10.26.13,Shadow,AMPS/188/0.5U, +5/164, PMPS/521/0.5U

Lantus: 0.5U @ AM+1
Five P's: All systems go
Issues:
* He broke into the treat bag (low carb treats from YoungAgain) at around AM+2 for few minutes before I caught it. I don't think he ate too many. No visible problems.
* He wasn't interested in his treat after the test at +5 or his normal food after that. Usually he goes after both. I'm thinking he ate more treats than I thought. They are low carb but may be keeping his number up a bit?? Otherwise he is resting like he normally does this time of day.
* BG at +7 was 238...retest was 193. Weird numbers. Not eating but drinking normally and resting peacefully in one of his spots. He spit up some watery stuff. I think he OD'd on carnivore YUMS.
* Shadow's AM+10 read 366. Immediate retest was 429. WTF. This is heading the wrong direction real fast for unknown reasons. He ate a bunch of Carnivore Yums, a low carb treat, eight hours ago that he wasn't supposed to. He has not eaten anything since that I know of. He is drinking water and behaving normally, maybe a little sluggish, but he sleep a lot during the day. His next shot is not due for 2.5 hours as I didn't shoot him until AM+1. His urine just tested negative for ketones or glucose. Give me some ideas here.

I am trying to get Shadow back on track after a hypo scare earlier in the week due to probable insulin OD. I over reacted with HC food and syrup but luckily joined this board, bought a glucometer, and went to work. He has been settling down since then and I have been conservative about getting him back on the juice. His shot this morning looks like it might be the right dose for now. I will do the start low, go slow approach. Right now, I have the time to deal with this but sometimes work, etc. will not allow for a high maintenance routine. He is showing signs of possibly getting off the juice and if he does, great, but that is not paramount. Reasonable stability with reasonable monitoring is the goal. I would like to get Shadow on a safe routine with Lantus that a friend can deal with if I have to be away for few days.

Re: 10.26.13, Shadow, AMPS 188, +3 154,

Welcome to Lantus Land Steven and extra sweet Shadow!!

Looking good so far, and we'll see how he does after several days on the .5 dose. Glad you shot this morning too! We have to start somewhere and .5 is a good safe place.

Don't forget to keep your spreadsheet updated. Sometimes it's easy to forget, and then you have a problem and the numbers aren't there for anyone to look at.

Just because you can't test 10 times a day, doesn't mean you can't be on the TR protocol...as long as you can get 4 per day, that's enough...and even if you can't always, it's still doable

Good luck with Shadow! I know you're extra careful because of your prior experience with your friends cat having a seizure, but I can say I've NEVER heard of any of the cats on this board going into hypoglycemic seizures or coma. (at least in my time here)

Re: 10.26.13, Shadow, AMPS 188, +3 154,

Great job on the spreadsheet. :thumbup

I think 0.5U is a good move for now. Keep up the testing and try to keep shooting very 12 hours if possible. Of course if he goes below 50 you will reduce again.

The low carb treats likely shouldn't be much of a problem.

BTW Welcome to Lantus Land. Our "post and ask before shooting" number here for beginners is 150. So you are moving in the right direction in that regard. Hopefully Shadow is on a mission to remission. Good job you are catching on fast. Any questions just keep asking. :smile:

Here is Shadow's intro on health.

Condo question

He wasn't interested in his treat after the BG test at +5 nor was he interested in his normal food after that. Usually he goes after both every time. I'm thinking he ate more treats than I thought. They are low carb but may be keeping his number up a bit?? Otherwise he is resting like he normally does this time of day. I will keep an eye on him and keep testing regularly today.

Also I don't completely know how this condo system works. Tomorrow do I start a new post or just change the heading on this post?

Re: 10.26.13, Shadow, AMPS 188, +3 154, +5 162

Each day you do a new condo, and you "link" the previous days to it, so tomorrow, you'd start a new one, and then put the link to this one into it so people can quickly go back and see what's been going on with Shadow.

If you look for my post today, you'll see where I have the link to yesterday's condo posted in today's condo

Re: 10.26.13, Shadow, AMPS 188, +3 154, +5 162

The condo system is really just so everyone helping can keep track of what's going on at a glance. So you start a new one every day you post and as Chris mentioned include a link to the prior condo.

