2/26 Simone AMBG 165.6 (ns), +6=236, +8=352.8, +10=516.6 dose advice?

[Zipdrive]

Woke up to a little bit of a shock this AM.

Tested Simone first thing and her BG was 9.2 mmol/L (165.6). Thinking there was something wrong with the test I done another within 2-4 minutes using the other ear and it was 8.9 mmol/L (160.2). I then tested myself and I was 5.6 mmol/L (100.8). Seems the meter is OK.

Gave her breakfast of 1/2 tin Fancy Feast Chopped Grilled Feast with a few kibble mixed in as she is not fully on wet just as yet and will test again in 1 - 2 hrs unless it's best to test sooner. I'm also hold off giving her the 2u dose from the pen this AM until more testing is done.

Yesterday her AMBG at 6:00 was 18.9 mmol/L (340.2) and 2 hrs after her shot she was at 17.4 mmol/L (313.2). The +12 was 21.3 mmol/L (383.4). I didn't test any more that day.

Any reason why this mornings number was so much lower then the previous days. Not that I'm complaining.

 

[Gill & George]

Stalling the shot, was a good idea, since this is quite low and you don't have much data yet.

Usually when we stall, we would stall for 30min, but we would not feed, we want to see if they are coming up on their own.

Do get a test in 1 hour if you are home as the data will be useful and it will give you some idea of how she responds to food.
But if you want to shoot, today, because you have fed, and because we haven't got the data, it might be tricky to safely do that @+1, because we won't know how much that number is influenced by food.
So it might be better to wait till +2, but if the +1 was crazy high, it might be OK to shoot, you'd need to ask for advice when you get that number.

If you shoot at +1 or +2 you will be off schedule tonight by 1 or 2 hours since shots must be given as close to 12hrs apart as possible, if you get off schedule you can work your way back by shooting early by 30min a day, so with a 2hour stall it will take at least 4 days to get back on to your usual shooting schedule.

We have no way of knowing if that +12 this morning is Simmone's nadir or if infact that is her on her way up and she in fact went lower last night, one great habit to get into is to always grab a just before bed test, it can be very enlightening, especially as a lot of cats will go lower at night.

 

[Nan & Amber (GA)]

If you are in the process of transitioning to wet food, that can have a dramatic effect on BG numbers and reduce insulin needs greatly. You were wise not to shoot the 2U after getting that number.

Generally in this situation we'd say to stall without feeding before testing again-- the numbers you get in the next couple hours are going to be food-influenced.

Ah, Gill just posted to explain everything better than I was going to, so I'll just stop here rather than repeating.

 

[Gill & George]

If you are in the process of transitioning to wet food, that can have a dramatic effect on BG numbers and reduce insulin needs greatly. You were wise not to shoot the 2U after getting that number.

Good point about the food Nan.
When you get a chance do you think you could include any details of food/food changes on the signature.

 

[Zipdrive]

Thanks for the info. I didn't know about the not feeding part. Guess I missed reading that in one of the stickies. With so much info to read it gets a bit overwhelming. I didn't want to skip a shot or delay it as it would mess up her 12 hr schedule but when I done a curve on Feb 23 her nadir was at 5.8 (104.4) at the +9 mark but was 20.8 (374.4) first thing in the AM before any food that day. I can only imaging what she could of dropped too with already being this low today. I have been trying to get into the habit of testing first thing in the AM, then at the +12 mark to see if her nighttime shot will cause any issues. Now I'll add a bedtime +15 - +16 time.

This was the first day since I started testing that the number was so low in the AM. She has been given the wet food for about 3-4 days now. Everyday I increase the amount of wet and reduce the number of dry kibble I put in her bowl. I usually give her half a can each feeding at 6 AM & PM.

I've still have to get the 1/2 mark syringes but I've been holding off on them till the vet does the curve on March 1st and lets me know what I should be shooting.

 

[Nan & Amber (GA)]

You're doing great-- it is a ton of information to take in all at once!

