? New-completing first 2 weeks on insulin- 3 questions

[AnneforMarley]

Marley, age 10, has settled into this insulin regime after 2 weeks. He comes over now when I prepare the glucometer as he knows he usually gets a meal or a treat! I found the blood sampling stressful the first few times, but now it is easy, and he is also cooperative and so a good experience. He is on a mix of soft food: DM Purina (despises it alone!) mixed with Whiskas pates, and sometimes Fancy Feast fish and shrimp. Activity level: low in winter. Even after 2 weeks I think his peripheral neuropathy has cleared as doing stairs normally now. 5 Ps all present!
I sent my vet the results 5 days ago, and she sent me this email:
“Hi Anne,
I apologize for the telephone tag last week. Thank you for sending me the chart you have been keeping for Marley. This is very helpful, feel free to send any further updates to this email and I can put it all in her file.
Also thank you for the recommended website. I find my day is so busy I don’t have time to look into those types of things but it is and will be a good resource we can pass on to other clients.
As for Marley’s blood glucose curves, the low BG readings are concerning and I’m glad you reduced the dose and skipped a few as well. I am typically happy with blood glucose readings between 6-10 for cats as they will increase their levels by a few units due to stress which is often endured during blood sampling. I also find some patients take a few weeks (7-14 days) to level out and can become more sensitive to the insulin towards the end of the 2 week starting period as their body adjusts to the medication.
With this in mind my suggestion would be to try and give 1/2 a unit twice daily and see if this gives a more consistent curve so that treatments don’t have to be skipped.
Continue to keep me posted and let me know if you have any questions.”

1. Looking for feedback re what my target PMPS tonight should be given the reduced dose was held this morning and Marley’s blood sugars today were reasonable.

2. How long am I a “newbie”? When do I post on the lantus forum?

3. How are people measuring smaller doses such as .25 units in case I go in that direction? There are no markers, and I now use the 3 mL insulin pet syringe with .5 unit markers. I have seen people record drop, and I saw one person record small fractions in other posts!

With gratitude for your help,
Anne

 

[Ann & Scatcats]

Uj, we are lifelong diabetic newbies There is always things that happens and changes made.


I bump this for you so you get the help from the others who helped and replied to you from the start. So they See You.

 

[Veronica & Babu-chiri]

Hi and welcome!

Congratulations on having all the testing going so well !!

Feel free to post in the Lantus forum any time you want

You do not mention if you are following Tight regulation or SLGS ?

I'm guessing the 12.9 is a typo, or maybe you typed the mmol/L value in the mg/dl sheet please confirm

In any case since you are already starting to have some very good numbers going towards low please do read very carefully all the information about Hypo (http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/) and prepare a hypo kit (http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/) just in case hopefully you will never need it but is better to be safe than sorry

Regarding the DM purina you do not necessarily have to feed him that if he won't eat it, it can be any other food he actually likes as long as it is low in carbohydrates (10% or less) and as high in protein as possible, take a look to Dr Lisa's list if you haven't already there you can find quite a few options and maybe find one he likes better

By looking at his SS I do think he still needs a bit of insulin so I do think you could try 0.25 for a few days and see how he reacts to that dose, but you could ask in the Lantus forum for some other opinions

. How are people measuring smaller doses such as .25 units in case I go in that direction? There are no markers, and I now use the 3 mL insulin pet syringe with .5 unit markers. I have seen people record drop, and I saw one person record small fractions in other posts!

to measure 0.5 units you can either eye ball the amout placing the plunger in the middle between the zero line and the 0.5 marker ( as long as you are consistently giving the same every shot is ok ) pretty much like you did for 0.75 units or use a caliper (this is the link for that http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/)

For the 0.1 unit you will place the plunger almost in the zero line and for the drops you will have to see if you actually put the plunger at zero how many drops you still get so that you can adjust the plunger till only one drop comes out, I use BD syringes with half unit marks and this is how 0.1 and drop looks

 

[Diane Tyler's Mom GA]

