Dosing advise

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Websterthecat

Member Since 2014
We just got Webster back today. :mrgreen:

I rushed to Walmart and picked up everything that he needs including a Glucose meter.

We just checked his BG and it was 45. :o I read over the rules for treating Hypoglycemia and it said I was in low number range (40-60mg/dl). We followed the instructions and he ate a half dozen pieces of food and a 1/2 dozen temptation treats.

How long do I wait to recheck? Should I keep trying to feed him treats?

I was told that he was given a dose (1 unit I believe) of Lantus 6-7 hours ago. If I recall correctly from some of the reading that I did, the insulin should be at peak levels now?

His next dose is at 9:00PM eastern time which is 5 hours away. Should I give him the 1 unit at 9 or should I skip a dose?

Thank you everyone... and Webster says thanks!

UPDATE: It has been nearly 4 hours since he dropped to 45. I have been checking his levels every hour since. (see spreadsheet in signature)

He is due for a shot in one hour. I'm seeing that others are suggesting a lesser dose. I will post the +11 shortly and then the PMPS 15 mins before his next dose is due.
 
Re: Low numbers

Hi MIke,

How long since the last test? If more than 30 mins, test again.

Be right back...
 
Re: Low numbers

I'm sort of confused as far as the numbers presented on the "Rule of thumb for treating hypo" post viewtopic.php?f=28&t=15887

Are the numbers presented referring to a human meter numbers or the converted numbers used by devices such as the Alpha track? I'm using the Relion Mini.

Thanks again.
 
Re: Low numbers

Your spreadsheet is not up to date.
So you are saying that you did not get a BG before the shot (PS) and you got 45 at +7, 7 hours after the shot?
What is the does and insulin
If in doubt skip this evening's dose
 
Re: Low numbers

Larry and Kitties said:
Your spreadsheet is not up to date.
So you are saying that you did not get a BG before the shot (PS) and you got 45 at +7, 7 hours after the shot?
What is the does and insulin
If in doubt skip this evening's dose
Click to expand...

Thank you Larry.

My spreadsheet should now be up to date.

I just picked him up from the vet a couple hours ago. I was told that he received a shot of Lantus (I believe 1U) at 9:00am or 7.5 hours ago. I checked his BG 7 hours after the shot (+7) and it was at 45.
 
Re: Low numbers

Dose: 1.0 IU Lantus
Meter: ??? (from Walmart, so assuming human glucometer)

AMPS ??? - (insulin administered by vet this morning).

+7 - 47 - ate ½ doz pieces of food (carb content?) and ½ dozen Temptantions high carb treats.
+8 - 106

Is that an accurate summary, Mike?

106 is OK for now but keep monitoring clinical signs and test again at +8.5.

I've been through low numbers myself but I've had data to work with to guide me. I'm going to see if I can get someone more experienced eyes on this thread.

In the meantime I think it would help if you could tell us:

- The type of food (low/med/high carb) that you gave at +7 alongside the high carb treats.
- Did you feed anything at +8? If yes, what carbs (low/med/high) and how much?
- How long has Webster been on the 1.0 unit dose?
 
Re: Low numbers

HI Mike,

I've posted a request for assistance on the Lantus TR support board. I'll stay with you until someone more experienced comes to help.

Did you feed anything after the +8? Have you tested again?
 
Re: Low numbers

Critter Mom said:
Dose: 1.0 IU Lantus
Meter: ??? (from Walmart, so assuming human glucometer)

AMPS ??? - (insulin administered by vet this morning).

+7 - 47 - ate ½ doz pieces of food (carb content?) and ½ dozen Temptantions high carb treats.
+8 - 106

Is that an accurate summary, Mike?

106 is OK for now but keep monitoring clinical signs. What food did you give him alongside the high carb temptations? Also, how long has Webster been on the 1.0 unit dose?
Click to expand...

That summary is accurate. I'm using the Walmart Relion Micro meter.

