Dosing advice Julius has been from 158 to low of 40 now 302

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Kitties Momma

Kitties Momma

Member Since 2011
Hello All, let me preface this with 2 things:
-I have not been able to successfully use the template and I have already posted to the tech support forum about it
-I also posted on the regular forum.
If you are going to say either of these things to me please don't bother, I have been told this ad nauseum, what I am hoping for is feedback from you all about what you have done re: dose etc after this sort of incident.
Here is today's readings
6:56am 158
fed and gave .5u per my vets instructions last weekend
9:30am 58
12:56pm 40
called vet, fed him and gave him honey
1:29pm 67
1:59pm 94
2:29pm 109
4:18pm 144
Julius seemed very tired and not himself earlier. He still seems tired now. I am not going to give him insulin tonite regardless because I don't think its a good idea. My vet said to not give him any unless he goes over 200. I am going to continue testing him until I go to bed and in the AM test him and call the vet for advice on dose.
thanks for the input, it totally freaked me out!
 
Re: Julius went down to 40 today

Hi Julius's mom

I tried posting last night but the post blew. Marjorie got a ss going for you and it looked good.
Were you able to get the link from her?
 
Re: Julius went down to 40 today

Hi, Julius' mom!

Won't tell you to do either of those things, but will ask you to share your name so I can give you a proper hello and welcome! :-D

If you look at the stickies, you can see the dosing protocol that many of us here follow. That 40 today would earn Julius an automatic .25 to .5 unit reduction, or at the very least, a shave off the current .5u dose. I'm assuming because you're dosing .5u now, that your syringes have half unit markings on them? If not, you'll want to pick up some. The Relion syringes have them and can be obtained at Walmart, those several folks here use other brands found online through Hocks, American Diabetes Wholesale, Amazon, etc.

A .25u dose would be half-way between the zero line and the .5u line.

Others will be along with advice as well. A few more questions for you... When did you start insulin, and has Julius been on this dose that whole time? What are you currently feeding him? Have you been on a strict 12 hour dosing schedule? Do you have BG#s from any other days? Answers to these will help fill in the picture of Julius' experience thus far on lantus and will help us provide more detailed advice to you.

Welcome to Lantus Land! Please continue to post as you have questions!!
 
Re: Julius went down to 40 today

Julius's mom: please look at your condo from yesterday. Randi is right; I did a SS for you. I asked that you PM me your gmail address so I can establish you as the owner of the SS; even without that, you should be able to access it although I'm not sure how much editing you can do....so I need your gmail address to get it to you as the owner. Please...then we can be of much more help. Thank you so much!
 
Re: Julius went down to 40 today

hi there

sorry I have no input, but just wanted to welcome you to Lantus Land.
hope your evening goes smoothly. :-D
 
Re: Julius went down to 40 today

Hello all!! I got my template filled out! thank goodness! I know you need to see it to help me!!! The first couple days ? are because he was at the vet and I don't know, the rest is because I was not testing him between when I got home from work and his PM dose. I make no excuse it is not cool whatsoever. Julius has been on insulin for almost a month (since 2/15/11) he is on a raw diet which he loves, which is chicken thighs, canned salmon, canned tuna, canned sardines, beef, I add supplements and just made my first homemade raw food the other day. I am going to add the supplements to that until my father in law gets the meat grinder he ordered, then I am going to follow the recipe I found on here Dr. Laura right?? I did the meat/liver/egg and water but I didn't want to skip over the bone portion of the recipe so decided to add the supplement till I can grind my own meat. I also have a cat with food allergies and this diet has cleared that all up too! one less thing to worry about! I am very concerned about giving him his PM dose.... my vet said not to give him anything if he is under 200, but I know that is high, but I don't want him to go in the toilet over nite either! It seems to me he is very sensitive to the insulin and he does not bump much after he eats... 10-15 points tops..... so I can't count on that to save him either. Today I gave him a little honey and some food at 1pm because he was so low and I could tell he didn't feel well. I also gave him a little food before I left to go to work at 9:30am after his 58 reading... he had never been that low! What do you think I should do tonite and in the AM? he seems tired and in general I am leaning towards skipping his dose tonite because I think he is just wiped out from the day he has had.....
 
