Dosing question for tonight

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Luke B

Luke B

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Hi everyone, sorry Lindsay and I have been away for a while. So far things have been going very well with Bear. We did a 12 hour curve with him but according to our vet the readings were kind of abnormal, this was while we were giving him one unit of Lantus. She had us then do a 24 hour curve which, after her little calculations, adjusted his dose to 1.5 units. So we have been at that a few days now and Bear has been great. Well last night Lindsay was giving Bear his evening dose and thought she may not have gotten the insulin in since Bear kinda jumps at times when we give him his shot. Sure enough after being in the low 100's most of the week Bears BS was 560. So we gave him his food and his shot and went of to the Brewers game. We got home and Bear seems just fine. We had dinner and reached the time to takes bears BS tonight, he read 82. When we first started this we took our meter to the vet and compare it to theirs to gauge our accuracy to which it was reading 13 mg/dL higher then theirs, so technically that would put Bear at 69. We just fed him and decided we would turn here for advice. Do you think it would be wise to give the 1.5 units tonight or should we revert back to the 1 unit to be safe. I really don't want Bear going Hypo on a Sunday night.
 
Don;t shoot yet, I should have added!

Carl
 
In about 6 minutes =)
We usually give him his shot around 7:30. I was thinking of waiting a little and testing again in about 15 minutes. He just ate his evening meal and neither cat ate as much as they usually do. But we usually give Bear some fresh chicken breast after his shot as a treat. I think we'll leave their food out a little longer tonight so they eat some more.
 
Luke,
You CAN'T shoot 1.5, or even 1.0 into a BG of 69 (or 82). I am asking for some help from some Lantus folk. Please hold off till you see a post from one of them.

Carl
 
Ok, you got it. That was our plan tonight, to not shoot. Since were still new at this I figured it was best to ask first to confirm my thoughts and see what everyone else has done.
 
I am not certain what the "no-shoot" magic number is for lantus. In general, people don't shoot on numbers below 200 I think. I have done that, but that was before I knew it wasn't a good idea.
I'm thinking a no-shoot tonight, or a really low dose, but I'd want to see what Lantus folks say. I hesitate to advise dosing on an insulin I've never used - I'm a PZI guy.

Carl
 
Luke:

When you get a number like this, then we ask you to stall and to not feed. By feeding, you are bringing his numbers up and if you shoot, you could be shooting an artficially elevated number only to have him drop on you.

So no more food for right now....when did you last feed, how much, and what % carbs? I'm going to look at his SS and be right back.

PS I'm from lantus land ;-) ;-)
 
Hmmm...no Spreadsheet......

Ok...I suggest you read the link in my signature for dealing with low preshots. A couple more questions:

1. How long can you afford to stall and still shoot? Remember that if you stall, for instance, an hour tonight, then you have to make it up starting tomorrow morning in 15 minute increments twice a day or tomorrow night in 30 minute increments once a day.

2. Do you have plenty of test strips, HC food, karo, pokey sticks...all the equipment you need if you have to test alot?

3. Are you available to monitor frequently tonight?
 
Ok, thanks for the help. We're definitely not gonna shoot tonight but I'm gonna keep an eye on Bear and test every hour before bed to keep a good gauge on his numbers. I'll call the vet in the morning and talk it over with her. We usually feed 1/4 cup food per cat at each feeding, were still on the dry food our vet gave us at Bears initial diagnosis but I think we'll be switching him over to wet once this starts to run out. Anyways, we usually leave the food out about 45 minutes and let the cats get their fill. Usually there's not much left and we pick it up and put it in the closet so they cant get at it. I think tonight we'll leave it out and just let them finish it.
 
Good luck :-D

Just so you know...he can't hypo if he hasn't gotten insulin. You can check to make sure he's on his way up but if you are feeding dry food, he should come up and stay up.

We do recommend you try to transition him off dry food as soon as you can but you just have to be very careful with the insulin dose as you are weaning him from dry to canned as his BGs could really come down fast.
 
