diabetic cat on Lantus - unable to regulate

Laura, There is some interesting history on your excel spreadsheet that I think would be worthwhile including on the FDMB spreadsheet.

On Oct 22nd Chanel's AM preshot was only 97 but there is no data for the night previous so not sure if she got a shot or not or whether a pre shot test was done. Then on Dec 3rd, there was yet another AM pre-shot of 97 and no insulin was given that morning but a shot of 1.5u had been given the night before making me wonder just how low BG may have dropped and if the BG rise later on the 3rd is a bounce.

While the October data is a bit old, it still gives some dose history so if you can spare a few minutes to fill in the earlier data you collected, it may prove useful. All data is good data. :)
 
MrWorfMen's Mom said:
Laura, There is some interesting history on your excel spreadsheet that I think would be worthwhile including on the FDMB spreadsheet.

On Oct 22nd Chanel's AM preshot was only 97 but there is no data for the night previous so not sure if she got a shot or not or whether a pre shot test was done. Then on Dec 3rd, there was yet another AM pre-shot of 97 and no insulin was given that morning but a shot of 1.5u had been given the night before making me wonder just how low BG may have dropped and if the BG rise later on the 3rd is a bounce.

On October 21 she had her dental cleaning so she was still dizzy (actually dizzy for days, she would try to sleep with her eyes wide open and head up) so she did not eat anything but the soup from the Fancy Feast Chicken&Beef.
While the October data is a bit old, it still gives some dose history so if you can spare a few minutes to fill in the earlier data you collected, it may prove useful. All data is good data. :)
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Trying to get the papers in order. The main problem was that at that time the 400s values were probably mostly due to our inability to check her BG properly. We tried not to use the lancet device that came with the Alpha Trak2 because it was so loud she would jump up and run. After realizing that we actually get her to the point where she was hyperventilating, the vet suggested that it is better to come and have the BG checked at the hospital. Believe it or, their values were actually lower than ours so you can imagine how bad we were at it. The thing is that one time when we got to the vet she was 146 but they put her in a cage next to a cat who (I know I should use 'that' but for me cats and all animals are individuals too) was meowing a lot and she was in a lot of pain. So, one hour later, Chanel was 326. I will try my best in getting as much data as I can. In half an hour I have to get another BG value and give the insulin. If you look at the chart, today was just the opposite of yesterday and. I am so curious what her BG will look before insulin. Today she does not have a good day, she looks down and depressed. I am beginning to realize that I need to keep a very detailed journal about her (food, water, habits, medication, events etc.). Meanwhile, we bought One Touch Delica which is much better than the other device and I am not going back to poke her ear by hand only because last time I did, it was blood everywhere and I mean everywhere.
 
Laura Cristea said:
Trying to get the papers in order. The main problem was that at that time the 400s values were probably mostly due to our inability to check her BG properly. We tried not to use the lancet device that came with the Alpha Trak2 because it was so loud she would jump up and run. After realizing that we actually get her to the point where she was hyperventilating, the vet suggested that it is better to come and have the BG checked at the hospital. Believe it or, their values were actually lower than ours so you can imagine how bad we were at it. The thing is that one time when we got to the vet she was 146 but they put her in a cage next to a cat who (I know I should use 'that' but for me cats and all animals are individuals too) was meowing a lot and she was in a lot of pain. So, one hour later, Chanel was 326. I will try my best in getting as much data as I can. In half an hour I have to get another BG value and give the insulin. If you look at the chart, today was just the opposite of yesterday and. I am so curious what her BG will look before insulin. Today she does not have a good day, she looks down and depressed. I am beginning to realize that I need to keep a very detailed journal about her (food, water, habits, medication, events etc.). Meanwhile, we bought One Touch Delica which is much better than the other device and I am not going back to poke her ear by hand only because last time I did, it was blood everywhere and I mean everywhere.
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If you could please start a new thread tomorrow morning - each day we start a new post and reference this one from the previous day.

Just start out in the morning by creating a new post: 12/9 Chanel AMPS ### and copy/paste the url of this one into the top paragraph. Thank you!
 
I can understand that testing was difficult and I certainly didn't mean for my comments to come across as a criticism at all... just an observation. You are obviously doing all you can. I just found some of your older data interesting so just copying what is on your excel spreadsheet over to our sheet would be helpful. :)

On the testing front, it sounds like you hit the vein to get so much blood. It happens and sometimes it's hard to see exactly where you are poking. I am not familiar with the One Touch Delica but you may find you need to remove the cap from the lancing device so that you can clearly see where you are poking Chanel's ear.
 
