Different nadir times for Glargine?

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monty_dweezil (GA)

monty_dweezil (GA)

Member Since 2014
So, I've been reading a bit around the place, and am wondering if anyone has any info or advice or experience on this.

My Dweezil is on Glargine, 1 unit every 12 hours. If we were ABLE to get a blood glucose reading, we would be expecting his highest number to be just before his Glargine and his lowest number to be around 6 hours later. This is mostly what I've heard and it makes sense. Our vet also said the same thing.

However, now I've read that because Glargine is long acting, and has a kind of overlapping effect between doses, that the nadir is actually around 14 hours after the first dose.

This confuses me somewhat. I understand it in theory, as 2 hours after the second dose there would be the overlap effect so the most Glargine in the body, but I am still confused.

So...say you test prior to the morning dose...which is 12 hours since the previous dose. So instead of expecting to see a high number, would you then see a fairly low number that would then continue to go down once you give that next dose? And then if you tested 2 hours later (so a total of 14 hours after the first dose), would THAT be the lowest number of the day? So what happens after 6 hours? Nothing?

Help! lol
 
+14 us about when the +2 food spike may hit.
I wouldn't obsess about it; just test between +5 to +7 hours post shot, changing up the times throughout the week, so you can narrow in on when your cat hits the nadir.
 
ECID Every Cat is Different

Duration, overlap, carryover can all be different in your cat than the averages. Averages are just that, an average.

Wink was one of those cats that walked to a different drummer. His nadir or low was more around the +3 to +4 hour timeframe after his shot. That showed me he was getting a longer than average duration and his shots were overlapping a bit. It took some testing at different times to determine what was happening with him. The main impact was when I did the testing. Since lantus (glargine) dose changes are based on the nadirs (lows), I knew I needed to test earlier than a lot of people who's cats had their nadir around the +5 to +7 hour time frame.

Conversely, some cats have their nadir later than average. You simply learn to test later to catch those nadirs so you can determine dose adjustments.

Since you are using Lantus (aka Glargine) there are some good Stickies over in the Insulin Support Group for Lantus/Levimir, like this one on the Insulin Depot.

Carryover

Overlap
 
For a while remi dropped hard in the first hour and then would level out for the rest of the cycle. It was unclear as to whether it was overlap or carry over but in the end it just seemed like the lantus dropped his blood glucose quite fast. The suggestion over on the lantus sub forum was to test at +2 or even +1 (along with a +5 or +6) and this can tell you where your cat is heading in the cycle. The more data you collect over time you can begin to see patterns and understand a little of how lantus works for your kitty and you can also begin to steer a low number with food before it gets to the nadir.

Has anyone mentioned setting up a spreadsheet to record your blood glucose readings. It is really helpful to monitor the overall trend or your cat and allows members to make suggestions re dosing, feeding, testing.
http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/
 
Yes, i've actually got a spreadsheet ready to go, but the issue with us is we are yet to successfully test Dweezil's BG at all.

He went psychotic at the vet after just one test at his day at the vet for his glucose curve so they could not continue. Each time we try testing him, no blood comes from his ear at all and he hates it and must be firmly restrained. Either way, his readings would be higher due to stress, although at least it'd be something.

I can't even imagine testing his ear every few hours!!! After we've poked his ear several times, we can't try again for a few days until he's "forgotten" enough to even let us anywhere near his ears!
 
Are you giving him treats during testing? Many of us have found that some sort of pure meat protein works great to tempt our kitties and gain their cooperation for testing. My cats will do just about anything for some rotisserie chicken from my local grocery store. Freeze dried chicken, freeze dried liver or salmon are also favorites. Come to think of it, just about anything I'm having for dinner has to be investigated and taste tested. Tuna, a tiny bit of cheese, beef, pork, lamb or any other meat your kitty loves might help you during testing.

Another idea is to break the testing process down into little steps, introducing more steps each time.
  1. pick a place for testing where you cat is comfortable.
  2. take your cat to their test spot, give a little treat.
  3. warm up their ears, give a little treat.
  4. talk to them and let them know you are helping them, give a little treat.
  5. place your finger on their ear like you were going to poke them, give a treat.
  6. put the lancet pen on the ear but don't press it, give a treat
  7. do the actual poke, give a treat.
  8. bring the meter close to the ear, give a treat,
  9. touch the meter to the ear, give a treat.
  10. touch the actual test strip to the ear to sip up the blood with the blood strip, give a treat.
Practice the steps a dozen times a day or more if you can, adding steps as you go.

Eventually, you should get the cat to come running when you say "Time for a test" because your kitty thinks you're saying "Time for a treat".
 
Saoirse is another cat that had early nadirs on Lantus (as early as +2, avg +3-4, or as late as +12). I think she metabolises insulin quite fast. She was fairly early on Caninsulin, too.
 
Oh yes, Dweezil gets SO MANY liver treats!! The problem we have is there is just no blood coming out at all from his little ears (and they are very warm). And he is very sensitive to begin with so after a few tries, he is NOT happy (though he'll still eat the treats, heheh).
 
Don't try any more than three times in one go. Too stressful for you both. You can get a medication that numbs the ear in the US but am not sure what it is called and whether you can get it over in Australia.

Someone will know what I mean. :)
 
Have you tried lancets slightly bigger? They are the ones for alternative sites and are usually around 25 or 26gauge. I am probably the only one that uses 25g needles which is what my vet likes. I have lancets but bought 10 boxes of terumo needles which are super sharp. Whatever you use it will get easier.

Max can nadir anywhere between +3-7.
 
When I first started I ended up using the end of a needle. That certainly got the blood flowing! I felt bad but better then poking away again and again. You will get the hang of it.
 
Oh my goodness, i just tried poking myself on the tip of my thumb with the freehand lancet and i actually gasped from the pain!! Got some good blood too.

Now if only it'd work with Sir Dweezil!!!
 
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