1/13 Mally AMPS 248, +2 142, +4 63 - Dosage question

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Chris & Mally

Chris & Mally

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Hi Everyone! I'm new to the group and Mally is a brand new Lantus user. I started with a new vet yesterday and you can find a little background here in this thread.

Mally is currently on 1 unit once a day. I know this is not the protocol for Lantus and my vet is aware of that as well. He only has her on this dosage for a few days and plans to put her on it BID after he looks at her numbers for the next few days. I'm not completely sure of his reasoning for the current dosage, but I'm going to go with him on this and give him what he is looking for.

I'm happy to be a part of this group and I look forward to getting to know everyone better!
 
Re: 1/13 Mally AMPS 248, +2 142

Hi there and Welcome!

I'm so glad you found a nice vet, he sounds very coopertive. I totally understand your meeting the vet part way, better to not start a battle right off. I think the few days won't hurt much, it's not ideal but we have seen much worse begininngs :o Perhaps you could call after 3-4 days and ask if you could show them your data and discuss switching to BID dosing sooner.

Not sure why the vet wants to start that way, maybe he just wants you to get used to testing and shooting insulin without the 24 hours worries and timing stress. It can be time consuming and tiresome when you have to stay up till 2 AM because your cats BG is very low after his evening dose, so maybe he wants you to be able to get some sleep and see how the insulin lowers the BG without over stressing you right off. Just a theory as to why he is starting out that way when he knows it will need to be 2 x a day.

Anyway I wish you lots of luck and I think you will be very happy with using Lantus once you get into the routine with it. Hopefully it will be a short school program and Mally will be OTJ (off-the-juice=remission) quickly....we did mention that a great number of cats go into remission with Lantus on this forum didn't we? :-D We even have a little party when you make it!!!!!! party_cat
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

Hi Chris. You can always get your post to the top of the page by adding another reply, you don't have to open a new thread (condo.) As Gayle mentioned you also can edit your original subject line, but editing does not 'bump' your condo to the top. So make sure to add a reply as well. I hope that made sense.

Yes this 63 is still within normal ranges, but I understand your concern since the drop from this morning is about 185 points lower.

What food do you feed Mally? I know you mentioned canned food, (yeah!). To get this number to stay steady and not drop any more you can feed some low carb food now. If Mally continues to drop to below 50-40 you can add some higher carb gravy. Since this is your first day, let's not have the excitement like Baby did!

Feed some lo carb now and hope that Mally will 'surf' in these lovely numbers you have now. It is not exceptionally early in the cycle... just a little early.

Keep posting your numbers in this condo so all your info is together.
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

Chris I hope some helps you here. You are looking fine so far. I have to leave to pick up kids and will check back in an hour or so. Good luck. You are not in the danger zone.
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

Mally, along with my other three cats were switched to all canned food two weeks ago when Mally was originally diagnosed. I feed them Fancy Feast and I use Janet & Binkys list to choose the lower carb foods.

I tested Mally again at 2:38 PM and she was at 61. I just gave her some food because she came into the room looking for food in the bowls. She's eating right now.
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

I tested Mally again at 3:08 PM. She was at 82. I'm guessing the food she had at 2:45 raised her numbers a bit.

These are her numbers so far today:

Test – 9:33 AM (Before Feeding)
BG 248
Fed Meal – 9:38 AM
Gave Shot – 10:08 AM
Test – 12:06
BG 142
Test – 2:08 PM
BG 63
Test – 2:38 PM
BG 61
Fed Food – 2:45 PM
Test – 3:08 PM
BG 82
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

Chris,

I am probably one of the minority here that believes this, but I think it needs to be said. I think a BG of 63 is too low. I have discussed with my vet and she feels the same way. At 63 I would be giving some high carb food or at least getting more food in Mally. My vet says they have seen seizers in cats that fall below 50. I am sure this isn't the case with every cat, but better be safe than sorry.

