dosing assistance please!!

[GA Carol & Dante]

I have a question for shooting Lantus as my vet has instructed me in this way: BG >150 .5 units , BG= 150-100 .25 units, BG<100 don't shoot at all. Dante was diagnosed in 2015 and I have been closely monitoring him, thanks to this forum and the help I have received!!
One month after being diagnosed, he went into remission, 1 month later, he had heart failure, so I have been trying to get him into remission ever since.

My question is: Is it better to shoot 1 unit every other day and allow the high-low BG swings or do I give him .5 units every day and keep him steady? Thanking you in advance for your wisdom and sharing it!

 

[Chris & China (GA)]

It's actually better to find a dose you can safely give every 12 hours.

A cat's metabolism is faster than a humans. Lantus needs to be given every 12 hours

Do you have an updated spreadsheet for Dante?

 

[GA Carol & Dante]

Thank you for your response, I have a spreadsheet that I just made sure everyone should be able to access?? https://docs.google.com/spreadsheets/d/1INCUkiGngm3rmJ2vmMfYF5W9ADhalrn1AHS_Q5lNqyI/edit#gid=4271891es,

 

[Chris & China (GA)]

Dante is looking pretty good, but I really think he'd benefit from twice a day dosing

I'd like to see how he does .....maybe try .25 every 12 hours for a few days and let's see how he does?

 

[GA Carol & Dante]

Chris, Thank you, aha, so this am, Dante's BG was 144, and w/o his Lantus, his BG went to 211. Normally, I would wait an hour after he eats, so his BG would be higher, and then shoot him, but I didn't do that today. If I did, his BG would have been under 200 at 6pm, 12 hours later.
So if I can give a dose of perhaps .25 every 12 hours, that may regulate him even more?? Wow! However, .25 is very difficult to do!
Wow, China's BG's are great! Dante's swing can be 150, so I am afraid to shoot him below 150, you know your dosing very well and how it affect China, that is great!!

 

[GA Carol & Dante]

Wow, I just read your reply, Whew, I am on the same track with you then, THANK YOU!!!

 

[GA Carol & Dante]

OK, I will start the .25 dose tomorrow morning and night, but if he dips below 100, I don't shoot at all, correct??

 

[Sienne and Gabby (GA)]

Hi, Carol and welcome!

It sounds like your vet is more familiar with Prozinc or other, shorter acting insulin than Lantus. With Lantus, you adjust the dose based on the nadir (lowest point in the 12-hour cycle) and not on the pre-shot value. So, the take away message is that you need to get some additional tests during the cycle. You've done a great job getting Dante's spreadsheet (SS) set up and logging your pre-shot test data. If you can get at least one additional test during both the AM and PM cycles, that will help you to know how that dose is working.

Since you've been admiring China's SS, take a look at more than just the 2018 page. Chris, like many of us, tests a lot. You don't have to be a dyed in the wool testaholic but you do need to get more than pre-shot tests. Without that information, you will have no idea whether Dante is in safe numbers.

Another consideration is that you don't want to feed Dante within 2 hours before his shot time. You don't want food to influence the numbers. Lantus generally takes 2 hours to start working (this is called "onset") and reaches the lowest point in the cycle ("nadir") at approximately +6. When you feed Dante, as you mentioned, this causes his numbers to rise. The problem is you're shooting a food influenced number. You don't know just how low Dante's numbers will go once the food wears off.

I agree with Chris in that you want to be able to give a dose of insulin every 12 hours. If that means you need to reduce the dose, that's fine. Dante's numbers may run a little higher but you will be consistently giving him a shot.

 

[Chris & China (GA)]

OK, I will start the .25 dose tomorrow morning and night, but if he dips below 100, I don't shoot at all, correct??

Until you get a little more mid-cycle testing, I'd suggest if you get a Pre-shot under 150 that you stall, don't feed and post for help.

Test again in 20-3o minutes....if the number goes up (without the influence of food), it's probably going to be safe to go ahead and shoot.

As you learn more about how Dante responds, you will learn to shoot lower and lower numbers

 

[Chris & China (GA)]

Normally, I would wait an hour after he eats,

You want to NOT let him eat for the 2 hours immediately before shot time so the Pre-shot test isn't influenced by food.

Once you get the Pre-shot, if it's over 150, go ahead and Feed/Shoot.....all within about 5-10 minutes.

With Lantus, the onset isn't usually for 2-3 hours after the shot, so it's not necessary for them to eat a certain amount first. You will have time to get him to eat!

