Missing the optimal dose

[Clarycat]

Hello

I read a lot about missing the optimal dose and continuing to increase past this, and I’d like to ask about the effects of this if anyone is able to shed any light please?

If the dose was continued to be raised, could it be that the BG levels would remain a constant high without ever going low? Or would it eventually drop into a possible hypo?

It’s that confusion over whether the vet was correct with the increases in dose and a further increase is needed or if he’s just constantly high because the increase was made too soon.

 

[Diane Tyler's Mom GA]

Your previous post for continuity
https://felinediabetes.com/FDMB/threads/from-prozinc-to-lantus-what-to-expect.281573/
I see from your previous post you switched from Prozinc to Lantus
It would be helpful if you could set up your signature and our spreadsheet where we enter our cats BG numbers to see how it's working so we can help you if needed

I'll give you the links and if you need help with setting up the spreadsheet just ask ,we have a member that would be happy to do it for you

First off we adjust the dose by how low your cats BG is dropping which is called the nadir
( the lowest point in the cycle) and we adjust the dose by 0.25 units at a time

Giving too much insulin can cause a hypo
Are you still using the Freestyle Libre or are you testing your kitty with a hand held meter?

Have you read the information about Lantus ?
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
Read all the yellow stickys especially the 2 dosing methods and see which one you would like to follow, they will explain when an increase or decrease is needed

Here is the link so you can set up your signature and spreadsheet
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

The signature is at the end of everyone's post in gray ,information about our cats
Can you add to your signature from UK

 

[Diane Tyler's Mom GA]

https://felinediabetes.com/FDMB/threads/pettest-glucose-meter-genteel-lancets.281288/
On this post you asked
Hi everyone
I’m based on the uk so I have very little choice where I buy the Pettest genteel lancets from, but there are lots of similar looking alternatives. Does anyone use this meter and do you use the branded lancets or do you buy other generic ones?

Thank you

Christine


And I had answered

Hi Christine did you mean the Advocate Pet Test Meter? I really haven't come across any members using it
Most of use human meters that's what our numbers are based on
Here is a link for our UK members ,lots of information
https://www.felinediabetes.com/FDMB...-vit-b12-and-other-need-to-know-stuff.137376/
You can buy any brand lancets 26 or 28 gauge
Feel free to ask any other questions you have

 

[Bron and Sheba (GA)]

Hello

I read a lot about missing the optimal dose and continuing to increase past this, and I’d like to ask about the effects of this if anyone is able to shed any light please?

If the dose was continued to be raised, could it be that the BG levels would remain a constant high without ever going low? Or would it eventually drop into a possible hypo?

It’s that confusion over whether the vet was correct with the increases in dose and a further increase is needed or if he’s just constantly high because the increase was made too soon.

If the dose is continually raised past the best dose, the cat will eventually have a hypo. The way to avoid this is by home testing. By looking at the data we can tell you if the cat is getting too much insulin or not enough. Just getting a test done every few weeks or even once a week at the vet, will not give you this information.
If you are having issues with this I would recommend you look at hometesting and setting up a spreadsheet and entering the data onto it so we can see it. We also increase in smaller increments than the vet does.

 

[Clarycat]

Thank you all. I have added my signature/spreadsheet. The readings are a combination of Freestyle Libre and Pettest meter but since his had the Lantus all tests so far are from the Pettest meter. He’ll have a Libre on from tomorrow.

 

[Diane Tyler's Mom GA]

Thank you all. I have added my signature/spreadsheet. The readings are a combination of Freestyle Libre and Pettest meter but since his had the Lantus all tests so far are from the Pettest meter. He’ll have a Libre on from tomorrow.

