11/25 Stasiu amps 405

JoannaDV1

JoannaDV1

Member Since 2019
After 8+ weeks of this, numbers are still high and we are up to 5.6U Lantus. Stasiu’s numbers seem to barely move. We have changed his food and are more strict about administering the Lantus every 12 hours. Could he be insulin resistant? Could something else be going on? Should we try different insulin? He is starving and fiends for his food.
 
Could you please update the BG numbers on the ss. It only goes up to the 22.

Thanks.

Also Good Job DH, I know you thought it was going to be difficult to get him on board with shooting and testing, great news you have been able to teach him.

I'm trying to figure out what to suggest but I'm a bit confused as to what I am looking at.

I see you have the relion now, my suggestion.
Just use that, forget about the AT (unless you need it for a back up or to run a curve for your vet if he/she doesn't like human meters), if you start comparing with them you will drive yourself completely nuts.

Make a clear note when you start solely using the relion, insert a line that marks it clearly on the SS so there is no confusion.

Could you also mark clearly where you have changed to just Fancy Feast. Could you please remind me what you changed from? Thank you.

He does seem to have some movement in numbers the last couple of days..
 
Gill & George said:
Could you please update the BG numbers on the ss. It only goes up to the 22.

Thanks.

Also Good Job DH, I know you thought it was going to be difficult to get him on board with shooting and testing, great news you have been able to teach him.

I'm trying to figure out what to suggest but I'm a bit confused as to what I am looking at.

I see you have the relion now, my suggestion.
Just use that, forget about the AT (unless you need it for a back up or to run a curve for your vet if he/she doesn't like human meters), if you start comparing with them you will drive yourself completely nuts.

Make a clear note when you start solely using the relion, insert a line that marks it clearly on the SS so there is no confusion.

Could you also mark clearly where you have changed to just Fancy Feast. Could you please remind me what you changed from? Thank you.

He does seem to have some movement in numbers the last couple of days..
Click to expand...
I updated the SS and had written in the Remarks section of the SS when I changed his food and when I started using Relion only.
When he was diagnosed with diabetes, the vet gave us D/M dry and moist food. We changed to FF pate classics on 11/12.
 
OK, one other thing if you could add shot times in the am and pm please.

I'm not sure about insulin resistance, there isn't enough info to support that one way or another.
On 11/22 he went from red to yellow, so he is getting some movement.


I know you want to be seeing nicer numbers, but I am concerned about the speed at which you are taking the dose up. Usually with those yellows you were getting in there you would want to hold on to the dose for 6 cycles.

It is important to understand that taking the dose up too quickly can result in you seeing higher numbers when they bounce off dropping too fast or lower than they are used to. With the data you have been able to get up until now and the frequent dose changes that you have made, I am not confident that you have got to this dose in a safe manner, I'm wondering if you have shot past a good dose. Especially when we factor in the food change of 11/12

We do sometimes fast trak doses, if a kitty is in high flat numbers, but, we do have to have the data to support us doing that confidently, and you haven't always had that with many nights not having any pm mdcycle tests. Take the night of 11/21, he was droppping into yellow at +2 then was up at red by morning, that makes me think that he may have dropped lower, perhaps even to blue, then his body, not being used too those lower numbers, will have bounced.

Bouncing is normal, but as far as dosing goes we largely ignore it and we have to concentrate on how low the dose is taking our cat in order to decide whether we need to increase/hold or reduce. Right now with the info we have, it's extremely hard to say.

So how do we move forwards.

  • hold for at least 6 cycles
  • continue with data gathering as you have been doing lately
  • a couple of tests each cycle, and follow up a sharp drop with a test an hour later to see if he continues to slide down. (like on 11/22, I would have got another test to see if he was dropping lower than that 266)

I'm going to ask a few other experienced members to take a look at Stasius SS and offer their opinion, and help you with a plan. They are usually on later because of their time zone.

In the meantime, have you had a look at the two dosing methods we use?
Which one did you wish to follow?

I was sort of guessing that you are more of a TR sort of a gal, given that you have been changing doses frequently. But do tell which as advice needs to be tailored to the dosing method
Here is a link that describes the two methods and what is required.

http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/
 
Joanna --

With the dosing methods we use, doses are changed in 0.25u amounts. I'm having a hard time figuring out how you're measuring amounts like 4.9, 5.4, 5.6, and 5.8u. Most of us struggle with some of the 0.25u amounts that don't fall on a full or half dose marking on a syringe. Are you using calipers?

