New diagnosis, blood sugar still rising, so many questions..

Hi all,

I am very new to Feline Diabetes - my kitty Thomas (who is jolly, fat and orange and the sweetest boy ever) was diagnosed this past Friday after I noticed him acting lethargic and not eating for a day or so. At that time they measured his BG and it was over 20 mmol/L (about 360 mg/dl). My vet put him on 1/2 a unit of Lantus once daily. I am also giving him subcutaneous fluids by needle to keep him hydrated and syringe feeding him Hills A/D because he won't eat on his own. Monday is BG was around 18 so my vet increased the dose to 1 unit of insulin once daily. His BG dipped to 16.2 about 7 hours after insulin (I bought a meter and am doing the testing at home). Yesterday it was 21.7 before insulin, 21.2 about two hours afterwards, so my vet said that today I should start giving him 2 units once daily and check in with her tomorrow. Today I was unfortunately not able to do a reading before he got the two units (my mom came and administered it because I was at work) but his BG 3 hours past insulin was 22.9. I just took another reading (6 hours past insulin) and it's 19.3.

They tested his urine on Monday (no ketones thankfully) and found that he had a bladder infection so he's now on Baytril for that - has been since Monday night. I'm managing to get 120ml of subcutaneous fluids into him each day via needle, and about 3/4 to a can of Hills A/D using the syringe feeding.

I guess I'm mostly just confused and scared (and he doesn't seem too thrilled either, though he is seriously a champ about the fact that nearly hourly I'm coming at him with either a needle, a plastic syringe full of goopy food, or a pill to shove down his throat). I don't understand why, despite the introduction (and increase) of insulin, his daily overall BG seems to be rising still. Even the vet tech at my clinic said that seems odd - the vet wasn't there when I stopped by to pick up some stuff today. The vet's going to phone me tomorrow though and discuss potentially increasing the insulin to 3 units once daily.

Any thoughts on this - anyone have any idea why the BG would keep rising in spite of the added insulin? Or is this just part of getting regulated and I just need to be patient?

I appreciate any and all comments or advice - I just want my baby to feel better. Thank you!

Amanda

 

Re: New diagnosis, blood sugar still rising, so many questio

First off Lantus and well all insulin for that matter needs to be given twice a day, 12 hours apart. Cats metabolize insulin faster than either dogs or humans. So Thomas maybe dipping really low when the insulin kicks in and then shooting really high again when it wears off.

Also infection can raise BGs as well so once his infection clears he should also drop down a bit.

What food have you been syringe feeding him, if he isn't eating on his own, then there really isn't much that can be done about his diet right now, but I suspect that the food is high in carbs, but needs to be in order to get enough calories in him to keep him from going into fatty liver disease.

Mel, Maxwell, Musette & The Fur Gang

 

Re: New diagnosis, blood sugar still rising, so many questio

HI Amanda, and welcome to FDMB! You've found a great resource for most any kind of feline diabetes related issue. There are lots of kitties here using Lantus, and their moms and dads will no doubt be along shortly to give advice and suggestions about what might be going on with your Thomas.

First and foremost - super kudos to you for hometesting!!

I'm not very knowledgeable about the whole FD thing, but a couple of things jumped out that could be complicating the effectiveness of Thomas's insulin. I've read many posts here indicating that infections can influence how well kitties respond to insulin. Hopefully others will have some advice on how to consider that as it relates to his readings. Second, the HIlls A/D is probably pretty high in carbs, and carbs are bad for diabetics. I don't know the specific carb content of A/D, but corn flour is the fourth ingredient listed for the canned version, so it's probably a contributing factor to some degree. Personally, I despise all Hill's products, but that's just me - others might have a better opinion of them.

As long as you are testing his BG levels regularly, you might want to consider a different food. There are two really good lists of canned foods for reference:

https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50

and

http://binkyspage.tripod.com/canfood.html

One caution would be that if you change food and reduce the total carbs that Thomas will get, you may see an immediate and significant reduction in BG levels, so be sure to continue testing regularly!

