Dosing advice for Nigel ASAP!

AmericanTemplar

AmericanTemplar

Member Since 2019
Hi there,

Nigel has been on 1u Lantus for about a week now, and got a Freestyle Libre installed on Sunday. His numbers have been low for the past couple of days and @MrWorfMen's Mom suggested that I don’t give him his morning dose, which he should be getting in a half an hour. Can others confirm?
 
Have you gotten the AMPS number yet?

Can you explain why you are doing 1u in the morning and 0.5u at night? Lantus is best given as one consistent dose. I think if you do shoot, I'd stick with 0.5u for now.
 
The inconsistent dosing wasn’t intentional, but in reaction to his low numbers the last couple of afternoons.

He’s at 118.
 
If you shoot, would you be able to monitor and do you have plenty of supplies on hand? If yes, stay with 0.5u.

Have you decided if you are following TR or SLGS?
 
He’s been on it for a week. Unfortunately, I’m not able to stick around today. It was suggested to skip his dose this morning in another thread in the main forum and see how it goes.

What does TR & SLGS mean. Still figuring all of this out as we’re new to all of this.
 
OK, if you are unable to monitor, then skip is the best thing to do.

TR=Tight Regulation
SLGS=Start Low, Go Slow

You can read the stickies about both.
 
Thanks! I’ve read both threads but I don’t fully understand the difference between the two methods. Is it just a matter of how dose increases/decreases are timed and the quantity of insulin that is adjusted?
 
It would be good to reread them and the other stickies, and also print out a copy of the hypo instructions/toolkit. It took me many times reading to mostly understand.
 
If I can make a recommendation, I'd start with SLGS for now, to give you a bit of a break (hopefully). That will give you time to learn more and get your handheld meter figured out. You can always change later if you'd like :)
 
Hi Grant, and welcome to you and Nigel.
I agree with @Mandy & Rex: The Lantus dose should be consistent. Lantus is a "depot" insulin and builds each shot on the preceding shot. This is one of the reasons for it's success. It doesn't "tank out" when the insulin is "gone". The key is to find a dose that you can shoot consistently and to follow either TR or SLGS with regard to how long to hold a dose and by how much to increase or decrease. You will have to determine which method is best for you and your lifestyle, so re-read the "stickies". If you are feeding any dry food at all, you have to follow SLGS.
At this point in Nigel's diabetes adventure, you have to take into consideration that you are just beginning. It takes at least a week to establish the Lantus "depot". So you should not be jumping around in dose. Every time you change the dose or skip a shot the "depot" needs to recalibrate itself.
Another thing to keep in mind is that Nigel's body needs to get used to Lantus and it may take a few months--even longer--for you to see the effect the insulin has on his blood glucose. Getting regulated and hopefully achieving remission is often compared to a marathon, rather than a sprint.
So ask as many questions as you need. Everyone here wishes the best for Nigel.
 
@Ella & Rusty & Stu(GA) thanks!

So should I be planning on sticking with 0.5u from here on out, given the drops that he’s had on a full unit?

I’ve reread the SLGS thread and will probably need to again. But, if that is the less demanding method, then that is what I’ll use.
 
AmericanTemplar said:
@Ella & Rusty & Stu(GA) thanks!

So should I be planning on sticking with 0.5u from here on out, given the drops that he’s had on a full unit?

I’ve reread the SLGS thread and will probably need to again. But, if that is the less demanding method, then that is what I’ll use.
Click to expand...
I think I would stick with the 0.5U for now. It will permit you to shoot consistently. You can certainly start with one method and later switch to the other if you decide to. TR is considered the more "aggressive" and is based on scientific protocol. The most important thing is to use the method that will work for you.
The food lists in www.catinfo.org that @Mandy & Rex cites are really good.
 
Previous thread

That should give the rest of you some back story- it's long though!
Cliffs notes version: Freestyle Libre sensor, huge drops after shots, low response to high carb dry, the greens have all been food managed with the first set using karo syrup, currently no high carb wet food.

Does that sum it up about right Grant?
 
Also, all of the info and suggestions given here is much more than I heard from the vet. She basically told me that Nigel would have the Freestyle Libre on for ten days to figure out dosing, then he’d have another check up in 6 months to see how he’s doing. She didn’t say anything about modifying dosage on my own.
 
majandra said:
Previous thread

That should give the rest of you some back story- it's long though!
Cliffs notes version: Freestyle Libre sensor, huge drops after shots, low response to high carb dry, the greens have all been food managed with the first set using karo syrup, currently no high carb wet food.