Marley, age 10, has settled into this insulin regime after 2 weeks. He comes over now when I prepare the glucometer as he knows he usually gets a meal or a treat! I found the blood sampling stressful the first few times, but now it is easy, and he is also cooperative and so a good experience. He is on a mix of soft food: DM Purina (despises it alone!) mixed with Whiskas pates, and sometimes Fancy Feast fish and shrimp. Activity level: low in winter. Even after 2 weeks I think his peripheral neuropathy has cleared as doing stairs normally now. 5 Ps all present!
I sent my vet the results 5 days ago, and she sent me this email:
“Hi Anne,
I apologize for the telephone tag last week. Thank you for sending me the chart you have been keeping for Marley. This is very helpful, feel free to send any further updates to this email and I can put it all in her file.
Also thank you for the recommended website. I find my day is so busy I don’t have time to look into those types of things but it is and will be a good resource we can pass on to other clients.
As for Marley’s blood glucose curves, the low BG readings are concerning and I’m glad you reduced the dose and skipped a few as well. I am typically happy with blood glucose readings between 6-10 for cats as they will increase their levels by a few units due to stress which is often endured during blood sampling. I also find some patients take a few weeks (7-14 days) to level out and can become more sensitive to the insulin towards the end of the 2 week starting period as their body adjusts to the medication.
With this in mind my suggestion would be to try and give 1/2 a unit twice daily and see if this gives a more consistent curve so that treatments don’t have to be skipped.
Continue to keep me posted and let me know if you have any questions.”

1. Looking for feedback re what my target PMPS tonight should be given the reduced dose was held this morning and Marley’s blood sugars today were reasonable.

2. How long am I a “newbie”? When do I post on the lantus forum?

3. How are people measuring smaller doses such as .25 units in case I go in that direction? There are no markers, and I now use the 3 mL insulin pet syringe with .5 unit markers. I have seen people record drop, and I saw one person record small fractions in other posts!

With gratitude for your help,
Anne

Hi Anne to measure 0.25 units on the syringe that have half unit markings
You put the top of the plunger in between the first long line and the 0.5 unit mark
That would be 0.25 units
You do have syringes with half unit markings correct
You just eye ball it the best you can
So right now you are giving 0.5 units is that correct

 

[Lisa and Witn (GA)]

I don't have any advice to offer, but wanted to tell you are doing a great job.

 

[Sienne and Gabby (GA)]

You are welcome to post on the Lantus board at any point once you've got your spreadsheet set up -- which you do! I'd encourage you to look over the sticky notes at the top of the Lantus board if you haven't done so already. You will likely want to read the sticky about dosing methods so you can decide which approach to dosing you'd prefer to follow.

 

[Deb & Wink]

I am typically happy with blood glucose readings between 6-10 for cats as they will increase their levels by a few units due to stress which is often endured during blood sampling. I also find some patients take a few weeks (7-14 days) to level out and can become more sensitive to the insulin towards the end of the 2 week starting period as their body adjusts to the medication.

So your vet likes to keep cats just below renal threshold, not necessarily in normal non-diabetic numbers.

6 mmol/L x 18 = 108 mg/dL
10 mmol/L x 18= 180 mg/dL below renal threshold

We on the other hand know that some cats can achieve remission. Become diet controlled and not need insulin at all. Those normal non-diabetic numbers would be <100 mg/dL (<5.5 mmol/L)

Ann, what is your goal for Marley? Just below renal threshold like your vet is happy with? Or do you want to try for remission?

2. How long am I a “newbie”? When do I post on the lantus forum?

When ever you feel you are ready.

1. Looking for feedback re what my target PMPS tonight should be given the reduced dose was held this morning and Marley’s blood sugars today were reasonable.

do you mean you did not do the shot this AM? Is that what you mean by held? We call that a "skip".

Or do you mean you did a stall without feeding?

Target is anything above 150 mg/dL (8.3 mmol/L) for now.

 

[AnneforMarley]

Uj, we are lifelong diabetic newbies There is always things that happens and changes made.


I bump this for you so you get the help from the others who helped and replied to you from the start. So they See You.