 

Re: New diagnosis, blood sugar still rising, so many questio

Whoa you need to slow down on the insulin increases. Around here we increase lantus insulin only by 0.25 to 0.5 depending on the circumstances. What is likely to be contributing to the high numbers is the infection and I'm very suprised your vet didn't mention this. Be careful because as the infection clears up the BG is likely to drop and you may find you have too much insulin on board.

That food probably isn't the best for Thomas either what is recommended is low carb canned food. Not sure where you're located but I'm guessing it's not the US since you're getting your BG readings in mmol. If you're in Canada then Binkys List will be helpful for you. If you're somehwere else let us know it is likely that there are other members where you are located that can help you with food choices.

What will really help people around here help you is if you set up a spreadsheet for Thomas, here is the link to do that:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

It is fabulous that you are home testing and managing assisted feeding and sub q fluid injections. This will really help Thomas. You have found your way to just the place you need to be. Someone has cross posted you into the lantus forum so I'm sure that others will be across shortly to assist you further. Keep posting any questions that you have, there are so many experienced wonderful people here that will be only too happy to help you and Thomas.


Oops, missed that you were only dosing once daily - bad vetty bad! Hopefully your vet is the type that will learn with you then they won't make the same mistakes the next time they get a diabetic kitty.

 

Re: New diagnosis, blood sugar still rising, so many questio

Welcome Amanda,
Where are you located? The BG you are giving are not what those in the US recognize but I do as I am in Canada.
If anyone asks, you can convert the numbers so they understand.
BG Conversion Calculator

Lantus for cats is given twice a day, every 12hours, so select a good am/pm time and start giving 1unit am and 1unit pm. I picked 6am/6pm as it gave me time to travel to/from work and be home for the two shots.
You are basically starting over as the shot you give in the morn was gone 12hours later so of course your test showed a high number again the next morn... Go with 1unit am and pm for 5 days and let things settle. Then, you will be able to see better how the dose is, if needing to be more. Your increases will be .25units or .5units, so you will need to have u100 syringes with 1/2 unit markings. There's no way to eyeball a .25unit increase!

There are some links with info about Lantus and the shed that new people are directed to read.
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed

For food, cats do much better on wet low carb and many cats are found to be diet controlled once they are switched to the better foods. There is a list of many foods from which you can choose under 10% carbs, and also try to keep a few cans of high carb on hand in case your cat's BG goes too low. Any that says grilled or with gravy will be good.
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

To start, you usually hold a dose for about 5days / 10 shots as you need to let the shed settle. You will base your dose adjustments on the nadir, the lowest point in the cycles. The main guidelines are as follows:
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

If you were to do a curve, something that's good to do maybe once a week to see how things are going, here's a typically common curve:
How to do a Curve
Example of a typical curve:
+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.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
If I were doing a curve, I usually check +3 +6 +9
The three main tests that are important are before am shot, before pm shot, and just before bed as many cats go lower overnite.

So that should about get you started.

 

Re: New diagnosis, blood sugar still rising, so many questio

Amanda,
First off, the food is fine for now. A/D is only 13% carbs, so not that high. Also, I have seen people say that you should syringe feed food that is NOT the food that you would feed once he can eat on his own, because you don't want him to associate the food in the bowl with what he was force fed by syringe.

When he can eat on his own, you would want to feed him a lower carb food, and it doesn't have to be prescription food. There are dozens of choices that are cheaper and lower carb - so better for him - and you can find them on these lists. Look at the % cal from carbs" column and find flavors that are 7% or less carbs.

http://binkyspage.tripod.com/CanFoodOld.html
http://binkyspage.tripod.com/CanFoodNew.html

Carl

 

Re: New diagnosis, blood sugar still rising, so many questio

Thanks for all the replies so far! This is awesome and both Thomas and I say thank you

