? URGENT please help with dosing

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jaybeth

jaybeth

Member Since 2021
Unfortunately my SS is not updated. My Nick (who is my best friend’s cat, hence why the sheet is not updated) was DX august 2020. He was on Vetsulin right after DX, then was on ProZinc until October. He’s on Lantus now and he’s primarily on FF pate — he has wet C/D as needed — he’s prone to blocking even with plenty of extra water. Every single day he is all over the place - one day his pre-shot test will be 130 and we will lower his dose to prevent a hypo, and by his next shot he will be in the 500s. He is not getting into any other food and we just do not understand why he is not sticking to one range of numbers. He’s typically on about 3 units of Lantus every 12 hours now. Please help. He is so loved and he WANTS to be happy, and play, and enjoy his life again. He’s only 11.5 and he is an incredible cat.
 
@tiffmaxee or @Bron and Sheba (GA) can you offer any advice? They cross posted to the FDMB FB group but I may be the only moderator around right now. One admin there is under the weather and it’s also late for our East Coast admin. There isn’t a ton of data, but I seriously wonder if the dose is too high. Nick is bouncing from his lows, no?? Maybe too soon to tell, but I figured I reach out and ask here!
 
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Previous post
https://www.felinediabetes.com/FDMB/threads/bg-level-71-stalling-please-help.255175/#post-2874078
Jadon you or your friend need to update the spreadsheet so members can see what's been going on with Nick's BG numbers in order to give you sime advice ,the units you are shooting are all over the place , have you read the sticky again ?
Why is he eating C/D?

@Chris & China (GA)

@Sienne and Gabby (GA)

@Wendy&Neko

@Bron and Sheba (GA)

Intro link below
https://www.felinediabetes.com/FDMB/threads/sudden-bg-drop.255108/#post-2873507
 
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jaybeth said:
he’s prone to blocking even with plenty of extra wate
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What do you mean he gets constipated?
If he is
Either an 1/8 to 1/4 teaspoon twice a day.
I give Tyler an 1/8 of a teaspoon twice a day maybe every 2 days
You have to see what works for him, , if it's too much cut back, just be sure to add a nice amount of water to his wet food when you add the miralax to it.
You can buy the store brands such as Clearlax ,etc it's much cheaper , it's the same thing as miralax

aka Miralax or generic form is polyethylene glycol 3350)
At my supermarket I buy the clearlax same thing, you can get CVS Brand, Wallgreens etc
 
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Diane Tyler's Mom said:
What do you mean he gets constipated?
If he is
Either an 1/8 to 1/4 teaspoon twice a day.
I give Tyler an 1/8 of a teaspoon twice a day maybe every 2 days
You have to see what works for him, , if it's too much cut back, just be sure to add a nice amount of water to his wet food when you add the miralax to it.
You can buy the store brands such as Clearlax ,etc it's much cheaper , it's the same thing as miralax

aka Miralax or generic form is polyethylene glycol 3350)
At my supermarket I buy the clearlax same thing, you can get CVS Brand, Wallgreens etc
Click to expand...
He’s prone to his urethra blocking — he (thank god) has not been constipated. So that’s why he’s getting C/D in small amounts every few days. We are going to get together tomorrow and update it best we can but it is 1am here so it’s a task for tomorrow! It’s just been so difficult watching him bounce and struggle with all these dose changes. We feel totally lost. The IM specialist has not been too much help.
 
jaybeth said:
He’s prone to his urethra blocking — he (thank god) has not been constipated. So that’s why he’s getting C/D in small amounts every few days. We are going to get together tomorrow and update it best we can but it is 1am here so it’s a task for tomorrow! It’s just been so difficult watching him bounce and struggle with all these dose changes. We feel totally lost. The IM specialist has not been too much help.
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Max had gotten two major blockages- the first almost killed him. I did the whole Rx urinary food, then moved to non-Rx urinary food…then to just high quality canned food (but he still got dry food too until his FD DX). Do you know what type of crystals Nick gets? I can’t remember completely but depending on the type it may give you some food leeway.
:bighug:
 
jaybeth said:
He’s prone to his urethra blocking — he (thank god) has not been constipated. So that’s why he’s getting C/D in small amounts every few days. We are going to get together tomorrow and update it best we can but it is 1am here so it’s a task for tomorrow! It’s just been so difficult watching him bounce and struggle with all these dose changes. We feel totally lost. The IM specialist has not been too much help.
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Oh good thank God he doesn't have that problem.
Once you have the SS updated so our more experienced members can take a look I'm sure they will be able to give you some advice about his dose.
One thing I can tell you is that we don't increase doses by 0.5 units ,we increase or decrease by 0.25 units at a time

Lantus likes consistency, we need to find a dose where you can be able to shoot the same amount for both cycles unless he earns a reduction .
That's why I suggest you read the SLGS dosing method again
You also have to be testing more at night .
Once you update the SS let us know

Maybe after that you can start posting on the Lantus Page , there are a lot of Lantus users there. We do a new post everyday on the Lantus page so we can see what's going on. We can talk about that later , we post a certain way there

@jaybeth
 
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It sound like dry food is (mostly) out of the picture. If not, there's a great section on the Feline Nutrition site that discusses urinary blockages. The answer is water, not Rx food.