Hello Ann from Anne-YES, we are life long learners, and so much to learn and grow. Thank you for your thoughtfulness in bumping me. I have no idea how you do it, but it worked. Sorry about the delay, as I was out for the evening. This is my first email ever from Sweden!

 

[AnneforMarley]

Hi and welcome!

Congratulations on having all the testing going so well !!

Feel free to post in the Lantus forum any time you want

You do not mention if you are following Tight regulation or SLGS ?

I'm guessing the 12.9 is a typo, or maybe you typed the mmol/L value in the mg/dl sheet please confirm

In any case since you are already starting to have some very good numbers going towards low please do read very carefully all the information about Hypo (http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/) and prepare a hypo kit (http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/) just in case hopefully you will never need it but is better to be safe than sorry

Regarding the DM purina you do not necessarily have to feed him that if he won't eat it, it can be any other food he actually likes as long as it is low in carbohydrates (10% or less) and as high in protein as possible, take a look to Dr Lisa's list if you haven't already there you can find quite a few options and maybe find one he likes better

By looking at his SS I do think he still needs a bit of insulin so I do think you could try 0.25 for a few days and see how he reacts to that dose, but you could ask in the Lantus forum for some other opinions


to measure 0.5 units you can either eye ball the amout placing the plunger in the middle between the zero line and the 0.5 marker ( as long as you are consistently giving the same every shot is ok ) pretty much like you did for 0.75 units or use a caliper (this is the link for that http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/)

For the 0.1 unit you will place the plunger almost in the zero line and for the drops you will have to see if you actually put the plunger at zero how many drops you still get so that you can adjust the plunger till only one drop comes out, I use BD syringes with half unit marks and this is how 0.1 and drop looks
View attachment 51763 View attachment 51764

Thank-you Veronica! Lots of useful information here for me. Yes, I corrected the typo error due to conversion. I am slowly getting rid of the expensive Purina DM diet with the vet prescription ($70.00 Canadian worth!) by halving it with other low carb options. The article on the digital calipers was interesting. That seems like a safe way to show someone else who may be drawing up these small doses in the future.

Appreciate all this information. p.s. Visited Mexico City last year- absolutely LOVED it- such rich history, culture, and amazing museums and art galleries!

 

[AnneforMarley]

You are welcome to post on the Lantus board at any point once you've got your spreadsheet set up -- which you do! I'd encourage you to look over the sticky notes at the top of the Lantus board if you haven't done so already. You will likely want to read the sticky about dosing methods so you can decide which approach to dosing you'd prefer to follow.

Yes, I think the SLGS I will try to follow. Are there different moderators for the different groups? Thank-you!

 

[AnneforMarley]

So your vet likes to keep cats just below renal threshold, not necessarily in normal non-diabetic numbers.

6 mmol/L x 18 = 108 mg/dL
10 mmol/L x 18= 180 mg/dL below renal threshold

We on the other hand know that some cats can achieve remission. Become diet controlled and not need insulin at all. Those normal non-diabetic numbers would be <100 mg/dL (<5.5 mmol/L)

Ann, what is your goal for Marley? Just below renal threshold like your vet is happy with? Or do you want to try for remission?

When ever you feel you are ready.
do you mean you did not do the shot this AM? Is that what you mean by held? We call that a "skip".

Or do you mean you did a stall without feeding?

Target is anything above 150 mg/dL (8.3 mmol/L) for now.

Hello again, Deb: My goal for Marley is absolutely remission. I did realize that the vet recommendation was more loose then on this website. I have changed the wording to a skip. So I did skip at the AMPS of 83. The PMPS was 175, and the lowest reading in the middle was 144. That means that Mrley will have gone 24 hours with no insulin....

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.
• Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
  • a.) give nothing
  • b.) give a token dose (10-25% of the usual dose)
  • c.) feed as usual, test in a couple of hours, and make a decision based on that value
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

So, do you think I made the right decision with a. As I was leaving for the evening, c was not an option, and I think the "token dose" might add to the confusion as I have been on 3 different doses in the 2 weeks: 1 unit then .5, and now the recommendation for .25 units lantus.


