8/10 Naomi AMPS 394, +6 398, PMPS 69!!! What dose to shoot & when?

https://www.felinediabetes.com/FDMB/threads/8-9-naomi-amps-350-6-350-pmps-367.233396/#post-26084

Hi!

The 6 cycles of 3.50 of Lantus are over, so is it time for an increase?

 

I'm not seeing any great numbers there. Yes, please increase to 3.75. Let's cross our fingers and paws that this is the magic dose

 

Let's see!

After 3 years of experiments on insulins and doses, I had great expectations of Lantus and it's disappointing not to see good numbers. I know I'm being impatient here. Should give time for it to work

 

Unfortunately I can't see the spreadsheets from those years...but it looks as you were feeding (previously I presume) Royal Canin Dry...this one?
Royal Canin - 'prescription' Glycobalance Protein:51 Fat: 34 Carbs: 14 Phos: 200 ‘prescription’ diet - is that correct?

That would be considered a medium carb diet...so while not optimal for diabetic cats, I suppose it's not as bad as some higher carb dry foods. The contents of that product are however very questionable. Chicken Meal, Corn Gluten Meal, Soy Protein Isolate, Ground Corn, Barley, Chicken Fat, Natural Flavors, Brown Rice, Powdered Cellulose, Dried Beet Pulp (Sugar Removed), Psyllium Seed Husk, Potassium Chloride, Anchovy Oil (Source of EPA/DHA), Soya Oil, Fructo-Oligosaccharides, Calcium Carbonate, Potassium Citrate,

I see corn, soy, more corn, barley, brown rice...no meat or meat byproducts...lots of other stuff that cats really don't need at all...if meat isn't listed in the first three ingredients it's really not the best choice for diabetic cats...

So, that was then, this is now. I see these foods listed until April: Humulin & Purina DM wetMay 2020 : Renal wet Current Diet: Hill's k/d (2 pouches) & Sheba Classics pate (1/2-1 tray) per day - free feeding

What are the carb counts on those foods? What is Yanna eating now?

Also, Lantus is a depot drug and it takes time and patience to first; find the right dose and second; build the depot.

I don't see your dosing protocol on your SS or your signature. Am I overlooking it? It will make a difference on how often you increase.

If you're following TR it's time for an increase - if so, please add that to the top of your SS. And then let's review the diet and find out what's on the menu today.

 

We were texting at the same time. Changed my title. Naomi's PMPS is 69!!!!!

 

I'm actually on a computer Great news! Naomi has hit the effectiveness of Lantus!

So what's Naomi going to eat at this nice number?

 

She eats 1 pouch renal & half tray pate mixed with 60 ml water for AM and the same for PM.

This morning she ate some of her food and then we went to the vet. She didn't have time to finish all of her food, she eats slowly and it takes her about 6 hours to eat what's in her bowl.

At the vet she had Sq for the first time (200ml), a Zofron injection also for the first time.

When we returned home I gave nothing to eat because it was +9.

And then PMPS 69!!!

Is it because of the fluid? Was it absorbed in 5 hours and made such a difference in her BG?
Is it the Zofran? No carbs in her stomach for so many hours? Or is it Lantus?
Such a coincidence she had Zofran and subqs today for first time!

Should I give her food now or wait more?

 

Absolutely please feed her! She needs to take her time if she's going to go any lower...

It's odd Luci is usually low too when coming back from the vet...

 

OK. What about insulin? Maybe a token dose later or skip it?

 

When is her shot time from now? How many hours?

ok, I see I made a mistake...It IS PMPS. Can you stall? No food

 

I didn't realize is WAS PMPS - your time is upside down from mine...

So you need to stall for 20 minutes, test again...which way is she headed?

 

OK I took the food back. It's almost an hour past her PM shot. So PM +1 hr BG 63 now

 

uh oh...she's still going down. Can you afford to hold for another 20 minutes (based on the time you usually shoot)...if she's still dropping I would not shoot this low...

can you please add these new numbers to your SS?

 

Sure I can hold for 20 min!

I've been waiting for this moment for so long! (not the hypo, just the insulin working!)

 

PM +1,5 hrs BG 61 still dropping. Maybe feed her now?

 

I"ll be away for the next hour or so. 15 dogs are waiting for me out in the fields to eat and it's getting dark here in a while. So, I'm going to feed Naomi now, my sister is staying with her. Hope I'm doing the right thing

 

Since you've skipped the dose, she's most likely not going to do anything overly dramatic. I think you're safe to go out and feed those pups...

