But be aware that, because Lantus is a 'depot' insulin, there will probably also be some residual effect from the 1 unit you gave last night. That may increase the effect of the .25 you've given this morning.
I'm guessing you'll be getting a test at +2 to see how she's looking?

You're seeing some really lovely numbers there. It's definitely an improving picture for your girl!

Please shout out if you need help at any point.

Eliz

 

Is there a good guideline to follow? No insulin below 100? 115? Thanks for your help.

 

Actually, the general guideline for those new to dealing with feline diabetes is that no insulin is given below 200. That's just until the caregiver has gathered some data and gets an understanding of how the insulin is working in their cat, after which folks will usually give shots at lower preshot numbers.
Many will not given insulin below, say, 150. But some experienced caregivers (and those using longer lasting insulins, especially Levemir) will sometimes give shots at numbers lower than that. It all depends on the cat....

Do you know about the Lantus protocols here? There are two; 'Start Low Go Slow' (SLGS) and 'Tight Regulation' (TR). They each set out different guidelines.

Edited to add: Here are links to the SLGS and TR stickies:
LANTUS & LEVEMIR - START LOW, GO SLOW METHOD (SLGS)
LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL

But not everyone follows a 'protocol'. Some folks just sort of 'paddle their own canoe' and do what seems to work for their kitty.
.

 

Is there a test result for Bojangles yet? How is she doing?

Do you have any higher carb food or syrup available in case her numbers drop too low?

And FYI, here is the link to the FDMB Hypo document. It is well worth reading it through and then printing it out to keep with your 'hypo kit' (high carb food etc):How to treat HYPOS - THEY CAN KILL! Print this Out!!
.

 

Do please post an update when you can.
Hoping all is OK...
.

 

Hi, Bojangles' #s seem okay...86@+3, 87@+4. I do have both high carb & Kari syrup.

 

I see the chart saying no insulin below 150....I'll also go to the support group pages. Guess I should hold off doses and speak w/vet tomorrow. Last guideline I had from her was preshot <180 give .5 unless nadir drops below 54 at which point no insulin...Bobo's lowest nadir was 61.

 

Looking nice so far.
With these improving numbers I'm wondering if you might be able to try a 'remission trial' very soon. It's looking really good for your girl.....
.

 

I thought you'd given one unit last night, but looked just now and saw .5 unit.... Sorry, my mistake....

 

No I originally incorrectly posted the 1 unit & updated that...that's my mistake. The vet was hoping she'd move to remission. If her numbers hold steady, I'll talk w/the vet before further insulin.

 

PS How nice to be "talking" with someone from the UK. This board shows just how small the world can be!

 

Hi Marcy,

Just popped in to see how things are going. Bojangles is responding really well to her insulin treatment.

.

 

There ya go, @Bojangles' Mom , you're now talking to two people from the UK. (And it's nice to talk with you too!)

I love that this is an international forum. There are members here from all over the world.
The vast majority are from the US (and Canada), but there are quite a few folks from the UK, and OZ and NZ; and there are also folks from many, many more countries, though in smaller numbers.
It's really nice to be able to talk with people from other countries - and continents. And it's a huge bonus that the international nature of this forum means there's usually someone online at any time of the day or night if anyone needs help or support.
.

 

Bobo did well today. Lowest reading was 86 (+3)...118 (+11)....121 PMPS. Will talk with the vet in the morning to see how they feel I should proceed.

Big thanks from New Hampshire!

 

Her PMPS was 121, so I didn't give insulin. +3 was 157 and this morning's preshot was 165, so did give .5 unit insulin. I did notice that she cleaned quite a bit out of her dish overnight so could be either or both the no insulin last night and the eating overnight that affected her numbers. Guess I should look into a small auto feeder that I can have close up at 4am to make sure I accurrate morning readings.

 

Auto feeders are a great help.

Just a note, Marcy. Lantus likes a lot of dosing consistency. It can take a number of cycles for a dose change to be effective so hopping between doses can lead to greater uncertainty several cycles hence. Bojangles' numbers are really good. Perhaps if you were to stick with a 0.25 unit dose morning and evening it might give you two preshot numbers high enough to give insulin more consistently. (@Chris & China - would appreciate your reviewing this suggestion, please. )


Mogs
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Thank you.

