2/22/15 Smudges

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Jenni

Jenni

Member Since 2015
WARNING: Newbie here with a lot of concerns and questions. I just started the home testing today and do not have an AMPS # but have tested 3 times today and updated SS including diet info.

After receiving diagnosis on 2/13/15, started 2 units of Lantus twice daily on 2/15. After 1 week at this dose and starting LC wet food diet, Smudges exhibited signs of hypo on Friday 2/20 evening (excessive meowing, discomfort/distress, very brief head quivering, and an extremely ravenous and sudden appetite for wet food). He also vomited up most/all of the FF he ate in the 2 hours prior with his shot. I was not home testing at that time and cannot confirm that he actually went into hypo but something was clearly wrong! I freaked out and put a dab of Karo on his gums and after eating a ridiculous amount of FF he settled down, stopped the meowing but clearly wanted to be left alone.

The next morning I awoke to him sleeping comfortably by my side--big sigh of relief. Prior to this diagnosis I never considered diabetes nor do I have any education about it. I have since tried to immerse myself with information, mostly from this site. I can't tell you how grateful I am that this resource is available and the effort and time that people are willing to devote to help others. I would truly be lost without the guidance I've received thus far.

I have been hugely disappointed with the information (more accurately lack of) provided by my current vet. I was basically told to start Lantus at 2 units twice daily and bring Smudges back in two weeks for a curve test. I was also instructed to buy a bottle of Karo and "rub some on his gums" if he exhibited signs of hypo without being told what hypo even is or what to watch for. I feel completely unprepared to deal with this! I've had several conversations with the vet clinic about this and they seem very nonchalant about it. The vet clearly did not like it when I suggested that 2 units of insulin twice daily may be too high if I'm also doing a food change to low carb wet. I was told that at BG 455, wet food could not possible make so much of a difference that 2 units would be too high to start with. I was also told that curve testing prior to 2 weeks after diagnosis would be too soon as a cat's body takes time to adjust to the insulin.

After reading info from this site and Smudges' "episode" on Friday, I am inclined to believe that 2 units may be too much to start. His current weight is 11.58 lbs. Yesterday evening I made the decision to reduce his dosage to 1 unit twice daily.

Here are some questions and please remember I am new to all of this and very freaked out by this whole experience. I do not like poking my kitty with needles--it causes me a lot of stress--but want to do what is best for him.

What is an appropriate dose of Lantus to start with?
Is decreasing to 1 unit (from 2) appropriate in this situation?
At what point do I increase/decrease that dose?
Do I keep my appointment this Friday to do a curve test if I am home testing? Just started today (see SS) but will only be able to do limited testing during the work week.
Is leaving a mix of low carb Evo/Hills C/D kibble during the day/overnight appropriate? He has always been a free feeder and I fear that switching to a 2-3 times daily feeding schedule may be too much for his system right now.
How low or high must his BG # be to be considered dangerous and require immediate intervention? What do I do if this happens?
How often is appropriate for BG testing right now? This is the 2nd week of insulin but just reduced to 1 unit yesterday.

Home testing is no fun for me or Smudges--neither one of us like it. I'm having difficulty poking the ear vein on the first try and little pools of blood are visible under the skin on both ears already. Is it okay to keep poking these areas? Do they get better or did I just hurt my kitty's ears? Can this be avoided? I tried testing the foot pad but could not get enough blood to come out to test.

I'm extremely nervous about going to work and leaving him all day tomorrow. I hope to do an AMPS and PMPS with at least 1 or 2 additional tests in the evening, if appropriate. What is recommended and for how long to I need to keep doing multiple tests daily? The thought of poking him so much is pretty hard to take right now.

Help, please!
 
Hi Jenni,

This sound exactly like what my vet instructed me to do the first time Sami was diagnosed with diabetes. I had no idea that it was such a bad protocol until I found this site (more than two months after diagnosis), and even the second time around I still didn't fully learn my lesson and was still taking the vet's advice. It wasn't until I started strictly following the Tight Regulation Protocol and the advice of the experts here, that I saw improvements with Sami's numbers.

Sami was a DRY FOOD only cat the first time she was diagnosed and the vet never even suggested that I convert her to wet food. Within two weeks of the full switch to wet food Sami started to improve. This was after two months on insulin with minimal home testing and primarily a dry food diet. With a month an a half of finding this site and switching Sami to wet food she was off insulin.

