11/10 Did a partial curve, need advice

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Jamielvsaustin

Jamielvsaustin

Member Since 2014
Charlie is either extremely low at the time we should be giving him a shot...or his next shot he's extremely high. I know, we've got to be doing something wrong. But I'm not going to give my cat insulin when he tests at 55 or 67 or even 72. Especially if one day he tests at 275 and 4 hours later he's down to 49. I just can't risk it...but I know I need to do my part on regulating him. I guess, I just don't know how to do it...without freaking myself out into a poor decision.

Anyhow, I did as much of a curve on Saturday as I could. I ended up testing every hour because he dropped so low. I gave treats each time I tested, so that may have affected his levels...but I didn't give anything high carb because I wanted to monitor him, and we'd decided to lower his dosage amount anyway. He got lower during this curve, than the time I thought he was hypo'ing....his personality/behavior never changed and that helped me to decide not to try to change his readings (by giving high carb items or karo syrup). If at any point I thought he was in danger I would have reacted appropriately and said screw the curve...

How could he go from 48 to 442 in such a short period of time? (3.5 hrs) PMPS was given on time.
 
Hi guys-

Welcome to LL! I'm at work, so I have to be brief, but I am sure others will be along.

First and foremost, any time a kitty drops below 50, s/he earns a .25U reduction. So on the evening of 10/28, his dose should have become 1.00U, and on the evening of 11/08, his dose should have become .75U. So, as of now, Charlie's dose should be .75U.

What you are seeing with the extreme highs after extreme lows is called "bouncing" - basically, the liver takes over and tries to protect the body from going hypo. This usually happens when a kitty's body is not used to the low numbers, although we do have some long-term bouncers here.

Given how Charlie dives and climbs, I would very strongly urge you to get more tests in during every cycle. He could definitely be dropping into dangerous numbers on a regular basis, but with testing only at preshot time, you're just seeing what are most likely bounces.

Same thing goes for getting preshot tests - you really do not want to be shooting without knowing yours starting point, as this could be asking for serious trouble.

Treats -especially if they are low carb - should have little-to-no effect on his BGs, and they are an important part of the process - we want Charlie to be HAPPY about being tested!

Additionally, Lantus dosing is based on the nadir (the lowest point in the cycle), not the preshot values. Given Charlie's patterns, this is something to keep in mind.

I'm sure others will be along with more info soon. In the meantime, there are stickies at the top of this forum with tons of great info!
 
There are some stickies that will help you better understand Lantus and how it works. I started with the one on the protocol and read them all. Once I started home testing I quickly was urged to get more yests in and found that Max went green at night more than during the day which explained his crazy bouncing numbers. Had I not tested then that he could have been overdosed and gone hypo while I slept! I would take Amy!s advice and lower the insulin and then follow the protocol. If you post daily advisors will help you decide what to do with dosing and when. Welcome to LL.
 
Wow that is lots of different numbers and lots of different insulin doses.

I am new and so can't advise on dosing but I will tell you what worked for me mad my cat remi. We started low at 0.5 twice a day. Whilst he was still higher than I would have liked on this dose it did help his numbers to stabilise and for me to begin to see how he reacts to the lantus and what his curves might look like. I then slowly increased the dose by going to 0.75 twice a day. This bought his numbers down a little more into the yellows. We kept this dose until he stabilised and then increased to 1, etc. by the time we got to 1.25 he got into the numbers that were great. From there we have begun to slowly decrease.

I think that by jumping around on dosing and when you do it you are going to struggle to get your cat regulated. Maybe others could advise but have a look at my spread sheet and maybe that might give some ideas. I think it shouldn't be a rush to get them into great numbers but a slow and controlled reduction.

The other thing I wanted to point out is that I don't rely on the unit markings on the syringe. These can be way out and so influence numbers. If you compare two side by side you will see what I mean. I always use a metal ruler to double check the amount I am giving. The number isn't the bit that's important it's the consistency of dose that is. Some people use digital calipers but I found this works just fine. Following advice here I found a syringe that I tonight was accurate and marked it as my test syringe. I then used that syringe to convert it to mm on the metal ruler. So for me 1 unit is 2.5 mm on the metal syringe. I use this measurement regardless as to whether this lines up on the syringe I am loading up.

Hope that helps.
 
