2 and 1/2 or 3 units?

Status
Not open for further replies.
babyg

babyg

Member Since 2019
Hi, everyone,

Cat's old Lantus dose was 2 units twice a day. Vet and family are giving me grief to jump her to 3. I gave her 2 and a half on 6/01, tried the 3 on 6/03 and had kind of a lower am preshot number so they told me to skip giving her a dose; continued the 3 that evening; and switched it back and have kept it at 2 and a half since 06/05 pm shot. If you look at the spreadsheet (2nd tab has sensor data), I am monitoring with a Libre sensor and am double-checking the preshot number with my meter. She is still in the 300s. Also giving me issues on and off with eating. In your guys' experience and opinion, should I continue to hold the 2 and a half a little longer or go back up to the 3?
Btw, if I put this in the wrong spot or should title it different, please feel free to let me know or/and move it. Thanks!
 
You have no data in most of the U column squares. How often are you giving the insulin?
If you are giving it twice a day, could you update the SS so we can see what you have been giving please.
We can’t give dosing advice with an incomplete and not up to date SS sorry.
 
I filled in the U's. She only recently became unregulated so I am not used to filling out the U's since her dosage has been the same since 2019.
 
Have you chosen one of our 2 dosing methods. Link below. Have a look and when you have chosen can you put that into the spreadsheet and your signature please. I will give you the link to the signature as well.
DOSING METHODS https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

HELP US HELP YOU https://felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
In this thread you will find the link to the signature and what to put in it. It’s important. We find out that information so we can help you.
Can you also put what type of glucose meter you are using please …a human meter it a pet meter
 
Sorry about all the questions but we need to know, to help you.
Thanks for fixing it all up.
First of all, it is good to know that DKA was in the history. With that in mind, do you ever test for ketones?……..I can see you are testing for ketones in the SS that’s greats,!
It is important she eats well with that DKA history and gets enough insulin. I would not skip doses of insulin with a history of DKA.
I would stall, don’t feed for 20 minutes and see if the BG is rising. You can also post and ask for help.
With SLGS you need to hold the dose for 7 days and do a curve on the 7th day and then increase if needed as per the SLGS method. If you are unsure, post and ask for help.
You have been chopping and changing the dose a bit in the last week so I would stay with the 2.5 units for now for the 7 days and see how that goes. If the dose needs to be increased, I would increase it to 2.75 units not 3 units.
 
Ok, that helps. What is making me self-doubt is because her numbers are not looking better so far and we are now starting cycle 4. I'll give it more time to see if things improve. Thank you.
 
babyg said:
Ok, that helps. What is making me self-doubt is because her numbers are not looking better so far and we are now starting cycle 4. I'll give it more time to see if things improve. Thank you.
Click to expand...
Remember Lantus is a depot insulin and it takes 6 cycles for the depot to fill and you skipped a shot 2 days ago which would have emptied the depot o bit and it has to refill..
Don’t forget the PM mid cycle tests. A lot of cats drop at night and if you are not testing you won’t know if she has dropped or not.
 
Yes, right now she has the Libre sensor on, giving me 24/7 data (I put the graphs on the second tab of my spreadsheet if anyone is interested!). I am also double-checking the sensor for the preshot numbers and also for any questionable numbers (too high, too low).
 
We just got back. They said test results should be in by Friday. But now I'm an emotional wreck because when I asked what could have caused her to lose regulation, they said it could be stress or a tumor so of course I'm freaking out. My brother, who once had a diabetic dog, said it's common that their insulin needs can change over time and that I'm overreacting and I hope that's true.
The other thing is this is the third vet now that is saying to do the 3 units, so I keep feeling like I'm being a bad furmom if I do the SLGS method to work my way up to the 3. They want me to do 3 units and if her preshot is between 200 and 100, to give 1.5 units.
Additionally, now she's been taking to the wet food over the dry, so am concerned how the new doses can affect things if she continues eating the wet. Her appetite was not the best so I was trying to get her to eat anything so as to avoid hepatic lipidosis, so that is how we started back with the wet again. Of course I'll continue to monitor her but am still scared to leave her alone if I go to work. I never expected her to lose regulation so feeling overwhelmed at the moment.
 
Last edited:
babyg said:
My brother, who once had a diabetic dog, said it's common that their insulin needs can change over time
Click to expand...
Diabetic cats are completely different than diabetic dogs. Cats have the unique ability for some of their pancreatic cells to heal. Their insulin needs can change too, but down as well as up.

With Lantus, you need to keep giving the same dose for at least 3 days, 7 days if there is any dry food in the picture. You only gave the 2.5 unit dose for 2 days/4 cycles. Since you are now feeding more wet food, I would go back to 2.5 units and keep giving that dose for 7 days, unless she goes below 90. Reducing the amount of dry food can make a huge difference in the amount of insulin needed, so best be cautious.
babyg said:
hey want me to do 3 units and if her preshot is between 200 and 100, to give 1.5 units.
Click to expand...
That vet doesn't really know how Lantus works.

