Dose Reduction? Advice Please

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Wulfwin

Wulfwin

Member Since 2010
Hi all,

I need some advice on whether or not to decrease my kitty Jason's insulin tonight, and by how much if I should. His lowest nadir from 11/12 to 11/14 was 192, but he was usually in the low 200s. Yesterday and today his BG has dropped down to 52 and 46, respectively. I'm not sure how much of yesterday was due to the fact that he threw up all morning, so had little to no food in his system after the shot (he started throwing up about 1 hour after the AM shot - I think something was wrong with the canned food I fed him that morning). I didn't even give him any insulin last night because his PMPS was only 65. His nadir today was 46, and I actually gave him some high carb treats to boost his BG.

Jason's currently on 1 unit BID Lantus (he was dropped from 1.5 units BID on 11/11/10). Any advice on how much I should give him tonight?

Thanks!
 
If his glucose is less than 150 and he's not eating, I wouldn't shoot ... not unless you like testing every 15 minutes, pulling out the high carb foods and karo syrup, and losing sleep.

If his glucose goes up AND he is eating again, the experts (I'm not) may suggest a reduced dose.
 
sorry Jason hasn't been feeling well. Question - have you been able to test for ketones yesterday or today? Does he have any history of ketones?
 
Two thoughts - maybe the infection is clearing so Jason doesn't need as much insulin. And could the Clavamox be upsetting his tummy? Can you give some Pepcid if that's the case. No dose advice, but welcome to Lantus Land (LL).
 
As a newbie, I was advised not to shoot PS numbers below 170... I would usually wait and continue to to test and then shoot once we reached a shootable number. If the PS was between 170 and 200-ish, I would generally make a slight reduction in dose. Please note I am not one of the experts here, but was advised by one and that directive worked well with my cat's progress. Hope your kitty is feeling better tonight.
 
have you reviewed the stickies in this forum, and the Dosing Protocols linked in one of the stickies?

I think Jason is one of those cats who is racing down the dosing scale. We just have to keep up, or preferably stay a step ahead of him. :mrgreen:

The 46 today earned him a dose reduction. Normally the next dose would be 0.75 units BID, but since this 46 came right after a skipped shot last night, I am comfortable suggesting 0.5 units BID as his next dose. What do you think? That dose should allow you to get numbers that you are comfortable shooting every 12 hours.

The reason I asked about ketone testing is that *if* Jason has ketones or if he has a history of them, then it would not be advisable to reduce by that much when he is feeling under the weather. On a quick scan of your spreadsheet, I don't see mention of ketones when he was diagnosed. Are you testing regularly for ketones?

FYI, in the Lantus group, we don't set a "no-shoot" number for most cats. Usually with newbies, we will suggest that they can easily shoot anything over 150 or 180, depending on the cat. Lower than that, we encourage you to post for advice and someone here can walk you through the decision-making process for your situation. Normally it is better to stall a little bit and then shoot full dose rather than to shoot a reduced dose. Each situation is different, though, and there is almost always someone here to help.
 
At +11, his BG is sitting at 173. I have another 20 minutes or so until PMPS time.

Libby and Lucy said:
have you reviewed the stickies in this forum, and the Dosing Protocols linked in one of the stickies?
Click to expand...

I have reviewed them the last few days, I'm just pretty nervous since his numbers have been so different over the last week, and the drop to 46 especially makes me nervous.

Libby and Lucy said:
The 46 today earned him a dose reduction. Normally the next dose would be 0.75 units BID, but since this 46 came right after a skipped shot last night, I am comfortable suggesting 0.5 units BID as his next dose. What do you think? That dose should allow you to get numbers that you are comfortable shooting every 12 hours.
Click to expand...

I should be able to stay up and test him for at least 3 or 4 hours post shot, later if he drops low. I feel ok with trying 0.5 unit BID.

Libby and Lucy said:
The reason I asked about ketone testing is that *if* Jason has ketones or if he has a history of them, then it would not be advisable to reduce by that much when he is feeling under the weather. On a quick scan of your spreadsheet, I don't see mention of ketones when he was diagnosed. Are you testing regularly for ketones?
Click to expand...

No history of ketones, and I have not been able to test for them yesterday or today. I did worry if that was the problem yesterday, but he was showing no other symptoms of DKA, and he started to eat again with no more throwing up around +6 post AM shot yesterday. I admit that I haven't figured out how to do the testing for ketones. I have to use covered litter boxes due to his diarrhea, so I can't reach in while he's urinating. Is it ok to dip the stick in the litter after he's gone? A urinalysis was done when he was diagnosed on 10/13 which showed no ketones. I should be able to test for them on Saturday (possibly every Saturday) as that's the day he goes to the shelter vet clinic with me and the vet can draw the urine from the bladder.

BJM said:
If his glucose is less than 150 and he's not eating, I wouldn't shoot ... not unless you like testing every 15 minutes, pulling out the high carb foods and karo syrup, and losing sleep.

