? Post hypo dosing, new to this

[juliepatchouli81]

hello, I am new to the forum and haven't yet set up my bio. I have been blindly shooting 1.5( on the short side yesterday) units of Lantus but got a monitor and was working up to using it. Mouser was diagnosed almost two months ago and has been all over the place with her numbers at the vet. After numerous visits we adjusted her insulin numerous times, numerous vet curves etc. my vet finally settled on 1.5 units and we have a fructosamine scheduled for tomorrow. It's been about 3 weeks on the 1.5 unit since our last vet visit.
Last night about 5 hrs after her shot I noticed her twitching in her back leg and whiskers and acting lethargic. I got out her monitor and got a 21! It's a relion confirm micro. Itwas my first time trying to test her so I tried again and got 22. The vet comparison on their meter a few weeks ago read 100 points higher, but the week before that my meter was on par with vet number, so I'm not sure what to think. I went into panic mode, gave her some gravy fancy feast and waited about 30 minutes. Tested again at 31, gave some more dry food and karo syrup. 30 minutes later she was up to 57, waited 20 up to 60. Gave rest of gravy wet food, tested in 30 and it was 121. I fell into a restless half sleep and just visually watched her, tested again 5 hrs later. She was up to 400 ( tested about an hr before normal feeding/shot time)
Now I am wondering if I should give her no insulin, reduced insulin, or what to do. The vet isn't open for another hour. Can someone please advise? I am thinking I should take today off and test throughout the day, although now her numbers are up she's a bit less cooperative and on to me.

 

[tiffmaxee]

She has definitely earned a reduction of .25. Anything under 50 for a new diabetic using a human meter calls for a reduction. I'm glad all is well. You did the right thing by feeding and testing until over 50 without food for 2 hours. There is a sticky on handling low numbers. Also please read the TR and SLGS stickies so we can help guide you. Those are the two protocols we follow here. We also like to see all the numbers you have and the best way to do that is to start a spreadsheet. There are instructions on how to do that but if you need help there are people that can help you. I'll be right back with more info.

 

[Doodles & Karen]

Good job testing and bringing Mouser up. You can see why it's so very important to home test. I would go ahead and skip this mornings shot to help drain the depot and since we don't have a lot of data I'd suggest reducing to 1unit tonight. It's easier to go back up in dose if needed once you start collecting more data. Typically we reduce and increase in .25 increments but again without a lot of data and that 21 bring the dose down to 1 unit and we can adjust from there. If you skip the shot this morning there is no need to test much. You always need to test before giving each shot and a few midcycle tests including at least 1 before you go to bed. I shot blind myself in the beginning and ended up in the ER with Doodles because of a hypo. The furctosamine tests cannot give you the data for adjusting the dose.

This is the best place for you and Mouser to be! There are 2 protocols we use either Start Low Go Slow SLGS or Tight Regulation Tight Regulation (TR) these stickies are found at the top of the forum. You'll need to read both and decide which protocol you'd like to follow. If Mouser is eating dry food than you have to follow SLGS. You'll need to set up a spreadsheet and put that into your signature Spreadsheet Instructions . These instructions are found in the "New to the group" sticky at the top of the Lantus & Levemir page.

In effort to not overwhelm you I'll leave it there for the moment. If you need help setting up the spreadsheet or have questions please ask. We've all been where you are. In reference to the difference in meter readings. The pet meter will always run higher and that varience narrows as their BG numbers are lower and over 300. Most of us use the human meter (I use the relion confirm). The most important thing to know is that anything under 50 requires intervention with karo/gravy etc. just like you did.

 

[tiffmaxee]

Karen was faster than I am at getting you the links.

 

[Doodles & Karen]

Karen was faster than I am at getting you the links.

Elise, I have the links saved We're off to the vet shortly so maybe you can stick around a bit this morning?

 

[Jill & Alex (GA)]

The vet isn't open for another hour. Can someone please advise? I am thinking I should take today off and test throughout the day, although now her numbers are up she's a bit less cooperative and on to me.

I think skipping a single shot may give you a chance to relax and breathe after your experience last night. My guess is it would be a welcome relief, but do call your vet when they open to let him know what happened. Obviously, the dose has to be reduced! You don't want to do that again!

Edited to add: You did a great job bringing the numbers up!

