3/22 Oliver pmps 356 +2~412 +4~367 +6~358 - 3u too high?

Yesterday’s Condo for Oliver

Yesterday's recap for Oliver:
155 - amps (3uLantus)
367 - +2
398 - +4
337 - +6
398 - +9
398 - pmps (3uL)
389 - +3
369 - +5
364 - today's amps (3uL)

Oliver's first full day here went pretty well. He has checked out the whole place just about, tried on all of the little and big hidey spots, squirmed his way out of the small places (making a note to stay out of them in future), slept alot and ate alot. His only annoying habit but fixable is that he shakes his head after being poked so the blood goes all over. I need to hold his head so that he can't shake until I have a chance to get some into the meter and blot his ear. It's almost like a twitch type reaction.

I am trying to get him to eat his food and not head over to Shadoe's; she gets really pissed when he does that and DOES hiss at him. But, he is oblivious to everything except THE FOOD. I am hoping that once he settles down a bit, his appetite will come down like Shadoe's did once we got a handle on her needs.

This big boy is so laid back that even Booboo has come right up to him, and sniffed his tail a couple times. Unfortunately, when Oliver moved to sniff at Booboo, she freaked and took off to hide. His reaction? Whatever, and he went back to sleep.

I'll get a couple tests today, maybe +4 (in 10min) and +8 because not much is going to happen from the looks of yesterday's numbers. I figure he needs more, but the shed needs filling nicely, then we can see how things go.

Oliver has selected a couple spots as his favorites and luckily, they are not ones that 'belong' to Shadoe or Booboo.

Re: 3/22 Oliver amps 364

Great photo! Here's to a good day for you and all 3 cats!

Ella & Stu

Re: 3/22 Oliver amps 364

Gayle,

When I see this curve on a regular cat, I see that the liver is in protective mode. It accounts for the rise in BG throughout the day. If it were me, I would drop him back to the 1 u of Lantus and watch his test results. Even if he ran in the 300s for a few days, he will begin to drop.

And, Gayle, I do know that the regular diabetic cat and the acrocat are quite different. I had an acrocat, and I helped my petsitter determine that she also had an acrocat. He was on 16 u Lantus twice a day when she called me. A switch to PZI and Humalog on a sliding scale brought his numbers under 300 for the first time in a year. When they went under 200, my friend was panicked. As he settled down into the sliding scale, she saw numbers in the 100s.

If you put the numbers that Deborah and I got into the Spreadsheet mix, you will see that he was dropping the preshot numbers nicely on 1 u. You might get different info from the board members if they see that drop.

The vet, in my opinion, started him too high. And then the vet proceeded to increase his dosage without doing any home testing. Moving a cat to 4 units bid of Lantus in less than a month is not good. Once the shed gets too full, he is then at risk of hypoing.

Any questions. either put them on the board or PM me.

Hope this helps,

Claudia

Re: 3/22 Oliver amps 364

Good Morning Gayle
As usual a great kitty report.
How nice that they seem to be getting along. That's prett quick.
Maybe Shado figures he can't be that bad cuz he is getting tested and shots as well.
Now Booboo is odd man (girl) out.

Re: 3/22 Oliver amps 364

Hi Gayle ~

I would bet that his tummy upset was related to all the traveling. After all, he went from the vet clinic to a foster home, left after 4 days and had pretty much been on the road since. Cats don't seem to enjoy whirlwind vacations. And then there are those vaccinations right before he left that no doubt contributed to his gastro issues. If he's still having trouble, you can give him some DM as it also helps with diarrhea.

I think you should ignore the dose in the vet notes and drop him back, remembering that he was started on too high a dose and increased too fast, in 1 unit increments, and without being regularly tested. He was beginning to show a good response to 1 unit. I feel that Oliver has been on a rollercoaster for awhile but the best way to find out is to start over. Yesterday you had an inverted/flat curve which usually is a pretty good indication of too much insulin. That 155 could be from his shed starting to clear out.

Glad to hear that he's settling in so nicely!

Deborah

Re: 3/22 Oliver amps 364 lower pm dose? 3u too high?

I wondered if this dose of 3u Lantus is right for Oliver.
Because I don't know much on his history, I just started him at the same dose mentioned in his paper work.
Now, it seems that his most recent shots were at 1u for the few days of his trip here.
Only ps values are known, so no nadir is known.
For that reason, I stuck with the 3u.

So, Oliver's been flat pink and I don't know if this 3u is too high, if I need to wait for the shed to fill, or if I should decrease his dose.

We are about 15min away from pmps, so i have tested him now for consideration. 356 is still pink.
Will go with the 3u for this shot, if no suggestions received, and can adjust tomorrow morn if needed.

Re: 3/22 Oliver amps 364 lower pm dose? 3u too high?