If his glucose goes up AND he is eating again, the experts (I'm not) may suggest a reduced dose.
Click to expand...

He is eating, though not quite as much as he normally does.

Ele & Blackie said:
Two thoughts - maybe the infection is clearing so Jason doesn't need as much insulin. And could the Clavamox be upsetting his tummy? Can you give some Pepcid if that's the case. No dose advice, but welcome to Lantus Land (LL).
Click to expand...

I'm pretty sure the Clavamox is giving him diarrhea (which he's on probiotic powder for), but he hasn't had the throwing up issue except for yesterday morning, so I'm thinking that it was a reaction to the morning canned food (either he's sensitive to turkey or something was wrong with that particular can). He seems to be feeling well today - no throwing up, and his energy level has been quite high.
 
It looks like Jason is serious about having his dose lowered.

Where is Jason with regard to how much longer he will be on the Clavamox? Like Ele noted, his insulin needs may be dropping as the infection you've been treating him for is clearing. That's wonderful on both counts! I wouldn't suggest the Pepsid unless you clear that with your vet and if the vomiting has stopped, there's probably no need. Thanks for clarifying.

Also, it's not necessary to have a cytocentesis (needle draw for urine) to test for ketones. You can test out of the litter provided you first test a bit of clean litter mixed with water for ketones. If it comes up negative, then you can test ketones from a bit of litter that Jason has anointed. Were you worried about DKA because of the low numbers? Generally, DKA happens when numbers are high, there's not enough insulin, and an infection is present.

Just to add to what Libby said, with Lantus, the dose isn't generally adjusted based on the pre-shot number. Dose adjustments are based on the nadir. I'm not quite sure who advised SaraJaye in this manner, but that information is not consistent with the protocol that's used here.
 
PMPS is 179, so I'm going to go ahead and try a 0.5 unit dose.

Sienne and Gabby said:
It looks like Jason is serious about having his dose lowered.

Where is Jason with regard to how much longer he will be on the Clavamox? Like Ele noted, his insulin needs may be dropping as the infection you've been treating him for is clearing. That's wonderful on both counts! I wouldn't suggest the Pepsid unless you clear that with your vet and if the vomiting has stopped, there's probably no need. Thanks for clarifying.
Click to expand...

The vet wants to do a full 3 weeks on the current dose of clavamox. It was upped to 1.4ml on 11/3 based on a culture and sensitivity we ran (he was on 1 ml BID for about a week prior to that). So 11/24 will be his last day. We plan to run blood work on him again about a week after finishing the antibiotic.

Sienne and Gabby said:
Also, it's not necessary to have a cytocentesis (needle draw for urine) to test for ketones. You can test out of the litter provided you first test a bit of clean litter mixed with water for ketones. If it comes up negative, then you can test ketones from a bit of litter that Jason has anointed. Were you worried about DKA because of the low numbers? Generally, DKA happens when numbers are high, there's not enough insulin, and an infection is present.
Click to expand...

Thanks for clarifying about the ketone testing! The info I read in the faqs just mentioned sticking the ketostix under him while he was going or trying to catch some. They mentioned not wanting to test old urine, but I wasn't sure if that meant you shouldn't test in the litter. I'll have to try that next time I catch him going. I was only concerned about DKA because of the vomiting and he hadn't been tested recently for ketones. He hasn't had vomiting like that before, so I wasn't sure what was going on.

Sienne and Gabby said:
Just to add to what Libby said, with Lantus, the dose isn't generally adjusted based on the pre-shot number. Dose adjustments are based on the nadir. I'm not quite sure who advised SaraJaye in this manner, but that information is not consistent with the protocol that's used here.
Click to expand...

Now that I understand better how Lantus work from reading this board, that makes sense.
 
Evening Sarah - lots of us have tested for ketones by laying some saran wrap over his litter, "sticking" to the sides, so that he squats over it and the urine pools on top of the saran wrap and you can dip your ketostix in that pool. I have NEVEr had any luck trying to catch Shadow mid-stream and she is so modest, that she goes streaking out of the kitty box if anyone ever walks into the laundry room while she's "doing her business." hope this helps the next time you have to test.
 
Hi Sarah no dose advice here. I do have a trick that could help with you're getting urine to test. Over the years I have had cats (not ill) that never urinated anywhere out of the litter box but if got locked out of LB area would use a bean bag chair, office chair of the vinyl-leather type etc. So I take a clear plastic bag and put it in the box. Don't know if a solid bag would work, figured it might help to see the litter. If he's not an overzealous hole digger he might go in it. My cat doesn't dig when he urinates so I just cover the whole thing with it still in layers after flattening out the litter. You only need a couple of drops but I usually get the whole urination. Hope this helps. BTW You have wonderful tests going on congratulations :mrgreen:
 
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