Dosing advice please

Tony’s person

Tony’s person

Member Since 2020
Hi. My Tony was low last night at PMPS (62). I didn’t give insulin. I did feed him some higher carb treats (Greenies) and a big meal of his KD food (he has CKD) and some Karo Syrup on gums. He was acting totally fine but I didn’t want him to drop lower. He should have been way past the nadir.
Retested +1, 130. At +3, 141. Then we went to bed, since he hadn’t had any insulin I was no longer worried as he was over 120 and seeming to be going up.
This morning he was 162. He doesn’t want to eat much...which is unusual for him.
Question: should I shoot? If so, I plan to go to .75u (down from 1u). Or should I go to .5 since he hasn’t eaten much (2 tablespoons..I’ll keep trying to feed before shooting). thanks.
 
Here's the link to your previous thread. Tony earned a reduction to 0.75U with that 62 last night.
I would however be wary of giving him his shot if he is not eating. Do you think you will be able to feed him before onset?
 
Yes. Agreed - the .75u is the maximum I’d give. And I will use that as his standard for now, unless he goes lower still.
He still isn’t eating so I don’t think I should give him anything. Does that mean I just skip all the way to tonight, or do I retest and give it once/if he eats at some point?
What did you mean by “before onset” ? Apologies...not understand that comment.
Thanks again for helping.
 
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
Is there a reason he is not eating? That would be more of a concern to me than his dose. Is it just a matter of him not being so hungry now and he will eat later? Have you tried a different food? Is he just bored of this food?
 
Got it. How do I test for the onset??
FYI: He’s now 176. Just a bit of food (2 tbsp?) and no shot yet. I’m leaning towards giving .75u now??
I don’t know why he’s not eating. This is very unusual for him. He ate a bit, just not his usual, which has been pretty strong appetite for a while now. I tried 3 foods. I could try fresh turkey meat, which he loves...but i worry about straight protein like that because of his CKD.
Prior to his diagnosis he was never a big eater. His diabetes was definitely not weight related. He’s always been fit and trim.
The only thing I can think of is that he maybe gotten I to the dog’s kibble overnight. Usually I take the dog food up before bed, but the dog isn’t a big eater either and she hadn’t eaten all day so I wanted her (the dog) to have access to it in case she decided to eat.
Anyway, given that he’s not really eaten and we’re now an hour overdue, should I skip or give that .75u?
 
Update: just tried a few pieces of turkey breast (real, not deli meat). He won’t eat it. That’s so unlike him. He’s drinking water. But very quiet...not talking at me like he normally does.
 
Bandit's Mom said:
How long overdue? Can you make up the time over the next few days?
If you can monitor, you can shoot.
Click to expand...
90 mins overdue. If I give a small dose now, how exactly do I monitor (watching, retesting how often amd for how long, etc) and how do I make up the time over next few days? Thanks for all your help.
 
Ok, I gave him something close to .5u It’s hard to get it exact between .75 and .5u on the syringe, but I erred on the low side of estimate. I’ll retest in an hour or two. He’s acting fine...just not hungry.
 
Lantus onset is typically at +2. But it is different for different cats and could be anywhere from +1 to +3. You get to know when you cat's onset is by testing at +1 on some days, +2 on others and then +1.5 etc.

https://www.felinediabetes.com/FDMB...y-to-shoot-handle-lower-pre-shot-numbers.147/
https://www.felinediabetes.com/FDMB/threads/getting-back-on-a-12-12-shot-schedule.101059/


Tony’s person said:
Ok, I gave him something close to .5u It’s hard to get it exact between .75 and .5u on the syringe, but I erred on the low side of estimate. I’ll retest in an hour or two. He’s acting fine...just not hungry.
Click to expand...

I would keep trying to get him to eat. Please get a +2. I hope its only a case of him being too full to eat right away.
 
Bandit's Mom said:
Lantus onset is typically at +2. But it is different for different cats and could be anywhere from +1 to +3. You get to know when you cat's onset is by testing at +1 on some days, +2 on others and then +1.5 etc.
Ok, I’ll do a +2 and will keep trying to feed. Since this is so unusual for him, I am hopeful too that he’s just full. I could try the FF which he really likes...but I try to avoid because his creatinine levels nearly doubled since his onset of diabetes and change of diet to include more protein...still they are not crazy high but I want to keep that from progressing too quickly.
https://www.felinediabetes.com/FDMB...y-to-shoot-handle-lower-pre-shot-numbers.147/
https://www.felinediabetes.com/FDMB/threads/getting-back-on-a-12-12-shot-schedule.101059/




I would keep trying to get him to eat. Please get a +2. I hope its only a case of him being too full to eat right away.
Click to expand...
 
