? Yoshi amps457 vet wants to increase to 2u

Hi Jennifer,
Your spreadsheet is beautiful graphically!
All the readings are still too high and none are dangerously low.
Assuming Yoshi is still drinking and urinating a lot and doing well otherwise, I recommend increasing the glargine insulin to 2 units twice a day.
Please continue checking the glucose levels before each insulin injection. We need to get his glucose readings lower than the 400s and 500s that you are recording.
My recommendation is an exam, fructosamine test with simultaneous glucose on the glucometer 3 weeks from now (assuming we do not end up increasing the dose before that time).
I know you don't want to come for the fructosamine and you want to do a glucose curve at home. If that's still your decision, please send me the curve in 3 weeks and we will schedule a 30 minute phone consult (cost $73) to go over the results and our plan for Yoshi instead of doing it in the hospital. The disadvantage to that plan is that I do not get to perform a physical exam or weigh him. I recommend that you purchase a baby scale so you can weigh him in pounds and ounces accurately.
As always, if he is not eating or if the readings are too low (below 200 in general), please let me know because we might decrease the insulin again if the readings are going below 200. Conversely, after a week, if his readings are still in the 400s and 500s, we will need to increase to 3 units twice a day, especially if he continues to drink and urinate excessively.
I know our original guidelines on August 31, 2019 when we first restarted the insulin were the following: "If the glucose is below 200, do not give insulin. If the second dose of the day is below 250, do not give the second dose of the day."
But now that you have been doing your readings at home consistently and he has been on 1 unit of insulin consistently with high glucose readings, I am editing the guidelines to say that you can give the insulin as long as he is eating and as long as the glucose readings do not fall below 200.

Here is what she wants to do ^ ***cross posted in main forum
 
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I think the 2U is a good idea because Yoshi needs a boost out of the high numbers. Take a look at Tina's spreadsheet at the beginning, and how we had to increase to 3 units to finally start getting nicer numbers. It's scary I wasn't testing more, and I'm so very thankful I found this forum.
 
Typically we increase in .25 dose increments. It's safer than single unit dose increases and it's possible Yoshi could improve on 1.25. He's definitely ready for an increase.

Sorry, but I just don't agree with everything your vet said; you don't need a fructosamine test to tell you what you already know.
You can weigh your cat at home.
You can increase the dose safely in .25 increments.
Testing frequently can tell you when he's going lower on his current dose.
You will need to learn how to dose below 200 - that's the only way you're going to get Yoshi to 'green' numbers - those are below 100...it'll come...many cats here are doing well (including Luci, my stubborn Luci) staying below 100 and it requires me to shoot low to stay low...

Best to you!
 
Sue and Luci said:
Typically we increase in .25 dose increments. It's safer than single unit dose increases and it's possible Yoshi could improve on 1.25. He's definitely ready for an increase.

Sorry, but I just don't agree with everything your vet said; you don't need a fructosamine test to tell you what you already know.
You can weigh your cat at home.
You can increase the dose safely in .25 increments.
Testing frequently can tell you when he's going lower on his current dose.
You will need to learn how to dose below 200 - that's the only way you're going to get Yoshi to 'green' numbers - those are below 100...it'll come...many cats here are doing well (including Luci, my stubborn Luci) staying below 100 and it requires me to shoot low to stay low...

Best to you!
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I know, @Sue and Luci. I don't agree with her either. I am going to increase a bit (I need half unit syringes desperately). I will likely start at 1.25 or 1.5 but I am not sure what that looks like on a 1 unit syringe. This board has been my lifesaver. I don't intend on disregarding any advice given here. I have shot below 200 when he was on prozinc, so I think I can do it with Lantus. I have to tread lightly with this vet. She could very well tell me to go somewhere else if I don't follow her protocol. Maybe I just won't say anything. I am for sure not moving to 2 u especially since I am not home to test.
 
Something very interesting the vet said, was that you might decrease insulin if he's going under 200.
What?
Safe is always better. So many cats linger in higher numbers for way too long though.
On 9/3, you got a 75 at PMPS on one unit. That looks very out of place. Any idea on that?!
 
Tina Marie and Jan said:
Something very interesting the vet said, was that you might decrease insulin if he's going under 200.
What?
Safe is always better. So many cats linger in higher numbers for way too long though.
On 9/3, you got a 75 at PMPS on one unit. That looks very out of place. Any idea on that?!
Click to expand...
I have no clue what was going on. I tested, there was a lot of blood, I got an error message, tested again and got a 75. He was super hungry when I got home that day and acting strange like scouring for food. In retrospect I am wondering if I didn't put enough food in his timer. I usually do. Or maybe he went too long without food. I honestly don't know. I just freaked out when I saw the 75. He hasn't been anywhere near it since.