Does that sum it up about right Grant?
Click to expand...

Yes, he’s pretty much been just on low carb wet food for the past couple of days. Before that he was on a combo of low carb and slightly higher carb wet food. I gave him a little dry food last night, since it was all I had with a higher carb content. He’s taking to the Fancy Feast, but there isn’t enough in a can to last the whole day. Guess I’ll have to get a feeder. Should I get him the same wet food with gravy for higher carb food?
 
I just finished reading your other condo. Wow, you had some excitement this week. I'm glad you are skipping today, too!

If you look at the chart, you can find other FF flavors that have higher carbs - ie gravy added. If you need to give HC to boost his numbers, it's suggested you squeeze the gravy out and give that, not the food itself. Gravy is where all the carbs are.
 
Grant, I know you purchased the Relion Prime meter and that I suggested you take the time to learn to test while the Libre is in place so you can continue to monitor without missing a beat when the sensor runs out or in the event that it falls off early. Having done some more investigating into the use of the Libre I was quite surprised to find the following on the MyFreestyle site itself.

The FreeStyle Libre Pro sensor is not a replacement for self-monitoring of blood glucose.
Continue your normal testing routine while wearing the sensor.
​
I also found multiple user reviews suggesting the readings humans were getting on the Libre were sometimes high and sometimes low when compared with blood testing. It seemed both low and high BG level readings were problematic. Because the Libre is reading from interstitial fluid rather than blood, it's understandable that readings might not be identical to a blood test however the degree of difference noted in the comments I read were significant in some cases (50 points or more were reported).

So it seems to me that while the readings you are currently getting provide some relative information, I'm not convinced they are completely accurate as far as BG levels are concerned. I think for the sake of getting accurate readings, it would be best if you start learning to test Nigel's blood sooner rather than later.

While I know you are questioning whether Nigel is diabetic at all and I agree the diagnosis was arrived at, with less than what I would consider optimal medical testing, it's still possible Nigel is diabetic and needs a small dose of insulin so being able to test Nigel going forward is of paramount importance to keep him safe. Even if it is determined that Nigel is not diabetic now, I would strongly suggest that periodic testing of his BG would be prudent to ensure he isn't perhaps borderline. Catching diabetes early and treating ASAP increases the odds of the cat going into remission.

Please have a look at the testing videos if you have not already done so and ask any and all questions you might have about testing. I really think it will be time well spent in the search for a definitive answer regarding the diagnosis and keeping Nigel safe and healthy going forward.

​
 
Thanks for this @MrWorfMen's Mom ! I’m going to watch another video and give him a test with the Prime tonight.

So, the FL is showing him at 198 now. Should I hold off on the insulin tonight?
 

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Do you think you could try to get a test done with the Prime as well before his usual shot time?

Eta: what food did he eat today? You mentioned being out of fancy feast.
 
Is that a +10? Looks like he may need a bit of insulin (I'm thinking less than half unit right now) but with his BG behaviour the last few days, I'd rather wait until closer to shot time to render a final opinion. Do you think you can try for a blood test arountd +11.5?
 
Yeah, he had FF today. I just fed him and tried the test on him twice with the Prime with no luck. Tried it on myself as well and it didn’t work. Not sure if I got a dud or if I’m doing something wrong. I read the directions. Anyway I tested him with the Freestyle Libre as well and got 238 so have him about 0.5u. Seem like the right idea? I’ll try to figure out what could be wrong with the Prime. He hates the test by the way and doesn’t make it easy.
 
Ok so you know the drill.......+1 and +2 tests to see what Nigel is up to Ok?
The prime takes a bit more blood than some other meters so that may be the problem you are running into . If Nigel doesn't like his ears played with, make it a habit to play with them a bit at every opportunity without trying to test. Get him used to it one step at a time. More to follow shortly.
 
Good call in the treat. He shrivels up his ears when I play with them, so will try to do it more. Both times I used as much blood as was recommended but nothing happened.

Generally he’s acting kinda naughty tonight. First he knocked over a full beer and then I caught him licking the lube off of a bike chain.
 
Thanks for the giggle. I have a little menace too.....hence her name! :woot:

When testing, it can be helpful to warm the ear first. If you have an old Rx pill container fill with hot water and hold it on Nigel's ear for a few seconds before testing or use a hot washcloth in a baggie (don't get ear wet). It also helps if you put a thin skim of Vaseline on the spot you intend to poke. It helps the blood bead up so you can catch it with the strip rather than have it spread out into the fur on the ear.

