Looking for advice with insulin dosing

I have about 4 pages on one thread on the main message board but people told me to post here for dosing advice. I hope the link will work to my spreadsheet, which I just created today. I am trying to figure out if I should continue the current regimen. https://docs.google.com/spreadsheet/pub?key=0AmgxUHbbBYkndDJCQkQzMndfY0Y0NXl4THFSVHh2X1E&outpu

 

Welcome Terri

I have been following your post over on Health for awhile now so I had a basic grasp of your situation and we are more than happy to try to help you to the best of our ability. But to be very honest, with only one days set of numbers it is really hard to give much advice, as of today's numbers it looks like the 2u both am and pm are just about ideal of a dose for Midnight. The problem lays in that with limited data then we can only give you limited help and since cats are living, breathing creatures what is ideal today can be too much or too little on another day, the formula just isn't as easy as if the cat weighs this, eats this much then give this much insulin.

If you look at my Autumn's spreadsheet you will see that she has been on the same dose now for weeks but her numbers change all the time...at the very least I would ask that you test before each shot and try to get at least a couple spot checks in during the day, this is strictly for Midnight's safety while she is on insulin. For even as long as I have been treating Autumn she can and does throw me curve balls and on several occassions has fallen as low as the 20s without any outward signs of hypo.

If this isn't something you can or are willing to do, then I will do my best to help you with what limited data you provide but I'm afraid I will not be comfortable giving you much dosing advice without at least an occasional curve (testing every 2 hours between shots) because I am not willing to risk Midnight's safety. There are several folks here that are only able to get the preshot tests and maybe a spot check or two in daily but then when they have a day off run curves and that is fine, that gives me enough data to base at least a logical and safe dosing advice on, but without those data points it is a lot like trying to figure out how to cook a complicated dish without all of the recipe.

Mel, Maxwell, Autumn & The Fur Gang

 

Hi. This is my first time on this site and I'm not sure if I'm asking my question in the right spot. I am pretty happy iIfound this message board and I really hope it helps Poo and I. Have spent thousands on vet bills and medical supplies and they still havent told me what a normal blood glucose is. So maybe someone here can help. My cat has diabetes and
nd I have him on wet diabetic food and he gets 1 unit of lantus in the am and 1 unit in the pm. We have had a rough road with a lot of problems but we had a few days where things seemed stable. Then yesterday morning I gave his 1 unit after he ate and when I fed him 12 hours later(w.ith a little snack at noon) he vomited. I checked hios sugar and he was 2.7 but not really symptomatic. I gave him more food and he ate. But I held; his pm dose. During the night he got me up a few times and nefory I fed him , I checkedhis big and he was 4.1 and seemed to be acting normal just hungry. He ate a fair amount just now but I havent given his lantus yet. From what I read online, I think 4.1 is within a normal range for the am beforehe has eaten. So my question is should I hold his insulin? If he is diabetic and not in remission than he needs the insulin otherwise he will spike up and become symptomatic for hyperglycemia. However, I don't know if there's a number where i should hold it because I don't want to have a hypo episode.Any help you can give us would be great. I just wish there were some guild lines to follow like a sliding scale.

 

So, based on yesterday's findings, what would you suggest?

 

Based on yesterday's results alone...If there was data to support it, I would say that Midnight's nadir was just about perfect. I wish I had more points of data to work with to be certain that +6 was in his nadir. Since not every cat on Lantus nadirs at +6 and he could have dropped lower following that spot check or before it and was on his way back up.

One day's set of numbers don't really tell me a whole lot, but if that is what I had to go off of I would continue the dose but test at least 4 times a day to make sure that he doesn't drop any lower than that on this dose. And depending on how long you have been giving 2u am and pm be prepared to walk up a hypo situation once he starts to settle into the dose.

Mel, Maxwell, Autumn & The Fur Gang

 

For tmandl and Poo:

Hi tmandl, We are glad you found this site too

Could you please start a new thread for yourself and Poo, by clicking on the NEWTOPIC* button? If you exit out of this thread, it should be somewhere around the top left of your screen. That way we can answer your questions and not get them all mixed up with Terri and Midnight's. It can get really confusing if we are answering or talking to one person and the other person thinks we are talking to them. Know what I mean?