I can't give any dosing advice, because I can barely figure out what I should be doing for Sami, but there are many experts here that will gladly help out with that.

Good luck on this journey. Sami and I are doing it for a second time after being OTJ (off insulin) for 5 years, but with the help of the group I am very hopefully that we will be able to get her back to remission again.
 
Oops, didn't mean to post yet - i'd just started. I'll answer your questions below:

What is an appropriate dose of Lantus to start with? 1.0u is ok, 1.25 would be according to the calculator. If a cat has a symptomatic hypo they can become more sensitive to insulin, so it's not a bad idea to use the 1.0u while you get your feet on the ground with the testing. Either dose is ok - it's up to you.

Is decreasing to 1 unit (from 2) appropriate in this situation? Yes, it's ok. 2.0u was too large for his size.

At what point do I increase/decrease that dose? I think, per your last post on main health, that he's been on insulin for 1 week now. Is that right? Would you insert rows into the spreadsheet to reflect any data you have, dose amount, any tests you can recreate or remember, and show his diagnosis on the ss? That's our go-to doc for everything and it's helpful to have it all there.

For a kitty starting out, here are the guidelines:
"General" Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Do I keep my appointment this Friday to do a curve test if I am home testing? Just started today (see SS) but will only be able to do limited testing during the work week.
That's up to you, but you probably don't need it. You're going to base dosing decisions upon the tests you get at home. It's possible to do fine with working full time - you'll want to always get a before-bed test so that you have information to help you adjust the dose, and to keep Smudges safe. People use timed feeders and get tests when they can when they work long hours.​

Is leaving a mix of low carb Evo/Hills C/D kibble during the day/overnight appropriate? He has always been a free feeder and I fear that switching to a 2-3 times daily feeding schedule may be too much for his system right now.

How low or high must his BG # be to be considered dangerous and require immediate intervention? What do I do if this happens?
How often is appropriate for BG testing right now? This is the 2nd week of insulin but just reduced to 1 unit yesterday.
 
He he he Julie is having some problems with premature posting this morning!

Free feeding is fine for a diabetic kitty just remove the food at +10 so that your PS BG number isn't food influenced. Better that it's low carb wet food though.

We intervene with high carb wet food or low carb with a drop or two of syrup at below 50 (dry food isn't so good for steering numbers it takes longer to kick in and also longer to wear off). This isn't a dangerous level but because there is insulin on board we intervene then to make sure it doesn't get dangerous.
 
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dang! i keep posting when i'm trying to just tab over. Not sure what's up with that.

You can free feed with low carb wet food. He'll get used to it. Dry food is hard on their kidneys, even if it's low carb. It sounds like you've experienced some of the downsides of dry food on the body with your other kitties. www.catinfo.com has great information on feeding any cat.

We intervene when th blood sugar goes below 50. You have time to intervene, give some gravy from a high carb gravy cat food, or use karo syrup or honey, to bring them up at that point. Normal blood sugar is 50-120 and the goal of tight regulation is to get the cat back into normal numbers so their pancreas can heal, and hopefully, begin producing insulin again.

You always want to get preshot tests in and ideally, one other test at some point during the 12 hour cycle. Maybe just as you walk in the door from work. Always get one before you go to bed too, many cats have their lowest numbers at night. Lantus dosing is based upon how LOW a dose takes a cat, so you want to know how low the cat goes.

You don't have to memorize all of this at once. It takes a while to get the hang of things.

By the way, this post may help you find information in the Lantus/Lev group.

ok, do you have more questions now?
 
I wouldn't bother with the vet appointment either you can get your own curves in a less stressful environment at home. Try not to be stressing when you're taking the tests because Smudges will sense it and be stressed too. Have you tried poking yourself with the lancet, it really doesn't hurt and a cats ears are less sensitive than our fingers. You're not aiming for the vein either, just next to it, hopefully someone will come along with a picture of the sweet spot for you. A treat (LC of course) after each test is essential too, most cats then come to associate the testing with the treats. Vyktor starts purring as soon as he spies the meter :) What gauge lancets are you using? For starters you probably don't want anything with a number higher than 28 - the higher the number the thinner the lancet.

Good to have you and Smudges here, we'll get you on track ;) keep asking as many questions as you need (or just want) to
 
Just completed his 4th BG test today. It looks like my SS is updating properly but will list below also:

6:30 am - Ate kibble
10:30 am - 324, gave shot
12:30 pm - 326
4:30 pm - 164
7:30 pm - 296

Due for 2nd shot at 10:30 pm. We are normally on a 6-6:30 schedule but due to Friday's "episode" and my decision to decrease his dose to 1.0 unit we slid off schedule this weekend.