Good morning. I see on your spreadsheet that you did shoot a small dose late. Please update your spreadsheet as to the dose and your title to show amps. Does Tony have any other medical issues? Do you have nausea medication on hand, either cerenia or ondansetron? With CKD they do sometimes get nauseous so if you don’t have any I would discuss that with your vet. Vets used to suggest Pepcid but most recently it’s rarely recommended any more. If the apparent inappetence is actually not and due to eating dog food this time it’s still good to have that discussion with your vet.
 
tiffmaxee said:
Good morning. I see on your spreadsheet that you did shoot a small dose late. Please update your spreadsheet as to the dose and your title to show amps. Does Tony have any other medical issues? Do you have nausea medication on hand, either cerenia or ondansetron? With CKD they do sometimes get nauseous so if you don’t have any I would discuss that with your vet. Vets used to suggest Pepcid but most recently it’s rarely recommended any more. If the apparent inappetence is actually not and due to eating dog food this time it’s still good to have that discussion with your vet.
Click to expand...
I don’t understand the request? My spreadsheet is up to date with the .5u that I gave. And my signature line lists his CKD?? I don’t have any nausea meds on hand for the cat, but I can ask the vet about that. Tony did eat around 1pm - about 2 tbsp of FF. I don’t like to give him FF because I believe it’s bad for his CKD. But he sure does like it.
I’ll be testing him again in a bit to see if we’ll do a PM shot. At 5pm he was only 101. If he hasn’t gone up I may withhold insulin again.
 
When I looked the dose was not there. It is since I see. I said I saw that he has CKD. I asked if he has any other medical issues. It’s all right in my post you quoted. But what I don’t know is which method you are following or if you aren’t following either of ours. That is needed for dosing advice but it appears that’s not what you want.
 
The spreadsheet says "leaning to SLGS" and since Tony is getting KD which is high carb food, SLGS is the only option.
 
Right, ok. I’m not sure what happened - I did enter the dose this morning after I gave it around 9:30am and then I updated the sheep again when I did the +2 test.
I later did a +8 and recorded that. And then a bit ago (at the time for his PMPS per the now later schedule) he was only 107. So I am not going to dose tonight.
I was looking for advice this morning. @Bandit's Mom was kind enough to offer it and I felt ok with the .5u. I then updated my sheet and went on with my day.
 
Wendy&Neko said:
The spreadsheet says "leaning to SLGS" and since Tony is getting KD which is high carb food, SLGS is the only option.
Click to expand...
Ok - that’s a linkage I didn’t realize. For a month or so Tony’s geriatric vet and I were trying other foods as a mix — we started with FF but I switched to Wuvera because it’s lower Phosphorus but still more protein. His latest labs (from last week) showed that his phosphorus is fine, his sodium is on higher/normal side, but his creatinine was high than it had been. He’s still boarderline mild/moderate. We’re going to up his SubQ to twice weekly and the vet said to trend back more towards the KD, now that his BG is obviously trending lower than it was when we decided to try the lower carb food.
If SLGS is the method that dictates, it’s fine by me. It just seemed sort of counter-intuitive to me because if anything we’re titrating down, not up.
 
With SLGS, you take reductions at higher numbers than you would with TR. So it works on the way down dose too. Some cats also need a bit higher carb food to flatten out on insulin, maybe Tony is one of those cats.
 
Ah, ok. So, using Alphatrak2, what number would earn him a further drop? And where do I go from .5u?? Is it either dose .5u or withhold? With SLGS is there some fixed number under which you should definitely without insulin? And how much do they need to eat before a low dose like .5u? I feel like I’ve read so many things that my head is spinning. And during the week it’s even worse ... I unfortunately have such a stressful job that it’s all I can do to hold it together during the week.
Also, I’ve read the pinned posts about dropping dose of under 90 but those say that is with a human meter. I’m not sure of the equivalent for the Alphatrak2?
thanks @Wendy&Neko
 
With the AT (or the human meter), you reduce if he goes below 90. We don't have a way of translating the AT to human meter, so we use the same number.

As for withholding insulin, that really depends on your comfort level and the data you have on shooting lower and lower numbers. Definitely no shot below 90.

We have doses called 0.25 units, as well as 0.1 unit. Pictures in the Sticky Note on Fine Dosing.
 
@Wendy&Neko , I can’t find the Fine Dosing sticky. I searched the Lantus forum as well as general. My phone seems super slow when searching the forums. Can you tell me which forum it’s in so I can try to find manually? It looks bolder in your note, but doesn’t seem to link to anything. apologies in advance if I’m being really daft.
 
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