We usually Test/Feed/Shoot...all within that 5-10 minutes...You Test (to make sure they're high enough for insulin at all) Feed (to make sure they're at least willing to eat) and Shoot

 

[GA Carol & Dante]

Wow, Chris, Sienne, Thamk you! - you are incredible(!), I have been to 3 different vets, none of them told me to adjust according to the nadir, all looked only at the Pre-shot number! None of them told me to test more often, only exactly as I am testing now. After seeing your charts, I see how you know your numbers so well that you don't flinch at shooting low numbers; you sure didn't reach that point testing 2x daily like me!!! Got it! THANK YOU SOOOOO MUCH for sharing your wisdom!!

You're absolutely correct, I am shooting food-influenced numbers because I am still scared stiffless, (if that is a word) . Immediately after Dante was diagnosed I was taught incorrectly by the tech how to measure units in the syringe. Long story short: believing I was shooting 2 units 3 x within a 36-hour hour period was actually 20 units 3x in 36-hours for a total of 60 units. Dante went into severe shock after the 3rd shot and at the ER hospital his BG registered at 21. My vet's hospital paid the $2700.00 2-day ER hospital bill and also 60 units of Lantus after I informed them of incorrect instructions. Yes, I even had to practice with the tech by injecting water into the syringe, so that I understood how much a unit was. Now you can see why I am scared, so to see China's chart, I was blown away that Chris could shoot at low numbers and not have China in the hospital, seriously, I am waaaay too scared to do that, so I am completely in awe!! My hands would be trembling if I shot Dante at low numbers, so you guys are just amazing! Question: Sienne, viewing Gabby's SS, how are you able to shoot .51 or .48, units? What instrument are you using that allows your unit measurements to be so precise? Also, seeing a BG of 38 or anything <50 would scare me out of my wits!!!

More questions, sorry: So what is the ultimate BG goal? I thought 80-200 was normal, why do you still shoot below 75, and, at what range would be considered being in remission? Would you suggest I do a curve this weekend? To ensure I understand a curve, it is testing every 2 hours in between pre and post shots, right? Please correct me, thank you!

Ok, yes, I have the test/feed/shoot process down to about 5-10 minutes.

Got it, I will start additional pre/post shots tomorrow, also: Pre-shot at 6am =<150 wait 20 min, test again, if still <150, don't feed, don't shoot but post here. (his BG may go up due to stress from the delay in feeding...?) If second test is >150, feed, shoot .25 units and still post here! thank you! Hmm, will anyone be up that early in the morning though? If not, if still <150 before I go to work at 8:45am, do I shoot .25units?

FYI: (6am and 6pm Food: .75 oz Fancy Feast Classic+1.15 oz Slow cooker shredded (home-made)chicken+1.15 oz Weruva Kitty Gone Wild, Fowl Bal or La Isla Bonita, etc) Treats: Shaved Bonito flakes 2x daily before brushing his teeth, ugh!

Thank you sooo much for your time and patience with me!

 

[Chris & China (GA)]

Now you can see why I am scared, so to see China's chart, I was blown away that Chris could shoot at low numbers and not have China in the hospital,

If you look at China's Profile, you'll see her spreadsheets from day 1....we didn't start out shooting low!! It's all about testing enough to understand how your cat reacts to both food and insulin and gradually learning to shoot lower and lower numbers. The best three words we say around here are "Know Thy Cat!"

So what is the ultimate BG goal? I thought 80-200 was normal, why do you still shoot below 75, and, at what range would be considered being in remission? Would you suggest I do a curve this weekend? To ensure I understand a curve, it is testing every 2 hours in between pre and post shots, right?

You're wanting to stay in normal numbers as much time as possible....this allows the pancreas to hopefully heal. Normal numbers are 50-120 on a human meter.

A cat that can stay in normal numbers (with the majority of them under 100) for two weeks without insulin is considered in remission.

Yes, a curve is every 2 hours for 12 hours or every 3 hours for 18....but, if you test often enough, you don't need to do a "proper" curve at all. I never did one in the almost 5 years before China went OTJ, but I tested often enough "here and there" that I understood how China was doing. Getting spot checks at different points in the cycle gives you as much (if not more) information as a "curve"

Pre-shot at 6am =<150 wait 20 min, test again, if still <150, don't feed, don't shoot but post here. (his BG may go up due to stress from the delay in feeding...?) If second test is >150, feed, shoot .25 units and still post here! thank you! Hmm, will anyone be up that early in the morning though? If not, if still <150 before I go to work at 8:45am, do I shoot .25units?

