? Hoping for some advice

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Critter Mom said:
Like it! :cool:


Are you supporting the back of the ear with something? (I use a folded 1" strip of kitchen paper (4-ply when folded) wrapped around my index finger; others use little flat cosmetic cotton pads.) The bit of support really makes a difference because it makes it much easier to get a blood sample really close to the edge of the ear. With a bit of practice you can freehand the poke with a lancet and use an action similar to that you might use to prick a balloon. If you're sometimes catching the marginal ear vein when poking that might be the cause of the discomfort.


We've found that cats tend to have a particular style: some typically run lower at night, some lower during the day. Trouble is, without enough BG data to understand what's going on it's hard to tell. For example, Mommy may actually be running lower during the daytime cycle but then bouncing up to higher numbers on the night time cycle (and producing more pee). Be sure to keep asking for hints and tips about home testing techniques. It might be worth posting on the Lantus board for more input - and suggestions on how to improve success rates when trying to test a difficult kitty! :)

In the meantime, it might be a good idea to do spot checks on Mommy's urine to see whether there's any glucose present. That would at least tell you whether her BG levels are breaching the renal threshold. The only other thing I can suggest is getting the vet to run fructosamine tests to give you an idea of how well/poorly Mommy has been regulated over the previous couple of weeks.


Mogs
.
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Yes, I'm supporting her ear with a warm cloth, and making - or trying to make - the experience as unpleasant as possible. I kiss her, spend time with her first, brushing her (she loves that) then bring out the dreaded utensils and perform the test. My technique has improved, but her attitude has not :) I tried again today right after her morning feeding and shot; I want to obtain a semi-fasting test from overnight, but don't want to risk a scamper-and-hide-under-the bed before she gets her shot. I know that's shooting blind, but she's doing so well overall, though last night she pee'ed more again. Not rivers of urine, but one med-sized paddy and two larger-sized ones, plus the water bowl was half empty, so she's definitely drinking more at night, too. But I failed in my attempt, as the moment she ate and got her shot, she glanced at me with that sidelong look, "Yeah, I KNOW where this is heading" and she eluded me, making her mad dash under the bed, the little witch. On the upside, her revert-to-feral instinct is a great sign of improvement, as when she was really feeling lousy, she barely cared if a bomb went off. And she was always more timid and wary than Boy, though very affectionate once you gain her trust. On the downside, it's fu&#ing up my attempt to get a reading on her levels from overnight. I can get a mid-day reading more easily, while she's eating lunch. She seems more relaxed, then. It's just the morning. She's like her daddy in the morning: in no mood to be bothered.

I'll take her into the vet at the end of the month, as scheduled, for fructosamine tests. At this point, hauling her into a carrier and forking out $500 is my only choice.
 
I just got a test! She had her shot at 8:20 a.m., so about an hour ago, plus food. It was 74, which is too low, right?
 
C.W. Gortner said:
I just got a test! She had her shot at 8:20 a.m., so about an hour ago, plus food. It was 74, which is too low, right?
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That's awfully low so early in the cycle. Give her a little snack of her regular low carb food if she'll eat it. Try hard to get another test no later than 30 minutes from now. There's no data for us to see where her nadir tends to be but somewhere in the +5 to +7 range is typical for Lantus.

If there's any way you can get her trained to eat, be tested and injected in a smaller space it would be so much easier for you. Not easy I'm sure but you can see how BG testing is so important.
 
Yeah, I panicked and called the vet. FYI: I'm using the Alphatrak monitor and apparently, a reading under 20 is considered too low, according to the company guidelines.

Unfortunately, I don't have a smaller space. We have two bedrooms upstairs, with the living room, dining room, kitchen, sole bathroom, and my writing studio downstairs. She never comes downstairs during the day, not once in the full 7 years she's lived with us. She keeps to the upstairs bedroom all day, her Princess Suite as we call it, so that's where I have to feed, test, and dose her. There's a bed she can hide under. She only goes downstairs late at night when we've gone to bed. She's a former feral; as much as we love her and she loves us, she's not going to change. She's very cautious and fearful by nature.

