? 3/22 AMPS 192 What to do??
- Thread starter Vanda Kay
- Start date
https://www.felinediabetes.com/FDMB...last-3-doses-please-help.299322/#post-3255519
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Vanda Kay
Member
Thanks!
Basically flat. Hopefully someone more experienced stops by to advise.
Have you decided on a dosing method? I see Wendy was talking about a reduction to 0.75 units on 3/20 if following SLGS but it looks like you’re holding 1 unit?
Have you decided on a dosing method? I see Wendy was talking about a reduction to 0.75 units on 3/20 if following SLGS but it looks like you’re holding 1 unit?
Last edited:
Angela & Cleo
Very Active Member
Hi @Vanda Kay those are nice high blues. When new to FD, we usually suggest to stall without feeding and test in 1/2 hour to see if the BGs are rising.
If you haven't fed yet, and if you can monitor, and have supplies (high carb food, honey/Karo/syrup and lots of testing supplies, you can shoot the full dose.
What did you decide to do?
If you haven't fed yet, and if you can monitor, and have supplies (high carb food, honey/Karo/syrup and lots of testing supplies, you can shoot the full dose.
What did you decide to do?
Vanda Kay
Member
I checked again and it was still 182 up until 4 hours after her usual shot time so I didn't shoot. Then I spoke to the vet who's worried about ketones and wants me to give her 1/4 shot now, nearly 5 hours after the usual shot time. I don't know what to do.Its now 225
See you shot 5 hours late… are you going to shoot late tonight too and then work back? I don’t think you’re supposed to overlap by that much.
For the spreadsheet, I'd recommend a few tweaks to how to document to doses so it's easier to see the timing. The AMPS could be 184@+12, 184@+16, 235@+17. For the PMPS, that would be 289@+10. At a glance, that shows us how much you stalled this morning, and how much earlier you shot tonight.
For future reference, shooting that much earlier is not recommended. This post tells you what to do when you end up late with a Lantus shot: Getting back on a 12/12 shot schedule
0.4 ketones is still fairly normal on the ketone BG meter. As long as Landa has seen nothing higher, you could have skipped. Once you have a bit more experience, you will find you could have shot the entire dose at that 184. Landa was at 188 at +7 last night, and basically the same number this morning for several hours, meaning she wasn't going to go down any more on last night's insulin dose. In the beginning, especially since she was so flat, you could even have shot a partial dose in the AM after stalling for an hours and seeing her numbers were still the same. Consider this a learning experience for next time.
One housekeeping note, could you put SLGS in the signature, as that is the dosing method listed on the spreadsheet. Just saves us a minute looking it up. Although I always open the spreadsheet, sometimes there are questions that don't need the spreadsheet to answer.
For future reference, shooting that much earlier is not recommended. This post tells you what to do when you end up late with a Lantus shot: Getting back on a 12/12 shot schedule
0.4 ketones is still fairly normal on the ketone BG meter. As long as Landa has seen nothing higher, you could have skipped. Once you have a bit more experience, you will find you could have shot the entire dose at that 184. Landa was at 188 at +7 last night, and basically the same number this morning for several hours, meaning she wasn't going to go down any more on last night's insulin dose. In the beginning, especially since she was so flat, you could even have shot a partial dose in the AM after stalling for an hours and seeing her numbers were still the same. Consider this a learning experience for next time.
One housekeeping note, could you put SLGS in the signature, as that is the dosing method listed on the spreadsheet. Just saves us a minute looking it up. Although I always open the spreadsheet, sometimes there are questions that don't need the spreadsheet to answer.
Vanda Kay
Member
Hi. I only gave 0.25 as the late shot and my vet said it would be ok to shoot 2 hours early. I have to get back on schedule by the time I go to work on Monday evening and Landa's numbers are high again. The vet is constantly warning me about ketones. I haven't got the sticks yet or worked out how I'm going to catch the pee. Landa is a very hard to handle cat with semi feral behavior when it comes to any kind of intervention. It's a miracle I'm able to give her insulin at all.
Vanda Kay
Member
Thanks. I have read that note before and followed it when I first started giving Lantus and needed to change the schedule by 15 minute increments. Now I don't have the option because I need to leave for work at 6pm on Monday evening. How do I get back to that safely please? Landa's numbers are high again and I can't skip a shot. She only got 0.25u yesterday at 10.30am, then 1u at 8.30pm. The low did not go below 220. When can I have her her morning shot today? Also, what do you mean by "partial shot" and how would I determine the amount? I messed up by not giving her the shot yesterday morning and now I'm in a pickle. I will be at work Monday 6pm- 9.45pm. A late schedule doesn't work for Landa since she's been waking me up for food at 5am every morning for the last 5 years. About ketones: my vet said this number can increase suddenly and I have to check regularly. When Landa was diagnosed 3 weeks ago, she had no ketones in her urine.
