Changed Subject: High Number 454 Right Now. What To Do? Help

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ToddyTiger

ToddyTiger

Member Since 2010
So, Todd has a follow up appointment with our regular vet tomorrow. They're gonna check his blood pressure, do a blood panel (to check kidney values) and check his urine. They will probably keep him for the afternoon.

But here is my question... Does Todd need a higher does of Lantus? I will be talking with our vet about this tomorrow.

When Todd saw a specialist two weeks ago, they did a fructosamine test. When it came back, I was told that his BG levels were in the 200's and I shouldn't up his insulin at this time. But when I think about it, that is rather high, isn't it?... He currently receives 1.5 units of Lantus twice a day. I've been checking his BG at home, usually in the evening before giving his last shot of the day. It's been roughly 290 to mid 300's for the last week. I really feel we should up it to 2 units and see how he does. The specialist really felt that we didn't need to, but since we are seeing our regular vet tomorrow, I think I should bring this up with her and see what she thinks.

Tell me, what do you all think?
 
Re: Lantus: Need Some Advice on BG Numbers and Current Dose

i did'nt see a spread sheet. do you have any mid cycle numbers to see how this dose is working?
 
Re: Lantus: Need Some Advice on BG Numbers and Current Dose

I'm afraid I don't have an online spread sheet. I have a notebook that I keep his BG numbers in when I take them. I've only been doing home testing for about a month and a half. So I don't have a lot on info to go on.
 
BG 454 Right Now!!

Ok, so I just checked his BG and it's 454 at 11:40pm. I gave him 1.5 units of Lantus around 9:30ish pm.. Maybe I'm freaking out for no reason, but I've never seen it go this high before.

Is he ok?... should I be worried right now? he has an appointment at 8am tomorrow morning for a follow up. Should he be ok until morning? I've seen him go to the water dish several times within the last two hours. He's been tired all day, and seems just as tired right now.

Anyone?.. help?

**I called the 24 hour vet hospital and they told me that he will probably be fine until his appointment tomorrow, as long as he is still drinking water. They said I could check his BG again in a couple of hours. If it's still high, I should bring him in. But the tech I spoke with said that since he is on Lantus, I may not have given it enough time to bring down his BG and that it may have even been higher than 454 all day. That might explain why he was tired off and on all day. But now I feel bad for not doing anything sooner. :(

I hope he will be ok until morning..
 
Re: Changed Subject: High Number 454 Right Now. What To Do?

the lantus should be kicking in about now and the number should go down from this point. you certainly cannot shoot more insulin tonight. it is possible that he got what is called a furshot tonight but there is no way to know for certain and shooting more insulin so soon could be dangerous.

if you could get those numbers online somewhere then people could look at them and see if the dose seems to be too low or not. can you work on either a spreadsheet or type at least a couple weeks worth of them on here?

fwiw, a fructosamine number in the 200's isn't bad actually. a fructosamine number is not a direct comparison to a bg number attained at any given moment. fructosamine's convert to a bg number. here's the chart http://www.sugarcats.com/infirmary/fructosamine.asp

if you have only been testing before the evening shot and/or don't have morning and mid-cycle numbers to analyze, it is even possible though that the 1.5 u could be too high. without enough data, it could be impossible to say at this point.
 
Re: Changed Subject: High Number 454 Right Now. What To Do?

next time can you check to see what his number is 3 and 5 hrs after the shot? that may tell us how low he goes and whether he needs a dose increase.
suspect he might have an infection so when he goes to the vet make sure they get his urine via cystocentesis and run a culture & sensitivity test on it to see if he does have an infection. you should get a preliminary call in about 24 hrs if they've spotted infection. full results would be in about 72 hrs.
get blood and urine test, okay?

if his numbers stay mostly flat or don't go anywhere below 300, you can increase dose by 0.5u and hold that dose for 6 shots, okay (unless he goes down to the 40s in which case decrease by 0.25u)?

guessing you've already looked at the stickies on the lantus forum. if you haven't please read them as soon as possible and look at the tilly protocol most of us use there.
 