Were the treats CarnivoreYUMS? If so those do have some carbs and may raise the numbers a bit if he ate many.

And when you have a question, you can edit the first post so it would look like "10.26.13, Shadow, AMPS 188, +3 154, +5 162 Condo question" and use the ? icon so it's more obvious.

Re: 10.26.13, Shadow, AMPS 188, +3 154, +5 162, +7 193, weir

Oh good.
Glad to see you decided to come over here. It really does have the most eyes so there is usually someone popping on and off if you need help sooner than later.

Funny how all the other Shadow's have been males. I'm the only one with a female.


the cycle doesn't look weird to me.
You've just lost some of the shed with the skipped shot.
When the depot refills, the numbers could look a little better. We'll see.

Re: 10.26.13, Shadow, AMPS 188, +3 154, +5 162, +7 193, weir

Welcome to Lantus Land!!

If no one has already suggested this, please take a look at the starred, sticky notes at the top of the Board. You are welcome to follow Start Low Go Slow (SLGS) or the Tight Regulation Protocol. The TR Protocol is described above if you want to compare.

The initial dose of Lantus can be determined by a formula -- initial dose = 0.25 x ideal weight in kilograms. Most cats end up with a dose around 1.0u, give or take. Clearly, the 1.5u dose was too high for Shadow. However, dropping the dose back to 0.5u may not be enough. It's often easier on the nerves to work the dose up than to have to be steering numbers with high carb food when you're still new at managing your cat's diabetes.

We encourage people to post one condo, per cat, per day. Not everyone posts on a daily basis but many of us do. The people here are very knowledgeable and generous with their time and expertise. We are here to help! This is also a community and we want to be able to get to know Shadow and you.

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366-

Is there an emergency? You have the 911 icon up.

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366-

Hey Steven!

It's ok...We often see some pretty wonky numbers when we're first starting out. They don't always have to make sense. Sometimes the only thing we can do is hold tight and go along for the ride. Shadow's in charge.

Remember, he was in the 500's just a few days ago. He hasn't had any insulin since then...I'd expect him to be pretty high

Make sure there's no contraband he could have gotten into (the low carb treats shouldn't have mattered, but if there's anything else in them other than meat, they could)

High numbers worry US, but take time to do any damage. As long as he's eating, acting normally and has no ketones, just take a deep breath and relax. The only time it's a medical emergency is when they're too low, and it doesn't look like that's going to happen tonight.

If you ever have concerns over the meter/strips, you know to test yourself.

It'll be ok Steven...it really will

Please go ahead and take the 911 down...we use that for medical emergencies and it scares us to death to see it. Numbers that are really low are emergencies, and times when Shadow might be acting terribly sick. Other than those times, you can use the ? icon and we'll know you have a question

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366-

Steven & Shadow said:

Shadow's AM+10 read 366. Immediate retest was 429. WTF. This is heading the wrong direction real fast for unknown reasons. He ate a bunch of Carnivore Yums, a low carb treat, eight hours ago that he wasn't supposed to. He has not eaten anything since that I know of. He is drinking water and behaving normally, maybe a little sluggish, but he sleep a lot during the day. His next shot is not due for 2.5 hours as I didn't shoot him until AM+1. His urine just tested negative for ketones or glucose. Give me some ideas here.

Click to expand...

The Carnivore Yums are 10% carbs but include Potato Starch which may cause a food spike depending on how any he ate.

More likely though this is just fluctuation from skipping shots and changing dose. It's normal at this point. I would keep shooting 0.5U every 12 hours for 3 days, provided he is over 150 at shot time. Under 150 post here and ask for help. This will give the depot time to stabilize and then we can evaluate the dose. If he goes below 50 then of course you will reduce.

One housekeeping note. When you add a question to the title of the first post, be sure to also bump the thread and post your question at the bottom. Many don't re-read the first post again so add any new info as a new post to bump the condo.

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366-

Chance are good you are right. I expected blue numbers today so it is concerning to see 400 range readings. I know why he went high before. This one is different as there doesn't seem to be a reason for it. I don't think he ate anything other than some 1.5 oz of Friskies Pate at AMPS and the Carnivore Yums at AM+2, no more than a 1/3 cup at the max and probably much less. I picked it all up and the bag didn't look much different than it did before.

