Help, "LO" only 2 hours after insulin. Dose advice for AM?

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Are you using an implanted monitor like the Freestyle Libre? We tried that one for two weeks. Hope all goes well!
 
Help? Dwee was around 144 at his evening shot time and in the past when he's been below 195 at his evening dose time, lowering his dose TOO much (like under 1 unit) made him bounce way up high for 1-2 days afterwards so I gave him 1.2 units to try to avoid that.

But within 90 minutes he was down to 90 and now just over 2 hours later, the monitor just says LO. The lowest it goes is 36.

He seems his normal self. In 45 minutes I'm going to give him some medium carb food.

Yesterday and last night he was all red and pink numbers after him being on only 1.5 units for the last few weeks which has proven many times to not be enough to keep him not too high.

It's almost as if we have to always be chasing him. When he's always red and pink, we have to raise the dose by 0.4 or so to bring the numbers down. This usually takes 1-2 days before any lowering actually occurs but then it drops quite well.

This morning for instance he got 1.8 units and it worked great to bring his numbers down, but now that he's had even just 1.2 units at night, within 2 hours it's too much and he's hypo?

I couldn't have given a consistent dose of 1.8 units again as it'd be way too much. But CONSISTENTLY giving 1.5 units results after a few days of his numbers being always too high.

I...am...stressed.
 
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I don't know how an implanted monitor works, but if you're getting a Low, you need to do something now to get his numbers up. If you wait 45 minutes, he could be in trouble. We recommend feeding a teaspoon of HC food and getting a test every 15 to 20 minutes until the numbers come up above 50. Does the implanted monitor constantly give you readings?
 
Rather than 36 in your spreadsheet, I would actually type "LO" because you don't know how low he went. I hope you are feeding him some HC now. It is very early in the cycle and nadir is hours away, so you may be having to feed him HC for a while. Please just give him a small amount, so he is still hungry when you may need him to eat later.
I too have to be leaving for work soon.
Up you go, Dweezil.
 
Thank you so much. I didn't wait. I gave him some high carb food which he gobbled up (half a fancy feast can. I want him to eat more again soon so need him to be hungry).

Yes, the monitor gives constant readings. It is now saying 44 which is at least an improvement.

Now it says 65. Phew. For now. Lucky I'm awake until 1am each night, he sleeps with us and my partner is up 5am. It's 9pm now. Still...what dose will be best for him then?? Who knows...
 
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That's great it gives constant readings. You need to get him up over 50 and because it is early in the cycle, as Dyana said, you will need to monitor him closely for several hours.......no sleep for you tonight!!
Please keep us posted. I am in Sydney and will stay with you for a few hours ....at least until the US wakes up and comes online.
 
He's just had some dry food and is grooming. Good. Again, for now.

Back to sleep in front of the heater. Up to 95.
 
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Just watching from the sidelines. Since the Freestyle Libre is relatively new for animals and I can't find any studies on kitties, I was wondering if you have ever tested the readings for the FSL against a hand-held meter for comparison, especially with those hypo numbers.
 
He just had more Fancy Feast but doesn't want any more dry food. I wish he would. Nervous hovering cat mother.

Back up to 113 now. It'll drop again though, dammit. I'll be here with more gobbles.
 
Oh, and apparently the Libre is conservative in that if the BG is 5, it will say it's 3 to err on the side of caution. Which is a good thing if it's true in Dweezil's case.

Oops, forgot to convert those world numbers to US.
 
monty_dweezil said:
He just had more Fancy Feast but doesn't want any more dry food. I wish he would. Nervous hovering cat mother.

Back up to 113 now. It'll drop again though, dammit. I'll be here with more gobbles.
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It is good to be a hovering cat mother when the bsl is low;)
It is better to give wet food than dry food to bring the numbers up as they will work faster.
What protocol are you following? You have earned a reduction with the 'lo' number today.
Looking at your SS you are not dosing consistently but giving different doses frequently.
 
I know. We are inconsistent due to consistent 1.5 unit doses leave him really high all the time, but 1.7+ after 1-2 days results in this.
 
monty_dweezil said:
I know. We are inconsistent due to consistent 1.5 unit doses leave him really high all the time, but 1.7+ after 1-2 days results in this.
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What foods does he eat. Is he on a low carb diet or are you giving him h c dry food regularly?
Looking at the SS, 1.5 does give some good numbers in some of the cycles....(10 and 11 th amd 17 and 18 th).
Some of the higher numbers could be bounces from the lower numbers.
If I were you, I would stick to one dose for several days and see what happens. Don't chop and change. Lantus likes consistent dosing.
It is hard to know what dose to give now........he has earned a reduction......but he has had 1.8 twice then 1.3.
What dose do you think he should have now @Tuxedo Mom
 
I would like to know too. During the 2 weeks he had no monitor, we gave 1.5 units each dose consistently and the few checks we got were always high (pinks) and his urine glucose was always high too.