 

Hi tmandl, in case you haven't seen my PM, I've already posted your question in the Main Forum for you. ;-) http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=93650

 

I am still trying to figure this out. I am under the impression that the pre-shot blood sugar is less important than the blood sugar 6 hours after the shot. Is that correct? It just seems strange to me that even if the blood sugar is still very high (like 250-500) before the shot, it doesn't affect dosing adjustments at all. Are we not trying to keep the blood sugar normal before AND after the shots? Anyway, based on my lack of understanding of all this, I tried increasing Midnight's dose and apparently I was totally wrong. I updated her spreadsheet today. I know I shouldn't have given her any insulin in the morning. Lesson learned, believe me! So I know that 3 units was too much, at least today. I have been told to change the dose slowly, like no more often than once a week. Is this correct? So should I go back to 2 units for a week? I will be keeping a closer eye on her blood sugar for a while. I know I am supposed to check it several times every day, before every shot, etc. but I am just not to the point of doing that. Please don't kick me off this board. I love her and I want to take care of her, but I am just not as thorough as a lot of people here (or everyone here).

 

Hi Hon,
I don't give dosing advice, I don't have that much experience. But will give you my opinion to where you are right now, hope that's ok.

I looked at the SS, I think you upped the dose yesterday? It said 2 units, but your notes said 3. So I'm not sure on that.

To start, unless your cat has been on insulin for a long time, with high doses like 10 units, you don't ever increase it by more than .50 units and that is based on the mid-cyle numbers, not the pre-shots. As with everything else, every cat is different and on rare occasion, this is done, but it is no where near the norm.

I noticed that you said earlier, you have some difficulty getting tests? What seems to be the problem? I might be able to help you there, I had a lot of trouble with that the first couple weeks. You have to keep in mind, those tests can be the difference in life or death. Sometimes, those of us with an issue with the testing just have to buck up, it's too important to not do it.

Your notes say that there was no sign of hypo when your kitty went dangerously low. Please understand that a percentage of cats don't show any signs, that doesn't mean there isn't a very high risk going on.

This board is very quiet today, I'm sorry that Mel and some of the others aren't around to help you. I'll try to send some pm's to a couple and see if they can drop by.

I am very concerned about your dosing. Would you please not dose her 3 units tonight? Take her back to 2 and play it safe until we can get someone else to help you? It will not hurt her in anyway and should prevent a recurrence of what happened earlier, which is dangerous at that level. Many cats are at ER vets with BG's in the 20's, I don't want that to happen to you or your girl. While you're waiting, read up on the stickies at the top of the page, there is so much good info there.

I'll go try to reach some others with experience to help.

 

No, I had increased the dose a little over a week ago because her pre-shot sugars were still very high. I am still learning all this. Sometimes it takes a while for things to sink in with me. I just don't see how it is ok for her pre-shot sugar to be really high. And the only thing that really matters is her 6-hours-later sugar. I plan to check her blood sugar more often, but not necessarily several times EVERY day. I understand the rationale behind that, but it isn't for everyone. Some people just aren't that aggressive with this whole process.

 

Hi there - I can't see your spreadsheet so I can't speak to what you did or did not do. But I can help you with some clarifications, I hope.

You are right that Lantus dosing is primarily based on the nadir (the low point of a cycle) which is generally around 6 hours after a shot - but it can vary for different cats.

Now, although the eventual goal is to have blood sugar normal all the time......the reality is that Lantus works on a curve...it kicks in 2-3 hours after a shot - drops to its lowest 5-7 hours after the shot - and then gradually rises generally 10-11 hours after the shot.

Yes the preshot numbers matter - but the bottom line is you are trying to find a dose that keeps the cat below 280 preshot and above 50 at all points in the cycle. Especially if you're like a lot of people and can't test very much, its a lot more important that your cat doesn't go too low and have a "hypo" than it is that your cat doesn't go too high.

And thats why dosing changes are based on the low point in the cycle....and when you do have the chance to get a test 5-6 hours after giving a shot - its important to do so.

That's the principle behind the Go Slow dosing approach which is http://binkyspage.tripod.com/SLGS.html

OK - now on to the preshots - they do matter - but ONLY in conjunction with those nadir (middle) numbers. You see, a cat has a natural tendency to react to low blood sugar by creating its own form of glucose - which brings its numbers up high. So you might think that a cat that is testing at 300 before every shot isn't getting enough insulin - actually they might be dropping dramatically when the insulin kicks in - and then reacting to that drop by bouncing high. That's why you can't trust preshots.

