Re: Do I take he lantus shot BG 202?
it overwhelms everyone at first, sarah. don't worry - as you understand more, it will get infinitely easier. really!
just for a little perspective, a non-diabetic cat might run anything over 40-100ish. We call 50-120 as normal numbers on insulin. If you're interested in working towards remission, newly diagnosed cats have the best chance - the most recent study says 90%+ can go into remission if you get their blood sugar into normal (50-120) numbers as quickly as possible.
There are quite a few things about insulin and diabetic cats that are counter-intuitive. One is that the lower the number you shoot, the flatter the cycle typically is. We all thought if you shoot 1u at 350 and the cat drops 200 points to 150, giving that same dose at 150 will kill the cat. But it doesn't work that way. Lantus works best when it's dealing with lower numbers. Here's a discussion on
Shooting Low, ie, shooting the full dose into normal numbers. Shooting a full dose - that you've worked up to appropriately per the protocol - into normal numbers might mean that Remi's blood sugar will only move 10 points in the entire 12 hours. It's really odd, but that's how it works.
What you want to do is to work up to that dose carefully, adjusting per the protocol, as you see his blood sugar gradually come down.
You're not ready to yet, but as you get more experience, as quickly as possible you're going to want to summon up your courage and shoot everything over 50ish, as long as Remi is eating normally and you can monitor. Anytime you shoot a number lower than you've shot before, we encourage people to get a +1 and a +2 to see where the cycle is going.
I'd really encourage you to get a timed feeder. If a cat goes into low numbers (under 50) our first tool is food - so a timed feeder is worth its weight in gold for people who have to be gone and can't monitor. Here's a recent discussion on
timed feeders. Getting one as soon as possible will let you have food dispensed over time when you have to go to work.
With feline diabetes, you're weighing risks - if Remi always stays high like he is now, you don't have to worry about a hypoglycemic event, but high blood sugar will take a toll on the rest of his organs, especially his kidneys. If you get him into normal numbers, you have to worry about hypoglycemia, but you have the possibility arise that he may go off of insulin and become diet-controlled, and keeping him under 200ish will spare his organs from the damages of high blood sugar. There's no perfect solution, but this is why so many people jump on the Tight Regulation bandwagon to try to get their cats off of insulin.
phlika29 said:
Thanks Wendy
I gave a reduced shot 50minutes late after he ate. I will make sure I get a +1 and +2 reading. But I really do feel out of my depth now. I don't know what to look out for. I had felt that it was beginning to make sense and then this reading has really confused me.
Why did he drop so low tonight?
Does it mean it's too high a dose?
What dose do I give tomorrow morning (neither me nor my partner can be at home).
How will he ever get better if I am too scared to dose the lower numbers.
Sorry I don't mean you have to answer all these questions.
Sarah
I'll take a stab at your questions. His blood sugar is dropping some because you are getting closer to a good dose. In general, people have to go up to get to the *right* dose, and when they hit the "sweet spot", the blood sugar will flatten out. On the link I gave you above about shooting low, there are several spreadsheets that show cats changing when they get to a good dose. Take a look at those and you can see the change when they get to the dose that flattens out their cat.
No, this is not too high of a dose - well, not if your goal is remission. In fact, you'll probably end up increasing the dose still if that's where you're hoping to go. Do you understand how Lantus works? When you shoot, the insulin builds up in the body and slow releases. The size of the "depot" is related to the size of the dose, so when you increase a dose, the depot will build and then it is slow releasing slightly more. When you decrease, the previous dose's larger depot can still be giving more insulin out for a few cycles. My point is that there can be a bit of a delayed reaction to dose changes, which is why we give a dose increase 6-10 cycles to see what it can do. I think you're seeing 200's now because you increased the dose yesterday, and it can take this long to see the result of an increased dose. There is a great description of
The Insulin Depot here - take a look at the link on that page that is about the difference between Lantus and Levemir - it will help you understand how the depot works.
Tomorrow morning - first some questions. Is he your only pet? If you leave food out, will he eat it all at once or will he graze and come back to it? Is tomorrow the only day you're gone all day, or is that typical?
How will he ever get better? I think educating yourself on what happens when you shoot lower numbers will help you to help him. Read through the posts I've linked and ask questions. We know how Lantus works - and for most cats it follows a very distinct pattern. You get a lot of tests in - you're going to be able to keep him safe, and once you have experience "steering" his blood sugar by giving him small amounts of carbs, you're going to feel so much more in control.
Everyone goes through this, Sarah. It is unnerving at the beginning! Hang in there and lean on us. We can help you learn how to keep him safe. :YMHUG:
he got his dose later and so I have to give it later tomorrow. How do I get it back to where it was before? 15 minute reduction each day. Or more slowly than that?