Insulin was administered by vet this morning 8 hours ago.

+7 BG @ 45
Fed him temptation high carb treats after low reading plus a few bites of WM Special kitty high carb bad food.
+8 BG @ 106

He was recently diagnosed with diabetes on Tuesday and had a 5 day stay at the hospital due to DKA. They have been administering 1/2U doses and I believe they may have just increased his dose to 1u in the past day. My prescription was written for 1U ever 12 hours starting at 9PM Eastern time tonight. They said to feed, forcefully if necessary before giving injection.
 
Re: Low numbers

Thanks for the additional info. I have concentration problems so it's helpful to have the summary to refer to. :smile:

How long is it since the last test? If more than 30 minutes can you test again, please.
 
Re: Low numbers

It is great that you got that meter and caught that 45 today!! I would continue monitoring until 9:00 tonight before making any final dosing decisions; however, I would be very inclined to shoot less that 1U for sure. As a general rule, any reading below 50 calls for a dose reduction of .25U, but your case is a little different since you just started today! We also want to be very careful about keeping out of DKA, since he's already been there once.

Also as a general rule, once you get a reading below 50, you want to feed high carb food in a small quantity - enough to bring the BGs up, but not so much Webster gets too full, because we need him to want to eat more if he needs another carb boost. One favorite high carb (HC) food is Fancy Feast Gravy Lovers. You need to test no more than 30 minutes apart once you get these low readings, and you are ultimately shooting for two tests in a row that are well above 50 and NON-food-influenced. You want to know he's in safe numbers without the need of carbs.

Did you pick up any ketostix while you were out? Since Webster has a history of DKA, you do want to test him for ketones regularly.

Here is the link to the post about handling low numbers:

Handling Low numbers
 
Re: Low numbers

Critter Mom said:
In the meantime I think it would help if you could tell us:

- The type of food (low/med/high carb) that you gave at +7 alongside the high carb treats.
- Did you feed anything at +8? If yes, what carbs (low/med/high) and how much?
- How long has Webster been on the 1.0 unit dose?
Click to expand...

-It was the cheap "special kitty" (high carb i suppose) he only had a few bits and lost interest. He was very interested in his favorite salmon flavored Temptation treats so I have him a 6-8 or so.

-He's was not very interested in food at +8, only treats. I did not give him any more after seeing that his BG went back up to 106.

-I'm uncertain exactly how long but I was told that they were giving him 1/2u for a while and bumped it up to 1u in the past day or so.
 
Re: Low numbers

Actually, keep it up for a little bit....I'm just starting the evening ritual with my own crew, so my availability is a little sporadic at the moment.
 
Re: Low numbers

I'll do my best. Before you go, should Webster have a little food now? Low or high carb? I'd appreciate your advice for Mike and Webster on this.
 
Re: Low numbers

Webster's +8 is looking very good - I would hold off on food for now; however, I would continue to test at least every hour. If he starts dropping again, I would step up the testing to every half hour. We usually try to not feed high carb food unless we get a number under 50; however, there are other circumstances that do call for feeding high carb when the kitty is over 50 (like a super-fast drop, or the bean needing to leave for an extended time)
 
Re: Low numbers

Amy&TrixieCat said:
It is great that you got that meter and caught that 45 today!! I would continue monitoring until 9:00 tonight before making any final dosing decisions; however, I would be very inclined to shoot less that 1U for sure. As a general rule, any reading below 50 calls for a dose reduction of .25U, but your case is a little different since you just started today! We also want to be very careful about keeping out of DKA, since he's already been there once.

Also as a general rule, once you get a reading below 50, you want to feed high carb food in a small quantity - enough to bring the BGs up, but not so much Webster gets too full, because we need him to want to eat more if he needs another carb boost. One favorite high carb (HC) food is Fancy Feast Gravy Lovers. You need to test no more than 30 minutes apart once you get these low readings, and you are ultimately shooting for two tests in a row that are well above 50 and NON-food-influenced. You want to know he's in safe numbers without the need of carbs.

