6/3 Zeus AMPS 93: And back down: Update: Numbers are back up

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knolet

knolet

Member Since 2012
Good Morning,

My cat was diagnosed in the beginning of May. He's been on 1.5 units of lantus 2 times per day. He was eating Purina DM canned and free fed dry, but I don't know how much he usually ate since I have 2 cats.

The doctor wanted to do a BG test yesterday at +6. My number was 175, his was 224. But my numbers had been in the high 200's or low 300's. Vet said not to give any dry food yesterday, so I didn't. I've been wanting to switch him to all canned anyway. Vet said to increase dose to 2 units - I started last night.

This morning, Zeus' was 88 in one ear and 118 in the other. I shouldn't give a shot with that low of a number, should I?

Any advice would be greatly appreciated. My Vet doesn't open for half an hour, but even then it's only the receptionist... Vet doesn't get in as early.
 
Re: To shoot or not? low number I've never seen & concerned

You are absolutely correct do not give insulin on that low of a preshot...I'm sorry I really can't be a lot of help today, my little girl passed away last night and I'm still just kind of numb...If you don't get a fast enough response here as we are a fairly small group, please post on Health to get more eyes.

But the normal procedure with a low preshot like that is to either stall without feeding to see if they are rising or to completely skip the shot and start over on the evening shot.

Mel, Maxwell, Musette(GA), Autumn & The Fur Gang
 
Re: To shoot or not? low number I've never seen & concerned

Our general advice to new Lantus users is never shoot below 200. From your spreadsheet, you've barely got 1 week of tests for use in making these decisions, so I would stick to the 200 as a "No Shoot" limit. As you collect more data, you will learn whether you can lower that limit safely. Only do this when you have data! And start off when you can be home to monitor and slowly reduce your limit.

Other members have experienced a 100 point drop when eliminating dry food; given the 2 mid-cycle tests I see, that could wind up either triggering compensatory liver response to raise the glucose back up (sometimes resulting level is so 'new' to the cat that this may happen) or running into hypo territory.

Keep getting those mid-cycle tests in the +5 to +7 range which is where your likely nadir will lie. Those are the numbers that will help you to adjust dosing.
 
Re: To shoot or not? low number I've never seen & concerned

Thanks so much - I will use 200 as my guide... and keep testing. Tonight the numbers were back up there, 374 and 335. I gave him 1.5 units which is what he was at prior to last night, but wondered if I should have done 2 as the Vet said yesterday? Zeus is really hungry tonight.
 
Re: Update: Numbers are back up RE: To shoot or not?

You need 5-7 days to stabilize at a given insulin dose, any time you change it (ETA: I'm conservative). And some cats start the day in the 300s, swing down around 120 then swing back up in a given 12 hour period. That is why dosing is adjusted based on the nadir or lowest point, and why you need to test around then. You've got to know how low he goes before you know if the insulin can be increased or decreased.

You've just phased out dry food, so that needs a day or so while to stabilize for you to see the new pattern (ETA: depending on how much was being consumed and the cat). The 2 unit recommendation by the vet was made before you did that, so it is no longer appropriate (conditions changed). You had to skip this morning because he was so low. Wait and see what eliminating dry food does - you might even wind up reducing his insulin dose!

If you are following the Lantus Tight Regulation protocol, which has lots of data collection and testing, you can adjust dosing faster, but it requires diligent testing and vigilant monitoring.

Pop over to that forum and read over the stickies, then ask any questions you may have. Read some of the other posters and look at their spreadsheets. The Tight Regulation protocol has the best chance for remission.
(ETA: I specifically suggested this forum so she could review posters spreadsheets as there are many posters)

Until you get him regulated, he isn't able to use all of what he eats, so he feels very hungry. Its OK to feed him! If you haven't read it yet, Cat Info has lots of info about diet and nutrition for cats, including obesity, diabetes, and renal disease.
 
Re: Update: Numbers are back up RE: To shoot or not?

If you are home testing, a new dose should be settled in 3 days / 6 shots; you do not need to wait 5 to 7 days for any dose to settle except when you first start giving insulin.