Hi there and Welcome! :cool:

Here is a link to the Tight Regulation protocol we use as a guide. It's both safe and effective.

Is kibble still in the picture or have you completely transitioned?
I ask because completing the transition to 100% low carb wet can have a HUGE positive impact on BGs and reduce your kittys insulin needs pretty darn quick.

I encourage you to get on board with the TR protocol. Plenty of experienced folks here to help you along the way .
In terms of potential for remission having a newly diagnosed kitty (<1yr) is an advantage.

Make the most of it - It's well worth the effort involved.

Hang in there - and hang in here :cool:
 
Amy&TrixieCat said:
First and foremost, any time a kitty drops below 50, s/he earns a .25U reduction. So on the evening of 10/28, his dose should have become 1.00U, and on the evening of 11/08, his dose should have become .75U. So, as of now, Charlie's dose should be .75U.
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Most of what Amy said is right on the mark, but I do want to address this paragraph. I know she said she was in a hurry when she wrote it, so I'm thinking this isn't exactly what she meant.

We don't normally recommend reductions retroactively, especially from something 2 weeks ago. We go by whatever we are seeing now. However, I see that you DID reduce his dose then, from 2 units to 1.25 units, so you're all good there anyway.

If you look at that day, though, you can see an example of what we mean by the "insulin depot." You didn't even give a shot that morning, and he dropped to the 30's anyway! That's because there was still some leftover action from the 2 unit shot you gave the night before. Most likely the 31 you caught on Saturday also had some influence from the 1.25 unit dose you gave the night before so you *could* argue that he might not need a reduction from the 1 unit dose. However, 31 is a pretty low number and I would take it seriously and reduce again.

How much to reduce? That depends. It looks like you are at a point with Charlie where you'll want to decide what your goal for him is, and what you are able to do to help him get there. You're doing a good job of getting preshot tests now. If you can start adding some tests at other times in the cycles, you'll be able to know for sure whether he is still going low on the new dose. In that case, I think a 0.25u unit reduction (to 0.75u) should be ok. If you can't increase the testing, then I would probably take a larger reduction and possibly continue skipping shots when you have a lower preshot reading.

On your spreadsheet, you can see that the times he did drop really low, he bounced back up to 400s/500s by preshot. It would be reasonable to assume that the other times you have seen 400/500 at preshot might have also been preceded by a low number you didn't catch. If you can just grab extra tests whenever possible, you can start catching those. You don't have to do curves all the time, just test before bed every night, maybe right before you leave for work or right when you get home, and a little more on weekends.

Those are my thoughts. What do you think?
 
I wish we could test more during the week. On a good day we would be able to test AMPS +9 up until the actual PMPS…and then a couple hours after that…maybe till +4 (if we stay up till 11:30). We’re not going to be able to get midcycle tests. Our schedules are so crammed pack because of work and school. 
I thought, when he was having the really high nights, and low mornings…perhaps we should consider giving his evening shot sooner. Maybe even by an hour. With the thought process that maybe it’d help level him out a bit. Lower him at night, and make him a little higher in the morning. Thoughts?
It’s currently +10 and he’s at 330. I can only imagine he’ll get higher.
He’s been on a single unit for 3 consecutive shots, skipped one and then back on…and will likely get 1 unit tonight.
Charlie (and Gus) have completely transitioned to wet food only. They don’t eat the recommended amount (per the can) as it’s too much….it gets wasted. They’re getting about a can and a quarter of a can, each, a day. Gus is a fatty mcfatty…so I might start making sure he gets less than that.
We bought some single ingredient treats this weekend and both cats are a fan of the chicken and the beef lung…but are absolutely NOT fans of the fish. (fine by me, it stinks to high heaven)
Ugh…I hate feeling so unsure and not knowing what the right decision is. Maybe changing him to 0.75u instead of giving his PMPS early is a better option. *Shakes fists* I feel like we’re making SO many changes. Was everyone’s fist month like this? I cringe thinking about giving him 2.00u in the beginning…and if we’d kept up with it…who knows what we would have done to him.
I will say, it’s gotten a lot better for me when it comes to testing him…and in turn I believe for him to. We have a little routine and I don’t get that sickening feeling in my stomach, my hands don’t sweat and shake, and I don’t feel slightly dizzy anymore. I’m not having to stick him multiple times as often anymore. I think he really enjoys the warming sock that I use (found out 23 seconds is perfect). After I staunch the bleeding I hold the warming sock back up there for a bit. And after his injection I give him a little scritch on the spot afterward (kind of like when the dentist jiggles your cheek if they’re giving you a shot). Right now, as long as I’m feeding him and not taking too long-I don’t have to restrain him. (which is a big deal to me) So there are some positives. … maybe I’m asking for too much.
 