What I can tell you is that I tested my non-diabetic cat the other day and her numbers were in the high 50's and she isn't on insulin and she is perfectly fine with those readings. So 63 might not be life threatening to a non-diabetic cat, but I am not a doctor and it might be for a life threatening number for a diabetic cat.

I would also call you vet and let them know that Mally dropped this low on the first dose. They may decide that 1 unit is too high to start with. Do you have syringes that have the half unit marks? It might be better to start off at .25 or .5 twice a day instead of 1 unit once a day. You might mention to your vet that you have been doing your own research and have some ideas. They might not always agree, but at least they might have an open mind to your ideas. This is what I have done with my vet and it is working well for me. I am still not in agreement with everything my vet says, but at least she listens to what I have to say.

Hope this helps.
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

I have the syringes with the half unit marks. I made sure to specifically ask for them when I filled the Lantus prescription.

I'm not an expert at this but I've decided that after today, I'm going to switch Mally's dose to .5 unit BID. When I send the information to the vet on Monday, I'll tell him that I did the full unit the first day and felt more comfortable switching to .5 BID.

The syringes are so small and .5 unit is hard to read. I'm going to go out and buy a magnifying glass with a light on it. I just don't want to screw this up.
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

I tested Mal again at 3:38 PM and she was at 78. She doesn't want any food at this time.
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

She's doing super! Surfing like a pro!!!

I'm gonna bet in no time at all Mal will be otj. Don't let those 60's scare you. You're gonna need those beautiful lower numbers to have more chance at remission. Now, on the other hand, some kitties are not comfortable there and I guarantee she will let you know if she doesn't. She'll whine for food, bug you and be all irritating until you feed her some lc food.

For example, Seymour just loves the lower digits. He won't whine until he's in the 30's and sometimes not even then. I'll give food depending on where he is in the cycle determines if it's hc or lc. It is scary the first few times, but you'll get the hang of it and we're always here if you need help.

Congrats on such a pretty first day on Lantus!!!!
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

Thanks, Andrea. Mally decided she wanted to eat again and is eating right now. The food was set out for her, but she wouldn't take it at first. She came in the room meowing at me even though she had food. I picked her up for a bit and when I put her down, she went and ate.

One of my civvies, Prue, thinks we're having a party in here. Her dinner will be served shortly. :lol:
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

Chris, my personal feeling is that if we're to "teach" kitties' pancreas to start working again, we need to "lead by example", and 63 is a good, nice number to have. If they are ever going to go into remission, time spent in "normal ranges" will help them learn what is normal; they may not have felt "normal" for a very long time, and don't quite know what it is. Their body has to relearn it all over again...so keeping in the "normal" range is good, know what I mean? (and BTW...none of that means jack when I'm sitting here watching Esse go lower and lower...and then...have to shoot lower numbers. I still get scared about numbers in the 60s...it's a normal part of the bean learning process, I suppose...)

And something else I've learned well: kitty will eat if they need the food. They don't supress hunger like humans do; we can tell our bodies "not now, I'm busy" or whatever. For them, their bodies say "hey, get some food RIGHT NOW" and they do eat if they need to. (I think we should be more like our kitties that way...)

I think you'll be all right...expect some higher numbers over the next few days, while her body tries to "fight" against the "normal" numbers (which she sees as not acceptable), and just keep on keepin' on.

Best-
Michele
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63 - Question about dosage

Mally's +7 was 145 and it's time for dinner for all four cats. Not sure how much she'll eat but like Michelle said, she'll eat when she's hungry.

As I mentioned, my new vet put Mally on 1 unit once a day for the first few days. I'm thinking that I should go to .5 BID and I'd like some input before I make that switch.

This is the data I have so far for today on the 1 unit.

1/13/2010
Test – 9:33 AM (Before Feeding)
BG 248

Fed Meal – 9:38 AM
Gave Shot – 10:08 AM

+2 Test – 12:06
BG 142

+4 Test – 2:08 PM
BG 63

+4.5 Test – 2:38 PM
BG 61

Fed Food – 2:45 PM

+5 Test – 3:08 PM
BG 82

+5.5 Test – 3:38 PM
BG 78

Fed Food – 3:50 PM

+6 Test – 4:10 PM
BG 79

+7 Test – 5:08
BG 145

I'd appreciate any advice about changing Mally's dosage to .5 BID.

