? 5/22 Boris +6 477, +8 463, +10 355, PMPS 280, +2 169, + 153

learjetta

learjetta

Member Since 2019
Today we are performing our first home BG curve on Boris, and it hasn't gone well so far. Boris was given a dosage increase last week from 1u to 2u BID, and overall we have seen his numbers trending downward. Typically we do AMPS, +5, and PMPS, and they've all been high, but pretty close together, relatively speaking. This morning his AMPS spiked to 492, and his +2 is 468! He's also drinking a lot more than normal.

We recently added a timed feeder for overnight meals, and the one night I did check, he came and ate without any issue. However, I'm wondering if maybe last night he didn't get his snack and slept right through it? Or is this a delayed reaction to the change in his feeding schedule? Pretty sure we didn't have a fur shot or a shoot through, though he is a long haired cat and maybe we missed without realizing?

We are supposed to call in his BG numbers to the vet tomorrow, and I'm nervous they'll want to increase his dose to 3u based off of today's numbers. My concern is, he was on 3u between the end of April and beginning of May (for 2 weeks), and it caused his BG curve on 5/7 to read 90s, 60s, 90s, 200s, then 100s (sorry this isn't in the SS, I don't have the actual values from the vet and it's from memory), so they had us drop the dosage back down to start over. We are leaving for our destination wedding 6/8 (returning 6/13), and need to have him stable (even if a bit high) while we are gone. We are having a paid pet sitter experienced with giving insulin take care of him, but I'm not sure she'll be able to test his BG while we are gone.

Let me know if you need additional details I forgot to include.

Thanks!!!
 
Hey!

I'm moderately new to Feline diabetes but it looks like Boris is in a bounce. A bounce happens when Boris' BG levels drop lower than he is used to and his liver and pancreas panic and send out a bunch of extra glucose / glycogen to get his BG back up to the levels he has become used to. It could be that he took a dive last night after his nice and flat yellow day which could have triggered the bounce. It seems to be a common trend in cats that have a nice and flat yellow curves that they see a lot of action in the next cycle. I will pass along some advice that I got from when I first started on Lantus so I could get better feedback from the board and understand Mowgli's patterns better myself.
  1. Choose a dosing method, there are two for Lantus: Tight Regulation (TR) and start low go slow (SLGS). Because you are still feeding Boris dry food Tight regulation is out since cats on TR must be on a full wet food diet. For now it looks like SLGS is the right method for you ;) You can find information on SLGS on the stickies at the top of the forum. Once you choose a method you should add it to your signature so that you can get the proper advice for the dosing method.
  2. We execute dose changes by + or - 0.25u at a time. Cats react strongly to insulin so by changing by a full unit there is a chance that you could be skipping on by the ideal dosage for Boris. To do this we use 100u syringes with half unit markings, you can get them at most pharmacies but it seems like most people in the US use the relion syringes from walmart as they are the best bang for your buck!
  3. Doses for Lantus are based on Nadir values
  4. You should always try and get a before bed BG reading. This is because a cats BG commonly goes lower in the night than the day time. These PM tests will give you an indication if you have to worry about really low BG levels while you're asleep.
We will assume right now a SLGS dosing method... I see you are transitioning Boris off of dry food so once that is complete you will be able to consider Tight Regulation. In SLGS you hold the dose for a full week, then you do a curve to determine if a dose increase or decrease is needed. Since Boris is most likely in a bounce you may not want to use today's curve as the dosing reference material. Especially if the reason Boris is so high is because he is in a bounce from dipping low last night (indicating that this dose could be just right or even too much for Boris). If you do decide to increase your dosage I would certainly encourage you not to increase by one full unit. Try just 0.25u.

As for the 3u dosage while you're away - I personally think it's better to be safe than sorry - choose a lower dosage until you get back(it seems like you feel the same way). You definitely don't want to have a hypo event on your hands when you're supposed to be celebrating your wedding (CONGRATS!!)

Sorry if I am repeating information that you already know... These tips have really helped me becoming a little more confident with where Mowgli is at. Hopefully someone with a little more experience than I have can elaborate a little more and give you some further advice :)
 
AmandaE said:
Once you choose a method you should add it to your signature so that you can get the proper advice for the dosing method.
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Done! I also copied your signature style as it is MUCH easier to read!

AmandaE said:
As for the 3u dosage while you're away - I personally think it's better to be safe than sorry - choose a lower dosage until you get back(it seems like you feel the same way).
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Absolutely agree on this! I'll be stressed enough leaving him in somebody else's hands, and definitely want to be conservative.