With TR, which is the more aggressive of the dosing methods (and I suspect that's why Gill noted you may like this approach better than SLGS), you need to hold a dose for at least 3 days/6 cycles. The depot needs that amount of time to stabilize with each change in dose. If you don't allow the depot to stabilize, you may end. up over dosing your kitty.

I know you want to get Stasiu out of the high numbers. As Gill noted, you're beginning to see some breakthrough. Please don't rush the dose changes.
 
Sienne and Gabby (GA) said:
Joanna --

With the dosing methods we use, doses are changed in 0.25u amounts. I'm having a hard time figuring out how you're measuring amounts like 4.9, 5.4, 5.6, and 5.8u. Most of us struggle with some of the 0.25u amounts that don't fall on a full or half dose marking on a syringe. Are you using calipers?

With TR, which is the more aggressive of the dosing methods (and I suspect that's why Gill noted you may like this approach better than SLGS), you need to hold a dose for at least 3 days/6 cycles. The depot needs that amount of time to stabilize with each change in dose. If you don't allow the depot to stabilize, you may end. up over dosing your kitty.

I know you want to get Stasiu out of the high numbers. As Gill noted, you're beginning to see some breakthrough. Please don't rush the dose changes.
Click to expand...
What are calipers?
With the syringes I have, not sure how I’d see the 0.05 increase with a 0.25 increase, if that makes sense. The 1/2 unit markings are so close together.
 
JoannaDV1 said:
With the syringes I have, not sure how I’d see the 0.05 increase with a 0.25 increase, if that makes sense. The 1/2 unit markings are so close together.
Click to expand...

How are you measuring 5.6 then??
Maybe you could show us a pic of your syringe with what you call a 5.6 dose drawn??

most of us have needles with half unit markings and we can only really manage to draw doses in 0.25 unit steps
so 5
5.25
5.50
5.75


How are you doing
4.9
5.2
5.4
5.6
and so on........????

With a normal insulin syringe I would not be able to measure those doses you have recorded in your SS.
Just trying to understand what dose Stasiu is actually getting, to best advise.
 
Let me clarify. You said:
...not sure how I’d see the 0.05 increase with a 0.25 increase
Click to expand...

A half unit is written 0.5u. It's not 0.05u. The latter is a 20th of a unit.

I actually don't understand the piece of your response that I quoted, even if I read the 0.05u as a half unit. It looks like you've been tinkering with doses by 1/10 of a unit in some cases.

Part of why Gill and I are being so persnickety is that syringes all by themselves have a surprising amount of measurement error. If you line up a bunch of your syringes, you'll see the markings are not consistent. With the kind of increments you're noting, I have no idea how you are measuring the doses you're using in a consistent manner especially given the measurement error associated with the syringes.

One way to be consistent is with calipers and we can get you information on how to measure doses with calipers.
 
Like you said, when drawing up doses in these tiny syringes- it’s not very accurate. When I draw up 5.6, the 0.6 is a hair above the 0.5 mark. I am a nurse, in fact, a NICU nurse so I know about small doses.
 
Sienne and Gabby (GA) said:
Let me clarify. You said:

A half unit is written 0.5u. It's not 0.05u. The latter is a 20th of a unit.

I actually don't understand the piece of your response that I quoted, even if I read the 0.05u as a half unit. It looks like you've been tinkering with doses by 1/10 of a unit in some cases.

Part of why Gill and I are being so persnickety is that syringes all by themselves have a surprising amount of measurement error. If you line up a bunch of your syringes, you'll see the markings are not consistent. With the kind of increments you're noting, I have no idea how you are measuring the doses you're using in a consistent manner especially given the measurement error associated with the syringes.

One way to be consistent is with calipers and we can get you information on how to measure doses with calipers.
Click to expand...
So you’re basically saying to do 5, 5.25, etc- which makes sense. But I had been going on my vets recommendations.
 
Just saw that he dropped into Yellow from red at +2.