During that first 20 minutes, go ahead and post so hopefully someone will come on and be there for the re-test......Not feeding for a few minutes shouldn't cause him a lot of stress (but it'll probably cause YOU some....LOL)

Someone is usually online 24/7 here. We have people from all over the world so when the last of the West coast members are heading to bed, the European's are getting up! You might want to add some extra information to your Signature, like Your name/cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues? and a general location. It just helps to have all that information there for anyone who's coming to help you.

If still under 150 and you have to leave, you're better off skipping the shot until you learn more about how Dante responds to shooting lower numbers. He may be higher by the next shot time, but he'll be safe. Better too high for a day than too low for a moment!!

 

[Sienne and Gabby (GA)]

The "secret" of those fractional doses is digital calipers. I bought mine through Harbor Freight. If you were to line up several syringes, you'll notice that the lines on the syringe may vary a bit. A way to compensate for the syringes being a bit "off" is to use calipers to measure the dose. We do have instructions for how to measure doses with calipers if you decide to go that route.

I want to underscore Chris' point. Nobody is comfortable shooting low at the outset. We work ourselves down to the point that we're able to shoot pretty much anything above 50. Trust me -- I don't think Chris was entirely comfortable shooting that first green number (and I was here when she did). Everyone has a healthy respect for low numbers and we're here to support everyone as they develop a comfort level. Further, you MUST be data ready to shoot low (See the Shooting & Handling Low Numbers sticky for information on becoming data ready.) You learn how to steer numbers and take a BG test and get a 38 and handle it without having a panic attack! (You do have a panic attack the first time, though!!)

FYI - on a human meter, normal BG is 50 - 120.

 

[GA Carol & Dante]

Great, thank you, duly noted. I have just updated my signature, thank you soooo much, I just don't know how to rename the link to the SS instead of showing the path, ugh! Curve info noted; as I am gone for 8 hours and test at 5:45am, I can do a second test every am and 2 tests at night after work. On weekends, I will do spot checks throughout the day until I "Know thy cat"! You're right, I was more stressed, Dante was perfectly fine with waiting for his food, hah! I will write more tonight, I have to get ready for work, THANK YOU!!!!

 

[GA Carol & Dante]

Sienne; Gotcha, will re-read again tonight, thank you so much, and I will go the caliper route, thank you. I wish I didn't have to work today, but unfortunately I will have to sign off temporarily, ugh!

 

[Myagi (GA) and Heidi]

 

[GA Carol & Dante]

Heidi, Hah, I love it!! Thank you for the cutest pic and encouragement!! Woo Hoo!! You are doing great with Myagi too! I need to start testing more often! I Like how you added a column for time, if you don't mind, I have copied your idea, easier than adding it to the notes! I am constantly seeing new things every time, Thank you!

 

[GA Carol & Dante]

Good Morning to all early-risers! So, I tested more frequently last night and Dante's BG stayed constant at 170 at +2, +3, +4 PMPS with .25 units; however, this morning, I just tested him at 5:00 and he is 130. This is where I am a bit scared, if I shoot him .25 units, (his swing is up to 150, so he may come down too low). If I don't shoot, his next pm BG will be really high. I know I don't have enough data, but now I 'see the light' as I am putting all of you in a difficult position! Previously, I would wait an hour after eating, then shoot at a higher, food influenced number and my vet was fine with this; thanks to Sienne, this is not good and I am not shooting for the correct numbers. At this point, I am going to wait and re-test in 15 min which will be 45 min later from first test, if Dante is still low, do I ship the shot? I don't know if I can measure anything less than .25 units accurately... I am going out today to buy the caliper that Sienne suggested as there is a local Freight Harbor store 30 min away. I have never used a caliper, and couldn't find the instructions offered on this site, so I will find a Youtube video. Thank you for your wisdom!

 

[Sienne and Gabby (GA)]

I know it seems like there's a big difference between 170 and 130 but once you factor in 20% for meter variance, they are pretty close to the same number (170 +/- 34 = range of 136 to 204).

You have a couple of options:

• shoot
• stall -- don't feed Dante, though. Wait 15 - 20 min and retest. If you're not yet comfortable with the pre-shot number, continue to stall.
• shoot a "BCS" (big chicken sh*t) dose. Shoot a reduced dose.
• skip

With shooting a reduced dose, you don't know whether the depot will kick in and if the lower dose will prevent numbers from dropping too much. If you stall, you will need to get back on your preferred schedule. Depending on how long you stall, it could make a mess of getting back on schedule.