I have only done a stall once, but during a stall, is it important to keep the cat fasting or without feeding? I did not do that. I allowed Marley to eat a bit, then retested, and he ate more, and then I gave the delayed insulin dose.

Looking forward to your wisdom! Anne

 

[AnneforMarley]

Hi Anne to measure 0.25 units on the syringe that have half unit markings
You put the top of the plunger in between the first long line and the 0.5 unit mark
That would be 0.25 units
You do have syringes with half unit markings correct
You just eye ball it the best you can
So right now you are giving 0.5 units is that correct

Yes, I went out and purchased the 3 unit syringes with half unit markings. It is a challenge but I find using my 8 times makeup magnifier mirror helpful!
I think I will try callipers. I am giving 0.5 units, but there is a suggestion that I should try 0.25 units twice a day. I appreciate your help!

 

[AnneforMarley]

I don't have any advice to offer, but wanted to tell you are doing a great job.

Thank you for the words of encouragement. I was actually an intensive care nurse, and then a nurse educator and I became very competent with short acting insulins and continuous infusions. Now I work in a clinic that includes many non-compliant diabetics on long acting insulins such as lantus daily.
But this is a whole different knowledge base and language and I am filled with awe and inspiration by you all!

 

[Deb & Wink]

During a stall, you do not feed. Fasting. Wait 20 minutes, test, if BG reading is above your threshold, you go ahead and shoot. If BG still too low, you stall again, 20 minutes, retest, if above threshold, give shot.

If your schedule does not allow you to stall more than once, or your schedule does not allow you to stall at all, and the BG number is not above your threshold number, then skip.

Between 150 and 200, which that 175 was, I would have given a token dose. Simply to get some insulin in Marley and keep the "depot" from draining so much.

 

[AnneforMarley]

During a stall, you do not feed. Fasting. Wait 20 minutes, test, if BG reading is above your threshold, you go ahead and shoot. If BG still too low, you stall again, 20 minutes, retest, if above threshold, give shot.

If your schedule does not allow you to stall more than once, or your schedule does not allow you to stall at all, and the BG number is not above your threshold number, then skip.

Between 150 and 200, which that 175 was, I would have given a token dose. Simply to get some insulin in Marley and keep the "depot" from draining so much.

Got it! I like that idea of keeping the "depot" from draining.

One quick question: with a reading of 144 two hours prior to the PMPS, and no nadir reading today what would you do? maintain or decrease to 0.25 units which was one recommendation.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

 

[Sienne and Gabby (GA)]

The moderators are for the entire website. We are not specific to any one particular board. We're more problem solvers if there are issues with a post that needs to be moved, dealing with spam, helping to get an exchange between members resolved, etc. As it turns out, the current moderators also have been on the FDMB site for a long time. I've been a member for over 10 years.

 

[Deb & Wink]

One quick question: with a reading of 144 two hours prior to the PMPS, and no nadir reading today what would you do? maintain or decrease to 0.25 units which was one recommendation.

I'd wait and see what the PMPS was. No harm in dropping back to the 0.25U dose for a bit. Dose may need to go up again in the future.

Because of the dry food, you have no choice of dosing protocol and must use SLGS (Start Low Go Slow). If you can ever wean Marley off the dry food, than TR (tight regulation) would be an option for you. From the protocol for TR "Feed a high quality low carb canned or raw food diet."

If the BG at PMPS met the decision threshold, I'd shoot the last good dose. As long as you're around to monitor.
ECID Every Cat is Different, Every Caregiver is Different, Every Cycle is Different.

You have to test enough to know when the onset, nadir, duration, overlap is for YOUR cat with THIS insulin. So there is often more testing needed at the beginning of this journey with diabetes to determine those data points.

If you have enough test data to know when YOUR cat onsets with this insulin, had done some testing on either side of the typical +6 time to know when your cat nadired usually, and knew that your cat would go eat if you left out some food for the middle of the cycle, it's usually safe with Lantus to shoot. Gentler curve then some of the in-and-out insulins, so it can (but not always) keep cats in safer BG ranges.