Happy to review a suggestion. How do you do that? Is it by liking a suggestion? Still learning the ropes - not super internet savvy since I don't have internet or cell at home/

 

Oops, Marcy. I see my above post was confusing. I tagged Chris because she's very, very experienced and I wanted her to check if what I had suggested to you was OK. I tend to be very, very conservative in my approach to insulin treatment and Chris may be able to provide better recommendations for you.

 

Ahhh..now that I see it from that point of view, can blame my morning brain. We only "skipped" one dose, last night since it was 121. Have reached out to the vet to learn their thoughts. I have some .5 syringes on order - should have today or tomorrow. Very hard to tell a .25 on the 1 unit syringes. As always, I appreciate your thoughts.

Do you have advice on a good autofeeder? I don't need anything huge since it will be only the overnight meals and I'll want to clean it up between uses since it's the canned food. Of course I realize what's available here and the UK could be different.

 

Cat Mate twin feeders (C20?) might be worth a look. They're basic but burgle-proof.

ETA:

They come with an ice pack so good for summer.
.

 

I am looking at those right now. My sister had the 5 meal feeder of these (I'll likely borrow hers to try since her kitties are no longer with us). With the 2-meal feeder, do you know if the door closes at an appointed time or does it stay open once it is open? That would be the main reason for me to buy one - to keep Bojangles out of the food from 4am-6am. I don't think I could get up at 4am to remove the food and get back to sleep again. I can put her meals out without problem mornings/evenings, and I can pick up the daytime dish at 5pm when I get home, so it's mostly for keeping her off from food in the wee hours of the morning when I really hope not to wake up to pick up the dish. She hasn't eaten enough by bedtime to justify picking up the food then.

 

I got a Catmate C50 but I sent it back. The timer on it is very clunky and imprecise, plus it needs a HUGE amount of space. Unlike the Petmate 5 which rotates the food tray compartments towards the cat, the Catmate C50 rotates the lid so the cat needs to move around the feeder at mealtimes. (You're talking about having the C50 in the centre of a circle of diameter 3' plus.)

The Catmate C20s will not re-cover food once the tray opens. If removing food is more important then I'd suggest the Petmate 5. If you set the food out in one compartment and leave the rest empty then you could set the timer to rotate the feed tray at the time you wish to pull the remaining food. Any meal remnants will be rotated under the lid, leaving an empty compartment at the feeding position.

.

 

Thank you. My sister does have the Pet Mate version. Right now, I think the covering of the pm food for the wee am hours is most important as I think she eats between 4-5am and that may scew the 6am pre-shot reading. However, that may also mean I get woken up at 4am as she's hungry with no food. Guess we'll trial & error the process to see what works best for her sugar and my sleep! Thanks for your advice.

 

Glad to help, Marcy. BTW, if you set the feeder up to provide a meal at 3am then rotate any remainder back under the lid at 4am it might help with the "feed me" furry alarm clock problem.

 

Good tip, thank you!

 

Actually, depending on which protocol you choose, I'd probably suggest going back to .5 twice a day until he earns a reduction

When you gave .5 when he was at 111, he had a beautiful green surf, the next morning at 116, another .5 and another green nadir (94)....there was no testing on the PM cycle (156) but by morning he was at 96, so the .5 you gave that night probably had him surfing more greens

Then when you only gave .25 that morning, although he had two more green numbers, he was also still "feeling the effects" of the higher dose depot (the .5) and then you skipped....and his numbers have been rising ever since

His numbers were looking pretty darn good at the .5 dose....I'd return to that dose until he drops below 50 (for Tight Regulation) or below 90 (for SLGS)...BUT you also need to decide which protocol you're going to use going forward.

Tight Regulation is going to give him the best chance at remission, but is more aggressive than Start Low, Go Slow is so it's not for everybody. You can also change your mind later if one protocol doesn't work out for you

Since you are fairly new and don't have a lot of data on Bojangles, I'd suggest a "stall and ask for help" limit of around 150 right now....This just means that if your preshot is below 150, stall, DON'T feed and post for help so someone can make sure they're watching out for you during that cycle

 

@Chris & China - Thank you.