But still keep an eye on her..I hope she's eating well. Thought I'd hear from you earlier...guess we crossed wires at some point about 'waiting 20 minutes a second time' to see what her numbers were...if at the second test, the number was still dropping, which it was and you decided not to shoot, I presumed you would go ahead and feed her at that time...I hope that was the case and I'm just misunderstanding how things went...

 

I fed her 1/2 tray Sheba at +1.5hrs after I took her BG. Came back at +3hrs her BG was 63. Had another 1/2 tray. I'll check her @ +4hrs in about 15 min.

 

+4hrs 87

Skip insulin for tonight?
What about her AM shot? Should I forget all about her previous doses and start with 1.25 based on her ideal weight (5kgs)?

 

I wouldn't make that decision this early. And I certainly would not 'forget about all her previous doses and start with 1.25', why would you think to do that? Is there something else that I'm not aware of that might lead you to think that?

Lantus is best used when used consistently. Same time of day 12 hours apart, same amount every time - precisely. If you're measuring with calipers all the better to get it consistent. She has not earned a reduction with these numbers, therefore no need to change the dose.

 

You are hours behind giving a shot tonight. If you shoot, it would take days to get back to your preferred shooting schedule.
You can only shoot
1. 15 minutes early each shot equalling a total of 30 minutes a day OR
2. 30 minutes early on one of the shots per day.

Some cats like mine and @Sue and Luci 's do go low after a vet visit.

This is an awful lot of fluid. It is usually recommended to give 100ml/day, 150ml for large cats or in extreme circumstances. Large amounts of fluids make the heart work harder.

Regarding the low numbers, this could be a factor. I did not notice a difference with Rover but I have a vague memory of people who did. Hoping someone chimes in on this.

 

Since she's in Greece her time is all different from hours...she skipped her shot already when Naomi was at 69...so I think she's talking about the next one...I've had a hard time keeping up on this one because of the time difference...

So Yanna, can you help us understand what time of day you're looking at and asking about the next shot? Thanks!

 

I think I haven't understood how it works yet. Before her PMPS low number I was ready to increase at 3.75 because of just one reading @269 in 6 cycles.

In today's PM cycle her lowest number has been 61. Is this not a reason for reduction? In 6 hours it's her AM shot. If I see green or blue should I still shoot 3.5 like I did the last three days?

It's hard for me to explain something I haven't completely understood. I hope it makes some sense what I'm writing!

 

I can understand your dilemma. First you have not selected a dosing method: SLGS or TR

A low number of 61 does not earn a reduction.

Could you please read this and see what you think:
https://www.felinediabetes.com/FDMB...ng-reductions-and-starting-otj-trials.150160/

 

Yes! It's 00:20 Tuesday 8/11. In Greece we're 8? hours ahead I think. So I'm in the middle of the PM cycle that started Monday 18:15 8/10. I skipped the PM insulin of Monday and in 5.5 hrs I'll have to shoot for AM Tuesday

 

Ok so we're talking about the next dose, which will be in 5 1/2 hours - the morning dose - and it must be getting terribly late for you now - you need some rest.

Please be sure to update your SS. Let us know what Naomi is eating. Select a dosing method. Your SS header needs to be updated with those items (dosing method TR or SLGS, food she's eating currently).

 

Dosing method: TR
Current diet: Hill's k/d & Sheba pate classics

I'll make sure this is written in the SS (the diet is already there) . I'll have to add the method. Can't do it from mobile phone for some reason. Just turned on the PC

 

Thank you for doing that!

Ok, so that clarifies the question about reducing the dose...she didn't go under 50 today, so no reduction on the next shot.

Please check the carb count in the Hill's k/d formula. It's quite high.
https://catinfo.org/chart/index.php

I see it listed in the 27-29 carbs per serving - that's much higher than anything I give Luci. That would definitely raise a kitties blood sugar way up...could be used in an emergency situation...but not fed on a regular basis.

 

I read it. Naomi hasn't earned a reduction yet!

 

Can't open the link above but I've used another carb calculator a member here suggested and it's around 8,7% carbs. Her phosphorus level has gone up in the last month that i give her Sheba. I got Alu-caps from the vet so maybe i should feed her only Sheba. I don't know.. I'll come back tomorrow with questions about diet.

As for her insulin.. Since she hasn't earned a reduction, what can i do with the dose. keep it @3.50 even if i see a blue number?

