John asked me to weigh in on the discussion regarding when to give HC.
Good morning. I posted a few questions in my condo yesterday and was wondering if you could give me your thoughts.
Thanks,
John
Question: I am trying to learn the differences between Humulin N and Lantus. If Apollo ever starts to go low (under 50), if I give him some HC or karo or what not depending on the situation can I with "100% confidence" prevent a hypo episode? Meaning as long as I am able to feed I can prevent the hypo no matter what the Lantus dose, right? Sorry this question is a bit hard to follow. I am trying to understand that it is "impossible" to cause a hypo episode on Lantus as long as you are feeding during the lows, right? Or is there ever a case that no matter how much you feed a low there is just too much Lantus in his system for you to be able to overcome that on your own? Hope everyone could follow that and understands what I am trying to say.
Marjorie and Gracie wrote:1. You should always get a +2 no matter how high your PS is. The +2 will tell you a lot about where the cycle is going. If your +2 is not pretty close to your PS, then you should be prepared and if it's more than 50 mg/dl below your PS, you should start thinking about the possibility of needing to catch the slide before it starts with some LC.
My response:
But I thought letting him slide down on his own (without my interference unless necessary) was a good thing? Like the other day when I gave him food too soon that he almost missed out on a dose reduction because I didn't let his body get as low as it would have on it's own. I guess I am confused as to when to give LC especially early in the cycle when numbers are dropping? Wouldn't it be better to let him go down on his own (unless he gets to under 50) and then bring him up with HC if need be?
Marjorie and Gracie wrote:2. I know none of us like to test a lot but testing is your friend and helps you catch those drops you saw between +3 and +4. If you had done a +3.5 (yes, I know....125 you think you got room to wait an hour), then you could have caught the drop and again controlled it. It's picking out the patterns. You have a kitty who dropped roughly 150 mg/dl in three hours....that's a flag to be a little more vigilant. I hope Apollo is just on this mission to be done with all this and that's why he keeps throwing these cycles at you.
My response:
Why would I want to control it? Again I thought the best approach was to let him drop on his own to get a true response/result of the dosage give? Only give food if he goes into a danger zone?
As I'm reading it, the nub of your question is whether or not to intervene when Apollo's numbers are dropping in order to gain a possible reduction. Hopefully, I'm following your question correctly.
As I'm sure you're expecting, the answer is, "It depends." It can depend on where in the cycle a drop is occurring, how fast the drop is, if Apollo earned a reduction the previous cycle, how easily you can manipulate his numbers with food (which may depend on where in the cycle this is happening and how much momentum there is), your comfort level with managing the numbers, how much sleep you've had, and probably a few things I'm not thinking of. In an ideal world with an ideal cat, you're right -- it would be best to let our cats float gently down into the "earn a reduction" zone. Many of our cats have their own ideas about this, though.
I think some of what you're asking really depends on you and your comfort level. You have a good grasp on Apollo and how to manage his numbers. As long as you feel like you are in control of the numbers, it's fine to be patient and wait to see if Apollo drops below 50. Obviously, if number are dropping fast, you'll want to test every 30 min. You can opt to intervene if you know that your cat will bounce off of a fast drop, if he's not holding reductions well, or it needs to be tougher for your cat to earn a reduction. (This is a model that I use as do some others. Apollo doesn't need to work harder to earn reductions nor is he bouncing.)
Just so you know, a cat can have a hypo on Lantus. We've never had a fatality but there have been cats that have seized. Patti's Boris is one that immediately comes to mind. We've had beans who have, without realizing it, overdosed their cat (e.g., shooting 5.0u vs. 0.5u). In this latter situation, the bean realized it, and we started her feeding HC very early and there were no ill effects other than a lot of experienced people who were working in shifts with her losing sleep. Probably, if you are testing and know your cat, it would be extremely difficult for a cat to experience a symptomatic hypo. Gabby has dropped into the 20s and didn't experience any symptoms that I observed but I test aggressively and she would not have been in that range for very long. I think this is more the issue -- does the person test, how well do they know their cat, and if in low numbers, it's brief. I do think if you are feeding and/or know to rub Karo into a cat's gums, chances are you will avoid a bad situation. It may, however, necessitate a trip to the ER. Again, this doesn't happen often in LL. In Apollo's case, you are diligent and you've learned how to manipulate the cycle with food. There are no guarantees but we have all learned how to keep our cats' safe and our track record is very good.
Humulin N is very different than Lantus. N is a faster acting insulin and is notorious for big drops. It's much harsher than Lantus. Lantus is a long acting insulin that, once a cat is regulated, will have a flat curve. Overall, N is not a particularly good insulin for cats.
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