 

[Gill & George]

This was the first day since I started testing that the number was so low in the AM. She has been given the wet food for about 3-4 days now. Everyday I increase the amount of wet and reduce the number of dry kibble I put in her bowl. I usually give her half a can each feeding at 6 AM & PM.

This will be making a difference.

Not sure what you have decided to do? Have you shot?
If you have, I would get a +1 which I reckon must be now if you kept to your schedule.

 

[Zipdrive]

Just done a test and she reads 8.0 mmol/L (144). With not shooting her as of yet here are the numbers by time. I'm not sure how to fill out the spreadsheet in this case as I haven't given her a shot so there is no real + mark time after her initial 7AM injection. Do I just fill it in normally and make a comment about not giving her an injection ?

6:00AM - 9.2 mmol/L (165)
6:15AM - Breakfast (1/2 can FF with a little kibble mix. She ate about 2/3 of it).
7:00AM - Injection time (no shot this AM)
8:00AM - 8.0 mmol/L (144)

 

[Gill & George]

Do I just fill it in normally and make a comment about not giving her an injection ?

Yes make a note saying no shot in the units column. then continue filling in as normal.

With that +1 after food and no shot, possibly best skipping at this point since you will find it hard to get on schedule.

If you are home today as it is sunday, even though you haven't shot, you could still gather a bit of data, it will help for when you are next faced with this decision.

Maybe get a +3, at somepoint when last nights dose 'wears off' she will start to go up and possibly quite quickly, try not to worry, she will get back on track soon enough.

 

[Nan & Amber (GA)]

I'm impressed that she's staying blue-- not even a food bump!

Yes, if you don't shoot then you can put "ns" (for "no shot") in the dose column, then fill in any tests with the "+" time relative to what would be the normal shot time. With that number, I wouldn't shoot unless you can stay and monitor all day, with plenty of strips and high-carb food/honey standing by.

[and once again, Gill types faster than me!]

 

[Gill & George]

[and once again, Gill types faster than me!]

LOL usually everyone else types faster than me. I must be on fire today

 

[Zipdrive]

Yep I'm home all day. I too was surprised with the numbers after her breakfast Nan. Hope the meter and or strips are OK and not giving false readings. Simone usually gets her shots at 7 AM & PM, so wouldn't the 7PM shot from last night have worn of by the 7AM time? She even received a little nibble last night before bed.

I've been trying to read as much as I can about the different insulin types and I read that Lantus starts to peak around the 3 - 4 hr mark then levels out for the duration of the 12 hrs.

I'm updating her SS now and will test throughout the day. Would the 8AM test I did be considered +1 considering Simone's injection is usually at 7AM. Or would it be +2 from the 6AM initial test. I want to get this right so the spreadsheet curve I make for the vet is correct.

Simone and I Thank you for all the help.

 

[Gill & George]

7PM shot from last night have worn of by the 7AM time

if only it were so easy.
It can vary, so sometimes we get longer duration and better overlap

Those links might help explain it.

 

[Zipdrive]

Thanks Gill. I too wish it was that easy.

If she keeps up the low numbers and the injection has to be reduced below 1u I will definitely have to do the manual dose injection.

 

[Nan & Amber (GA)]

If you shot at 7pm last night, make 7am the "shot" time, then count from there, so 8am is +1.

 

[Zipdrive]

If you shot at 7pm last night, make 7am the "shot" time, then count from there, so 8am is +1.

That's what I thought Nan, thanks.

That's how I did her first curve on Feb 23. I tested first thing in the AM (right around 6AM give or take a minute), then she was given her breakfast a few minutes later, her shot at 7AM, then every 2hrs after that I tested her right up to her 7PM shot. She did get her diner at 6PM so the 7PM test would of been slightly off. I think I'll add in a +11 time.

If your wondering why the hour between her meals and shot, that's what the vet said to do.

