New Member Dosing Advice Needed

[Mandykins]

Hi all, FYI I’m from Canada but will use US numbers for convenience. My girl Tubbs is turning 10 this year and was just diagnosed with diabetes. Diagnosed June 22, started on Lantus June 25 (I spent the 2 days waiting to be shown how to administer the insulin researching on the Feline Diabetes FB page and was able to request Lantus). The FB page has been phenomenal with help, and I’m ready to start managing the dosage based on advice here.

Started home testing July 1 with the FreeStyle Lite human glucose meter, spreadsheet in my signature. We’re currently giving her 1.5 units of Lantus twice daily; this was the starting dose, so it’s been just over a week at that dosing (last night I reduced by .25 thinking her measurements were low enough, and then after re-reading everything it seemed that we should have left the dose the same so gave 1.5 again this morning). I have seen people mention that’s a high starting dose - testing method is pretty much SLGS but will be testing prior to insulin each time, and spot checking when possible.

Based on our current results, should I be changing anything at this time or keep going as is? Her starting BG was 493, Fructosamine done with the same sample was 673 umol/L (sorry I can’t figure out how to convert this number, it all looks wrong so leaving in the same format as it was on the test results as the glucose test was in mmol/L). Thanks all in advance!

 

[Ale & Bobo & Minnie (GA)]

Hi Mandy and Tubbs,

welcome and great job doing all the research and having your ss setup. I’m going to let others chime in about the dose too, but my feeling is that your instinct in lowering was right based on her lower amps today. I feel it’s better to be lower on the dose and safe at first. There isn’t quite enough data yet since you just started testing 2 days ago. You’re doing spit checking during the day which is great. Do you think you could also try to get a +2 after her pm shot. It helps you gauge where she’s headed overnight. a few questions:

Do you have your hypo kit set up?
Are you holding the food off at least 2 hours before the am and pm tests?

welcome again!

 

[Sienne and Gabby (GA)]

Welcome to FDMB.

There a couple of basics that may be helpful. First, it's important to get at least a before bed test every night. If you don't get any tests during the PM cycle, you're missing half of your data. Not having some idea of what's going on at night will make it hard for you and us to know what's going on. Many cats experience lower numbers at night so it's also important to get PM cycle tests for that reason, as well.

There are two dosing methods we use with Lantus -- Start Low Go Slow (SLGS) and Tight Regulation (TR). In order to decide on which dosing method is possible, the first issue is what you are feeding your cat. If there is any dry food in your cat's diet, your only option is SLGS. With SLGS, if the dry food is higher in carbs, you can start at a dose of 1.0u. If your cat is being fed a low carb, canned or raw food diet, you would start at 0.5u. With TR, the starting dose is based on your cat's weight (initial dose = 0.5 x cat's ideal weight in kilograms).

I would suggest sticking with the dose. It takes a week for the insulin depot to stabilize. Depending on the dosing method you choose, the point at which you evaluate the dose and decide if a dose increase is needed varies -- a week for SLGS, 3 days for TR. The point where a dose reduction occurs is also specific to each dosing method.

Fructosamine levels are not calibrated in the same way as blood glucose numbers. Over 600 tells you your cat has been in a diabetic range (poor glucose control) for approximately 3 weeks.

It's difficult to offer a dosing recommendation without the PM numbers. So far, Tubbs is having a good response to insulin and is in safe numbers. Your seeing some lower numbers (nadir) around mid-cycle which is another reason to get some PM tests. If it were my cat, I would stick to what you're doing.

 

[Mandykins]

Hi Mandy and Tubbs,

welcome and great job doing all the research and having your ss setup. I’m going to let others chime in about the dose too, but my feeling is that your instinct in lowering was right based on her lower amps today. I feel it’s better to be lower on the dose and safe at first. There isn’t quite enough data yet since you just started testing 2 days ago. You’re doing spit checking during the day which is great. Do you think you could also try to get a +2 after her pm shot. It helps you gauge where she’s headed overnight. a few questions:

Do you have your hypo kit set up?
Are you holding the food off at least 2 hours before the am and pm tests?

welcome again!

Thank you so much for the advice! Yes, I’ll add a few tests after her PM shot, I should be able to get at least +2 and +4. She eats all of her food in the first 6hrs after her shot (we’re doing test/feed/shoot), so yes, no food in the 2hrs prior to her shot I do have a bit of a hypo kit set up, she’s on Fancy Feast pate chicken (the Canadian version of FF Classic pate) but I have some higher carb dry food and treats that I’ve “converted” into my hypo kit. We did need to transition her food from when she was diagnosed; so we picked up Dr Elsey’s Clean Protein dry food and the FF, mixed the two dry foods together and have transitioned to about 80% wet food and 20% Dr Elsey’s. Reason for this is to maintain some fiber in her diet (the first day or two she had some very dark almost black stools, we had tried going straight to wet with no transition so may be able to get her completely off the dry if we can find a fiber supplement to add to the wet).

Welcome to FDMB.

There a couple of basics that may be helpful. First, it's important to get at least a before bed test every night. If you don't get any tests during the PM cycle, you're missing half of your data. Not having some idea of what's going on at night will make it hard for you and us to know what's going on. Many cats experience lower numbers at night so it's also important to get PM cycle tests for that reason, as well.

There are two dosing methods we use with Lantus -- Start Low Go Slow (SLGS) and Tight Regulation (TR). In order to decide on which dosing method is possible, the first issue is what you are feeding your cat. If there is any dry food in your cat's diet, your only option is SLGS. With SLGS, if the dry food is higher in carbs, you can start at a dose of 1.0u. If your cat is being fed a low carb, canned or raw food diet, you would start at 0.5u. With TR, the starting dose is based on your cat's weight (initial dose = 0.5 x cat's ideal weight in kilograms).

I would suggest sticking with the dose. It takes a week for the insulin depot to stabilize. Depending on the dosing method you choose, the point at which you evaluate the dose and decide if a dose increase is needed varies -- a week for SLGS, 3 days for TR. The point where a dose reduction occurs is also specific to each dosing method.

Fructosamine levels are not calibrated in the same way as blood glucose numbers. Over 600 tells you your cat has been in a diabetic range (poor glucose control) for approximately 3 weeks.

It's difficult to offer a dosing recommendation without the PM numbers. So far, Tubbs is having a good response to insulin and is in safe numbers. Your seeing some lower numbers (nadir) around mid-cycle which is another reason to get some PM tests. If it were my cat, I would stick to what you're doing.

Thank you so much for the detailed information, I appreciate it! We’ll add at least a few +2 and +4 tests to see what her PM tests look like and will try to get later ones in.

Her diet currently consists of about 80% Fancy Feast pate (Canadian version of FF Classic), and 20% Dr Elsey’s Clean Protein dry to ensure she gets enough fiber (she had some very dark stools when we went straight to wet, so will see if we can find fiber supplements to add to the wet food so she’s 100% on wet - we went back and did a weeklong transition from a high carb dry to the FF/Dr Elsey’s.

Since there is dry food in her diet, and based on what works best for us, I’ll be going with SLGS - we’ll be testing before we feed/shoot, and then do glucose curve once per week to see if we can modify the dose. Yesterday was 1 week since starting insulin, so I’m glad we’re already seeing some green numbers! I know we’re just getting started, but it does give me some relief knowing we’re making some kind of difference.

 

[Ale & Bobo & Minnie (GA)]

Thank you so much for the advice! Yes, I’ll add a few tests after her PM shot, I should be able to get at least +2 and +4. She eats all of her food in the first 6hrs after her shot (we’re doing test/feed/shoot), so yes, no food in the 2hrs prior to her shot I do have a bit of a hypo kit set up, she’s on Fancy Feast pate chicken (the Canadian version of FF Classic pate) but I have some higher carb dry food and treats that I’ve “converted” into my hypo kit. We did need to transition her food from when she was diagnosed; so we picked up Dr Elsey’s Clean Protein dry food and the FF, mixed the two dry foods together and have transitioned to about 80% wet food and 20% Dr Elsey’s. Reason for this is to maintain some fiber in her diet (the first day or two she had some very dark almost black stools, we had tried going straight to wet with no transition so may be able to get her completely off the dry if we can find a fiber supplement to add to the wet).



Thank you so much for the detailed information, I appreciate it! We’ll add at least a few +2 and +4 tests to see what her PM tests look like and will try to get later ones in.

Her diet currently consists of about 80% Fancy Feast pate (Canadian version of FF Classic), and 20% Dr Elsey’s Clean Protein dry to ensure she gets enough fiber (she had some very dark stools when we went straight to wet, so will see if we can find fiber supplements to add to the wet food so she’s 100% on wet - we went back and did a weeklong transition from a high carb dry to the FF/Dr Elsey’s.

Since there is dry food in her diet, and based on what works best for us, I’ll be going with SLGS - we’ll be testing before we feed/shoot, and then do glucose curve once per week to see if we can modify the dose. Yesterday was 1 week since starting insulin, so I’m glad we’re already seeing some green numbers! I know we’re just getting started, but it does give me some relief knowing we’re making some kind of difference.

Dry foods are not the best during a hypo situation because it takes longer for them to be digested and bring up the bg. Make sure you have honey, that’s the fastest best thing in a real emergency. I’d try to have at least 1-2 cans of fancy feast gravy lovers or tuscany which are high in carbs. You’re doing great so keep it up! And Sienne is right, her numbers look really good, yellows and blues are not a bad place to be if you’re a diabetic cat. It seems like she’s handling the testing well so all good news. I’m not sure you need a curve every week. Every 2 weeks should be enough

 

[Red & Rover (GA)]

I do have a bit of a hypo kit set up, s

During a low numbers or hypo event, you will see "karo" mentioned a lot. To us Canucks that's corn syrup. Honey and maple syrup work as well.

 

[Mandykins]

Just an update - still testing pre-shot, struggling to get the night time tests in but will for sure be able to do some good middle of the night testing this weekend, as I'll be setting some alarms to ensure I can compare it to the daytime testing I was able to do last weekend. Yesterday morning she had her lowest pre-shot number - 151. I wasn't comfortable giving her the whole dose as I had to go to work, so gave her half instead. It looks like we're trending downwards! So happy to see good results.

 

[Bron and Sheba (GA)]

Yesterday morning she had her lowest pre-shot number - 191

Did you mean 151?
Do you have an automatic timed feeder so that you could leave some food out for her while you are at work. a lot of us use them here as they are invaluable.
I would look for some canned higher carb food to have in your hypo kit instead of the dry food. FF gravy lovers is higher carb.
Have a lot on this FOOD CHART
Medium carb 11-15%
High carb 16% and above

 

[Mandykins]

Did you mean 151?
Do you have an automatic timed feeder so that you could leave some food out for her while you are at work. a lot of us use them here as they are invaluable.
I would look for some canned higher carb food to have in your hypo kit instead of the dry food. FF gravy lovers is higher carb.
Have a lot on this FOOD CHART
Medium carb 11-15%
High carb 16% and above

Thank you, yes! I edited my post, I meant 151. I'll pick up some of the FF Gravy Lovers for her.