? 2 units SID ? Wonky numbers

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Champoux

Champoux

Member Since 2017
Link to my previous thread: http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-first-low-numbers.177370/#post-1955527

Hi ! After the sudden drop on May 3, that was discussed in the last thread, I spoke a lot with my vet and we've been constantly adjusting doses. She started by suggesting we go to 1 unit once a day. My mother and I followed her word and gave Champagne only 1 unit in the morning.

However, his numbers stayed really high throughout the day. We suspected it might've been a bounce, since he'd been low the previous day. When he reached 28.9 at+10, we called the vet again and she said to give 1 unit in the evening could be a good idea too. So we did.

He once again stayed really high throughout the night and was 29.1 at his AMPS. Our vet called in the morning, before his shot to hear about how it went. When I told her he'd stayed this high, she suggested we go back to 2u, once a day and that we feed him bigger portions, but less often than we used to, as to not influence the numbers too much. I gave him 2u that morning but he dropped extremely fast (26.6 mmol/L at +2, to 13.6 at +4), then continued his descent to reach 6.2 towards +10. My mother and I steered him a bit with food in the afternoon, not to stop him from dropping, but to slow him down a bit. Of course past his shot time, which he didn't get, he went back to rising to high numbers again.

The morning after, he once again got 2 units, but it didn't affect him in the same way at all. It's as if he'd received nothing at all. Again, my mother and I suspected a bounce since his numbers had been quite low the day before. He stayed high all day and like the previous day, didn't get his PM shot. Now the weird thing. He started dropping during the night, without any insulin. He was at 13.1, two hours before his AM shot.

Now I'm supposed to give him 2 units this morning, but I'm wondering if all those fluctuations are normal or if I'm doing something wrong. Is my vet too quick on adjusting the dose ? His spreadsheet looks like an incoherent rainbow.

Sorry if I'm asking too many questions at once, the last days have been a bit confusing, to say the least.
 
Lantus is meant to be given every 12 hours for a cat so you will get wonky numbers if giving once. You need to find a dose you can shootveveryb12 hours or try a different insulin.
 
No, you aren't crazy, those are huge adjustments in insulin dose! And that, while it's always hard to say for sure (especially before you've accumulated a lot of data), it's very likely that the high numbers you saw after the blues were due to a bounce. The fact that he's lower now may mean that the bounce is breaking, and I think you are right to be carefully considering the dose and overall approach this morning.

The goal is to be at a dose that you can shoot twice a day, something that gets him into better numbers, but keeps him safe. So far, though it's tough to tell with the skipped shots, it looks like the 2U isn't too much for him (though it's higher than we'd usually recommend as a starting dose), but I'd like to hear some of the dose experts weigh in if there's time before you shoot.

How long until you are due to shoot?
 
Nan & Amber said:
No, you aren't crazy, those are huge adjustments in insulin dose! And that, while it's always hard to say for sure (especially before you've accumulated a lot of data), it's very likely that the high numbers you saw after the blues were due to a bounce. The fact that he's lower now may mean that the bounce is breaking, and I think you are right to be carefully considering the dose and overall approach this morning.

The goal is to be at a dose that you can shoot twice a day, something that gets him into better numbers, but keeps him safe. So far, though it's tough to tell with the skipped shots, it looks like the 2U isn't too much for him (though it's higher than we'd usually recommend as a starting dose), but I'd like to hear some of the dose experts weigh in if there's time before you shoot.

How long until you are due to shoot?
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Thanks for your reply ! I was wondering if skipping doses like that would do more harm than good, yet my vet suggested this strategy twice in the last week. Normally I should shoot in 30 minutes.
 
I don't know why it is, but almost all vets think in whole units. With the protocol and method we use here, we do dose adjustments in 0.25 units, so as not to pass the correct dose for the kitty at the time. Cats need insulin every 12 hours as their metabolism is higher than humans. If your vet said to give 1.00 unit SID, we would probably suggest trying to split it into 0.50 units BID.
Right now, as Nan said it is hard to read what dose he should be trying as the spreadsheet has too many dose adjustments and skipped shots and not enough data yet. I would maybe try 1.50 BID and see how that goes. I would try to hold the dose (unless he earns a reduction) for at least 3 days and then reevaluate. You're doing a great job of testing. Keep getting that data.
 
