? Malacahai's AMPS 536- Looking for guidance, should I increase dose?

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Deena and Malby

Deena and Malby

Member Since 2016
Hello,
Looking for guidance on dosage and to help me get Malachai regulated.
I'd like to better understand his numbers. I know I need to start changing up how I test w/more Pre-test. I'm hoping I didn't miss a good dose!?
Malachai's AMPS was 536 and I ran a curve yesterday. I did raise his dose to 3.75 this morning (from 3.5) although I can go back down if that is the consensus. I do feel that he needs an increase though.
Not sure why I can't seem to get his numbers down. Might be a high dose cat??? HELP!!!
Malachai has been diabetic for 7 months and is still unregulated and still in high numbers. His BG seems to be higher lately but he does alteast seem to have a consistent "flatter smile" on his numbers.
The fantastic folks on this site gave me some great suggested yesterday and suggested I post today for guidance...a link to yesterday's conversation is provided below.

Thankyou!!!
Deena and Malachai aka Malby

http://www.felinediabetes.com/FDMB/...-two-meals-a-day-or-many.180378/#post-1998174
 
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Hi. Please read yesterday's advice again. Chris suggested you increase. You did. Now hold the dose, get all the tests you can and see what happens. It would help to read the protocols again. I know it took me awhile to fully understand how depot drugs work.
 
good morning Deena,

Good job on curve yesterday. Glad that you increased his dose

He maybe a high dose kitty, but too soon to tell. All cats are different and some cats make you wait until you get closer to the right dose.

At the moment you will just need to be patient, test his BG before you shoot and those mid cycle and before bed shoot. Like you did yesterday do a curve once a week. If you can get additional tests in that is good too. This will give you enough data to look at how he did with the current dose by looking at last week data.

Do you test him right when you get up in the morning?
 
Marvin's Mom - Nat said:
good morning Deena,

Good job on curve yesterday. Glad that you increased his dose

He maybe a high dose kitty, but too soon to tell. All cats are different and some cats make you wait until you get closer to the right dose.

At the moment you will just need to be patient, test his BG before you shoot and those mid cycle and before bed shoot. Like you did yesterday do a curve once a week. If you can get additional tests in that is good too. This will give you enough data to look at how he did with the current dose by looking at last week data.

Do you test him right when you get up in the morning?
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Hi Nat,
Yes, I test him right when I roll out of bed at 7am. He is fed right after and then injected at 7:15am.
 
That's good. Right now if you just get a mid cycle in the morning, and focus on some evening test that would help a lot.

What are your work hours, or are you off at the moment?
 
Hey Deena, I see you did increase today which was suggested yesterday. I hear your concern with him not being regulated as of yet but, remember, he has only been on Lantus since 3.21.

The more data you get the better it helps to figure this sugar dance out. As it was said yesterday, always get a pre shot number. It is just not safe to shoot blindly like that. And if you could get more test in at the PM cycle that would help too. With Lantus, the dosing is based on the nadir so those are 2 other important numbers to get as well. Without them, you could be holding a dose that is too high and he could be bouncing and looking like he doesn't have enough insulin. All data is good data.

Post daily for guidance if you are unsure. Peeps are from all over the world here and someone is usually online that will be able to help you.
 
Hi Deena.

I'm glad to see you are starting to get your preshot tests in. I cannot stress enough how important they are. I would also encourage you to do everything you can to try to get some nighttime tests in - at least a "before bed" test. Many cats go lower at night. Some people here set alarms so they can get up and grab a +5 or +6, and some drink a lot of water before bed and use nature's alarm ;).

I'm glad you increased the dose. Now if you work on getting those tests in, we'll see where to go from there.

Something many of us were told at the beginning: this is a marathon, not a sprint. We all want to see results right away (this is the age of instant gratification, after all), but with FD that doesn't always happen (in fact, most of the time it doesn't). Here's a pair of patience pants for you:

8578459_orig.jpg


We've all had to wear them, at some point!
 
Bobbie And Bubba said:
Hey Deena, I see you did increase today which was suggested yesterday. I hear your concern with him not being regulated as of yet but, remember, he has only been on Lantus since 3.21.

The more data you get the better it helps to figure this sugar dance out. As it was said yesterday, always get a pre shot number. It is just not safe to shoot blindly like that. And if you could get more test in at the PM cycle that would help too. With Lantus, the dosing is based on the nadir so those are 2 other important numbers to get as well. Without them, you could be holding a dose that is too high and he could be bouncing and looking like he doesn't have enough insulin. All data is good data.

Post daily for guidance if you are unsure. Peeps are from all over the world here and someone is usually online that will be able to help you.
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Hi Bobbie,
Yes I remember reading that the dosage for Lantus was based off the Nadir, that's why I have so many mid-day tests. When I first started testing, I really wanted to figure out at what time he was at his lowest.
I was originally skipping the pre-shots as he was just always high at +12 (and he's really hard to keep still in the morning because he's a frantic hungry Bengal).
I assumed I would start incorporating the pre-tests once his numbers started to go down although I now realize that those numbers also help everyone here recognize if he's being under or overdosed. I'm trying to get those pre-tests in but for the 99.9% of the time, he's testing in the 400-600 range for pre-tests.
 
