? 8/18 - 12-hour BG curve, dosing question

Michele and Coco Chanel

Michele and Coco Chanel

Member Since 2021
Do you think it’s time to up the dose ¼ unit 2x day? Coco was on Vetsulin 1U 1x day starting approx. July 1. Switched vets - on Lantus, 8/2, 1unit 2x day.

I’ve had a couple exceptionally high pre-shot numbers, like today, approx 100 above normal high - just when it looked like numbers were starting to lower. :-(

Thank you,
 
Suzanne is correct that you should hold the dose since you got a nadir of 97. Do a curve 7 days after that. I think you are experiencing a bounce now.
 
Okay. I did read about the nadirs in the SLGS sticky, but I guess I'm concerned because the pre-shots are still up in the 300s. I know I'm supposed to be patient, but I also don't want high numbers longer than necessary. I appreciate the help and having somebody who knows what they're doing looking at my SS.
 
JaxBenji said:
Hi! Technically on SLGS, if nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose. You saw 97 on 8/10 (it should be green btw :D) and coco could have gone lower last night, hence the red preshot this morning.

perhaps @Chris & China (GA) can stop as I see they have before or @tiffmaxee if shes on.

I think this is your last condo - just linking for continuity https://www.felinediabetes.com/FDMB/threads/8-4-coco-amps-304-5-73-7-70-pmps-325.250877/
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Thank you for the continuity link. Sorry about that. I read the instructions, and I saw about one thread per cat, but I wasn't sure if that only applied to a single issue, but the continuity makes sense. Must get frustrating for all of you with newbies. ☹️ Thank you for your patience.
 
Lantus is not dosed based upon the Amps//PMPS. It’s dosed based upon how low it takes your cat. The preshot scan be high due to bouncing from going into lower bg than used to or dropping too fast or not getting enough duration. You can increase faster if you switch to TR. You will need at least one more test at night though. .

You only got a pmps test last night. She could have gone a lot lower at nadir and that might be why you saw a high amps. If you test at +2 and it’s lower than the pmps there’s a good chance the nadir will be a lot lower. That’s when it’s good to set an alarm and get a test between +5-7.
 
We ask all members to do a test before each shot so that you don't shoot a number that is too low. This is for safety. The reason we look at the nadirs is we want to see how LOW a dose takes a cat and this is also for safety, because if you give a cat more insulin than it needs, it can cause hypoglycemia. This is why we ask for midcycle tests as well as the tests done before each shot, as the curve produced by Lantus should create a dip somewhere in the middle. Maybe you've seen this in the Basics sticky:

Example of an ACTIVE, but NOT necessarily typical Lantus/Basaglar cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.​

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.​

Don't fixate on the higher numbers. I know, it's really really hard not to! I do it myself sometimes! The more you can test, the more you can see what the trends are and where Coco's nadirs may fall. This will also change over time, so the more data you provide, the easier it will be to offer advice. Because you are following SLGS, if you can find a day on a weekend when you can do a curve, testing every 2 hours for 12 hours or every 3 hours for 18 hours, that will provide a fuller picture of what might be happening to Coco. TR is the more aggressive method, but it requires at least 4 tests per day: 2 preshot tests and 1 test in the AM cycle and 1 test in the PM cycle. If you look at my Ruby's SS, I try to adhere to this as much as possible and test more when I can.
 
Should I leave some food out overnight in case BG drops? The only night I've done that was when the PMPS + 2.5 was 149. The only reason I don't leave some food out is I'm concerned Coco will eat it right before time for her morning shot and she won't be hungry.

I always left dry out before :-(, so my cats were used to eating at night. They are grazers. I let them eat throughout the day but pick up all food 3 hours before PM shot.

Thank you,
 
Can you get a timed feeder? They spin around so you can leave food in a slot to open at a certain time and then when that time is up it opens to another slot that is empty. That will train the cat to look for food at a particular time.

another thing that helps is to always get a +2. That will tell you if the cat is going up or down and you can feed accordingly.
 
Michele and Coco Chanel said:
Okay. I did read about the nadirs in the SLGS sticky, but I guess I'm concerned because the pre-shots are still up in the 300s. I know I'm supposed to be patient, but I also don't want high numbers longer than necessary. I appreciate the help and having somebody who knows what they're doing looking at my SS.
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FWIW pre-shots are the last to come down...I get that it's frustrating but try to focus on the nadirs. Looks like you've gotten some good advice...hang in there :bighug:
 
OMG! I never thought of a timed automatic cat feeder!! I was thinking of those feeders that you put dry in that dumped food continuously. That's a perfect solution. Of course, I won't know which cat ate out of it, but at least neither will be eating right before the shot. Thank you all so much!!!!
 
JaxBenji said:
Hi! Technically on SLGS, if nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose. You saw 97 on 8/10 (it should be green btw :D) and coco could have gone lower last night, hence the red preshot this morning.
Click to expand...

Sorry to keep bothering everybody. I did a 12-hour curve yesterday. Last Friday I had a 151 at 6+; Monday, 115 at +4; Tuesday, 115 at +6.

I know those are just general guidelines, and it's not so black and white, but if I have one reading within the suggested guidelines, at any point within the 12 hours, do I not adjust the dose and hold for 7 more days? I mean, I don't want to keep asking everybody each week to look at my numbers. :-( My work schedule is crazy the next couple weeks, so I won't be able to get midday readings every day.

Also, Coco's teeth are getting cleaned in two weeks. They're pretty bad, so hopefully that will help with numbers too.

And once their ears are bleeding easier with a prick, do you all continue to warm up the ear anyway? Does that have anything to do with them not feeling the prick as much, or is it just to make it easier to get a good blood drop?

Thank you!!
 
Hi Michelle,

Don't worry, you're not bothering anyone. A lot of us here post every single day, so it's no trouble if you ask for help. That's why a lot of us are here volunteering our time.

You may want to increase Coco's dose by .25, but I'm going to tag @carfurby and @tiffmaxee for confirmation.

According to the Dosing Methods sticky for SLGS:

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.​
    • 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

If you're not able to get midday readings because of work, more evening/night readings would be good to get, as cats often decide that nighttime is when they do their diving.

Also, members of the Lantus forum are asked to create one new post for each cat each day. This way we don't have to scroll through many days of conversation to get at the current's day's concerns. :)
 
I think you can try an increase. It would be good to get some mid day and night tests occasionally. I’d do that when your +3-4 is lower than usual as we dose based upon nadir and without those tests we don’t know if she’s going lower. I never had to warm up Max’s ears and he ne Er reacted to the pricks so once she bleeds easily you won’t need to do that.

Please start a new thread and link this one to it. Also you forgot to add your cat’s name to the subject bar.
 
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