Dyana said:
I don't know why it is, but almost all vets think in whole units. With the protocol and method we use here, we do dose adjustments in 0.25 units, so as not to pass the correct dose for the kitty at the time. Cats need insulin every 12 hours as their metabolism is higher than humans. If your vet said to give 1.00 unit SID, we would probably suggest trying to split it into 0.50 units BID.
Right now, as Nan said it is hard to read what dose he should be trying as the spreadsheet has too many dose adjustments and skipped shots and not enough data yet. I would maybe try 1.50 BID and see how that goes. I would try to hold the dose (unless he earns a reduction) for at least 3 days and then reevaluate. You're doing a great job of testing. Keep getting that data.
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Yes, it's exactly why it's confusing for me too. There have been too many changes at once in a short period, so I have no idea how Champagne could react to his dose today. So far the vet had told me to give him 2 U SID for the whole weekend and then send her his numbers on Monday so she could see what it looks like and possibly adjust the dose. But since his BG is all over the place, I doubt that will work efficiently. Thanks for your reply !
 
The problem with the once a day dosing is that you are not getting the duration to keep him in a nice range.

The 2u might have been a bit too much for him, that huge drop from black to blue, no doubt triggered a bounce, combined with no shot at pmps resulted in another black amps.
I think trying to shoot a dose that you are able shoot BID would be a good way forward, the 2u seemed to make him drop pretty hard and fast, so that may be a bit too much to try BID, you could try 1.5u as Dyana mentioned, if you are able to monitor as you have been doing over the last few days, or if you are unable to monitor then maybe a more conservative approach of 1u BID may be appropiate to keep him safe. With the SID shooting, change of doses it's hard to say what the dose is actually doing for Champagne.
I don't think the vet gave the 1u enough time to see where the dose would take him, it looks like when you reduced to 1u BID he was in a bounce cycle, (I think the low blue the previous day(5/3) may have triggered a bounce, additionally it can take up to 6cycles for you to see the true effect of a dose, so even on TR we would usually hold a dose for at least 6 cycles, before taking the dose up.
How much does Champagne weigh? is that a healthy weight for him?


@Dyana @tiffmaxee
am I right in thinking that the hills m/d is higher than 10% carbs? or am I mistaken:confused:
 
Gill & George said:
The problem with the once a day dosing is that you are not getting the duration to keep him in a nice range.

The 2u might have been a bit too much for him, that huge drop from black to blue, no doubt triggered a bounce, combined with no shot at pmps resulted in another black amps.
I think trying to shoot a dose that you are able shoot BID would be a good way forward, the 2u seemed to make him drop pretty hard and fast, so that may be a bit too much to try BID, you could try 1.5u as Dyana mentioned, if you are able to monitor as you have been doing over the last few days, or if you are unable to monitor then maybe a more conservative approach of 1u BID may be appropiate to keep him safe. With the SID shooting, change of doses it's hard to say what the dose is actually doing for Champagne.
I don't think the vet gave the 1u enough time to see where the dose would take him, it looks like when you reduced to 1u BID he was in a bounce cycle, (I think the low blue the previous day(5/3) may have triggered a bounce, additionally it can take up to 6cycles for you to see the true effect of a dose, so even on TR we would usually hold a dose for at least 6 cycles, before taking the dose up.
How much does Champagne weigh? is that a healthy weight for him?


@Dyana @tiffmaxee
am I right in thinking that the hills m/d is higher than 10% carbs? or am I mistaken:confused:
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I will be able to monitor him, but since I'm getting low on test strips and they have to get shipped (probably won't have them until tomorrow or tuesday) I can only test him every 4 hours. Is that a safe enough gap between tests ? Also I don't have a scale yet, but at his last trip at the vet on April 24, he weighed 12.5 lbs. I couldn't say for sure if he gained or dropped some since then. He is on the lean/thin side. His hips are visible, his spine easily felt, but his ribs aren't visible and have a light padding. Yeah I also felt like the change in dosing was a bit impatient. Maybe we should've waited longer while he was on 1u BID. Thanks for your advice !
 
