dosage help? 2/27 - Marley AMPS~158 / +4~63 / +6~96

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AmySawyer

AmySawyer

Member Since 2014
Morning guys! :cool: ~O)

Yesterdays - viewtopic.php?f=9&t=114479&p=1205829#p1205829

This morning she was the lowest she's been since making the switch. Seems like she's workin the juice today! Since it wasn't below 150, we gave her .5 unit & fed her as we regularly do. Daryl is getting off at 10am today so I will plan to go home then so we can get a +4 test just to make sure she's safe. Last night Marley & Ziggy were going crazy with their cat nip toys! It is so great to see her playing & being active again! :-D

Will Update as the day goes on!

Hope everyone has a great day! :smile:

Amy
 
Re: 2/27 - Marley AMPS~158 / +4~63

Did the +4 test & it was 63... so I gave her 1/2 a can (3 oz can) of FFC just so it wouldn't continue to drop too much in the next 2 hours.

Hopefully that was the right thing to do?

Will test again at +6 & update.
 
Re: 2/27 - Marley AMPS~158 / +4~63

Feeding that lower number was the perfect thing to do, but I'd test a little sooner than 2 hours later if you can. Normally if kitty is in the down part of the cycle and hitting the 60's or 50's, a test every 1/2 hour is good. You don't want her to spend much time below 50. If you can't stay home when you see a lower number like that, leaving food is good. You could even leave slightly higher carb food out to keep her safe.

It's great news that she's playing again! :-D
 
Re: 2/27 - Marley AMPS~158 / +4~63

Hi Amy,
63 on the Alpha Trak corresponds to a number in the low 40s on a human meter. It's good that you fed Marley. I hope that you'll be able to monitor her today. You don't want her dropping any further.
For the numbers to watch for when using the AlphaTrak meter, see Table 3B in the above "sticky":
http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

You are seeing really good results, but don't forget that the Alpha Trak reads higher than a human meter. Many of us here, even though we see in your signature that you are using the Alpha Trak, don't mentally make the correction when we see bg numbers.

Ella & Rusty

p.s. It is really great that Marley is feeling so much better.
 
Re: 2/27 - Marley AMPS~158 / +4~63

Thanks for that link Ella! It's very insightful! I printed it out to keep on hand.

Should we keep the dose at .5 unit or reduce it to .25? This is really tricky on the syringes that I have, really testing my eyesight & accuracy! But tomorrow will make 1 week that she has been on the Lantus, & that is her lowest BG value before nadir, so I'm not sure whether we keep the current .5 dose or reduce to .25..... any thoughts?

I was not able to go home to test at 11am (+5), but will definitely test at 12pm (+6) & update. She gets fed after that test normally anyway. Hoping it increased a little with her snack earlier, but my Husband is home monitoring her anyway. She's acting normal & snuggling so we haven't been too worried.

Will update after +6 test.
 
Re: 2/27 - Marley AMPS~158 / +4~63

Hi again, Amy,

I would suggest that you put the ? icon in your subject line and something like "dosing help" so as to get some experienced eyes on Marley's situation. You haven't been giving Lantus for very long, you are on a low starting dose, and it looks like Marley is going low now every cycle. The TR protocol is very specific with regard to when to take reductions, and it looks to me like you should reduce, but I would want one of the really experienced dosing people (Sienne, Marje, Jill, Julie, for example) to take a look at your spreadsheet.
The syringe problem is one that everyone has. None of the brands are precise, and when you have to eyeball the dose, it is hard. The only way to gain precision is to use calipers. When you have time you can read the threads on dosing with calipers:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=79851&hilit=calipers

But in the meantime you really need to focus on the TR protocol. Here is the relevant info. from the "Lantus and Levemir Tight Regulation Protocol" sticky at the top of the Lantus Forum.
REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.

It will be necessary to test kitty's blood glucose levels multiple times per day.

Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.

Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).

Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.

