Quick help needed!

[Jan D & Squeaky]

Hi! Squeaky's reading was only 97.... so that means no insulin tonight, right?

Yikes, I have a 15 minute window to know this for sure.

Hmmm, seems to me I was told, better to skip a shot than give too much. So I'm assuming to not give him insulin, this is safe.

 

[Chris & China (GA)]

Hey Jan! Sorry you didn't get some faster help but yes, skipping was the better choice tonight! Here's some more advice for you too!

Lantus works best when given at the same dose, both AM and PM. The dose should be based on how LOW it takes them, not the Pre-shot.

Each time you change the dose, the depot has to settle. The depot is like a spare tank of insulin that slowly releases into the bloodstream which is what makes Lantus so gentle and long lasting. But for the depot to "release" the right amount, it has to settle into the dose. It can't "release" enough to equal a 1 unit dose until the depot has filled enough. It takes 5-7 days for the depot to fill up when you're first starting. If the 1U dose proves not to be enough, you go up to 1.25 and then give the depot time to fill up so that it can release enough to equal 1.25 units. Each time you increase the dose, you have to give it time to catch up.

It's very important to get tests mid-cycle (5 to 7 hours after the shot) so you see how low the current dose is taking him. I understand you're not terribly comfortable with testing yet, but please keep at it. It's the only way to know what's going on inside his body. If you hadn't tested tonight and given that 2U dose again, you could have woken up to a tragedy in the morning.

When we do dose increases, we only do them in .25 to .5 unit increments. Going from 1U to 2U is a 100% increase in dose! That's like a human going from 30U to 60U...there's a lot of "in between" to try first!

If Squeaky were my cat, I'd drop back to the 1U dose, get tests before every shot and get at least 1 test mid-cycle on the AM cycle and at least a "before bed" test on the PM cycle. Hold that same dose for at least 3 days (unless he drops below 50 at any time)

 

[Jan D & Squeaky]

Hey Jan! Sorry you didn't get some faster help but yes, skipping was the better choice tonight! Here's some more advice for you too!

Lantus works best when given at the same dose, both AM and PM. The dose should be based on how LOW it takes them, not the Pre-shot.

Each time you change the dose, the depot has to settle. The depot is like a spare tank of insulin that slowly releases into the bloodstream which is what makes Lantus so gentle and long lasting. But for the depot to "release" the right amount, it has to settle into the dose. It can't "release" enough to equal a 1 unit dose until the depot has filled enough. It takes 5-7 days for the depot to fill up when you're first starting. If the 1U dose proves not to be enough, you go up to 1.25 and then give the depot time to fill up so that it can release enough to equal 1.25 units. Each time you increase the dose, you have to give it time to catch up.

It's very important to get tests mid-cycle (5 to 7 hours after the shot) so you see how low the current dose is taking him. I understand you're not terribly comfortable with testing yet, but please keep at it. It's the only way to know what's going on inside his body. If you hadn't tested tonight and given that 2U dose again, you could have woken up to a tragedy in the morning.

When we do dose increases, we only do them in .25 to .5 unit increments. Going from 1U to 2U is a 100% increase in dose! That's like a human going from 30U to 60U...there's a lot of "in between" to try first!

If Squeaky were my cat, I'd drop back to the 1U dose, get tests before every shot and get at least 1 test mid-cycle on the AM cycle and at least a "before bed" test on the PM cycle. Hold that same dose for at least 3 days (unless he drops below 50 at any time)

Thanks Chris. I appreciate your detailed explanation. Had to read it about 5 times to get it.

I am getting the feeling that my vet doesn't know what she is doing. We didn't have a good reaction with a different med dosage change she recommended recently.

I have a bunch of questions for you, so I'm going to number them. Answer at your convenience, I'm going to bed.

1) After the BG test, he ate some (not a lot) and then fell into a deep sleep. Very quickly. Does that sound okay? Well maybe it's just because he's older (13). I'm wondering if it's related to any of the meds he's taking.

2) Wow, I don't possibly see how I could change the dose .25. There is no mark for it on the syringe and it would be too hard to see. Even .5 would be challenging, but the new syringes I got from Walgreens do have marks for that.

3) Well now that he had such a low reading, I agree with your assessment to drop back to 1U. Yes I can test before every shot as I have been doing.

What is a "mid-cycle on the AM cycle" mean? Does that mean 5 to 7 hours after the morning shot?

4) Before bed? We tested at 10 pm tonight, he ate some and was asleep by 10:20 or 10:30. That doesn't sound so helpful to me. But if I wake up early in the morning I could test him. 5 am, 6 am.

However, I think we still need to slow down the emotional charge around the ear pricks if possible before we do this more often.

5) How to deal with a vet who doesn't know what she is doing? Her team is trying so hard to help me......

6) So it sounds like tonight's great reading happened because the depot filled up.... and maybe the 2 doses of 2U?

Have a good night.

And thanks from the bottom of my heart.
Jan

 

[Chris & China (GA)]

1) After the BG test, he ate some (not a lot) and then fell into a deep sleep. Very quickly. Does that sound okay? Well maybe it's just because he's older (13). I'm wondering if it's related to any of the meds he's taking.

Cat's normally groom, then sleep after they eat. In the wild, they Hunt, Eat, Groom, Sleep. Also, cat's sleep for 20 out of 24 hours so it's kind of normal to find them sleeping!

2) Wow, I don't possibly see how I could change the dose .25. There is no mark for it on the syringe and it would be too hard to see. Even .5 would be challenging, but the new syringes I got from Walgreens do have marks for that.

