2 Month Diabetic Phattie went from a few greens 2 weeks ago to 300's. Help! :)

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Kelley & Phattie

Kelley & Phattie

Member Since 2015
Hello All!

Phattie was diagnosed diabetic 2 months ago, so I am still learning.

A week and a half ago, she was in the green a few times so I couldn't give her a shot. This weekend she was in the 300's even after I nudged her dosage up a little. Today I came home from work early to check her at 7 hours and she was actually higher than her pre-shot.

She was very playful when her numbers were down, but the last week and a half she has been pretty subdued with only a few short bursts of energy.

She is a rescue cat, so she get some quirky little nervous behaviors when she is stressed, and I've noticed her doing some of those the last week. Not sure what is stressing her out, probably senses my stress (about her). She has had a history of pancreatitis, so not sure if the stress is bringing that about and making her BG rise.

When I brought her in, she had DKA. So I am worried with these higher numbers that it will happen again.

I've been feeding her low carb soft food, leaving it out for her. I try to be as regular with her shots as I can, but sometimes I am off by a couple of hours (which I have noted in the chart).

Can anyone offer me some advice on what my next step is? Or any ideas why she is suddenly up and having trouble going back down? All information is appreciated.

Thanks!!

Kelley
 
Kelley, we determine the Lantus dose based on how low that dose can take Phattie. On your last post here, Phattie had earned a reduction and I suggested going to 1.0 units. She had just gotten a 1.25U dose and earned a reduction by going under 50. You stayed at that dose (or close to it) for 3 cycles and she got a green nadir of 92 on the evening of the 16th. That was great and looked like a good dose for her. Then things started to change. You reduced on the morning of the 17th due to the blue preshot. The reduction depleted the Lantus depot and her numbers went up as a result. It seems that after that you were reacting to her preshot numbers and increasing based on preshots, instead of the nadirs or low points.

I think it's possible that you've increased too much. I'd go back to either 1.25U or 1.0U and stick to it for at least 6 cycles, unless she earns a reduction again. Try to get some mid cycle tests if you can. Getting a before bed test at night is very helpful. If you are at work all day, get either an out the door test or in the door test if you can. Or if you shoot just before you leave in the morning, get a test just as you get up.

By the way, if we are on a dose that is getting green nadirs, you should stick with that dose for 8-10 cycles if you are using the Tight Regulation (TR) Protocol, or a week if you are using Start Low Go Slow (SLGS) method. It would be great if you would look at the Sticky Notes for those two and decide which you'd like to follow for dosing so we can help you better. Regardless of which you are using, you stick to the same dose for a minimum of 6 cycles (for TR) or a week (SLGS), unless kitty earns a reduction. Lantus likes consistency.
 
I agree with @Wendy&Neko, the last week or so the dosing has been a bit all over the place and I do think you may have increased a bit too soon. Even at the beginning of April the dosing was a bit wonky. And then there was that week were no tests were done, so anything could have happened during that time frame. As Wendy has already suggested, I think you should reduce to 1.0u or 1.25u and then hold the dose for 6-10 cycles depending on nadir. It is so important that Phattie gets a consistent shot not a variable between one dose and another.
 
The depot is an interesting thing to learn about - it's the reason that Lantus and Lev can give long flat cycles. This sticky has some great info on it that is more than worth the read. It's pretty essential to understand the depot in order to understand how to adjust the dose.

One aspect of what Wendy & Tina are talking about is that in order to decide what to do next, you want things as settled as possible with the dose. Each dose change unsettles things. Think of it as wanting to see a smooth lake, but someone's rocking the boat. That's the same effect as changing the dose.

And in a particularly unhelpful quirk - too much insulin can look just like not-enough insulin. I'd follow Wendy's directions, hold it for a few days and check back in with us for some dose help then. :bighug:
 
Thanks Wendy, Tina and Julie!

I read the stickies about the depot and tight regulation.

So basically I panicked and messed things up trying to control the levels. Embarrassing, and sad for Phattie, but now I know better. :(

I just gave her the 7pm shot back at the 1.25 dose, and I'll leave it like that for a few days and then check back with you guys for the next plan of action. I should be able to stick tightly to 7 am and 7 pm for her shots, except for Thursday (kickball league). Hopefully this helps.

Thanks for being patient and helping me out with this.
 
believe me, you aren't the first and you won't be the last. It makes all kind of sense to see a high number and think it means more insulin. Who wouldn't think that? The older insulins were dosed that way, but these newer long-lasting insulins are dosed with a different mindset. You'll get it - don't worry. You haven't hurt Phattie.
 
Kelley & Phattie said:
Thanks Wendy, Tina and Julie!

I read the stickies about the depot and tight regulation.

So basically I panicked and messed things up trying to control the levels. Embarrassing, and sad for Phattie, but now I know better. :(

I just gave her the 7pm shot back at the 1.25 dose, and I'll leave it like that for a few days and then check back with you guys for the next plan of action. I should be able to stick tightly to 7 am and 7 pm for her shots, except for Thursday (kickball league). Hopefully this helps.

Thanks for being patient and helping me out with this.
Click to expand...

Don't feel embarrassed. We have all been there. I too did my own experimenting with adjusting the dosing, before really understanding the depot.
 
Hello trusted advisors!

I followed your advice and have been as regular as possible with Phattie's insulin since last Monday night. Her shots were at 7 am and 7 pm except for Thursday and Friday morning. Same dose every time. She has been sticking in the 300's and 200's.

How should I proceed from here?
 
Per the Lantus Tight Regulation protocol (are you following that?) you could increase the dose by 0.25 units.
 
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