 

[juliepatchouli81]

Thank you all, I ended up giving her .5 unit and am staying home from work today to test her later, if she lets me. I have a call in to the vet, waiting to hear back. Now we are both napping on the couch after a rough night and will read all the info you kind folks have posted a bit later. I've been reading here and there for the last month but really need to commit to being her advocate.

 

[Jill & Alex (GA)]

I hope you're able to get some rest. No doubt it was a rough night.
Let us know if/how we can help.

 

[tiffmaxee]

I'd get a +1 and a +2 test in and post results in the subject box. I'll keep checking in as I'll be home until 9:30 and then need to go to the vet with Max. Did she eat? BTW onset usually is around +2 but every cat is different.

 

[Gill & George]

Hello and welcome.
You did the right thing last night, well done for catching it, must have been very scary. I'm glad that you had a monitor and decided to use it, you can now see how important it is to home test.

One other thing, if your vet has been basing the dosing on curves run by them at the surgery, that can be quite problematic as cats BG often rise by quite a margin through vet/car stress so basing the dose on potentially inflated numbers at the office can lead to kitty being on too much insulin.
I'm not sure how useful the fructosomine test will be to you, as already said, you cannot really use it for dosing decisions, the best thing to do to help with that is to continue using your monitor on a regular basis and start recording the numbers on a ss. We can certainly help you to understand the protocols and the nuances. From the way you handled the situation last night I would guess that you have thankfully been lurking and reading up on FD for the last couple of weeks. you probably averted a much more serious situation, well done

If Mouser is still eating dry food then of the the two methods we follow here, SLGS would be your only option, it is a prerequisite for TR that kitty be on an all wet LC diet. If you decide to transition to an all wet LC diet try to do it slowly, removing dry food can have a significant impact on BG and we wouldn't like to see you deal with numbers in the 20's anytime soon

Since you shot 0.5 u I agree with Elise, you should try and get a +1 and +2, even thought she is in the 400, it is not uknown for kitties to dive to the 40's from the 400's, and seeing as you have no data yet for her response to insulin it may be sensible to be cautious.

 

[juliepatchouli81]

I'd get a +1 and a +2 test in and post results in the subject box. I'll keep checking in as I'll be home until 9:30 and then need to go to the vet with Max. Did she eat? BTW onset usually is around +2 but every cat is different.

I just tested her again and she is at 389 about 5 hrs after .5 unit and food, I spoke with the vet and she said to give 1 unit now (1:30) and monitor every 2 hrs, no insulin tonight. So we'll see how it goes, looks like I'm taking another day off tomorrow to go a more formal curve at home, most likely our scheduled fructosamine will be canceled. I really appreciate all the help and advice!

 

[rhiannon and shadow (GA)]

great that the fructo test is cancelled.... that's money you don't need to spend....

you can do it yourself at home and it sounds like you already are.....
especially since some vets charge more than $30 /test and they keep the cat all day which stresses most of them out immensely.

Don't react to having that number up to 389 ( or higher)
we call that a bounce.... and it's normal....
She will come back down....

Keep asking questions....

 

[Gill & George]

I just tested her again and she is at 389 about 5 hrs after .5 unit and food, I spoke with the vet and she said to give 1 unit now (1:30) and monitor every 2 hrs, no insulin tonight. So we'll see how it goes, looks like I'm taking another day off tomorrow to go a more formal curve at home, most likely our scheduled fructosamine will be canceled. I really appreciate all the help and advice!

I would not recommend giving 1u 5 hours after you gave 0.5u, lantus needs to be dosed every 12 hours.

 

[juliepatchouli81]

... From the way you handled the situation last night I would guess that you have thankfully been lurking and reading up on FD for the last couple of weeks. you probably averted a much more serious situation, well done

If Mouser is still eating dry food then of the the two methods we follow here, SLGS would be your only option, it is a prerequisite for TR that kitty be on an all wet LC diet. If you decide to transition to an all wet LC diet try to do it slowly, removing dry food can have a significant impact on BG and we wouldn't like to see you deal with numbers in the 20's anytime soon

Since you shot 0.5 u I agree with Elise, you should try and get a +1 and +2, even thought she is in the 400, it is not uknown for kitties to dive to the 40's from the 400's, and seeing as you have no data yet for her response to insulin it may be sensible to be cautious.