There are many things besides stress or tumours that can cause a cat to lose regulation. Needing a dental or any other source of infection/inflammation, hyperthyroidism, pancreatitis, are just a few of them.
 
Does it count at all that she started the 2 and a half on the 6/01 pm shot, and stayed on that until 6/03 pm shot where she got 3? I know 6/04 I was told to skip the morning does since the 3 brought her to 188, but then we continued with the 3 after that. So what I'm wondering is even though the 2.5 was continued again on 6/05, did anything from the previous days help to count towards the shed and towards seeing the full effect of this dose? Because so far she is still in high 300s to mid 400s. Two local vets and then one teaching hospital vet want me to do the 3. Everything I read on here makes sense but everyone outside of here acts like I'm some terrible person withholding insulin from my cat. It is a horrible feeling. When she first got regulated, the vet she had at the time followed a method somewhat similar to on here; we raised her a half unit at a time and held it for a little while before moving on to the next half unit. But he later moved to a different state so we can't see him anymore, sadly. I will say that in the time we briefly tried the 3 units, we were getting better numbers (more in the 200s, even a couple numbers hit blue).
 
Last edited:
She gets her shot at 6 central time. I am so confused and guilt-ridden about what to give her. If I hold the 2.5 any longer, is it really going to break out of those 400s/300s? Just seems like a big drop would have to happen for anything decent to come of it. Do these dose results really change/improve that drastically after 6 cycles? Looking at old spreadsheets from the first time she got regulated and it seemed a very minimal change in efficiency between half units of doses. But then I don't have a lot of experience with this since we didn't have to change it that many times for her to finally get regulated, thankfully.
 
We want to see 7 days continuously on the same dose. Skips or changing doses resets that counter. The only thing that changes the dose is if the goes below 90, in which case you would reduce the dose by 0.25 units. That 3.0 units took her down low enough you didn't feel you could give her dose, so that means it's too high a dose for you. Over time, and with more data, you should be able to shoot lower numbers. The guideline for not shooting below 200 is for new members. But you have to be able to monitor and have the data to shoot lower.

babyg said:
If I hold the 2.5 any longer, is it really going to break out of those 400s/300s?
Click to expand...
You have not held the 2.5 unit dose long enough to see what it can do. Also, we look at how low a dose is taking the cat to evaluate what to do with it. Seeing higher numbers at preshot times doesn't factor much into the decision. We need to see those curves and spot checks mid cycle.
 
You had one cycle with higher numbers, and it was 300's, not 400's. It was also the second cycle after the increase, when we often see some higher numbers. We don't know why. It's a phenomenon we call "New Dose Wonkiness" and is over after a couple cycles. The tests on 6/2 AM were not representative of what the 2.5 unit dose can do. You have to hold the dose a minimum of 6 straight cycles to begin to see what the dose can do. 7 days when following SLGS. Besides, the first cycle you shot 2.5 units, she was in the 200's. Since you started the 2.5 unit dose again, there had been no mid cycle test data to see how she's doing on it.
 
It's on the second tab called "sensor." I haven't had the chance yet to transfer the data from the libre sensor, so I just put the pictures of the graphs there.
 
June 6th cycle, 1st hour 321, 2nd hour 318, 3rd hour 354, 4th hour 355, 5th hour 317, 7th hour 391, 8th hour 383, oth hour 443, 10th hour 422. I still need to put the actual numbers but the graphs are there. I know it'll be easier to read once I transfer
 
It would be immensely helpful if you could copy a few of those sensor numbers onto the spreadsheet. We are specifically interested in how low the dose takes the cat. On May 31st, June 1st and 2nd, was she in the 70's or 80's? That would explain those higher numbers as a bounce. It would also mean she'd earned a reduction down to 1.75 units by going below 90.
 
Okay, I went ahead with the 2.5 again but because of my indecision had stalled a little on her shot time. The 70s and 80s were actually not her real numbers at all. The sensor they put on was faulty and it was giving super low numbers, which I double-checked on my meter and verified to be false. Definitely can disregard those low numbers. We replaced her sensor on June 2nd. The numbers from this new sensor are still kinda iffy; sometimes they match my meter, sometimes they are about 50 points off; the lower they get, the more they seem to be off. I will work on plugging the sensor numbers into the spreadsheet. Just gonna try to get her to eat real quick and then I'll get to it so it's easier to read.
 
Sorry everyone, I fell asleep after feeding her. I've only been getting an hour or two sleep at a time so it's been rough lol. I updated the spreadsheet with the sensor numbers and hope I transferred okay in my sleep-deprived state. Sometimes I had scanned a few times within the same hour, so I generally picked the highest number to place on the spreadsheet, unless it was a number that was out-of-the-ordinary low. Mind you, sometimes the sensor differs from my meter, but hopefully this helps. I appreciate the help tonight with trying to figure out her dose. Shot time has become sort of a crisis moment for me. I am personally thinking, though, that the 2.5 isn't cutting it so far and that we are probably going to end up at the 3 like how they want. The 3 saw some decent numbers but 2.5 is not impressing me yet. Tomorrow morning would make 6 cycles on it. Might be seeing slightly better numbers yesterday/today (maybe due to the wet food?), but I know she can have better. Trying to be patient but also don't want her in higher numbers for too long.
 