BUT if you are going to try to follow what they call the Tight Regulation protocol - thats where the advice to increase the dosage if the preshots are consistently over a certain number. For me the easiest to understand version of that protocol is this one http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

As for dosage changes - generally they should be small - .25 or maybe .5 - not 1 unit at a time.....its just too big an increase at one time. Lantus builds up in the body over time and it takes several days to reach its full effectiveness - and that is why its recommended that you wait 5-7 days at a dose before you make a change.


I hope I helped a little here. There are lot of people who can't test their cats very often, but we try to test before each shot because if you give insulin to a cat whose blood sugar is too low - the overdose could result in the need for a trip to the emergency vet.

I work fulltime during the week and so what I do is test my cat more on the weekends. If and when you increase a dose, you really should only do it when you can be around for the rest of the cycle and get a midpoint test in....otherwise you are again risking an overdose.

I do know people who simply give their cats shots twice a day based on a dosage that their vet gives them and they don't test at all. They go in to the vet periodically and have a curve run, and thats how the dosage gets adjusted.

But I don't think you can have it both ways.....either there needs to be a curve performed by either you or your vet - or you just need to leave the dosage at whatever your vet recommended and let it go.

 

I set the spreadsheet so that anyone with a link should be able to see it. It is at the beginning of this thread, but I will try to put it here again. https://docs.google.com/spreadsheet/pub?key=0AmgxUHbbBYkndDJCQkQzMndfY0Y0NXl4THFSVHh2X1E&outpu

Thanks for all the advice. It makes more sense now. I just don't see how to keep it at a good reading pre shot AND mid cycle.

 

OK, I was going by the SS, like I said.

Being that she dropped to mid 20's, she has earned a reduction. If it was my Lucian, I would drop it by .50, making the dose 2.5 because she earned it.

I'm not real good at explaining things, I'm afraid. But the midcylce numbers going too low is life threatening, preshots being higher than we would like, is not. Plus, Lantus being a depot insulin, it builds with time. Her low point today, could easily be much lower tonight, on the same dose. Does that make any sense? The key is to keep them as stable as possible, in non diabetic numbers, from 40-120 I believe it is. As the midcycle numbers drop into good range, the preshot numbers will follow in time, it just takes a little longer with the preshots. That's why, when they are in good numbers during midcycle, without going too low and 20's is too low, you hold that dose and wait on the preshots to follow. If they don't, in about a week, you increase in small increments, .25-.50, based on the nadir or lowest point in their cycle.

Here's the kicker though, without the tests, you don't know what the lowest number is or how much to increase or decrease the dose. Yeah, it sux, I never thought I'd be able to do what I do with Lucian, but amazingly enough, he settled right in.

I don't test all day. I test before shots, to make sure it's safe to give a shot and then test about midway to see how far he's fallen and again before I go to bed. That's a normal day for us. 4 times a day. And if he's running real high, I won't do the before bedtime test, because I already know he's going to be several hundred points above hypo threat during his cycle. I know there are some people that test 10 times a day, no matter what the numbers are and if that works for them, great. It doesn't for me. But it also took a few months for me to get comfortable with it either way. When Lucian is showing low at +4 or +6, then I will be testing every 30 min to an hour, depending on how low, so I can guide him with small snacks, to keep him from hypo. Repeated testing isn't needed when they are in safe numbers IMO and that is just my opinion. But I do know that without the testing I would never know when he was going too low either. He hasn't gone below 46 yet, but some cats are showing obvious sign in the 40's, just like some in the 20's show nothing.

I sure hope I haven't confused you even worse! :lol: Like I said, I'm not good at explaining and hope someone will pop in and give you a hand.

 

OK - Real quick - now that I can see your spreadsheet...

from the Go Slow protocol (Which is the one you would be following since you aren't testing very often)

"Step 3. After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve (blood glucose tests every 2 hours, starting at shot time and continuing until the next shot). Follow the cat’s normal feeding schedule during the curve. The curve should be evaluated by someone experienced at interpreting feline blood glucose curves, in order to check for signs of rebound and other possible problems. If no rebound is present, follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):

a) If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
b) If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
c) If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.


*****

OK - so when you were on 2 units of Lantus BID - you got a midpoint test that was below 90. That meant you should have taken the dose DOWN .5 to 1.5 units

Instead you took it up 1 unit to a total of 3 units and you got a 26. I'm glad your cat was OK - that's a very scary number and I am glad you aren't going to do that again.