Yes, long time lurker here. I got the monitor pretty early on in our journey but have issues with blood, the vet tried to show me how to use it and got a vein so blood everywhere and I almost passed out. I'm glad I had it and was able to get past my issues when it counted I n order to save my kitty.
Mouser has been on strictly wet FF classics (and some royal canin diabetic we have phased out) since diagnosis. Prior she was a free fed dry food eater. She loves the wet food!
I spoke with the vet and she said to give her 1 unit now, I tested her 5 hrs after .5 unit and food (would that be known as +5?) and she is still at 389. I'll be testing her every 2 hrs today and do a more formal curve tomorrow, if Mouser cooperates. She's been awesome about it but her little ear is sore after all this new poking, poor thing. Should I be alternating ears like I do with her shots or is it better to stick with one?

 

[juliepatchouli81]

I would not recommend giving 1u 5 hours after you gave 0.5u, lantus needs to be dosed every 12 hours.

Ugh, I knew I should have checked with you ladies and gents first. Too late now, it's done. Our vet is great, Mouser loves her but she's young and I feel like she might not be very knowledgeable with this. Hopefully home testing will help us get Mouser on the right track, I've been going broke and it's been incredibly stressful. Her numbers have been all over the place.

 

[rhiannon and shadow (GA)]

so you gave 1 unit five hours after the last shot??

If I am reading that right, you need to monitor....

and yes you can alternate ears....

do you know about the sweet spot?

 

[tiffmaxee]

You will need to watch her closely. You don't want to dose sooner than 12 hours unless all is stable and then you have a 15 minute per cycle or 30 minute per 24 hour span to play with. What's done is done so just monitor closely. I'd get a +1 and +2 to start and go from there. Posts all results in the subject box for help. Make sure you have plenty of test strips, mc and hc food and karo or honey should it be needed. You can steer her with these.

 

[Jill & Alex (GA)]

I would not recommend giving 1u 5 hours after you gave 0.5u, lantus needs to be dosed every 12 hours.

Lantus is *usually* dosed every 12 hours when following the protocols used on the FDMB. However, there are several exceptions and there are other/more frequent dosing methods used elsewhere as well.

I spoke with the vet and she said to give her 1 unit now, I tested her 5 hrs after .5 unit and food (would that be known as +5?) and she is still at 389.

Giving insulin 5 hours after the last shot isn't recommended because you could end up overlapping the nadir from the first shot with the onset of the second.

Should I be alternating ears like I do with her shots or is it better to stick with one?

I always alternated ears, but some use the same ear. Some also use Neosporin ointment on kitty's ears, but I usually didn't because my cats groom each other. I didn't want another kitty ingesting the medicated ointment.

I would not recommend giving 1u 5 hours after you gave 0.5u, lantus needs to be dosed every 12 hours.

Ugh, I knew I should have checked with you ladies and gents first. Too late now, it's done.

Given the fact that Mouser was in the 20s last cycle and the greatly reduced dose this morning, another shot @ +5 *probably* won't be too much of a problem, but yes, please monitor carefully and skip tonight's shot.

 

[Gill & George]

With Mouser going so low last night the high numbers you are seeing are likely a bounce this is when the liver panics due to the drop in BG the end result being it dumps glucose into the blood stream, causing the BG to soar. Bounces can last 6 cycles (3 days), but are shorter in some kitties, so you may see higher numbers for a few days,
Given that she went so low I think I would have been tempted to skip shooting at +5 and then shoot the 1u tonight if she is still high just to allow the depot to drain. However, as you have just shot, don't panic, just monitor, I would get a +1 and take it from there, but be prepared to monitor with lantus being a long acting insulin those two doses are going to interact with each other and you may see a significant drop when the 1u dose kicks in.

Have you got enough test strips(more than 20)? you might need them? now would be a good time to get some more if you haven't got many.

Have you had a look at setting your spread sheet up? here is the link with instructions, if you have problems let us know, there are folk here who can help you with it remotely. Try and get that sorted out it will make it much easier for us to help you if you do.

How much does mouser weigh? is it a good weight for him?

As you have been lurking and now you have conquered you fear, have you thought about the different dosing methods? which one would you like to follow?

 

[juliepatchouli81]

Have you got enough test strips(more than 20)?

Have you had a look at setting your spread sheet up? here is the link with instructions, if you have problems let us know, there are folk here who can help you with it remotely. Try and get that sorted out it will make it much easier for us to help you if you do.

How much does mouser weigh? is it a good weight for him?

As you have been lurking and now you have conquered you fear, have you thought about the different dosing methods? which one would you like to follow?

I have probably 35-40 strips and will pick up some more tomorrow.