Great job setting up your signature and SS
Have you read about Lantus especially the 2 dosing methods and chose one and add it to your signature and SS up top where it asks you

They will both explain when you need to increase or decrease
Is there any way you can add a US tab up top on your SS
The members that help here are used to seeing US numbers otherwise we have to take the World numbers and times them by 18
If you don't know how to do it I can tag a member to add it for you, then I'm pretty sure once you add the World they will automatically convert thecBG on the US tab
Just ask if you need help with that
I'll give you the link for Lantus please read all the yellow stickys especially the dosing methods which are TR and SLGS and see which one you want to follow
Do you have the U-100 syringes with the half unit markings?
We adjust the dose by 0.25 units at a time
So these syringes make it easier to do that
If you have the Lantus pens you can only adjust them by whole units so that's why we use the syringes , insert the syringe into the gray rubber stopper and draw out our insulin

We also adjust the dose by how low our cats BG is dropping (nadir, lowest point during each cycle, not by the Pre Shots

 

[Diane Tyler's Mom GA]

Can you add to your signature from UK so members know
The Hills DM you have in your signature is the dry food correct,? That's about 18% carbs which is way to high. Can you add dry to it in your signature so membets are aware of it.
You can always tap on your previous post and read it again if you plan to transition to all low carb wet food
Don't do it until you are home testing because it can drop your cats BG by 100 pointsc

 

[Clarycat]

Great job setting up your signature and SS
Have you read about Lantus especially the 2 dosing methods and chose one and add it to your signature and SS up top where it asks you

They will both explain when you need to increase or decrease
Is there any way you can add a US tab up top on your SS
The members that help here are used to seeing US numbers otherwise we have to take the World numbers and times them by 18
If you don't know how to do it I can tag a member to add it for you, then I'm pretty sure once you add the World they will automatically convert thecBG on the US tab
Just ask if you need help with that
I'll give you the link for Lantus please read all the yellow stickys especially the dosing methods which are TR and SLGS and see which one you want to follow
Do you have the U-100 syringes with the half unit markings?
We adjust the dose by 0.25 units at a time
So these syringes make it easier to do that
If you have the Lantus pens you can only adjust them by whole units so that's why we use the syringes , insert the syringe into the gray rubber stopper and draw out our insulin

We also adjust the dose by how low our cats BG is dropping (nadir, lowest point during each cycle, not by the Pre Shots

Thank you! I’ve sorted the signature now.

I do use the vial of Lantus, not pens, with the U100 syringes. As for the dosing method, I’m under strict control of a vet which has been okay so far (unless the spreadsheet tells another story!). I’m expecting an increase in a couple of days if BG levels continue like this. The vet hasn’t increased Lantus yet but I’d be surprised if she didn’t increase it by 0.5

 

[Diane Tyler's Mom GA]

Thank you! I’ve sorted the signature now.

I do use the vial of Lantus, not pens, with the U100 syringes. As for the dosing method, I’m under strict control of a vet which has been okay so far (unless the spreadsheet tells another story!). I’m expecting an increase in a couple of days if BG levels continue like this. The vet hasn’t increased Lantus yet but I’d be surprised if she didn’t increase it by 0.5

Thanks for setting up the US tab on your SS
Please don't forget to add to your signature that the Hill DM is dry food and from the UK
The dry is about 18% carbs too high , but I see you already read that in my post #7 , post numbers are to the right
Just tap in your name up top ,then tap in signature and add what I said then tap Save
Do your syringes have the half unit markings ?

 

[Bron and Sheba (GA)]

Hi,
Can you get some tests i during the PM cycles? It would be good to see if the BGs are dropping at all overnight.
It takes 5 to 7 days for the depot to fill initially with Lantus so you don't increase the dose before then.
If you are going to swap to a lower carb diet, which would better, I would not increase the dose at the same time. Do one change at a time.
Is the Hills MD the wet or dry food?
I am assuming the meter, the Pettest meter, is a pet meter, not a human meter. Is that correct?

 

[Clarycat]

Thanks for setting up the US tab on your SS
Please don't forget to add to your signature that the Hill DM is dry food and from the UK
The dry is about 18% carbs too high , but I see you already read that in my post #7 , post numbers are to the right
Just tap in your name up top ,then tap in signature and add what I said then tap Save
Do your syringes have the half unit markings ?

Signature sorted. Yes, the syringes have half unit markings.