Anyhow - based on the protocol recommended for Start Low - you should go down to 1.5 units per shot. Recognize that if you test you are probably going to see high numbers for a couple of days because the cat is going to bounce high as a reaction to being so low.

Then stay with that dose until you are able to get another midpoint test - and then do whatever is appropriate (a,b,c) from the lsit above.

 

So you don't think I should go back to the 2 units twice a day? When I was there, someone told me that midcycle reading was ideal. I just (mistakenly) thought that since the preshot numbers were still quite high, that I should INCREASE the dose. It sounds like you are saying I should go down to 1.5 units twice a day, not 2 units twice a day, right? Just want to make sure I understand this.

 

You can't for a while......and that's OK. See, cats and people with working pancreas create insulin as they need it - so we generally don't go too high or too low). Though if you've ever had the "sugar shakes" as I call them - that's when your bg drops suddenly and it takes a bit for your body's insulin making to catch up.

But in diabetes, we're just giving a shot and hoping we are kinda sort balancing the insulin with the food......and we don't have the ability to add/subtract as the cat eats or exercises or does any of the other things that affect blood glucose levels......so we just can't be that precise.

The hope is that we find a dose where the cat is in numbers that are considered "normal" for as much of the time as possible so that the pancreas has the best chance to rest and heal itself. Then, in time, the numbers start to come down as the cat starts to make its own insulin...and eventually many cats go into remission.

That said - there is such a fine line between normal numbers and a cat that goes into hypoglycemic shock that only people who test frequently and monitor closely should be trying to get a cat down to "normal numbers" using insulin. The rest of us just try to keep our cats controlled which depending on who you read - is either 240/280 for a high each day.


And yes - if you are going to follow the Go Slow protocol - go down to 1.5 units twice a day (because your cat had a nadir less than 90 on 2 units twice a day) and see where you stand after a few days.

But that doesn't make me right...there are lots of people with a lot more experience and knowledge here - I'm just quoting from the protocol....so I don't take offense if others give you different advise and thats how you go. I tend to be really cautious because i can't test often.....

 

Mel said that - but she also said that it was tough to judge on just one days data - and that you should stay at the same dose, but test at least 4 times a day to make sure he didn't drop any lower than that, and be prepared to walk up a hypo situation.
If you can't do that - I think she would likely agree with me that it was safer to take it down to 1.5 units

Em

This is what she posted back to you
"Based on yesterday's results alone...If there was data to support it, I would say that Midnight's nadir was just about perfect. I wish I had more points of data to work with to be certain that +6 was in his nadir. Since not every cat on Lantus nadirs at +6 and he could have dropped lower following that spot check or before it and was on his way back up.

One day's set of numbers don't really tell me a whole lot, but if that is what I had to go off of I would continue the dose but test at least 4 times a day to make sure that he doesn't drop any lower than that on this dose. And depending on how long you have been giving 2u am and pm be prepared to walk up a hypo situation once he starts to settle into the dose."

 

Hi Terri

Deb asked if I would pop over from the Lantus Tight Regulation forum to help. I think the ladies have done a pretty good job of explaining those high preshots.

I will see if I can add anything to help clarify further.

Lantus is a long duration insulin which, as others have said, builds a depot subcutaneously. When you start giving insulin shots, you typically don't see an immediate change to the BG because those shots first go towards filling this depot. Once the depot is full, then the insulin you give is used by the cat and you start to see some change in BG. This is the reason we hold the initial doses for so long regardless if you use the TR protocol or the SLGS Approach. The beauty of these long duration insulins is their cumulative nature where one shot builds upon the previous.

When making dose changes, we do it slowly and incrementally. Think of changing course in a cruise ship. The captain can turn the wheel but it takes patience and time for the ship to actually change course. That's how these insulins work...so we all learn patience like we've never known

In TR, the normal range we strive for is 50-120 which is the normal BG for a non diabetic cat. I think when we all start giving insulin, we think it is simple...that you give the calculated starting dose and then the kitty comes into normal numbers and everyone is happy.