1.5 is not enough, but much more is too much.

It'a possible the 1.5 works well after a higher dose has been reduced so it's using the 1.5 and the extra depot. But with no depot, 1.5 on its own isn't enough.
 
monty_dweezil said:
I would like to know too. During the 2 weeks he had no monitor, we gave 1.5 units each dose consistently and the few checks we got were always high (pinks) and his urine glucose was always high too.

1.5 is not enough, but much more is too much.

It'a possible the 1.5 works well after a higher dose has been reduced so it's using the 1.5 and the extra depot. But with no depot, 1.5 on its own isn't enough.
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The food you are giving could also make a difference. Do you consistently give the same number of carbs and about the same amount?
I am going to tag a couple of people who may be able to advise you better than I can about what to do to get a consistent dose and what dose to start off with.@Wendy&Neko @Tricia Cinco(GA) & Harvey @Chris & China @Sienne and Gabby (GA)
 
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Thank you so much.

We consistently feed at the same time, alternating between several low carb wet foods. We keep medium and high carb wet and dry foods around in case.
 
We'll be going to bed in about an hour and a half. Dweezy will have some more food then to take with us to bed. If his number is ok, he'll have low carb. If it's too low for my liking, it'll be some high carb.

Thank you all again SO much for being here for us. Right now he is contentedly asleep with his chin curled upside down as they do.
 
monty_dweezil said:
Thank you so much.

We consistently feed at the same time, alternating between several low carb wet foods. We keep medium and high carb wet and dry foods around in case.
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That's good!
Hopefully one of the tagged ladies, or someone else, will have some ideas to help with the dosing.
You've done well tonight keeping him safe. They do like to keep us on our toes, don't they?!
 
Hi. I checked in with you a bit ago. I see some weeks are missing on the spreadsheet (just remembered that Dweezil knocked the meters off). You need to find one dose and stay with it. Please do not look at the high numbers and just see where the nadirs are before changing. With SLGS, you must stay with one dose for a week unless you get a lime green, then you decrease 0.25u and stay with that for several days. I feel 1.5u is too high. I would try 1 or 1.25u for several days with no changes. Do not look at the high numbers, please.

@rhiannon and shadow (GA) @Bobbie And Bubba @Gill & George Your thoughts?
 
Wow, what a night! or morning.........glad he came up and as others have said, wet food is best for steering numbers upwards rather than dry as dry kibble takes to long to work.

I am not familiar with your meter. What is the "take action" number?


ETA: Are you following SLGS or TR?
 
SLGS. The meter is a constant implanted one.

My take action is when he goes under 60 I think.

The problem also is that on 1.5 his low numbers are also high. There seems to be no real change. High numbers are red and low numbers are pink.

Last night he had 1.8 units and it did absolutely nothing. High and low the same. This morning 1.8 brought him down nicely, but then the 1.3 tonight was too much with the overlap.

He has had ketoacidosis twice from not being on a high enough dose. The first time was in May and he was on 1.7 units consistently and SEEMED ok but we didn't really know. Then we went away for 6 days and on the third day in the cattery he got ketoacidosis. We had dropped his dose to 1.5 units while he was there to avoid hypos, but the opposite happened.

The second time he got it after a week and this time on 2 units. It just seemed to stop working. After that he was on 3 units at the cattery with the monitor while we were overseas as 2 units did not bring down his numbers at all MOST of the time. Sometimes however, they seemed to work too well (prolonged but asymptomatic hypo).

Also while he was consistently on 1.5 units without his monitor, his water consumption increased, and his urine test strips were always high. He did not lose any weight though.

In any case, we are scared to ignore constant high numbers (reds) and high low numbers (pinks) due to the ketoacidosis. We check for ketones daily of course, but high numbers constantly for him are not good. He shows no ill effects until he collapses in a medical emergency. When he was brought into the hospital the second time his BG was 342 which is lower than many numbers he's had since. So we fear the high AND the low.
 
Get some sleep ! The photos are adorable!!

Could you put into your signature that he has had DKA twice. That is a game changer. If you could get him off the dry you could be following TR and not have to hold a dose as long. But, I am sure you know that.

I am not sure what the new dose should be because of the change in dose a few times in the last few day. I am hoping some veteran peeps will weigh in to help with that decision. Could you also add a ? mark in your title when you awaken and ask for dosing advice. That way more eyes will be on it.
 