Others can explain it better but giving the shot an hour early is like an increase and an hour late a decrease. You do have about 30 minutes each day to play with I think. That is why so many people were stressing about the time change back from daylight savings. Some people play around more with the times but I think only when they know really well how their cats will react and have lots of testing info to back it up.
 
Hi, Jamie and welcome to Lantus Land.

Libby and Amy made some very good points that are definitely worth thinking about. I do have one question for you based on what you mentioned about your schedule. Would it be feasible to shoot a little earlier? It sounds like you're home by +9 in the AM cycle. Shooting earlier would allow you to get some additional tests before you leave for work/school and has the advantage of getting some PM tests that aren't too late into the evening. It may not work but it is something to think about.

As for shooting early, for now, I'd discourage it. Because Lantus has an insulin depot and because of the way this insulin works with respect to there being overlap between the shots, like Elise mentioned, shooting early is like a dose increase. It's a viable strategy in some situations but I don't think that it's a good strategy for for your kitty right now.
 
Thank you for clarifying my thoughts, Libby! Yes, what I really meant is what SHOULD have happened when those tests in the 30s popped up; I'm sorry I implied to take the reductions retroactively.

Sienne's suggestion of trying to shoot a little earlier is a good idea, if it's something you can make work. When my Trix was diagnosed, I shifted my schedule so that I could get a couple of post-shot tests in before I left for work, just to be sure she was safe. I have to admit Charlie dropping as low as he has done has me concerned, so as Libby mentioned, grabbing tests just whenever you can will be a big help in filling in the picture.

It sounds like you are making great progress. I remember all too well how scary and stressful it all was when Trix was first diagnosed. I also remember everyone telling me how their kitties come running when the hear the jar of test strips being shaken....and I remember thinking "no way" :lol: !!! I quickly learned - "yes way"!!! These kitties know we're helping them, and treats and special extra attention don't hurt, too! It really keeps getting easier, and before you know it, all aspects of this are second nature.
 
You have come to a great place for good advice and lots of moral support. :YMHUG: :YMHUG:

Yes, we all tend to feel over whelmed at first, but as you have found, things do get easier. I always kiss Tess's fur after I have sniffed for any odor of insulin after the shot. :-D Cats ears start to bleed more easily and they get used to the routine. Amazingly, many of us have formed a closer bond with our FD kitties, we interact with them so much more. they know what we are doing is making them feel better.

Gus is a fatty mcfatty…so I might start making sure he gets less than that.
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Just like w/ humans it's time to start counting calories. Canned cat food vary greatly in calories per ounce, from less than 20 to over 40. Dr. lisa Pierson's food list includes the calories per can as well as the carbohydrate info. I'd start looking into the low carb foods (lower carb foods are better for all cats to help keep FD from happening) that are lower in calories too. That way Gus can eat and get fewer calories, you don't want a hungry, Grumpy Gus. Dr. Lisa also has a great page on safe weight loss for cats.
 
Hi Jamie!

Not to add to your decision-making burden, but one really important factor to consider in deciding your goal, is that a cat that gets tightly regulated soon after diagnosis has an excellent chance of having their pancreas heal, going off of insulin and becoming diet-controlled. We don't know which cats will be able to do that, but the stats are pretty great - as many as 90% plus in one study of those that get their blood sugar back into normal numbers (50-120) in the first month went off of insulin. That's one reason why people are such big fans of tight regulation. Even for cats that don't go off of insulin, keeping their blood sugar under control protects their organs from the damage of high blood sugar.

It can be an intensive protocol, but if your cat is one whose pancreas will heal and go off of insulin, it's a great pay-off.

Cats are considered newly diagnosed for the first year on insulin, but the chances for remission are best early on. We have had cats go off insulin even after 3 years - Amy's Trixie, who posted to you above, was more than 3 years on insulin.

More information on that is on this page - specifics on that study are on the pdf about 5 paragraphs down that is called "Management of Diabetic Cats Using Long-Lasting Insulins."
 
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