Anyway, a vet tech answered my frantic call, as my particular specialist doesn't work on Saturdays (of course). The tech basically said, "This is why we don't recommend home testing, because clients will focus on one number." WTF?! I'm really sick and tired of their holier-than-thou attitude. Then she went on to say, Lantus kicks in right away, then levels out over the cycle, so I should test her again in an hour or so, and if she's running any lower, to bring her in. When I protested that I can't bring her in or even test her if she's hiding under the bed, the tech added that Mommy's last BG via blood work was 97, so while 74 is low, it's not cause for major alarm. Yet.

No help from the vet - which I've come to expect. But, as Mommy had eaten earlier with her shot, I managed to feed her again, about half a can of FF. She seems okay at the moment; she crept out and pee'ed, too, but she detests the testing so much that as soon as she saw me, she bolted back under the bed, so I slid food on her plate to her. I really can't even attempt to test her again until later this afternoon or possibly not until this evening, as she's hyper-vigilant right now and not amenable. I won't dose her tonight unless I have a reading. Otherwise, I'll let her coast through the night without a dose and re-test her in the morning. She'll hate me but now, I simply can't shoot blind anymore.

And I agree, regardless of what the vet tech says. To me, 74 is too low this early in the cycle and indeed into her treatment. Two days ago at midday, or 4+ hours into the cycle, she ran at 119, which is also quite low for her. It might be she's over the crisis hump and her starting dose of 2 units twice daily is too much. If she consistently reads under 200 in the next few days, I'll cut her dose to 1 unit and see what happens. I wish she was more cooperative with home testing because now, it's simply unavoidable. For her and for me.
 
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Years ago my cat got lymphoma. She would hide under the bed making it impossible for me to get her out. I bought wooden risers for the bed from Bed Bath and Beyond. Best investment I ever made! When Max got sick no matter when I needed him I could crawl under and get him.

We go up and down in dosing by .25 increments. When you can’t test because she’s hiding I would feed her some mc food when she’s getting low. I hope you find a way to get her tests when you need them. I can imagine how scary this is for you. I didn’t test at home at first so my vet had me come in for a nadir every few days. I remember how scared I was when the meter read 60 there.
 
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C.W. Gortner said:
Anyway, a vet tech answered my frantic call, as my particular specialist doesn't work on Saturdays (of course). The tech basically said, "This is why we don't recommend home testing, because clients will focus on one number." WTF?! I'm really sick and tired of their holier-than-thou attitude. Then she went on to say, Lantus kicks in right away, then levels out over the cycle, so I should test her again in an hour or so, and if she's running any lower, to bring her in. When I protested that I can't bring her in or even test her if she's hiding under the bed, the tech added that Mommy's last BG via blood work was 97, so while 74 is low, it's not cause for major alarm. Yet.
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WTF indeed! The most important benefit of using a home glucometer is the very ability to focus on just one number; the number that tells you your cat's blood glucose is too low! I wonder whether that vet tech would recommend human diabetics not home test their blood glucose levels ...

That blood work 97 could have been stress-influenced (so Mommy could have been potentially running lower at home) and the 74 you caught was very early in the cycle. You were perfectly right to be concerned and to seek advice from your vet. It's disheartening that not a lot of help was forthcoming. :(

Lantus typically has an onset about 1 hour or so after administration (although ECID) and each cycle will be influenced by the amount of insulin already in the depot. Some cycles are more active than others (a test result at +2 hrs after injection where BG is similar to or lower than the preshot BG can often signal a very active cycle where closer BG monitoring might be needed).

Here's something that might help you to sequester Mommy if she's running low on a cycle and you need to be able to get hold of her for closer monitoring:

Kitty Playpen

IMG_20160218_163535.jpg



The top cover unzips so it's really easy to reach in and pick up the cat. Plenty of room for food, bed and litter box.

