AMPS Level/Dosage

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@H.M. Victor, I am following you and checking out your Spreadsheet. Humulin N is a similar insulin to Novolin N--what my kitty has been on for nearly 4 years. I understand your hesitation in dosing. From looking at Victor's numbers, as far as we know, he has not dipped below the renal threshold [240 or 250] and stayed there for a long period of time and is nowhere near the danger zone [below 50] at his current dosage. If it were me, I would continue with the 3 units. I don't see any signs you should back off the dosage as long as he is eating. Are you giving the Laxatone for constipation or for hairballs? I give Bama about a teaspoon or so of canned pumpkin once or twice a day as dessert when he has had bouts of constipation and hairballs. Make sure the can says pumpkin and not pumpkin pie filling as that may contain spices.
 
Bama Kitty Mom (AL) said:
@H.M. Victor, I am following you and checking out your Spreadsheet. Humulin N is a similar insulin to Novolin N--what my kitty has been on for nearly 4 years. I understand your hesitation in dosing. From looking at Victor's numbers, as far as we know, he has not dipped below the renal threshold [240 or 250] and stayed there for a long period of time and is nowhere near the danger zone [below 50] at his current dosage. If it were me, I would continue with the 3 units. I don't see any signs you should back off the dosage as long as he is eating. Are you giving the Laxatone for constipation or for hairballs? I give Bama about a teaspoon or so of canned pumpkin once or twice a day as dessert when he has had bouts of constipation and hairballs. Make sure the can says pumpkin and not pumpkin pie filling as that may contain spices.
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Thanks for the response. I did go ahead with the 3 units this morning; I figured that since his numbers at mid-cycle didn't seem to go below the mid-200's even with a dose of 2.5, staying with the 3 units would be okay. As a newbie, it really is anxiety-inducing trying figure out how to adjust dosing based on his numbers, which is why I'm infinitely grateful for this forum.

We give the Laxatone mostly for constipation, though he does get hairballs with some regularity as well. Thanks for the tip about the pumpkin, we could certainly give that a try.
 
H.M. Victor said:
He's doing okay. As for increasing the dosage, I know it probably does need to be increased, but it just makes me nervous.
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I understand that it can be scary but you have to find a dose that works for Victor, which you still haven't found. Staying in those higher numbers is also not good for him and could possibly cause more issues along the way. Some cats can have a bit of resistance issues, and if you hold a dose for to long it gives that resistance more time to dig its heels in it and be more stubborn. As long as your home testing, changing his dose when needed will be fine because you can monitor him.
 
AshleyDiamond said:
I understand that it can be scary but you have to find a dose that works for Victor, which you still haven't found. Staying in those higher numbers is also not good for him and could possibly cause more issues along the way. Some cats can have a bit of resistance issues, and if you hold a dose for to long it gives that resistance more time to dig its heels in it and be more stubborn. As long as your home testing, changing his dose when needed will be fine because you can monitor him.
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I know. I will try to be brave and do the 3.5 units tomorrow morning.
 
H.M. Victor said:
I know. I will try to be brave and do the 3.5 units tomorrow morning.
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Yes definitely raise the dose. He's not even close to blues yet. You're going to have to get him off the wd food... It's not doing him any favors. Once you do his numbers will go down.
 
JanetNJ said:
You're going to have to get him off the wd food... It's not doing him any favors. Once you do his numbers will go down.
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I have no doubt that his current food is the main reason why his numbers are staying so high. I know it seems like it a simple thing to do to just go out and buy some cans of wet food, but for us it really isn't. Everything we buy is literally on a month-by-month basis because the monthly income is all we have and once it's gone, we just have to wait until the next month. I did email my dad and told him about our situation and asked if he could help us out, so hopefully we don't have to wait until next month, cause I know that wouldn't be good.

Despite still being nervous about increasing his dose, I will. Could you, @Kris & Teasel - and anyone else - give just a little extra reassurance/encouragement for me and my boy?
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Also is there a certain number where, if his glucose result is below it we shouldn't give him the 3.5 units?
 
