Did I increase the dose to quick?

[MissMolly]

Molly is by no means close to remission or regulation, some of which is my fault as I tried doing a sliding scale working with someone. We even tried shots at +10 which didn't seem to make much of a difference only to my health as I was getting no sleep *sign*

But anyways that's not why I'm posting. So not sure how much her spreadsheet will help with earlier days. What's done is done and there's no going back. Guess what I'm saying is I don't need to be told I messed up as I'm well aware of that myself. Trust me I've cried plenty and even felt like a awful pet mom but I need to put that behind me for what's best for her.

So moving forward starting with April 25/2017 I decided to go back to 1.50 units every 12 hrs. Her numbers still weren't great but she was maintaining the same numbers pretty much all the time. So I decided she was probably due a increase and upped her to 1.75 every 12 hrs. Still no great improvement but around the same. But now that I've upped her to 2 units every 12 hrs I found that she's having way higher numbers twice in the morning. I can't seeing it being a rebound as we've never hit any numbers I should be concerned about. I was thinking food at first but looking back over her log book I see she had the same food a bit ago with no impact on her numbers. The only other change was I gave her 1.75 units for a couple nights and she stayed lower the next morning but yet when I gave her the 2 units she gave me higher numbers.

Guess what I'm asking is do you think I should go back to the 1.75 units every 12 hrs and let her stay there for a couple weeks to see what happens? Did I up her to quick perhaps?

 

[tiffmaxee]

I don't have enough info. I think it's possible she is dropping lower at night. You need the nadir to determine dosing. I'd get a before bed test and if it's before *5-7 set an alarm for one more test around +5-7 each night. I'd vary the time as we don't know when she will nadir. Don't beat yourself up for the past.

 

[MissMolly]

So maybe it would be best to go with the 1.75 units tonight if she's hanging around the 14 to 15's. I can work that with the testing. I was wondering if perhaps that's what it was. Will update tomorrow.

Thank you

 

[babyBoo]

I find trying to get a test at +2 or 3 to be very helpful at catching low dips. It kind of determines how important I need to get a mid cycle test or if I am not going to be around (such as going to work) I take a cautious approach and give a MC or HC meal rather than an LC.

If it were me I would hold this dose if I could get more tests done. For example I would want to get at least one test done each cycle that was +3,4, or 5 unless a previous +2 test indicated that the cycle was unlikely to be active and heading low.

 

[MissMolly]

I find trying to get a test at +2 or 3 to be very helpful at catching low dips. It kind of determines how important I need to get a mid cycle test or if I am not going to be around (such as going to work) I take a cautious approach and give a MC or HC meal rather than an LC.

If it were me I would hold this dose if I could get more tests done. For example I would want to get at least one test done each cycle that was +3,4, or 5 unless a previous +2 test indicated that the cycle was unlikely to be active and heading low.

I find that no matter when I test her she normally stays around the same number. With her lower numbers mostly hitting at the +12 mark. The first of April she hit on that awesome number but terrified me to be honest. Seems it all went downhill from that But I haven't really tested her much overnight so I guess I'll have to start. But I guess you're correct for me to hold the this dose so I can see if that's the problem or it's something else entirely different.

Then I start wondering if perhaps I should switch her to Levemir.

 

[babyBoo]

That 5.5 isn't actually horrible really. Your going to have low numbers late cycle like that once in awhile. I think the bg probably dipped a little low on the comfort level on the evenings of 6th and 8th this month, but maybe only a blue number and your cat helpfully bounced the numbers up a bit. If you can afford the time and cost of getting an extra 1 or 2 early to mid cycle tests always. This dose might be OK from the data I see.

 

[MissMolly]

No the 5.5 was probably a good number but it was so new to me that I got scared that I was giving her way to much, when in hindsight perhaps if I stuck with that dose right then and there we might have been on to something. I could be totally wrong on that, and I guess we'll never know now as I changed the way I was dosing her pretty much right after. It still makes me sad to know we might have had a good thing starting and I did something to mess it up. But as I said there's no going back with it now.

Maybe I'll convince Hubby we need to do a overnight curve on her

 

[babyBoo]

I think your on the right track now, I don't think you've messed anything up. How's your cat doing? I'd imagine she seems a lot healthier even in those yellow numbers than before insulin treatments, right? I know my cat was heading towards a certain death and being constantly uncomfortable, to looking very healthy and happy even in the yellow numbers.