Deena Traina said:
+5 378
I just don't understand why he is testing higher when he was testing in the mid-200's (occasionally) on lower doses?
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With a AMPS of 536, he had a higher starting point. But, with filling in the SS with some more data especially in the PM cycle ( a lot of kitties go lower at night) then we will know if he is going a lot lower in the PM and bouncing up in the AM.

As far as him hitting mid 200's on a lower dose, their insulin needs are constantly changing; what worked earlier can become not enough later on. It happened with Bubba and it is frustrating. It wasn't until Bubba got up to 5.25 units until he started earning reductions and coming down.

Keep on keeping on Deena and we will all try to help you figure it out along the way. :bighug: I see that Tricia gave you a pair of patience pants to wear. I have a nicer pair ( no offense @Tricia Cinco(GA) & Harvey ) and since it's summer time, you might like these. They are a littl too tight on me. Well, actually, they are way to tight on me LOL

upload_2017-7-11_16-47-31.png
 
Unfortunately, cats are complicated. You will also learn that different food affect their numbers, sometimes they may have an infection which is pushing their numbers up. Marvin had a couple UTI early on when he was dx. Teeth problems also affect their BG. Some cats react quickly and some don't. With Marvin, the only reason he is doing well now is that we were able to confirm he had a problem. A lot of patience is needed with kitties that don't react to insulin quickly. If you want to go quicker you would need to take a like at the TR approach, testing is even more important with this approach. I If done properly I think you can increase every 6th cycles (3 days) depending of course on the numbers. am not familiar with it, so maybe someone can provide you more information about it. This would have been a better approach at first for Marvin, but I didn't feel comfortable as I was working, and all the testing needed to make sure you don't miss a good dose and that it is safe to increase.

The following link, near the middle of the page has a section about Approaches to Regulation, you may have already checked it out, if not here's the link: http://www.felinediabetes.com/FDMB/...the-basics-new-to-the-group-start-here.18139/

If the TR approach interests you I would definately look to chat with someone with lots of experience with it and see if they can guide you through.
 
PS: For me Marvin's numbers didn't make any sense to me until he started reacting to the insulin or when someone would point something concrete out to me on his spread sheet. For example his Nadir is not always mid cycle, it is often late in his cycle on or after +8 or +9, a few time even later. So finding a pattern is difficult at first. You are doing great, asking good questions and willing to try some suggestions.
 
Marvin's Mom - Nat said:
PS: For me Marvin's numbers didn't make any sense to me until he started reacting to the insulin or when someone would point something concrete out to me on his spread sheet. For example his Nadir is not always mid cycle, it is often late in his cycle on or after +8 or +9, a few time even later. So finding a pattern is difficult at first. You are doing great, asking good questions and willing to try some suggestions.
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Hi there,
I don't think my schedule would allow me to test enough for TR.
I had his urine/blood tests done 6 weeks ago and everything checked out fine. I took him in again to rule out dental issues (he has a lot of saliva, it's very obvious when he cleans himself) and the vet thought Malachai might have had some inflamed gums on one side so he put him on Clavamox for two weeks to see if that would lower the numbers in case malby had an infection. That didn't lower his numbers at all (or raise them) so I'm assuming he didn't need to be on the Clavamox.
Luckily for me, his numbers seem to be pretty consistent. Super high in the AM, falls a bit and has steady number (usually Nadir's +5-+7) and then goes back up.
His numbers today were:
AMPS 536
+5 378
PMPS 410.
Just need to get the numbers down!
 
Deena Traina said:
I just don't understand why he is testing higher when he was testing in the mid-200's (occasionally) on lower doses?
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If you look at Chino's spreadsheet, you'll see that he occasionally had green nadirs long before we reached an effective dose. Each time it happened, he was coming down from a bounce, and this tends to generate momentum that pulls his BG down faster and lower than usual. It wasn't until we reached a good dose that we started seeing green at least once a week.
 
SLGS will get you there safely and posting here will give you the support you need and people will take the time to work with you to get him there. If your gut is telling you he maybe a high dose cat, that is insulin resistant, you can get him tested for IAA and IGF-1 (for Acromegaly). Normally, from what I read here people wait till dose reaches 6U. If you want him tested for that earlier to rule it in or out, that is always an option for you to look into with your vet. Some times cats are just high dosers for no other reason than they want to be different ;) and when they reach that good dose they start coming down.
 
Deena Traina said:
and the vet thought Malachai might have had some inflamed gums on one side so he put him on Clavamox for two weeks to see if that would lower the numbers in case malby had an infection.
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If there is gum inflammation , unfortunately, the only thing that will help is to have a cleaning and have the plaque and or tartar removed. That is what causes the inflammation and an AB won't take care of it.

If it's been a long time since his last cleaning or he's never had one, you might want to consider it. A bad tooth was what took Bubba out of remission the first time. :rolleyes:

Since he just had blood work done 6 weeks ago, you won't have to have that repeated for the dental visit. Usually, vets will use BW that is within 3 months old.
 
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