Dosing advice please (first hypo)

Status
Not open for further replies.
Lori&Scout

Lori&Scout

Member Since 2012
Nipper has diabetes, pancreatitis, and probably acromelagy. My spreadsheet is out of date, sorry for that. I stopped updating it when I switched her from Caninsulin to Lantus and the readings got much more boring (i.e. consistent). Here's the summary: I've been gradually increasing her Lantus dose (first 0.5U per week and then 1U per week) since late January, and she's up to 11U. BG is now consistently between 10-15 mmol/L (180-270) and a little lower at nadir then before injection but not by much. She's not gone below 10 (180) on Lantus before today. My goal has been to gently try to break through this insulin resistance and then back off the dose and see how she does.

The past week she's been vomiting more than usual (vomiting on empty stomach, not vomiting food/hairballs), eating less, and seems a bit off (sleeping more, meowing less). This happens when her pancreas is bad so I haven't been terribly concerned. BG has been in her normal range since Monday night, but I was away for the weekend and my friend was catsitting so I didn't get any readings for during the weekend.

Then this happened:

PMPS: 14.6 (263)
+10.5: 5.5 (99)
+12: 4.4 (79)

I had injected 12U before bed (first 12U dose after a week of 11U). Woke up and bowls were still mostly full so she didn't eat much in the night. I encouraged her to eat at +10.5 and +12 but she didn't eat a full meal either time.

I didn't give morning injection. I plan to keep testing hourly until it goes back up and intervene with honey if it goes any lower. She is snoring on the couch next to me. Anything else I need to do?

I don't know what to shoot this evening. If her appetite is not back to normal I need to give a lower dose, but not sure what to give. Any advice would be appreciated.

Thanks :)
Lori
 
Hi Lori,

Just going to re-read your post and have a look at Scout's SS. Back soon.
(Edited to add: It's Nipper, not Scout :oops:. SS not yet updated.)
 
Last edited:
Hi Lori,

Those last two readings are pretty much the same (allowing for meter variance).

What did you feed her at +12? Low carb?
What glucose meter are you using? Alphatrak or human meter?

Eliz
 
Thanks. (This is Nipper, not Scout, FYI.) I'm updating Nipper's spreadsheet from the meter readings as we speak.

She's been getting low carb food only.

Human meter. New batch of strips so I tested myself as a control. Nipper is lower than me. :-/
 
Lori&Scout said:
Thanks. (This is Nipper, not Scout, FYI.) I'm updating Nipper's spreadsheet from the meter readings as we speak.
Click to expand...
Opps, sorry!
Since this is now +13 it is likely that Nipper is just fine.
But you may just want to keep an eye on her over the next few hours if you can, as Lantus has dropped some cats' BG up to 16 hours post shot.
 
Those numbers you're seeing at the moment are really nice numbers. You just want to ensure that she doesn't drop much lower.
She may well be coming up on her own now. Let's see what the next test result brings.
 
Lori,

You may find the following info from the FDMB FAQ's helpful in giving a context to the numbers you're seeing:

"Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":

· Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]

· Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]

· Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]

· Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]

· Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]

· Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]"

"There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a home glucometer. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure."

The above info comes from this document:
http://www.felinediabetes.com/fdmb-faq.htm#regulation

Eliz
 
Hi Elizabeth,

Thanks for all the info!! I got stuck doing work (don't they understand I have a kitty to look after???) I know they can get quite low and be OK, but with such a high dose I've been on the lookout for a hypo and now we're quite near hypo range and Nipper is not eating much I'm anxious about giving her too much insulin. I remember going through this with Scout 4 years ago... I stayed up with her all night the first time she was in the greens. :)

I just got a 5.7 and put down some Purina DM which she nibbled and then refused. I think she's got some pain and nausea from the pancreatitis. I'll try some chicken thighs or tinned tuna for dinner as those are her favourites. She had a tin of Sheba this morning so she's not starving. I don't like giving her too much of that as it upsets her tummy further.

I'm thinking that the increase to 12U plus not much food onboard was just enough to tip the scales... We are now 8 hours from her normal PM injection time. I'm thinking of dropping to a lower dose tonight if her appetite is still not back. What do you think?

Lori
 
Hi Lori, thanks for that update.
I am sorry that Nipper is feeling a bit poorly though....

Can't help with Lantus dosing advice, sorry: I'm a PZI gal. ;)
But I'm sure the Lantus folks will be online shortly.

Keeping fingers and paws crossed here that Nipper feels better very soon. :bighug:

Eliz
 
Thanks Eliz! She's in the very low percentage of pancreatitis sufferers that didn't present with loss of appetite, and it's fairly uncommon for her to be off her food. I've rung the vet and asked for some more kitty opium to help her with the pain. Hopefully this will pass and she'll be back to "normal."

I had PZI with Scout, great stuff. Lantus has been brilliant so far. We're off that horrible Caninsulin roller coaster of blacks and yellows in the same day. On Lantus her numbers, while high, have been very consistent. This is the first time they haven't been either.

