12/5 Please help

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BoobyK

BoobyK

Member Since 2018
My sweet Booby has been struggling with his numbers since we came back from vacation last week. He has been on 2 units for a long time and I usually dont have to many issues. He vomits clear when he is down in 50 to 60's so its usually my cue. I have backed him off to 1.5 but cant seem to get it every 12 because he is in normal range at the end of it but the next time he will be too high. I do not like having to wait for shot but have no choice when he is lower. He was at the vet a month ago and everything was normal. He even had a great curve. Thanks for any advice.


https://docs.google.com/spreadsheet...o2anuHCaS4zF5QXE7vcek_a6wE/edit#gid=361360320
 
BoobyK said:
My sweet Booby has been struggling with his numbers since we came back from vacation last week. He has been on 2 units for a long time and I usually dont have to many issues. He vomits clear when he is down in 50 to 60's so its usually my cue. I have backed him off to 1.5 but cant seem to get it every 12 because he is in normal range at the end of it but the next time he will be too high. I do not like having to wait for shot but have no choice when he is lower. He was at the vet a month ago and everything was normal. He even had a great curve. Thanks for any advice.


https://docs.google.com/spreadsheet...o2anuHCaS4zF5QXE7vcek_a6wE/edit#gid=361360320
Click to expand...
Hi. Your dose is too high. Reduce to 1.25. If it's still off balance you may need to go back to 1 unit. You want two shootable numbers.
 
I wondered that too but since he was getting 400's at the end of 12 hours I wasn't sure. I will back down on his AM shot. Thank you
 
Based on the limited data, it looks like you have some bouncing going on, coupled with no shots leading to higher numbers. I'd suggest also trying to get some mid cycle tests in especially in the pm cycles, since many kitties like to go lower at night. You've seen evidence of this at green am preshots. Skipping is not ideal with history of DKA, so it would be good to find a dose you can give consistently am and pm cycles. 2u appears to be too much at the moment, I would hold the 1.5u and continue getting mid cycle tests to see how low the dose is taking Booby. We dose based primarily on how low the dose is taking the kitty, with only some consideration given to preshots. With Lantus, you don't want to jump around doses, it tends to disturb the depot. I would presume you are following SLGS since you have dry food in the mix. Might be worth a quick refresher if you haven't looked at the dosing methods recently...

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
 
Christie & Maverick said:
Based on the limited data, it looks like you have some bouncing going on, coupled with no shots leading to higher numbers. I'd suggest also trying to get some mid cycle tests in especially in the pm cycles, since many kitties like to go lower at night. You've seen evidence of this at green am preshots. Skipping is not ideal with history of DKA, so it would be good to find a dose you can give consistently am and pm cycles. 2u appears to be too much at the moment, I would hold the 1.5u and continue getting mid cycle tests to see how low the dose is taking Booby. We dose based primarily on how low the dose is taking the kitty, with only some consideration given to preshots. With Lantus, you don't want to jump around doses, it tends to disturb the depot. I would presume you are following SLGS since you have dry food in the mix. Might be worth a quick refresher if you haven't looked at the dosing methods recently...

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
Click to expand...
Thank you, I just did a +6 and he is 411, not use to seeing these high of numbers. I use hard copy weekly sheets I made up and just entered the data where he started varying. He was on 2 units for almost 2 years until he got sick earlier in the summer. I had to back off to 1 then 1.25 then 1.5 for about 2 weeks but he had to go back to 2 when he was recovered.
 
PMPS is 98, I just gave him his FF pate and he ate half, not unusual as he sometimes takes a break and comes back later to finish. Just wondering if it would be wise to just go down to 1 or if its to soon. I couldn't get a +5 thru 7 but I did a +8 as soon as I got home and he was at 136.
 
