Mid-Day Dosing Question

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Janel and Alabaster

Janel and Alabaster

Member Since 2017
Hello All,
My kitties BG this morning was 190 and he has been usually much higher. We currently give him 2 units. This morning we gave him only 1 unit. He gets his insulin twice a day. My question is, if we check him 6 hours from the morning dose, and he's reaching towards the 400's, should we give him another unit to keep him down before checking him for his PM dose? I guess I'm just wondering if anyone gives mid-day dosing, or if it's best no matter what the mid-day BG is, to just stick to every 12 hour dosing.
 
Best to stick with every 12 hours on a consistent basis. Have a look at the sticky notes to understand that Lantus is dosed on a 12 hour cycle. After several days with a consistent dose and a few mid-cycle tests, you will have some data to suggest if the dose should change. The goal at this point should be stability and collection of data to determine the anatomy of an active cycle for Ally (when it starts, how low it goes, how long it lasts). I think frequent changes in dose are keeping the depot from stablizing - this will continue to appear as a moving target without that stability.

Can you hold the dose at consistent shot times 12 hours apart for 3 days and collect a few mid cycle tests at AM and/or PM?

I think that will help!
 
Okay, thank you both. I was worried to give him a full 2 units with his sugar being at 190, especially if we're not home during the day. I'm going to steer clear of 3 units for sure. We definitely will be doing .25/.50 doses. We're just waiting for our syringes to be delivered. Hopefully they come soon! Should come by Monday :) We will stick to our doses at 6:30am and 6:30pm. Thanks for the great advice.
 
Janel and Alabaster said:
Hello All,
My kitties BG this morning was 190 and he has been usually much higher. We currently give him 2 units. This morning we gave him only 1 unit. He gets his insulin twice a day. My question is, if we check him 6 hours from the morning dose, and he's reaching towards the 400's, should we give him another unit to keep him down before checking him for his PM dose? I guess I'm just wondering if anyone gives mid-day dosing, or if it's best no matter what the mid-day BG is, to just stick to every 12 hour dosing.
Click to expand...

Hi, Janel! No, do not give Alabaster a mid-day dose. Lantus works best on the every 12 hour schedule. Someone that's able to help with dosing advise much better than I will probably jump in. But I'll just add that it's recommended to adjust doses up and down by .25 increments rather than whole units. That way you won't miss a good dose for him. And those dosing changes are made from how low his BG goes (his nadir) which if he is like Callie is very difficult to find most days.

It's all really complicated at first, but hang in there and keep asking questions.

Oops! Cross-posting. Glad your other syringes are on the way. They help. Usually with a newly diagnosed kitty, if the BG is below 200 they say don't inject since you don't have a lot of info on how he will react. I've given half my usual dose though when that's happened. Later your low shoot number gets lower.
 
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Thank you so much! We'll make sure to test him tomorrow and Sunday mid-day to see where he's at. And definitely wont be giving any other shots except the 12 hour shots. I seriously can't wait to get our syringes we ordered that have that option. I think it will make a good improvement. Thank you for chiming in :)
 
Janel and Alabaster said:
Thank you so much! We'll make sure to test him tomorrow and Sunday mid-day to see where he's at. And definitely wont be giving any other shots except the 12 hour shots. I seriously can't wait to get our syringes we ordered that have that option. I think it will make a good improvement. Thank you for chiming in :)
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The sticky notes on dosing really help. I printed copies for myself, and I was honestly carrying them around the house with me at testing time. And talking to myself...It does get easier. :bighug:
 
Oh gosh thank you so much. It has been overwhelming but this website has helped IMMENSELY. I'll have to print them off. I read them, but I think I really need to take another look.
 
One last question: By looking at this picture of half unit syringe dosings.. can someone explain the markings and how I will know what .25/.50/1.5 units will look like?
upload_2017-7-21_11-5-9.png
 
Janel and Alabaster said:
One last question: By looking at this picture of half unit syringe dosings.. can someone explain the markings and how I will know what .25/.50/1.5 units will look like?
Click to expand...

Here's where it gets a little tricky but don't worry you'll get it.

In the half unit markings ( one on the left) the marks on the left side are half units, the ones on the right side are whole units so first line on the left is 0.5u, second line 1.5 u and so on, on the right side first line is 1 unit, second line two units
 
From the same sticky - just a bit further down is the picture included below. It shows a syringe with 1/2 unit markings and a dose drawn between the .5 and 1 line to indicate .75.