Simone's +2 was 9.2 (165.6)

 

[Nan & Amber (GA)]

Your vet may be thinking of Vetsulin-- it acts quickly, so it's very important that there is a good meal "on board" at the time when the insulin is given, there isn't a big margin for error. Lantus is much more forgiving and takes a couple hours before it starts to really get going, so you just need to make sure that the cat is willing to eat and has eaten a meal before that time. What we do around here is "test, feed, shoot", all in the space of a few minutes (many people take the distraction of the mealtime to shoot the cat while his/her face is in the bowl!). We want the pre-shot test to be as close to the actual shot time as possible-- a lot can change in an hour!

 

[Zipdrive]

Thanks again Nan. I think I'm going to do the "test, feed, shoot" starting tomorrow, providing her levels are high enough to warrant one.

I'm not sure what I'll do for her PM shot tonight. I guess the numbers will tell. If she gets into the high teens or the low twenties then I might be able to give her a dose, even if it's a reduced one.

 

[Nan & Amber (GA)]

Post early for advice-- you can get a +11 like you had been using for your pre-shot to get an idea of where she's headed to get the ball rolling on discussion.

She'll almost certainly be pretty high by evening with the skipped shot, but we'll see. She's in charge, here!

 

[Zipdrive]

She's in charge, here!

You can say that again, LOL.

I'm going to be testing throughout the day as if I was doing a regular curve so I will definitely post her evening numbers to see where we stand. Time to go out and shovel snow before Simone's +3. Victoria BC has flowers starting to bloom and up island we get a good dump of the stuff. It's the end of February for gods sake, enough snow already.

 

[Zipdrive]

3 PM (+8) and the BG has climbed up to 19.6 (352.8) as predicted without her AM dose. I will post again with her 6PM (+11) number just before she gets her diner. It looks as though with the numbers now climbing that I can maybe give her the 2u dose this evening.

 

[Nan & Amber (GA)]

How late will you be able to monitor tonight? Looking at your spreadsheet, I'm actually wondering if the 2.0U is too high-- since you've been monitoring (admittedly, not much data), the only time you were able to shoot that dose both AM and PM you ended up with the blues this morning, and who knows how low she went overnight. Mind you, the blues are where you want to get to, but initially we want to find a dose you can shoot consistently.

If you edit the subject line to the post to add a "?" in the drop down and ask for "dose advice?" in the subject, you should get some expert eyes on this (I can't really suggest a specific dose, not enough experience).

 

[Zipdrive]

How late will you be able to monitor tonight?

All night if need be.

Looking at your spreadsheet, I'm actually wondering if the 2.0U is too high-- since you've been monitoring (admittedly, not much data), the only time you were able to shoot that dose both AM and PM you ended up with the blues this morning, and who knows how low she went overnight. Mind you, the blues are where you want to get to, but initially we want to find a dose you can shoot consistently.

If you edit the subject line to the post to add a "?" in the drop down and ask for "dose advice?" in the subject, you should get some expert eyes on this (I can't really suggest a specific dose, not enough experience).

The vet increased her dose to 2 units on Feb 15. I started spot testing on the Feb 19 and noticed her late afternoon levels weren't dropping below 198 so I made the call and increased her dose to 3u for a couple days (bad judgement on my part) and done a curve on Feb 23 and started her online spreadsheet. With having a low number at the +12 mark on Feb 23 I only gave her a 1u dose that night then because of the 430 the next morning I went back to the 2u dose and have stayed there other than the no shoot this morning. I think I'm the fly in the ointment by switching doses and should of left them at the prescribed 2u.

 

[tiffmaxee]

So what is your monitoring ability for tomorrow's a.m. cycle? Skipping shots is not the best way to go but I understand why you did it.

I'm trying to come up with a dose that you can shoot every 12 hours and wondering if you should shoot 1.75. See what others think.

 

[Wendy&Neko]

Could you put NS (no shot) or Skip in the unit columns for the times you skipped. That tells us you skipped instead of just forgetting to fill the amounts in. As the depot can influence several cycles after a reduction, knowing if Simone got insulin or not impact our suggestions. Did you get the syringes so you can do the in between doses?

