? Three weeks into monitoring - still struggling with bouncing numbers

[Vanda Kay]

Hi again,
I now have nearly 3.5 weeks of data on the ss and I'm still not understanding what's going on or what to do about the dosing. The SLGS method is definitely for me - I don't have the ability or nerves to go for TR - and yet this morning we went down to 58 a mere 2 hours after the PM shot. I just can't figure out Landa's pattern. Is her nadir at +12-14 did her BG level just drop like a stone overnight because I finally managed to get some sleep? Why did her BG drop so quickly post shot, from 239 to 69 in just 2 hours? Should I have given a reduced dose this morning (her AMPS was 239)? I really don't have the mental resources to deal with BG numbers that go down that low and I can't always be here to monitor or have someone keep an eye on her. And het her highs are still in the high 300s or higher. I guess I have to go back down on 0.75 after that nadir this morning, but is that enough of a dose reduction to avoid this again? It doesn't help that her appetite isn't great at the moment. I took her to see a new vet on Friday who has been highly recommended by a few friends but she wasn't in today. I was told over the phone that another vet at the practice got my message and said not to reduce the dose. That seems nuts! Please help!

https://www.felinediabetes.com/FDMB/threads/3-22-amps-192-what-to-do.299365/#post-3256522

 

[Marielle]

For continuity, here is your previous post: https://www.felinediabetes.com/FDMB...-and-pm-dosing-any-views.299505/#post-3257951

Below is the information for the SLGS dosing method. According to this method, if a kitty drops below 90, they earn a dose reduction.

You may want to go back to your last post and read the advice offered by two of our key experts on the forum, paying specific attention to why your Landa is bouncing, and more specific attention to their advice about not shooting different doses.

Most all of us here understand how overwhelming it is when you have an initial diagnosis, and we understand the frustration of trying to get Landa regulated. I encourage you to follow the advice you've received so far and continue to post daily here on the forum and ask as many questions as necessary until you feel more comfortable.

I'm sure one of the forum experts will weigh in here soon. Hang in there, Vanda!


From the SLGS sticky:
START LOW, GO SLOW (SLGS)

The Start Low, Go Slow Method (SLGS) with Lantus, Levemir, or Biosimilars for Diabetic Cats has been adapted from the FDMB's original 5 Steps to Regulating Your Diabetic Cat. Adaptations were necessary to accommodate the action, nuances, and exceptions of the newer Lantus, Levemir, and their Biosimilars insulins.

Requisites when following the Start Low, Go Slow Method:

• Learn the signs of and how to treat Hypoglycemia and prepare a Hypo Toolbox.
• Test regularly for ketones and know about Diabetic Ketoacidosis (DKA).
• Use a meter calibrated for humans, not a pet-specific meter. Reference numbers given are for measuring blood glucose with a human meter.
• Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
• Most kitties are easier to regulate when fed small meals throughout each cycle. Others adapt well to free feeding.

Starting Dose:

• 1u BID if kitty is not on a wet/canned low carb diet
• 0.5u BID if kitty has been switched to a wet/canned low carb diet
• If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
• Generally, shots are to be given 12 hours apart.

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

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!

 

[tiffmaxee]

Reduction earned. New dose for the next 7 days is .75 UNLESS there’s a bg under 90 which would call for another reduction. For most, FD is a marathon and not a race. Hang in there.

 

[Vanda Kay]

For continuity, here is your previous post: https://www.felinediabetes.com/FDMB...-and-pm-dosing-any-views.299505/#post-3257951

Below is the information for the SLGS dosing method. According to this method, if a kitty drops below 90, they earn a dose reduction.

You may want to go back to your last post and read the advice offered by two of our key experts on the forum, paying specific attention to why your Landa is bouncing, and more specific attention to their advice about not shooting different doses.

Most all of us here understand how overwhelming it is when you have an initial diagnosis, and we understand the frustration of trying to get Landa regulated. I encourage you to follow the advice you've received so far and continue to post daily here on the forum and ask as many questions as necessary until you feel more comfortable.

I'm sure one of the forum experts will weigh in here soon. Hang in there, Vanda!


From the SLGS sticky:
START LOW, GO SLOW (SLGS)

The Start Low, Go Slow Method (SLGS) with Lantus, Levemir, or Biosimilars for Diabetic Cats has been adapted from the FDMB's original 5 Steps to Regulating Your Diabetic Cat. Adaptations were necessary to accommodate the action, nuances, and exceptions of the newer Lantus, Levemir, and their Biosimilars insulins.

Requisites when following the Start Low, Go Slow Method:

• Learn the signs of and how to treat Hypoglycemia and prepare a Hypo Toolbox.
• Test regularly for ketones and know about Diabetic Ketoacidosis (DKA).
• Use a meter calibrated for humans, not a pet-specific meter. Reference numbers given are for measuring blood glucose with a human meter.
• Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
• Most kitties are easier to regulate when fed small meals throughout each cycle. Others adapt well to free feeding.

Starting Dose:

• 1u BID if kitty is not on a wet/canned low carb diet
• 0.5u BID if kitty has been switched to a wet/canned low carb diet
• If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
• Generally, shots are to be given 12 hours apart.

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

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!

Thank you. I have read all of the info posted, but my brain can't take it all in from very severe sleep deprivation and anxiety. I'm not shooting different am and pm doses, just adjusting according to PS numbers and amount of food eaten. I assume the advice on low PS numbers still stand i.e. when to skip, when to give token or reduced dose.