Yeah, it takes some practice! Most of us just eyeball it as best we can to get it in between the marks. Here's a picture of .25

You can also use calipers if you want to. Then you ignore the lines on the syringe altogether!
Here's some information on Dosing with calipers

What is a "mid-cycle on the AM cycle" mean? Does that mean 5 to 7 hours after the morning shot?

Yes

Before bed? We tested at 10 pm tonight, he ate some and was asleep by 10:20 or 10:30. That doesn't sound so helpful to me. But if I wake up early in the morning I could test him. 5 am, 6 am.

"Before bed" is in reference to you, not Squeaky! You might want to consider changing his shot schedule to an earlier time if you can. I finally decided on 6am/6pm (and I HATE mornings!) But I got to where I could Test/Feed/Shoot without totally waking up and I'd go back to bed for a few hours. At night, by shooting at 6pm, I could get tests up until midnight (+6) so when I finally slept, I knew she'd be OK.

A lot of times if you test 2-3 hours after the shot you can almost predict how the rest of the cycle can be so on the PM cycle, if you shoot at 10pm, could you get a test at midnight? If not, grab one at 5-6am. The more testing you do, the better you're going to understand how Squeaky is responding to treatment.

5) How to deal with a vet who doesn't know what she is doing? Her team is trying so hard to help me......

This one is tough. Personally, I gave up on the vet's around here. None of them knew what they were doing. I did finally find a vet I trusted to do general check-ups, dentals and sick calls with, but when it came to the diabetes, I did what the people here told me to do until I understood it enough to start making my own decisions on dosing. I'm a big believer in "real life experience" over "book learning" and the sad truth is that vets get very little formal education on diabetes and they just don't have the time to stay up to date with the latest treatments for every disease in every animal they see. I chose to drink the FDMB Kool-aid early. When I did have to take her in, I'd just start the conversation with "she's on X units of Lantus and her blood glucose runs between Y and Z"....and that was usually the end of it. If the vet did give me some (unwanted) advice, I'd smile, nod my head, say "I'll think about that"...and come right back here.

6) So it sounds like tonight's great reading happened because the depot filled up.... and maybe the 2 doses of 2U?

Only 2 doses shouldn't have filled up the depot ....I highly suspect that 2U is just too much insulin for Squeaky right now.

Don't try to learn everything overnight. You'll just give yourself one heck of a headache!

 

[JL and Chip]

Hey Jan,
Just as a precaution, can you post a photo of the syringes you’re using or as least provide the info that’s on the syringe barrel/box/bag? I’m thinking you said at one point that you had picked up 1/2 cc syringes from Walgreens and I think it’s worth double checking that you are using the correct syringes as well as drawing to the appropriate line. It’s probably fine, but never hurts to verify, right?

 

[Jan D & Squeaky]

Hey Jan! Sorry you didn't get some faster help but yes, skipping was the better choice tonight! Here's some more advice for you too!

Lantus works best when given at the same dose, both AM and PM. The dose should be based on how LOW it takes them, not the Pre-shot.

Each time you change the dose, the depot has to settle. The depot is like a spare tank of insulin that slowly releases into the bloodstream which is what makes Lantus so gentle and long lasting. But for the depot to "release" the right amount, it has to settle into the dose. It can't "release" enough to equal a 1 unit dose until the depot has filled enough. It takes 5-7 days for the depot to fill up when you're first starting. If the 1U dose proves not to be enough, you go up to 1.25 and then give the depot time to fill up so that it can release enough to equal 1.25 units. Each time you increase the dose, you have to give it time to catch up.

It's very important to get tests mid-cycle (5 to 7 hours after the shot) so you see how low the current dose is taking him. I understand you're not terribly comfortable with testing yet, but please keep at it. It's the only way to know what's going on inside his body. If you hadn't tested tonight and given that 2U dose again, you could have woken up to a tragedy in the morning.

When we do dose increases, we only do them in .25 to .5 unit increments. Going from 1U to 2U is a 100% increase in dose! That's like a human going from 30U to 60U...there's a lot of "in between" to try first!

If Squeaky were my cat, I'd drop back to the 1U dose, get tests before every shot and get at least 1 test mid-cycle on the AM cycle and at least a "before bed" test on the PM cycle. Hold that same dose for at least 3 days (unless he drops below 50 at any time)

You are educating my vet I believe. I copied your message to her in an email. To help her understand why I decreased Squeaky's dose back down to 1 after she told me 2.

Also Becky in California told me about bouncing, I have told my vet about that as well.

There is so much to learn! Step by step..... baby steps..... I feel we are moving forward positively and thank you all.

 

[jt and trouble (GA)]

You are learning together. I did the same with Troubles Vet.

 

[Jan D & Squeaky]

You are learning together. I did the same with Troubles Vet.

Yes it's pretty apparent that she doesn't have a handle on this.....

 

[Jan D & Squeaky]

Hey Jan,
Just as a precaution, can you post a photo of the syringes you’re using or as least provide the info that’s on the syringe barrel/box/bag? I’m thinking you said at one point that you had picked up 1/2 cc syringes from Walgreens and I think it’s worth double checking that you are using the correct syringes as well as drawing to the appropriate line. It’s probably fine, but never hurts to verify, right?

Thanks for caring. they are 0.3 mL, 29 gauge, 12.7 mm (1/2" length). Hey would you mind taking a look at Squeaky's spreadsheet and telling me if I need to know anything? Thanks a bunch.