One more Question - Need Fast Advice - Sami - 1/26

[Tina & Sammy]

Hi everyone,

Sami and I haven't been here for quite some time, but lately Sami has had a bout of High Glucose, I believe at least in part due to the illness and passing of another feline family member.

Anyways, I am nervous about shooting tonight. Over the last couple of days I haven't been extremely happy with Sami's numbers and this morning she was back up to 600. I went against protocol and gave her 1 full unit this morning because her numbers were so high and the half unit didn't seem to be doing enough. And I test often. But now she has dropped from 597 AMPS to 161 (+11).

I am feeding her now and I really do have an hour before I need to give the PM shot, and I know her sugar will rise after eating, but I am nervous about giving a half unit.

Here are how her numbers went today:

AMPS 597
+2 - 502
+4 - 441
+6 - 345
+8 - 306
+10 - 216
+11 - 161

No matter what, I will get up several times over night to test, but I won't be able to test as often tomorrow during the day because I will be at work.

What do you recommend? The few times over the last 4 years that Sami has needed insulin she has gotten two shots and has regulated naturally and was again OTJ. This bout has been going on since 1/9, but there were about 5 days in there that we stopped insulin because we thought she was going too low. So technically since 1/9 she has only been on insulin 10 days during this time and on 1/12/15 she went from 500 PMPS to 90 at AMPS the following morning, I didn't shoot that morning, but then she spiked back up to 525 on the evening of 1/13/15, which is why we pulled back on the insulin. Because we figured she went lower during the day when I couldn't test because I was at work.

Here is a copy of her spreadsheet:
https://docs.google.com/spreadsheet/ccc?key=0Al6Ca0hrotiedEI4MnVfRGhUd3NESDdNMms1c0swblE&usp=sharing

 

[Sienne and Gabby (GA)]

With the run of numbers Sami has been having, I'd suggest a vet appt. These are abnormally high and could be the result of an infection. Dental issues are notorious for having this kind of effect on BG numbers.

With nadirs over 300, the protocol does stipulate that you can raise the dose by 0.5u. So what you did was fine although sticking with one dose for at least 6 cycles would be better advised. I'd see what your PMPS tells you -- are numbers still falling. If so, you might want to go for the 0.75u dose and then hold it for the next several days.

 

[Wendy&Neko]

Sorry you had to come back here. What illness caused Sami to need insulin again?

Lantus likes consistency in dosing, and we determine what to dose based on the nadir, or how low a dose takes the kitty. We have two protocols in this group, SLGS and Tight Regulation. Take a read of them both, and see which you'd like to follow. Both protocols suggest holding a dose for at least 6 cycles, sometimes more, based on the nadir values and the protocol.

I'd go back to .5U and hold the same dose for at least 6 cycles. This morning's number could have just been a bounce. I know it's hard to see those high numbers, but try to ignore the high preshots. They will eventually come down.

ETA: I see Sienne suggested .75, that would also work.

As for tonight, how much flexibility do you have in your schedule. If she's still going down at +12, you can try waiting a 1/2 hour and see if she starts coming up. Basically if she's around the same or coming up, you should be OK to shoot. It might be a livelier cycle tonight because of the 1.0U you shot tonight this morning. I find that often it's the cycle after the one you shoot that's affected.

 

[Chris & China (GA)]

It would have been better if you hadn't just fed her so we'd know at PMPS if she was still dropping....now we won't know if she's higher at PMPS due to the insulin wearing off or due to the food

It's also going to be important going forward to give the same dose, AM and PM...it looks like some times you were giving less than .5 and other times greater than .5

I think since there's no way to know for sure how much the food will be influencing the PMPS result, your choices are going to be

1. Stall and don't feed any more until it's been 2 hours since she's had any food and then reassess ....but you'd have to be able to shoot 12 hours later in the morning

2. Go ahead and shoot the 1 unit dose but be prepared to test tonight and stay up if necessary (we don't get too concerned until they drop below 50)

3. Go back to the .5 unit shot and hold it for at least 6 cycles and let's see what she's really doing...this is probably the best idea if you can't stall tonight

 

[julie & punkin (ga)]

Couple of thoughts. I think your blue at +11 tonight is the bounce clearing from when she hit blue #s the night of the 24th. When a bounce is clearing it can have a lot of momentum - so no matter what you do about tonight's shot, I'd make sure and test this evening.