Did you pick up any ketostix while you were out? Since Webster has a history of DKA, you do want to test him for ketones regularly.

Here is the link to the post about handling low numbers:

Handling Low numbers
Click to expand...

Thanks for you help Amy!

Yes I picked up some sort of Ketone strips made by Relion. They are simply called "ketone test strips".

I wanted to get the ketostix that others were talking about but they were not available where I was. Do you know if the ReliOn Ketone test strips are any good?

As for the "handling low numbers" guidelines, are the referenced numbers for the a human glucose meter such as the Relion? I understand that human meters read differently (lower I believe) than pet meters.
 
Re: Low numbers

I'm sure the ketone strips you got will be just fine!

Yes, the link I posted refers to a human meter. Most of us use human meters, so that's kind of where our lingo lies; we ask folks who use animal meters to clearly state it so we are aware.
 
Re: Low numbers

HI Mike,

Can you post the +9 test result here first when you get it, please? (googledocs can be a bit sluggish to refresh on my PC).
 
Re: Low numbers

Critter Mom said:
HI Mike,

Can you post the +9 test result here first when you get it, please? (googledocs can be a bit sluggish to refresh on my PC).
Click to expand...


Just took the +9. We are at 178 so that great I suppose! Spreadsheet updated.
 
Re: Low numbers

Looks like he might be "bouncing" off that 45 he got. How long until you shoot tonight? Do you have a lot of test strips on hand and are you able to monitor closely this evening? Do you have high carb food on hand?

Just trying to gather a little info that will be needed when making a dosing decision for Webster this evening.
 
Re: Low numbers

I can stick around for a bit....about to start dinner soon, but I can peek in. Webster is in safe numbers now, so that's great!
 
Re: Low numbers

That's a reiief. Thank you for coming to help, Amy. I'll take down the TR 911 now.

Mike, you did great! Keep posting your test results so we can see how you're getting on. I'll try to check back in a while.
 
Re: Low numbers

Mike

It looks like you will be able to shoot insulin tonight but as the others have said you need to ask the advice of experienced members on what that dose should be. It sounds like 1 unit may be too high. In order to do that you need to keep taking blood glucose readings from Webster as you get closer to shot time and post them up.

What normally happens is that you amend the title of your thread by pressing the edit button in your first post in this thread. My advice would be to put something like:

16/11 Webster first day on insulin +7 47 dosing advice needed for PM

You can add icons and if you need help quickly you add the 911 icon or the question mark icon.

you need to withhold food for 2 hours before his evening shot so that the blood glucose reading you take just before you shoot tonight isn't affected by food and so that he will be hungry enough to eat before you shoot him. I personally don't feed my cat after +7 or 8 unless his blood glucose is very low.
 
Re: Low numbers

phlika29 said:
It sounds like 1 unit may be too high.
Click to expand...
Hi Mike,

I think that according to Tight Regulation Protocol dosing guidelines, if numbers go below 50 on a cycle then that should qualify for a dose reduction. I second Sarah's suggestion to change the opening post thread title to ask for dosing advice for tonight. I'd recommend letting your vet know about the low number, too.
 
Re: Low numbers

One final suggestion from me. When you do get the pre shot try to get it 15 minutes before the shoot is due. Then post the numbers up here and that should hopefully give people time to reply to you. It is always best to shoot on time or 15 minutes late (or early) and that way you keep to a tight schedule.
 
Re: Low numbers

Yes - excellent suggestion!

phlika29 said:
One final suggestion from me. When you do get the pre shot try to get it 15 minutes before the shoot is due. Then post the numbers up here and that should hopefully give people time to reply to you. It is always best to shoot on time or 15 minutes late (or early) and that way you keep to a tight schedule.
Click to expand...
 