Re: Changed Subject: High Number 454 Right Now. What To Do?

Please do not react to one high number. The only time you react to a specific number is if it is LOW. You need to look at trends, and how he is at preshot time and how he is at his nadir, and make decisions from there.

Jen
 
Re: Changed Subject: High Number 454 Right Now. What To Do?

good morning. i have to agree with cindy, if you could get a series of numbers for us to look at..say the last weeks collection, and then if you could add some +2 +4 +6 +8 to it as soon as you can.
you say you test at the end of the day..
you have to test BEFORE each shot and preferably at least an hour, better two since feeding for you am and pm shots.
please do not panic.
sounds like your just beginning to learn.
hang out here on the board every day and tell us the numbers...we'll get you straight ok.
but the board should become your 2nd home for the next few weeks.
breath ok,
lori
 
Re: Changed Subject: High Number 454 Right Now. What To Do?

With a spreadsheet, you are going to see the entire picture.
See below:
Example of a typical 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.

If you look at Shadoe's and Oliver's sheets, links in my signature, you will see that they are both very different in how they react to insulin.
Shadoe's nadir is closer to +5 or so, but Oliver's is closer to +10.
It's no big deal for Oliver's numbers to go up up up till +5 or so and then come down down down just before his next shot! The guy's got it all upside down!
Shadoe on the other hand, can start dipping low by +2, if she feels like being sneaky, so I test her earlier.

Those tests in the middle of the cycles are going to provide you with a wealth of knowledge.
Toddy could be like Ollie and just be slower at reacting to his shots so it looks like he is going high.

If possible, putting some of your numbers into a spreadsheet will allow the others to give you much more feedback and input that relates to Toddy's numbers.

One high number could be due to Toddy going really low and bouncing high, so maybe he needs less insulin, OR, it could be that he is just staying high and needs more insulin!

The answer will be found when you uncover the numbers in the middle!
 
Re: Changed Subject: High Number 454 Right Now. What To Do?

wonderfully put gayle!
 
Re: Changed Subject: High Number 454 Right Now. What To Do?

Thank you Gayle. I will try to make Toddy a spreadsheet. I think I'll need some help with it, as I am NOT good at doing things like spreadsheets.

he seemed better this morning. He ate a bit and was purring while doing so. I'm actually thinking the 1mg of cyproheptadine I gave him yesterday is what did it. He was tired all day, was drinking tons and seemed off. When I took him to the vet this morning, she did a full blood panel (including another fructosamine) and urine test. They should be back either tonight or tomorrow. His blood pressure was normal (thank goodness!). So she said to stop giving the Cypro and try the Mirtazapine again. When we got home I gave him some food, his shot and the mirtazapine. He perked up within 20 minutes. Was chatty and wanted love and food. Was purring up a storm. Now though, he is resting in his kitty bed, but he seems tired again. Just kinda sitting there spaced a little. And he is still drinking a lot of water this morning. I completely forgot to check his BG before giving his shot. I remembered about an hour and a half after. So I did check it. It was 331 at 11:42am AFTER Lantus. I will check again in a few hours and then again tonight, so I can get kind of an idea of what is happening. Because I mentioned to the vet that I thought he miiiight need a higher dose of insulin, but of course, we need more info first.

Thank you for the help everyone! I'm sorry for the freak out, but I had just never seen his numbers that high. I was very, very worried and very, very tired.
 
Re: Changed Subject: High Number 454 Right Now. What To Do?

he's been on 1.5 long enough, so if you check a few midpoints and he doesn't go below 300 you can raise it to 2u.
if you check a few midpoints and he doesn't go below 200 you can raise it to 1.75u.
stick with that new dose for at least 3 days, unless he goes below 40, whereupon you reduce the dose by 0.25. (for some cats i'd recommend just shaving the dose by a little then, but with a bunch of high numbers and then a big low i'd recommend a 0.25u reduction.)
 
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