Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3 67

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Jamielvsaustin

Jamielvsaustin

Member Since 2014
I am looking for some direction on how to dose going forward after our morning scare.
Charlie did not get his insulin this morning, because he dropped down to 38 after his first testing. When that happened I gave him karo syrup, high carb treats, wet food and dry food-basically, whatever the boy would take. And he was happy to take it. The only symptom that I noticed was that his eyes were really dilated. They would shrink when I made him look towards the light (if that doesn't sound ominous, I don't know what does), but they stayed pretty wide open-he's Siamese so typically you can see a lot of blue in his eyes.

The vet prescribed 2 units twice a day. Charlie last weighed 10.2 at the vet (on the 20th of Oct). That's what we gave...while I read the suggestions here to ease him into it, I thought it better to follow my vet's advice (no hard feelings towards her, it's my belief they're kind of like a jack of all trades, master of none). Since we now know 2 units is too much and he skipped a dose this morning, where do we go from here?

I thought knocking him down to 1.5 for the next two doses, and then 1.25 for the next two would be a good idea. But I plan to do a curve on Sunday (haven't had the opportunity to do it yet)...I want his body to be as close to regulated as it can be, given the circumstances.

Recommendations?
 
Re: 10/28 Charlie amps 69(not given)+2 38+3 67+4 127+5 207+6

With that 38 you are right that you need a reduction. My vet was on the other end of the spectrum and started at the time 14 lb 10 oz Max on one unit. He came down fast and I wasn't home testing so he had a three week break before resuming on just .25u. That was NOT the way to go. Please add Dosing Advice to your first post so a dosing advisor will help you before the next insulin shot. Charlie is probably bouncing from the low of 38 but the 2 unit dose will take some time before it is not influencing the numbers. Good job catching that 38.
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Hello and welcome Jamie. Good job on testing and catching that low today. I see on your post on Health, http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=127580, that you thought his ideal weight is around 11 lbs, which is 5 kg. If you are following the Tight Regulation protocol, it recommends the following for starting dose:

Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:

the formula is 0.25 unit per kg of the cat's ideal weight

if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
Click to expand...
Using Charlie's current weight, as he is underweight, the formula works out to 1.15 units, so you could either round that down to 1U or go to 1.25U. Because Lantus is a depot insulin, it likes consistency on dosing, which means sticking the same dose for at least 6 cycles (unless he goes under 50) and re-evaluating after those 6 cycles. To be on the safe side, I'd pick 1U and stick to that for 6 cycles. However, you do need to try to get some mid cycle tests. We determine the dose of Lantus on the nadir, or how low it gets the kitty. 2 units got him too low. If you could get some random tests between +3 and +7 for the next few days, that'll help us determine how well Charlie is doing on 1 unit.
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Hi Jamie

You know I am a newbie and so have no idea re dose advice but just wanted to say I would follow Wendy's advice of 1 unit twice a day. Not just because I am sure it is a good dose but also because it is easier to measure on the syringe and when you are new to it this takes off some of the pressure of making sure you are giving the same amount each day :cool: .

The one unit will also hopefully allow his blood glucose levels to come down and begin to level off at a lower level but not drop so much that you are worried about leaving him to go for work. Again as a newbie the pressure of having to get blood glucose readings in short succession when it is still hard to do is extremely stressful.

Wendy's suggestion will allow you to work up to the right dose safely and get used to monitoring Charlie more easily at the same time. For what it's worth remi weighs 5kg and started on 0.5 unit twice a day and we have worked up to 1.25.

Best wishes

Sarah
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Hi Jamie!

I'm looking at Charlie's ss right now and seeing that 490 - don't let that freak you out. That's a normal response to Charlie getting so low this morning, combined with not getting his insulin shot. We call the body response to the low numbers a Bounce. It's described in the second post in this thread. Skipping his shot was the right thing to do in this circumstance.

I agree that 1u is a good dose for Charlie to go to now. It's far less nerve-wracking to work UP to a good dose than it is to be overdosed and trying to catch the low numbers and keep your sweet kitter safe. Lantus dosing is based predominantly upon how low a dose will cause a cat to go. So we don't increase a dose based upon high preshot numbers. It's very likely you'll see high numbers for a while, maybe even as long as a full 3 days. Don't worry if that happens, they will come down. I'd stick with the 1u for every shot until we see what Charlie goes to once the bounce clears out of his system.

And welcome to Lantus Land - the best place you never wanted to be. We'll be happy to teach you what you need to know to take care of Charlie. cat_pet_icon
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

He continued testing high all night. In fact, it was so high the glucometer only said "H". The user manual indicates that his readings are currently over 600.
The husband and I couldn't agree on what to give, so we compromised at 1.25. He gave him his dose tonight, and I had him show me on the syringe exactly where he measured to. (Our syringes have half marks).

Thanks everyone for the help. I'm sure you'll be hearing more from me.
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Ok, that's a reasonable choice, Jamie. Just stick with the 1.25u for now. Lantus does best if you don't change the dose with every shot. So plan on this dose for 6 cycles unless he goes below 50. He might stay HI for several cycles, even the full 3days.