Without more data, it's very hard to interpret the spreadsheet. What things look like is that Nick may be bouncing. When he drops into lower numbers, his liver and pancreas kick in and release a stored form of glucose along with counterregulatory hormones that cause numbers to spike back up. It's a normal response -- annoying, but normal. It takes roughly 3 days for the bounce to clear. However, I'm guessing at this.

One of the headaches with the FB group is that most people offer advice without looking at a spreadsheet. It's much more difficult to attach a spreadsheet on FB and the level of experience (moderators and admins excepted) is far more limited than here. We'll do our best to lend a hand but we really do need more information.
 
Sienne and Gabby (GA) said:
It sound like dry food is (mostly) out of the picture. If not, there's a great section on the Feline Nutrition site that discusses urinary blockages. The answer is water, not Rx food.

Without more data, it's very hard to interpret the spreadsheet. What things look like is that Nick may be bouncing. When he drops into lower numbers, his liver and pancreas kick in and release a stored form of glucose along with counterregulatory hormones that cause numbers to spike back up. It's a normal response -- annoying, but normal. It takes roughly 3 days for the bounce to clear. However, I'm guessing at this.

One of the headaches with the FB group is that most people offer advice without looking at a spreadsheet. It's much more difficult to attach a spreadsheet on FB and the level of experience (moderators and admins excepted) is far more limited than here. We'll do our best to lend a hand but we really do need more information.
Click to expand...
Yes — the SS will be updated with times, numbers, and dosages. I just figured I could post ahead of time — can I tag you when I get it updates?
 
Jadon I see you corrected Nick's diagnosis date on your spreadsheet, please fix it in your signature now to 8-2020. Tap on your name and then tap on signature correct it and hit save
@jaybeth

I'm sure once you update your SS @Sienne and Gabby (GA) won't mind if you tag her. You can also tag @Wendy&Neko
I see in your previous posts she had replied back to you

Previous post
https://www.felinediabetes.com/FDMB/threads/bg-level-71-stalling-please-help.255175/#post-2874078


Intro link below
https://www.felinediabetes.com/FDMB/threads/sudden-bg-drop.255108/#post-2873507
 
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Posted in FD group on facebook also:

"Okay.... I'm going to comment here and then copy/paste on FDMB.

There isn't a lot of data on your spreadsheet, which makes it a challenge.

How did you end up at 3u? From the limited amount of data, I suspect 3u may be too high and he's bouncing... but it's hard to know without more data."
 
Just a couple of observations...

It's important to always get a pre-shot test. It's the only way to be certain that it's safe to give insulin.

If this were me, given the +2 and the +4 and how different those numbers are, I would have retested to make sure the test info was accurate. If it is, expect to see a bounce back into high numbers. That's a rather large drop in the span of 2 hours. It could easily trigger a bounce.
 
Wendy&Neko said:
Could you please fill in the units for the dates where they are blank. I'd like to know how/when you went to 4 units from a 3.5 unit dose that was getting you into the 50's on November 6th.
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ahhh yes. totally forgot! We try to test before shooting but we are still getting in the hang of things! we did double check — we have a hypo kit on hand and just gave him a LC mini meal
 
@jaybeth
Jadon did you get a pre shot test this morning 11-14?
Please add SLGS to your signature
I also see his +7 is 56
Following SLGS it says
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
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
Jadon why did you give 4 units this morning?

@Wendy&Neko
Should he reduce?
 
Definitely reduce the dose. 4.0 units is too much insulin. I wish we had some more data on 3.0 units to see how it was doing, but it did look like he got down to at least 101. We dose based on how low the dose is taking the cat. In that previous post Diane linked, the suggestion was to go down to 2.5 units, hold the dose for at least a week and get some more data. Provided he doesn't go under 90, in which case you'd reduce again. Like Sienne suggested, I expected you were seeing a lot of bouncing due to lower numbers.

It is much easier to go up in dose than to fight low numbers due to too high a dose. Provided of course, that there is no recent DKA or ketones in the picture.
 
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