Now that we're not in a middle of the night crisis, i want to give you some more information about last night.
I would not increase back to 2u, no. Not at this point. We're a data-driven board, so we look at the most current BGs and figure out how to proceed. He demonstrated clearly last night that 2u was too much. Depending on how he is tonight, i probably would stick with the 1.0u for now.
I'm unsure whether or not 1.5u was too much. Lantus forms a precipitate in the body when it's injected - called the depot - and that precipitate slow releases into the body. The size of that depot is in relationship to the size of the dose. What we know is that when the cat's been at a dose (2u) and the dose is reduced (to 1.5u), the depot continues to give at the same rate as it was for 2u for a while. We can see the effect of that previously larger depot in the BGs for as many as 4-6 cycles after the dose reduction.
That means that the 40's you got last night could still have been from the previous shot - that's what Wendy was referring to. Understanding how the depot works is pretty important. It's the cause of Lantus and Lev's ability to provide longer blood sugar control in cats, but it's also a little tricky in that you have to understand that prevous doses can affect your current blood sugar. Yesterday morning's 2u is likely still holding down today's blood sugar. The farther away you get from it the less the effect is.
This is also why I was asking last night how many days he'd been getting the Lantus. If you see a strong effect on the first day of the shot, with essentially no depot built up yet, that means something different than if you see a low number after a week when the depot is full.
Here is a link to more about
the insulin depot.
Wrigley's starting dose is a little higher than we would've started him. I was tempted to suggest you drop to 0.5u to begin with, per the Start Low Go Slow method, just because he's alone during the day and for starting out, it's easier (and less nerve-wracking) to start with a smaller dose while you learn a little bit. The weight-based formula that goes with Tight Reg would've had you start at 1.0u, as Chris suggested. I'd encourage you to look at those two dosing guidelines and decide which one you want to follow. That helps us guide you in the way that works for your life. Because you'd mentioned DKA that factored into the suggestion that you just decrease to 1.5u last night instead of decreasing more than that. If you want to follow Tight Reg, here is
a post with ideas on how people manage it while working full time jobs. Even if you choose SLGS, I'd employ some of the tricks from that post to help keep Wrigley safe while you're at work. A timed feeder is worth its weight in gold with a diabetic cat.
I did want to offer you a suggestion on how to record what happened last night in his spreadsheet.
In the column where you put his pmps, you can stack up the previous test so it shows that you stalled. You can shrink the font or widen the cell to help it all fit in. It should look like this:
PMPS.........U
12=67
12.75=85
13.25=81
The rest of it is great. I just want it to show that you stalled for an hour or so before you shot, because that is important.
I wanted to add one more thought about the dry food. We don't usually suggest feeding cats dry food here. It's typically too high in carbs and it can be a burden on their kidneys, and diabetic cats already are dehydrated. So typically you'll hear "ditch the dry food" - but in your circumstance last night because we thought there was a background of DKA and because it's essential not to skip shots with a cat that's recently had ketones, one technique we use in that circumstance is to increase the carbs of the food so that the cat can get enough insulin. I expected the dry food to raise him high, honestly. We've seen cats have their blood sugar increase by 100's of points just from 3-5 pieces of kibble and it can last that way for another day. It's powerful stuff in most cats. The fact that Wrigley didn't go high from it was surprising. It suggests he is not very carb sensitive, or the dry food wasn't high carb (was it Young Again kibbles?) or ? But it did surprise me.
Ordinarily you want to give canned food - it has more water in it and is therefore easier on their kidneys, and if you have to give high carb they wear off in a couple of hours. You might want to pick up some high carb gravy cat food for using for low numbers on your way home from work.
www.catinfo.org has the list of carbs - I've linked you straight to that list. You want something over 16% - over 20 or 25% is even better. A lot of people like Fancy Feast because the cans are small and otherwise you may be throwing away cat food. Or giving it to your other cat. The Fancy Feast gravy lovers are all 20% or more. There are plenty of other options too - just scan down the carb column and find something that's available to you.
Usually when you see a test less than 50, you pop off the lid, put it back on the food and squeeze to get out about a teaspoon or so of gravy. Feed it to the cat and recheck the blood sugar in about 20 minutes. So having a cat food with enough gravy is helpful.
ok, hopefully I haven't overloaded you - read lots and ask questions on anything you don't understand.
When you get home and test Wrigley, would you please edit the subject line with the current information? You'll notice that people edit the subject line whenever they have new information. That lets people monitor from the main page and people can see if you need help. To edit your subject line, go to the top right of your post and look for "thread tools." I'm out of town tonight but know others will be watching for you.