As Sienne and Gabby (GA) said, moderators are more for keeping the message board running smoothly. Different people with different levels of experience help out in the forums they feel more comfortable in. I'm a good generalist with most of the insulins and medium level FD knowledge. I tend to leave the Lantus dosing advice to the people that hang out on the Lantus ISG more, unless asked specifically for help. That is more because of personal time constraints in life and other responsibilities than anything else. Besides, there are a lot more people in the Lantus ISG that know the nuances of using the protocols than I do. So I leave it to the "experts."

I'll never get everything exactly right with the different protocols for all the insulins. There is a lot that is not written in the various protocols, but I have made extensive notes and study them all the time.

I'm trying to help out more in the Prozinc ISG and Vetsulin/Caninsulin ISG forums lately, since the major support people that used to help out there, have been unavailable for months. No one ever gets everything right. It's why having this as a peer reviewed board makes it so valuable. If we say something wrong, or not quite correct, we hope that someone will step in and make corrections.

Also, sometimes simply having someone else explain a matter differently can make the 'light bulb moment happen". Having a point made in different words can make the point clearer. Or if the point was expressed in a different way, it may be more understandable.

p.s. OOPS! on that lid on the Purina dry food getting left off the other day.

p.p.s Since you are in Canada, you should enter all your data on the "World" tab of the spreadsheet. If the formatting is correct, it will automatically copy the data to the US version. I'm mentioning this because there is a 12.9 at +10 for PM cycle on 3/5/2020. You may want to try and fix that.

 

[AnneforMarley]

The moderators are for the entire website. We are not specific to any one particular board. We're more problem solvers if there are issues with a post that needs to be moved, dealing with spam, helping to get an exchange between members resolved, etc. As it turns out, the current moderators also have been on the FDMB site for a long time. I've been a member for over 10 years.

I'd wait and see what the PMPS was. No harm in dropping back to the 0.25U dose for a bit. Dose may need to go up again in the future.

Because of the dry food, you have no choice of dosing protocol and must use SLGS (Start Low Go Slow). If you can ever wean Marley off the dry food, than TR (tight regulation) would be an option for you. From the protocol for TR "Feed a high quality low carb canned or raw food diet."

If the BG at PMPS met the decision threshold, I'd shoot the last good dose. As long as you're around to monitor.
ECID Every Cat is Different, Every Caregiver is Different, Every Cycle is Different.

You have to test enough to know when the onset, nadir, duration, overlap is for YOUR cat with THIS insulin. So there is often more testing needed at the beginning of this journey with diabetes to determine those data points.

If you have enough test data to know when YOUR cat onsets with this insulin, had done some testing on either side of the typical +6 time to know when your cat nadired usually, and knew that your cat would go eat if you left out some food for the middle of the cycle, it's usually safe with Lantus to shoot. Gentler curve then some of the in-and-out insulins, so it can (but not always) keep cats in safer BG ranges.

As Sienne and Gabby (GA) said, moderators are more for keeping the message board running smoothly. Different people with different levels of experience help out in the forums they feel more comfortable in. I'm a good generalist with most of the insulins and medium level FD knowledge. I tend to leave the Lantus dosing advice to the people that hang out on the Lantus ISG more, unless asked specifically for help. That is more because of personal time constraints in life and other responsibilities than anything else. Besides, there are a lot more people in the Lantus ISG that know the nuances of using the protocols than I do. So I leave it to the "experts."

I'll never get everything exactly right with the different protocols for all the insulins. There is a lot that is not written in the various protocols, but I have made extensive notes and study them all the time.

I'm trying to help out more in the Prozinc ISG and Vetsulin/Caninsulin ISG forums lately, since the major support people that used to help out there, have been unavailable for months. No one ever gets everything right. It's why having this as a peer reviewed board makes it so valuable. If we say something wrong, or not quite correct, we hope that someone will step in and make corrections.