 

Thank you. Unfortunately, in rural NH, I don't have internet or cell service at home and pretty much have to run to work weekday mornings as soon as she's fed & has her shot. Not really ideal for a stall setting. I'll probably keep to the .5 unless her numbers get too low. So far, she seems to have done well with the .5 unit. I'm doing SLGS (from what I've read anyways), so do you have thoughts on the SLGS and the 96 reading? Drop to .25 since I wouldn't be home with her if it happened on a weekday?

 

If you're doing SLGS, having him drop below 90 would have earned him a reduction to .25 back on 8/19

Lantus dosing is based on how low it takes them with only a little consideration given to the Pre-shot number....there are lots of us that will shoot anything over 50 because we have the data on our kitties to know it's safe (and can be home to monitor them)...and we're doing TR

The problem you're going to have is IF you keep changing the dose based on the Pre-shot number, you're not going to get the best results from Lantus....that being said, of course you also need to be safe

What time do you shoot and what's your schedule like? When do you have to leave for work and when do you get home?

 

I am away 6:30am-5pm weekdays. So I shoot as close as possible to 6am and then again at 6pm or as close as possible to the perfect 12 hours. The changes in shots were recommended by the vet. The vet said once below 180 preshot (and as long as nadir is above 54) to go to .5 dose. The 96 I wasn't sure of (and was at a time when I was "offline") which is why I dropped that dose to .25...and then it seemed others on here were recommending giving nothing when lower than 150 which is why I didn't dose last night.

Sounds like I should keep at .5 as she was responding well to that.

Does that mean if she drops below 90 again that I should start the .25 dose ongoing regardless of pre-shot numbers (whether it is 120-150 range or 120 and below). It's so confusing and it scares me to give too much when I'm not there to monitor her....or too little and have it not working as I'm giving too little.

 

It feels like we're stuck in between TR and SLGS...certainly we've done well giving .5 when she's tested below 150 (which SLGS doesn't seem to recommend) yet I'm not home enough weekdays to do the more fully "aggressive" TR on the lower pre-shot tests.

 

We talk about a "no shot" limit of 150...we really need to rephrase that because it doesn't necessarily mean "No shot"!

What we tell people is that once they're testing, have their spreadsheet going and are over here in the Lantus ISG that if they get a pre-shot of under 150, you should stall, don't feed and ask for help...at least the first few times so that someone with experience can make sure that they can keep an eye on you over the rest of that cycle in case kitty drops too low....As you get more tests in and more data on Bojanges, your "no shot" limit comes down...first it's 150...then you learn how he does and then maybe a few days later you'll shoot a 140...then a 130....etc. etc. etc... (This would be what I'd call Tight Regulation protocol, NOT SLGS)

If you're going to do the strict SLGS, then yes, if he drops below 90, you should reduce ALL his shots to .25

 

Just saw your last comment...Yes, you're kind of stuck between the 2 protocols at this point!

We do have people here who do TR, but "modify" it to fix their kitty....that may mean giving a "light" shot when you can't be home to monitor and his preshots are low, but what a lot of people do is get an autofeeder or just make sure to leave down food for their cat if they shoot a lower number and have to leave

Here is a great sticky on "Can I do TR with a full time job"....read it and maybe it'll help clear things up for you on which protocol will work best for you

 

Thank you....that clarifies a lot. Sounds like I should continue at .5 until we measure below 90 and then drop to .25 units ongoingly to see if .25 will maintain us? Unless her preshot numbers climb and stay higher in which case that would be going back to .5?

 

Well that's where we're on a fuzzy line....if you're doing SLGS, you drop when they drop below 90 and HOLD it for a week, then do a curve to decide if you should go up again or hold where you're at

On TR, as soon as you see the numbers trending up, you go back to the last "good dose"

 

Thank you...I do believe while "stuck in the middle" that I'm closer to SLGS. That seems to be the best way given my time away from home. Thank you for clarifying some of the information on here. We'll keep to .5 until we go below 90 and then will attempt .25 for a week and see how it works. Thank you!!!

 

You might want to add SLGS to your signature line so if you ask for help again, people will know where to start from

 

Thank you, I'll do that. Bojangles numbers last night at +3 and +4 were under 90, so that means we get to drop to .25 units and trial that for a full week...correct?