Early this afternoon I let Shadow out in the side yard and watched him poke around for about 10 minutes. He didn't eat anything, just poked around. Then I took him back inside. I then gathered up all the trash from the house in a bin and went back out to the side yard to put it in the big bin. Sitting up on the fence right next to the bin was a huge red tailed hawk. It just looked at me and didn't even move. I moved toward it and it just turned around, ignoring me. It hasn't been an ordinary day.

It's almost +11.5 so I'm going to do another test now just to see what's happening.

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366-

You have to remember Steven..we aren't in control...Shadow is!

If he saw that hawk, that could have spiked his BG too...Stress, excitement, changes in routine, can all raise the numbers

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366-

Dale 'n' Chip said:

One housekeeping note. When you add a question to the title of the first post, be sure to also bump the thread and post your question at the bottom. Many don't re-read the first post again so add any new info as a new post to bump the condo.

Click to expand...

I am unclear here. I am not sure what you mean by "bump the thread". Please explain at your convenience. Also I haven't had to do it yet but tomorrow I will want to link to this thread. Any tips on this trick will be appreciated. Thanks Steve.

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366,

OK..when anyone replies to your condo, it "bumps" your condo to the top of the page on the board, so if you have a new question, and you add it to the bottom as a new comment, it brings the whole condo back to the top.

You only "edit" the first post if you want to add new test results, OR if you have a question that you forgot to ask in your original condo for that day, you can go to that first post, and "edit"...adding the ? icon. Also, if you have a medical emergency, you have to edit that first one to get the 911 to show up if we're just scanning the board.

The rest of the time, you just add a reply..whether to answer something we've asked in reply to your condo, want to add more information, or something new has happened that you need help with

As for linking it tomorrow, you just find your post (the easy way is up along the top left ..you click where it says "View your posts"). Once you go to that post, you copy the link in the address bar. Then you start a new condo and paste the link into the body. You don't have to be fancy about it, but yesterday I wrote how you do it for your spreadsheet and gave you the link to the Tech Support board on how to do it too. It works the same way, but again, it's not necessary

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366,

It just means post a new post in the thread (like you just did) with the updated info or question.

Only thing you need to change in the first post is the title (and icon) which is always visible to all at a glance.

I like the bullet points in the first post, but as the thread progresses most people scroll to the bottom for the latest, so that's why you "bump" the thread with a new post for anything you add to the condo.

BTW it looks like the cat version of Carnivore Yums is only 7% carbs. But they do have potato starch. Dry food with potato starch causes a steep spike in glucose for Chip.

Re: 10.26.13, Shadow, PMPS 521 !!

OK. Something is going on here. Shadow's PMPS BG level was 521. I retested and got a similar result. I tested myself to check the meter and the meter is reading accurately. He's due for 0.5U of insulin. I'll hang here for 30 minutes and then I'll go with that if I don't hear otherwise. A few days ago I did 1.5U in a similar situation and it was too much.

He is definitely sluggish right now. Usually he is up and about whining for food right now. His is pretty much sleeping instead right now.

He is peeing and pooping and has been drinking water today but not in the last hour or so. He hasn't eaten since AM+2. He ignored his food at Am+5.

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366,

Shoot your usual 0.5u dose. Lantus dosing is not based on the pre-shot numbers. Every new dose needs to have a chance to settle otherwise, the changes in dose yield wonky numbers.

Re: 10.26.13, Shadow,AMPS 188,+3/154, +5/162,+7/193,+10/366,

This would be a good time to adjust your subject line with your pmps.

You can just have it... or keep the amps number and then the pmps number....
When the line gets really long, the last numbers aren't visible.

You can add the question mark if you want input....
sounds like you will be shooting 0.5 u in a few minutes.


ETA: I see Sienne beat me typing.

Re: 10.26.13, Shadow,AMPS 188...0.5U, PMPS 521...0.5U

It looks like you gave Shadow his PM shot -- at least that's what's on your spreadsheet (SS). Just to provide some background. When you see high numbers at test time, it's very tempting to want to increase the dose. The big lesson here is patience. Lantus dose is adjusted based on the nadir, not on the pre-shot numbers. I'm assuming the date of diagnosis is correct in your signature. If so, with the Tight Regulation Protocol, Shadow's dose is reduced if his numbers drop below 40, since he's been diabetic for more than a year, or if his numbers are in the 40 - 50 range on 3 separate occasions. With SLGS, the dose is reduced if numbers drop below 90. Doses are raised after a week (3 days/6 cycles with the TR Protocol) if the nadirs (lowest point in the cycle) are not where you'd like them to be -- in other words, if they are above normal BG range.