A few people recommended getting him off Hills A/D - I've been thinking about that as well, because I know it's higher in carbs but it's what my vet recommended for now because it's easier to syringe feed him with it. It's interesting, for Thomas's whole life (he's 8) he has had either Royal Canin Urinary SO wet (bladder issues in the past) or low-carb brands like Wellness, Almo Nature, Merrick etc. He had become a little fussy about a month ago, and after trying kind after kind I finally just started giving him Fancy Feast. My vet said this could have triggered the diabetes so of course I feel terrible, however it does make me think that perhaps if we can get him regulated and back on the grain-free wet food, he might become a diet controlled diabetic and not need the insulin. However, for right now that's not the case so I think I may try giving him some of the Merrick stuff I have (it's got about half the carbs of Hills A/D) or mix it half and half with the Hills and see what happens over the next day or so.

To those who said that Lantus should be given every 12 hours, should I just start doing that (1 unit every 12 h) or talk it over with my vet first? I do wonder if it would be better to have him on a lower dose (1 unit or less every 12 hours) until this infection clears so I may have to discuss that with her as well. Until he starts eating/drinking on his own I can't help but be really worried, but hopefully that will change once he gets a bit more regulated.

I'm going to go back and re-read all the responses so far in more detail, and I'm sure I'll have more questions. Thank you so much everyone, you have no idea how much this helps and makes me feel less alone with all this.

 

Re: New diagnosis, blood sugar still rising, so many questio

Amanda,
If the FF flavors you fed Thomas were the "classic" varieties, then it is doubtful that those caused his diabetes. They are all in the 5% or lower range. The gravy flavors would be higher, and you can see all the FF's on the "old" food chart I linked you to.

If you are going to go to 2x per day shots, then what you would do is take his total daily intake now, and split it in half. Most cats start at 1u, or .5u BID (twice a day, twelve hours apart). you should discuss it with your vet, and show him the information on Lantus dosing and the TR protocol that others have provided links to, so he will have a chance to review all of the literature.

Carl

edit to add: Showing him the information we've provided links to will help him to understand that there is some great information out here on the internet, and he won't think, like some vets apparently do, that you are getting some wacky info from a bunch of internet crazy cat people! You might also try to get some idea of how much experience the vet has with feline diabetes. It isn't something that most vets see every day, and given the fact that he prescribed Lantus on a once-a-day shot basis, and that he had you increase the dose so much so soon indicates that he may not be up to date on treatment methods specific to cats. My vet has been in practice for 30 years, and she has had about 100 feline diabetic patients. I've seen more than 100 people join this site with newly diagosed sugarcats in the past six months! We see them "everyday", and while we aren't professionals, and we aren't vets, we have lots of experience on board...

 

Re: New diagnosis, blood sugar still rising, so many questio

Welcome, Amanda!

Well, I suspect your brain feels like its going to melt. There's an awful lot of information that's been thrown at you. Let me try to summarize the major areas that are important for getting you and Thomas started on this journey.

Home testing - you're already doing this, which is great. Testing is key to your managing Thomas' diabetes and for keeping him safe. You'll want to keep track of the results of your testing. Most of us keep a spreadsheet that we link to our signature here. That way, if help is needed, people can see our cat's progress and have the context for a question you may be raising. You can also easily e-mail your spreadsheet (SS) to your vet.

Food - The Hill's AD isn't horrible when it comes to carbohydrates (13%). It is horrible in terms of ingredients, though. It's mostly animal by-products. We encourage everyone to feed a low carb, canned food. Low carb is less than 10% carb but most of us feed substantially less. (Gabby gets Wellness chicken or turkey -- 4% carb.) You can find a higher quality, premium canned cat food that's lower in carbs than AD and costs a lot less. A few people have given you links to food lists so you can choose which foods Thomas will like.

Dosing - Gayle provided you with the basic instructions we use if you want to follow a Tight Regulation Protocol for Lantus dosing. It looks to me like you are increasing Thomas' dose rather quickly. With Lantus, you do want to be giving a dose twice a day. If you switch your dosing to twice a day, you may want to drop the dose back to 1.0u. I would then hold that dose for 3 days unless you see that Thomas' numbers are running low (below 50 or 2.8).