Also, sometimes simply having someone else explain a matter differently can make the 'light bulb moment happen". Having a point made in different words can make the point clearer. Or if the point was expressed in a different way, it may be more understandable.

p.s. OOPS! on that lid on the Purina dry food getting left off the other day.

p.p.s Since you are in Canada, you should enter all your data on the "World" tab of the spreadsheet. If the formatting is correct, it will automatically copy the data to the US version. I'm mentioning this because there is a 12.9 at +10 for PM cycle on 3/5/2020. You may want to try and fix that.

The moderators are for the entire website. We are not specific to any one particular board. We're more problem solvers if there are issues with a post that needs to be moved, dealing with spam, helping to get an exchange between members resolved, etc. As it turns out, the current moderators also have been on the FDMB site for a long time. I've been a member for over 10 years.

 

[AnneforMarley]

The moderators are for the entire website. We are not specific to any one particular board. We're more problem solvers if there are issues with a post that needs to be moved, dealing with spam, helping to get an exchange between members resolved, etc. As it turns out, the current moderators also have been on the FDMB site for a long time. I've been a member for over 10 years.

10 years! So much experience and I thank you for clarifying.

 

[AnneforMarley]

I'd wait and see what the PMPS was. No harm in dropping back to the 0.25U dose for a bit. Dose may need to go up again in the future.

Because of the dry food, you have no choice of dosing protocol and must use SLGS (Start Low Go Slow). If you can ever wean Marley off the dry food, than TR (tight regulation) would be an option for you. From the protocol for TR "Feed a high quality low carb canned or raw food diet."

If the BG at PMPS met the decision threshold, I'd shoot the last good dose. As long as you're around to monitor.
ECID Every Cat is Different, Every Caregiver is Different, Every Cycle is Different.

You have to test enough to know when the onset, nadir, duration, overlap is for YOUR cat with THIS insulin. So there is often more testing needed at the beginning of this journey with diabetes to determine those data points.

If you have enough test data to know when YOUR cat onsets with this insulin, had done some testing on either side of the typical +6 time to know when your cat nadired usually, and knew that your cat would go eat if you left out some food for the middle of the cycle, it's usually safe with Lantus to shoot. Gentler curve then some of the in-and-out insulins, so it can (but not always) keep cats in safer BG ranges.

As Sienne and Gabby (GA) said, moderators are more for keeping the message board running smoothly. Different people with different levels of experience help out in the forums they feel more comfortable in. I'm a good generalist with most of the insulins and medium level FD knowledge. I tend to leave the Lantus dosing advice to the people that hang out on the Lantus ISG more, unless asked specifically for help. That is more because of personal time constraints in life and other responsibilities than anything else. Besides, there are a lot more people in the Lantus ISG that know the nuances of using the protocols than I do. So I leave it to the "experts."

I'll never get everything exactly right with the different protocols for all the insulins. There is a lot that is not written in the various protocols, but I have made extensive notes and study them all the time.

I'm trying to help out more in the Prozinc ISG and Vetsulin/Caninsulin ISG forums lately, since the major support people that used to help out there, have been unavailable for months. No one ever gets everything right. It's why having this as a peer reviewed board makes it so valuable. If we say something wrong, or not quite correct, we hope that someone will step in and make corrections.

Also, sometimes simply having someone else explain a matter differently can make the 'light bulb moment happen". Having a point made in different words can make the point clearer. Or if the point was expressed in a different way, it may be more understandable.

p.s. OOPS! on that lid on the Purina dry food getting left off the other day.

p.p.s Since you are in Canada, you should enter all your data on the "World" tab of the spreadsheet. If the formatting is correct, it will automatically copy the data to the US version. I'm mentioning this because there is a 12.9 at +10 for PM cycle on 3/5/2020. You may want to try and fix that.

Yes, thank you for the advice on insulin dosing.
Clarification- Marley is on soft low carb food since on insulin. Prior he was on Purina DM dry as I was out of the country for a month thus so auto feeder.
As I have some left over I give him tiny rewards with it until it is gone. Then I will try other lower carb rewards I have read about that are not dry food. The crunch is thus less then 1 percent of his daily diet.
I JUST figured out the World/US tab now as often it was missing on my iPhone and sometimes it was there. I most often had to do the calculations. Hence the error but corrected- thank you.
Appreciate the assistance!