Re: Julius went down to 40 today

Hello Julius' Mom and welcome. I wanted to know if you have been testing him for ketones? I was looking at the ss and noticed that until the past couple of days, his numbers were a little high. Choco went into DKA a week after being diagnosed with Diabetes and his numbers the couple days before he went to the emergency vet were in the mid 200's. When you said Julius wasn't feeling well, it just brought flashbacks to the couple days leading up to Choco's episode. I'm sure that's not the issue but just wanted to see if you are testing for the ketones just in case. I'm sorry but I don't have any dosing advice but if you put dosing question in your subject box, the right people will be able to help you with your question. Have a great night!
 
Re: Julius went down to 40 today

Hi Julius's Mom and welcome!
I see on your SS that your doses are pretty inconsistent. One of the things that Lantus needs is consistency: the same dose in the AM cycle and the PM cycle. Also, it takes a while to build the Lantus "shed" (the "depot" of insulin that stays under the skin and helps to regulate the blood glucose). The size of the shed depends on the size of the dose, so if your doses are inconsistent, you will not be able to achieve consistency. I am not comfortable with recommending dosing for others, but if Julius were my cat I would chose one of the doses (probably .5 unit for now) and stick with it for 3 or 4 cycles and monitor what happens with his bg. If it looks like that is too much insulin for him, someone knowledgeable will be along to help you decide what his dose should be.
Anyway, I want to welcome you and reassure you that you will get very good advice on this board.

Ella & Rusty

p.s. Yes on putting "dosing question" or something similar in your subject line. Go back to your first post of today and edit the subject line accordingly.
 
Re: Julius went down to 40 today

welcome to Lantus Land!

I have a question - what brand of meter are you using?

I agree with Ella that picking a dose and staying with it for a few days is the best way to see what is going on. Numbers tend to get wonky when Lantus is given in different doses each time. If you would feel better skipping tonight and starting over at 0.5 or even 0.25, that would make sense. I think 1 unit is too much for Julius right now, and 0.75 also looks like it might be too much.
 
Re: Julius went down to 40 today

hello all, he jumped up to 302. I called the vet and am going to test in a little bit.... I am going to probably give him .5 at his normal time... I tested him for ketones tonite and it is negative.... thank god! I am using a freestyle light meter and when I get a really high or low number I always test twice..... I swear I want to barf right now I am so nervous...
 
Re: Julius went down to 40 today

I agree with Libby -- it will be safer to reduce Julius' dose for now so you can give the same dose of insulin twice a day.

A couple of cautionary notes...
This morning, Julius dropped 100 points between AMPS and +2. If you had to leave the house, it would have been a good idea to leave higher carb food than what you are routinely feeding Julius. If you don't want to add HC gravy from regular canned food due to allergies, etc., that's fine. You can mix honey or Karo syrup into what you're feeding to raise the carb level. There was a fair amount of momentum in that initial drop -- in an ideal curve, the +1 is higher than your pre-shot value and the +2 is about the same. The concern is you don't know how low Julius dropped. Getting the +2 was great. It told you about the cycle. Leaving higher carb food would have been a buffer until you got home.

Please, please, please get at least a spot check in the PM cycle before you go to bed. Many cats have lower numbers during the PM cycle. For safety sake, you need to get at minimum, one test during the PM cycle.

I think you mean Dr. Lisa -- she's a vet. Dr. Laura is a radio personality who's political views I won't comment upon other than to say that having a degree in physiology does not give you the credentials to dispense advice on anything other than physiology.

As for Julius' diet, you're feeding a lot of fish. Aside from issues with heavy metals in fish, feeding fish on a daily basis can contribute to health problems -- although you are adding supplements.