C.W. Gortner said:
I'm using the Alphatrak monitor and apparently, a reading under 20 is considered too low, according to the company guidelines.
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My vet gave me the following reference range (from the UK Merck Veterinary Manual, IIRC) for feline blood glucose levels as measured on pet-calibrated glucometers and lab equipment:

3.9mmol/L (70mg/dL) - 8.3mmol/L (150mg/dL).

Anything lower than the bottom value of the reference range means the cat is at minimum biochemically hypoglycaemic and action needs to be taken to protect the cat.

A reading under 20 on an Alphatrak would lead me to immediately lather my cat's gums with glucose syrup and straight after I'd be legging it to the vets for emergency treatment, glucose tube in hand.



Mogs
.
 
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Max onset usually at +2.5 or 3 except for when he didn’t. I tried to get a +2 test because then I knew if he was going to have an active cycle. But as Mogs said ECID. Tge more days you test the better you will know how your cat reacts to lantus.
 
Just had a gander at the online US Merck Veterinary Manual diabetes mellitus page which says:

The normal fasting value for blood glucose in dogs and cats is 75–120 mg/dL. In cats, stress-induced hyperglycemia is a frequent problem, and multiple blood and urine samples may be required to confirm the diagnosis.
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Reference range would be lab values (pet-calibrated). I am assuming that the 120mg/dL is the upper limit for non-diabetics. (Perhaps fasting BG falling in the 121-150mg/dL range might point to an animal being pre-diabetic? Pure speculation on my part here.)


Mogs
.
 
Thanks for all the support and advice. I love that kitty play pen! :)

I've been running on fumes of late. My husband went abroad to visit his family for the holidays (he comes home tomorrow) and I'm in charge of the entire carousel here, both our indoor cats, all the household crap, plus caring for two outside ferals, one oif whom is determined to invade our home and is utterly adorable, but picks fights with Boy, so I can't let him in. I'm sleep-deprived. I freaked out today at that 74 BG reading and then was enraged by that idiot vet tech, so I watched Mommy like a hawk until 4:00 p.m. She was fine, she ate her snack and her lunch but she stayed under the bed, until she came out just as I collapsed into my bed for a nap. She jumped up next to me, licked my face over and over, and nestled beside me, purring. I started crying. Despite her odd ex-feral ways, she's so intuitive; it was as if she knew I needed reassurance. I slept for about an hour and a half, then fed her and Boy a snack at 5:45, but held back on their full dinner to keep her hungry until shot time. Then I went downstairs and played a video game (ever since she was diagnosed, I've discovered that playing video games really relaxes me, go figure. I'm in-between writing books at the moment, too, and need the distraction). At 8:40 p.m, I returned to her suite with the rest of her dinner. By then, she'd been on a nearly 13-hour cycle since her a.m. dose.

She was hungry, waiting for me on the stairs with Boy, just like my avatar pic here. She gobbled up her food, I brushed and kissed her, then - lo and behold! - I managed to test her again. It was only about 10 minutes after she ate, so not enough time to really skewer the result. Also, because I was more relaxed and determined, as there's no avoiding home testing anymore, I switched our game plan. I held her upright against my chest so she could feel me while I knelt on the bed behind her; she seemed to prefer that to being reclined against the pillows like before, maybe she feels less vulnerable this way, and I pricked her ear - which took three pricks, as I'm going manual because that stupid lancet device clicker thing freaks her out. She dealt with it. She didn't like it, but she wiggled less and I just kept telling her over and over what a silly girl she was, and I sang her special silly song (don't ask). I got a reading of 297 this time, so I dosed her. She didn't jump off the bed and hide. She blinked at me, as if to say "Well, that sucked," and started grooming her paws. All in all, it was the best home testing experience we've had yet. If I'm relaxed about it, then she is. Or she is, mostly.

She's all over the place right now as far as BG readings go, but that's to be expected. I'll just keep testing her twice a day as best I can. I know my cats, and my gut tells me she's running lower in the mornings and higher in the evenings; that's her particular style. Again, like her daddy. I'm a night owl, too.