For now, I would encourage you to think about x2/day dosing. It's also important to get a spot check or two in between your shot times since Lantus dosing is based on the lowest point of the cycle, not the pre-shot values. Finding a lower carb food may also cause Thomas' numbers to drop so being able to monitor Thomas' blood glucose (BG) is important.

 

Re: New diagnosis, blood sugar still rising, so many questio

You don't need to talk it over with your vet; cats need insulin every 12 hours, so there's nothing to discuss.
If you want to see how long a dose lasts, give the shot then test every 2hrs and see how the numbers drop and then rise again well before it's 12hrs past.

Feeding fancy feast wet food did not cause diabetes; I can't see how a vet could say that. Maybe the vet can explain why some cats become diet controlled when their diet is switched to fancy feast foods?
If you compare the foods you have been feeding to Binky's list and have the carb content, you may find the the Merricks and fancy feast are perfectly fine to feed.

I think I asked before, but where are you located? Your BG numbers are not the usual provided by those in US. Are you in Canada or another country?

 

Re: New diagnosis, blood sugar still rising, so many questio

How do you transition from 2 units once daily to one unit twice daily? I don't want to give him too much or not enough insulin in a 24 hour period. Currently he's getting his insulin at about 1:30pm (not my ideal as I work all day, but we started at noon and I'm trying to transition him to about 7pm). Ideally I'd like to get him to a 7am/7pm schedule...

Oh and to answer questions about where I live, I live in Canada and we use mmol/L. I'll try and remember to convert over next time I post here

 

Re: New diagnosis, blood sugar still rising, so many questio

Hi Amanda,

OK great! I am in Winnipeg, and there are many others in Canada, so lots of people to help and maybe even someone close by.

So, if you gave 2u at 130pm, you can always wait till 7am and give the 1u, and then give the next shot at 7pm another 1u. It's better to give a little less and get some higher numbers than worry about giving too much and having overlapping doses. You could give .5u at 7pm and then a full 1u at 7am, but it's up to you... I think I'd go with waiting till morning.
He's already getting too little if you have been giving shots only once a day, but by tomorrow, you'll be on the right path by starting the day with a 1u shot and another 12hrs later.

 

Re: New diagnosis, blood sugar still rising, so many questio

Just a postnote before I head off to bed - did one final BG test about an hour ago (9 hours post insulin). Reading was 17.7mmol/L. This means that today, his BG level went as follows:

3 hours post insulin - 22.9 (412 mg/dl)
6 hours post insulin - 19.3 (347)
9 hours post insulin - 17.7 (318)

I won't be able to do a full curve as I have to get some sleep, but I thought it was interesting that his BG did not dip to it's lowest half way along the 12 hours, as I was told it should/would. Should I consider this before switching to 1u twice a day?

Thanks again everyone and good night

Amanda

 

Re: New diagnosis, blood sugar still rising, so many questio

Hi Amanda,
the lowest point in cycles (nadir) is commonly around +6 or so, but that does not mean everyone's is like that.
I have one cat whose nadir was around +4 but is now closer to +5.5 or so. I have another cat whose nadir was close to +8 or 9 and eventually was closer to +11.
That's why it's important to do the occasional curve so you can find out where YOUR cat's nadir is located. Also, nadirs don't stay put - you may have one day where it's at +7 and another where it's at +9, but you are learning the general vicinity to expect the low point.

Depending on the insulin you use, you may have an earlier nadir if the insulin you are giving is not as long lasting. I think that Prozinc is more like 10hrs but Lantus/Lev are closer to 12-14hrs, so you may expect a low point sooner if giving prozinc. In some cases, you will see people talk about using R which is a harsh, short acting insulin which is lasting maybe 4-5hrs but pulls down high numbers around +2 or so.