You will be able to use the 1/2 unit markings for a 1/2 unit dose, but will have to go between for quarters such as .75 or 1.25.

5e86c3d4.jpg


For consistency, some use calibers. Another tick is to utilize colored water in 1 "reference" syringe.
 
So the scale on the left--you see the 5, 10, etc. Then right above those numbers on the right are four little marks. Those are the whole units--1, 2, 3, 4.

To the left of those and in between those marks are five even smaller lines. Those are the half unit lines. So if you're counting all the lines together from one side to the next, 1.5U would be a total of three lines down--left .5, right 1, and next left 1.5U. Does that make sense? I am terrible at explaining things like this. Hope someone else gets on with a better explanation. The .25 are harder to gauge. You kind of have to eye-ball it or use calipers.
 
Thank you All!!! ... Oh boy. Those are great explanations, but I'm a little confused. :confused: I'm going to print this thread off and write the information on the pictures. So for the picture above.. would 2.5 be the third line from the bottom on the top? Would this be 2.5 as an example?
upload_2017-7-21_11-34-29.png
 
What I ended up doing is I marked on a piece of paper the zero then one unit and 0.5 units (I used a calpiher but you can use the serynge marks) and did makings in between them (in this cases consistency is more important than extreme accuracy) I placed the paper on the fridge so that it would be vertical that way is easier to compare with the syringe every time
 
Carol in Chicago said:
Best to stick with every 12 hours on a consistent basis. Have a look at the sticky notes to understand that Lantus is dosed on a 12 hour cycle. After several days with a consistent dose and a few mid-cycle tests, you will have some data to suggest if the dose should change. The goal at this point should be stability and collection of data to determine the anatomy of an active cycle for Ally (when it starts, how low it goes, how long it lasts). I think frequent changes in dose are keeping the depot from stablizing - this will continue to appear as a moving target without that stability.

Can you hold the dose at consistent shot times 12 hours apart for 3 days and collect a few mid cycle tests at AM and/or PM?

I think that will help!
Click to expand...
I will do the mid-cycle tests tomorrow and Sunday. What will the mid-cycle result be telling me? Is this result his lowest he is going for the day?
 
Janel and Alabaster said:
I will do the mid-cycle tests tomorrow and Sunday. What will the mid-cycle result be telling me? Is this result his lowest he is going for the day?
Click to expand...
Roughly, we're not sure when his actual nadir is right now. His depot still needs to stabilize with consistent dosings. It can move around too but the mid cycle tests between +5 and +7 can help you narrow down where the insulin is peaking action and his lowest number (nadir) is at, for that cycle. You'll see a lot of us do like "scatter" tests, so different times on different days :). Obviously, if you have a full time job and aren't home mid-cycle, more scatter tests are done on your days off ;).
 
A picture might help here:

curve.gif


The +5 to +7 tests will help to identify when and how low peak action / lowest number is. I my case, my cat Rose will routinely have a peak action and lowest number at +5 - +6 during the day (but has been later at night). When possible, I test at +5 and +6 trying to catch this low point during the day, but do not yet have a good understanding of overnight activity.

The overall anatomy of the curve is good to know for your cat (how steep, how long, how low). Once you start to see better numbers, this data will be helpful to fine tune with dose and food. Again - consistency is the key to get to a point where this data will make sense. Right now, focus on consistent dose at a consistent time and determining the low point. There is a great deal of focus on the low point for safety reasons.

Hope this helps. Please keep asking questions!
 
Thank you both so very much! This is all very helpful. :bighug: I just want him feeling better, and for his back legs to be working normally again. :(That's been the most heartbreaking thing to see. Hopefully with all this good testing and consistency he'll be back to being a happier cat sooner than later.
 
Since you don't have much data right now is hard to say when his nadir is every cat is different, some have the nadir between +5 and +7 but some have it latter closer to the next shoot.

Those tests you are going to be doing during the weekend or at night before you go to bed during the day or at any time you get the chance to do it will help determine how your kitty reacts to the insulin
 
Janel and Alabaster said:
Thank you both so very much! This is all very helpful. :bighug: I just want him feeling better, and for his back legs to be working normally again. :(That's been the most heartbreaking thing to see. Hopefully with all this good testing and consistency he'll be back to being a happier cat sooner than later.
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I'm sure he will be better it just requires patience
 
Veronica & Babu-chiri said:
Since you don't have much data right now is hard to say when his nadir is every cat is different, some have the nadir between +5 and +7 but some have it latter closer to the next shoot.