 

[Gill & George]

Hi there Miss Molly and Momma Bean,
Welcome to LL.

Firstly, don't stress about what went on in the past, been there bought the T-shirt, what's important is where you go from here.

If it were me, and if I were able to get at least one, but preferably two tests a cycle, I would hold on to this dose. Although I agree with Elise that there is limited data to say for sure what's been going on, nothing screams to me that she is going to low or that the dose was taken up too fast. That said, when I see pm cycles devoid of test, it does always make me nervous, if you can try to always get a before bed test that would be great, for me that was a +4/+5, so in the evenings I would usually always get a +1/+2 and a +4/+5 as a minimum, often I tested more because I couldn't help myself, I'm a self confessed testaholic, but the truth is I didn't need to

On another, related, subject, how long you hold on to a dose depends on the protocol you decide to follow, so on TR you'd reasses every 6 cycles whereas with SLGS you would reasses every 7days. Ideally you would need to get a couple more tests in a day to safely follow TR.

As for that 5.5, I think what's happened since then, is the reduction was premature, that's seen molly in slightly higher numbers for a while, in other words the reduction failed, and perhaps a little glucose toxicity has set in, that can mean that you need to go up a little higher than that dose to begin to see movement again.

 

[Tanya and Ducia]

she's having way higher numbers twice in the morning. I can't seeing it being a rebound as we've never hit any numbers I should be concerned about.

Rather you are not aware of her hitting lower number at night - many kitties naturally go lower at night. Those Pink AMs do look like bounce to me. I agree with the above - more tests in the PM cycle are needed at least until you feel your SS with data. The dose is based on the lowest point - chances it is at night but you do not know it for sure.

 

[MissMolly]

Hi there Miss Molly and Momma Bean,
Welcome to LL.

If it were me, and if I were able to get at least one, but preferably two tests a cycle, I would hold on to this dose. Although I agree with Elise that there is limited data to say for sure what's been going on, nothing screams to me that she is going to low or that the dose was taken up too fast. That said, when I see pm cycles devoid of test, it does always make me nervous, if you can try to always get a before bed test that would be great, for me that was a +4/+5, so in the evenings I would usually always get a +1/+2 and a +4/+5 as a minimum, often I tested more because I couldn't help myself, I'm a self confessed testaholic, but the truth is I didn't need to

On another, related, subject, how long you hold on to a dose depends on the protocol you decide to follow, so on TR you'd reasses every 6 cycles whereas with SLGS you would reasses every 7days. Ideally you would need to get a couple more tests in a day to safely follow TR.

We dose at 8 am and 8 pm so early wouldn't be a problem. Even the later times is not such a big deal. I just tested her at +7 and she's come down quite a bit since this morning so it might be interesting to see where she sits at +12 or perhaps I should test her before that?

I was doing TR on the sliding scale but I kinda think SLGS maybe a better option for us. We're kinda doing a bit of both I guess as she only gets a low carb diet. No high carb foods or treats, no kibble and just protein treats.

I haven't quite figured out how to do the testing on my own yet so I have to rely on Hubby's help. Will start to get to work on that tho right away because if I can do it myself I can for sure do it more often.

And Thank you

 

[MissMolly]

Rather you are not aware of her hitting lower number at night - many kitties naturally go lower at night. Those Pink AMs do look like bounce to me. I agree with the above - more tests in the PM cycle are needed at least until you feel your SS with data. The dose is based on the lowest point - chances it is at night but you do not know it for sure.

I'll do some more testing tonight with that dose to see if that's the issue.

 

[Tanya and Ducia]

I'll do some more testing tonight with that dose to see if that's the issue.

If she does go lower at night and you caught her at it you will feel more confident about the dosage and more data in the SS will enable more people to offer their view. Win-win for Molly.

 

[MissMolly]

If she does go lower at night and you caught her at it you will feel more confident about the dosage and more data in the SS will enable more people to offer their view. Win-win for Molly.

So very true, I love my sweet girl more than I can say.

 

[Tricia Cinco(GA) & Harvey]

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

First, congratulations on home testing! You are doing a great job, and it really is the best way to keep Molly safe. You've been given some great pointers about when to test, so I thought I would just share some about how to test: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/.