Thanks again. I feel like an idiot as I stumble through this maze of learning how to manage her diabetes.
 
She tested this a.m. at 77. So, for some reason she is running low in the morning. Now I don't know what to do. Should I dose her or wait until the evening to see where she's at? At 77, I don't feel comfortable shooting her with 2 units. Yesterday she was 74 but I had already dosed her an hour before. This time, she's this low without her a.m. shot.
 
That is too low to dose. There is variation amongst kittehs. For Leo, his no-dose number is 200 (on AlphaTrak 2).

Some people develop sliding scales. We probably need more AMPS and PMPS readings to recommend values for Mommy.
 
Sliding scale would be something like:
120-150: 0.5U
150-200: 0.75U
200-300: 1U
300+: 2U
 
JeffJ said:
Sliding scale would be something like:
120-150: 0.5U
150-200: 0.75U
200-300: 1U
300+: 2U
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I'm using AlphaTrak, too. I figured as much, thanks! I won't dose her this morning. If I can manage a mid-afternoon test to see how she's trending, I will. If not, I'll just wait until the evening. I thought maybe yesterday's a.m. 74 reading was an anomaly but she came in around the same level again today, so to me, that means something. Just not sure what yet.

Should I post in the Lantus forum or is this enough?
 
Lantus is not typically dosed on a sliding scale. Because of the "depot" nature of Lantus action, it tends to work best when dosed consistently morning and evening, so the goal is to find a dose that you can do that safely.

That said, 74 or 77 on an AT is too low to shoot at this point. Eventually, with a lot of data and testing regularly, you might get down to that level, but definitely not now while you're still getting a testing rhythm established.

I'm guessing that the 2.0U dose is too high, and that she might have been going even lower at night. The other possibility (less likely, but possible) is that she has very late nadirs, but that will only really be visible after you've gathered more data.

The "hospitalization" in your sig did not involve ketones or DKA, correct? If so, a skip is probably OK. If she has ketones in her past, however, I'd suggest a different course of action, re-test in a half hour and consider shooting if she is rising in BG. Best if you haven't fed breakfast, so that you can get a non-food reading.

It's good that she's spending some time in such good numbers!
 
What does Mommy weigh currently? You mention that she's underweight, here are the recommendations from the Lantus board for starting doses:


Tight Regulation (TR) dosing method:
  • the formula is 0.25 unit per kg of the cat's ideal weight
  • if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
Start Low, Go Slow (SLGS) dosing method:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet


2U would be a large starting dose for all but the largest cats using the more aggressive (TR) dosing method. It's not uncommon for large starting doses to be established during a vet hospitalization-- cats often experience raised BG under vet stress, plus cats are often slow to see any sort of regulation, so the vets will keep raising the dose until they see some response. Back in the lower stress environment of home, the dose that "works" in the hospital is often too large.
 
They did detect trace ketones during her hospitalization but no DKA. She had acute pancreatitis, but it started to resolve quickly. Her most recent lab results are on my spread sheet. She also has stage 2 kidney impairment, but her values are stable.

She ate breakfast this morning. To establish a regular testing routine, for now I have to incorporate food. She eats and then I test her; it's much easier this way because I feed her on the bed, talk to her and pet her, and then test her within 5 minutes of eating, so the result isn't affected, as it takes about 20 minutes for food to be digested and affect the BG. She eats very regularly and often. Like I said, I'll try to test her again in the midday and see where she's at; if not, I'll wait until the evening. At her diagnosis, she was running in the high 500 - 600+ - at one point in the hospital she was so high they couldn't even get a reading!- so her reading last night of 297 is actually a vast improvement for her. I don't know if she goes lower while we're asleep, but her pee output / volume does increase significantly at night, not during the day.