 

Yes, Marcy. Then you do a curve to decide whether to hold, or increase.

NB: If Bobo drops below 90 again on the 0.25 IU Lantus dose during the week, post again for advice.


Mogs
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Great, will do. Since I'm "offline" for the most part at home without internet and cell, if she dropped below 90, should I skip a dose until I connect here? It would mean a full skip of a dose since unless it is a weekend I wouldn't be back home until her PM dose.

 

Maybe tag Chris and ask for further advice on how to proceed? The reason I suggested you ask for further advice is that if a cat seems to be heading for remission it can be beneficial to taper the dose down to c. 0.1 units Lantus for a period; and if the numbers hold you then run an OTJ trial. The taper can boost chances of a strong remission. I don't know what the FDMB guidelines are for the taper or whether it is applicable to cats following SLGS. Chris should be able to give you much better guidance on this. If you ask ahead of time, then you'll know what to do when you can't access the intertube.

(I ended up using elements of the Tight Regulation protocol tailored to meet my and Saoirse's specific circumstances. Her first OTJ trial wasn't a success so I reinitiated Lantus treatment and the second time round did the taper. Saoirse's second OTJ trial was successful.)


Mogs
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@Chris & China: Do you have thoughts on this? I've dropped Bojangles' dose to .25 as she was below 90 last night. Since I have to "shoot and scoot" (give Bojangles her dose and immediately head to work Mon-Fri) I won't be able to ask for advice about shooting and if I should shoot what dose if her numbers fall below 90 this week while on .25. Do you advise a taper? How does one measure a .1 unit? I should have .5 unit syringes this evening when I arrive home, so the .25 at best is eyeballing half of that. How can I measure .1 units?

And thanks Mogs!

 

Marcy, I dropped to .1, but I was doing Tight Regulation. As far as measuring, I went just a hair below the plunger line on the syringes with the .5 markings. I have also seen, holding the plunger in tight, inserting into the inverted vial, and letting go of the plunger. Essentially gets a drop or two. I would assume that following the SLGS and reductions under 90 that going to .1 would be advisable.

 

I used that method as part of Saoirse's taper.
.

 

Thanks, I was trying it last night into water with food coloring so I could have a comparison for myself. Doesn't work as well when you can't invert what you're trying to draw from. Inverting was key!

 

She went below 90 on the .25 dose last night, but only to 84 as far as I could measure through the +4. She tends to drop in the +3/+4 range and then starts to rise. Can't wait for those darn .5 unit syringes to make measurements a bit easier (shipment was delayed, so anxiously awaiting). Does anyone have thoughts on staying .25 or if I should try the .1? Her AMPS was 116 this morning. She seems to be doing fine on the .25 shots and not dropping too low, but we've only just started with the .25 doses - only a couple of days in.

 

Can you get any mid-cycle spot checks in today, Marcy?

ETA:

There's probably still some influence in the depot from the 0.5 IU.

 

This evening at +11 and the PMPS and up until +4 after that. Today I'm at work.

 

That sounds good. Maybe post the AM+11 and PMPS and ask for suggestions later? Bobo's responding really well: you're doing a great job with her.

 

Thank you. I'll do just that. Can't post until tomorrow morning, but will do so. I'm not too concerned that she's getting too low as thankfully my mom stops in mid-morning and makes sure she has a bite to eat (she needs to be reminded sometimes - wish I had that problem). But if I can move her even lower, that's even better! (Lower on the doses that is!)

 

Lucky you getting help from your mom. (Hi, mom!)

If you get the +2 or +3 looking a lot lower than preshot then monitor closely. Bobo held that reduction from <1 down to 0.5 really well. Fingers and paws crossed (and lots of anti-jinxes) that she will gradually drift gently down fully into normal numbers.



If it was my cat and I was in any doubt about safety, assuming no ketones or DKA risk factors were in play, I would skip rather than risk her going too low if I wasn't able to monitor her at lower numbers.

 

Thank you for the good wishes and thoughts. I forgot to put on her spreadsheet that I did check ketones and those are still negative....I'll add that now.

I'm thankful my mom can check in on her as well, but in our family Bojangles IS her grandkitty.