Champoux said:
I will be able to monitor him, but since I'm getting low on test strips and they have to get shipped (
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That's one of the problems with AT strips, that and the cost.

Another option would be to get a human meter and some test strips from a local pharmacy, you could keep the AT strips for when your vet wants to run a curve (as they are more familiar with the AT, and tend to prefer it) or if Vet wants some numbers, the AT could be your backup meter, I found out the hard way that its a good idea to have a back up, late one evening George, sent his meter for a swim in his fountain with one very precise swish of his tail:rolleyes:, that saw me racing to the pharmacy to get a meter before it shut for the night.

A lot of folk in the US use the relion from walmart, as that works out quite economical, strips are easy to get hold of and as you can see you soon run out of them.
 
Gill & George said:
That's one of the problems with AT strips, that and the cost.

Another option would be to get a human meter and some test strips from a local pharmacy, you could keep the AT strips for when your vet wants to run a curve (as they are more familiar with the AT, and tend to prefer it) or if Vet wants some numbers, the AT could be your backup meter, I found out the hard way that its a good idea to have a back up, late one evening George, sent his meter for a swim in his fountain with one very precise swish of his tail:rolleyes:, that saw me racing to the pharmacy to get a meter before it shut for the night.

A lot of folk in the US use the relion from walmart, as that works out quite economical, strips are easy to get hold of and as you can see you soon run out of them.
Click to expand...

Yeah, me and my mother have been thinking about getting a human meter too. Is there a huge difference in the numbers you get from a human meter compared to a pet meter ?
 
Dyana said:
It is 13% carbs according this sortable food chart by Dr. Lisa Pierson.
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Thanks Dyana.
Champoux said:
Yeah, me and my mother have been thinking about getting a human meter too. Is there a huge difference in the numbers you get from a human meter compared to a pet meter ?
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Yes there is.
Another thing to bear in mind is that the dosing methods we use on this site were developed using Human meters, so it does keep things simpler.

Folk have tried to figure out a conversion factor for the numbers from human to AT, but what was found was that the numbers followed no pattern, other than at higher numbers there was more of a difference, and it was determined that on TR the reduction point with an AT meter would be 68, with a human meter you'd look at a reduction point of 50.
More interestingly if you did decide to follow SLGS, there isn't an agreed reduction point for the AT meter, all the numbers on SLGS are for a human meter.

Dyana confirmed my suspicions in that the Hills md, is a little high in carbs, ideally you would want him on under 10% carb (if you decide to change to a lower carb please make the change slowly), it might be worth taking a look at the chart that Dyana linked and seeing if there is anything that you would find suitable. With the early CKD, you'd also want to look at keeping the phosphorus content down the link Dyana provided is searcchable so that will help.
 
Gill & George said:
Thanks Dyana.

Yes there is.
Another thing to bear in mind is that the dosing methods we use on this site were developed using Human meters, so it does keep things simpler.

Folk have tried to figure out a conversion factor for the numbers from human to AT, but what was found was that the numbers followed no pattern, other than at higher numbers there was more of a difference, and it was determined that on TR the reduction point with an AT meter would be 68, with a human meter you'd look at a reduction point of 50.
More interestingly if you did decide to follow SLGS, there isn't an agreed reduction point for the AT meter, all the numbers on SLGS are for a human meter.