One trick that can help is to keep an old syringe with the dose in a colored liquid like coffee or tea or food coloring. Use that as a comparison when you draw up your dose. Especially with 2 people shooting that can help make the dose consistent.

See you tomorrow! :-D
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

I am currently giving 1.25, I check my measurement by using a metal ruler and making sure the top of the plunger always sits on a certain mark on the ruler. One you start looking closely at the syringes you will see that they are not all the same! You need to try to get the dose really consistent each time. I also use a bright light and magnifier.
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Charlie cried out and tried to bite me this morning as I gave him his medicine :(

Testing didn't go so well this morning either-had to poke him 3 times. But he got a decent reading-341. I know it's high, but considering yesterday-I'm completely okay with it. And as some of you have mentioned, expect to see it like that for a bit longer.
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Bouncing after a day like you had is a relief, isn't it? It will give you time to regroup before the next good day. Don't forget to start a new thread each day, okay? It does get easier. :smile:
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Jamie, are you using the Neosporin with Pain Relief ointment? That takes the owies out of his ear. I slathered it on pretty heavily every night and then wiped it off in the morning before the first test.

Some people put it on about 20 minutes before they are going to test to give it time to numb the ear. I tried it on myself, where my cat had run across my bare foot and scratched me - the stuff is amazing at taking the owie out.

If he's mad about being handled, make sure you're giving him a food treat every single time you have to do something to him. Cats will accept this, amazingly enough. He should begin to associate you doing things to him with getting a treat.

Also, many cats will ignore the shot if you give it while he's eating. Wait til he gets started with his face in the bowl, lift up a tent and shoot as quickly as you feel you safely can.
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

If you are having trouble finding a treat that gets his attention.....
experiment.
not all cats like the freeze dried....

it could be a bite of tuna ( canned people kind) , lunch meat ( just check to make sure there is no sugar)
some cats love pastrami.

my cat's special treat is raw shrimp.... only way I could give her shots.
and if I really need her attention.... I buy her a crab leg. :o :lol: ;-)
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

julie & punkin (ga) said:
Also, many cats will ignore the shot if you give it while he's eating. Wait til he gets started with his face in the bowl, lift up a tent and shoot as quickly as you feel you safely can.
Click to expand...
This has been working very well for us. This morning I don't know if he even noticed I was touching him. No flinching...not ear flicks or tail swipes...nothing, just kept mowing down.

Rhiannon we tried freezed dried shrimp for both of the cats and they seemed so offended....maybe even grossed out a little bit. The dogs, however, love it. So it won't go to waste...but we've yet to find the "kitty crack" so to speak.

We'll keep trying.
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Another one that is actually for humans but cheaper in the lon run can be found at www,hineyville.com I've bought the freeze dried turkey and the chicken
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

You can edit the subject line that appears on the main page by going to the first post in this thread (condo) and clicking "Edit", then update the subject line so it's current.

When you got that amps of 75 yesterday morning, the first question that comes to my mind is "if he was on his way UP and got to 75, how low was he during the hours BEFORE the 75?"

For his safety, you really want to get into the routine of testing him mid-cycle every single cycle. When you're only testing preshots, you just don't know how low the dose is taking him. We know he got into the 30's on 2.0u.

What we know about diabetic cats is that if they are given the right amount of insulin, their pancreas can heal and begin putting out insulin again. Newly diagnosed cats are especially able to do this - as many as 90%+ can heal and go off of insulin in the first month if the stars align and they are lucky.

When the cat's pancreas begins putting out insulin, it's supplementing what the person is injecting, which can mean that the dose that was just right before is now too big. That sends the cat into low numbers - like the 38 you got a week ago.

If I were a betting person, I'd say that Charlie's pancreas is healing and putting out insulin, and you're going to need to be reducing the dose carefully in order to keep him safe. I don't have a crystal ball, but even with the tests you do have on his spreadsheet, that's what it looks like to me.

I can't encourage you enough to get those mid-cycle tests. It's likely he's going to need his dose adjusted again soon.
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Thanks Julie, we will take your encouragement seriously. Tonight I also didn't give him his shot. He was in the 60's...and +2 pmps he was in the 70's. I'm hopefully that you're right and his body is healing itself. And if that's the case I want to help make him as stable as possible.
 
Re: Dosing advice! 10/28 Charlie amps 69(not given) +2 38 +3

Hi Jamie,

I think I'd go ahead and reduce his dose to 1.0u. The protocol we follow has the dose reduced if a cat goes below 50. In your case, however, I'm thinking he may be going lower in between your tests. For his safety, I'd reduce and try to step up the testing. Some cats go down the dosing scale very quickly. We've had cats go off of insulin in literally a week or so.

He may be high in the morning from getting his shot skipped tonight. Even if he is, I'd still reduce the dose.

However, if he's less than 150, I think I'd consider skipping the dose again.
 
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