What a very handsome boy!! :):bighug:

Yes, I would encourage you to increase to 3.5 u. Here's why:
  • Your lowest BGs are almost all in the high 200s and the end goal (which will take time and be approached very cautiously) is to have nadir values in the 90s to low 100s. There's a lot of room to drop.
  • Ideally you want nadir numbers to be about 50% lower than PSs. Yours are less than that right now. He is dropping and that shows he's responding to the insulin but not strongly enough right now.
  • We usually recommend dose changes of 0.25 u but at the dose level he's at and the level of his BGs it's safe to increase by more than that every 2 days or so until you start seeing quite a bit of blue. Then you can go with smaller 0.25 u changes.
  • The longer he sits in higher numbers the harder it can become to shift him from there. The excess glucose can undermine his cells' sensitivity to insulin. It's called glucose toxicity, a label that sounds worse than it is. The way through that is by frequent careful dose increases.
  • You're testing enough to follow his response to insulin. When you increase the dose or are worried about an impending drop for some other reason (eg. not eating enough) getting a BG test at +2 can be very useful and predictive. If it's a much lower number you'd intervene with a small snack to "steer" the numbers.
  • Even if he gets into numbers that scare you because they're lower than you've seen (eg. greens) you can post here with a 911 icon on your title to get immediate help.
I truly understand your discomfort because you're taking advice from internet people. We never give advice lightly, though. We look at the SS data and the patterns that show and couple that with our experience evaluating responses to insulin. That's not to say we don't make a mistake occasionally but we try to give the best advice while being cautious. This is a peer reviewed forum and others can see the advice given and will step in to agree or disagree much of the time. In the end, though, it's always your call and you hold the syringe.

I hope this helps put your mind at rest. :)
 
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Re the dose reduction or "no shot" number: at this point you might go with 250 (a very conservative number). Post here for help if that happens. As you get more data on your SS that number can change.
 
Kris & Teasel said:
What a very handsome boy!! :):bighug:

Yes, I would encourage you to increase to 3.5 u. Here's why:
  • Your lowest BGs are almost all in the high 200s and the end goal (which will take time and be approached very cautiously) is to have nadir values in the 90s to low 100s. There's a lot of room to drop.
  • Ideally you want nadir numbers to be about 50% lower than PSs. Yours are less than that right now. He is dropping and that shows he's responding to the insulin but not strongly enough right now.
  • We usually recommend dose changes of 0.25 u but at the dose level he's at and the level of his BGs it's safe to decrease by more than that every 2 days or so until you start seeing quite a bit of blue. Then you can go with smaller 0.25 u changes.
  • The longer he sits in higher numbers the harder it can become to shift him from there. The excess glucose can undermine his cells' sensitivity to insulin. It's called glucose toxicity, a label that sounds worse than it is. The way through that is by frequent careful dose increases.
  • You're testing enough to follow his response to insulin. When you increase the dose or are worried about an impending drop for some other reason (eg. not eating enough) getting a BG test at +2 can be very useful and predictive. If it's a much lower number you'd intervene with a small snack to "steer" the numbers.
  • Even if he gets into numbers that scare you because they're lower than you've seen (eg. greens) you can post here with a 911 icon on your title to get immediate help.
I truly understand your discomfort because you're taking advice from internet people. We never give advice lightly, though. We look at the SS data and the patterns that show and couple that with our experience evaluating responses to insulin. That's not to say we don't make a mistake occasionally but we try to give the best advice while being cautious. This is a peer reviewed forum and others can see the advice given and will step in to agree or disagree much of the time. In the end, though, it's always your call andf you hold the syringe.

I hope this helps put your mind at rest. :)
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It does help, thank you so much. I have no doubt that all of you don't give advice lightly and that you want to help other people do the absolute best they can for their kitties, and I do take everything you guys have told me so far to heart. I would honestly be lost without this forum. :bighug:
 
Oh, what a sweet, trusting face. I'm glad you've moved ahead with the 3.5u. Once he starts spending time below the renal threshold, he'll feel better. I've noticed Bama tends to eat better when he gets his 2nd and 4th meals of the day than he does with the 1st and 3rd meals which are right before his shots when his blood sugar is higher. Just think how far you have come since his diagnosis. If you are anything like me, I was all nerves and angst with measuring and shooting the insulin and now that I am testing, I am all nerves trying to get the blood samples. But our furbabies need us to do the hard things and push through the discomfort for them and so we do.
 