That rarely happens. When Midnight was diagnosed, her body had become used to the high numbers as the new normal. When she started getting lower numbers (and they don't have to be really low) or if her BG dropped quickly, then the liver releases counterregulatory hormones and glucagon to bring numbers back up to what the body perceives as normal. We call this a bounce and it can take the body up to 72 hours (six cycles) to clear these hormones and glucagon from the system. it is important to ignore these bounce numbers when dosing.. If it only takes 1u to get her to normal numbers but you give 1.25u because of the high preshot, then she is going to come down even lower and then bounce even higher. Plus, she would be at risk for a clinical hypo.

Almost all cats on insulin bounce at some point....some get over it quickly, others bounce a long time. But you hold the dose, ignore the bouncy preshots, and dose on the nadir. There may be days when you can't see the nadir for the bounce. That's where you don those patience pants and let the bounce clear before you change the dose.

On cats who are well regulated, like mine, the bounces can be in the 130-200 range. She occasionally sneaks up a little higher but I wait to see what her nadir is before I make dose changes.

As far as what Midnights dose should be now, the 1u was a good starting dose for her; however it wasn't held long enough even for TR. and then it was increased to 2u. So the possibility exists that you've already bypassed her good dose.

Because she only had two shots at 2u before she went to 66 and you shot a reduced dose one cycle in between, I have to wonder if it might be best to take her back to 1u. And I'm not generally one who backs doses down if you can continue getting a PS test, a mid cycle test, and a before bed test, then you might want to try 1.25u but give it time.

One of the best pieces of advice I've gotten over the last few years is to decide where you want her nadir and then dose for that number. If one dose leaves the nadir too high, take it up a bit. If it leaves the nadir too low, take it down. But lantus likes consistency in dose and time so as close as you can get to shooting every 12 hours, the better. And do not be tempted to raise the dose based on the PS unless her nadir IS her PS which is not unheard of with lantus but it is also not common. The AMPS is usually the last number to come down.

Questions? It's a steep learning curve but you have some really great ladies here willing to help.

 

The other ladies have pretty much covered everything I was going to say. Except for one other suggestion, and that is if you aren't going to test everyday at least at the preshots and then again around nadir at least either in the am or pm cycle. Then Lantus is probably not the best choice of insulin for you to be shooting and still be able to keep Midnight safe. A better fit might be Prozinc that is an in and out insulin and can be dosed off the preshot numbers on a sliding scale, but even with that insulin you are still going to need to be testing at the very least at preshots daily.

To use Lantus properly you need to be getting at the very least 3 tests a day and then running a curve (test every two hours from one shot to the next) to determine how Midnight is doing on the dose and where her onset and nadir are. Without that very bare bones of data it is impossible for use to responsibily offer dosing suggestions, except that when you increase a dose you don't increase by full units you increase by either .25u or .50.

Without additional data I can't tell you if her preshots are staying high because she is dropping low mid-cycle and bouncing back up by preshot, which is what would be suggested if her preshots are remaining high off that 60 something the other day. Or if it is simply not enough insulin.

Personally if this was my cat I would drop back to 1u twice a day, get at the very least the preshots every day as well as a few spot checks, then run a weekly curve and base dosing raises off that nadir number.

But with no more data than you have at present I just can't make an informed decision on if 2u is too little and needs to increase to 2.25 or if it still too much and needs to drop down. Because of both lack of data and the big jumps in dose increases it is very likely you have skipped over the ideal dose but when that happened is impossible to tell with out numbers to look at.

Mel, Maxwell, Autumn & The Fur Gang

 

:lol: :lol: :lol: Mel...GMTA! ;-)

 

TMR,

Let me ask you a couple of questions please.

If that 26 you had received today, had been at the pre-shot before you gave any insulin, and then you had gone ahead and given the insulin, what do you think would have happened to your cat?

What would have happened if you did not do a preshot test at all and your cat was at a very low number but you did not know it and went ahead and gave your cat insulin?

That is why we recommend that you test before every preshot. You can not assume that your cat's BG will be high enough to shoot to go ahead and give insulin without testing.

Don't worry, no one is going to 'kick you off this board". There are warnings, suspensions and then banning occurs but that is up to the webmaster, Rebecca and she does not warn/suspend/ban someone for asking information.

About the worst that is going to happen to you on this board is that we are going to stuff your head full of information, give you the confidence with all this information to know that you can help your cat, and expand your family members by several hundred people because we think of every member as part of our special FDMB family. :shock: :lol:

There is a way to add your spreadsheet to your signature link. That way, you do not have to add a link to the ss everytime you do a post. Here are those directions from the Tech Support forum.