From the high numbers below, depending on what you test at 7am, you could go with the 1u in the morn and 1u again in the eve, then give it a couple days to be sure the dose needs increasing.
I hope that answers some of your question

 

Re: New diagnosis, blood sugar still rising, so many questio

Just wanted to pop on and say welcome to the FDMB family! cat_pet_icon You're going to meet a ton of super friendly folks who deal with feline diabetes day in and day out. Perhaps unfortunately, we end up knowing more about feline diabetes than many vets! LOL

It's ok to disagree with your vet as you learn more about diabetes in cats. Some vets take this opportunity to learn more about something they don't deal with on a daily basis, and some don't. We have to learn to help our fuzzy loves. :smile:

Welcome again and don't hesitate to ask questions. We are all here to help our sugar kitties as well as help each other. :mrgreen:

 

Re: New diagnosis, blood sugar still rising, so many questio

Oh lord. I just talked to my vet and discussed last night's curve with her. She doesn't want to move Thomas to twice daily with the Lantus and told me to increase it to 3 units once daily (that means he's increased from 1 unit to 2 units to 3 in as many days). I told her this seemed like a big increase very quickly and she said that she doesn't want to risk ketoacidosis and that since his BG is still quite high 3 the increase to 3 units is fine.

I don't know what to do - you all seem so knowledgeable, but my vet is really good too. Ack. This is really stressful...

 

Re: New diagnosis, blood sugar still rising, so many questio

Your vet may be good but I disagree that she is good in her knowledge of feline diabetes. Please listen to the people who have responded to you and use Lantus every single day, some for years. You run the risk of hypo if not hometesting, and you run the possible risk of ketones by shooting only once a day. No matter what insulin many of us have used over the years, none of them work with a single shot a day.

 

Re: New diagnosis, blood sugar still rising, so many questio

Did she explain why she is against twice a day? What she is doing is trying to get the bg down as quickly as possible, hence the increases. She's just going about it in a way that we don't agree with or recommend. The protocol at FDMB is SLGS....start low, go slow

Carl

 

Re: New diagnosis, blood sugar still rising, so many questio

She said every cat's nadir is different and not all cats need dosing twice a day.

So seriously I should go against her advice? Should I do one unit twice daily? Do I call her and tell her what I'm doing? I am trying to remain calm but this is a little overwhelming.

 

Re: New diagnosis, blood sugar still rising, so many questio

Amanda

Ask your vet, to test her knowledge of FD, if it is true that cats metabolize insulin twice as fast as dogs or humans. The correct answer is "yes".

Carl

 

Re: New diagnosis, blood sugar still rising, so many questio

She did say that most cats do end up on twice daily insulin, even with Lantus, but that not every cat does and that's what they are trying to figure out.

 

Re: New diagnosis, blood sugar still rising, so many questio

Every cats nadir IS different. ECID. But none of the kitties we see gets 24 hours out of a dose of insulin.

 

Re: New diagnosis, blood sugar still rising, so many questio

Amanda
We, and your vet, advise. But you decide. You hold the needle. But no matter what you choose, we're going to be here to help you deal with this.
carl

 

Re: New diagnosis, blood sugar still rising, so many questio

Hi Amanda--

Here's a link to the AAHA dosing guidelines: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

Note p. 218 (4) where it says that insulin should be given every 12 hours.


Here's a link to the Lantus (glargine) dosing protocol: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

Note on p. 2 where it says "Begin with 0.25 IU/kg of ideal weight BID" (BID = Twice a day)



Hopefully if you print out and go into your vet armed with these articles, she will then support your decision to give 1u twice a day. She seems to have done her research, but unfortunately she is dosing your cat like a dog, who have metabolisms similar to people. Cats have much faster metabolisms, and the duration of action in a cat for Lantus is only 12 hrs--so for the other 12 hrs your cat is getting no insulin. (Bandit's old vet did this, too--finally I just ignored her dosing advice and followed the correct protocol, with the information I found here). Most cats do not need much more than 1u twice a day when on a low carb canned diet, so giving 3u without following the proper dosing protocol could be very dangerous for your cat.