No worries about missing +5 or +6, the+8 was good enough to see that he has been coming down all day. Usually when you get a preshot number than is lower than you are comfortable with, you would stall, not feed and retest to see if the number is coming up on its own. Can you retest in about 10 minutes so we can see what is happening? With SLGS you can shoot above 90, but we don't have much data to see what he does when you give insulin at lower numbers yet, but as I said yesterday, skipping is not ideal with history of DKA.
 
I'm so sorry, he is long term diabetic but I use hard copy sheets that I print up. It's just easier to have on my counter. He was doing great and had his last curve at Nov 2nd which the vet said is bookcase great. Unfortunately I throw them out at the end of each week unless I had issues and the numbers that are on the spreadsheet are the current week. When I did mids he was usually around mid 100's. I don't really get low numbers from him at all except this summer when he had a stomach issue for about a week.
 
Yes I have 4 boxes of test strips, I buy them by the case. I can monitor until at least 2 to 3am.
 
I checked his ketones with keto-mojo monitor and it is 0.4, I checked glucose first with the Relion Prime and it was 148 but when I checked with keto-mojo glucose was 189. Could my Prime monitor be going bad? I think that's a large variance between meters especially when waiting to shoot. I think I should only give him 1 unit and do a curve tomorrow just to see where he is and how the Lantus is working for now. Please any thoughts and advice always welcomed. Although he is long term diabetic these low numbers are still something I don't usually see, I'm usually dealing with the other side of the numbers and a little nervous with this.
 
Is it 3 hours since PMPS? I see some comments on your SS that say "Gave his PM shot at +7". Does this mean that you gave the PM shot 7 hours late and the AM shot 5 hours after that?
 
Thank you I will give 1.0 and just stick with 1 meter, I know to check ketones when hes running high but do you check frequently when they run low as well?
 
Sharon --

You might want to take a look at this link regarding dosing methods with Lantus. We use one of two methods -- Start Low Go Slow (SLGS) or Tight Regulation (TR).

In looking at Booby's spreadsheet, a couple of things jump out. Every time you skip a shot, numbers skyrocket. It's likely a combination of a "bounce" due to a normal number plus the skipped shot. Bounces occur when a kitty's numbers drop into a range they aren't used to, numbers drop low, or numbers drop quickly. The liver and pancreas release a stored form of glucose along with counterregulatory hormones as a response which cause the numbers to spike upward.

With the dosing methods we use, SLGS is the least aggressive. Without benefit of more data, for a longer term diabetic, you can shoot numbers above 90. If you've not done this routinely, you will want to work. your way down to shooting lower numbers. (With TR, we shoot considerably lower numbers.) If you see a pre-shot number you're not yet comfortable shooting you have a few options:
  • Stall -- do not feed your cat and wait 15 - 20 min to see if numbers are rising. You can repeat this process for up to 2 hours but you will be off schedule and you will need to gradually walk the time back to your usual shot time.
  • Shoot a reduced dose
  • Skip
Each of the above options has its pros and cons.

I'd realize you're used to doing all of this on your own. It is very helpful for us to see your test data. We're pretty numbers driven since it's the only way we know how your kitty is doing and no one wants to make a suggestion that would jeopardize your cat's safety.
 
BoobyK said:
I know to check ketones when hes running high but do you check frequently when they run low as well?
Click to expand...
While it's less common to see cats in lower numbers throw ketones it can happen. As you know, the trifecta for ketone generation is:

* Not enough insulin.
* Not enough calories.
* Presence of infection, inflammation or other systemic stressor.

Things to be extra conscious of that might indicate/increase risk of ketone generation:

* Not eating enough, nausea, vomiting, or other GI upset.

* Hanging around water bowl / drinking too much / not drinking at all.

* BG above renal threshold (greater than c. 220 on human meter) for part of the day (glucose in urine can provide an environment conducive to development of UTIs)

* If kitty has a known health issue (in addition to the diabetes).

(Apols if I'm teaching grandma to suck eggs here. :oops: )



Mogs
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