Thanks!!!!!
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

Someone with far more experience will come along and tell you much better than I will, but I think that 1 unit once a day is not such a great way to work Lantus. I'd rather see 0.5U in the morning, and then again in the evening, for several days, and see where the numbers take you. The biggest thing is that it really needs to be consistent - every 12 hours - for the Lantus to work correctly in the system. Is there a normal breakfast dinner time that you already have for all cats? And if not, can you adjust it so that their schedule can be 12 hours? That way, Mally can build the shed consistently, and keep stuff flowing in the bloodstream all the time...

And 145 is a great number. Nothing to be scared with there, you know?

Best-
Michele
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

Chris your kitty is doing great.

I can't type much as I have 7 yr. old waiting for dinner. But your cat was not in danger at 63! My cat who is now OTJ sometimes tests at 65-69 with NO insulin. Also home meters usually test a bit low as a safety measure.

Please... we try to get into the 60's so the cat's pancreas can heal. Do not be scared of a number in the normal range. My vet told me that NORMAL non-diabetic numbers are between 60-120. I've never heard of a cat going into seizures at 50. confused_cat

Michele is correct about the consistency of twice a day dosing. You will get a more even and gentle response.
Good luck!
 
Re: 1/13 Mally AMPS 248, +2 142, +4 63

msarobix said:
Chris,

I am probably one of the minority here that believes this, but I think it needs to be said. I think a BG of 63 is too low. I have discussed with my vet and she feels the same way. At 63 I would be giving some high carb food or at least getting more food in Mally. My vet says they have seen seizers in cats that fall below 50. I am sure this isn't the case with every cat, but better be safe than sorry.
Click to expand...

chris, i would suggest you look at the spreadsheets of kitties who have gone off the juice to understand just how incorrect this advice is. we do not feed high carb to a 63 unless it follows a huge drop at the beginning of the cycle.

here's the link: http://spreadsheets.google.com/pub?key=pZ1soNpOWRCB5WKzukx_dHQ&gid=1

vets tend to freak out when they see double digits in the office because *most* kitties bg's run higher in the office than at home for a simple reason... they're highly stressed at the vet's office! there are some kitties whose numbers drop with stress, but they are not in the majority.

click on the spreadsheet links in my signature for more examples. the levemir spreadsheet (lev works in a similar fashion to lantus) shows what was done to get my own cat OTJ after fully understanding the concept presented in the tight regulation protocol (also linked in my signature). the idea is to get kitty's numbers into the normal range as quickly as safely possible to enhance the chances of remission. 63 is a very normal and acceptable number for nadir. dose adjustments are based on nadirs. a dose reduction is *usually* indicated when a newly diagnosed kitty drops below 50.

msarobix said:
What I can tell you is that I tested my non-diabetic cat the other day and her numbers were in the high 50's and she isn't on insulin and she is perfectly fine with those readings. So 63 might not be life threatening to a non-diabetic cat, but I am not a doctor and it might be for a life threatening number for a diabetic cat.
Click to expand...

no, a 63 is not a life threatening number for a diabetic cat. my own diabetic cat tests in the 50s and 60s when off insulin. my non-diabetic cats routinely test in the 40s & 50s.

msarobix said:
I would also call you vet and let them know that Mally dropped this low on the first dose.
Click to expand...

keeping your vet informed is always a good idea, but years of experience has shown us a response like this is not unusual on the first dose. it happens a lot with lantus.

hope this helps...
 
I posted this question earlier, but I think the board ate my post. :smile:

Anyway, what if I just switched Mally's dosage to .5 BID instead of doing 1 unit once a day. I'm only supposed to do the 1 unit once a day for the first few days and then the vet said he would change her over to twice a day. I'm thinking that starting tomorrow, I'll changed to .5 BID and really get her going right.