I dunno.. reading the stuff above.. and it not being that unusual for vets to increase by too much and too fast.. and that you know to test for ketones and all that jazz.. He's had a lot of changes lately, that any single one of could shoot his BGs sky high.. even if you do start getting great curves on 3U, what about when he settles into his new home, or when he realizes that you are his permanent mommy and not going to ditch him, etc.

3U or higher being the "right" dose for a normal kitty on a good diet would be odd (as you are most definitely aware of given shadoe and all ), not impossible, but odd.

As for whether it should be a gradual decrease or a do-over.. I don't know.. like I said.. I'm a big chicken.. after mucking stuff up with Nova for 3 months so bad (didn't know any better).. I just had to start over and put the past in the past.. take a fresh start at it all.. It's your new life together, I don't see anything wrong with you guys making a fresh start together.

I know I would most definitely be too chicken to shoot 3U in ANY cat on a LC diet without seeing a thorough spreadsheet first. So I know you are already far braver then me, and can probably handle a more aggressive approach .

Re: 3/22 Oliver amps 364 pmps 356 - 3u too high?

I went with the 3u for this pm shot as I did not want to delay too long.

I would still like to know if it would be good to lower Oliver's dose or not.

Re: 3/22 Oliver amps 364 pmps 356 - 3u too high?

does Oliver have any history of ketones, that you know of? And do you know how long he had been on the 3u dose (or 4u, or whatever it was?). Was he started at 3 units, or lower? (I know you may not know these answers, but thought you might if he came with any paperwork. If not, we deal with it).

So far what I'm seeing is probably RBC, or else not enough juice. I don't have a problem with reducing the dose, though, if you want to try that, as long as he doesn't have a history of ketones and if you promise to test for ketones daily. It might be just the thing.

3 units is not a high dose, if you look around other condos, and Oliver is a big boy. It *is* pretty high for a starting dose, so if they did start him in that range, it could be too much. How much does he weigh? If his ideal weight is 15 lbs, then starting dose by the current protocol would be about 1.7. As you know, most cats go *up* from their starting dose before they come back down. If he was at 3u for a while and didn't have any problems, then it might not be a bad dose for him. Chronic rebound is not very common with Lantus, though it's not impossible if overdosing is ongoing.

What we usually run into is that once they are stuck in high numbers for a period of time, it requires more insulin to overcome the glucose toxicity that has established itself. Once the glucose toxicity is smushed, then the dose might start going down very quickly. Sometimes lowering the dose off the bat works too, so if that makes you comfortable then it's worth a try.

Re: 3/22 Oliver amps 364 pmps 356 - 3u too high?

Libby,
Here are the notes from his file. - dated 3/17/2010
HISTORY: Living at Casco Bay Veterinary hospital for last 2 weeks. Diabetic for last 6 weeks, on Glargine 4unit BID. Canned food and DM dry, very calm cat, eating fine.
8 yrs old 15lbs.
From owner's vet file:
2/2/10 - possible UTI - peeing outside of box for 2weeks
2/16/10 - owner is dropping Oliver off, has been finding urine all over.
2/17/10 -tests indicate DM / poss. acidosis
starting dose: 2u BID
2/19/10 - owner advise doing well, likes science diet
2/25/10 - rechecked. still on 2u
3/11/10 - BG readings 845am 517mg/dl 400pm 363mg/dl - m0ve up to 3u
That's the last notes.
Not much to go on, but it gives a bit about the dosing since dx.
The trip dose was decreased to 1u.

His weight - it may be 15lb but I can feel all of his spine and some of his ribs, so if he is OK then Shadoe is an obese rock. He just feels so light for his size! Maybe it's just the old Ukrainian in me that is thinking OI, eat something!

So, what do you think I should do with his dose? Continue for the 10cycles or reduce for a bit?

Re: 3/22 Oliver pmps 356 +2~412 +4~367 - 3u too high?

Oliver seems OK, but sleeping alot.
He's eating OK as well, and not near as much as on his arrival. Sadly, I think he's been talking to Shadoe and she must have told him that he does not have to eat everything I give him, but he can hold out for better stuff.
He's pretty happy with pats and scratches under the chin and on the neck, plus he really likes being brushed. I think he's claimed the small rug he's on now; he'll move here and there, but goes back to that rug to sleep.
He also decided to use the same LB as the others, so that cuts down on my work.

He's sticking in the pinks, almost deja vu to me; I just don't know if he is getting too high of a dose or I am just holding to increase after 6 cycles or so.

I'll aim for a bedtime test if I don't fall asleep first.

Tomorrow am will be 6cycles and Oliver's pretty much solid pink. Should I hold his dose for a couple more days, or make a change?

Oliver's doing fine, better than I am because I'd like to see a peek of some lower numbers.