 

[Zipdrive]

So what is your monitoring ability for tomorrow's a.m. cycle? Skipping shots is not the best way to go but I understand why you did it.

I'm trying to come up with a dose that you can shoot every 12 hours and wondering if you should shoot 1.75. See what others think.

I can monitor all day tomorrow too, but unfortunately I don't have any syringes yet so as to do a part dose from the Lantus pen. I was waiting to see what the vet suggested when Simone goes in for her next curve on March 1st.

Could you put NS (no shot) or Skip in the unit columns for the times you skipped. That tells us you skipped instead of just forgetting to fill the amounts in. As the depot can influence several cycles after a reduction, knowing if Simone got insulin or not impact our suggestions. Did you get the syringes so you can do the in between doses?

I've only skipped today's AM shot. Oops, I see I've missed entering the PM units on my spreadsheet, my bad. Entered now.

I'm also thinking of holding off food till the 7PM shot tonight. Good or bad? I'd like to try and get Simone's test, feed, shoot time as close as possible but she has her breakfast around 6AM & 6PM when I have mine.

 

[Nan & Amber (GA)]

I've only skipped today's AM shot. Oops, I see I've missed entering the PM units on my spreadsheet, my bad. Entered now.

Aha! That does change the picture, quite a bit. You've shuffled doses quite a lot, but that's different than skipping-- the depot isn't quite as drained each reduced shot compared to a skip.

I'm also thinking of holding off food till the 7PM shot tonight. Good or bad? I'd like to try and get Simone's test, feed, shoot time as close as possible but she has her breakfast around 6AM & 6PM when I have mine.

Generally, you want the pre-shot test that determines whether or not it is safe to shoot to be both 1) close to shot time, and 2) free of food influence, so, yes, you should hold off food until you have that pre-shot test in and have decided you are definitely shooting. I'm guessing that's not going to be much of a question tonight, but going forward you might want to shuffle things around a bit-- maybe even shooting earlier to match mealtimes rather than moving mealtimes to match the shot times. Whatever works best for you.

 

[tiffmaxee]

I can't even imagine shooting without syringes. I hope you can get some soon.

 

[Zipdrive]

+11=542

I think with the high numbers this evening I can go ahead with her 2u dose at 7PM and keep testing for a while after.

Aha! That does change the picture, quite a bit. You've shuffled doses quite a lot, but that's different than skipping-- the depot isn't quite as drained each reduced shot compared to a skip.

Generally, you want the pre-shot test that determines whether or not it is safe to shoot to be both 1) close to shot time, and 2) free of food influence, so, yes, you should hold off food until you have that pre-shot test in and have decided you are definitely shooting. I'm guessing that's not going to be much of a question tonight, but going forward you might want to shuffle things around a bit-- maybe even shooting earlier to match mealtimes rather than moving mealtimes to match the shot times. Whatever works best for you.

I'd like to do all 3 within a couple of minutes of each other, but it was my vet that wanted me to wait the hour. Now with the vet wanting to do the curve this Wednesday I'm to bring Simone in at around 7:30 AM, let them take a sample, then bring her back home to eat and get her AM shot, then bring her back 2 hrs later and leave her for the rest of the day. The reason for this is because the last time Simone was at the vet for her curve on Feb 15, she didn't eat and was really stressed so the numbers were off. I'm going to mention the test, food, shoot thing and see what the vet says. It would work fine for me as I'm up at 6AM or just before so I can test her, give her a little food, then give her a shot all within a couple minutes easy.

I think I'll try and sneak out tomorrow and just buy the darn syringes. I need to get some more test strips as I'm down to my last 58 and don't want to be left short.

 

[tiffmaxee]

If you do a curve yourself you don't need to bring him to the vet for one. He will likely be higher there too. The only curve my vet did was the day Max got his first shot. I'm wondering how much experience your vet has with lantus. There's no need to wait an hour to feed. That doesn't make sense.

I think you can shoot the 2.0.

 

[Zipdrive]

Thanks Tiff.

