Doing a curve today and am shocked by Lucy's +2...never seen that before. Increased dose a few days ago. My spreadsheet has 2 tabs so you have to go to the second tab now. I'll be monitoring closely...she is all over the place!
I don't get it because her diet and her insulin injections are totally regular and don't change!
The reason she's all over the map is because you've been increasing her dose based on preshots without knowing where her nadirs are on each dose as far as I can tell looking at you're spreadsheet. Lantus dosing is based off the nadir which is why before adjusting the dose you must know how low they go on it.
She's probably been diving and bouncing for awhile now. And you've been reacting to the higher numbers caused by those bounces by jacking the dose.
So I need to figure out when her nadir is and determine dose increases based on that? Does it not make sense to increase it if any of her numbers, preshot or not, are in the 300s?
Yes you have to know where her nadir or lowest point in the cycle is and base her dose on that. Insulin is a hormone it doesn't work like a pharmaceutical drug like say aspirin. Too much can look exactly like too little without knowing how low the dose takes them which is why we run curves when we can't test often.
What happens when the dose is too high is the cat's blood sugar drops too low or too fast and her body goes into self preservation mode and releases stored sugars and counter-regulatory hormones which sends the numbers rocketing back up again by the next preshot. It's nature's way of protecting her from hypo and death.
The more you raise the dose the higher the numbers go. The only way to stop the pendulum swing is to reduce the dose.
Ok, her +3 is 39 so should I give her some MC food? I have some gravy lovers fancy feast. For her PM shot should I go down to 3 units? Or lower? When I started insulin with Lucy, we were given ProZinc...I didn't really understand that insulins have different ways of monitoring...or maybe I forgot. Because prozink is based on preshots...so I need to get my mind out of thinking that way. Her jumps make sense now...I feel like an idiot.
Please don't feel bad. Just be aware how different Lantus is from ProZinc.
What you might want to do is start over at 1.0 unit and test for where Lucy's nadir falls. Every cat reacts to insulin a little bit differently. Once you see her pattern, you can raise her dose if necessary in 1/4 unit doses.
Ok quick primer on the differences in Lantus and Prozinc. Prozinc is a u 40 insulin, Lantus is a u100 insulin...They use completely different syringes. Did you change syringes when you change insulin?
Prozinc is an in and out insulin. Which means you inject it does it's thing and is wearing off by the next preshot.
Lantus is a depot insulin it builds up a deposit under the skin. Each shot builds on the next one. Think of pouring water into a funnel. You want to pour fast enough to keep the water level with the top of the funnel. Pour too much the water overflows (hypo) don't pour enough the level drops (hyperglycemia) Pour just the right amount the water flows freely out the bottom of the funnel while the level at the top stays even.
Yes, that makes sense. The funnel analogy helps a lot. I remember learning about the "depot" but not truly understanding that. I have her some gravy so I"ll test again here shortly.
As far as "starting over" with Lantus. Is it safe to go from 3.5 units to 1? I'm not home during the day M-F so I'm not sure how that would look/or work...
Oh, and yes, I did switch to the U-100 syringes when we switched to Lantus. Our vet gave me that information.
Do you think you can catch her in the litter box at least once a day during the week to get a ketone test? I would much rather see her run high for a little bit while we get her sorted back out than possibly hypo and pass away while you're gone. I lost my first girl to a hypo overnight and that is the worst feeling in the world. I still feel like I killed my best friend even through rationally I know I did the best I could for her with the knowledge I had at the time.
That could be the gravy talking right now...Test again in another half hour, you want 2 rising test. And you may need to keep feeding her small amount every so often today to keep her from dipping down again.
My game plan if she was mine would be reduce down to 1u hold during the week run a curve on the weekend when your free and adjust from there.
Only did the gravy that one time...her +5 = 91 so we're on the up. Do you think a 2 unit dose would be fine for tonight? Going to only 1 unit makes me nervous...
I can do another curve tomorrow but then it's back to work on Mon.
You know Lucy best and you hold the syringe if 2u tonight makes you feel better then go for it. My suggestion was based on my own cats. Give her little ears a rest tomorrow. Any dose change is going to take about 3 days before you'll see the full results as the shed readjusts so another curve tomorrow is just going to make her a pin cushion. And not really give you much useable data.
I'm home all the time with mine and unless its a curve they get tested about 4 times a day. Just enough to keep them safe but not so much as to turn them into a pin cushion. lol
Ok, that sounds good. I'll do another curve next weekend and try to get home asap for a test if I can on Wednesday or something...I think I will go to 2 and just keep it at that for a while.
Most Lantus cats nadir between +4 to +7 but Every Cat Is Different. Onset or when the insulin begins to work is also different for each cat. And to complicate matters both of those two points can and do move around some just about daily. That's where your meter becomes your best friend.
Typically you should see a slight rise between preshot to +2 then a gradual drop to nadir around +6 then a gentle rise again to the next preshot so you get a smiley shape if you plot it on a line graph.
Stayed out of the 400s at least...