Dosing advice?

[Vanlora Light]

Hi, so I'm looking for thoughts on Missy's spreadhseet. It all over the place now.
He was on 0.50 units, then I saw him going very low in the morning, changed the dose lower and the numbers got high so I freaked out, upped the dose abit, I don't think 0.25 does it for him, but it's really hard to get anything in between 0.25 and 0.50 units.

In my experience trying 0.25 units out with him 2 times when it was time to change the dose to lower, it didn't work out. So what do I do?
He doesn't do well with the 0.25 and seems he can get good numbers from 0.50 units or a bit lower.

I've seeked advice here and other forums before and I've gotten the advice to lower the dose to 0.25 before and he didn't do well on that.

 

[Sienne and Gabby (GA)]

A couple of observations....

Lantus dosing is based on the nadir -- the lowest number in the cycle. It looks like you've been basing your dose on the pre-shot numbers. While it's important to get a pre-shot test so you know if it's safe to give insulin, you also need to know how low that dose is bringing Missy's numbers. For example, you had a low pre-shot of 52 on 5/23. You have no idea how low your kitty's numbers went when you gave your usual dose of 0.5u. The minimum number of tests you need are 4 -- your two pre-shot tests and at least one additional test during both the AM and PM cycles. With the information you've collected, you don't have enough data to know whether to raise or lower the dose or when Lantus onset and nadir fall.

With an AlphaTrack meter, you should have reduced Missy's dose when you saw a test result that is below 68. In fact, you do not want to shoot if the pre-shot number is below 68. It's not safe.

We use two dosing methods with Lantus -- Start Low Go Slow (SLGS) or Tight Regulation (TR). The longest a dose is held if numbers aren't in the range you want is a week. Holding a dose that isn't getting numbers into a good range can cause glucose toxicity to develop. What this means is that your cat's body starts to treat the higher numbers like the new normal.

I'll be honest. I would not feel comfortable offering any advice about dosing unless you can get more tests. There is a good possibility that Missy is dropping into low numbers and then bouncing back into higher ranges. Without more test data from the middle part of the cycles, there's no way to know how low her numbers are going.

 

[Bron and Sheba (GA)]

I agree you need to be testing during the cycles to see how low the dose is taking Missy.
On two occasions on 5/22, 5/23 you gave the dose of insulin when the BG was under 68 on the alphatrak meter, and then you did not test again during the cycle. Please don't ever give insulin if the BG is under 68 on the alphtrak meter. And if you do give a dose of insulin when the BG is lower than you have shot before it is wise to get at least a +2 and another test in that cycle.
I would be careful getting dosing advice on some of the FD FB pages.

 

[Vanlora Light]

I agree you need to be testing during the cycles to see how low the dose is taking Missy.
two occasions on 5/22, 5/23 you gave the dose of insulin when the BG was under 68 on the alphatrak meter, and then you did not test again during the cycle. Please don't ever give insulin if the BG is under 68 on the alphtrak meter. And if you do give a dose of insulin when the BG is lower than you have shot before it is wise to get at least a +2 and another test in that cycle.
I would be careful getting dosing advice on some of the FD FB pages.

Okay I'll try to stick with 0.25 units then today and test him couple times, if he doesn't go low with the 0.25 (nadir) then what does it mean, can't go back to 0.50 because how low he got in the morning. In my past experience with him when I changed the dose lower like people said, I tested him and he needed to dose up again in few days. I'm so hesitant to take advice now because of that but also I don't know what to do myself in these situations.

 

[Sienne and Gabby (GA)]

You need to have a bigger picture than numbers in one cycle will provide. For many cats, if numbers drop low, there's a bounce into higher numbers. The bounce is a result of the liver and pancreas releasing a stored form of glucose along with counterregulatory hormones both having an effect on blood glucose numbers. It can take several days for a bounce to clear. This is why you can't base a dosing decision on one cycle especially because you have no other mid-cycle test data. One of the harder aspects of managing your cat's diabetes is that you need to begin to recognize patterns and understand how your cat is responding to insulin. No two cats respond in exactly the same way. Ideally, as you have more test data, a clearer picture will emerge and you will have a better sense of what dose will work for Missy. I'd also encourage you to look at the link I posted on dosing methods. That will also give you more guidance regarding how to make decisions about dosing.

I also agree with Bron. If people on Facebook groups or other feline diabetes sites did not ask to see your spreadsheet or were giving you recommendations based on pre-shot numbers only, that's problematic if not irresponsible.