Hi,
Can you get some tests i during the PM cycles? It would be good to see if the BGs are dropping at all overnight.
It takes 5 to 7 days for the depot to fill initially with Lantus so you don't increase the dose before then.
If you are going to swap to a lower carb diet, which would better, I would not increase the dose at the same time. Do one change at a time.
Is the Hills MD the wet or dry food?
I am assuming the meter, the Pettest meter, is a pet meter, not a human meter. Is that correct?

I’ll have more tests once the freestyle is on today. I do want to stop the dry food, or at least have a lower carb one (apparently Thrive is good?) but I’ll do this gradually. Yes the Pettest is a pet meter. Unfortunately because the last Libre failed very quickly I’d have had 3 different spreadsheets so just put the readings on one.

 

[Bron and Sheba (GA)]

I don't know thrive dry food.
I'll tag @Teetee (UK) as he is very knowledgeable about cat food in the UK.

 

[Sienne and Gabby (GA)]

And tagging @Elizabeth and Bertie another UK person.

I hate to say this but how your vet has been advising you is not consistent with either of the approaches we use for dosing. Generally, if your cat's blood glucose drops below 90, you would reduce the dose by 0.25u. We also evaluate how effective the dose is on a weekly basis. For example, where you held the 4.5u dose for 24 days. We would have encouraged you to increase the dose if Tigster's numbers were not in a normal range. The longer you stay at a dose that is not lowering numbers, the greater the possibility of glucose toxicity developing. (It's a horrible term that means that your cat's body get acclimated to the higher range so it takes a bit more effort to get the numbers to come down.)

 

[Clarycat]

And tagging @Elizabeth and Bertie another UK person.

I hate to say this but how your vet has been advising you is not consistent with either of the approaches we use for dosing. Generally, if your cat's blood glucose drops below 90, you would reduce the dose by 0.25u. We also evaluate how effective the dose is on a weekly basis. For example, where you held the 4.5u dose for 24 days. We would have encouraged you to increase the dose if Tigster's numbers were not in a normal range. The longer you stay at a dose that is not lower numbers, the greater the possibility of glucose toxicity developing. (It's a horrible term that means that your cat's body get acclimated to the higher range so it takes a bit more effort to get the numbers to come down.)

Thank you, I appreciate this.

 

[Elizabeth and Bertie]

Hi Chris, waving to you from Surrey!

I don't use the PetTest meter (I use One Touch Verio human meter) but I do use generic lancets which look very similar to the lancets sold for the Genteel lancing device. I'm happy to pop a few in the post to you if you'd like to see how they compare?

[pic is from eBay, where I usually get mine from]

RE lower carb dry food, the lowest carb kibble that we know of at the moment in the UK is Thrive 'chicken'. That seems to be a smidge under 10% calories from carbs. The 'chicken & turkey' seems to be a bit over 10%. And the fish flavour is quite a bit higher. ...We do advise that care needs to be taken if switching to a lower carb food because this can reduce blood glucose and therefore the need for insulin. So, as Bron says, if switching to lower carb don't do that at the same time as raising the insulin dose...
As to dose, that 4 units of Lantus looks like a very high starting dose to me, especially given that your cat was getting some very steep drops on 4.5 units of Prozinc, and some of those high flat numbers may just be due to 'bouncing' (rebound). Would be good to see more numbers from the night cycles to see if there are drops in numbers that are being missed. If this was my cat I'd certainly want to rule that out before increasing the dose further.

Which syringes are you using? ...If it's the BD U100s that many UK folks use then be aware that the markings on these can be quite wonky. And many UK folks use digital calipers to measure insulin doses with these BD syringes (instead of relying on the markings on the syringe barrel).


Well done for testing BG, and for getting going with this so quickly. You're doing great!

Eliz

 

[Clarycat]

Hi Eliz

Thanks so much for the offer of the lancets! I’ve actually got some now which are perfect.

I purchased some chicken Thrive which he loves so I’m integrating that slowly.

Tigster’s night time readings have gone as low as 3.9 now, so the vet won’t increase anymore. I am waiting to see what they say as I’m expecting an update today. However, I have tried to lower the dose myself before and the vet went absolutely nuts. As I’ve said before, they’re a very good vet but have Tigster on a very tight rein. Just to say - he’s never suffered a hypo under their care!