I don't know why she's running higher at night, maybe from all the food she eats during the day, i.e., it bolsters the BG? It's high protein / low carb Fancy Feast canned, but she's getting both breakfast and lunch. She also gets dinner and a decent-sized after-bedtime snack, too - nearly a full can of Fancy Feast for snack at bed - because her weight loss was so severe. She's been putting on weight now, which she needs. Food is pretty much a consistent factor with her, until the late hours of the night. For example, she had dinner last night at 8:45 p.m. and her snack at 12:30 before I went to bed. She didn't eat all her snack right away, so I don't know when she ends up finishing it, but when I get up, the plate is always bare. So, 77 may well be a morning fast reading or as close as we can get, which is still quite low.

What a conundrum.
 
She was 6.7 lbs at hospitalization. Ideally, she should be 8 or 9 lbs or so, she's not a large cat, however.

In the hospital, they started her at 1u after the initial fast-acting IV insulin, but they didn't see the preferred response. She wasn't going lower enough or maintaining it if she was, so they switched her to 2u. But her last lab BG was 97, which is within normal range, and that was taken at her follow-up appointment two weeks later, which, while a short visit, was stressful for her. Very stressful, in fact; she was panting. Still, her BG showed no stress-induced hyperglycemia. Her appointment that day was at noon and she'd had her morning shot already, plus food.

I'm also starting to suspect 2u is too high. But, how to adjust safely? I'll need to see more p.m. /a.m. values. Or maybe give her only 1.25 u tonight and see what tomorrow's a.m. test reveals? If I can even figure out how to measure 1.25 on the syringe. The hospital gave me a test sample with saline that I use to measure with, those little markings on the barrel are like hieroglyphics. Here's a pic of 2 u that they gave me. Basically, it's four notches down from the top to be 2u: ( I can't insert the pic. grr)
 
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I'm glad she's eating so well! Good girl!

One reason besides food that she's likely running higher at night is that she's "bouncing" from the earlier lows. When BG gets too low (according to the cat's body that is-- for a cat that's been diabetic for a while, that could even be a number in the 300's!), the liver "panics" and acts to bring BG back up. That's one reason it's often hard to get a cat regulated in the beginning--- the high numbers you see could be a sign that the cat is getting too much insulin, not too little! Looking at the spreadsheet, I think it's possible that Mommy has been doing some bouncing, but the good news is that if she is, her bounces are fairly short, which will make it much easier to figure out what is going on.

At 6.7 lbs (underweight), the TR starting dose would be 0.75U. Since she's on low-carb food, SLGS would recommend 0.5U. I do think lowering the dose from 2.0U is warranted here, given the readings the past two mornings, but the low ketones reading makes things a little more complicated. I don't think I'd recommend going as low as 0.5, for example. Hopefully other people can weigh in today with ideas before your evening shot time.
 
I think I could try 1.25 u to start this evening. I can't insert this stupid picture of my sample syringe. If 2u is four notches on barrel from the top, then 1.25 would be 1 and a quarter notch, right? I'm using u-100 o.3 ml 31 gauge syringes. Pathetic :(
 
Do your syringes have half-unit markings? Here are sample syringe pics:

resource.gif


If you're using syringes with half-unit markings (on the left), then yes, 2U is 4 notches (left-right-left-right). 1.25U would be 2 notches (left-right) and then halfway between the 2nd (right) and 3rd (left) notch.

I think 1.25U is reasonable, though again let's see if other folks weigh in with an opinion here.
 
If you're using syringes with half-unit markings (on the left), then yes, 2U is 4 notches (left-right-left-right). 1.25U would be 2 notches (left-right) and then halfway between the 2nd (right) and 3rd (left) notch.

I think 1.25U is reasonable, though again let's see if other folks weigh in with an opinion here.[/QUOTE]


I posted a pic. I don't know if my syringes match left or right.
 
Your syringes are like mine. The right hand scale is for whole units and the left is for half units. Reading from zero and looking at both half and full unit marks you have: zero - half unit - one unit - one and a half units - etc. That means a dose of 1.25 u would be half way between the right side whole unit mark and the left side 1.5 u mark. Does this help? It'll get easier to eyeball between marks over time. Try to be as consistent as you can when eyeballing.
 