Re: Low numbers

Critter Mom said:
phlika29 said:
It sounds like 1 unit may be too high.
Click to expand...
Hi Mike,

I think that according to Tight Regulation Protocol dosing guidelines, if numbers go below 50 on a cycle then that should qualify for a dose reduction. I second Sarah's suggestion to change the opening post thread title to ask for dosing advice for tonight. I'd recommend letting your vet know about the low number, too.
Click to expand...

Thank you. I changed the post title and included an "Update" in the original post.
 
+11 update - BG @380

....and hes eating once again. Looks like his 3rd or so tablespoon of food in the past couple hours.

This is very nerve-racking. He went from low up to 380. I really hope that I can get the hang of this because its really stressing me out. :-|
 
Unless he is over 200 mg/dL on a human glucometer at shot time, I would be very cautious in giving insulin. Because of how low he already went on the presumed 1 unit (*), he may be more sensitive to the effects of insulin.
* You may want to confirm that 1 unit with the vet; some vets start too high with 2 or more units. If that is the case, he may actually be OK with 1 unit.

The formula for a starting dose is based on the lean weight of the cat as follows:
How much does he weigh?
How much should he weigh?
Take the lower weight.
Convert to kilos (pounds/2.2)
Multiply by 0.25.
Round down to the nearest 0.25 for a starting dose.

If he is over 200 mg/dL, I'd suggest backing down to 0.5 units. Lantus builds up its effects over 5-7 days on the first dose level, then any dose adjustments take about 3-5 days to stabilize. The 0.5 units will overlap a bit each shot and build up a depot of Lantus insulin crystals under the skin which slowly dissolve to take effect.

If he is between 150 and 200 AND you can stay up all night if he should start going too low and you need to intervene, you might give him 0.25 (eyeballed) to 0.5 units.

The nadir, the lowest glucose after the shot, is usually around +5 to +7 hours after a shot of Lantus. Generally, the glucose starts rising again after this.
If you do shoot tonight, you'll want to test at +2 when there may be a food spike. If there is no spike and he's dropping, that is a clue he may go low on you again.

The standard protocol for intervening with numbers under 50 mg/dL on a human glucometer is
Give 2 teaspoons of high carb food.
Wait 20-30 minutes.
Re-test.
Repeat as needed.
You want to get 3 rising numbers, get past the nadir, and be in safe numbers before relaxing.
 
Hi Mike!

Just want to make sure you saw that Sienne responded to your post on the Lantus TR forum:

Sienne and Gabby said:
Welcome to Lantus Land!!

I was reading your thread on the Health board and you were getting great guidance there.

With a cat that is newly recovering from DKA, skipping a shot is not a great idea. One of the big contributors to the development of ketones is not enough insulin. This is a vulnerable time for Webster. Even though he may be ketone-free right now, ketones can develop very quickly. Given that you've got a bounce that's starting and the drop into the 40s, I'd reduce the dose to 0.75u. You may want to get some early tests in -- I'd suggest starting with a +2 and +3 just so you know where the cycle is going.

There are some basics that are helpful to keep in mind for a kitty that's recovering from DKA:
  • Like Amy suggested, pick up some ketostix at the pharmacy. Test as often as you can stalk your kitty to the letterbox. Alternatively, Novamax makes a glucose/ketone meter. There are several other brands around, as well. Even though the strips are expensive, getting at least a test a day for blood ketones will let you rest at night knowing that Webster is not throwing ketones. Either a meter or ketostix are fine. Just stay on top of the ketone situation.
  • Add water to Webster's food. Add as much as he'll tolerate. Water helps to flush any ketones from his system.
  • Make sure he's eating. Lack of calories also contributes to the development of ketones. If Webster isn't eating, he's burning stored fat as fuel and this form of metabolism produces ketones. It honestly is OK if you need to feed high carb or highly calorie dense food if that's what he'll eat. If he's feeling better and eating his regular food, that's great! But, if you need to give him the kitty equivalent of a hot fudge sundae to get him to eat, then do it!

