? Advice on Frankie's spreadsheet please

[Sue484]

Morning. Can someone with an experienced eye look over Frankie's spreadsheet and tell me how you think he is doing? Is he still bouncing? Is he doing better on 4 units than 5? Or worse? Do you anticipate he will need an increase over the weekend, or do you think this a failed reduction? Sorry for so many questions. I feel like a newbie again!! The only reason I am panicking about this is because of his severe neuropathy which is getting worse despite Zobaline.

 

[BJM]

Have you ruled out low potassium levels? These can happen in unregulated diabetics. Low levels can be fatal.

Also, if you read over the 2 Lantus protocols, they provide guidance for dose adjustments.
Tight Regulation
Start Low, Go Slow

 

[Sue484]

Yes potassium levels were checked just over a week ago and were fine. So do you think he needs an increase or is this a failed reduction?

 

[Elizabeth and Bertie]

(((Sue)))

It must be so hard for you to see Frankie like this.
But what the past few days have shown is that he can respond to the insulin. We just need to try to find out how to have him do that more often...
The experienced Lantus folks will help you with advice on dosing.

No advice here, other than that you take care of yourself as well as Frankie. And remember to breathe....deeply..... It may seem like a cliche but it really will help you to feel better.

“Sometimes the most important thing in a whole day is the rest we take between two deep breaths.”
(Etty Hillesum)
.

 

[Sue484]

I have posted on the Lantus forum with a few questions but no real answers to them yet.

 

[Elizabeth and Bertie]

I have posted on the Lantus forum with a few questions but no real answers to them yet.

Most Lantus folks are in the US, and therefore tend to be online later in the day and into the night (from the UK perspective ).

If your questions seem to be getting missed though then do post again, and shout louder.
.

 

[BJM]

You have been changing the dose in mostly full unit increments. We change the dose by quarter or half unit increments (eyeball the quarter unit ones).
So when you reduced after the test of 77 mg/dL, you did it by a full unit. Following Start Low, Go Slow, a glucose below 90 mg/dL triggers a reduction of 0.25, so you should have dropped to 1.75, not to 4.0 units.

 

[Sue484]

So are you saying he is on too much now? He should be on 1.75 units? I actually dropped it by 2.5 units after the low 77 figure as I was scared at how low it was. I dosed 4 units the next day after asking for advice on here. I was advised to do 3 or 4 units after the 77.

Most Lantus folks are in the US, and therefore tend to be online later in the day and into the night (from the UK perspective ).

Of course, I was forgetting that.

 

[Sue484]

I wish the US would hurry up and wake up!! I'm starting to get seriously stressed here!! Am I giving Frankie too much or too little? I thought I knew what I was doing until I joined this forum. Now it's as clear as mud......

 

[Sienne and Gabby (GA)]

Sue:

I have a couple of thoughts. BJ is correct in that regardless of whether you're following TR or SLGS, dose changes are made in no more than 0.5u increments (with TR) and with SLGS, the changes are made in 0.25u increments. I'm guessing you got nervous with the pre-shot of 108 and gave a temporarily reduced dose. With TR, you hold the dose for 3 days; with SLGS, dose increases are made after a week. Given that you're able to get some spot checks, you can use either method providing Frankie is on a low carb, canned food diet.

One thing to keep in mind with Lantus is that it is a depot-type of insulin. Any change in dose has an effect on the depot. Think of it like throwing a rock into a still pool of water. There's a ripple effect. You need to give the dose up to 3 days/6 cycles to stabilize. So, any time you change the dose and especially if you make changes too quickly, the depot reacts and you can end up with wonky numbers. I don't know if this is a failed reduction, not enough insulin, or a depot that's still reacting to the back-to-back changes. I think we need to see what's happening at least during the PM cycle in order to figure this out.

Do you know which approach to dosing you want to follow? That will make a difference in when you can increase and potentially but the size of the dose increase. There's information about both Tight Regulation (TR) and SLGS in the sticky notes at the top of the board.

 

[Sue484]

I only decided to try Tight Regulation today. Before, the doses going up were by my vet. I only went back up to 5 as I thought it was a failed reduction. My gut is telling me he needs 5 units.

 

[Sue484]

So after tonight we should know what to do? I will assume it is a failed reduction if still no decent numbers.

 

[manxcat419]

If I remember right, the reduction to 4 was to make sure that switching completely to wet food didn't take him too low? Now he's transitioned over to all wet, it looks as though he might need to go back up in dosing as the food hasn't had too big of an effect.

On Tight Regulation, he was close to earning a reduction (below 68 on Alphatrak would be a 0.25 unit reduction) but he just missed it by a few points. Based on that and the fact that the change in food doesn't appear to have affected his numbers very much, it looks as though you could go back to 5 and see what happens with that, though you might need to be ready to start with 0.25 unit reductions if he has a strong reaction to taking the dose back up (he was really, really close to earning a reduction on TR on the 3rd)!

 

[Sue484]

Thanks @manxcat419 . Yes you were right about transitioning him to wet food. Thanks for explaining it to me and not just posting hyperlinks!!! That is basically what I was thinking anyway. I will have to start tomorrow now as he has had his dose tonight.

 

[manxcat419]

No problem - I was just hoping I'd remembered the details right and wasn't confusing Frankie with anyone else! I used to prefer increasing in the morning anyway - it makes it much easier to monitor the first cycle on the higher dose. All other things being equal, I would expect the increase back to 5 units to make a decent difference to his numbers once his depot fills as that was the dose that got him into good numbers before.

 

[Wendy&Neko]

Sorry, but I'm going to add some links for you. The first is your previous thread on this forum. We like to have continuity so that those giving suggestions can see what was recommended previously.

I had asked about syringes on your last post when you had asked about getting smaller doses. There are pictures on the New to the Group Sticky Note that show you how to get those in between doses for when you get to those .25U changes. I presume since you are in England that you are using the BD UltraFine syringes? There are a couple of additional ways to measure besides eyeballing. On the bottom of the Tight Regulation Protocol Sticky is a document called Management of Diabetic Cats. On the page marked 255 of that document there is a description of how to measure small doses, as well as a link to a document that can be used as a paper ruler - only for the BD syringes. Yet another alternative (final link I promise), is that some people use digital calipers to measure the dose. Here is a link describing how to dose with calipers.

Good luck with the increase - I hope it brings back those nicer numbers again.

 

[Sue484]

Thanks. I have fed him some HiLife tonight. Meant to be zero carbs and he has come down a tad for the +2 reading. Fingers crossed for even better tomorrow.

 

[Sue484]

Just saw your other post. Sorry. You've got a good memory to remember Frankie out of all the cats that are posted about here. I won't be able to test at all tomorrow morning, just the sitter coming in at about +6 hours. Nighttime I will get the better results I hope (unless I fall asleep!). Must remember to set my alarm.

Thanks for the links. At least I got a bit of background to them, so thanks. I'm not sure what syringes I have. I must check the packaging in the morning!!

 

[julie & punkin (ga)]

I posted this afternoon in your post on Main Health. Sorry for the confusion. I hadn't seen your post here.

Elizabeth's right - for us on the west coast, your morning post today was at 3:39am!

 

[Sue484]

I presume since you are in England that you are using the BD UltraFine syringes?

Yes, you were spot on with the syringes. I will have to learn how to do 0.25 increases/decreases now.

Elizabeth's right - for us on the west coast, your morning post today was at 3:39am!

Oops, sorry. Panic over now, so you can all sleep soundly without me having another meltdown!

Good luck with the increase - I hope it brings back those nicer numbers again.

So do I. Keep your fingers crossed.

 

[Tina & Sammy]

Hi Sue,

I know you transitioned Frankie to wet food, but I can't remember if you mentioned the carb % you are feeding him. All wet food is not the same and you need to make sure that you are feeding a low carb wet food. You probably are, but I just wanted to make sure you were aware of this. When Sammy was first transitioned from dry food to wet food we fed food that was between 7-9% carbs, but now we are finding that he does better on 4-5% carb food. Hope that helps.

Sorry I can't be more help with the dosing.

 

[Sue484]

Hi @Tina & Sammy. I used the UK low carb food spreadsheet to get a selection of different foods for him. He is currently on Felix Meaty Loaf 4.9% and Hi Life 0%. He obviously does better on the Hi Life!! I know what I am going to do with his dosing now, so panic over, but thanks for the help.