As for dry food being out of a cat's system, it can take up to 3 days to clear completely, so I would wait a good 3 full days after removing the dry food, and only then can you know how much insulin your cat will need to get some decent numbers.

Remove the dry food, and then think about changing the dose.
With the reaction you got from the 2u, I bet you would be good to drop back to the 1.5u because you will need to give less insulin once the cat is no longer eating any dry food.
My cat Shadoe could jump almost 200 points if she stole any dry food, even just a mouthful, so I know that the dry will mess with your numbers.

ETA: you can post where you like, read whatever stickys you like in all forums. On this forum, you can still follow the protocol mentioned in the TR forum.
The holding a dose longer is for people who are NOT home testing, not for people who have ss up and with regular test numbers in it.

"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
 
Re: And back down: Update: Numbers are back up RE: To shoot

Thanks for the guidelines - that is very helpful. This stuff is so confusing and overwhelming for a newbie, happy to be able to learn so much from all the collective years of knowledge here managing FD.

And the number is back down to 145 this morning - another no shot morning :-D
 
Re: And back down: Update: Numbers are back up RE: To shoot

She ate less tonight; she may be low again in the morning. If so, the next time you shoot, you may want to drop back to either 1.25 or 1.0 units. Its important to get a dose that can be given every 12 hours.

Also, it is important to be consistent with the amount you are feeding her and when you are feeding it. Folks who spread out the food into mini-meals generally feed in the 1st half of the cycle (ex: 0, +3, +6), then pick up any food left out 2 hours before the next test. If scheduling is an issue ,the PetSmate 5 compartment feeder seems to work well for folks.

For safety reasons and in order to know what intervention had what result, make 1 change at a time, rather than 2 (dose increase OR removal of dry, not both at the same time). This will help you identify the separate effects of each intervention, plus reduce the risk of hypo events. (Ex: If dry food had been the only food and you switched completely to canned at the same time as the insulin increase, it could have caused a hypo event - scary, time consuming to monitor and treat, and potentially fatal)
 
Re: And back down: Update: Numbers are back up RE: To shoot

BJM said:
Its important to get a dose that can be given every 12 hours.
Click to expand...

Ok good - so that was my question - I just posted on the health board - see below. If his numbers are back up to around 300 tonight, your recommendation would be to lower his dosage by 1/4 or maybe 1/2? Post dry food, free feeding, the Vet said to feed 2X daily with shots, but I think I'm going to try to feed at least three times (dividing his food between the three). Yesterday was the first time I did that (but it wasn't divided equally as I didn't start until mid day). Should I hold off on the dosage change then for a couple more days to see what the addition of mid day food does?

Thanks so much for the advice :smile:

Good Morning, for the past three days, Zeus has not gotten any insulin in the morning because his numbers were below 150 - for 2 days they're actually below 100. While I'm really happy about this, I'm also a little concerned because I know Lantus is supposed to be given 2X daily. He hasn't had any dry food since Wednesday - so today will be the 4th day off the dry food. On Thursday last week, the Vet wanted to increase his dosage from 1.5 to 2. I did that Thursday night, but have backed it down to 1.5 since. His numbers yesterday, with no morning insulin were 277 at +6 hours after eating, and then 297 at PMPS.

My question is... what to do now? I don't know if three days is enough time to make the decision, but it kind of seems to me that maybe I should lower his evening dose, so that he'll need a morning dose as well, which would hopefully keep his numbers from getting into the yellow? But I really don't have enough experience to make that decision. Any thoughts?

Thanks so much! Happy Sunday.
Kathie and Zeus
 
Re: 6/3 Zeus AMPS 93: And back down: Update: Numbers are bac

Lower the insulin dose first.

If you adjust his feeding schedule, it needs to be the same day AND night. Many cats go lower at night, so you want to be sure he has enough food.

Ex feed after preshot and at +4 both morning and night
 
Re: 6/3 Zeus AMPS 93: And back down: Update: Numbers are bac

With all this advice, it might be best if you remember the "Start Low, Go Slow" approach until you feel more comfortable with your approach to dosing.

_Rebecca
 
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