You can't use Lantus to beat down high numbers. It just doesn't work well at it - it takes a while to build up in the body and for the depot to slow-release. Lantus dosing is all about "how low does this does take my cat?" You want to hold any particular dose for a minimum of at least 4 consecutive shot cycles, then adjust depending on what the low points are in those previous couple of days.

You've gotten good advice from both Sienne & Wendy, so i won't address the dose. I think you have a choice there, depending on what you want to do.

 

[Tina & Sammy]

Sorry you had to come back here. What illness caused Sami to need insulin again?

Lantus likes consistency in dosing, and we determine what to dose based on the nadir, or how low a dose takes the kitty. We have two protocols in this group, SLGS and Tight Regulation. Take a read of them both, and see which you'd like to follow. Both protocols suggest holding a dose for at least 6 cycles, sometimes more, based on the nadir values and the protocol.

I'd go back to .5U and hold the same dose for at least 6 cycles. This morning's number could have just been a bounce. I know it's hard to see those high numbers, but try to ignore the high preshots. They will eventually come down.

ETA: I see Sienne suggested .75, that would also work.

As for tonight, how much flexibility do you have in your schedule. If she's still going down at +12, you can try waiting a 1/2 hour and see if she starts coming up. Basically if she's around the same or coming up, you should be OK to shoot. It might be a livelier cycle tonight because of the 1.0U you shot tonight this morning. I find that often it's the cycle after the one you shoot that's affected.

Wendy, Sami wasn't ill, it was another one of our cats, who passed away last Monday. I was hoping that her numbers would fall back in line after his passing, but so far they haven't done what I expected.

I know I went against protocol, I tried really hard to stick to a half unit, but I was also on the fence about whether the insulin was still good, and had planned on getting a new prescription filled today, but after this drop, I think the current supply is still working.

I do have a bit of flexibility tonight, so I could stall, but I will have less flexibility in the morning for AM shot.

When you say "I find that often it's the cycle after the one you shoot that's affected." What exactly do you mean by this. That the evening cycle will be more affected by the morning shot?

 

[Tina & Sammy]

With the run of numbers Sami has been having, I'd suggest a vet appt. These are abnormally high and could be the result of an infection. Dental issues are notorious for having this kind of effect on BG numbers.

With nadirs over 300, the protocol does stipulate that you can raise the dose by 0.5u. So what you did was fine although sticking with one dose for at least 6 cycles would be better advised. I'd see what your PMPS tells you -- are numbers still falling. If so, you might want to go for the 0.75u dose and then hold it for the next several days.

Sienne, Sami actually just came off a cycle of antibiotic last night. Because the last time she went high we had thought it was also an infection, so that was the first thing we checked, she wasn't showing in signs, but after her November HIGH she slowly started to climb again, but again I think it might have a lot to do with the illness and passing of one of our other cats.

 

[Wendy&Neko]

Yes, you could still feel the effects of the 1.0U dose tonight, so good plan to keep an eye on her this evening.

 

[Tina & Sammy]

It would have been better if you hadn't just fed her so we'd know at PMPS if she was still dropping....now we won't know if she's higher at PMPS due to the insulin wearing off or due to the food

It's also going to be important going forward to give the same dose, AM and PM...it looks like some times you were giving less than .5 and other times greater than .5

I think since there's no way to know for sure how much the food will be influencing the PMPS result, your choices are going to be

1. Stall and don't feed any more until it's been 2 hours since she's had any food and then reassess ....but you'd have to be able to shoot 12 hours later in the morning

2. Go ahead and shoot the 1 unit dose but be prepared to test tonight and stay up if necessary (we don't get too concerned until they drop below 50)

3. Go back to the .5 unit shot and hold it for at least 6 cycles and let's see what she's really doing...this is probably the best idea if you can't stall tonight

Hi Chris,

Yes, in the past week I was shooting a little above or a little below .5 unit because I couldn't test during the day and I was nervous about her going too low. I talked to the doctor on Saturday, after I had already given 1 unit in the morning, and we agreed to stick to a SOLID .5 unit for a couple of days. But after 3 dose at .5 and she skyrocketed I was freaking out, and the doctor wasn't in today for me to bounce ideas off of.