There are blood ketone meters if you have trouble with the urine strips. Same concept as testing the BG. We have the KetoBM but there are other brands that work too.
Vanda Kay
Member
Thanks. I use Freestyle libre because she won't let me touch her ear. There's no way I can get blood from her ear or anywhere else.
Vanda sent me a PM and I'm responding here. Vanda said:
Sigh....
If I had been around last night, I would have suggested different options than what your vet recommended. We generally do not suggest getting off track with your shot time more than 2 hours. Even with a 2 hour stall, it can still be really hard to get back to your usual time if you're that off schedule. Lantus is an insulin that likes consistency. It's one of the reasons that when you have to adjust for shot time, we do it in small increments so you don't end up destabilizing the depot. Your vet was also wrong (sorry) on that count in that you really shouldn't shoot early by 2 hours. Because Lantus is a depot type of medication, an early shot acts like a dose increase. A late shot acts like a dose reduction. And, if you shoot late then shoot early, you are likely to get wonky numbers because you are making back to back adjustments to the shot time and it's resultant effect on the dose. And to complicate matters further, you gave a significant dose reduction.
Since it sounds like you need to be back on schedule for Monday. Your best option is to skip the AM shot and then give your PM shot at the usual time. If you hadn't shot 5 hours late, you could have shot at +6 and then shot at +18. (In other words, you shoot twice at 18 hours after your typical shot time which gets you back on your preferred shot time.) My only concern is with ketones. Does Landa have a history of DKA?
For the future, with a pre-shot of 184, I would have given serious consideration to shooting. That is a perfectly fine pre-shot numbers. Whether you shoot, depends on how confident you are with managing low numbers (someone will help you and there's a sticky note at the top of the forum on what to do), if you'll be around to monitor, and if you have sufficient supplies should numbers drop.
In general, your options if you encounter a lower than usual pre-shot are to:
It helps to remember that the insulin is petering out by shot time. With Lantus, there is overlap between doses which is why you may be seeing a lower than expected pre-shot (and the pre-shot was flat when you look at the PM +7 from the previous evening). In addition, it takes roughly 2 hours for Lantus to start working AND you're feeding your cat, which has an impact on the numbers.
Sigh....
If I had been around last night, I would have suggested different options than what your vet recommended. We generally do not suggest getting off track with your shot time more than 2 hours. Even with a 2 hour stall, it can still be really hard to get back to your usual time if you're that off schedule. Lantus is an insulin that likes consistency. It's one of the reasons that when you have to adjust for shot time, we do it in small increments so you don't end up destabilizing the depot. Your vet was also wrong (sorry) on that count in that you really shouldn't shoot early by 2 hours. Because Lantus is a depot type of medication, an early shot acts like a dose increase. A late shot acts like a dose reduction. And, if you shoot late then shoot early, you are likely to get wonky numbers because you are making back to back adjustments to the shot time and it's resultant effect on the dose. And to complicate matters further, you gave a significant dose reduction.
Since it sounds like you need to be back on schedule for Monday. Your best option is to skip the AM shot and then give your PM shot at the usual time. If you hadn't shot 5 hours late, you could have shot at +6 and then shot at +18. (In other words, you shoot twice at 18 hours after your typical shot time which gets you back on your preferred shot time.) My only concern is with ketones. Does Landa have a history of DKA?
For the future, with a pre-shot of 184, I would have given serious consideration to shooting. That is a perfectly fine pre-shot numbers. Whether you shoot, depends on how confident you are with managing low numbers (someone will help you and there's a sticky note at the top of the forum on what to do), if you'll be around to monitor, and if you have sufficient supplies should numbers drop.
In general, your options if you encounter a lower than usual pre-shot are to:
- Don't feed your cat and stall. Wait 20 or so minutes and re-test. Repeat the process if numbers aren't rising.
- Shoot a reduced dose.
- Skip
It helps to remember that the insulin is petering out by shot time. With Lantus, there is overlap between doses which is why you may be seeing a lower than expected pre-shot (and the pre-shot was flat when you look at the PM +7 from the previous evening). In addition, it takes roughly 2 hours for Lantus to start working AND you're feeding your cat, which has an impact on the numbers.
Also, you're seeing high numbers due to Landa bouncing. When the numbers are dropping into lower ranges, her body panics. The liver and pancreas release a stored form of glucose along with counterregulatory hormones. They cause numbers to spike. It takes several cycles for the numbers to come back down. It's a normal process although it's a process that's quite annoying for the caregiver.
Nothing wrong with being paranoid about ketones, but I'd be more worried if Vanda had ever shown ketones before. 0.4 level ketones is in the normal range, not a number to worry about. My cat was in way higher number than yours, and I'd occasionally do a fur shot. 
. I'd test for ketones and cross my fingers, and fortunately she never showed anything other than trace for ketones. Is Landa eating well and still having a normal level of activity? If yes, then it's even less worrying.
. I'd test for ketones and cross my fingers, and fortunately she never showed anything other than trace for ketones. Is Landa eating well and still having a normal level of activity? If yes, then it's even less worrying.Very common.
Vanda Kay
Member
Yes, Landa is eating normally and seems fine. Her nadir went pretty low today (82) and then she bounced. She's up in the high 300s tonight. I had to skip tonight's shot so I can get back on track at 5.30am tomorrow morning. I hope that's not terrible. But I can't be awake all night checking her lows. Once we're back on schedule, it'll be much easier. I've learned my lesson now.Nothing wrong with being paranoid about ketones, but I'd be more worried if Vanda had ever shown ketones before. 0.4 level ketones is in the normal range, not a number to worry about. My cat was in way higher number than yours, and I'd occasionally do a fur shot.
Very common.
Could I just ask about the dosing protocols please? How do I decide which one to follow? Landa is on 1u BID, wet food only, mostly LC but "sweetened" with a teeny bit of gravy to get her eat it. I am desperate to get her regulated. How long does the bouncing go on for? Is there anyone I can chat to about it and how you get past that? Thank you so much for your help!
That's great to hear that Landa is eating well and seems fine. Cats are so much more than their BG numbers.
We have two dosing methods we use with Lantus, described in this post: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
Read them over, and see which one might fit your lifestyle and goals for Landa. TR requires more testing and an all low carb or wet food diet. We dose by nadirs, or how low the dose takes the cat. With TR we reduce the dose if they go below 50 on a human meter. For SLGS we reduce if they go below 90 on a human meter. If you are following SLGS as per your signature, and since she went below 90 today, you would reduce the dose tonight to 0.75 units. She went to 68 on the 18th too, so should have had her dose reduced then. The length of time we hold the dose also varies between the two dosing methods.
You are right that she is bouncing now, or at least from what you describe. It would be great if you could keep your spreadsheet current. Bouncing is completely normal and 99% of cats do it to start. It also drives us caregivers nuts, mostly because there isn't a lot we can do but wait it out. It can take up to six cycles/3 days for them to get over a bounce. The way to get them to bounce less over time is to get them used to spending more time in normal blood glucose numbers. Which can take time. Patience is a good trait with feline diabetes - not my strong suit!
We have two dosing methods we use with Lantus, described in this post: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
Read them over, and see which one might fit your lifestyle and goals for Landa. TR requires more testing and an all low carb or wet food diet. We dose by nadirs, or how low the dose takes the cat. With TR we reduce the dose if they go below 50 on a human meter. For SLGS we reduce if they go below 90 on a human meter. If you are following SLGS as per your signature, and since she went below 90 today, you would reduce the dose tonight to 0.75 units. She went to 68 on the 18th too, so should have had her dose reduced then. The length of time we hold the dose also varies between the two dosing methods.
You are right that she is bouncing now, or at least from what you describe. It would be great if you could keep your spreadsheet current. Bouncing is completely normal and 99% of cats do it to start. It also drives us caregivers nuts, mostly because there isn't a lot we can do but wait it out. It can take up to six cycles/3 days for them to get over a bounce. The way to get them to bounce less over time is to get them used to spending more time in normal blood glucose numbers. Which can take time. Patience is a good trait with feline diabetes - not my strong suit!
Vanda Kay
Member
Thanks, Wendy! Not my strong suit either. I need to update the spreadsheet. Apologies for the delay in replying. I haven't been very well (lack of sleep, low immunity etc.). I'm trying really hard to get these numbers to turn.
I do have one question based on a suggestion from my vet, after she consulted an internist friend of her's: what are the views of folks here on differential dosing AM and PM? Landa's numbers have been much better/low after the AM shot, including +11 hours, which really threw me off course and gave me a panic attack. After the PM shot and overnight, they're consistently very high. The vet suggested 0.75am and 1.25pm. I need to give her her pm dose in the next half hour and don't know how much to give. Her BG is now 300 and rising. This morning I only gave 0.5 because I couldn't not get her to eat enough.The nadir was 219 at +6. I will start catching up on the spreadsheet today!
My other question is since I'm following SLGS, if she has a nadir below 90 on a second consecutive day, do I need to reduce again by 0.25?
I do have one question based on a suggestion from my vet, after she consulted an internist friend of her's: what are the views of folks here on differential dosing AM and PM? Landa's numbers have been much better/low after the AM shot, including +11 hours, which really threw me off course and gave me a panic attack. After the PM shot and overnight, they're consistently very high. The vet suggested 0.75am and 1.25pm. I need to give her her pm dose in the next half hour and don't know how much to give. Her BG is now 300 and rising. This morning I only gave 0.5 because I couldn't not get her to eat enough.The nadir was 219 at +6. I will start catching up on the spreadsheet today!
My other question is since I'm following SLGS, if she has a nadir below 90 on a second consecutive day, do I need to reduce again by 0.25?