My hope is to find a wet food that he will eat willingly. He has never been a fan and has a sensitive tummy to it. I was surprised that he accepted any of it during the first week of his insulin last week. Unfortunately, since Friday night he is just "not having it." I will keep trying but he really loves that Evo! Since he has lost 3 lbs since last October I am happy just to keep him eating. He loves kibble and it is going to be difficult to make the transition. I thought we were on a good path until Friday...

Questions:

Do I shoot 1 unit at 10:30 and then again at 6:30 in the a.m. to get back on schedule? I will be unable to shoot during the week after 7 am and 6:30 seems to work well for the most part.

What are the dangers of varying the shoot schedule a bit? (i.e. - an hour early or an hour late) Do I need to make any adjustments?
 
You might want to skip tonight's shot in order to get back on schedule. No, you can't shoot at 10:30 tonight and then again 8 hours later. That's not safe. I'd just skip tonight, sleep well, and get on schedule in the morning. You can vary by an hour or so without a problem most of the time - the exception might be if you are shooting a lower-than-usual blood sugar. That might not be a good idea. You can post here and ask for someone with experience to look if you run into that position. Shooting late is never a problem, except that you might end up with a problem with the following shot. As much as you can stick to 12 hr intervals it's good, but it's more flexible than we used to think.

The trouble with dry food is the effect on kidneys. If you look at the catinfo site i gave you above, there is a section on transitioning dry food addicts to canned food. That's likely been a factor in your other kitties and their kidney disease. It's too dehydrated for them, even if every other factor in the food is perfect, which it usually isn't.
 
I have the ReliOn Micrometer and use the 30 gauge lancets. The only bigger size that Walmart had was a 26 and I was afraid that may be too big. He definitely feels it and doesn't like it. He sits for it extremely well until the poke happens. Then he would like to bolt and I'm afraid he will succeed before I get the test. So far--so good but I've had to poke he repeatedly to get the samples.

I'm confused about the "sweet spot." I've been poking the vein assuming that is the only way to actually get blood. If I poke off the vein will I get enough blood? Did I just damage Smudges' poor little ears? I see a bit of a bump where the red pools have collected under the skin and just want to cry!
 
And yes, I have poked myself accidentally with the lancet and (call me a big baby) but I think it hurts too. Can the lancets be reused if cleaned properly with alcohol?
 
You want to poke off to the side, not on the vein. I have poked the vein on purpose when i felt desperate to get a test, but it hurts them more and tends to bleed too much.

Look at the post I linked above for you - there is a photo that is helpful. I put a flashlight under punkin's ear so i could see the capillaries to poke.

After you poke, always apply pressure for at least a few seconds to staunch the bleeding. that will prevent bruising under the skin and make everything less painful. His ears will heal - don't worry about it. Think about how cats ears look when they've been fighting - they always seem to get the short end of the deal. You'll get the hang of it before long and he'll accept it as long as you always follow things with a treat. I boiled chicken breasts, diced them 1/2", froze most of it and kept a couple of tablespoons out in the fridge for pokey treats.
 
While getting Skooter used to testing, he would get baked chicken as a treat, and I also used neosporain with pain relief on his ears nightly. He doesn't always require a treat now with testing, and I should be better about giving him something regardless.

After noticing that after his dx, I was always spending my quality time poking him etc, I made an effort to go and grab him and snuggle with him without the poking, so he didn't start associating ME to getting poked all the time. He will get used to it, I promise. I read stories about how kitties will come and sit nicely and wait while their humans get the test stuff ready and I was like, that will NEVER be my cat. It still isn't 100%, but he will sit in my lap now, most of the time, and is a big sweetie about it.
 
no, don't reuse them. The metal actually frays out like mad. I'd discard after each test. I have poked more than once in one setting with them, but someone posted a photo showing how the metal frays with each poke, and they must be very painful if you reuse them. They are the cheapest part of this whole thing, so i'd be liberal with using them.
 
Thank you so much for your advice and quick replies. Diabetes is a whole new and unwanted world for me and I have much to learn. All of the acronyms and info are a little mind boggling. I feel like my brain is ready to explode. Of course, I am hopeful that with a diet adjustment he will go into remission at some point but need to prepare myself for any possibility.