I, too, had trouble testing by myself at first (Cinco), and then with my Harvey, who was a challenge all his own! But soon both the cat and I got used to it and I could test Cinco (and later Harvey) anytime, anywhere, without a problem. You will, too!

I'd also like to share a post we put together to help new members get comfortable here: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

There's lots of great info on this site, and some of it can be overwhelming, especially when you're already stressed because your baby is sick. Just try to read as much as you can, and ask lots of questions. We were all new once, too, and we love to help!

 

[MissMolly]

I think your on the right track now, I don't think you've messed anything up. How's your cat doing? I'd imagine she seems a lot healthier even in those yellow numbers than before insulin treatments, right? I know my cat was heading towards a certain death and being constantly uncomfortable, to looking very healthy and happy even in the yellow numbers.

Sorry I totally missed this post. Molly seems quite happy when she sits in the yellow numbers to be honest. She tends to want to play more, almost kitten like again. She's more tired when she's in the pinks and believe it or not when she's dips lower. Weird I know. The only thing I truly noticed with Molly before she got sick was she was peeing and drinking more. This went on for about 3 days before I took her in. She was in the 20's at the vet on that occasion. If she was diabetic prior to that I'm not sure as she didn't give us any signs that she might be sick. She's the only cat we have so it's easy to see what she's eating, drinking and her little box habits so I think we would have picked up on something.

 

[MissMolly]

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

First, congratulations on home testing! You are doing a great job, and it really is the best way to keep Molly safe. You've been given some great pointers about when to test, so I thought I would just share some about how to test: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/.

I'd also like to share a post we put together to help new members get comfortable here: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

Thank you so much. I'll have a look at those posts. I did manage once to test her on my own by straddling her from behind. Not so sure she liked it but it worked at the time. Haven't been able to get her myself since.

 

[MissMolly]

So it would seem she's not running lower overnight. Well at least not last night anyways. Looking back at the last few days it appears when I give her the 2 unit evening shot she's way higher the following morning. Whereas if I lower her dose she seems to stay on par in the morning. Any suggestions? Should I go back and hold the 1.75 unit dose for another while, hold the 2 unit in the morning and lower it in the evening? So confusing on what to do. The vets here are quite happy if she stays up in the higher numbers, I'm not so keen on that as I don't want for her to damage her kidneys.

 

[Gill & George]

Good job getting the pm tests.
I would hold the 2u, we try to look at the overall picture rather than at an individual test result, and the dosing is based on how low the dose is getting Molly rather than the PS, generally what we are looking at preshot is to see whether it is safe to shoot, ie is BG high enough. Remember also that there can be up to a 20% meter variance so to me the 311 is not much different to the 274 that you got after you shot 1.75u.
I guess the main difference with how we do it here on FDMB to how you'd been dosing, is that we don't use a sliding scale for lantus. The method we use is quite successful, particularly TR at getting kitties regulated, and with a fair wind, OTJ. But it requires a little patience, consistency an a little faith, take a look at Georges ss, he went otj last year. Start at 2015, then on to 2016, the progress at the time seemed painfully slow to me, I kicked myself for not starting insulin sooner, my vet wanted to try tablets first (they don't work in cats, I later found out), but I followed TR, taking my dosecreases as we needed, every 6 cycles until we broke through.

Lantus is a depot insulin, every time you change a dose the depot has to adjust.

If you were to take the dose up and down, the depot would also be increasing and decreasing, and as if fills or empties that would also affect numbers, this can lead to 'wonky' numbers and cycles, making it difficult to make dosing decisions.
The dosing methods we use here on the site rely on consistent dosing, and then evaluating the cycles, after a minimum of 6 cycles (usually) we would look at the numbers and take the dose up if necessary (Of course if kitty earns a reduction by dropping below 50 on a human meter, we would take the dose down by 0.25u)

Personally I liked TR because it had the backing of a vet study and it allowed me to make changes to the dose more quickly than SLGS, which helps get kitty into good numbers more quickly. I know you said you thought slgs, but if the higher numbers make you anxious, TR will certainly get Molly where you would like to see her more quickly, on SLGS you would hold for 7 days and then run a curve.
Generally you have been getting enough tests (as long as you don't ignore the pm cycles) to do TR. At this stage if it's possible I'd probably look to get a test in the first half of the cycle, vary when you do it. Spotting a drop in the first half of the cycle can give you the heads up for an active cycle.

 

[Gill & George]

The vets here are quite happy if she stays up in the higher numbers, I'm not so keen on that as I don't want for her to damage her kidneys.

FD kitties can get quite dehydrated because they pee a lot, one way you can help protect the kidneys, while she is at this phase is by adding a little extra water to her food, that will help her stay hydrated.
When was Molly diagnosed? was it Feb2017?

 

[MissMolly]

Good job getting the pm tests.
I would hold the 2u, we try to look at the overall picture rather than at an individual test result, and the dosing is based on how low the dose is getting Molly rather than the PS, generally what we are looking at preshot is to see whether it is safe to shoot, ie is BG high enough. Remember also that there can be up to a 20% meter variance so to me the 311 is not much different to the 274 that you got after you shot 1.75u.
I guess the main difference with how we do it here on FDMB to how you'd been dosing, is that we don't use a sliding scale for lantus. The method we use is quite successful, particularly TR at getting kitties regulated, and with a fair wind, OTJ. But it requires a little patience, consistency an a little faith, take a look at Georges ss, he went otj last year. Start at 2015, then on to 2016, the progress at the time seemed painfully slow to me, I kicked myself for not starting insulin sooner, my vet wanted to try tablets first (they don't work in cats, I later found out), but I followed TR, taking my dosecreases as we needed, every 6 cycles until we broke through.

When you look at the numbers using the States measurements it really doesn't look like a big difference. Kinda seems a bigger difference when using the Canada measurement.

Congrats on getting George otj Going to look at your sheets.

 

[MissMolly]

FD kitties can get quite dehydrated because they pee a lot, one way you can help protect the kidneys, while she is at this phase is by adding a little extra water to her food, that will help her stay hydrated.
When was Molly diagnosed? was it Feb2017?

She's actually not peeing any big amount. She was in the beginning upwards to 6 times a day but that's settled down now to about 3 - 4 ranging in size from big to small. I log all her pees, food and water intake. But I will do that anyways with the food.

She was actually diagnosed back in Dec 2016. We started on Caninsulin first but that vet seemed quite content when Molly had a fructosamine score of over 350. I wasn't. So we went to another clinic in March and that's when we started on Lantus. Vet passed us off to a vet tech (no doubt she knew what she was talking about somewhat) that only dealt with Lantus but we just couldn't agree on how much food Molly should have. Her idea was 3 ounces 2 times a day at shot time. Um that's just slightly over a tin of fancy feast a day. So neither of us would budge much on the food so I told her it was pointless for us to continue working together as I would only be lying to her if I told her Molly was only eating that little a amount. I also found to when I would just feed her twice daily she would gorge on her food and of course throw up seconds later. So off we went to another vet. This one told me she had to use a cheat sheet as she wasn't quite familiar with animal diabetes. OK then lolol

Then I tried the sliding scale working with someone. I couldn't keep up with the 10 hr dosing and to be honest I couldn't see any true benefit in it. I'm searched the web and I can't find any documents on a sliding scale working on a cat using lantus.

So here we are.....no wiser, maybe a few more grey hairs.

 

[Gill & George]

[/QUOTE]
I'm so used to looking at the US (spain) measurements, the

Her idea was 3 ounces 2 times a day at shot time.

We've found that small regular meals works best with lantus.
When we first started, George had 4meals a day amps/pmps and +5 pm and am. (total of about 10 ounces a day)
After a bit, when we started seeing more movement on his numbers I changed so that he still got the same quantity in 24hrs,
he would get 3 ounces at amps and pmps, but then he would get snacks at +2 +4 +6, (I use an autofeeder so I'm not at his constant beck and call)
When he got regulated and went to micro dose, I changed that to amps/pmps 3ounces and snacks +3 +6+9, and that's what he is still on.
How much food/calories the individual cat needs is quite a topic, it's very difficult to judge, there are many threads debating the subject, it is definitely a case of ECID. If Molly is at a good weight then, use the scales if she is maintaining with what you are feeding her great, but if she is gaining, you might want to reduce her portions. George is fluffy and needs to loose some of it, I have not been able to get him to loose weight, since going OTJ I have halved the amount he gets for his snacks, and he remains the same. He wasn't gaining on more food, but he is also not loosing on less, he doesn't get takeout anywhere, no mices no friendly neighbours, it is what it is with him. So if Molly is a good weight, monitor her and keep her there, as from experience, it's difficult to get them to loose.

We started on Caninsulin first but that vet seemed quite content when Molly had a fructosamine score of over 350. I wasn't

I wouldn't have been happy with that either, lower range for a diabetic, but we want more for our furbies.
Georges fructosamine was 260 when he was tested last summer, and 330 in begining of april last year(his lab results are on the ss)
As far as I understand the fructosamine is not a good way of judging regulation in a diabetic cat.

I also found to when I would just feed her twice daily she would gorge on her food and of course throw up seconds later.

When he was on insulin, I tried not to routinely feed in the latter half of the cycle, as it has been found that feeding then can put the brakes on the insulin and lead to higher PS, some folk whose kitties have issues with acid tummy, or scarfing and barfing if they go too long without eating will give a snack of boiled chicken breast (for example) as that has been found to not impact BG.

 

[MissMolly]

Molly lost 2 lbs back in Dec. Wasn't bad for her to drop those as she was 16 lbs. Since then she's been sitting steady at 14. I'm sure she could afford to lose a few lbs but as you said that's kinda easier said then done. She's has access to food at all times. She has since the day we got her. Before she got sick we did allow her to have a bowl of kibble down. She maybe ate a few pieces overnight, rarely any in the day. We also treated her to temptations and purina luvs. Since she got sick we've removed all of that from her diet. I find when she's a little lower she tends to eat way less unlike when she's spitting out those pink numbers she'll devour whatever you put in front of her.

But whatever went on with her last night with the highs you would never say it by the way she's acting this morning. I have a kitten in the house Hopefully the playing will help her shed a few lbs.

 

[Gill & George]

George weighs about 16lb now, he too lost a couple at diagnosis, and we'd had him on 67g of Hills metabolic for years, he never lost any weight on that, don't even get me started on Rx foods.

She's has access to food at all times.

Hmmm that can work fine, we have folk that free feed, I couldn't can't do that with George, he'd probably eat it all in one sitting.
One thing that we do suggest is that you take up any food 2hours before shot time, it's so that we know that the number at PS is not food influenced.
And on that note, do you think that sometimes she might get a snack of something in the mornings just before her breakfast? that might influence the BG more than you might think.

I find when she's a little lower she tends to eat way less unlike when she's spitting out those pink numbers she'll devour whatever you put in front of her.

LOL could be describing what I noticed with George. You may also find that when Molly starts to get into lower numbers or drops suddenly that she will be hungry too.
George would come and find me and beg for food when he dropped into the 40's or lower or if he had a sharp drop, like if he was clearing a bounce and dropped 100 - 200 pts in an hour. ECID they don't all do this, but it was sure handy that he did.
Overall though his appetite did decrease/ as did other symptoms like excessive peeing, even before I started to see him in blues and greens.

We also treated her to temptations and purina luvs.

Kitty Crack!!! Yes we stopped those too, they can be handy to have if she is fussy about food as you can use them in the event that her bg is dropping and she won't eat anything else, that said, I prefer to use wet HC as that is in and out of the system quicker, and generally never had a problem with George being fussy about what he was eating. I swapped him onto freeze dried treats of chicken breast and tuna, he loves those just as much, and a healthier option. I was a bit mean with the treats though, he would only get one small piece for an ear poke (always watching the calories)

 

[MissMolly]

Hmmm that can work fine, we have folk that free feed, I couldn't can't do that with George, he'd probably eat it all in one sitting.
One thing that we do suggest is that you take up any food 2hours before shot time, it's so that we know that the number at PS is not food influenced.
And on that note, do you think that sometimes she might get a snack of something in the mornings just before her breakfast? that might influence the BG more than you might think.

It is possible that she is eating a little. This morning I don't think she did as I tend to wake frequently throughout the night since she got sick and she was up in the window on her perch and then came down and got some cuddles from me. I have removed her food 2 hrs prior and she's gone 4 hrs with no food but I never really see that it has much impact on her numbers. Might be because we aren't really close to regulation. But I'll try to note that in her log from now on.