Need Help with Dosage Amount

Good Morning... I posted this to the Lantus Relaxed board a couple of hours ago, but nobody seems to be on. Then I posted to the regular Health forum and the advice given there was to come here and ask for your input.

Last night I introduced Oliver on the Health forum and didn't really expect to be needing advice so soon but Oliver's BG is 107 this morning so I don't know where to go from here. He has been on 2.5 u for the last 3 days. Previously to this morning he had been running in the 300's-400's again.

Here's a little background... Last Thursday his first reading of the day was 64 after having been on 3.5u for a couple of weeks. Oliver was alert and perky and not hypo by any means. He had a bit to eat and retested at 88. (The mornings prior he had been running in the low 300's.) So we skipped his am shot and his BG climbed steadily all day. By the time he was to get his pm shot he was 555. The vet had me reduce him to 3u at that time.

The next day...
7am... 261
Gave him 3u
1pm... 100
7pm... 262
Gave him 3u

The following day...
7am... 141
Skipped the injection because I couldn't reach my vet in time for advice and I would be away all day and unable to monitor Oliver. So of course his BG climbed all day. When I did finally hear from the vet she told me to drop him to 2.5u which is what he got that evening.

Since then his numbers ran high in the 300's-400's for the past two days. Now this morning at 7am we're seeing the 107. What should I do? I know if I don't shoot at all then we will keep bouncing all over the place... But I don't know what might be the right amount to give so he doesn't go hypo. I was trying to stick with my current injection schedule as I travel a lot and my cat sitter visits on a set schedule. (Side note: we're past his usual injection time now so I don't know if a small dose can be given at some point without starting on a new timetable or if I have to just wait and let things run their course and get back on track with his evening injection. Tested him again at 8:45am after he had eaten a little and he was up to 137.)

Need your input please about what to do next.
Thanks,

Wendy and Oliver

 
Posts: 5
Joined: Tue Sep 25, 2012 12:16 am
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HI Wendy

I can't give dose advice - please put a question mark on your post so it catches someone's eye. You shouldn't shoot a partial dose, but you an shoot a normal dose delayed, you just have to adjust your future shoot times to back up to his normal time 15 minutes at a time. Let me see if anyone is around so you don't have to skip a dose - you know how that goes.

Lisa

 

Usually, when we see a cat who's numbers keep causing you to skip shots, we recommend lowering the dose so you can shoot twice a day and begin to get things evened out. Does Oliver have any health issues or any history of ketones? If not, you may want to reduce the dose to 1.5 or 2.0u. and see if that allows you to stop skipping.

You can certainly give a reduced dose this morning. You can then use this as your new shot time or gradually work your way back to your time by moving shot time 15 min. earlier each cycle. If you shoot, you'll need to be around to monitor.

It would help a great deal if you could compile all of your test data into a spreadsheet.

 

Wendy

It's not clear what time zone you are in or how many hours it has been since you were supposed to shoot - could you post that info? It seems you are a couple hours past shoot time.

Thanks

 

Thank you for your replies...

I am in the US eastern time zone. His shot time should have been at 7:45am this morning so we are nearly 3 hrs past that now.

When Oliver was dx back in early July he had ketones (low) which were resolved after spending a few hours at the vets on IV and other meds. (follow up tests the following week and all the weeks after showed no ketones. ) He also was dx with pancreatitis at that same time. We gave him subqs daily and then every other day for several weeks. I stopped giving them last week. He still gets omeprazole and potassium daily. I think the pancreatitis must be resolving though because he is eating very well, playful again and his BG numbers have been improving. Sure hope when we go back to the vets for his next blood work up that we can give up everything but the insulin!

Wendy

 

Wendy, I'm glad you finally got over here. This is a very active forum and they will be able to guide you well,
good luck.
Nancy

 

Wendy

Sienne's advice is good advice. However, since you are several hours past shot time, please consider how long it would take to get Oliver back on the schedule you need for your work and travel. Several hours of delay translates into several days of different shoot times, working your way back 15 minutes every cycle. 3 hours delay means 12 cycles or 6 days to return to your current shoot time. Skipping the dose and restarting this evening may be the better option for you in terms of scheduling.

Good Luck!
Lisa

 

Thanks, Nancy... I sure hope so!