A couple of considerations.... When you shoot, the new dose typically doesn't kick in for approximately 2 hours. You don't have enough data yet on Dante to know when his onset starts but you do have some time. You will also be feeding your kitty his breakfast. Food will cause numbers to rise. In addition, it's the end of the cycle and the effect of the insulin from the previous cycle is wearing off.

 

[GA Carol & Dante]

Thank you Sienne, I just tested a min ago and he went up to 156 at +1.5, without his shot. Are you able to measure .12.5 on a caliper? I am going to buy one today. If so, and if I had one, I would have shot .12.5, and be scared stiffless, hmm, I think I am making that my own vocabulary here...

 

[Sienne and Gabby (GA)]

Carol:

I hate to ask this, but can your reorganize Dante's spreadsheet so the most recent numbers are at the bottom? If you look at the spreadsheets here, we enter the data top down. For those of us who read spreadsheets on every cat, we are accustomed to looking at them in the same way. It's very hard to spot trends if your spreadsheet is "upside down."

To label the spreadsheet in your signature:

• Go to your spreadsheet and copy the URL (the http:// information) at the top of your browser;
• Get to your signature block set-up
• Typed whatever you want to name the spreadsheet (e.g., Dante's Spreadsheet)
• Highlight the name
• Click on the icon at the top of the text box that looks like a link/paperclip (If you hold your cursor over it, it will say "link"). A box will open.
• In the box, paste the location for Dante's spreadsheet.
• Click on "insert"

If I haven't missed anything, your spreadsheet should be named in your signature.

 

[GA Carol & Dante]

Of Course, I would have only had the courage to even think of shooting a .12.5 dosage because of you guys,otherwise, forget it!! I like the fact that I was given options, thank you!

 

[GA Carol & Dante]

Ah, my vets were repeatedly asking me to historically record with the most recent at the top, so I changed it; will revert, and thank you for the instructions, will do now.

 

[Sienne and Gabby (GA)]

Here's the post on using digital calipers.

 

[Tricia Cinco(GA) & Harvey]

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

You are in excellent hands with Sienne - she was invaluable to me when I first joined, so I won't offer any more advice, but I did want to share a link with you to a post we did to help new members become comfortable with our forum. Kind of an
FAQ. http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

I just don't know how to rename the link to the SS instead of showing the path, ugh!

It's easy. Go into the edit signature window and type the name you want to give your SS (like Dante's SS). Highlight it. Then click on the icon in your taskbar that looks like a link in a chain. Paste the URL for the spreadsheet in that box and click "insert. Viola! You use the same method to link your previous condo each day when you start your new one.

Keep asking questions. We love to help!

 

[GA Carol & Dante]

Thank you Sienne, I will read the link on calipers you just sent. Hello Tricia, thank you! I have been on the general forum, but felt I wasn't experienced/knowledgeable enough to be in the Lantus forum, I am still no, but willing to learn! Yes, Sienne is Fantabulous! As just stated, having support of such experienced and wise members, allows me to try something out of my comfort zone, or rather, for now, just 'Thinking' of going out of my comfort zone: shooting at anything below 100 is mind blowing to me! Thank you for instructions on editing the SS link as well!!!

 

[GA Carol & Dante]

Wow, Marje worked with me when I first joined, and after Sienne mentioned 'Caliper', I remembered Marje saying something about that; however, that was waaaay beyond my realm at that time! Thank you for the instructional link. Marje helped me with my second low BG crisis after Dante's initial hospitalization. she is another angel as you all are, thank you! Tricia, thank you for the link as well, I will be reading that one too!!

 

[GA Carol & Dante]

Ugh, so now I have reversed my SS, but the heading cannot be pasted to when I scroll I am not able to see the title in each row, any suggestions? Thank you! I bought the caliper and on my Reli On 3/10 ml 31 gauge 5/16" syringe, 1 unit =.65mm, does that sound right? I watched the video several times; however, she is using a different brand of syringes.

 

[GA Carol & Dante]

I just figured it out, I had to freeze the top 2 rows!

 

[GA Carol & Dante]

Hmm, Ok, so now, Dante's BG is at 104, I tested every 2 hours today, so without history it is still not enough data. I was told that if the BG was below 150, I am supposed to wait and retest in 20-30 minutes, unfortunately, Dante was screaming at 5:30 for food. and he just finished eating a few minutes ago. I have learned that I am not shooting for the current BG of 104, but what it will be in a few hours if I shoot him now. Should I just not shoot tonight, or try to measure and shoot .12.5 which is half of his current dosage of .25 2x daily? I bought the caliper yesterday, and I now understand why a light box is necessary! Thank you for any assistance!