Your last couple of posts here so people can follow the history:
http://www.felinediabetes.com/FDMB/threads/dweezils-continuing-readings.183155/ and
http://www.felinediabetes.com/FDMB/threads/dose-advice.182299/

We dose Lantus based on how low it takes kitty. Try to ignore the bounces. To figure out how well a dose is doing, we need to hold the same dose, unless he earns a reduction. 1.8 is too much insulin, so I am glad you shot 1.5 this morning. Keep giving that same dose for at least six cycles, so we can see where he ends up when the bounce is over.

For homework, you might want to read the Sticky Note on the Lantus depot. What you shoot in one cycle may have impacts more on following cycles than the current one. We don't decide on dose based on preshot numbers, but rather the low points.
 
It does look like the 1.8 is too much.

I'm a little confused there are some days when you have not entered anything in the dose column, were those no shot days? If the were it helps if you pop NS in there that way we know for certain that you didn't shoot.

I believe that with the meter you care using anything under 40 comes up low, @Girlie's mom was using this meter and had some issues with it.

Looking at the numbers he didn't seem to be running that high on 1.5u, he was in blue just 3 Cycles after what looks like a couple of skipped shots, and a likely bounce from hitting a low green on
That means that you didn't see the full impact of the 1.5u dose, as it can take up to 6 cycles for the depot to settle and also for a bounce to clear.
 
Thanks for putting in your signature that he has had DKA twice this year. As Bobbie said, that is a game changer as far as the suggestions we give. Are you testing his urine for ketones frequently? I would test daily while you are trying to figure out a good dose so that you can catch any ketones quickly.
As you no doubt know DKA usually happens when there is not enough food + not enough insulin + and an infection, so you are wise to be vigilant about it.
 
monty_dweezil said:
Yes! It is the Freestyle Libre. My previous 2 threads blab more about it. lol
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Okay! Well, here's my spiel on my experience with the FreeStyle Libre:

HI/LO: If BG goes over 25 (U.S. 450), the Freestyle Libre meter just says HI, and if it goes under 2.8 (U.S. 50), it just says LO. That makes it challenging to know just how high or how low the BG levels are. I looked at Murphy's SS, and you'd have to test manually with the low numbers the Murph was getting for a while.

She had it implanted (stuck on) on/in 4 July, but it started to break down and give lots of error messages by 12 July, so it didn't even last the two weeks, even though Girlie ignored it and did nothing to jar it at all. The vet didn't expect it to give accurate readings for two weeks anyway. A cat's body is quite different from a human's, so it doesn't necessarily attach as strongly or as well as it would on a human arm.

My vet would only use it for one two-week stretch at a time, so we couldn't have kept her on it indefinitely the way humans do.

I'd make sure to also have test strips ready to double check readings if they look odd or if the sensor seems to be dying early. Use a normal meter especially if you get error messages from the reader or if you get low readings or anything that seems odd (like a string of really high readings like I had just before it died).

You've already had it put on, but for others who might be considering it: If you do get it implanted, ask your vet what they're going to use to stick the sensor to the outside of her skin. My vet used some kind of glue, and when they removed the meter, some of the top layer of her skin came off, and the glue had to grow out to fall off. It was a bit icky, to be honest. If I decided to use it again (which I wouldn't), then I'd ask the vet about using something like the patches below to stick it to her skin instead, but they might not work because of the fur: Freestyle Libre Patch 1 and Freestyle Libre Patch 2

Honestly, my bottom line: I loved the idea of the convenience, especially when I was new and had never done a manual test. I wouldn't use it again. I might have gotten a dodgy meter, but I just don't trust the accuracy of the results. If you look at my SS, you can see how dramatically different the readings are with the Freestyle and then directly after, when I was using the AlphaTrak2: it's like I had a different cat! (Dates 12 - 15 July Freestyle at home; dates 16 July on AlphaTrak2).

I'll be really curious to hear how you go with it! :-)
 
Well, today was odd. The morning numbers were high as usual, then they slowly came down on a 1.5 unit dose. At 4.40pm he was 306 and I tried to feed him his normal dinner and give him 1.5 units, but he wouldn't eat. We tried many things. He was hungry and kept trotting after us but then walked away from the food.

We wonder if he might want more of the higher carb Fancy Feast he got last night, as to him it'd be like junk food. He is of course NOT getting that!

Anyway, so we eventually gave up and went out for dinner. We got back at 7.40pm and his glucose was now 142. No insulin had been given yet. He has finally eaten his favourite treat, plain tuna loin, but that's it. He is rejecting his normal low carb boring food.

So...I can't give him any insulin! Last night when I gave him his insulin "on time" at 5pm when he was at 160, he then went down too low so early in the cycle probably because he was still going down naturally from the morning dose 12 hours earlier and I assumed he wouldn't still be going down after 12 hours.