AmandaE said:
To do this we use 100u syringes with half unit markings, you can get them at most pharmacies but it seems like most people in the US use the relion syringes from walmart as they are the best bang for your buck!
Click to expand...

Picked those up on Monday night in preparation for the next dosing change. I suspect my vet will want to increase his insulin, and probably will want to increase by 1u. I'm definitely going to push back for a lower change. Although if he's in a bounce, maybe a change isn't really a wise choice right now, and we should let it ride for a while. I hear what you're saying about the BG curve... is it still useful to put him through it today? How long should I give him to recover from the possible bounce before running a second curve?

AmandaE said:
Sorry if I am repeating information that you already know...
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Your tips were very useful, thank you! I didn't know about the night time readings dipping low, and I missed adding the SLGS to my signature. Always thankful for input as well!
 
learjetta said:
Done! I also copied your signature style as it is MUCH easier to read!
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It looks great!! I think I copied this style off of someone else as well #passiton :p

learjetta said:
Picked those up on Monday night in preparation for the next dosing change. I suspect my vet will want to increase his insulin, and probably will want to increase by 1u. I'm definitely going to push back for a lower change.
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Perfect! you're all set for quarter unit dose changes!

This is where it is kind of tough, it's one of the biggest struggles that I have faced since joining the message board, should I follow the advice of my vet? or should I follow the advice/ practices here. To make the decision I always consider both sides, and do whatever research I can. You are Boris' owner and you know what is best for him. It is especially useful that you are testing because you have a better idea of Boris' reaction to Lantus than your vet at this time. In this case - you already have the data that says 3u doesn't work well for him right now... it's too high.

When making my decision I personally sat and thought about all sides of vet vs FD and I decided for Mowgli and I that it was best to follow SLGS and seek advice / feedback from the members here... I get more immediate advice and it costs much less ;) of course if anything goes seriously wrong I would talk to the vet. Likewise... you need to decide, if you are following SLGS you should commit to the procedure which states to only increase by 0.25u, discuss it with your vet for sure, but you can't make 1u dose changes while following TR or SLGS.

learjetta said:
Although if he's in a bounce, maybe a change isn't really a wise choice right now, and we should let it ride for a while. I hear what you're saying about the BG curve... is it still useful to put him through it today? How long should I give him to recover from the possible bounce before running a second curve?
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RE: the curve, You're almost done with it now, might as well grab the points for practice ;) we can see that Boris is past his Nadir, so maybe grab a +9 for the hell of it and then your PMPS. Bounces can take anywhere from 3-7 days to clear but ECID (each cat is different). Your AMPS and PMPS should give you an indication if the bounce has cleared. Are you able to test any day throughout the day? Tomorrow is your 7th day on 2u so if Boris seems to have BG numbers that are back to normal - tomorrow could be the perfect time. I have a hunch that Boris will be ready for a dose increase based on his previous BG data, although I am not really experienced enough to offer dosage advice. If no one pops in with an opinion I'll tag a couple experts :D

I'm glad you found my tips useful, I hope that Boris starts seeing some lower numbers soon! Maybe some blues and greens :D
 
+8 463

Spoke with the vet's office and they suggested an increase to 3u, as predicted. However, I know for a fact that will send Boris into a tailspin, so I really don't want to do that.
 
AmandaE said:
Your AMPS and PMPS should give you an indication if the bounce has cleared. Are you able to test any day throughout the day?
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We both work from home, so we are here 90% of the time. So yep, I can test throughout the day!

AmandaE said:
Tomorrow is your 7th day on 2u so if Boris seems to have BG numbers that are back to normal - tomorrow could be the perfect time. I have a hunch that Boris will be ready for a dose increase based on his previous BG data, although I am not really experienced enough to offer dosage advice. If no one pops in with an opinion I'll tag a couple experts :D
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I suspect you are correct that he needs an increased dose, but 3u is just too much for him. So I'm not going to do that, regardless of what the vet wants. I'd rather bump it up a little bit instead, and see how he does. I don't know if I should do that while he's bouncing though (if that's what he's doing). I've been looking around trying to read up on how to handle his bounce, but haven't found much yet.
 
That's great news! since you're home a lot you guys should definitely consider TR once Boris is transitioned over to wet food completely! (I'm jealous)

Advice I've been given through a bounce is to hold the dose... but due to Boris' history I think he could handle the 0.25u increase @carfurby @Sienne and Gabby (GA) or @Marje and Gracie: I was wondering if I could get some more experienced eyes on this so that I don't lead anyone too far astray :smuggrin:
 
It's hard to offer dose advice without any night time tests. He most likely dropped lower last night and is bouncing today, but without knowing how low I can't suggest a dose change. I don't think today's numbers are good for the vet to use to make a decision either. If you are not able to get a lot of night time tests in, we usually suggest at least getting a before you go to sleep test each night. On the days I work I can't get night time tests in. I can't function without sleep. I use the weekends to get extra tests in when I need to.
 