The actual post in the Tech Forum has some pictures that illustrate some of the steps. They were lost when I did the cut and paste so you might want to go the Tech Forum for the complete post. It's called "How to Get a SS and Link in your Signature *updated 2/13/12" and is near the top of the announcement section.

Last but not least, {{{{{{{{{{Hugs for you}}}}}}}}}}}}. We will help you to get through this new sugardance you are doing with your kitty. Be sure to remember to take some time for yourself, give yourself treats - a glass of wine, a piece of chocolate, a bubble bath. Care for the caregiver is as important as caring for the cat. Take care.

 

Blood sugar was 201 this morning. I gave 1.5 units.

 

Morning Terri,
How about starting a new thread each day so we can keep track of you and Midnight. We can go right to it with the date, name, number in the headline.
It's easier on everyone that checks in on all the others, which most of us do.

Good number this morning, hope you're planning a +6 today, to make sure she doesn't go snorkeling when you aren't looking. ;-) We'll be waiting to see how she does.

Have a great day!

 

Yeah! I can access your spreadsheet via your signature link now. Even tiny things like this can help to simply your life when it is already so FULL. ;-)

 

So you think I should start a new thread every day? I thought that would be too much. It was 33 five hours after her insulin. I was asleep at the 6 hour point. I work night shift and had to take a nap this afternoon. Now I am kind of afraid to give her insulin tonight before I leave for my 12 1/2 hour shift at work. I will have to give her the insulin (depending on her blood sugar) around 6:30 pm and I won't be home until close to 8 am.

 

Hi there -that's quite a drop and its lower than you really want to have happening if you aren't around to be checking.....so I can understand you being nervous....I would be too. Again, following that go slow protocol - the drop below 90 today would mean that you'd take her dose down another .5 and plan on dosing her 1 unit twice a day....which is, if I remember right, was something suggested by at least one person yesterday.

But again, that's just my thought based off the protocol - I think that Mel and some of the other more experienced folks will likely be checking in her and be able to give you some advice.

* * *

Now the new thread thing is this - if you want to have people look at what's happening with your cat and perhaps weigh in on the situation - or just to say Hi and visit back and forth - or whatever....its easier if you start every day with a new post - and the subject would be the date/cats name/AMPS (for AM preshot) and the BG number. It makes it easier for your information to be found. Its definitely not "too much".

Your cat is doing well...but again, don't worry if you see a higher number bounce like you did last night.....its a normal part of the process.

 

I thought I wasn't supposed to make dosing adjustments more than once a week. Are you saying that I should adjust the dose every day based on the midcycle blood sugar from the day before?

 

Reductions in dose are made as soon as the cat "earns" it. That's because they are made for the safety of the cat (to keep them from going too low).

You are right that Increases in dose are made less frequently - a dose is generally held for 5-7 days - to make sure that its had time to "settle in".

Does that make more sense?

And I totally get how confusing all of this is.

 

Yesterday I was told to decrease the dose to 1.5 units. Based on how low Midnight's blood sugar went today after 1.5 units, should I only give her 1 unit tonight and for the next week?

 

Since you raised her dose in too big of chunks there is a very good chance that you over shot her ideal dose. So what I would do at this point is drop back to 1u twice a day. Test before every shot, get as many mid-cycle tests as you can, and then when you have a day off run a curve. Based off the nadir of that curve you can decide if you need to increase the dose or not.

Hold that 1u for at least a week before running the curve to allow her to settle on the 1u twice a day. Then once we have some more data we can help you figure out if you need to increase or not.

Dose decreases are earn anytime the cat's BGs fall below 50.

Mel, Maxwell, Autumn & The Fur Gang

 

"Hold that 1 unit for at least a week". HOLD to me means "do not give". But you mean DO give, but do not vary the amount, right?

 

Yes, that hold a dose phrase has been interpreted differently many times. You are not the first person to think it means do not give the insulin. Those colloquisims can be misinterpreted.

We mean keep giving that same dose, hold a dose steady, do not change that dose, do not increase the dose, do not decrease the dose.

Skip a dose means do not give the insulin.

The glossary we use can be found in Feline Health, Announcements section, called "Are you new and confused about our jargon? Read our glossary." Quick link to it is here: http://felinediabetes.com/FDMB/viewforum.php?f=28 It works for a lot of the terms we use here but hold the dose and skip the dose are not in there. :razz: