8/17 Hosanna +11 144 newbie dose question

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Hosanna

Member Since 2012
I am very new at this, and from what I've been reading, I think I need to start low, go slow. Thus am finding my way around and to this board. I am in the process of reading all the starred material, but I don't want to rush through it.
Martha was diagnosed with DM this past July 5th. I am beginning to think some of her other health issues are interfering with treating her diabetes. For example, she has struggled with IBD for about 5 years now---and so the issue of steroids could very well have a bearing on Martha's bg control.
She started off on prednisolone. About a year ago we switched her to dexamethasone. (Not quite sure the vet's reasoning). Then last year we began getting high bg readings on her regular bloodwork. Knowing diabetes could be right around the corner, we switched her to budesonide. That's supposed to act locally in the gut more than systemically. I breathed a little sigh of relief at that switch. Short-lived.
This past May 28, she seemed to be having an IBD flareup so the vet increased her budesonide from 1 mg to 1-1/2 mg. Two days later, Martha had full blown neuropathy and was sliding around instead of walking. The vet saw a possible connection and I, on my own initiative, put her dose back to 1 mg.
Now my question is, and I so hope this group can help me here--is the budesonide having an affect on her bg? If so, is there anything I can do to change that?
We went a whole month with her having that dreadful neuropathy before anything was done. I do understand part of the reason for that was she also has HCM and we were trying to keep as much stress off her as possible, and the "White coat syndrome" would sometimes send her over the edge. But this is the same vet who had her on 4 units of Lantus within the first few weeks of treatment, and she ended up with hypoglycemia. I love this vet to pieces but, over time, I have come to not trust him so much any more.
No point in saying to change vets because I already have the very best Internist and Specialized medicine clinic in the whole state. Her cardiologist is also with that clinic and he told me this week, after her scheduled echo, that, while she still has serious and advanced heart disease, it is getting better as we bring down the BG. Yay for that!
The medicines she is on are: budesonide, of course; amlodipine, benazapril, prozac (behavior issues), COQ10, B12 Meth, Miralax. Occasionally I will give her slippery elm.
I hope I am making sense, it's hard sometimes to formulate what I want to say. But I feel so alone in all this diabetes business and will appreciate any and all help you can give. If I ever sound "scattered," it's probably because I am....
 
Re: Lantus and other health issues

Hi Hosanna, Welcome! I am too new to offer advice about your kitty. There are wopnderful experienced folks here who can help you sort things out. I suggest you edit your original post above and click the (?) icon so they will notice your question faster. Good luck!
 
Re: Lantus and other health issues

Your vet sounds great when it comes to everything except diabetes management. Bottom line, given that vets need to know a huge amount about various illnesses across various species, they can't be experts at everything. On the other hand, we know diabetes. We can help you to figure out what questions to ask your vet.

Are you using oral or inhaled budesonide? Ostensibly, an inhaled steroid should not have the systemic effects that either the pred or dex have. Note that I said "ostensibly." We've seen any number of cats who, when their asthma flares, will have higher numbers. (Take a look at Tarragon's condo/thread from today.) Any steroid, especially oral ones that have systemic effects, can have an effect on BG numbers.

We've had any number of cats here who have to be on medications that effect BG numbers. There are lots of IBD cats and several cats with asthma. The general feeling is to treat the other illnesses as aggressively as you need to. You can always adjust the insulin dose around the other problems or other medications.

Whether you utilize a start low, go slow (SLGS) approach or tight regulation, we're happy to have you post here. If you want info specifically about asthma and/or IBD, I'd change your subject line and mention those issues. There are lots of people who can give input.
 
Re: Lantus and other health issues

Hello.
your 911 isn't showing on the tr forum list.
you have to put whatever you want to say for the subject line down on the first original post in the thread.
scroll down to your first post and click on edit and edit the subject.

and dosage isn't usually a 911 ...
say something like dosing question URGENT and use the icon question mark.....
 
dosing question URGENT

I already fed her, right after the test!!!! She was so hungry. Will it do any good to retest since she had food?
 
Re: Lantus and other health issues

If you want to get dosing help, please edit the very first post that you made. Do you see the edit button? Put this in the subject line:

8/17 Hosanna +11 144 newbie dose question

and use the ? icon. Do not use the 911 as this is not an emergency. I know it feels like it to you but it's not a hypo or something else that is life threatening. Someone will help you through this process. You will be fine and so will Hosanna.
Liz
 
Before I make any recommendation about dose, you MUST make a commitment to test. Getting pre-shot tests is not sufficient and unless you agree to stay up to get spot checks tonight, I am not comfortable suggesting anything other than to skip the shot.
 
This is another reason we suggest only one thread/condo per day. You have 2 threads going and it would be better to have everything in one place. I'm glad you figured out how to change the subject line. Only the subject line from your first post is visible on the board.
 