You could be correct about the bounce. The problem is that without any PM tests, there's really no way to know if this is the case. With Lantus, because dosing is based on the nadir, without any PM cycle tests, you're missing half of your data. Boris could easily be dropping into lower numbers without your knowing. Would it be possible for you to get a before bed test every night?
 
We tend to head to bed early most nights, but are up later on weekends. We are going to try and get a +2 tonight, and maybe a +5 or 6 if I can convince my other half to get up. ;)

His +10 was 355 tonight, so hopefully it’s coming back down now.
 
+2 is typically a good indication of how the night will go. If it’s similar / higher from a food bump there is less concern. If it’s much lower you may be in for a night of testing!
 
Do I call this +2 again? It's 169... heading down. We plan to check at 2AM (+5) just to see what is happening.
 
He's been generally coming down all day, and with that drop from PMPS to +2, I wouldn't wait until +5 I'd get a +3. I'd also suggest feeding some LC food now if you haven't.
 
+2 @ 169 is great! it is a big drop though. I agree that +3 or +4 could be better than a + 5. Just in case he drops that far again. It is clear that Boris is clearing his bounce and I would say you might be in for a night of some testing!

I don’t want to panic you at all but this is a good example of why it is always good to be prepared for a hypo event. I’m not at all saying that tonight will end that way. Not at all. But you owe it to yourself and Boris to know what steps to take just in case. You should review the notes on the Lantus forum on hypoglycaemic events just so you know what to do. You should also know the number for the nearest emergency vet. Again this is a just in case. Boris isn’t in the danger zone yet. At all.

Another reason you might need to get a couple more tests tonight is that if Boris goes below 90(5mmol) he qualifies for a dose decrease to 1.75u. Which is just where you want him to go!
 
+3 153

AmandaE said:
You should review the notes on the Lantus forum on hypoglycaemic events just so you know what to do.
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Karo syrup is within easy reach, forbidden dry food is ready to go if needed, and sadly, I'm familiar with the emergency vet.

So now this begs the question, did the snack help? Do I risk a few hours sleep?
 
It definitely looks like it helped for sure! Now I would plan a +5 to ensure Boris is on the way up. I am also on this train tonight. Testing twins :)
 
You are basically at the same number, given meter variance. Still very safe, but you have limited data at the moment since you are quite new, so I can't really gauge onset, usually that happens at +3, but Boris may have had an early onset, and is possibly going to surf along now, or start to rise. If you can set an alarm for +5 or +6 it might be worth checking. Any data is good data, it helps to start seeing how your cat responds to insulin and carbs ;)
 
Oh no! Mowgli is bouncing too?
AmandaE said:
I am also on this train tonight. Testing twins :)
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Oh boy! Poor Mowgli! How does he do with testing? Boris is just about over this nonsense!

Christie & Maverick said:
You are basically at the same number, given meter variance. Still very safe, but you have limited data at the moment since you are quite new, so I can't really gauge onset, usually that happens at +3, but Boris may have had an early onset, and is possibly going to surf along now, or start to rise. If you can set an alarm for +5 or +6 it might be worth checking. Any data is good data, it helps to start seeing how your cat responds to insulin and carbs ;)
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I think we will shoot for close to +6. The feeders are set to open 15 minutes after that, so at least I’ll be sure he ate as well.

Thank you both so much!
 
learjetta said:
Oh no! Mowgli is bouncing too?

Oh boy! Poor Mowgli! How does he do with testing? Boris is just about over this nonsense!
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I think Mowgli was suffering from a combo of a dose that was too low, waiting for his 1u depot to build and a possible bounce. He’s awesome with testing. I’m so lucky. When I started though he was on zylkene which is an anti stress supplement for cats so I think that gave me the space I needed to get him used to it. He does get kind of annoyed on curve day haha

Also no problem. I hope Boris has some steady and good numbers for you tonight! Looking forward to your am post ;)
 
+6 61

Boris had his wet food, and I added dry because I’m worried.

Will check again at +7 or 8.
 

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I love the picture. They're so adorable. I hope Boris came back up and surfed safely. He earned a reduction to 1.75 units. I'm glad you didn't increase like the vet wanted you to.
 
+8 59

They are cute, aren’t they? And quite the characters!

Gave Boris a treat to help prop up his numbers a bit.
 
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