 

[Vanda Kay]

Reduction earned. New dose for the next 7 days is .75 UNLESS there’s a bg under 90 which would call for another reduction. For most, FD is a marathon and not a race. Hang in there.

Thank you. Will do. Just one question about the 0.75 dose: I have the half unit syringes, but fiind it really difficult to see those in-between doses. Am I the only one?

 

[Marielle]

Thank you. I have read all of the info posted, but my brain can't take it all in from very severe sleep deprivation and anxiety. I'm not shooting different am and pm doses, just adjusting according to PS numbers and amount of food eaten. I assume the advice on low PS numbers still stand i.e. when to skip, when to give token or reduced dose.

I completely understand how overwhelming this disease can be--it's quite a learning curve for the caregiver. The forum is a great place to get answers or reinforcement or just to vent, if necessary.

Also, just want to add that it is clear you care so much about Landa--otherwise, you wouldn't be here. You're doing your very best to keep her safe, and that's a wonderful effort.

I'm a little concerned about the shooting protocol that you've mentioned here ("I'm not shooting different am and pm doses, just adjusting according to PS numbers and amount of food eaten."), and I'm going to tag @tiffmaxee to get her input and guidance. I'm worried you are adjusting doses incorrectly and not correctly following the SLGS dosing method. Let's see what she has to say.

 

[tiffmaxee]

Thank you. Will do. Just one question about the 0.75 dose: I have the half unit syringes, but fiind it really difficult to see those in-between doses. Am I the only one?

You are not the only one. That’s why lots of us use digital calipers.

https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/#post-862835

In the meantime I suggest finding a good syringe and filling it up to .75 with colored water. You can use it to fill future dosing. Use food coloring or coffee or tea. That way you will be as consistent as possible. Make sense?

 

[Vanda Kay]

You are not the only one. That’s why lots of us use digital calipers.

https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/#post-862835

In the meantime I suggest finding a good syringe and filling it up to .75 with colored water. You can use it to fill future dosing. Use food coloring or coffee or tea. That way you will be as consistent as possible. Make sense?

No. i'm sorry! I don't understand.

 

[Vanda Kay]

I completely understand how overwhelming this disease can be--it's quite a learning curve for the caregiver. The forum is a great place to get answers or reinforcement or just to vent, if necessary.

Also, just want to add that it is clear you care so much about Landa--otherwise, you wouldn't be here. You're doing your very best to keep her safe, and that's a wonderful effort.

I'm a little concerned about the shooting protocol that you've mentioned here ("I'm not shooting different am and pm doses, just adjusting according to PS numbers and amount of food eaten."), and I'm going to tag @tiffmaxee to get her input and guidance. I'm worried you are adjusting doses incorrectly and not correctly following the SLGS dosing method. Let's see what she has to say.

I just meant that I'm following the pre-shot numbers advice on the sticky: if below 150, dont' shoot, if between 150 and 200, one of three options, if above 200 but below usual PS number, a reduced dose might be a good idea. That is what I meant. And if Landa doesn't eat at all, then it's not safe to shoot and I have to skip.

 

[Vanda Kay]

You are not the only one. That’s why lots of us use digital calipers.

https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/#post-862835

In the meantime I suggest finding a good syringe and filling it up to .75 with colored water. You can use it to fill future dosing. Use food coloring or coffee or tea. That way you will be as consistent as possible. Make sense?

Could you also recommend a good HC wet food to have in my hypo toolbox please. I thought 15-16% was high, but it seems that is medium and I don't have anything higher. Thank you!

 

[tiffmaxee]

Fill a syringe with what you think is .75 with colored water. Then use that to measure each time you shoot. Better yet get calipers.

 

[tiffmaxee]

I just meant that I'm following the pre-shot numbers advice on the sticky: if below 150, dont' shoot, if between 150 and 200, one of three options, if above 200 but below usual PS number, a reduced dose might be a good idea. That is what I meant. And if Landa doesn't eat at all, then it's not safe to shoot and I have to skip.[/QUOTE

if under 300, post for dosing advice. Try stalling without food and retest in 20-40 minutes. If going up and close yo 200 shoot the full dose. If you feel the need to skip or shoot reduced doses too often, best to lower the dose so you can get consistent. We gradually lower the number until you shoot if over 90.

 

[Brianna & Xander]

Could you also recommend a good HC wet food to have in my hypo toolbox please. I thought 15-16% was high, but it seems that is medium and I don't have anything higher. Thank you!

The Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy (wordy title) is 20%! That's what I keep on hand. Haven't had to use it yet though. There's a great pdf here that shows the carb content for a ton of different foods.

 

[Vanda Kay]

Fill a syringe with what you think is .75 with colored water. Then use that to measure each time you shoot. Better yet get calipers.

I use disposable syringes that come with the needle attached! Do you reuse syringes and buy replaceable needles? I have ordered the callipers!

 

[tiffmaxee]

I use disposable syringes that come with the needle attached! Do you reuse syringes and buy replaceable needles? I have ordered the callipers!

Never reuse syringes. You can fill a used one with colored water and use it as a sample of .75 to be more consistent. When time to shoot load the amount that matches your sample in the new syringe. If this is confusing just do the best you can until the calipers arrive. They will help you a lot.