This is a very active board and we have people here on both East and West coasts and points in between as well as members from Europe. (I can't remember if we have anyone from other continents around at the moment.) In other words, there's usually someone around if you need help. People are also very generous with their time and their knowledge. We've all been new at this dance and understand how overwhelming the first weeks can be. It does get easier -- really!
Click to expand...


I wanted to add that the high numbers you are seeing now are CAUSED by him going into the 40's today. It doesn't signal that he needs more insulin - it's his body's way of responding and saving him from a hypo. Here's a description of bouncing. Look in the second post in that link.
 
It is nerve-wracking when you first start out, but you are not alone! So just about an hour till shot time? Do you have lots of test strips and high carb food on hand, just in case?

I also see you got some good advice from Sienne over in the Lantus TR group....just to help avoid confusion, and to increase the number of eyes seeing your posts, would you mind continuing to post only over there for this evening? That way YOU only have to go to one condo, too.
 
BJM said:
Unless he is over 200 mg/dL on a human glucometer at shot time, I would be very cautious in giving insulin. Because of how low he already went on the presumed 1 unit (*), he may be more sensitive to the effects of insulin.
* You may want to confirm that 1 unit with the vet; some vets start too high with 2 or more units. If that is the case, he may actually be OK with 1 unit.

The formula for a starting dose is based on the lean weight of the cat as follows:
How much does he weigh?
How much should he weigh?
Take the lower weight.
Convert to kilos (pounds/2.2)
Multiply by 0.25.
Round down to the nearest 0.25 for a starting dose.

If he is over 200 mg/dL, I'd suggest backing down to 0.5 units. Lantus builds up its effects over 5-7 days on the first dose level, then any dose adjustments take about 3-5 days to stabilize. The 0.5 units will overlap a bit each shot and build up a depot of Lantus insulin crystals under the skin which slowly dissolve to take effect.

If he is between 150 and 200 AND you can stay up all night if he should start going too low and you need to intervene, you might give him 0.25 (eyeballed) to 0.5 units.

The nadir, the lowest glucose after the shot, is usually around +5 to +7 hours after a shot of Lantus. Generally, the glucose starts rising again after this.
If you do shoot tonight, you'll want to test at +2 when there may be a food spike. If there is no spike and he's dropping, that is a clue he may go low on you again.

The standard protocol for intervening with numbers under 50 mg/dL on a human glucometer is
Give 2 teaspoons of high carb food.
Wait 20-30 minutes.
Re-test.
Repeat as needed.
You want to get 3 rising numbers, get past the nadir, and be in safe numbers before relaxing.
Click to expand...

Thank you. Lots of great information here.

I'm beginning to wonder how precise the vet was with dosing amounts and time between doses. Perhaps she gave his shot a little early and a generous 1U? I suppose this could be a factor?

Either way, I'm going to check him again in another 15 mins which will be 15 mins before his PMPS so that you guys can advise. I'll post in websters spreadsheet shortly.

Thanks to everyone who's here to help me tonight. This will be my first shot ever so its going to nerve-racking.
 
Amy&TrixieCat said:
It is nerve-wracking when you first start out, but you are not alone! So just about an hour till shot time? Do you have lots of test strips and high carb food on hand, just in case?

I also see you got some good advice from Sienne over in the Lantus TR group....just to help avoid confusion, and to increase the number of eyes seeing your posts, would you mind continuing to post only over there for this evening? That way YOU only have to go to one condo, too.
Click to expand...

1/2 hour before the shot. I'm about to check his BG. I purchased 50, prob have 40+ left. Will get more tomorrow. I have lots of temptation treats which he loves and a fresh bottle of Karo corn syrup just in case.
 
There are a lot of Lantus users there with experience with DKA, and other issues that have been known to happen at the same time as diabetes.

I'll pop over to that thread.
 
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