MrWorfMen's Mom said:
I can understand that testing was difficult and I certainly didn't mean for my comments to come across as a criticism at all... just an observation. You are obviously doing all you can. I just found some of your older data interesting so just copying what is on your excel spreadsheet over to our sheet would be helpful. :)

On the testing front, it sounds like you hit the vein to get so much blood. It happens and sometimes it's hard to see exactly where you are poking. I am not familiar with the One Touch Delica but you may find you need to remove the cap from the lancing device so that you can clearly see where you are poking Chanel's ear.
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Oh trust me, I know I am guilty and I would accept any criticism just to get Chanel on the right path. That said, I do not think your words were anything any close to criticism. Actually, your posting is encouraging me to get as much data as I can because looking by myself, I feel that I am crazy but having you looking at it would help with a fresh view. The values of today were: 324(am preshot, 1U) - 301 (+4hrs) - 229 (+8hrs) - 173 (pm preshot). Now the question is this: how much insulin should I give her? Yesterday she had 1.5U in the morning and kept getting higher BG values. Last night I gave her only 1U and she got from 385 last night (371, 3 hours later) to 324 this morning. I am tempted at this point to decrease the dose again, maybe to 0.75U? She mostly eats at night and she eats dry food and that should show in her BGs but it does not. She almost always gets better BGs before the shot when presumably the insulin wears off. Oh my, what should I do? Please let me know your thoughts.
 
Laura Cristea said:
Now the question is this: how much insulin should I give her?
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When you have a little more data, you want to shoot the scheduled dose if she's 150 or higher.

The first few times you get a PS under 150, you want to stall, don't feed and test again in 20-30 minutes. Post for help during that 20-30 minutes and make sure your subject line say something like "STALLING, NEED HELP" to grab someone's attention (you can always edit it back later when you have someone watching)

We have a tradition here...if someone encourages you to shoot a lower number, they will stay online to watch you and make sure everybody is safe as long as necessary (or they will find someone else to take over). Many times in the past I've spent most of the night up with someone to make sure their cat is OK and they're comfortable with what's going on.

If the number comes up without food, it's usually going to be fine to go ahead and shoot, but the first few times you'll want to get a +1 and +2 so if you need to intervene, you can do it early.

Laura Cristea said:
I am tempted at this point to decrease the dose again, maybe to 0.75U?
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We do need to find one dose that you're willing and able to give both AM and PM. Lantus works best with a consistent dose. With all the changes in dose you've done lately, the depot hasn't had a chance to stabilize and show you what it can do.

How about dropping back to 1U for several days (unless she drops too low) and let's see how she does?
 
Sorry just seeing your post and it appears you decided to try 0.5u. With the sparse data, it's hard to suggest what to do but you are on the right path now.

Lantus works best when dosing is consistent so no matter what pre-shot reading is, you should hold a dose for a week and see how Chanel does. Lantus is a depot insulin so it takes several cycles to get the depot built up and really see how the dose is working for her. I personally don't think 0.5u is a bad place to start but others may have a different view. From my perspective, she appears to be either an extremely late nadir kitty or she is going lower overnight and then bouncing from lower BGs that you haven't been seeing. The latter can suggest the dose is too high. Most cats on Lantus will hit nadir (lowest point in the cycle) between +4 and +7 but some can be a bit earlier and some a bit later.

You will need to follow Start Low and Go Slow dosing method due to the dry food Chanel is still eating. If her BG should drop below 90, then she earns a dose reduction and we do reductions in 0.25u increments. This sticky outlines the SLGS dosing method we use here.

I suggest you test Chanel again around +2 or +3 post shot tonight and see what BG is then. Those early tests at night can give some good clues as to whether it's going to be an active cycle or not. If BG at +2 or +3 is lower than pre-shot then it's likely to be active and more testing may be needed. If BG hasn't moved or is higher early on, I'd still get a test before bed just to be sure Chanel isn't dropping and stays safe through the night.

Lantus is dosed based on how low a dose is dropping BG so mid cycle tests are critical. If you are working full time then grabbing tests whenever you can is key and use the weekend or days off to get tests in that expected nadir timeframe from +4 to +7 post shot or do a curve which is testing every 2 hours for 12 hours or every 3 hours for 18 hours to see how her cycles look.

Let's see what Chanel does tonight.
 
Chris & China (GA) said:
When you have a little more data, you want to shoot the scheduled dose if she's 150 or higher.

The first few times you get a PS under 150, you want to stall, don't feed and test again in 20-30 minutes. Post for help during that 20-30 minutes and make sure your subject line say something like "STALLING, NEED HELP" to grab someone's attention (you can always edit it back later when you have someone watching)

We have a tradition here...if someone encourages you to shoot a lower number, they will stay online to watch you and make sure everybody is safe as long as necessary (or they will find someone else to take over). Many times in the past I've spent most of the night up with someone to make sure their cat is OK and they're comfortable with what's going on.

If the number comes up without food, it's usually going to be fine to go ahead and shoot, but the first few times you'll want to get a +1 and +2 so if you need to intervene, you can do it early.



We do need to find one dose that you're willing and able to give both AM and PM. Lantus works best with a consistent dose. With all the changes in dose you've done lately, the depot hasn't had a chance to stabilize and show you what it can do.