I've already dropped off a chart I made from the Feb 23 readings and will wait and see if the vet calls tomorrow to mention anything. If not I may create a chart based on the numbers from today and drop it off and see what they say about Wednesdays test. Personally I'd rather do the curve at home myself and then bring in a printed chart. Also at the vet they can only test till the +10 time before they close for the night, and with a late AM start they don't get a full cycle curve.

I know the vet has other patients on Lantus as she mentioned that she has had good results from them being on it, so you have to wonder. I think a couple of the staff have diabetic animals so you'd think they would know something and mention it.

Tonight I'm going to do a +12 test, feed and shoot with 2u, then check every 2 hrs after for a while and see what the numbers show.

 

[Zipdrive]

+12 PMPS=489.6 (27.2)

3 points lower then her +11 542 (30.1). How does that work.

Could some of the earlier higher numbers be because of not a big enough blood sample on the strip. The meter I use requires 0.75 microliters, which is a somewhat large sample when compared to others but I have been getting pretty good sized blood samples from Simone's ear with the larger gauge lancet.

 

[julie & punkin (ga)]

I am not familiar with that glucometer, but most of them will give you an error message if there is't enough blood, or too much blood. I don't know if it would just give a wrong number.

You're at a point where you're going to want to fine-tune the dose in less than 1u increments. Make sure you get the appropriate syringes - they are described on this sticky. I also did a video a few years ago on how to draw up a dose from either a vial or a pen - it's a bit further down the page on that sticky.

3 points lower then her +11 542 (30.1). How does that work.

Glucometers are allowed to be off by as much as 20% in the US - I don't know if that is true in Canada as well. That would mean that a test of 500 could be 400-600 on the very same drop of blood. For our purposes, you're looking at trends over a few days. The most critical numbers are if a cat gets into low ranges, and in low numbers that 20% variance is far less. For tonight, Simone is high from the skipped shot + perhaps a bounce from getting into blue numbers. It doesn't really matter what the actual number is, it's high. It'll come down though, so don't be too discouraged.

 

[Wendy&Neko]

I'd like to do all 3 within a couple of minutes of each other, but it was my vet that wanted me to wait the hour.

That there tells me your vet is more used to the in an out insulins like Caninsulin - which drops them hard and you want to make sure food is in them. Lantus is a gentler insulin and it's OK and even better to give several small meals. Don't assume because the vet clinic staff have diabetic animals that they know everything. I was shopping around for vets at one point and almost switched to one who had a diabetic cat on Lantus, until she told me her cat probably died from a hypo. Not home testing. Most vets I've shown Neko's spreadsheets to are fascinated because they don't usually see that kind of data.

And I completely agree you should do curves at home. Besides being much cheaper, it'll give you better numbers. My non diabetic kitty once tested over 220 at the vet's office, and 53 at home the next day.

I've had a meter give too low a number if too little blood, but not too high. You can always retest is you suspect a number.

 

[Zipdrive]

Did some testing throughout the night and into early this morning and updated the spreadsheet:

7PM 2u dose (PSBG) - 490 (27.2)
9PM (+2) - 409 (22.7)
1AM (+6) - 283 (15.7)
3AM (+8) - 281 (15.6)
5AM (+10) - 241 (13.4)

Feb 27 7AM quicky 1u dose (PSBG) - 184 (10.2) - will be testing often to make sure she doesn't go too low in the next 4 -6 hrs

I've made a call to the vets office this morning so as to talk to her about fine tuning the dose and emailed the office a link to Simone's spreadsheet so they can see the numbers. It seems that with Simone being on the mostly wet food diet now that a 1u dose is not quite enough and a 2u dose is a little too much. I'm just glad the picky little furball is eating the wet food. Now step 2 is getting the dose right.

I chose the GE200 meter I currently use as it has the most economically priced test strips at $59.99 for a 100. All the others in the various pharmacy's and such in my area are close to $80 for a 100, and since last Saturday I've gone through 50 of them so far.

Also with home testing, regardless of the meter being used, that's the one you have to go by anyways, not the vets.