Am i doing this right?

[csepulveda85]

So today will be my 4th day doing home testing and insulin.... The first day i saw a big difference but since then her levels are still very high (mid 300 to high 300). I called the doctor yesterday morning to ask if i have to keep her at her 1 unit or if i have to up the dose.
They told me no leave the one unit until our one week vet appt. By dinner her levels went lower but still in the 300

This morning i freaked out and called again because it was at 450! It has never been this high...
She doesn't seem bad.. She actually seems more alert and a little more playful but the levels are scaring me.

SO the doctor told me not to look at the numbers so much for the first week because this is the "honeymoon" stage and the unit has to stay the same until our next appt Saturday. The doctor said if its bad we may have to leave her (BUT I DON'T WANT TO :sad: ) i know she wont do good there without me. Last time i had to leave her just for urine she was banging and hissing at everyone. They couldn't even get her for me.. I had to go to the back and grab her out.

Hopefully it doesn't get this bad and the doctor made me feel like its a normal thing and not to pay attention to the meter numbers to much...

My question is --- Is this normal for the first week?

 

[Sue and Oliver (GA)]

What kind of insulin are you using? Are the 300 numbers preshot numbers? Have you been able to get any numbers midcycle? The questions are because she could be going lower at midcycle and bouncing up at the preshot time. If that was the case, you would not want to increase the insulin.

While it is true that insulin may take 3-5 days to really start to work, you should be able to get a good snapshot with your numbers if you get the numbers midcycle also.

It would be very helpful for us if you would set up a spreadsheet. Then, when you have questions, we have a quick snapshot of your history of doses and numbers. Here are the directions:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 It's a little tricky; if you need help, just ask.

No, it is not necessary ( or even very helpful) for your kitty to spend a day at the vet. Particularly as she sounds very stressed there, her numbers will likely be inflated. Then doses based on those numbers could be too high once she is home. Much better to do a curve (every 2-3 hours during one cycle) at home and send the vet the results. You just have to be her advocate and tell the vet that she is too stressed there and you will be doing the curve at home and sending the results to him. If he insists, it is time to look for a new vet. Always remember you are the customer; you get to call the shots.

 

[csepulveda85]

What kind of insulin are you using? Are the 300 numbers preshot numbers? Have you been able to get any numbers midcycle?

The insulin is Lantas and the number are preshot ... I haven't tried Midcycle, but i will today. The first day i took the reading an hour and a half before what i have been doing now and it was at 277, which was a good drop for me .. But when i get the reading now for the past three days at 930pm its at mid 300.

i will try to make a spread sheet ... Right now i have just been writing down the daily numbers in a journal type of notebook

I will try to do a midcycle number today around 4pm and see what her numbers are..

I know they are going to up the dosage but they said for the first week it has to stay at 1 unit until the vet sees her again.

 

[Sue and Oliver (GA)]

Here's some info on Lantus:

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive 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 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive 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 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive 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.

Note that the recommendation is to raise the dose based on midcycle numbers, not on preshot numbers. Glad you are getting some today.

There is lots more info on using Lantus on the Lantus support group forum: http://www.felinediabetes.com/FDMB/viewforum.php?f=9 See the starred topics at the top of the page.

 

[Elizabeth and Bertie]

Hello,

You've had some great advice here, but I just wanted to say what a great job you're doing! Well done!

Numbers CAN be high or even all over the place initially. But gathering data will help you to understand what's going on.

We all know that it's not easy at first but please know that you have the 100% support of this FDMB community. :smile:

Eliz in UK

PS. I don't think many people here know your name or your cat's name. Can you tell us again...?

 

[csepulveda85]

We all know that it's not easy at first but please know that you have the 100% support of this FDMB community. :smile:

Thanks... Its been great here with all the help...

I did a midday reading and shes down to 300! Which is a great drop from 450.... could it be that around the time i give insulin that shes at her high points?

 

[KPassa]

I did a midday reading and shes down to 300! Which is a great drop from 450.... could it be that around the time i give insulin that shes at her high points?

Not sure who originally posted it or if it's saved on a sticky somewhere, but check out this ever-so-helpful post that lets you know what to generally expect in regard to highs and lows:

Insulin has a timeline, and typically what you will see with Lantus is a curve that looks something like this:
Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

Someone may need to clarify, but I've seen it mentioned that Nadir (the +6 above) can vary from cat to cat anywhere from +5 to +7 depending on the way they metabolize the insulin.