I forgot about the stalling food to see if she was still dropping. It has been awhile. I could stall 2 hours from +11 and still be able to shot 15-30 minutes early tomorrow.

Because she dropped so much on one unit this morning I feel REALLY uncomfortable shooting 1 unit tonight. I feel much more comfortable shooting .5 unit and checking every couple of hours during the night. When I did this the other day (Saturday) and she was still dropping even after food and PM shot I just gave her high carb food to counter act. I don't have a problem with that, but now I am wondering if the 500's from late last night and this morning were some sort of rebound from the 1 unit that was given Saturday morning.

 

[Chris & China (GA)]

If you can stall tonight until +13 and still shoot 12 hours later in the morning (11hr 45min anyway), I agree that the .5 would be the best idea tonight and just hold it for several more cycles and let's see what she does

If you do stall, at least you'll have a non-food influenced number for tonight

 

[Tina & Sammy]

If you can stall tonight until +13 and still shoot 12 hours later in the morning (11hr 45min anyway), I agree that the .5 would be the best idea tonight and just hold it for several more cycles and let's see what she does

If you do stall, at least you'll have a non-food influenced number for tonight

Okay, thanks. I will keep you posted. I will check her again in an hour to see where she is. I will pull the food to make sure she doesn't eat any more until I check.

If she is still dropping in an hour at +13 after eating at +11, should I skip the shot all together? Or still shot the .5 and monitor heavily this evening. The latest I can shot tomorrow morning will be around 8:00 am - 12.5 hrs from right now.

 

[Tina & Sammy]

Just to make it clear the test at +11 was pre-food also. I tested and then gave her food, planning on shooting within the hour after food.

 

[Chris & China (GA)]

We like to have them without food for the 2 hours prior to shots so we know the number isn't food influenced...at least until you really know how she responds to both food and insulin. We have a few cats around here that can graze right up until shot time, but their caretakers really know how their cats respond

Since you're back from the falls, it's like starting over though, so it's better to take the food up 2 hours before scheduled shot times

It really looks like "something" changed between August and November....it could be that the infection you talked about threw her out of remission, and even though she's been on the antibiotics, there might still be something going on. Might be a good idea to have her teeth looked at if you haven't lately

I think you're probably going to be fine to shoot the .5 tonight....and if you'll hold it for a few more cycles and post here daily, we'll be able to help you get her into some better numbers

 

[Tina & Sammy]

We like to have them without food for the 2 hours prior to shots so we know the number isn't food influenced...at least until you really know how she responds to both food and insulin. We have a few cats around here that can graze right up until shot time, but their caretakers really know how their cats respond

Since you're back from the falls, it's like starting over though, so it's better to take the food up 2 hours before scheduled shot times

It really looks like "something" changed between August and November....it could be that the infection you talked about threw her out of remission, and even though she's been on the antibiotics, there might still be something going on. Might be a good idea to have her teeth looked at if you haven't lately

I think you're probably going to be fine to shoot the .5 tonight....and if you'll hold it for a few more cycles and post here daily, we'll be able to help you get her into some better numbers

I just tested, still 30 minutes out from 2 hours from food, and she is 390. I feel comfortable shooting .75 or .5 tonight as I can monitor her throughout tonight, but that won't be the case tomorrow during the day. Should I hold off for another 30 minutes to get a true 2 hours from food reading?

Also, I have been pulling the food immediately after she eats and has a shot, should I be leaving it out until 2 hours before shot time to allow her to eat when she wants. I am wondering if this is part of the problem. She really is a grazer and gets quite agitated if she doesn't have food when she wants it.