Since he doesn't like his ears touched, if you can get a blood bead, you can catch it on your fingernail and then test from there. Just make sure your hands are clean so nothing skews the test results.

ETA Even if your test attempt is unsuccessful, give Nigel a treat so he comes to associate all the fuss with a treat.
 
MrWorfMen's Mom said:
Thanks for the giggle. I have a little menace too.....hence her name! :woot:

When testing, it can be helpful to warm the ear first. If you have an old Rx pill container fill with hot water and hold it on Nigel's ear for a few seconds before testing or use a hot washcloth in a baggie (don't get ear wet). It also helps if you put a thin skim of Vaseline on the spot you intend to poke. It helps the blood bead up so you can catch it with the strip rather than have it spread out into the fur on the ear.

Since he doesn't like his ears touched, if you can get a blood bead, you can catch it on your fingernail and then test from there. Just make sure your hands are clean so nothing skews the test results.

ETA Even if your test attempt is unsuccessful, give Nigel a treat so he comes to associate all the fuss with a treat.
Click to expand...
I think I’ve managed to get enough blood. The issue seemed to be something having to do with it not starting up correctly.
 
Ok. I am not familiar with the prime but experienced the same type of problem with a different meter. It seemed to be the way the strip got "seated" in the meter. I started putting the strip in and making sure the meter turned on properly, then pulling it back out just enough to turn the meter off so that when I was ready to get the sample on the strip, I could just push the strip back in quickly with it already in the right position.
 
Ok, that is both good and not so good. Great that you got the test. CONGRATS! GOOD JOB! A difference of 60 points is however significant and confuses the picture.
I'm going to suggest that you test again with the Prime at +2. Nigel may not have been as high as we thought at PMPS or he may have dropped a lot in this first hour. No way to know.
I like @majandra suggestion. Let's see what that adds to the mystery here.
 
Hmm, still quite higher than the prime. I'm curious to see if the FL will reach down to that 127, and how long it takes to do it.
I agree about getting your +2 with the Prime as Linda suggested.
 
Well that didn't really tell us anything much except that the reading on the FL are all over the map. I know BG changes constantly but that just seems a bit too erratic. I wouldn't bother trying to chase the numbers right now. There is the graph that we can look at tomorrow and see if it does match up within a half or full hour. Obviously it doesn't in 15 minutes. There's something to be said for the old technology!
 
I'm not sure what you did to share the graph the first time (Yesterday) but it was actually not too bad. The second one today was a bit smaller and harder to see.
 
Grant, your SS is showing a +1 tonight of 202 but I thought you got the Prime reading of 127 and the FL reading of 188 at +1. Can you clarify the difference please.

We need to be consistent here with what you're reporting here and what gets logged so anyone else helping is not totally confused (we are confused enough with the differing readings and we know what we are doing). I think now that you have been able to test successfully with the Prime at +2 we should start logging the Prime readings and put a note in the comments that the PMPS for tonight is from the FL and the rest are the Prime meter.
We can add a row to the spreadsheet below todays date and put a note there "Started use of Relion Prime".
 
MrWorfMen's Mom said:
Grant, your SS is showing a +1 tonight of 202 but I thought you got the Prime reading of 127 and the FL reading of 188 at +1. Can you clarify the difference please.

We need to be consistent here with what you're reporting here and what gets logged so anyone else helping is not totally confused (we are confused enough with the differing readings and we know what we are doing). I think now that you have been able to test successfully with the Prime at +2 we should start logging the Prime readings and put a note in the comments that the PMPS for tonight is from the FL and the rest are the Prime meter.
We can add a row to the spreadsheet below todays date and put a note there "Started use of Relion Prime".
Click to expand...

That was 10-15 after +1. I’m thinking now that I know that I can use the Prime, that maybe I should reserve it for when his BG dips into lower levels? I’d rather not have to prick him every 15 minutes during this period of bouncing numbers as long as I have the FL installed. Or do you think it’s too far off to trust it?
 
The problem is that with dropping numbers, you don't want a meter/reading that may be reading high. So while it's possible the Prime is reading a bit low I'd rather trust it and be able to take action as soon as needed than deal with a inaccurate high reading and not take action. Hypoglycemia is something you don't mess around with and a 60 point difference is very significant even at the higher numbers. It could be deadly at lower numbers. Sorry to both you and Nigel, but until we figure out what Nigel is doing, I think the safest thing is to use the Prime.
 
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