Feed a high quality low carb canned or raw food diet.

Feed small meals throughout the day. Some kitties adapt well to free feeding.



Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.
(Revised 10/28/2013)

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

Please do not let yourself become complacent or blasé about drops into the 20s or 30s.
If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
Please ask for advice.


If anyone suggests otherwise, they are putting your cat at risk! Our kitties are not just numbers. They are living beings who trust us to look out for them. The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive.

Keeping YOUR cat safe is the #1 priority of the FDMB.
Let's keep all our kitties in the Lantus Tight Regulation ISG safe by suggesting and taking appropriate reductions.


If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.

Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...

Lots to learn, that's for sure!

Ella & Rusty
 
Re: dose reduction? 2/27 - Marley AMPS~158 / +4~63 / +6~96

Thanks Ella

I have read & re-read that sticky so many times....It certainly is a LOT to remember & take in. I printed it out & have a bunch of it highlighted & on my desk at home as a go to guide.

The first 3 days Marley was monitored very closely & it seemed like she was leveling out & forming a pattern but this morning it was much lower than normal, but still not below 150 so we thought it would be OK to do the normal .5 dose.

I'm just wondering if this is a good or bad sign as to how she is responding to the Lantus?
I am thinking it's a good sign (?), & maybe just need to reduce her dosage to .25 unit instead of .5 but like I said I am very inexperienced & want to get as much feed back as I can before dosing again at 6pm this evening.

Will read up on the calipers...but for now we will just try to eyeball it as closely as we can on the syringes. It's crazy what a huge difference such a tiny amount of insulin makes!

At +6 Marley was 96 & we fed her a full 3 oz can of FFC, so she should be at a much better BG level when it's time for her next dose at 6pm.

Will keep updating as the day goes on.
 
I would suggest that you reduce Marley's dose to 0.25u. Also, you may want to take a look at this post on handling low numbers. Whenever you see a number that's below 80 on the Alphatrack (or below 50 on a human meter), you need to monitor more frequently in order to be certain that numbers don't drop too low. I would have re-tested at +4.5 to make sure the food was raising Marley's numbers. The linked note describes the process of monitoring.
 
Thanks Sienne.

I printed out that link as well. She was not showing any signs of hypo at all... but she did eat the food we gave her & it did rise within 1 1/2 hours when we tested again.

We will reduce the dose tonight to .25 unit (or as close as we can get... Like I said earlier it's really hard to be exact on these syringes).

Will continue to post her stats on this post & on the spreadsheet.

My husband is home with her, but I am at work right now & it takes 2 of us to test her still (she is getting better though!). We will test again as soon as I get home which would be +10. But also like I said, after the +6 test she got a full can of food so that should bring her up significantly as well (I think...)
 
+10 test BG was 160.

PMPS - 215. Dose .25 unit. & her dinner of 1 3oz can FFC.

Will do a +4 test tonight too.

Hopefully she won't drop too low after lowering the dose.

Will update tomorrow!
 
Hi Amy and Marley, I don't have advice or anything, I just wanted to say hello and welcome to you both :-D . Marley looks great in green :mrgreen: . Have a great night!
 
You did all the right things. I'm glad you reduced the dose. Even though you & I talked about you using the AT and you have it in your sig line, i was reading along and thinking "great, 60's!" I'm glad Ella caught it!

As wendy said, if you have to leave after a lower test, leaving food was the best possible thing to do. if you ever have any doubt, leave higher carb food. better to have her high than too low and alone.

It might sound silly, but i think it would be helpful for you to put AT in your subject line every day along with the numbers. We've had a couple of other people who use ATs do that and it keeps it up front so we don't fall into human-meter-autopilot!

great to see Marley responding to the insulin!! woo-hoo - that's what you want. so YES! it's a very good thing!
 
I second what Julie says about putting AT into the subject line this morning - I missed it too. :oops:

Congrats on the reduction, Marley is doing GREAT! :-D :-D
 
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