He also could still be fighting a UTI. Getting urine checked again Friday
 
Jennifer

I am out of town now, but I will be back in Chicago Sunday and can come over and show you what the doses look like at 1.25 and 1.5 (I can bring over my calipers)

Are you using syringes with half unit markings?
I agree with Sue that you do not need the fructosamine test etc
Don't worry about your vet - I have a fantastic vet practice not very far from us (@Paigeworthy will attest) that knows all about feline diabetes and will be supportive

I am going out now and I can't' find it, but on a sticky there are instructions for what a half unit and .25 unit looks like
 
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Stressedcatmom said:
I am going to increase a bit (I need half unit syringes desperately)
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Are you anywhere near Walmart? Can you get the Relion U-100, 31 guage, 15/64's syringes? They're about $13 for a box of 100. They have lots of markings - I use calipers even with the markings. From Harbor Freight - about $14 for a little calipers will help you a lot once you get it set for your syringes - people here on the forum will help you get them calibrated.
 
If you are following TR, if the majority of nadirs are over 300, you can increase the dose by 0.5u. I realize you are following SLGS -- my point is that you can increase by 0.5 if you really feel the need. I would not increase Yoshi's dose to 2.0u -- that's double the largest dose increase based on any dosing method we use.

One thought is that you are generally testing enough to consider switching to TR. The advantage for Yoshi is that TR is more aggressive -- the doses are evaluated after 3 days vs. a week. You have the option to increase the dose by a larger amount (i.e., 0.5u) if nadirs are still high. Using TR may be a way to strike a compromise with your vet and still keep Yoshi safe by not increasing by 1.0u.

If I had to guess (or attempt to mind read), I suspect your vet is thinking about Lantus in much the same way as one would use Prozinc or a shorter acting insulin. She's focusing on the pre-shot number. As I'm sure you're tired of hearing, Lantus dosing is based on the nadir. Gabby was one of those kitties who could start the day in the 400s, drop into the 40s, and then bounce back to the 400s. If all you focus on are the pre-shot numbers, then I would have increased Gabby's dose vs. decreasing and ended up over dosing my cat.

Ultimately, you need to do what you're comfortable with.
 
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Stressedcatmom said:
I am comfortable with 1.5, but not 2.
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And this is critical, like Sienne said.
When I agreed with your vet on 2U, I wasn't considering your schedule too, like I should have. Plus I was going against the protocol. My reason: vets are not our enemy, and they can be right at times! I really want a new vet, but until then, I don't want to upset the one I have. Not always easy, because he has both helped, and hurt us. But he does want to learn.
Do consider TR!
 
I agree with Sienne. A 0.5 unit might be the a good but safe compromise. Time to get Yoshi into a better set of colours.
 
Thank you all for all your help. I’m getting beside myself. I shot a 2 last night and he’s 581 this am. I think he bounced last night while I slept. I intended to test him at +5 but I fell asleep.

I gave 1.5 this am. Again, I am eyeballing it. The syringe was a little passed the 1 unit mark, about half way. I’m going to hunt for syringes that have a half way mark after work. I will test before I leave at in an hour and a half
 
Sienne and Gabby (GA) said:
If you are following TR, if the majority of nadirs are over 300, you can increase the dose by 0.5u. I realize you are following SLGS -- my point is that you can increase by 0.5 if you really feel the need. I would not increase Yoshi's dose to 2.0u -- that's double the largest dose increase based on any dosing method we use.

One thought is that you are generally testing enough to consider switching to TR. The advantage for Yoshi is that TR is more aggressive -- the doses are evaluated after 3 days vs. a week. You have the option to increase the dose by a larger amount (i.e., 0.5u) if nadirs are still high. Using TR may be a way to strike a compromise with your vet and still keep Yoshi safe by not increasing by 1.0u.

If I had to guess (or attempt to mind read), I suspect your vet is thinking about Lantus in much the same way as one would use Prozinc or a shorter acting insulin. She's focusing on the pre-shot number. As I'm sure you're tired of hearing, Lantus dosing is based on the nadir. Gabby was one of those kitties who could start the day in the 400s, drop into the 40s, and then bounce back to the 400s. If all you focus on are the pre-shot numbers, then I would have increased Gabby's dose vs. decreasing and ended up over dosing my cat.

Ultimately, you need to do what you're comfortable with.
Click to expand...
I saw this after I shot last night. Ugh
 
Sue and Luci said:
Are you anywhere near Walmart? Can you get the Relion U-100, 31 guage, 15/64's syringes? They're about $13 for a box of 100. They have lots of markings - I use calipers even with the markings. From Harbor Freight - about $14 for a little calipers will help you a lot once you get it set for your syringes - people here on the forum will help you get them calibrated.
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I have a city Walmart, not a full one. I will call them this afternoon. Thank you
 
Carol & Murphy said:
Jennifer

I am out of town now, but I will be back in Chicago Sunday and can come over and show you what the doses look like at 1.25 and 1.5 (I can bring over my calipers)

Are you using syringes with half unit markings?
I agree with Sue that you do not need the fructosamine test etc
Don't worry about your vet - I have a fantastic vet practice not very far from us (@Paigeworthy will attest) that knows all about feline diabetes and will be supportive

I am going out now and I can't' find it, but on a sticky there are instructions for what a half unit and .25 unit looks like
Click to expand...
Thank you carol. I will message you. I think I’m going to have to switch vets.
 
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