I feel terrible for poking the veins. It is hard enough getting enough blood from them so I hope I can continue to get samples without doing that. Do you think it is necessary to do another test before bed time or has he had enough today?
 
Let me expand a bit on Julie's comment. Lantus is a depot type of insulin. The depot is what gives Lantus it's duration. It also allows for overlap between doses and what amounts to the cumulative action of the insulin. Thus, shooting as early as you were suggesting more than maximizes the overlap between the shots and can create a dangerous situation. In essence, shooting early acts like a dose increase. There are times when you can shoot an hour or so early as a strategic intervention. Shooting 4 hours early is not something you typically want to do. It's certainly not something I would suggest for someone new to insulin use nor is it safe to shoot early the first time and not be home to monitor.

A couple thoughts about testing:
No matter what the outcome of a test, successful or not, give your kitty a treat. You want your cat to associate testing with something positive. Some cats will come running to be tested. They recognize that there's a treat involved, attention, and ultimately, you're doing something that will help your cat to feel better.

If you're not already doing so, use a thicker gauge lancet. I'd suggest a 28 gauge lancet. Once Smudges's ear "learns" to bleed, you can switch to a 30 or 31 gauge lancet.

You don't want to poke into the vein. You want to test along the outer edge of the ear -- the area between the vein and the edge of the ear. If you poke the vein, you'll get way more blood than you need.
 
If I do not keep my appointment for a curve test this Friday, how will I know how to adjust the insulin dosage? Is that something people can help me with here? How much data is needed in order to do so?
 
Of course we'll help you. Take a look at the sticky entitled, "Tight Regulation Protocol." The general guidelines for dosing are there. Most of us do not rely on our vets to assist with dose decisions. Some vets get controlling (aka pissy) about it. My vet figured I was around my cat, had test data, and knew what I was doing. It takes a while to get familiar with the protocol but we're all here to help.
 
Need advice about this message just received from vet. Smudges' spreadsheet is current and numbers remain fairly consistent. Reduced initial dose from 2 units Lantus 2x/day to 1-1.25. I have no experience with diabetes or treatment and the vet's advice has seemed contradictory to the information provided here. Smudges continues to reject wet food but I've managed to integrate mostly Evo Cat/Kitten with his kibble to reduce carbs. Looking for some advice about vet's recommendations below. Agree? Disagree?

It looks like his blood glucoses are slowly heading in the right direction :) If we can keep him in the 150-300 range that should keep him out of having either a hypoglycemic crisis or getting ketotic. How are things going with the food? I'd say for now I'd keep him at the 1 unit Lantus SC every 12 hours and the current diet changes you're making for at least the next 1-2 weeks. I don't think you need to check his glucoses every day at this point unless you're worried he's acting unusual. if it works out to get a few "partial curves" (get a reading first thing in the morning then 6 hours later, then at 12 hours later) if you don't want to do BGs every 2 hours, the weekend of the 7th/8th that would be helpful. I wouldn't adjust his insulin until that point. We can then use that info to decide if we need to adjust anything or when to recheck again. Have you noticed a difference in his water consumption/urination yet?
 
Vets are not used to having people home test. Most people won't do it and I suspect that the majority of vets don't encourage people to home test. (In a completely cynical vein, why tell people to home test if they can charge you for doing curves at their office?) As a result, they tend to tell people to allow their cat's BG to sit in a higher range since the cat isn't being monitored. From the perspective of not testing, this makes good sense. However, if you are testing, you can work to get your cat's numbers in a normal range IF your goal is either remission or tight regulation. Not everyone has those goals.

If you are trying to get Smudges into remission or tightly regulated, then the vet's advice is at odds with the published and researched protocol. Based on the protocol, you adjust the dose every 3 days/6 cycles if the numbers are outside of the normal (50 - 120) range. Further, getting pre-shot tests and spot checks is essential. You would need to be testing a minimum of 4 times a day -- at pre-shot times and at least once during each cycle. If you look at spreadsheets, you'll see that many of us test considerably more. You need to know when your cat's insulin onset and nadir occur and how much duration your getting.

Let me offer a different perspective, as well. If this was a pediatrician and you were talking about your young child, do you think the MD would be telling you that you didn't need to test your child on a daily basis? You would be testing at pre-shot and probably at meal times -- more if the child was on a short acting insulin.

Regarding your spreadsheet, could you put the amount of the insulin dose in the column labeled "U"? That's the column for units of insulin.
 