@Kris & Teasel @JanetNJ Hey guys, I don't know if you'll see this before the time we give Victor his shot, but I have a question. While doing his PMPS test he was being more uncooperative than usual, and I got a decent-sized blood drop but as I was trying to put the strip to it, he moved his head and got it on my thumb, so I just put the strip to it there and I was wondering if that's okay or not. I did wash my hands beforehand and the only thing that I had on my fingertips afterward was the Vaseline that I put on his ears (which I wiped off my fingers with a napkin before trying to get the sample). Let me know.
 
Just seeing this now. I'm in Eastern Canada (EST).There shouldn't be a problem with the way you got that test last night. Some people will scrape the blood drop onto a fingernail and test from there if they have a squirmy worm kitty.

Don't worry about the red last night. It's likely a bit of a bounce reaction to the blue. Next time you see blue try to get another test an hour or two later to see how long the lower numbers last. At some point when you're getting to a better dose range a full curve should be done so you get a clearer idea of what the dose does over the whole 12 hour cycle.

I assume you gave 3.5 u last night too? It's not showing on your SS. Give that same dose today, AM and PM. Don't be surprised if we suggest a 0.25 u increase for tomorrow. ;)
 
H.M. Victor said:
@Kris & Teasel @JanetNJ Hey guys, I don't know if you'll see this before the time we give Victor his shot, but I have a question. While doing his PMPS test he was being more uncooperative than usual, and I got a decent-sized blood drop but as I was trying to put the strip to it, he moved his head and got it on my thumb, so I just put the strip to it there and I was wondering if that's okay or not. I did wash my hands beforehand and the only thing that I had on my fingertips afterward was the Vaseline that I put on his ears (which I wiped off my fingers with a napkin before trying to get the sample). Let me know.
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It's fine. I wanna see more blue today! :)
 
Those pinks yesterday look like elevated numbers from bouncing in reaction to the blue. You still have a good margin of safety so I'd increase to 3.75 u this morning. Do your best to eyeball that dose on the syringe and aim for consistency dose to dose rather than absolute accuracy.
 
Kris & Teasel said:
Those pinks yesterday look like elevated numbers from bouncing in reaction to the blue. You still have a good margin of safety so I'd increase to 3.75 u this morning. Do your best to eyeball that dose on the syringe and aim for consistency dose to dose rather than absolute accuracy.
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Okay, do you have any other advice for trying to eyeball that dose?
 
H.M. Victor said:
Okay, do you have any other advice for trying to eyeball that dose?
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If you have half unit marks on your syringes do your best to judge where half way across the gap between full and half unit marks is. If you syringes are full units only eyeball a quarter of the way to the best of your ability. You could draw up some coloured water in a reference syringe to use as a guide dose to dose.
 
Kris & Teasel said:
If you have half unit marks on your syringes do your best to judge where half way across the gap between full and half unit marks is. If you syringes are full units only eyeball a quarter of the way to the best of your ability. You could draw up some coloured water in a reference syringe to use as a guide dose to dose.
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Alright, we'll do our best with it.
 
H.M. Victor said:
Alright, we'll do our best with it.
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@H.M. Victor, no one can ask more than your best which you will automatically give out of your love for Victor. There will be setbacks, mistakes, and adjustments. Once Victor is regulated, you may find you are stepping down his doses instead of increasing them. His body is learning how to use this "foreign" insulin and it takes time for the "training" effect to work its effects.
 
I'm trying a .75 dose today for Sweet Pea. It looks to me like the black base of the plunger is about .25 width, so I'm pushing the insulin past the 1 so that the top of the black thing is below the 1. I also thought of possibly finding a thin rubber band that is approximately .25 and wrapping it around the syringe so at least it's close to the same every time. This diabetes stuff is tough!!
 
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