C.W. Gortner said:
Thanks for all the support and advice. I love that kitty play pen! :)

I've been running on fumes of late. My husband went abroad to visit his family for the holidays (he comes home tomorrow) and I'm in charge of the entire carousel here, both our indoor cats, all the household crap, plus caring for two outside ferals, one oif whom is determined to invade our home and is utterly adorable, but picks fights with Boy, so I can't let him in. I'm sleep-deprived. I freaked out today at that 74 BG reading and then was enraged by that idiot vet tech, so I watched Mommy like a hawk until 4:00 p.m. She was fine, she ate her snack and her lunch but she stayed under the bed, until she came out just as I collapsed into my bed for a nap. She jumped up next to me, licked my face over and over, and nestled beside me, purring. I started crying. Despite her odd ex-feral ways, she's so intuitive; it was as if she knew I needed reassurance. I slept for about an hour and a half, then fed her and Boy a snack at 5:45, but held back on their full dinner to keep her hungry until shot time. Then I went downstairs and played a video game (ever since she was diagnosed, I've discovered that playing video games really relaxes me, go figure. I'm in-between writing books at the moment, too, and need the distraction). At 8:40 p.m, I returned to her suite with the rest of her dinner. By then, she'd been on a nearly 13-hour cycle since her a.m. dose.

She was hungry, waiting for me on the stairs with Boy, just like my avatar pic here. She gobbled up her food, I brushed and kissed her, then - lo and behold! - I managed to test her again. It was only about 10 minutes after she ate, so not enough time to really skewer the result. Also, because I was more relaxed and determined, as there's no avoiding home testing anymore, I switched our game plan. I held her upright against my chest so she could feel me while I knelt on the bed behind her; she seemed to prefer that to being reclined against the pillows like before, maybe she feels less vulnerable this way, and I pricked her ear - which took three pricks, as I'm going manual because that stupid lancet device clicker thing freaks her out. She dealt with it. She didn't like it, but she wiggled less and I just kept telling her over and over what a silly girl she was, and I sang her special silly song (don't ask). I got a reading of 297 this time, so I dosed her. She didn't jump off the bed and hide. She blinked at me, as if to say "Well, that sucked," and started grooming her paws. All in all, it was the best home testing experience we've had yet. If I'm relaxed about it, then she is. Or she is, mostly.

She's all over the place right now as far as BG readings go, but that's to be expected. I'll just keep testing her twice a day as best I can. I know my cats, and my gut tells me she's running lower in the mornings and higher in the evenings; that's her particular style. Again, like her daddy. I'm a night owl, too.

Thanks again. I feel like an idiot as I stumble through this maze of learning how to manage her diabetes.
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so glad it went better for you! The few weeks of testing can be hard on both human and cat... but it usually becomes routine pretty quickly. I always rewarded with some cold cuts or catnip and that made things better.
 
Hi C. W.,

Some things to perhaps ponder re the high PMPS, low AMPS and more pee at night:

1. Many cats have distinctly different BG patterns during the day and during the night, hence the real need to get mid-cycle tests on both AM and PM cycles. (IIRC the majority of cats tend to run lower at night.) Because of this response variation sometimes a dose that works well for one cycle may be too high for the other cycle.

2. If a dose is too high it can produce an 'upside down' curve, i.e. instead of dipping from preshot BG down to nadir and then rising again back to next preshot the curve rises after preshot to a peak mid-cycle and then drops down to next preshot. There's no way of knowing whether this might be happening in Mommy's case (other than the observation of extra peeing during the night).

3. Sometimes if the dose is too high it can produce a 'tick mark' curve: numbers fall from PS level in the early part of the cycle, get as high as (or possibly higher than) PS in the middle of the cycle and then drop down by the time of the next PS test.

As Nan suggests above, it's also possible that Mommy might be bouncing during the night time cycle after running in unfamiliar lower numbers during the AM cycle.