 

Re: New diagnosis, blood sugar still rising, so many questio

Try giving your insulin twice a day and the improved numbers will be all the proof you need.

There's not a single cat on this site who is getting insulin once a day, and that's because it's not that long lasting. Dosing once a day is causing your cat's BG to be like a rollercoaster... up and down, then up for a day, and then down for half a day, then up for a day, then down for half a day.

 

Re: New diagnosis, blood sugar still rising, so many questio

If the cat were doing ok on an exceptionally small dose (ex 0.5 or less) and occasionally didn't even need it, then yes, once a day insulin might work.
Your cat is not on a very low dose, more like a low to moderate dose and will do better with BID insulin. Take in those articles above, or be brave and tell the vet you aren't comfortable shooting only once a day when contemporary veterinary journals report the correct treatment is BID.

Additionally, a single large dose sends your cats insulin downward for 12 hours and then it skyrockets back up as the insulin wears off. When it goes zooming up, you run the risk of ketoacidosis, where the cat may become very, very ill and very, very expensive to treat in a hospital.

 

Re: New diagnosis, blood sugar still rising, so many questio

Hi all,

Just following up on yesterday's post - I have posted this to the Relaxed Lantus forum as well as I had asked this question over there.

I decided to listen to the vet and went ahead and gave Thomas the 3 units at about 10:30am yesterday and then tried to do a bit of a curve and of course monitor for hypo. I unfortunately do not have his BG level before administering the 3 units yesterday, but he's been above 20 mmol/L (in the 360-400 mg/dl range) all week despite increases from one to two units of Lantus.

Here's what happened:

10:30am - 3 units Lantus given
2:30pm (+4) - BG 10.0 mmol/l (180 mg/dl)
4:30pm (+6) - BG 7.3 (130)
5:30pm (+7) - 7.9 (142) **food was given between this reading and the previous one
7:30pm (+9) - 7.2 (128)
10:30pm (+12) - 9.1 (165)
6:30am (+20) - 8.2 (148) **this was first thing in the morning before food was given, he hadn't eaten in about 6 hours

I am not sure what to make of these results - on 2 units once daily there'd been almost no effect - on 3 there is clearly quite an effect, but I expected more of a rise after the 12 hour mark. Is it possible he's a 24 hour dose kitty after all? Given these new eadings, will continuing 3 units once daily be too much? I'll be talking to my vet of course about this before giving him his insulin in about 2 hours, but I was curious to see what people here thought...

 

Re: New diagnosis, blood sugar still rising, so many questio

Amanda,
Kitty has only been on insulin for a week, right?
It can take 5-7 days for the shed to fill, as I understand it. I thing what you may be seeing is just him getting used to getting insulin. I also think it might be too high a dose, but I will let lantus experienced folks try to explain things better than I can.
Carl

 

Re: New diagnosis, blood sugar still rising, so many questio

Hi, Amanda ~

That 3U dose looks plain scary high to me. And so does the once daily dosing. Let's see what other Lantus members have to say.

I posted this on Relaxed Lantus:
http://felinediabetes.com/FDMB/viewtopic.php?f=32&t=62112
"I unfortunately do not have his BG level before administering the 3 units yesterday" -- Would have been interesting to know how high he was before the 3U. Will you be testing and shooting again at 10:30AM this morning?

I know, Amanda, if you look at just those numbers, they're looking pretty good. The concern that I have is the lowering effect and the duration of the 3U already when you've just started that dose and the Lantus depot/shed hasn't filled yet. As you continue that dose, I'm worried about steeper, extended drops in Thomas's blood glucose numbers. That's beginning to look a lot like what we went through with our cat Willie.

"but I expected more of a rise after the 12 hour mark." -- And normally that's what you'd expect to see, Amanda. I'm worried that the duration you're seeing so early into starting that 3U dose could be the beginning of an overdose.

PLEASE be careful. Are you going to be around to test Thomas often?

Eva