I’m using the Sol-Vet syringes, with a magnifying glass I did try callipers but really couldn’t get on with them. These syringes seem to be okay?

Thanks again

Chris

 

[Elizabeth and Bertie]

Tigster’s night time readings have gone as low as 3.9 now, so the vet won’t increase anymore.

3.9 is in normal range (certainly on a human meter, and on a pet meter too but that would be getting quite close to hypo range). But if you see that number with the Libre it's best to check with a hand held glucose meter. The Libre measures glucose in interstitial fluid, not blood, and is a bit behind what the BG level might be. ...There is also not much room to drop further though if transitioning to lower carb diet...
That drop to 3.9 is also a big drop, and the speed/extent of the drop could easily cause a bounce.

However, I have tried to lower the dose myself before and the vet went absolutely nuts.

Understood. We'd all like to be able to trust our vet's advice. That would be great. Sadly though, our experience is that there aren't many who are au fait with feline diabetes... Do keep an open mind, and be guided by the data your cat is giving you. At the end of the day you're the one holding the syringe, so it's your call, not your vet's. And, if you're in doubt, safety is key...
...Incidentally, my own two diabetics had awful advice from vets initially, and wouldn't have survived if I'd followed that advice (thankfully I found this forum)... My current cat-only vet is happy for me to decide my cat's insulin dosage, and, despite (or perhaps because of) her considerable experience with cats, has said that she "honestly wouldn't know how much to give her..."

I’m using the Sol-Vet syringes, with a magnifying glass I did try callipers but really couldn’t get on with them. These syringes seem to be okay?

From what I've seen the Sol-Vet are more accurate than the BD, they're made specifically for animals.

I never got on with callipers either, haha!
I have a 'good' syringe that I keep as a template. And I use that to compare other syringes to. And I absolutely rely on a magnifying glass too, my close vision isn't great...

Eliz

 

[Clarycat]

We'd all like to be able to trust our vet's advice. That would be great. Sadly though, our experience is that there aren't many who are au fait with feline diabetes... Do keep an open mind, and be guided by the data your cat is giving you. At the end of the day you're the one holding the syringe, so it's your call, not your vet's. And, if you're in doubt, safety is key...
...Incidentally, my own two diabetics had awful advice from vets initially, and wouldn't have survived if I'd followed that advice (thankfully I found this forum)... My current cat-only vet is happy for me to decide my cat's insulin dosage, and, despite (or perhaps because of) her considerable experience with cats, has said that she "honestly wouldn't know how much to give her..."

My vet has successfully treated many diabetics so it’s a really difficult situation. They’ve been in touch to say no increase (no surprise) and to check on Tigster’s symptoms, which actually are good. I’d be tempted to drop him down a bit - he is still bouncing - but I think I’d have to change vets and that’s a conversation I’m not ready to cope with right now, neither is the process of trying to find a vet who’s open minded.

They may ask me to drop the dose - who knows.


From what I've seen the Sol-Vet are more accurate than the BD, they're made specifically for animals.

I never got on with callipers either, haha!
I have a 'good' syringe that I keep as a template. And I use that to compare other syringes to. And I absolutely rely on a magnifying glass too, my close vision isn't great...

Eliz

I see you are using Prozinc. I have 4 sealed bags of 10 Sol-Vet u40 syringes if you’d like then? They’re no use to me anymore. Let me know I’d be happy to send them and see them go to good use!

 

[Elizabeth and Bertie]

I see you are using Prozinc. I have 4 sealed bags of 10 Sol-Vet u40 syringes if you’d like then? They’re no use to me anymore. Let me know I’d be happy to send them and see them go to good use!

Aw, bless you, that's very kind.
Am using Levemir insulin for my current diabetic, Bonbon. (I think that's the fifth insulin I've used in total, but that did indeed include a very brief spell with Prozinc. Also used two other PZI insulins (now discontinued), and Caninsulin initially....)
But...another UK member here, @Teetee (UK) , is using Prozinc, and he may also be using U40 syringes...

Eliz