Thanks, Lisa and Sienne... You made some good points. I'd just made up my mind to test Oliver again and be brave and shoot a lower dose on a new schedule. Then I remembered that I have out of town appointments that will keep me away from home for hours tomorrow so I wouldn't be able to stick to the new schedule. I guess messing with his usual schedule isn't the best idea right now. That means now I'll have to wait and poor Oliver is headed for another roller coaster ride. I really hate doing that to him.

I'll see if I can work on a spreadsheet for him in the next day or so. Hopefully that will help me and everyone else to better help Oliver.

Wendy

 

Hi Wendy,
Glad you posted here and got some feedback! One thing I'd mention on what you said earlier -

He may not be bouncing all over the place due to just skipping a shot. The overall effect of Lantus is cumulative due to the insulin depot that it works on. I used PZI on Bob, so I understand that a skipped shot can mean a big increase in BG numbers by the time the next shot time rolls around. With PZI, the insulin lasts 10-12 hours, then it is "gone". With Lantus, and the depot nature of the insulin, it isn't quite that simple, and with Lantus, the effect isn't that immediate or that obvious.

If Oliver has been getting doses like 3u or 2.5u, then the depot or "shed" is there based on his normal doses. When you skip a shot, or shoot a much lower dose, you don't necessarily see an immediate impact within the 12 hour cycle in question. There's still the depot of insulin that will drain and will continue to have some effect on his BG numbers. It isn't like he is running on "no insulin" for 12 hours until the next shot.

Oliver's bounces could also be caused by low BG numbers that might happen at times you haven't tested. They don't have to be really low "hypo" numbers either. A drop to numbers that are not "normal" to Oliver, like even a 100, can cause a reaction from his pancreas and liver, which will dump glucose (for lack of a better word) into his system. This can happen if the BG goes too low, or if it goes low quickly. Just using the numbers you posted as an example...

AMPS 261 (shot 3u dose)
+6 100
PMPS 262

At face value, those numbers don't look bad at all. It "looks like" the nadir happened at +6, which is considered typical. But it may not have. He may have been lower before or after that 100 meter reading. And a bounce sometimes doesn't show up until the cycle after the low numbers. You'll get sick of seeing it, but here we say very often that "Every Cat Is Different" (ECID). It's very true. As time goes by, you'll figure out what Olivers typical cycle looks like. He could be a late-nadir, or an early-nadir kitty. Only the testing data will reveal what his cycles normally look like, and you'll come to expect things to happen based on the dose and on when he eats every day (or what he eats, or how much he eats), based on history and recorded on your spreadsheet.

What I'm trying to say is that there are plenty of other reasons for "bouncing all over the place" taking place besides just a skipped shot, and that skipped shots many times will not show up "immediately" in his numbers.

Carl

 

VERY, VERY IMPORTANT TO ALL ADVICE GIVERS:

1. Wendy is using an ALPHA TRAC which registers 20 to 30 points lower than a human meter. The 64 she got a few days ago was probably a 34 or a 44.

2. Her cat has tested positive for KETONES in the past as recently as about a week ago. He was treated for ketones in the pet hospital in the past, and he had low potassium, and pancreatitis at that time. Blood tests showed he was anemic and had elevated liver enzymes. (Wendy, did he ever get antibiotics after the pancreatitis test?)

3. He gets omeprazole and potassium every day. Wendy "had been giving daily subq fluids for a few weeks, then every other day for a couple weeks and now have tapered them off entirely. He is drinking a lot less and there are smaller and a lot fewer wet spots in the litter box too."

4. Oliver weighed about 9 lbs about a week ago. He had lost 4 pounds in 2 months and was down to 6.5 lbs. recently. Wendy "managed to pack 2.5 lbs back on him in the last two months."

5. Back in May of 2011 he started getting eruptions and scabs on his face and ears. It was determined that he had some kind of allergies and was given a prednisone injection. He got another prednisone injection after that, and he also got oral prednisone for about 11 months and then Atopica for about 2 and 1/2 weeks. (Wendy, did you stop the Atopia at that point?)

Wendy travels for work, but is also lucky enough to have a pet sitter who knows how to BG test and who works in her vet's office. However, her vet does think it is okay to shoot without testing! Wendy does not agree.

 

Here is Wendy's most recent post in Relaxed: http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=79790&p=865294#p865294