4/20 Remy AMPS 373 /+5 175 /+7.2 148/+10 147 PMPS 182(First day of insulin)

Perezamado23 said:
Today's is Remy's first day of insulin and I was a bit surprised to see a blue so soon. I thought Lantus builds over time so I got a bit nervous.

Is this normal? Thanks.
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Welcome Samantha and Remy to the LLB forum :bighug:. Yes Lantus builds a "depot" over time but we've seen some newly diagnosed cats show movement right away on Lantus. We ALL know how nervous treating FD (feline diabetes) can be. You will need to remind yourself (and we'll remind you too;)) that you have the tools to keep Remy safe. You're home testing (yes!!!) and do you have a hypokit (an array of medium carb (MC) and high carb (HC) food, karo or syrup) prepared?
 
Thank you for your response!

Yes, I have his hypokit ready to go but hoping I never have to use it :)

I'm working from home today and tomorrow as I wanted to be around for his first few insulin days. I feed him about every 2 or 3 hours during the day as he had lost a lot of weight but will not feed him 2 hours prior to PM test/shot time.

Am I ok to follow the rule of "no insulin under 200 (I'm using a pet meter)?" since I have no history really for him? Do you recommend I test him again in a couple of hours or can I just test at PM shot time?
 
Perezamado23 said:
Yes, I have his hypokit ready to go
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EXCELLENT
Perezamado23 said:
Do you recommend I test him again in a couple of hours or can I just test at PM shot time?
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I'm the wrong person to answer this because I'm a testaholic :facepalm: :oops::cat:. Joking aside, any and all data is good data especially when new to insulin.

Perezamado23 said:
Am I ok to follow the rule of "no insulin under 200 (I'm using a pet meter)?" since I have no history really for him?
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Generally, if you get a lower preshot, we stall without feeding and test again in 20-30 minutes to see if the BG is rising on its own. Sometimes, the BG falls without food. When I was anxious about shot times, it was strongly suggested to me to get a +10 or +11. That can help with the shoot or not shoot decision. Since you're new (and it doesn't get any newer than day 1 :)) I would suggest getting a later cycle test, POST here with an indication in the thread that you're new and need help.
If no one is around, the refer to this sticky:
How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.

Have you read the stickies about Lantus? Its a LOT of information, so take it slow.
 
Angela & Cleo said:
EXCELLENT

I'm the wrong person to answer this because I'm a testaholic :facepalm: :oops::cat:. Joking aside, any and all data is good data especially when new to insulin.


Generally, if you get a lower preshot, we stall without feeding and test again in 20-30 minutes to see if the BG is rising on its own. Sometimes, the BG falls without food. When I was anxious about shot times, it was strongly suggested to me to get a +10 or +11. That can help with the shoot or not shoot decision. Since you're new (and it doesn't get any newer than day 1 :)) I would suggest getting a later cycle test, POST here with an indication in the thread that you're new and need help.
If no one is around, the refer to this sticky:
How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.

Have you read the stickies about Lantus? Its a LOT of information, so take it slow.
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Thank you for the detailed response.
I did ready the stickies about Lantus but my brain is a mush lately so I think not everything stuck (teflon brain).
I will test again at +10 and see where we are at. He will get a bit of food right now as I'm making my lunch and he is watching me like a hawk!
 
Perezamado23 said:
Thank you for the detailed response.
I did ready the stickies about Lantus but my brain is a mush lately so I think not everything stuck (teflon brain).
I will test again at +10 and see where we are at. He will get a bit of food right now as I'm making my lunch and he is watching me like a hawk!
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my best advice is POST POST POST any and ALL questions!
 
The first couple of cycles of Lantus we do suggest testing a little more often, in case your cat is one of those who has a strong initial reaction. We'd typically suggest, a +3, +6 and +9. But for now, I'd agree with Angela, a test at +7 or +8 would be better than +10, if you can manage it.
 
I just tested him (in between meetings) so at +7.2 hrs he is at 148. He ate 2 tablespoons of low carb wet food at +6.5

When do you recommend I test again?

I updated the thread title with my latest test results.

Thanks.
 
I tested at +10 (off by 10 minutes) and he is at 147.

I read on the AAHA guidelines (page 12) that if on the first day of treatment BG<150 at any time then I should decrease dose by 0.5U.

Should I move down to 0.5U starting on his dose tonight (which would be his second dose)?
 
Nice, he's flattened off. We use the SLGS dosing method and TR protocol here, not the AAHA guidelines for dosing. If you are nervous and want to back off by 0.25 units, that would be OK. 0.5 units is a big drop.
 
Wendy&Neko said:
Nice, he's flattened off. We use the SLGS dosing method and TR protocol here, not the AAHA guidelines for dosing. If you are nervous and want to back off by 0.25 units, that would be OK. 0.5 units is a big drop.
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Ok, thank you. I am a bit nervous as it’s our first day.
I will do his PMPS and if it’s still under 200 I will do 0.75, otherwise I’ll do 1.0?
How many tests do you recommend I do in the evening?
Sorry for all the questions, I thought I was ready for his first day but this “big” change has made me very anxious.
 
Hi Samantha
Exciting first day...actually first cycle. Your anxiety is understandable. We learn by asking questions. Keep asking :cat:.
How long before your PMPS?
 
Thank you for sticking around with me. I just tested and he has 182 - I'm using a pet meter.

Should I proceed with 1.0 unit at 6 EST? How often should I test tonight?
 
Perezamado23 said:
Thank you for sticking around with me. I just tested and he has 182 - I'm using a pet meter.

Should I proceed with 1.0 unit at 6 EST? How often should I test tonight?
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Thats good. It has gone up in the last 2 hours. Do you feel comfortable shooting now?
Do you have time in your schedule to stall without feeding for 20-30 minutes and then test again to see if the 182 (pet meter) is rising?
You could also reduce the dose as Wendy suggested in post #13.
 
Angela & Cleo said:
Thats good. It has gone up in the last 2 hours. Do you feel comfortable shooting now?
Do you have time in your schedule to stall without feeding for 20-30 minutes and then test again to see if the 182 (pet meter) is rising?
You could also reduce the dose as Wendy suggested in post #13.
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Yes, I can test again in 20 minutes.
How should I proceed after that? If it went up again I’m ok to give him his 1.0?
I honestly didn’t expect such an exciting first day!!
 
Perezamado23 said:
Yes, I can test again in 20 minutes.
How should I proceed after that? If it went up again I’m ok to give him his 1.0?
I honestly didn’t expect such an exciting first day!!
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Testing and shooting in 20 minutes from now can and will still keep you on schedule for tomorrow morning. If at 615PM (assuming that's 20 minutes from the PMPS test) its the same or higher, I would give the 1 unit and feed a little less than usual dinner portion in order to save it to feed at +1/+2. I would also test at +2ish to start.
Did I read that you recently changed Remy's diet to all LC wet food?
Also, not saying you'll need it, but you do have the MC, HC and karo/syrup on deck.
 
Angela & Cleo said:
Testing and shooting in 20 minutes from now can and will still keep you on schedule for tomorrow morning. If at 615PM (assuming that's 20 minutes from the PMPS test) its the same or higher, I would give the 1 unit and feed a little less than usual dinner portion in order to save it to feed at +1/+2. I would also test at +2ish to start.
Did I read that you recently changed Remy's diet to all LC?
Also, not saying you'll need it, but you do have the MC, HC and karo/syrup on deck.
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Ok, I’ll do that!
I’m normally feed him at 6pm, 8pm and 10pm as he is more of a grazer so I think that should work.
I switched him from higher carb to low carb when he was diagnosed. He wasn’t eating much dry food but he was eating a 22% carb wet food so was hoping to see a change with the diet (today is his 9th day of LC food)

I’ll test again at 6:15pm and report back.

I truly appreciate the hand holding!!
 
Perezamado23 said:
How many tests do you recommend I do in the evening?
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What time do you normally go to bed? With Lantus, the +2 or +3 is usually a good indicator of how the cycle will go, and whether you need to do more testing. It is possible that he could bounce with the lovely blues that he's not used to. But we don't have enough data yet to see how Remy will respond, so no guarantees.
 
Wendy&Neko said:
What time do you normally go to bed? With Lantus, the +2 or +3 is usually a good indicator of how the cycle will go, and whether you need to do more testing. It is possible that he could bounce with the lovely blues that he's not used to. But we don't have enough data yet to see how Remy will respond, so no guarantees.
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I just tested him and he is at 184 (pet) so he only went up by 2.

I normally go to bed at 10EST so I can definitely get in a +3!

Can I feed him now and give him the 1.0 unit?
 
Wendy&Neko said:
It's up to you. If you wait too long (stall), their numbers can start to go down without food. Give either 1.0 or 0.75 units, whichever you feel comfortable with. You'll have lots of opportunities to do this again.
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I gave him 0.75U and at +3 he was 289.
If tomorrow’s AMPS is above 200 should I stick with 0.75 or go back to the 1.0?
 
Since you are just new to this, I'd stick with 0.75 units. With our dosing methods, we find it's best to be consistent with the doses. We also determine how to change the dose based on the nadirs, or how low the dose takes the cat, not the preshot numbers. But it's also easier to start with a lower dose and work your way up in dose if needed, than having to handle low numbers right away.
 
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