Hopefully now that yourself and Mommy are reaching detente on the testing front you'll be better able to determine what's happening. My suggestion is to try to start getting PM mid-cycle tests ASAP (sorry, Mommy!). I don't do dosing suggestions but if my kitty were in this boat I'd be monitoring as closely as possible and I'd be a bit worried that the dose might be on the high side. (Other members may have a different view.)

C.W. Gortner said:
I love that kitty play pen! :)
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They're the mutt's proverbials! :) They take only minutes to set up and they quickly fold down flat for storage. Easy to clean, too. They're really airy and quite spacious when set up; more kitty hotel than pet penitentiary.


Mogs
.
 
I just tested her again at 6:45 p.m., before her evening meal. She's due for her shot at 8:40 p.m., so she usually only gets a snack after lunch, with full dinner tied to her shot, but our schedule is out of whack today and she was hungry for dinner early, since my a.m. test, as well as it went, sent her back into hiding and she missed lunch.

She was 161. No food. And not high at all, so . . . now what? Well, I'm not comfortable shooting her in that range, so I called my vet and got the on-call emergency doc, who remembered Mommy from her hospitalization there. The doc told me to not give her any insulin tonight and re-test her in the morning; if she's still falling within normal range, she "might" be becoming less insulin-dependent. And of course, to schedule an appointment with Dr Dick ASAP to get his input and possibly a fructosamine.

In any event, in case she requires a reduced dose later on this week, this is 1.25, right? I redrew the line - in black - around the syringe.
 

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C.W. Gortner said:
I just tested her again. She's due for her shot in two hours, but our schedule is out of whack today and she was hungry for dinner early, since my a.m. test sent her back into hiding and she missed lunch. She was 161. Not super high, so . . . now what? Take her down to 1.25u tonight and see how she coasts through to the morning?

This is 1.25, right? I redraw the line - in black - around the syringe
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No, the black outline doesn't correspond to 1.25 u. The first long black line on the left nearest the edge of the orange cap is the zero line. The right side of your black outline is running right on top of the 0.5 u line. The black surface of the plunger sees to be sitting on the 2.0 u mark. It's a bit fuzzy to know for sure.

Your best bet for dosing advice is the Lantus forum. There are two sets of guidelines for dosing - TR and SLGS. They were mentioned in post #120 above. Those guidelines spell out what to do if a pre shot BG is lower than usual, etc.
 
Kris & Teasel said:
No, the black outline doesn't correspond to 1.25 u. The first long black line on the left nearest the edge of the orange cap is the zero line. The right side of your black outline is running right on top of the 0.5 u line. The black surface of the plunger sees to be sitting on the 2.0 u mark. It's a bit fuzzy to know for sure.

Your best bet for dosing advice is the Lantus forum. There are two sets of guidelines for dosing - TR and SLGS. They were mentioned in post #120 above. Those guidelines spell out what to do if a pre shot BG is lower than usual, etc.
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Right, I'll check there. I see the lines better now and understand. The plunger is sitting on the 2.0 mark because that's my sample syringe. So, I'd move up from there to 1.25 or wherever.
 
tiffmaxee said:
Can upyou get another test about a half hour before shot time and post on tge lantus forum?
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I don't think I can get another test tonight, but if the opportunity arises, I'll try. Getting two tests today was a major accomplishment and I don't want to overwhelm her, as I'm trying to establish a routine that she can deal with, that will work long-term. For now, I'm going slow and aiming for daily pre a.m and pre-p.m.
 
I have the same kind of syringe markings. So I labeled some of the markings. One side shows 1.0 increments, the other side shows 0.5 increments.
 

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Based on the markings pic sent by JeffJ, am I actually giving her 2u? When I fill the syringe, I'm counting down four notches, based on this sample syringe that the vet tech gave me at Mommy's discharge. See here, without my pen drawing. I'm taking the plunger down to the 4th notch, no farther.
 

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For your post just above "am I actually giving her 2u" - yes, that picture shows 2U. You are past the 1.5 mark, and the plunger is lined up at the 2.0 mark. You are correct, each notch is 1/2 U.
 