I am on my iPad but will try to get a SS set up on Monday when I am back to work.

Mouser weighs approx. 10 lbs., the vet said its a good weight for her. She was a bit chunkier this winter. She has been ravenously hungry since we switched her off free fed dry, so she's been getting an extra tbsp. or so a few times a day (all wet diet now), in addition to her two full feelings at shot time. Also she lives up to her name and eats fresh meat a few times a week as well, sometimes daily.

I'm thinking the start low go slow is going to work best for us.

Just did a +1 test (actually hr 15 after 1 unit dosage) and she is at 351.

Thanks for all the help, I'm feeling a bit more hopeful about all this. She is a bit squirmy with the ear now, but I think she's giving in- freeze dried salmon after each test helps hopefully. She's been lounging in the large Chewy.com box I got yesterday and it's a lot easier to test her in the box. She knows what's happening now though and hops out before I can test her, any advice on how to get her to cooperate, positions to test her?

 

[julie & punkin (ga)]

This sounds like you've had an emotionally exhausting day and night!

Can I reiterate what was suggested above just to make sure you see it: Please skip the shot tonight and restart tomorrow morning.

When a lot of info is coming, it's really easy to miss advice, so I always encourage new members to go back and reread the posts when the crisis has passed.

The low numbers she got to likely triggered a bounce, (look in the second post in that thread for another explanation) which may keep her blood sugar high for as long as 3 days from now. So don't be overly-alarmed by this if it happens. It would be expected & normal. Her body is saving her from the hypo by releasing stored sugars and hormones to bring her blood sugar back up. It just takes a while for her body to then eliminate those once it's done the job of raising her blood sugar back up again.

You can go through the strips quickly sometimes. I always kept an unopened container of 50 in with my hypo supplies, just to make sure I never ran out in the middle of the night.

We rely heavily on the spreadsheet in order to help people. As soon as you can get it set up, that'll be really helpful.

In the meantime, keep reading and asking questions. This thread "Where Can I Find?" is often helpful for people to find info - you know you saw it somewhere, but now that you need it you're not sure where! From that post, here are a pile of tips for you:
Testing & Shooting Tips: here and here ; Dosing with Calipers; Preventing Overdoses

Glad to have you and Mouser here.

 

[Gill & George]

She is a bit squirmy with the ear now, but I think she's giving in- freeze dried salmon after each test helps hopefully. She's been lounging in the large Chewy.com box I got yesterday and it's a lot easier to test her in the box. She knows what's happening now though and hops out before I can test her, any advice on how to get her to cooperate, positions to test her?

I never used neosporin, but applying some gentle pressure with a cold wet cotton pad will help keep bruising down.
With George giving him a low carb treat every time we Poked really helped, I used freeze dried chicken and tuna, not sure what brands would be available to you, I am in Europe, but others use a small piece of boiled chicken breast as an alternative to dry, but if she is caving in to the freeze dried salmon, you're probably on a winner there

I never thought he would, but BFG, was soon trained and would hop on my lap for a poke and a treat when he heard me rattle the strips. I mostly tested George on my lap on the sofa, just because it was more comfortable for me, but sometimes if he was sleeping I would just grab a poke while he was in bed. Many folk here though find that setting up a testing station works best for them, always testing in the same place.
I just went with the flow as far as location was concerned, guess it's a case of seeing what works best for you. George is fairly easy going so testing wherever I grabbed him wasn't a problem, but it probably depends on the cat.

 

[Tricia Cinco(GA) & Harvey]

Hi and welcome to Lantus & Levemir Land, the nicest place you never wanted to be.

You certainly had a baptism with fire last night! I must say you handed it amazingly well. Congratulations on conquering your fear of blood in order to save Mouser's life, because that is exactly what you did.

My Cinco loved freeze dried meat (he preferred salmon), so that was his testing treat. Harvey doesn't like any treats that are diabetic friendly, so I reward him with a tsp or so of lc food and lots of praise and loving. It works well for us. With both cats, I always tested wherever they were when test time came around. If you were to read some of my earlier condos, you'd see I got into some interesting positions trying to test Cinco (hanging upside down off the edge of a sofa to reach him, under an end table ). Hopefully you and Mouser can work out something a little less inconvenient.

