11/27/20 Chicamonkey Starting TR today AMPS 454/ +2 403/+3 244/+4 132/+5 137/+6 144/+8 161/+10 230

Good morning all!
I want to start tight regulation with her today since I’m home for the next three days to closely monitor.
Her ideal weight is 10 lbs. so I’m shooting 2.0 U this AM based on protocol.( 2.5 was calculated but it makes me nervous)
We are ready in case of a hypo event.
I think she’s ready .... she has had two days on lantus now , since converting from NPH .
Any advice would be appreciated!
Thank you

Hope everyone had a great day yesterday

 

One recommendation here is that you increase by .25 increments.

That's a pretty large increase - and after 6 cycles on .5, the recommendation is to increase to .75.

Here's your condo from yesterday - https://www.felinediabetes.com/FDMB...amonkey-amps-310-pmps-298-2-268-4-250.239084/ We recommend that you copy/paste that one into the new one for historical purposes.

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.
• Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
• Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.

She hit some pretty good numbers yesterday - below 200 - so I would not have increased this morning based on those nice blues you got yesterday - she's bouncing today from going lower than she's used to.

So my recommendation would be to give .75 tonight - stay close today and watch carefully - do you have high and medium carb foods on hand? Karo or maple syrup? Plenty of testing supplies?

Please post here again for help if she starts to go too low.

I may not be here but others will be able to help you.

 

Thank you for this! I still have her high carb food and Karo syrup on hand in a prefilled syringe just in case. And plenty of testing supplies! Will check often today!

 

Does she like sweets? Luci LOVES honey and of course all other sorts of contraband. I've found that if I put a couple of drops of honey on the back of her paw she's in heaven...and of course her BG's will soar after that...she thinks it's a treat!

Once she starts dropping from the 400's she may take off...any time she drops more than 100 points, set a timer/alarm and test her again within an hour.

 

Will do! Thank you!
I do have honey... she’s typically not a sweet tooth girl... more salty
Just checked her bg 403

 

Excellent! Hopefully she'll just slide nice and gentle like down to the lagoon (green)...diligence is your friend today though.

Luci likes salty too...she likes all contraband - popped corn, crackers, etc. she used to love CheeseIts...those little orange crackers....I'm sure you can tell by now that Luci came by her diabetes due to her poor eating habits...she's a bad one for getting into things too!

 

Here too! My husband gained her trust through food.
I would often find them sitting at the kitchen bar together, he gives her a little dish ( Monkey bowl) as we have affectionately termed it. As you can see her she would wait for her bowl .
I feel pretty good about today. Confident in lantus, and her and how I think she’ll respond. BUT I’m also prepared.

 

Hi Suzi, could you update the field on your SS at the top left that says "Current Insulin" to Lantus from NPH? Thanks

 

Yes!! Thank you

 

I agree with Sue and Luci. The protocol does have a suggestion for starting dose, but that's for a cat that is not already on insulin.

As Chicamonkey was already on the 0.5u of Lantus (after being on the NPH), we need to take those numbers into consideration
She hit blue with the 0.5u, after 6 cycles and is relatively new to blue numbers, I might have held the 0.5u for 8 cycles.
I would definitely not go with the 2u as a dose, but cut the dose back to
either 0.5u (more conservative approach) or the 0.75u a little more aggressive.

As she is new to Lantus I might opt for the more conservative approach.
The downside is that you will have to hold onto the 0.5u for 6 cycles /3days (the cycle count recommences every time you make a dose change).

 

Thank you. Keeping a tight eye on her

 

One other thing, you may well get some wonky numbers, this happens when we flip flop with doses.
Going from 0.5 to 2 to 0.75. the depot has to readjust to the size of each new dose and it can cause some erratic numbers. Just bear that in mind.

 

Thank you I will

 

The lantus depot didn't have time to fill. Normally you hold initial dose for 1 week before any increases. Then only small increase. You gave a big jump before it was established, make sure you monitor closely the next few days.

Don't rush the method, it can be dangerous. You are dealing with a hormone that can kill.

 

Hi Suzy, that last drop was a big one - time for extra precautions on your part - if it were me and Luci dropped that much in an hour, I'd probably give her a teaspoon of medium carb food - something with 12-15% carbs - maybe a little gravy - it's time to put the brakes on those drops...

Don't wait until it's too late and those numbers are dropping too low...time is now to take some steps to slow things down. Not high carb or karo - yet - but don't wait a full hour now to get the next test. She's in too big of a hurry to suit my taste just now...

 

I agree ... gravy on board!

 

Suzi -

Who calculated your starting dose? The formula for the initial dose of Lantus is: initial dose = 0.25 x ideal weight in kilograms. For a 10 lb cat, the dose would be approximately 1.0u twice a day. However, given that your kitty was on NPH, you would stick with the same dose especially since you were seeing nadirs in the 100s.

In other words, I agree with Gil.

 

i feel like a horrible cat mom. Went against my own better judgement. A really dumb person calculated her dose (me).
I don’t know what I was thinking.
She’s holding her own at 130’s every 15 mins after some higher carb fancy feast.
I will stick with start low go slow method from now on especially since I had already started her on lantus after switching from NPH

 

Hey don't beat yourself up. It's a lot to take in. I had a brain fart when I calculated George's starting dose when we started.

Just take her back to the 0.5u tonight, and use that as your TR dose. You hold onto that for a number of cycles, 6 minimum, see what nadirs she gets and take it from there.

 

You may have seen an older formula for calculating the starting dose -- it doubles the formula I listed (i.e., 0.5 x ideal weight in kg). It was initially used only in hospital situations where a cat was being continuously monitored and the vet the did the work on Lantus realized it was too aggressive for home monitoring. The old formula is still floating around.

 

Oh my gosh

 

Thank you... I am beating myself up a lot though!

will take her back to starting dose

 

The important part is that it takes 5-7 days for the depot to get established...during that time, you don't change the dose unless it drops her too low. At the end of the 5-7 days, we'd have a good idea of what the starting dose is really doing.

Stop beating yourself up! We ALL made mistakes with our cats when we were new! Luckily, our cats usually did just fine despite our little screw ups (Thank God!)

 

You did great today! I was relieved to see her numbers never got below the blues...and now she's curving back up to the lemon tree!

Things will shake out over time! Just move carefully and cautiously as you proceed with increasing the dose...never increase based on a pre-shot number - increases are based on the lowest number reached during the mid-cycle...

You're a wonderful cat mom! No regrets now...you're doing fine

And next time you're out shopping pick up some medium and high carb fancy feast foods - just to keep on hand. They just love to swoop down sometimes when you least expect it...and those foods will help to bring them up in a slower, more controlled manner. Save the karo or honey as a last resort for when those foods just aren't doing it...

Have a lovely evening!

 

I held on to her “high carb” wet food ( just in case)
But all the kibble has been donated to my vet and the local shelter here.