I apologize for sending out a 911--to me, it was an emergency, but I now understand.
Also apologize for having so many condos going. I think I've learned this.
Since Martha was at 144, and since I already fed her--She was starving, and she had about a half can of Fancy Feast Seafood Feast which, according to the company, is Dry Matter Carbohydrates- 2.4% Dry Matter Protein- 57.4%
I will re-test her tonight around +2 and see what her reading is. If it's still under 150, no insulin, but if it's up over 175-200, 1/2 unit
Does this sound like a good plan?
 
How about testing at +1 (or even in 30 min.) instead?

The longer you stall, the more your shot schedule is thrown off track. No matter how long you delay, the subsequent shot will be 12 hours later. You then need to work your way back to your preferred shot time. If your +11 was 144 and you fed, by your usual PMPS, we may have a better idea of what the numbers look like.

Also, will you be able to test tonight? This is critical. If numbers should begin to drop, you need to know what's going on and be able to steer the cycle using food. The only way to keep Hosanna safe is to test. You are clearly concerned about her and want what's best. I know I'm being a pain in the neck about testing but we are invested in the safety of your cat. If you take a look at Lotus' condo from last night, you'll see people stayed up with her most of the night and into the morning helping her to manage the numbers and offer support.
 
I forgot to answer your other question. If you recall from your other condo, Lantus dosing is based on the nadir. The plan you were describing where you are thinking about what dose to give is based on your pre-shot values. As a rule, you shoot the usual dose.

That said, there are times when shooting a reduced dose makes sense. What you're not factoring in is that a late shot acts like a dose reduction. Thus, if you stall AND shoot a reduced dose, it has double the impact on the insulin depot. Rather than have a fixed plan, I'd rather you wait to see what the numbers look like. You may want to read this post on dealing with low pre-shot numbers.
 
You are showing 144 as her PMPS....did you already retest or did you mean to put that in the +11 column?

I agree with Sienne. We had another kitty the other night who was in the one hundreds at +11 and 268 at PMPS. So don't feed anymore and post her +12 if it's still low.

Normally, we put the kitty's name in the subject line...not the caregiver :-D :-D
 
Hosanna,

You should know that just like last night with Lotus, if there ever comes a time when you need help in the wee hours of the morning with Martha, the same thing will happen. That's why Sienne is stressing the testing. I've seen this dozens of times in the couple of months I've been posting more often in Lantus TR. If you have a crisis, someone (usually more than one person) will stay up with you as long as the crisis is going on. As long as you have access to the internet and to this site, you are never alone.

You'll get used to the "subject line" conventions, and the number of threads per day suggested, those things come with time. I didn't used to really understand the logic to them, but I do now. They make sense, and they make it possible for the good people here to respond to an emergency or specific questions.

You're doing great with Martha,
Carl
 
Just an FYI all.

FF Seafood Feast is listed as 3% carbs.

Carl
 
A quick clarification...

Was your +11 the 144? If so, what time (in +numbers) is the 160? Can your schedule accommodate being off your usual shot time?
 
My schedule is flexible and can accommodate the change in shot time. 144 was PMPS and 160 was 1-1/2 hrs later, after eating 1/2 can FF.
 
I don't quite follow your test results. How long after the AM shot did you get the 144? When did you feed? When did you get the 160?
Liz
 
The 144 was 12 hours after the 251. The 144 was after 4 hours of no food. The 160 was 1-1/2 hours after the 144 and after 1/2 can FF.
 
AMPS 261 (1.0u)
Ate at +8

PMBG 144 (fed 1/2 can FF 3%)
+13.5 160

Carl

edit - SS says AMPS was 261
 
Carl, you caught my typo! Yes, the correct number is 261. This is a whole different language.
 
Don't worry about typos! I'm the king of "needs an editor" :smile:
Have you been able to get another test? Did you see Sienne's last post?

Carl
 
I have not tested again but may right before going to bed. if it's a good number, I'll go on off to bed. I am really asleep on my feet, have been for over a week now and really hope this whole household sleeps deep and beautifully tonight. Thank every one of you for your help. I deeply appreciate it and feel we are pretty much out of the woods at least for a little while now. What a learning experience!
 
OK, just to be sure.... you did not shoot any insulin tonight, correct?

Carl
 
Good. Then sleep well and let us know what's happening in the morning. :smile:

Carl
 
Whew! What a ride last night. Indecision doesn't sit too well with me. But after the lower second reading after eating, I decided to forgo the insulin. This morning it was 245, which is great (I think) after skipping a dose. Plus, it's a little lower than the other recent 200s. We all rested well last night.
 
That's great to get a good night's sleep. This FD can be nerve wracking, that's for sure. And that 245 is not too bad, considering the skipped shot.

Could you open a new condo (NEWTOPIC button) for Martha today? The subject line should be
8/18 Martha AMPS 245

Also, include a link to this condo:
viewtopic.php?f=9&t=77308

so that we can trace back to see what's been going on with Martha. Thank you and Happy Caturday!
Liz
 
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