Thanks! I called Dr Dick this morning and am now waiting on his call-back. I wasn't comfortable not dosing her last night when she came in at 161, so I gave her only 1u to see how she'd do. She tested this morning at 291, but she'd already eaten about an hour before (I'd asked hubby to please not feed her before he went to work, but of course he did so anyway, about half a can of FF). An hour later, I got up and tested her. I gave her another 1u and called the vet. I think she probably needs between 1.25 and 1.75, and no doubt I screwed up by halving her dosage last night rather than following the .25 reduction protocol, but I want to keep her safe; a day or so of higher BG is less concerning to me than a plunge into hypo and another hospitalization.
 
Yes, you will probably end up at 1.25 to 1.75 for the optimum dose. I also have a hard time getting the 0.25 dosage added. Since many cats and dogs get such small amounts (under 10U), one would expect 5U or 10U syringes to be readily available. It would make micro-dosing a lot easier.

For 2 people handling 1 cat, it is important to stick to the protocol. We have a paper spreadsheet in the kitchen.
date
time
BG
dose
comments

And any feedings go into the comments. Also other drugs (B12, prednisolone, chemo). It is easy to do, and both people can write stuff on it.
 
Well, Dr Dick just called me back. To my surprise and relief, he endorsed my dose reduction to 1u 2x. He said to keep testing her morning and night, and not sweat any slight rises during the first week or so of her dose adjustment; if she goes higher than 350, however, I can add .25 u and so on, until we find the optimal dose. He said it was quite normal to have to adjust after a certain time on insulin and better we have to lower her dose than increase it from 2u, though he was, of course, grumpy. Evidently, he's not a fan of home testing, as it forces him to actually consider that a kitty parent might be competent enough to handle it, but he was impressed by my "diligence." I'll take her in to see him on 1/23 for a follow-up fructosamine, but in his opinion, she's doing much better than expected, thus far. The man is a real charmer (not).

Go, figure. I'm wiped.

As for our protocol here at home, hubby just thinks our cats are hungry all the time, but he assured me that he only gave her a quarter can before he left for work because she was asking him to feed her. I requested specifics on exactly how she made that request, and told him she can wait until I get up - which is shortly after he leaves, anyway - as I do the testing and the shot. Men :) However will he cope should I need to go on tour later this year for my new novel? I shudder at the very thought. He adores them but when it comes to medical stuff, he's all thumbs.
 
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Ok, then your hubby can do the AMPS test! For AMPS and PMPS, you want 2 hours of no food prior to test.

Some cats are hungry all the time, but if they have diabetes...there are rules! Up until 2.5 years ago, I never touched a syringe. If I can learn it (as an elder), then he can too.

Vets against home testing - yeah, we get a lot of that on the forum. Maybe some vets are doing revenue protection. If an owner doesn't test at home, then the owner is totally dependent on the vet for testing and dosing guidelines.
 
We've run into a hurdle. Mommy has decided that home testing is torture - what's worse, she now hides under the bed, right in a spot in the middle where I can't reach her, whenever it's time for her shot. I'm not sure what happened, exactly, as before I started home testing her twice a day, she jumped onto the bed every time for her meal and her shot. There was never an issue, and we weren't even home-testing that long. But the BG testing requires a prick, I know it hurts - no matter how gentle I am, it's still a poke to get blood - so she must be associating any attempt to inject / poke her with pain. We are now using 1u 2x daily and I had to back off from home testing for now, as she's not cooperating and giving her the shot is more important to me, given her situation. However, even if she's calmly in her tree nook, as she was this morning, and I kiss her and quickly shoot, without any visible reaction from her that I can see, seconds later she bolts under the bed. Mornings are easiest at this time, but nights are a nightmare, as she camps out under the bed and we have to sweep a pillow under it to get her out, corner her - while she's hissing and clearly freaked out - and give her the shot. She calms down later, even accepts affection from hubby, but she's basically avoiding me. It's frustrating and heart breaking, as we had the shot routine aced.

We see the vet on the 23rd and I'll request a fructosamine. Sigh.
 
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