How am I supposed to be consistent?
 
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monty_dweezil said:
SLGS. The meter is a constant implanted one.

My take action is when he goes under 60 I think.

The problem also is that on 1.5 his low numbers are also high. There seems to be no real change. High numbers are red and low numbers are pink.

Last night he had 1.8 units and it did absolutely nothing. High and low the same. This morning 1.8 brought him down nicely, but then the 1.3 tonight was too much with the overlap.

He has had ketoacidosis twice from not being on a high enough dose. The first time was in May and he was on 1.7 units consistently and SEEMED ok but we didn't really know. Then we went away for 6 days and on the third day in the cattery he got ketoacidosis. We had dropped his dose to 1.5 units while he was there to avoid hypos, but the opposite happened.

The second time he got it after a week and this time on 2 units. It just seemed to stop working. After that he was on 3 units at the cattery with the monitor while we were overseas as 2 units did not bring down his numbers at all MOST of the time. Sometimes however, they seemed to work too well (prolonged but asymptomatic hypo).

Also while he was consistently on 1.5 units without his monitor, his water consumption increased, and his urine test strips were always high. He did not lose any weight though.

In any case, we are scared to ignore constant high numbers (reds) and high low numbers (pinks) due to the ketoacidosis. We check for ketones daily of course, but high numbers constantly for him are not good. He shows no ill effects until he collapses in a medical emergency. When he was brought into the hospital the second time his BG was 342 which is lower than many numbers he's had since. So we fear the high AND the low.
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Hi there! I'm down in Sydney.

Take a look at the post I wrote earlier about the Freestyle Libre. It's a human meter and doesn't always work well on cats - it certainly didn't work well at all on mine.

When you go to low numbers - anything under 100 in US - 5.6 in World - please take a manual test of blood! You cannot trust the Freestyle Libre implant to give you an accurate reading, especially for low readings, and you want to keep your cat safe.

What manual meter are you using? Do you have an AlphaTRAK2 or are you using a human meter?

It's always good to have a hypo toolkit ready for those times when your kitty goes too low and into dangerous territory - anything in lime green colours. Here are the links for that:

Hypo toolbox

How to treat hypos

Are you using the Start low go slow method? I've linked it so you can read that, if you like. It gives really good information about how and when to change your dose, what can affect a dose, and what to do when you go too low.

It's so important to be consistent with dosing and not to change from one day to the next. You've got some really experienced people here who can guide you on that. I've learned that cats do what cats do, and we can't rush them on this journey. Especially at the beginning, their little bodies take time to get used to insulin and to start to adjust. It's been a crazy roller coaster ride for me, but I've learned how important it is to try to be patient with myself and with my cat.

Welcome to the FDMB forum! Your cats look lovely! :)
 
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I does look like he is breaking from his bounce.
It's best to find a dose that you can shoot consistently, but sometimes things happen, like cats not eating or caregivers not able to monitor. I'm guessing that he is coming down tonight because of the depot he has built up, and refusing his food. I hope he is eating better now. It is important for a cat with a history of DKA to get his insulin. How many hours late for the shot are you now? If his numbers started to come up soon, and you could give his insulin, would you be able to be off schedule by that many hours?
If you decide to skip tonight's shot, you can shoot earlier tomorrow morning. If you do that it would again put your shot schedule off, but it can be adjusted slowly in 15 minute increments per cycle, or 30 minutes per day.
Don't forget the recipe for ketones is not enough insulin + not enough food + an infection or other stress. Maybe, you could do two 18 hour cycles (give his insulin at +18 tonight, and then skip his morning shot, and then shoot on time at +18 tomorrow night), but that does give a little less insulin for the day for a recent DKA cat.
 
It's really hard because he's almost 5 hours late now. His morning dose is usually around 5am.

One other time in the past month this happened, I had to delay his dose by 6 hours and even then for some reason it didn't seem to work and he shot sky high. It was just as if his body wanted to be low until he wanted to be high. No matter what.

The last time he had DKA he actually had "excellent" control 3 days prior, had eaten well and in fact ate a heap and then threw it all up the morning before he went to the hospital and his BG was 19 so not TOO ridiculously high. They also found no source of infection.
 
So now 7 hours after his usual dose time, he is just above around 200. He has eaten a number of small low carb wet food snacks. He seems scared of his food for some reason but when he finally does creep up to his bowl and eat, he is hungry and eats well.

I want to do a token dose of 0.5 just so he has some insulin in there until 5am. But depending on his numbers at 5am, and taking into account the 0.5 dose at midnight if I give it, AND the fact he may not want to eat in the morning...his 5am dose may need to be less.
 
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