Updated the spreadsheet with the latest numbers. The numbers are a little better but still high. I would think we would be seeing better results now that we are past cycle 6 (unless I am just being impatient?). I know typically to hold 3 days to a week but based on the numbers we are seeing now, does it look like it could honestly improve? Shouldn't we be seeing something?
Edited to add that she ate more on her own today and was also more active. :) She didn't really bother with the dry food much. Maybe she'll transition herself over to the canned.
 
Last edited:
Update. The spreadsheet is getting so confusing now with both the sensor and meter readings. I think I have to have them each on their own tab because trying to combine them together is becoming a mess. Until I do, here were her pm numbers (sensor) last night:
+2 211, 202, 237, 249
+3 233, 231
+4 252, 229, 255
+5 305, 309
+7 280
+8 296
+9 331
+10 290
+11 307

This morning:
+7 250
+12 305
+5 286

Numbers look better, though the ear pricks probably produce a higher number than the sensor. Glad that we are mostly out of the 300s range. Ancy to see if this can get better though. She is barely touching the dry food now, but is still picky even with the wet. If I finish a week on the 2.5, Sunday's AM shot would be the 14th cycle and then time to up it if not better than this. Don't think any bouncing is going on anymore so not anticipating it to improve more, though I'm thankful for the improvement we are seeing. Any comments/recommendations welcome.
 
Hi, everyone,

I updated her spreadsheet again. So the numbers did improve on the 2.5; tonight's dose will make the 15th cycle on it. :) We are mostly in the 200s range now with some 300s here or there (maybe from the pancreatitis?). I think the numbers she's having now are better than before when she was "regulated," but probably could be better still. I'm not interested in driving her as low as I can possibly get her; as long as her clinical signs are good, that's my main concern. I highly doubt she'll ever go into remission at this stage in the game. But I'm thinking it'd be nice and good for her overall if we can see some numbers in the 100s range. If anyone wants to check the numbers and let me know what you all think; so far I am leaning towards giving her 3.0 starting Monday evening.
Edited to add that what I am concerned about with the 3 is that when we briefly tried it before, we got a lower preshot number than I'm used to (188, I think) and wasn't sure if safe to shoot at that or not; emergency vet advised to skip. Any thoughts appreciated!
Thanks!
 
Last edited:
As you are doing SLGS, are you able to do a curve one day soon? You don’t have many tests in during the day at all. Ae you able to get any more in, even a +2 or a +10 is good.
Then after we can see a curve, you may be able to increase the dose to 2.75 units.
If you get a lower than normal preshot, the best thing to do is to stall, dont feed, and test again in 20 minutes to see if the BG is rising. you can also post and ask for advice in what to do.
As you are set up with the spreadsheet and have your signature done, I would recommend you go over to the Lantus page and start posting over there where there are a lot of Lantus users who can help you.
On the Lantus page you post a new thread daily and the subject line looks like this:
6/16 Baby G AMPS xxx (and then if you want to ask a question you can ask it here , or you can use the ? Sign which is at the beginning of the subject line.
LANTUS PAGE LINK
 
I have plenty of curve data on the "Sensor" tab. I have to keep the ear pokes and sensor data separate because sometimes the results differ and I like to see by how much, but am mainly using the sensor right now so she's getting poked less. :p
So I see now in the SLGS guidelines we increase/decrease by .25? When did that change? When she first got diagnosed, I remember we went by half units, but that was a few years ago. .25 seems like an inconsequential amount to me (unless the cat's glucose is already in blues and greens), considering that syringes themselves are off that amount if not more sometimes (unless you use a caliper). I'm guessing most people on here use calipers then? And then eyeball the .25 since there's no line for it?
Thanks for the suggestion to use the Lantus page. I'm hoping to increase her dose tonight or some time this week for sure (trying to decide whether to wait until it's closer to the weekend when I can be home and monitor more), so that forum might come in handy, lol.
 
The dose is increased by 0.25 units unless the BG are consistently in pink or above BGs, then the dose can be increased by 0.5 but it has been like this for as long as I can remember.
0.25 units can make quite a difference to the BGs so I would not recommend a bigger increase
Some people use callipers but a lot use 1/2 unit marked syringes and eyeball the 0.25 unit.
Are you able to add any of the sensor BGs to the SS. Many people do.
 
Hi, I am over on the Lantus forum every day we're happy to have you join us! I know the .25 increments are a pain and seem tiny but, I cannot say this loudly enough -- you must trust the process

these dosing methods were developed using data from lots and lots of cats and their experiences and honed to perfection over time. Vets are pretty clueless about them tbh.

If your goal is getting back to regulation, join us over at the Lantus forum, follow SLGS and listen to the gurus like Bron, Wendy and others. You will see results.
 
Status
Not open for further replies.
Back
Top