 

[Tina & Sammy]

We like to have them without food for the 2 hours prior to shots so we know the number isn't food influenced...at least until you really know how she responds to both food and insulin. We have a few cats around here that can graze right up until shot time, but their caretakers really know how their cats respond

Since you're back from the falls, it's like starting over though, so it's better to take the food up 2 hours before scheduled shot times

It really looks like "something" changed between August and November....it could be that the infection you talked about threw her out of remission, and even though she's been on the antibiotics, there might still be something going on. Might be a good idea to have her teeth looked at if you haven't lately

I think you're probably going to be fine to shoot the .5 tonight....and if you'll hold it for a few more cycles and post here daily, we'll be able to help you get her into some better numbers

I think what changed between August and November is the illness of the other cat. He started losing weight last year and we couldn't pinpoint what the problem was, nothing came back abnormal on all the tests that we did. It wasn't until last week that we discovered he had a tumor and was highly anemic. That was when we made the decision to let him go.

The doctor looked at her teeth when we had her at the vet a week or more ago, and she didn't see any problems.

 

[Chris & China (GA)]

If she's at 390 now, I'd go ahead and shoot now

Most of us feed several small meals throughout the cycle and just take food up 2 hours before shot times. Small meals are easier on the pancreas than big ones anyway, so if she likes to graze, I don't see any reason why you can't let her and just take it up 2 hours prior.

Some of us try not to feed after +6 just because the insulin should be wearing off, so we don't want to add food while the insulin is wearing off, but that's something you're just going to have to learn about Sami

 

[Tina & Sammy]

If she's at 390 now, I'd go ahead and shoot now

Most of us feed several small meals throughout the cycle and just take food up 2 hours before shot times. Small meals are easier on the pancreas than big ones anyway, so if she likes to graze, I don't see any reason why you can't let her and just take it up 2 hours prior.

Some of us try not to feed after +6 just because the insulin should be wearing off, so we don't want to add food while the insulin is wearing off, but that's something you're just going to have to learn about Sami

Thank you so much for your help Chris. I will go ahead and shoot now. I think you mentioned that I should stick with the .5 unit for now until I have 6 cycles in a row. Is that correct. Or could I increase to .75????

 

[Chris & China (GA)]

Since Sami DID get into blues on the .5 dose, let's stick with that a little longer and see how it goes..I think the blues are probably more related to the 1 unit dose he got the cycle before, but since you can't test tomorrow, let's be safe

 

[Tina & Sammy]

Since Sami DID get into blues on the .5 dose, let's stick with that a little longer and see how it goes..I think the blues are probably more related to the 1 unit dose he got the cycle before, but since you can't test tomorrow, let's be safe

Okay, thanks. I just gave her .5 unit and will still monitor throughout the night. I will also leave out food for her grazing and pull it at 5:00 am tomorrow morning, 3 hours before shot time.

One more question, based on her spike and drop today would you says that this was from an effect from cycle from Saturday or degrading insulin. The insulin we are using is about 60 days old, and I was very tempted to get fresh insulin today.

Should I go ahead and get fresh insulin or just continue to use what I have for now?

 

[Tina & Sammy]

One more question, based on her spike and drop today would you says that this was from an effect from cycle on Saturday or degrading insulin. The insulin we are using is about 60 days old, and I was very tempted to get fresh insulin today.

Should I go ahead and get fresh insulin or just continue to use what I have for now?

 

[Wendy&Neko]

Are you keeping the Lantus in the fridge? If it's a vial, many people have kept it 5-6 months. Pens/cartridges are often used to the very end. Here is a post on Handling insulin.

 

[Tina & Sammy]

Are you keeping the Lantus in the fridge? If it's a vial, many people have kept it 5-6 months. Pens/cartridges are often used to the very end. Here is a post on Handling insulin.

It is always in the refrigerator. I will need to re-read the handling instructions, but I think I have been doing everything as I did when Sami was on insulin a few years ago.

I was just concerned because with every instance of high sugar over the last several years she regulates back to normal after a shot or two, but that has always been with FRESH insulin. The insulin that I am currently using is from November. The first few shots in November were actually with insulin that was a year old, but was clear and free from floaties. My friend who is a pharmacist said the insulin that was a year old should be fine as long as it was completely clear and free from floaties, but she was uncertain for the potency. She said that insulin is 99% affective up until the expression date, but that is only if it isn't open.

As soon as we got fresh insulin in November Sami was regulated after just two shots.