Lantus: much higher BG at AMPS than PMPS

Discussion in 'Lantus / Levemir / Biosimilars' started by Ella & Rusty & Stu(GA), Jan 23, 2010.

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  1. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

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    Jan 11, 2010
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    Lantus: much higher BG at AMPS than PMPS

    Post by Ella » Sat Jan 23, 2010 10:04 am
    Dear Lantus people and cats,
    I was advised to post this on the Lantus board (I originally posted it on the general diabetes board this morning: Sat. 23 Jan). My original post follows, but I must add that today his AMPS was 409, his BG at +6 was 68, his PMPS was 334. I am new to testing and I am more confused than ever! Am I giving too much insulin? too little insulin?? Here is what I posted this morning:

    I want to thank everyone for responding to my original post of 14 January. My cat, Stu (diabetic since Jan. 2006), who had been switched to Lantus from Idexx PZI Vet (5 units bid of PZI Vet) in early November, had been on 7 units of Lantus bid since early December because his BG level at +5 (at the vet's) had been in the high 300s (the vet had started him at 4 units bid in early Nov., raised him to 5 units, and then from 5 units to 7 units in early December). In early January (still on 7 units) BG had dropped to 78 at +5 at the vet's. I was worried at the precipitous drop and joined this message board! I received many messages of concern that 7 units were too much insulin, so I cut the dose at first to 6 units bid, and several days later (on 19 Jan.) to 5 units bid. On 21 Jan. I cut it to 4.5 units bid. I have been home testing 3 times a day (AMPS at 7 A.M., +6 at 1 P.M., PMPS at 7 P.M.) since 19 January (doing OK, but it is still not easy for Stu or for me!). I find that his AMPS numbers are consistently around 400, but his PMPS numbers have been between 100 and 225. At +6 his numbers have been between 83 and 89 except for 21 January, when the +6 number was 176. After reading other people's posts and a lot of the literature on feline diabetes, I suspect that I am dealing with carryover or overlap and the "storage shed". I would welcome your comments and advice. I have been giving 4.5 units bid for the past 2 days and also this morning (Sat., 23 Jan.) Should I lower the Lantus dose to 4 units bid beginning this evening? Stu is 12 years old, a large domestic shorthair and, except for diabetes, in excellent health. He weighs 15.8 lbs. He eats 4/5ths of a can of EVO turkey & chicken a day, spread out over 4 feedings (7 A.M., 12 P.M., 7 P.M., 11 P.M.) He gets about 1/4 cup of EVO high protein/lo carb dry food per day available for snacking. Thanks for your help.
     
  2. Ronnie & Luna

    Ronnie & Luna Well-Known Member

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    Dec 28, 2009
    lnk to Ella's first thread in FDBM health JAn 14th

    1st post in health
    viewtopic.php?f=3&t=2601&p=24155#p24155

    hi Ella welcome to the Lantus forum

    have you been able to set up a spreadsheet? you can learn to do in the TECH forum.
    also read thru Dr Lisa's site on Feline nutrition? http://catinfo.org/

    When you have a chance please read thru the information stickies up above on Lantus.
    Others will be by to offer suggestions and input, so if u can in the meantime, read the stickies up top.
     
  3. Fleapunk

    Fleapunk Member

    Joined:
    Dec 28, 2009
    Oh my goodness Ella.....started on 4U of lantus and up to 5 then 7?

    First let me welcome you.....WELCOME TO LL!
    There, that's done.

    We really need more data, looks like, just off the top of my head that Stu could very well be on too much lantus. Here we like to start low and go slow. Upping the dose based on a 300 BG level at the vets does not make me happy. Every time I bring my Punkin to the vet, her bg always bounces to the high 200/ 300 range, it's a stress number.
    As far as having such a high amps or pmps, that could very well be a bounce from the lower number he's getting during the day.

    It's so important to get a spreadsheet started, it's easy and trust me, if I can do it, anyone can!

    Hope you post often!
     
  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome to Lantus Land, Ella.

    I don't know if anyone has directed you to the Tight Regulation Protocol. We use a modified version of this protocol to guide dosing decision here. I may be the first person to suggest this but I won't be the last -- please look at the stickies/announcements at the top of the board. Much of the information about this Board and Lantus are contained in those posts.

    Like the others have said and what you have already surmised, I suspect that Stu is getting too much insulin and his BG is bouncing all over the place. Once you've had a chance to look at the protocol, you will note that increases and decreases in dose are done in much smaller increments than that your vet was suggesting.
     
  5. Lydia--(Rosie & Basil) GA

    Lydia--(Rosie & Basil) GA Well-Known Member

    Joined:
    Dec 28, 2009
    Hi Ella,

    I not good for much but saying hi and welcome yet! But I want you to know that I believe you will find your answer here once you get on board. Some of the action of Lantus is counterintuitive, especially, it seems, if you are used to other insulins.

    Hang in. It will get better!
     
  6. jojo and bunny

    jojo and bunny Member

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    Dec 28, 2009
    "today his AMPS was 409, his BG at +6 was 68, his PMPS was 334."

    hi there ella, i saw you on health earlier today. looking at that update you got, geez, i don't like that 5 units dose at all. worried. that is one heck of a huge drop and we don't even know if 68 was as low as he went! :shock:
    i think it is time to start over. all the cats here in lantus/lev ISG (called LL for short) are safe, owners can go to work during day or sleep at night without worry because of how they arrived at their dose. without going through the working up to a dose through the step by step protocol we use here one can never know if one's dose is too high (dangerous!), too low, and are left forever guessing. there is no guessing here. we know our dose is right because if a cat is on 5 units it is because that cat worked up to that dose the right way and BG numbers proven beyond a shadow of a doubt that the cat needs 5 units.

    suggestions are this~
    ~fill out a profile with more info so we can know more about your cat, what he eats, any health issues, when he was diagnosed, how old he is, any DKA history, etc etc.
    ~go to tech forum and read the spread sheet sticky and set one up (if you have any trouble people will help you!) so we can see all your recent numbers at a glance, patterns are so obvious then.
    ~read the stickys at the top of this forum, there is a ton of info there.
    ~post again tomorrow and everyday. i think once everyone knows more about your cat and what has been going on everyone will be suggesting for you to start over. ask questions! we don;t know what you have read and what you haven't and it is going to be soooo much info at once, no one can learn it all in a day.
    ~read the tilly protocol, it is a proven method for successfully using lantus in cats (what i was talking about earlier about moving up dosing scale in small timed increments).

    usually no one has to do all that at once, but i am very worried that your dose could be far too high. (reminds me also read on health forum or embedded in one the stickys at the top of this page the 'how to treat hypos' and 'the hypo toolbox' all diabetic cat owners should read those, but especailly one that is on such a large dose that was basically picked out of thin air).
    we'll see you tomorrow!
     
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