 

Here's the info from the food chart:

I don't believe there's any reference to any numbers in the blue range that would lead me to think she's earned a reduction. Unless you see a 50 or lower, she has not earned a reduction. Hence, she should get the same dose she's been getting. For the sake of consistency and the fact that she's finally seeing improving numbers. It means this dose is working.

 

+7hrs 90

OK, let's say i see a green number in 5 hours from now, and i give her 3.50. What will happen? Has anyone shot such a low number with so much insulin?

 

+7hrs 90

OK, let's say i see a green number in 5 hours from now, and i give her 3.50. What will happen? Has anyone shot such a low number with so much insulin?

 

I'm thinking that Naomi's #s will begin to creep up by shot time. So, this should be a more comfortable # for you to shoot.
Many members shoot green #s. With experience and data to back up decisions, it is very safe to shoot green. Often times you will see a flatter cycle(#s don't change much) when you shoot green. I personally didn't have to use much more than 1 unit of Lantus with my boys but, others on the board shoot larger amounts.
With new members that don't have much data or experience we always ask that you post for help when facing a green pre shot #.

 

Yanna, Here's an example of a high dose cat - she typically stays in the blues...but to keep her there she's getting 19 - yes, that's right. 19 units of insulin twice a day.
https://www.felinediabetes.com/FDMB/threads/08-10-amethyst-pmps-130.233438/

Please study some of the other SS's and look at the other condos...it's eye-opening!

 

Hi. Does your cat have kidney disease? KD is for that and I’m guessing that’s why fluids. That is double the usual dose. Is she average size or huge? When Max started fluids the first few times his bg did drop but then he adjusted and it didn’t make a difference.

 

Yes, I'll shoot a green. But 3.50 is scary and I can't trust Naomi that will eat when she has to. Her eating habits have changed since her pancreatic flare in June. |She eats better now but whenever she wants. It takes her 6 hours to finish her morning food.

 

Why was she give zofran? Is she vomiting or not eating? It sounded like she ate a lot. Zofran will not effect the bg.

ok. I see pancreatitis. Max had that. Zofran only works for about 8 hours. You need to get the pills and give 2-3 times a day.

 

Something I failed to mention in my last post. The board can be slow sometimes. Sometimes there are other members in the midst of a crisis and much needed advice or help can be delayed. I found it helpful to post well ahead of my shot time, if I thought I could be facing a green PS. You can always get that +11 prior to shot time to help in two ways. The +11 will tell you if Naomi's #s are coming up or going down by shot time which can help "predict" a cycle. It also gives you time to post on the board well ahead of shot time, thus giving members ample time to help.

 

yes, she has CKD. we tried SQ fluids for the first time at the vet today but didn't expect it would make such a difference. she has been hospitalised before and she has been on IV fluids.
she's average size, 200ml is too much

 

Wow! She's got Acromegaly? Yes, I'll open other SS's

 

You can learn to give fluids at home. How advanced is the kidney disease? Do you suspect another pancreatitis flare? The zofran will wear off quickly. Sometimes when Max had a flare he needed it for a month or more. I gave him the pills, 4mg twice a day. Your cat would need probably 2mg.

Mirtazapine now comes in a transdermal which doesn’t seem to have all the side effects of the pill which I used for one cat. It made her tremendously vocal and agitated so I used cyproheptadine. The transdermal doesn’t do that.

 

She had a pancreatic flare in June and since then her eating habits have changed. now she is better but not like her old self. So i asked my vet today to try Zofran and she gave her an injection. I've also got a prescription for pills

 

Oh,good. I’d give the pills daily until she’s back to normal eating and then gradually cut back. I learned that by trial and error. Once on board I sometimes used an appetite stimulant.

 

Naomi was not given any medication for her flare. She was hospitalised for a few days and then came back home with no medications, just a couple of cerenia injections. It was a very difficult time, she was not eating and I couldn't do anything. She's better now, but she will not demand her food like she used to, i have to spoonfeed her sometimes, so today i asked again my vet for a prescription and finally got one. she also offered to give her an injection. I'll start the pills tomorrow.

Today's results CREA 3.9 BUN 65 Stage 3 I guess?

 

I'm going to get some sleep! Her AM shot is in 4 hours. I hope someone will be around by that time. Thank you all for your time to reply!

 

Someone should be around. Sweet dreams

 

I’ll check back. There’s around 9 my time.