Sorry, I do need to get that spread sheet up. We have been writing down all our numbers on paper and keeping track that way but we have definitely been keeping track. We have tons of test strips and our emergency Hypo kit just in case. Bear has been doing nothing out of the ordinary to alert us to any serious problems. Since his diagnosis we've kept a very close eye on him.
 
Yeah, I really wanted to start Bear out on the wet food after his diagnosis but our vet was pretty adamant about using the dry to start so we went with that. She said it would be a little easier for us to get a handle on managing Bears numbers while we were still new at this. We only got the small 6 lb bag and that's nearly 2/3rds gone. We'll be mixing dry and wet soon and then fully going to wet. Oh, whats the best wet most people seem to use? I've seen a few brands thrown around, just wanted to know the top preferred.
 
Frequently vets put diabetic kitties on Purina DM. It is very high in carbs and low in quality. If you visit the Feline Diabetes Home page, there is lots of useful information listed on the right side. In the lantus forum, read all the stickies (* items at the top). It is a lot to learn but you will catch on, we all do.

This is a link to the food charts. http://www.felinediabetes.com/diabetic-cat-diets.htm
 
Luke:

Bear has been doing nothing out of the ordinary to alert us to any serious problems. Since his diagnosis we've kept a very close eye on him.
Click to expand...

Just so you know for future reference, some cats are asymptomatic when they hypo so you can't tell by watching them. My girl has gotten into the 20s even with me monitoring her numbers and I could not detect any difference in her behavior at all. She looked fine. Tonight shouldn't be a problem but just in the future, keep that in mind.

Welllll....most of us love our vets but we do not follow their advice on FD or even involve them because the experience in Lantus ISG usually is much better than what the vets have because we live it, breathe it day in and out 24/7 and vets do not typically have too many diabetic cats as patients. Yes, you do have to be careful when transitioning from dry to wet when on insulin but it's counterproductive to leave them on dry and we usually recommend you reduce the insulin dose and then start the transition slowly.

Most of us feed canned food that is less than 5% of calories from carbs. For some reason, I can't get the link to Binky's food list but it is in Carl's signature block. It's a good resource for finding foods of varying %carbs. In Lantus ISG (LL), many folks feed Fancy Feast low carbs varieties, many of us feed Wellness low carb varieties. It's kind of what the cat will eat and what works best for controlling the numbers.

I see Barbara gave you the link...good cuz I'm having a problem getting it.
 
Thanks much to everyone for the info. I see we still have a lot to learn, but we are getting there. Purina DM is EXACTLY what our vet put us on. Funny thing is she has many sugar cats that come to the clinic and her own diabetic cat going on 10 years now. I would have thought maybe she would have pointed towards the wet food route but maybe there's more money to be made by pushing this other stuff. :-D
Ok, We just got another reading after he ate at 7:15ish, its been about an hour and 45 minutes since we got the 82. He was at 194 now. Should we shoot, should we not shoot, what do you all think?
 
Luke:

In Lantus Land, if we advise someone to shoot, we commit to staying with them until the cat is safe. I'm not able to do that right now as I have two cats to give fluids to and my own diabetic cat to care for.

Also, the dry food throws in a whole 'nuther issue. In LL, if we stall, we don't feed. I have no idea if you feeding the dry food will keep him up or not...obviously he came down to his +12 number while eating dry food. Once he onsets, he could come back down.

I wish I could sit here and monitor with you and guide you through, but I'm not able to tonight.
 
Luke: in between kitties getting fluids..one down, one to go.

Just checking back in on you really quick. I feel bad about not being able to guide you through this. One thing that will help us immensely to help you:

Spreadsheet...it's invaluable to us; we can see trends, etc., whether the dose is too high, too low, and lots more info. Without that, we are make blind suggestions which we don't like to do.