Those tests you are going to be doing during the weekend or at night before you go to bed during the day or at any time you get the chance to do it will help determine how your kitty reacts to the insulin[/QUOTE
And some, like my Callie, don't show a lot of consistency. LOL I'm convinced she is trying to drive me crazy. ;):D:bighug:
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Okay, last question I swear lol. ;)
My husband was able to go home for lunch and check Ally's BG. He said it was at 151. If he is still at this number I would want to adjust his insulin accordingly correct? I saw a sticky for the Lantus board that talked about how much roughly to give via the numbers (nothing or 1 unit under 180). I'm worried if I only give him 1 unit that his dose isn't consistent, but I feel like 2 units which is suppose to get is too much. Thanks everyone
 
You'll need to see what the preschool test is the no shoot below 200 is at preshoot. Not mid day, at least for newbies (eventually you'll shoot low)

by the way nice number!!

I suggest you test and post the result asking for advice
 
Just to reiterate an important point: you have to keep a stable dose for a period of time. The frequent changes are wreaking havoc with the insulin's depot and causing some/all of the erratic BG readings you're getting. If you feel 2 u is too high and 1 u is too low, try 1.5 u and stay at that dose for a week to stabilize the depot, barring any drops into very low numbers.

Please read the information in the Lantus stickies about the two main dosing guides, TR and SLGS to see which works best for you. They really do give detailed instructions on how to decide on a dose.
 
Veronica & Babu-chiri said:
You'll need to see what the preschool test is the no shoot below 200 is at preshoot. Not mid day, at least for newbies (eventually you'll shoot low)

by the way nice number!!

I suggest you test and post the result asking for advice
Click to expand...
Thank you! Yep, we wont be dosing at all mid day. We're going to pretest him at 6:30 tonight and see where we're at.
 
Kris & Teasel said:
Just to reiterate an important point: you have to keep a stable dose for a period of time. The frequent changes are wreaking havoc with the insulin's depot and causing some/all of the erratic BG readings you're getting. If you feel 2 u is too high and 1 u is too low, try 1.5 u and stay at that dose for a week to stabilize the depot, barring any drops into very low numbers.

Please read the information in the Lantus stickies about the two main dosing guides, TR and SLGS to see which works best for you. They really do give detailed instructions on how to decide on a dose.
Click to expand...
That's the thing, we only have whole units to work with with our Pen until our syringes come in the mail.. which should be in the next couple days. I would love to be giving him half doses instead, but it's not an option yet. I've read the SLGS and once we get the syringes we will definitely be going that route. I really don't want to give him two whole units if his number is still pretty good. Not sure what to do :( I guess we'll see what his pre-test comes too.
 
Kris & Teasel said:
Just to reiterate an important point: you have to keep a stable dose for a period of time. The frequent changes are wreaking havoc with the insulin's depot and causing some/all of the erratic BG readings you're getting. If you feel 2 u is too high and 1 u is too low, try 1.5 u and stay at that dose for a week to stabilize the depot, barring any drops into very low numbers.

Please read the information in the Lantus stickies about the two main dosing guides, TR and SLGS to see which works best for you. They really do give detailed instructions on how to decide on a dose.
Click to expand...
Once we get the .5 syringes we will make sure to have him strictly be on 1.5 for two weeks. I appreciate the advice. :)
 
Janel and Alabaster said:
That's the thing, we only have whole units to work with with our Pen until our syringes come in the mail.. which should be in the next couple days. I would love to be giving him half doses instead, but it's not an option yet. I've read the SLGS and once we get the syringes we will definitely be going that route. I really don't want to give him two whole units if his number is still pretty good. Not sure what to do :( I guess we'll see what his pre-test comes too.
Click to expand...

You could try eyeballing the 0.5 on your syringe, use one that you may put a mark on it or colored water so that you can use as a pattern sort of speak, or a mark on paper that you can compare (calipers could be an option if you could get one), that way you can give him a smaller dose ( it will be less than one unit, probably very approximate to 0.5) and you will be using the same amount every day (is important to be consistent ) and you may be able to keep the dose for a few days and more importantly keep him safe
 
We got our syringes today!!!!! We checked him and he is at 175 so that's great. We're holding off the insulin and going with the SLGS method of checking him in two hours to see where he is at. We'll be starting the 1.5 tomorrow :)
 
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