Binnie's first curve - suggestions welcome!

[PatinToronto]

We've had a lot of surprises today. I've posted his BGs - most are 2 hourly. One was 45 mins after a previous low when I fed him a little and rechecked. The last was 3 hrs instead of 2 as I was tied up and couldn't get to it.
I haven't given him any evening insulin.

 

[Bron and Sheba (GA)]

Hi Pat and welcome to the forum
That is a lovely curve. And Binnie is a lovely boy!
However looking at the spreadsheet I am very concerned you are not doing any tests during the cycles but are continuing to increase the dose of insulin in 1 unit increments.
It looks like you are using the preshot BGs for dosing. Lantus dosing is done using the nadir or lowest point in the cycle, not the preshots.
So unless you are testing you have no idea how low each cycle is taking Binnie. For all we know Binnie could be dropping dangerously low during some of the cycles.
There are also many places where you are not testing before you give the dose of insulin…………I would strongly recommend you always test before every shot to see it is safe to give the dose.
I can see also that you have been giving 6 units in the morning and 5 at night. Lantus like consistency because it is a depot insulin. As you are following SLGS and Binnie earned a reduction in dose, you will need to reduce the dose to 4.75 units.

Do you think you would be able to get at least one test on every cycle to see how effective the dose is? A test sometime between +4 and +7 will tell us a lot of information….vary the times.
A fuctosamine test will only give you an average of the last few weeks BGs…..not any highs or lows. So the fructosamine test might look good on paper but it could have been very high and dangerously low and you would not know. So please don’t rely on the fructosamine test for dosing. I’m sure it has been the vet relying on the fructosamine tests….not you ….for dosing up until now.

Can you tell me what you are feeding Binnie please? I can see kibble in the signature. Is it a low carb kibble and is the Purina True Nature a wet or dry food?
If you are feeding a high carbs diet, this could explain some of why you have the dose up at 6 units.
However if you swap to a low carb diet, you need to monitor closely as the BGs could drop by 100 points and the insulin may need to be reduced.
Do you give snacks during the cycles?

Are you intending to give some insulin this evening.? You have given insulin with preshots fairly close to 212 before. Remember the new dose is 4.75 units.
It’s great you have a spreadsheet and doing hometesting.
I see you have SLGS as your dosing method but you are not really following it. If you did I’m sure you would get much better results. We would be happy to help you in any way and answer questions.
Bron

 

[Bron and Sheba (GA)]

I have just found your original post. Here is is for continuity https://felinediabetes.com/FDMB/threads/binnie-4-hr-glucose-76.257194/

 

[PatinToronto]

Hi Bron,
Thanks for your response. I felt very alone yesterday.
I'll try to answer your questions and concerns one by one:

Lantus dosing is done using the nadir or lowest point in the cycle, not the preshots.

Yes, I know that now.

A fuctosamine test will only give you an average of the last few weeks BGs

Yes, which is why I've dragged my feet on going in for yet another. Plus it's very stressful for Binnie, and I can't be with him since COVID (I have to wait in the car). And, at $285/visit, I'd rather spend the money on test strips.

Can you tell me what you are feeding Binnie please?

I see you found my early posts. I've bounced around a bit, but one of the moderators suggested all beginners should start here. Binnie is eating low carb wet food mostly, and a 3:00 PM-ish snack which is usually a tbsp of the kibble he loves - Royal Canin Weight. I don't think it's low carb, but it's been really hard to get him off it entirely. Still, he's come a long way!

Are you intending to give some insulin this evening.?

Your post came in too late for evening insulin, so I did NS - I was very concerned about any insulin after seeing how low he ran over the day.

I see you have SLGS as your dosing method but you are not really following it

Yes, the spreadsheeet has 2 months of sugars, but I only just joined here and learned of SLGS 48 hours ago.

Binnie's AMPS today was 16.7. I gave him 1u only, as I've heard consistently how high he is, and even though logically he should get 4.75, that is also high. I'm working after 3 today, so won't be able to do another curve.

 

[Katherine&Ruby]

Hi Pat, feel free to post every test result, not just when you're done with a curve. A cat's BG levels can vary widely, and the experienced members here can see a lot of things in numbers. I have a feeling he's going to be high today with no shot yesterday and a reduced dose this morning, so please test and post at +10 or +11 if you can to get advice on what to do if you are unsure, but your next shot should be 4.75 as Bron said if you have the half unit syringes to measure that.

 

[tiffmaxee]

Please start posting on the lantus forum where there will be more help now that you are set up. I’m sorry you felt alone yesterday. Many of us that help with lantus only look on that forum most of the time.
200+ is very safe to shoot. The dose he needs is the dose he needs and if on the right dose for now shooting a higher dose won’t have a bigger effect on the bg than shooting l lower dose if that makes any sense.

We do need to see more tests to know about dosing though. At the very minimum a curve every 7 days is needed but another test between +4-7 can be very helpful in figuring out how low a dose is taking your cat. When you only get the extra tests with a curve done infrequently the day you pick might not show the overall nadirs for the week.

 

[PatinToronto]

Thanks Katherine&Ruby and tiffmaxee! I'll switch back to the Lantus forum (whee - my head is spinning!) from now on.
I was going to do a BG about now as his nadir on the curve yesterday was at +4. I'm stymied about his PMPS this evening; I'm at work, and although my husband manages the insulin OK he is really reluctant to learn BG testing.

 

[tiffmaxee]

It will help you tremendously why your husband feels comfortable doing some of the testing.

 

[Katherine&Ruby]

Thanks Katherine&Ruby and tiffmaxee! I'll switch back to the Lantus forum (whee - my head is spinning!) from now on.
I was going to do a BG about now as his nadir on the curve yesterday was at +4. I'm stymied about his PMPS this evening; I'm at work, and although my husband manages the insulin OK he is really reluctant to learn BG testing.

For the first 6 months of Ruby's diabetes journey, I did all of the testing/shooting/feeding. Once I had to go back to work full time, my DBF took over during the day as he works from home and he does a great job. He texts me her numbers and I tell him what to feed, though these days he knows what to do without me instructing him. It's really bonded him to Ruby and it gives me peace of mind.