Dyana confirmed my suspicions in that the Hills md, is a little high in carbs, ideally you would want him on under 10% carb (if you decide to change to a lower carb please make the change slowly), it might be worth taking a look at the chart that Dyana linked and seeing if there is anything that you would find suitable. With the early CKD, you'd also want to look at keeping the phosphorus content down the link Dyana provided is searcchable so that will help.
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Alright, thanks for the info. I'll look into that and see what brand of human meter strips are sold near where I live (so those don't have to get shipped too). Also I looked at the food database and it seems the most suitable low-carb, low-phosphorus food on the list would be Weruva cat food. I just looked at their website and some of their low-carb recipes also contains vegetables like sweet peas and potatoes, wouldn't that normally boost the carbs up ? Thanks again for your advice !
 
Oh, thanks ! Glad to know this before I considered trying it. I'll look at other food options.
 
Champoux said:
Alright, thanks for the info. I'll look into that and see what brand of human meter strips are sold near where I live (so those don't have to get shipped too). Also I looked at the food database and it seems the most suitable low-carb, low-phosphorus food on the list would be Weruva cat food. I just looked at their website and some of their low-carb recipes also contains vegetables like sweet peas and potatoes, wouldn't that normally boost the carbs up ? Thanks again for your advice !
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I'm in Spain, and as Weruva is not available here I'm not familiar with their range, but as a general rule, there can be a big difference in carb content between flavours, so make sure that you are looking at the right flavours.

The news about Weruva is quite concerning. I'd be worried about trying a product that has those concerns. i'd probably wait for the dust to settle on that and see what happens, perhaps in the interim you can try one of the other ones.

Some folk with CKD kitties opt for homemade and use a supplement that is low P.
 
tiffmaxee said:
tanyascrf.org has a food chart based on phosphorus levels you can look at as well. Lots of good info there. Do you have labs with phosphorus level? If getting high you can add AH powder to the food.
http://www.felinecrf.org/
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I don't have recent lab results for phosphorus levels, though when discussing with my vet, she said he wasn't too high right now. I'm looking at those charts on Tanya's site, but it seems all foods with reasonable amounts of phosphorus are all above 10% on carbs (most of them are above 20%). I don't say I'm opposed to a diet change, but all options seem to have their pros and cons.
 
Yes, it's very hard to balance CKD and FD. I lost Max when CHF entered the picture. Wellness grain free turkey isn't too bad. I thought I had found another food but it tutned out it wasn't as low as the rep first told me. Even so with AH powder his phos remained acceptable. You have to pick and choose.
 
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Update: Thanks for all your replies. I ended up giving him only 1 unit this morning and I'm glad I did so. I just took a blood test at +6 and he is at 4.2 mmol/L ! He probably would've been at a hypo risk had he received 2 units. I just fed him so he doesn't drop any lower, but he looks perky and alert.
 
I would test again at +7.
With an AlphaTrak the reduction point and time to act with higher carb food is 68 or lower.
His depot of 2 units was reduced last night and the night before, so it's hard to say what dose you should go with. See what +8 is.
If you shoot the 1 unit again tonight, I think I would try to get a nadir test (around +6).
 
Dyana said:
I would test again at +7.
With an AlphaTrak the reduction point and time to act with higher carb food is 68 or lower.
His depot of 2 units was reduced last night and the night before, so it's hard to say what dose you should go with. See what +8 is.
If you shoot the 1 unit again tonight, I think I would try to get a nadir test (around +6).
Click to expand...

I tested him again at +9 and he was at 6.7, then at his PMPS and he was at 7.9 mmol/L. I ended up giving him nothing because he was a bit low to shoot and I won't be able to check him as often tonight. My mother will still spend the night awake to feed him regularly and to make sure he's fine.
 
I know we talked about hasty dose changes yesterday, but I'm wondering if 1u BID might not be a bit too much for Champagne ?

I really can't predict how he reacts to anything. Yesterday I was sure 1u would not be enough for him, yet he dropped lower than when he was on 2u. Probably the bounces have something to do with it. He dropped to 4.2 towards nadir and was only at 7.9 at the PMPS. I don't really have enough data to know how he'd react with a low pre-shot, so he ended up getting nothing at all yesterday. Yet he stayed in the blues for a good portion of the night without any insulin. Should I lower his dose to 0.5 this morning so it's safe enough dose to give twice a day ?
 
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