Alot of dry food kitties come off the juice pretty quickly once they are on a low carb canned food. It would be interesting to know what your vet feeds her diabetic kitty. Who knows....maybe you can learn all this stuff and help her get her cat off the juice!! My vet has been in practice 25 years and she is phenomenal but now she calls me and asks questions about FD. Not too many vets encouraging home testing and alot of their clients won't do it anyway and so they have no understanding about what a cat can do on insulin.

I don't know what the lowest number you have ever shot is. If for any reason you decided to shoot, please please please get a +1 and +2 and see where he is going. Post for help if you need it. But if you have not ever shot anything below 200, I would skip and start over tomorrow. Lots of variables going on there.

Once you get your SS, please feel free to join us in the Lantus ISG. There are lots of kind people, just like in Health, willing to help get your kitty better.
 
Yeah, Bears doing good. We're gonna test him again at 10 and see where he's at. If he goes high again we'll get him his dose in the morning and work from there. Better too high then too low I guess. Would you possibly be able to link me to the spreadsheet page again if you have it. I'm actually working off my wife's computer since mine just took a crap last week and needs to be fixed. That's the reason we haven't gotten the sheet up yet. It crapped out right when I was gonna do it. This was after we curved Bear twice and the reason we've been writing down all our numbers, time and dates. Thanks so much!!!!
 
Also, looking at our numbers, as we were just starting this, we've shot 1 unit at 129, and 1.5 units at 126, 185, 178, and 182. So far no episodes. The 178 and 182 were both shot with 1.5 units on 8-12-11 with a +12 number of 339 recorded the next morning on 8-13-11. This was before I was aware of the 200 magic number most people seem to adhere to, I just found out that tonight. See, still learning. Well we got another 30 minutes and were gonna test again. I''l give a number then to see where we're at.
P.S. we switched from 1 unit to 1.5 units on 8-10-11 on our vets advice
 
Here you go:

Spreadsheet

That would be great....it is really an enormous help. Glad Bear is ok.

Love to see you in Lantus ISG. The folks in Health are fantastic so if you elect to stay here, that is absolutely fine, too.

Just saw your post. It looks like she has been switching you around on dose. We don't do that. We follow a very specific protocol that has you at the same dose for 3-5 days as the lantus shed fills. With nadirs in the 200-300 range, we don't increase dose more than .25u at a time because you can pass up your fitting dose and could be overdosing. Same on decreases.

The 200 is for newbies to not shoot below at first and until you gather data. Once you have data and have gradually started shooting lower, then you'll learn to shoot anything above 50 but you have a long way to go. Most vets freak out at shooting in the 50s but the key is testing testing testing and have tons of data. You can look at Gracie's SS and see all the data we have so I can shoot in the 50s.

I'd save some strips tonight and not do much testing especially if you get another rising number. You can catch a +10 or +11 in the morning to see where he's headed so you don't get any surprises.

As you have time, you might want to start reading the "Stickys" in Lantus Land. Don't let it overwhelm you. We are there to walk you through and answer questions.
 
Ok, so last test for the night we got 295 out of him. We are now +2.5 after our skipped dose which should have come at 7:30. Ill get a reading ASAP in the morning to see where we're at. I'm assuming we'll be back in the 400-500's with the skipped dose again. I wonder if these wild fluctuations have anything to do with the possible missed dose last night when Bear jumped as my wife was injecting. We'll see.
 
Definitely could be. A missed shot results in the shed draining so unless it is very full, you'll see increased numbers.