Opinions?

Thanks!!!
 
ChrisH said:
I posted this question earlier, but I think the board ate my post. :smile:

Anyway, what if I just switched Mally's dosage to .5 BID instead of doing 1 unit once a day. I'm only supposed to do the 1 unit once a day for the first few days and then the vet said he would change her over to twice a day. I'm thinking that starting tomorrow, I'll changed to .5 BID and really get her going right.

Opinions?

Thanks!!!
Click to expand...
I said that I thought that would be a great idea a few posts up...and I still think so. Good luck tomorrow - and do you have 1/2 unit syringes?

Best-
Michele
 
Hi Michele! Yes, I have the 1/2 unit syringes and now I also have a magnifying glass! Those needles sure are skinny and hard to read.
 
I think switching to 0.5 units BID is an excellent idea. If you want to collect some data to show your vet why you did that, try to grab another spot check tonight, and of course the AMPS number in the morning. Most likely the numbers will continue to go up, and you can show your vet that the Lantus wore off too soon for once a day shooting to be effective. As Jill mentioned, you can also show him any of the spreadsheets of the OTJ (Off The Juice) kitties at the link she sent you.

I'll also echo what Jill said about today's numbers, 63 is a safe number and is actually pretty ideal as a nadir. :smile: There can be instances where we would recommend feeding high carb to a number in the 60's, for example if his AMPS was 400 and the +2 was 63, that is a fast drop early in the cycle so we might want to feed some high carb to slow that down. But Mally had a nice easy drop to a perfect nadir, it was actually a very nice day for her and one that I hope you'll see again often. :smile:
 
also..... if you haven't already done so, please read the stickies at the top of this forum (the posts with stars). Some of it will not make sense right away, but there is a ton of information that you need to know. Welcome!
 
Hi Chris and welcome.

You have already done an incredible job -- you found a vet who is informed about Lantus and even better, supports home testing, you've switched all of your kitties to low carb, canned food, you've familiarized yourself with some/most of the information here, and you are posting. Those are some of the bigger hurdles.

The front end of this learning curve is huge. Please don't hesitate to ask question. There are several very experienced Lantus/Levemir users here such as Jill, Libby, Cassandra, CD, and Heather one of whom tries to be here so there is guidance almost 24/7. There are others of us who haven't been around as long and do our best to make sure there's someone around who can respond to questions and get a pair or two of experienced eyes to your condo (that's what we call your thread for the day) if you have a question or concern we can't easily answer. There are also some very experienced people who drop by and lend a hand but on a less frequent basis.

You asked a question about whether to stick with 1.0 or 0.5 units of insulin. One means of gauging the initial dose is based on your cat's ideal weight. If you know Mally's ideal weight we can give you an approximate dose -- although, it's usually in the neighborhood of 1.0 unit. Ultimately, what your starting dose is, is your decision. One thing to keep in mind is that within the next few days you will be dosing twice a day. You need to be comfortable giving whatever the amount is, twice a day. The consistency is important. You may want to give your vet a call and let him know how Mally did on this dose today. It's also possible that Mally's numbers may be a bit higher after the 63. (There is a phenomenon called "rebound" whereby the liver will dump glucose into the system because it panics when a very normal number like a 63 occurs. The liver isn't used to having a BG level in the normal ranges so it takes action.)

The 63 is a very desirable number. The Tight Regulation Protocol that we use to guide dosing has very strong research to support its use. One way to reduce your cat's insulin dose and eventually reach remission/regulation is to have numbers drop below 50. This is not dangerous and is easily steered by the use of both low and/or high carb food. (So stock up on the 18% carb food with gravy!) Research would never see the light of day if it was putting a kitty's life in jeopardy and none of us would be here if this protocol didn't work.

Please post every day. Read our condos and study everyone's spreadsheets. And most importantly, ask questions. We'll do our best to answer. And again, welcome. This is an incredible place with incredible people who really do understand.
 
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