6/20 Julian dosage help!! PMPS 160

Julian AMPS- 242 4 units of insulin
PMPS- 160
ack what should I give him?! I feel like the dose is too high, and my vet asked me to put him back on a small amount of dry food.
I need to be back at work in 10 min

As I said yesterday, the 64 at PS yesterday said that 4 units is too much for right now. I would definitely reduce. What feels comfortable to you?

I'm with Libby -- 4.0u is too much and the dry food will only keep Julian's numbers up and prevent remission.

yeah Im not comfortable with that dose at all. I talked to his vet today... who actually recommended I start giving him dry food in small amounts to make sure he doesn't go hypo..... I'm not sure how I think about that. He said that in a day or two he would reduce the dose. Julian did not get his PM insulin. I had to go back to work, and I was not ok with possibly overdosing him and then leaving him.

Lucy,

Everyone has expressed their concerns about 4.0u of insulin being way too high a dose for Julian. You also agree that you feel it's too high.

Cats with diabetes should be feed low carb food. High carb food should only be used for actual hypo episodes, NOT to prevent them.

Skipping shots is not recommended and conterproductive as your insulin is designed to work for 12 hours. Cats will have a high BG when they go for 24 hours without insulin.

I see you shot 4.0u this morning.

Please, please call around and try to find a vet close to you that is very experienced with Feline diabetes.

eeraby said:

Everyone has expressed their concerns about 4.0u of insulin being way too high a dose for Julian. You also agree that you feel it's too high.

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Just speaking for myself, but I didn't say the dose is *way* too high, just that it is too high for now, until more data can be collected.

3 units was looking like it had some potential but the dose was increased without sufficient spot checks. My inclination would be to go back to 3 or 3.5 units, start collecting data for a few days, then make a dosing decision based on that data.

I understand that you are looking to your vet for dosing advice. That's fine, but you do need to be able to understand and support their recommendations. You are the one holding the syringe, so in the end it is your decision how much insulin to give. Have you given your vet the links to the Tight Regulation Protocol?

You're right, Libby. Perhaps "way too" was over stating it a bit.

Thank you.

Hi Lucy!! My old vet had me start my cat on 3u b.i.d. After doing that for 11 days, WITH NO HOME TESTING!!, I found this site, immediately started testing, and reduce Champ's dose to 1u b.i.d. I changed vets (another one in the same practice) and after speaking with him, showing him I had done my research about this protocol and what the rules were, he agreed with no problem to let me decide on what the dosing should be and what I should feed. Most vets realize their limitations when it comes to feline diabetes. Some will welcome you taking charge and some won't. I suggest you find one who will because it makes it easier on you and your cat. I don't understand why your vet would want you to raise Julian's BG by eating dry food instead of just having you decrease the dose of insulin. The goal here is to get your cat in remission and off insulin, not to give him enough insulin so he can continue to eat dry food. Dry food should be taken off the market. It has no redeeming benefits. It causes obesity and diabetes, that's it. I know it's hard to question the authority of your vet, but he might just surprise you when you show him a copy of this protocol and tell him this is what you're going to follow. Let him know you'll send him the link to Julian's SS on a routine basis and that he will be in charge for all other cat-related matters...just not the diabetes!!

I hope I've helped. This is something that none of us would ever wish for, but it's very do-able and survivable....for both the kitty and you!!

Good luck and I hope you have a fantastic day!

Hi Lucy, I'm glad you made it over to the Lantus forum!

I think what may be causing some confusion (and why everyone is telling you to reduce the dose and your vet is not), is that Lantus works differently than a lot of other insulins. You're not going to determine dose based off of one high number, but rather the trend over a period of days based on the daily nadir, when Julian is at his lowest number (usually the +6). Lantus requires a shed to be filled before it starts working on the blood glucose (Please read about it here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150), so the effects of a dose usually take 24 hours or more to show up in your testing until that shed is full again. That's why it's so important to shoot on a strict 12/12 schedule with a consistent dose.

Many vets don't realize this, and do dose adjustments with Lantus like you would with other insulins. Lantus needs to be dosed as you see here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Needing to reduce the dose like you do is a GOOD thing. So drop to 3u twice a day and make sure you're getting a +6 test in there and see what happens. After you've held that dose for a few days, you'll be able to see how the new dose is affecting Julian.

I just wrote my vet a kind but firm email saying I wasn't comfortable bringing dry food back into his diet. I also said I wasn't comfortable with his dose, and tomorrow I have off from work, so I can do another regulation, to see where he stands.

eeraby said:

You're right, Libby. Perhaps "way too" was over stating it a bit.

Thank you.

Click to expand...

You were not overstating it a bit at all.

Julian has only been on insulin since June 3rd, is that correct? He was started at 3U and yes, showed some improvement because he had previously not received any insulin for however long he had been diabetic. So of course he was going to show some response.

If she had stayed with the 3U, the same thing that happened the other day, a 64 at preshot, would have eventually happened also. Why? Because 3U is too high of a starting dose - period.

Dropping back to 3U will not help because it is still too high for the starting dose. The AAHA diabetes treatment guidelines are clear on the starting dose for cats - 1U twice a day - and it is what we've been preaching on the board for years with any and all insulin types! We finally have something "official" in the US on at least starting dose guidelines for glargine (Lantus) and ProZinc, but unless a vet is very proactive or their clinic is an AAHA accredited hospital they probably aren't aware of that.

Again, here is the link: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf Management of cats with Clinical DM is on page 4 of the .pdf file.

From that point the Lantus group here can get you on the right path because the protocol they use is more precise and better in our experience than the guidelines the AAHA are offering. But essentially he needs to be started over at 1U. You will feel much better about giving his shots when you have to leave and there's no need to leave dry food out. As long as he has some of his regular food available and is only getting 1U of insulin, he should be fine.

Lucy, it's unfortunate that some of us have had to educate our vets on some aspects of feline diabetes care. If you could share the AAHA guidelines with him/her, you may not only be helping Julian, but other cats in the future as well.

One last thing, I'm not seeing anyone mentioning ketone test strips in this thread, although it may have been previously. As high as he's been, you definitely need to be testing urine for ketones. If you need help regarding that, please let us know.

I'm sorry your head has probably been spinning about all of this. Sounds like your intuition is telling you what's best for Julian is the info we're giving you, so don't be afraid to tell the vet you will not give that much insulin to a newly diagnosed diabetic. It's just not safe and why play with fire?

Thank you for the info Vicky! I plan to have a sit down with my vet and see if he is aware of all this. I may start looking for another vet as well. The only reason I've brought him to this place is because it is walking distance from my house, and Julian is so scared of crates he loses his bodily functions and I don't even have a car. But it is expensive, and I don't like the vet.

Just for the sake of not confusing all of us (since I am so easily confused) could we please keep all the info to one condo a day.

I know you were answering Vicky's question's but it can get a bit confusing to others trying to help to have to jump back and forth to two or three threads.
You can start a new thread each day beginning with your AMPS and keep that thread going with all of your questions. You also post your PMPS in that thread and not start a new one until the next day when you have AMPS again.....did I confuse you more? :lol:

Thank you.