I welcome any dosing advice for anyone who turns up. I'll post more numbers later in the day as well.

Thanks :D

Lori
 
Hello Lori and sweet Nipper. I don't know if you've finished with the spreadsheet, there still seem to be some days (and nights) of missing numbers. Cats (like my Neko) will often go lower at night and we like to dose Lantus (and Levemir) by the nadir or how low it takes the cat. So without some night data (a before bed test is great), it's hard to say how low Nipper is getting on a given dose. I think I'd back down to 11 units for now, and see if you can gather a bit more data. Then if you aren't seeing good nadirs, I'd increase to 11.5 and see how she is doing there before attempting 12 units again, if necessary.

Neko is an acrocat, and when she was on Lantus, she would often nadir late like at the next preshot time. Looks like that's what Nipper did today. Were you planning on getting Nipper tested for acromegaly? Neko is on regular buprenorphine for the arthritis that goes with her acromegaly. Is that what you mean by kitty opium? Bupe is also good for pancreatitis flares.

One of the reasons Nipper may be off her food is that she's not used to being in normal blood sugars. The first time Neko had a good run in normal numbers she hid under the bed. :rolleyes: Sending lots of vines for Nipper to feel good again soon.
 
Thank you Wendy for the great advice! I think you are right that Nipper is a little off because of the normal numbers. She is eating but is being super picky. I had to entice her to eat her food by putting treats on it earlier. She seems much more on her game today than yesterday though.

I gave her 11U last night and 10U this morning. I updated my spreadsheet, but long story short, she has been between 4.2-7.2 every time I've checked since then! This is brilliant! Per SLGS protocol, I think I should back off to 9U tonight.

I'm so glad she's not bouncing, that's the really amazing bit.

Oh and in cute kitty news, this morning Scout tried to lick Nipper's head and Nipper totally stared her down. :mad:

I'd greatly appreciate any advice you have about the next few days. I'll try to get a few tests in each day and keep an eye out for hypo symptoms.

Lori
 
WOW! What a change in Nippers numbers the last couple of days!:) And I love the stare down cattitude. :joyful:

A couple of thoughts for you. Normally when the dose is between 5 and 10 units, we make changes by .5U sizes. Think on the order of 10% of the dose. Over 10U that would be 1U changes and below 5U it would be back to .25U changes. The second thought is that when you do a reduction, the larger depot can affect 4-6 cycles, longer at the larger doses. Nipper's cycle today could have still been seeing some effects from the previous 11U doses, but the skip in there should have helped to reduce the depot.

Given the above, you do have a couple of options besides reducing back to 9U. You could go to 9.5U or you could stick at 10 if you think today's numbers were influenced by the depot. If you can't monitor much though, I'd be conservative.

One more thing - the SLGS doesn't recommend shooting full dose on a 90 (5.0), but look at what a great cycle she had as a result! If you can't monitor a cycle like that, SLGS recommends either a skip or a greatly reduced dose for anything under 150.
 
Thanks for this information, Wendy. This is my first time doing a reduction with Lantus, very exciting!!! I shot 9.5U per your advice. She is eating well tonight, and since I'll be up late watching the election results I will be able to get in a few tests. :D

This is what I've been waiting for for MONTHS. A chance to give her poor body a rest and see if she can heal a bit. I'm not under any impression that she could go into remission, given the state of her pancreas, but it might help me reduce the dose to something I'm less nervous about catsitters shooting blind. :confused:

I'll keep you posted, but fingers and paws crossed for another day of greens!

Lori
 
Looks like you're making progress with Nipper. I'm glad you didn't back away too far with the dose - once you start seeing progress you want to keep it. Regardless of which dosing protocol you use, low numbers are considered under 50 and I've never seen a symptomatic hypo in a cat on lantus/Lev that was over about 35. You just want to take action when they get into the 40's and pull them back up using high carbs.

There are kitties with acromegaly, not treated by radiation or anything else, who can be safely kept in green/blue numbers most of the time. You do test often - if you added one test in the pm cycle you could aim to have her in a lower range and it would be ok. Here's a look at Tommy's spreadsheet for you. Keeping the BGs in green and blues seems to be able to help somewhat to keep the dose from going ever higher. On Tommy's spreadsheet, Lauren achieved constant blue/green around November of 2011. Tommy was diagnosed with acro in May 2011. Tommy lived to 18 - 4 years after his diabetes diagnosis. You can see from Wendy's Neko that she also keeps Neko in healthy numbers as much as possible.

If you can get her tested for acromegaly, it would be good to know if she has it or not. Are you familiar with the symptoms? You can find a lot of information on this post "Where Can I Find?" Look under the New to the Group sticky near the end of that post for the single topic links and you'll find several that mention it. There is also some information on the Acro/IAA/Cushings support group - which is inactive, but there is some info there. In the past 4 years cats with high dose conditions have just stayed on the Lantus/Lev insulin support group. There are several daily posters here that also have high dose cats.
 
Status
Not open for further replies.
Back
Top