The link that Julie gave to to Testing Tips is a great one. My favorite tip is to warm the ear first. I use a small sock with uncooked rice in it (about the size of a ping pong ball). Heat it in the microwave for 20-30 seconds (depending on your microwave), so it is warm but not too hot (remember, kitty's ears are sensitive). Hold it on the ear for a few seconds to warm the ear. I then put it behind the ear to keep it stable as I poke. After the last test of the day, I rub some Neosporin with pain relief on the ears. You can wipe it off in the morning and you'll find it helps the blood bead better. Harvey's ears looked like raw meat the first couple of weeks, but using the Neosporin really helped them heal and now you'd never know he gets poked many times a day (I'm a testaholic). Be sure you always give Mouser a treat when you try to test, even if you are unsuccessful in getting blood. You want him to associate having his ears messed with with the treat.

You're probably pretty overwhelmed already, so I'll leave you with this piece of advice: ask questions. The only dumb question is the one you don't ask. There are a lot of very nice, caring people here, who know how you feel. We were all new once, too. We love to help others because someone (lots of someones) helped us.

 

[Sienne and Gabby (GA)]

One thing that will help with testing is treats! Giving a reward after you test, even if the test isn't successful, is a great way to help Mouser make the association between testing and treats. There are any number of low carb treats you can use -- freeze dried chicken is a big favorite, Wellness makes jerky treats, Orijen has a moist lamb treat that's low in carbs, and you can always use cooked chicken or any other protein. Some kitties go crazy for baby food (Gerber or Beechnut Stage 2 -- it's protein and broth).

Some cats have other preferences. If brushing is a favorite, then brush your kitty after testing. Whatever your kitty considers a reward works.

 

[Tricia Cinco(GA) & Harvey]

BTW, now that you've gotten lots of responses, can you please remove the 911 from your subject line? It gives us heart palpitations when we see that! Thanks.

 

[juliepatchouli81]

BTW, now that you've gotten lots of responses, can you please remove the 911 from your subject line? It gives us heart palpitations when we see that! Thanks.

Yes, sorry! I've changed it to a ?, as I have some.
I've been testing her to afternoon, please let me know if I should post this question elsewhere. At +1 after 1 unit of Lantus she was 351, +2 she was 357, and at +4 she is 381. Is this normal that she is going up again? I haven't fed her since about 7 am.

 

[Kathy and TiTi]

Yes, long time lurker here. I got the monitor pretty early on in our journey but have issues with blood, the vet tried to show me how to use it and got a vein so blood everywhere and I almost passed out. I'm glad I had it and was able to get past my issues when it counted I n order to save my kitty.
Mouser has been on strictly wet FF classics (and some royal canin diabetic we have phased out) since diagnosis. Prior she was a free fed dry food eater. She loves the wet food!
I spoke with the vet and she said to give her 1 unit now, I tested her 5 hrs after .5 unit and food (would that be known as +5?) and she is still at 389. I'll be testing her every 2 hrs today and do a more formal curve tomorrow, if Mouser cooperates. She's been awesome about it but her little ear is sore after all this new poking, poor thing. Should I be alternating ears like I do with her shots or is it better to stick with one?

I see that you very much love your Patchouli, have courage, smarts, and determination. You will do well.

 

[Tricia Cinco(GA) & Harvey]

At +1 after 1 unit of Lantus she was 351, +2 she was 357, and at +4 she is 381. Is this normal that she is going up again?

We expected to see a bounce after that low last night. That could be what is happening. The shot you gave her this morning should be wearing off, and the shot at +5 should be in full swing soon, but bouncing may trump both of those. In other words, it's nothing to worry about.

I haven't fed her since about 7 am.

Most of us find that it's better to give several meals throughout the day, as opposed to two large ones, 12 hours apart. It's easier on the pancreas. The majority of the food should be given in the first half of the cycle, so as not to dilute the effects of the insulin as it is waning. If you work a full day, you might want to consider getting an autofeeder that you can set to turn every hour or two with a small bit of food in it. This is also handy for when you have to go to work and you're concerned that he might go lower while you're gone.

 

[juliepatchouli81]

We expected to see a bounce after that low last night. That could be what is happening. The shot you gave her this morning should be wearing off, and the shot at +5 should be in full swing soon, but bouncing may trump both of those. In other words, it's nothing to worry about.

Thank you, I needed that. Now to take a deep breath, pour a beer, and try not to worry too much. Mouser is really not digging the ear pokes right now but I'm doing my best. I'm sure we are both a bit stressed and tired now. The good thing is otherwise she seems pretty happy laying in the sun.

 

[AZJenks]

pour a beer

You definitely earned it!