Oh my gosh I hate being a newbie. I was wondering what the "u" column was for on the spreadsheet. It is now updated.

Smudges has been at the 1.25 units per day for 3 days now I'm thinking of increasing his dose to 1.5 against the vet's recommendation above. Would this be a good idea based on the spreadsheet data?
 
Hello and welcome from me too. We've all been new and know what it feels like. There's a lot to learn at first, but soon you'll become a lot more comfortable with it all.

Regarding the spreadsheet, I don't see a dose in the PM unit column. Is he getting the same dose at night? My vet told me I could do a different dose at night from the day time. True for some insulins, but not Lantus. We usually hold the dose a bit longer if kitty is getting blue nadirs.
 
Hi Wendy,

I am such a goof. The second unit column is now filled in. I did skip the PM dose on the 22nd because of a probable hypo incident the day before.
 
Not a goof, just learning as we all had to do. :bighug: Regarding increasing, here is what the protocol says. I've highlighted the bit that applies to Smudge.

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
 
Hi Jenni & smudges! Welcome to LL!
I can't give any advice as I am still trying to understand this sugar dance. However, I do want to say it does get easier. I, myself ,asked the same questions, and the advice, support & help I received from the people on this board has been and still is beyond wonderful! You & Smudges are in very good hands(love the black patch on Smudges' nose!)
Paula & kitty Michael
 
So I was able to get BG readings every two hours for much of the weekend. It looks like Smudges' BG is definitely going in the right direction! He has been at 1.25 units of Lantus for 6 days now and has successfully switched to low carb EVO Cat/Kitten dry. He has not had any higher carb dry for a few days now. Hooray!

After being diagnosed on 2/13/15, and per the vet's recommendation, we started at 2.0 units twice daily WHILE ALSO starting the switch from Hill's C/D dry to low carb wet food. It was all too much and on the 20th, he had an episode that scared the life out of me. So on week two, I reduced his dose to 1.25 units twice daily and that has been going well. His numbers have decreased a fair amount since the first week (SS is updated throughout the day).

After reviewing the Start Low/Go Slow Method, it seems that I should NOT change his dose just yet (Nadirs between 90-149) but I am looking for guidance on this. Today, he actually wanted to eat some FF chicken wet food but given his sensitive stomach and history of vomiting it back up I only let him have a very small amount. My goal is remission and if I can get him there with wet low carb wet food, I'm all for it. However, due to his sensitive tummy the switch will likely be a slow process. My hope is that his interest in wet food increases and he is able to eat a little more of it every day. That is my hope -- but after last week's hypo incident, I've decided to let him set the pace.

So, do I stay at the 1.25 units for now and consider decreasing dose only if Nadirs are below 90 for a period of time? I use the ReliOn Micro and I'm confused about the accuracy for use on animals. Are the readings actually higher than what they actually are? If so, what number do I use to determine an increase or decrease? Do the numbers referred to in the SLGS Method reflect actual readings or do they consider an "adjustment" for meter inaccuracy?
 
The majority of us here use human glucometers, so the numbers we talk about are all based on the actual numbers you're getting with your Micro, so if you're doing the SLGS protocol, then you'd reduce if he gets nadirs under 90

You would reduce if he drops below 90 even once on that protocol, not wait for any specific period of time

Since you skipped the shot on the 27th, I'd probably hold the 1.25 dose awhile longer and get the tests in that you can. Even an "out the door" in the morning and "in the door" in the afternoon will really help.

Always test before shooting, get what tests you can during the AM cycle during the week, and at least one test "before bed" on the PM cycle to make sure he's safe for the night and let's see where he's at in a few days

Looking pretty good so far though! Blues aren't bad!
 
Just had a PMPS of 207. So happy the numbers are getting lower. Sure beats our starting point at 455 2 weeks ago.

During the week I won't be able to get any good nadir readings due to my work schedule but will definitely do the AMPS, PMPS and one right before bed. This weekend has been hard on Smudges' ears--12 BG readings on Saturday & Sunday. Unfortunately, it took more pokes than 12 with a lancet to get all of those but it could be worse. I'm fortunate that he is a mellow kitty.
 
yes, I am definitely using the neosporin each time but I stopped using the heated rice sock as I didn't find it made much of a difference. The problem is mainly with me not poking right the first time and having to redo it or not getting enough blood. Also his instinct is to jerk when he feels the pin prick and shake his head sending that needed blood off into the air and not on my test strip :-)
 
Great job getting the curve done this weekend. :cool: As Chris says, he does look good for this dose at this point. Since you are thinking of following the SLGS method for now, could you put something to that effect in your signature? That way we know what the reduction points are and don't have to keep asking. Both the TR protocol and the SLGS method assume you are using human meters and use those numbers.

