? Day 3 of Lantus - low PMPS

Elizabeth20

Elizabeth20

Member Since 2020
Hi

Relatively sparse data while I waited for the depot to build up so we're working a little in the dark here.

Lily was sick three times today having been up to my boyfriend's with me for the weekend. She was sick overnight (not that unusual) but I measured her BG after she was sick this afternoon at around +5.5 to see what was going on and she had dropped for the first time so I assume we're cooking with gas now. She was sick again a couple of hours later but has been OK since.

Her BG was 9.5mmol at shot time. I checked the crib sheet here, and waited half an hour without feeding. She came up to 12 so I fed and shot as normal. I was up with her and my boyfriend's youngest both nights over the weekend so I'm about to go to bed. I can get a PM+1 in 15 minutes and I guess I will need to set an alarm to check she isn't dropping too low. I will leave food down as I free feed her anyway.

Any advice for how best to handle this in the circumstances? I can do a curve tomorrow and hopefullly get some more useful data.

Thanks

Liz
 
Thanks Cheryl. Grappling with the whole depot thing and a slower curve is like learning from scratch again, not that I'd got to grips with Caninsulin that well!
 
Could I ask a favour of you? Could you put a blank line in the spreadsheet after the last day of Caninsulin and before the first day of Lantus. Then put something like “start Lantus” on that row, so it’ll be very obvious when you switched.

Have you changed food at all lately? Just wondering why she is sick.

A curve tomorrow sounds like a good plan. When you report the results, please use the US numbers, which should be translated on the US tab. Although I “speak” mmol/L, a lot of the people here are from the US, as is the server that hosts us, so we use the US numbers by convention. You will also get more help that way.
 
Hi Wendy

I've put a blank line in as you suggested.

Wendy&Neko said:
Have you changed food at all lately?
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I did get her some new snacks - Iams freeze dried duck breast. She'd been having Thrive chicken before. I'm holding off giving them now. She's gone off her Carny as well but that might just be because she's been throwing it up - no one wants to see a bowl of what they've just thrown up! Her tummy has been small and firm for several days having been very big and squishy for a couple of weeks before while she was eating the whole world. No tenderness though.

She was at 194 at PM+11. Just not sure whether to reduce the dose.
 
I see that she is 230 at AMPS. Pretty much the same number as PMPS. I hope you shot the 0.5 units?

Here is the sticky in our dosing protocols:
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

TR is a more aggressive protocol that requires the cat to be on 100% canned or raw food and at least 1 mid-cycle test in addition to the pre-shot tests. With TR, you can get to Lily's optimal dose faster. Considering she is over the renal threshold...
 
Hi

Bandit's Mom said:
how much longer for AMPS? And when did Lily last eat?
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She had an hour to go and ate a little after that.
Bandit's Mom said:
I see that she is 230 at AMPS. Pretty much the same number as PMPS. I hope you shot the 0.5 units?
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Yes I gave her 0.5. I have read the protocol but I think I'll understand it better when I see it in action. I read too much information at once yesterday and fried my brain. Yesterday I waited and shot when she started coming up above 200. Today I fed her a little, waited and shot. I think once I have more data for her curve I will be more confident in shooting at a slightly lower number. I will test her every 3 hours, have I read that right? She tolerates it well.

She has responded strongly to insulin so far so I have high hopes for her. She doesn't like being at lower BG though - she gets quite sulky and doesn't want to go out.
 
So was the PMPS reading food influenced?

She has gotten used to higher numbers, so being in normal numbers is initially like caffeine deprivation. Once she gets used to lower numbers, it's the other way around. They are more active in lower numbers and not so much when they go higher. :-)

I would test for +1, +2 and +3 in different cycles. You want to know when her Lantus onset is. And also when her nadir is. By testing at different times in different cycles, you can understand how she behaves on Lantus.

====================================================

"Example of an ACTIVE, but NOT necessarily typical Lantus/Basaglar cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

An active Levemir cycle will have an onset at approximately +4 and a nadir around +8 - +10. However, please keep in mind every cat is different (ECID). Data collection will offer you a better picture of YOUR cat's response to either of these insulins.

Initially, don't expect to see "active" cycles after every single shot whether you're using Lantus/Basaglar or Levemir. Chances are, your kitty had diabetes for some time before diagnosis. It requires time for kitty's body to become used to dropping into lower numbers than their bodies have become accustomed. Don't expect immediate results! Regulation takes time and patience:
 
Bandit's Mom said:
So was the PMPS reading food influenced?
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Not last night but it possibly was this morning.

Thank you for walking me through this. I can't imagine how people manage with babies and the sleep deprivation plus worry about doing the wrong thing. Two broken nights and I'm immediately the stupidest person I know!
Bandit's Mom said:
She has gotten used to higher numbers, so being in normal numbers is initially like caffeine deprivation. Once she gets used to lower numbers, it's the other way around. They are more active in lower numbers and not so much when they go higher. :)
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I'm so looking forward to this. And I have all sympathy for her now - I'm so unreasonable without a pint of tea in the morning.

I'll test her in an hour.

Wonder if I'm the only one who forgets to eat themselves because they're so focused on what the cat's doing...
 
Sigh. Poor little body. No wonder she was so full of beans this morning! Well, she's stopped blowing wet raspberries out of her bum so one thing's stabilised at least.

Thanks Bhooma.
 
Did you make a food change by any chance that’s causing the intestinal distress? I see in your signature this is an issue but wonder when it started. There could be a food intolerance if you haven’t recently changed food that is usually caused by the protein.
 
Bandit's Mom said:
Were you able to look at the dosing protocols sticky?
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I read the dosing methods one three times (probably still some of it needs to sink in) and am still ploughing through the being data ready one. Sorry if I'm asking obvious questions I ought to know the answers to
 
tiffmaxee said:
Did you make a food change by any chance that’s causing the intestinal distress? I see in your signature this is an issue but wonder when it started. There could be a food intolerance if you haven’t recently changed food that is usually caused by the protein.
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History
She's previously had diarrhoea when using the litter tray but I always figured that's because she got stressed having to use it. She always wants to poop outside and would hold it till she was in a state. Then when I took her in a couple of months ago with a paw injury the vet said she had rubbery intestines and they would keep an eye on it. She has always been prone to vomiting after a couple of days when changing foods.
Since diagnosis
She had loose stools on chicken Bozita but better on lamb, and the only thing to sort her out so far was Carny. She did get constipation once probably from peeing out so much glucose, so I gave her some more Bozita to make her more comfortable. Back to Carny now. Then I got a mix pack of Carny and she got through 5 cans and three flavours and only during the 6th 800g can did she start puking. She's back on Carny now and seems fine. Other change was to duck breast freeze dried snacks last week. Hoping that's not the suspect because I bought 8 tubes of them! I haven't given them since she was sick.

Sorry, as always that was a lot!
 
It might take a little time to adapt to the duck. I’m not familiar with the foods you are feeding. I would suggest reviewing the ingredients paying special attention to the protein. It might be worth not feeding chicken for a while to see if it’s the culprit.
 
Yeah I've read chicken is a common one to develop a sensitivity to. She still has freeze dried chicken treats though and is fine. One of the varieties of Carny (both Bozita and Carny are European foods supposed to be much better quality than most UK ones) has duck in it so I wonder if it is duck that caused it. Soon see when we get back to that one in the second pack...
 
Today is Day 7 on this dose. Unless you see a number below 100 mg/dl / 5.5 mmol, you are good for an increase to 0.75U tomorrow AM.
 
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