How about dropping back to 1U for several days (unless she drops too low) and let's see how she does?
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Thank you for the info. Did not know that I can actually stall, unfortunately still learning and reading through the material. I will test her again in 1.5 hours and post it.
 
MrWorfMen's Mom said:
Sorry just seeing your post and it appears you decided to try 0.5u. With the sparse data, it's hard to suggest what to do but you are on the right path now.

Lantus works best when dosing is consistent so no matter what pre-shot reading is, you should hold a dose for a week and see how Chanel does. Lantus is a depot insulin so it takes several cycles to get the depot built up and really see how the dose is working for her. I personally don't think 0.5u is a bad place to start but others may have a different view. From my perspective, she appears to be either an extremely late nadir kitty or she is going lower overnight and then bouncing from lower BGs that you haven't been seeing. The latter can suggest the dose is too high. Most cats on Lantus will hit nadir (lowest point in the cycle) between +4 and +7 but some can be a bit earlier and some a bit later.

You will need to follow Start Low and Go Slow dosing method due to the dry food Chanel is still eating. If her BG should drop below 90, then she earns a dose reduction and we do reductions in 0.25u increments. This sticky outlines the SLGS dosing method we use here.

I suggest you test Chanel again around +2 or +3 post shot tonight and see what BG is then. Those early tests at night can give some good clues as to whether it's going to be an active cycle or not. If BG at +2 or +3 is lower than pre-shot then it's likely to be active and more testing may be needed. If BG hasn't moved or is higher early on, I'd still get a test before bed just to be sure Chanel isn't dropping and stays safe through the night.

Lantus is dosed based on how low a dose is dropping BG so mid cycle tests are critical. If you are working full time then grabbing tests whenever you can is key and use the weekend or days off to get tests in that expected nadir timeframe from +4 to +7 post shot or do a curve which is testing every 2 hours for 12 hours or every 3 hours for 18 hours to see how her cycles look.

Let's see what Chanel does tonight.
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OK, then I will test her again in 1.5 hours and post it.
 
Laura Cristea said:
Believe it or, their values were actually lower than ours
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Most cats read higher at the vet, however some cats go lower after a vet visit. Rover certainly did. I'm wondering if you have a cat that starts to go lower on the car ride to the vet or during the visit. Just a thought.

The testing will become easier, I promise. And yes, we all hit the vein every so often. Throw a dollar in the pot each time and eventually you will have enough for a decent bottle of wine.
 
Red & Rover (GA) said:
Most cats read higher at the vet, however some cats go lower after a vet visit. Rover certainly did. I'm wondering if you have a cat that starts to go lower on the car ride to the vet or during the visit. Just a thought.

The testing will become easier, I promise. And yes, we all hit the vein every so often. Throw a dollar in the pot each time and eventually you will have enough for a decent bottle of wine.
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Chanel absolutely hates going in the car and she can go as far as hyperventilating. And true, the testing became easier, even Chanel does not seem to fight it as much. At the vet they call her Velcro because she would try to hide under anyone's coat or neck and trembling. Unfortunately, Chanel does not fight nor flight, she always gets paralyzed by her fear. I wish she would run or at least scratch or bite.
 
Laura Cristea said:
Chanel absolutely hates going in the car and she can go as far as hyperventilating. And true, the testing became easier, even Chanel does not seem to fight it as much. At the vet they call her Velcro because she would try to hide under anyone's coat or neck and trembling. Unfortunately, Chanel does not fight nor flight, she always gets paralyzed by her fear. I wish she would run or at least scratch or bite.
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Have any of the doctors ever tried gabapentin on her? It is good with some cats to calm them down. You should ask them about it prior to an office visit. You can sprinkle it on top of her food about an hour before her visit.
 
Laura Cristea said:
Chanel absolutely hates going in the car and she can go as far as hyperventilating. And true, the testing became easier, even Chanel does not seem to fight it as much. At the vet they call her Velcro because she would try to hide under anyone's coat or neck and trembling. Unfortunately, Chanel does not fight nor flight, she always gets paralyzed by her fear. I wish she would run or at least scratch or bite.
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Ask the vet to prescribe gabapentin for future vet visits. It is used for vet visit anxiety, especially with ferals.
 
Red & Rover (GA) said:
Ask the vet to prescribe gabapentin for future vet visits. It is used for vet visit anxiety, especially with ferals.
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We had gabapentin including for the days before dental cleaning when she was in so much pain. She did not like the taste and she always managed to spit it out, or at least most of it. As for the dental cleaning, the vet said that she touched one of her bad teeth while Chanel was under general anesthesia. Chanel started convulsing right then. I think that may prove how much pain she was in, God only knows for how long.
 
Or could be too low a dose causing the numbers to go up. Time will tell. Today’s depot gave you a blue PMPS, but there were three cycles of 1.5 units in that depot. 1 unit might be a better place.
 
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