One trick you can use for blood tests is to quickly scrape the blood drop onto your fingernail, then test from there and let him shake away. Have you seen the post on Testing and Shooting Tips?
 
What can help with the shaking is to desensitize his ears. Most cats don't like having their ears fooled with in the first place, so if you can decide on one place to be your "testing spot" and take him there as many times a day as you can and just give his ears a quick rub (then a yummy treat!), he'll soon associate that spot with the yummy treat and not care what you're doing with his ears

Usually that stops the shaking...in the meantime, your house may look a little like a crime scene from NCIS with blood splatter on the walls...LOL
 
One more bit of encouragement. ..as you are poking his esrs, it is stimulating the growth of more capillaries. It takes a couple of weeks and then you'll get blood every time you poke.
 
Thank you for all the great suggestions. Smudges' numbers have been pretty consistent and wondering if it is time to increase lantus from 1.25 to 1.5 units twice per day. I am also thinking of adding some Evo wet food to his diet. He still has issues vomiting wet food like FF but I am hoping that if I try the same brand as his kibble maybe that will help with his stomach sensitivity so he is able to keep the wet food down. I have not tried it yet but hope to introduce it this weekend when I am home to monitor him better. I'd be grateful for any feedback.
 
canned food is so much better for our kitties - i think it's a great idea. There are all kinds of tips on that site I gave you above about how to transition a dry food addict. You can pulverize some dry food and sprinkle it on the canned. Since he's got a touchy tummy, you want to go very slowly in transitioning.

Here's the guidelines from SLGS (thanks for putting it in your signature, by the way - that's super helpful!):

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.

  • 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 do 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!
​
The way I read that is that you would not increase the dose without doing a curve. Do you have a day off coming up so you could do that? Personally, I'd prefer the 18 hr every 3 hours over the 12 hour every 2 hours option - mainly because so many cats give their lowest blood sugar at night that I think it's really important to do a check then. Overall he's looking pretty good and I wouldn't be surprised to find that he doesn't need a dose increase after you do the curve. By the way, you asked above about using a human glucometer - nearly all of the BG test number guidelines (like what's in the SLGS above) are in human glucometer numbers. If it's in a pet glucometer it will say so - and basically all there is in AlphaTrak (pet glucometer) is on one page of the Tight Reg Protocol document. So you can trust the tests you're getting with your Relion and compare it to the guidelines here for direction in how to proceed.

By the way, since this post is getting pretty long, you might want to start a new one tomorrow, or whenever you post next. Also, if you edit the subject line of your post (we call them condos, for where cats live), you can put any questions in there so you get a timely answer. Like today, I was just checking on you and saw you wanted dose help. Some people will put "dose advice?" in the subject line to make sure and get questions answered. You edit the subject line by clicking on "thread tools" on the top right of your post. There it says something like "edit title" or "edit subject line" and that will get you what you want. Lots of people scan the subject lines to see if anyone needs help, so it's definitely the way to go!

Smudge's ss is looking pretty great overall!
 
thanks so much for your response. I will work on your suggestions over the weekend. I did a curve last weekend and got quite a bit of data from that. My interpretation of the guidelines is that a small increase to 1.5 of Lantus would be in order but looking for confirmation if that is correct. I would definitely like to get him on wet food but the problem is that his stomach just cannot handle it even in small doses. It is always been that way with him.
 
you want to know how low the dose is taking Smudge before you increase his dose. The low point is typically somewhere in the middle of the cycle and the preshots are typically the highest point of the 12 hr cycle. Right now we know how high he's getting as the Lantus wears off, but i don't think we can be confident enough on how low the dose is taking him. According to the SLGS guidelines, if he's going below 90 at any point in the cycle, you would reduce his dose. He might or might not be getting there on this dose already.

Here's the guidelines:
julie & punkin (ga) said:
  • 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
Click to expand...

The reason for getting a curve right before you increase is that cats do change in their response to a particular dose, sometimes, as they are on it. So you would want a very recent (i'd think within a day) curve to base your dose changes on.

If you could do a curve Saturday or Sunday, then based upon how low he gets, you could have confidence in increasing the dose at that point.
 
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