So, you'll want to hold Shadow's dose for several days. You may want to rethink how long you hold the dose if Shadow's numbers are running high. You would need to hold the dose for at least 6 cycles.

I gave him 0.5U of insulin at PMPS +1, 12 hours after I gave him 0.5U this morning. I will test him at PM+3 & PM+6. I am a little worried about DKA. I tested for ketones a couple of hours ago and nada. He has peed since then but I didn't catch him. He is lethargic now and sleeping.

I haven't decided on a protocol right now. I haven't digested it all yet but I will have by the end of six cycles. Right now my schedule would allow me to TR but my schedule can change at the drop of a hat. All this makes me wonder what was going on inside of him when the only thing I was doing was checking his urine glucose from time to time and following the vet's not always timely advice.

You're doing fine Steven...you're just now starting to refill the depot after missing so many shots, so it's going to take a little time to see how he's doing. Since he is a longer term diabetic (15 months from Dx), we can be a little more aggressive, but no matter what, we do want to wait at least 6 full cycles to see what this dose does. (unless he happens to go too low during those 6 cycles)

You're taking very good care of Shadow, and we can help you get him healthier and happier, but it will take some patience. It's important to try to get the shots every 12 hours or the cycle count starts over...so if (for example) you give .5 units for 4 cycles, and for some reason (furshot, skipped dose, late dose) you are off schedule by more than about 30 minutes, we usually start the cycle count over.

Speaking of furshots, you do understand that if you give a furshot, you never shoot again until the next scheduled shot, right? Since there's no way to know exactly how much insulin might have gone into the cat, you don't ever want to try to "make up" what you lost. We all do a furshot now and then..it's part of the dance.

We totally understand how scary both those high numbers and those low one can be, but we're always here to help you through them. As long as he's ketone free, he'll be ok for a few days more while we fill the depot.

Edited to add...You say you gave the .5 at PMPS +1
No matter what the ACTUAL time is, WHEN you give the shot, that's the number that goes in the Pre-shot column, and the 12 hour clock starts for that cycle.

If you "stall", you can put the numbers you get at +12 (and on, like +12.5, +13) into the "remarks" column...and when you DO make the decision to shoot/not shoot, that's the number you put into the AMPS and PMPS column

If you don't shoot for some reason, you still put the number in, but in the U column you put NS, or No shot

So if you didn't shoot Shadow until an hour past the 12 hour mark from his dose this morning, that's a "late" shot...and tomorrow at AMPS, you'll want to shoot as close to 12 hours from tonight's shot....so if you shot at 7am this morning, and 8pm tonight, you'd want to shoot at 8am tomorrow

He is showing signs of coming around now. He drank some more water and nibbled at some food a couple of times. I wonder if I gave him a fur shot this morning? That plus the treats he scarfed plus the missed shots might explain part of the wacky profile today. I try to be careful not to give him fur shots and I will be doubly so now. The numbers don't scare me as much as not having an idea why they might be moving in an unexpected direction. I gave Shadow his juice at 7am and 7pm today. I'll adjust it a little in each of the next two days to get it back to 6am and 6 pm which works better for my schedule.

Right now I can do the four or more shots a day thing, but at any time I may not be able to do the mid-day shot. Hopefully I can stay with his program until we find the right dose to manage his BG to his optimal level.

Right now I can do the four or more shots a day thing, but at any time I may not be able to do the mid-day shot.

Click to expand...

I know you meant "tests", not shots, but just wanted to correct it in case there are lurkers watching.

Lantus has a VERY distinctive smell! You shouldn't have much trouble knowing if some (or all) of it didn't go into Shadow. It's a good habit to get into to just check real quick after the shot to feel for wet fur, but usually, the smell is the real thing you notice first.

For lack of a better description, it smells a lot like Bandaids and/or Scotch...if you have a drop extra, try putting it on the end of your finger and smelling it..it won't take much

I think what's probably going on is a mix of no shots, the potato starch in the treats and just plain wonky numbers. Won't make any difference if you worry yourself sick...Shadow's in charge.