He may continue to drop into this cycle do you think you or hubby, could grab another test no later than +4?
We need to figure out how low he is going.
Thanks
 
JoannaDV1 said:
So you’re basically saying to do 5, 5.25, etc- which makes sense. But I had been going on my vets recommendations.
Click to expand...
Yes that is what we usually do.
But, and this is very important, we need to first know how low the dose is getting the cat before we move up in dose, we need to figure out what their nadir is.

With Lantus, because it is a depot insulin, in cat's it takes up to six cycles to get the full effect of the dose, so we need to (usually) wait that long between dose increases or else we risk overdosing the cat. It is our experience here on the board that there are still many vets that are not familiar with how to dose lantus, (ie based on nadir), tending to pay more attention to the Pre Shot values and not waiting long enough between increases.

Does that make sense to you?

Thanks for updating the other results.

To try and help you straighten things out, we could do with the following information from you. (you let me know if this is feasible

  1. more midcycle data, doesn't have to be full on curves, two tests ideally on each cycle mid cycle. Anytime between +1 and +11, whatever fits in with you, it is good to scatter them about at different points in the cycle, since they can nadir at anytime in the cycle. A well regulated cat on lantus will often nadir at +6, but until they are well regulated, it can happen at anytime. George nadired as early as +2 and as late as +12 before he became regulated.
  2. please show what times you are shooting, so we can see if we need to take those shot times into consideration. Lantus does need to be dosed 12 hours appart dosing less than 12 hours apart, because of the depot, can act like an increase, and conversely dosing more than 12 hours apart can act as a reduction. So when looking at the numbers and making any recommendations it is important to know if we have to bear longer/shorter cycles in mind
  3. Please always test before giving insulin, I know he has always been high, but will be high until he isn't and you need to know if it is safe to shoot. We don't want to see you in a situation where you are fighting to bring his numbers up. Given how the dose has been taken up, I am nervous that you could find yourself shooting without realising he is much lower than normal, only to find that you end up fighting to keep his BG up for hours, or worse.
What do you think? do you think you can work towards that? I know you have long shifts, but not sure how on board hubby is now, so perhaps this is attainable for you now?
 
Gill & George said:
Yes that is what we usually do.
But, and this is very important, we need to first know how low the dose is getting the cat before we move up in dose, we need to figure out what their nadir is.

With Lantus, because it is a depot insulin, in cat's it takes up to six cycles to get the full effect of the dose, so we need to (usually) wait that long between dose increases or else we risk overdosing the cat. It is our experience here on the board that there are still many vets that are not familiar with how to dose lantus, (ie based on nadir), tending to pay more attention to the Pre Shot values and not waiting long enough between increases.

Does that make sense to you?

Thanks for updating the other results.

To try and help you straighten things out, we could do with the following information from you. (you let me know if this is feasible

  1. more midcycle data, doesn't have to be full on curves, two tests ideally on each cycle mid cycle. Anytime between +1 and +11, whatever fits in with you, it is good to scatter them about at different points in the cycle, since they can nadir at anytime in the cycle. A well regulated cat on lantus will often nadir at +6, but until they are well regulated, it can happen at anytime. George nadired as early as +2 and as late as +12 before he became regulated.
  2. please show what times you are shooting, so we can see if we need to take those shot times into consideration. Lantus does need to be dosed 12 hours appart dosing less than 12 hours apart, because of the depot, can act like an increase, and conversely dosing more than 12 hours apart can act as a reduction. So when looking at the numbers and making any recommendations it is important to know if we have to bear longer/shorter cycles in mind
  3. Please always test before giving insulin, I know he has always been high, but will be high until he isn't and you need to know if it is safe to shoot. We don't want to see you in a situation where you are fighting to bring his numbers up. Given how the dose has been taken up, I am nervous that you could find yourself shooting without realising he is much lower than normal, only to find that you end up fighting to keep his BG up for hours, or worse.
What do you think? do you think you can work towards that? I know you have long shifts, but not sure how on board hubby is now, so perhaps this is attainable for you now?
Click to expand...
Thanks for the advice! I can test more when I am
home. On works days, that obviously won’t be possible since my husband isn’t home either- I only work 3 days a week. We are trying to shoot 6am and 6pm daily. I always try to get a value before I shoot- sometimes it just doesn’t work (the meter or the cat being cooperative)- I’ve been better about getting it to work lately.
Thank you!
 
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