What you're seeing with the value in the pinks, is a bounce. It's the way the body protects itself from low numbers. Julius' numbers dropped and his liver panicked. It dumped a stored form of glucose and counterregulatory hormones into his bloodstream and his numbers spiked up. It's normal. It's annoying, but normal. (And if your vet mentions Somogyi rebound, politely say, "Um-hummm." and don't skip a dose of insulin. Somogyi has never been definitively proven in cats -- or humans, for that matter -- and has never been even examined with long acting insulin. It's existence is controversial, at best.) It can take up to 72 hours for a bounce to clear.
 
Re: Dosing advice Julius has been from 158 to low of 40 now

Glad you got the SS. Is it the one I sent you or did you do it on your own? If it's the link I sent you, I still need your gmail address so I can make you the owner :-D If you did it on your own..FANTASTIC!!! I'll just drop the one I did from my ownership :-D Good job!
 
Re: Julius went down to 40 today

Take a look at Gracie's spreadsheet. You'll see she was all over the place, a few times in the high 500's. Look before the very high numbers. There is always a lower than normal number in there somewhere. I didn't think the bouncing would ever end, and then, with consistent dosing, she stopped. Stick with it, stay consistent, and test as much as possible and things will get better.

Jason



Julius' Mom said:
hello all, he jumped up to 302. I called the vet and am going to test in a little bit.... I am going to probably give him .5 at his normal time... I tested him for ketones tonite and it is negative.... thank god! I am using a freestyle light meter and when I get a really high or low number I always test twice..... I swear I want to barf right now I am so nervous...
Click to expand...
 
Re: Dosing advice Julius has been from 158 to low of 40 now

Thanks to all! this has been a huge learning curve for me and my hubby. As you can see we did (recently) start a PM before bed test. I am only 31 but hit the hay at about 10, or sometimes earlier.... he started to go back down (he was 266 at 7:15pm) so I decided to skip his PM shot, partially because I worried he would go too low and he really seems tired, he has had a rough day! My instinct said to wait till the AM. He had dinner and is resting right now. I am going to test him again before I go to bed and in the AM first thing (around 6:45am) and call my vet when they get there (8am) I fully intend to start a .5u AM and PM dose and see how he does. I really don't want to bring him in for a $25 per test glucose curve I can do at home. I am going to ask them in the AM what they need me to bring him in for. I know the fish diet is not a plan. I gave them turkey necks tonite, and am awaiting my father in law to get his meat grinder. In the mean time I made the Dr Lisa (I don't listen to talk radio! Dr. Laura...;P) anyway I made it but because I could not grind up the bone because I don't have the grinder I did the meat/liver/egg and water combo and froze in portions. I am going to add the powdered supplement (call of the wild) to it until I get my hands on the grinder. I am going to order one too, but his will get her faster. Thanks again for all the feedback this has been a scary day for me, it makes me feel a lot better to know I can jump on here and get help!! ;-)
 
Re: Dosing advice Julius has been from 158 to low of 40 now

I just updated my template, my vet said that if he is under 200 give him nothing. However I want to do what you have all suggested which only makes sense with the consistent dosing. Yesterday when he was 158 preshot I gave him .5u and as you all know he went way down. before I fed him he was 199, I am going to test him at 8 (before his evening shot) if he is lets say between 155-180 for sake of conversation do you think a .25u would be proper or do the .5u? I have to admit my sister called me at 5am about the Tsunami in tears (she lives in VA I live in CA) and I am going to go to bed early I am sure.... what do you all think? p.s. my name is Tiffany! ;)
 
Re: Dosing advice Julius has been from 158 to low of 40 now

Hi Tiffany! Glad you're safe on the west coast.

If you're not sure what to do, post. People should be around to help. This post that Libby wrote on handling low pre-shot numbers is a good one to have handy if it's an odd time an there isn't anyone who can walk you through the process.

In the beginning of this process, we generally will encourage you to skip a shot if numbers are below 150. As you collect data and get comfortable with steering BG levels using food, you'll be able to shoot progressively lower numbers.
 
Re: Dosing advice Julius has been from 158 to low of 40 now

Thank you! I read that..... so I am wondering not to be nit picky, but lets say he is 160-190 would you do either .5u? .25u based on what I experienced yesterday or skip? I am trying to do a more regular schedule per so many on here think it will help even his #'s out... and I think it will too!
 
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