Yeah...I'd call it a night :-D Hope to see you in LL.
 
looks like tonight you're all set, but i wanted to second marjorie's recommendation to read the starred stickies in the lantus forum. one of the things you may be experiencing is "bouncing" and "new dose wonkiness."

every time you change a dose, including increasing it, although it's counterintuitive, for whatever reason their overall BG numbers can go up. logically you think "increase insulin = decreased BG." yes no yes no. before it goes down it often goes up - for as long as 3 days. after 3 days you can see what a dose will really do, but until then you might get an upside down curve, where the highest point is in the middle of the cycle instead of that being the lowest BG number. it's crazy, but that's how it works. we call that New Dose Wonkiness - the scientific name, of course.

the other thing that happens is bouncing. bouncing is when a cat's BG goes too low (too low is anything lower than they have become used to) their liver releases sugars to "save their life" and it very effectively shoots the cat's BG nice and high. they can stay that way for 3 days also.

those are the reasons that it's really important not to change doses without being careful about it. you also want to change by .25 increments to minimize the reactions and to try to hit the "right" dose. if your cat's BG number goes too low, you do drop the dose.

ok, i've probably made it as clear as mud for you. if you want to post in the lantus forum we can help you through learning all of this. trying to tell you at once is probably not helpful!
 
No, this is all making good sense to me, in fact the "new dose wonkies" is actually somewhat how I was explaining his silly number shifts to my wife after we increased his dose. So Bear was 494 this morning but as loveable as ever. I'm positive now that Lindsay must have mis-dosed on Saturday night. So I gave him his test treat, his morning breakfast, and his usual dose of insulin. I'm gonna keep an eye on him until I have to leave for work at 9. Once I get done working I'm gonna start working on the spread sheet so that's up here too. Thanks for all the help, it may sound goofy but I'm kinda enjoying all this. I'm a nursing student so all this is really helping me understand diabetes a lot better. Plus I kinda feel like a mad scientist with all this adjusting and playing with Bears numbers trying to get to the perfect range and maintaining it.
 
heehee, awesome luke. it is kinda fun when it begins to click and you get it. when you have time, read some other posts on the lantus forum. i've learned a ton just following people's questions. some other newbies include lisa & jynx, cinco and nemismom, emily & mr howell, sushi, and jessica & boo radley.

also, when you get your spreadsheet up and running you'll begin to see patterns emerge. that's a huge AH HA moment - because now you can see how YOUR particular cat is responding to the insulin. you learn about New Dose Wonkiness and go "AH HA THAT'S why he's so high . . ." it really is helpful.

and regarding the mad scientist in you, this is what i just wrote to lisa & jynx:

what's considered "low" numbers is actually anything below 50. we were advising you to add the high carb food last night only because it was so early in the cycle. 60 is an awesome number. a non-diabetic cat's range is about 50-120. what you're trying to do in this plan (following the protocol) is to keep the diabetic cat's BG in the normal range - it lets the pancreas heal and zowie, the cat (ideally) goes off of insulin. we tweak the dosage of the insulin and steer with the carbs in food to try to arrive at those magic numbers.
Click to expand...

go Mr Scientist. your tools today are one diabetic cat, insulin and different carbs of food. see what you can do. :-D
 
Morning Luke

Just checking in on Bear. I see Miss Julie, who is one of my midnight partners in crime in LL, has been in and has given you some great info. There is so much to learn that we make a good overlap team!

I really do hope you'll move over to the Lantus ISG because we have so much to teach you about using lantus. Looking forward to seeing you there and to seeing Bear's SS.

And again, sorry about last night. It's rare that I can't stay up or stay with someone. When you decided to not shoot and then thought you might shoot, I was at the busiest time here doing fluids and Gracie's evening routine. In LL, there are usually lots of folks around to help so if one of us has to bow out, we be sure you are covered by someone else. Like Julie ;-)
 
If Bear is testing that low on the dry diet, then it's likely he'll go into remission once you switch him to a canned diet, so make sure you're monitoring him closely and dropping the dose as needed! It may be a quick drop. But I think there is absolutely no reason to keep him on that dry diet when it's only keeping him in diabetic numbers. Not having to shoot insulin at all is a way better scenario!
 
Ok, Great news, I got Bears spreadsheet up and running. The link is at the bottom of the page so everyone can see it. Sorry again about the delay, my next semester of nursing school is starting and I have been having nothing but troubles from my school. Long story but its taking a lot of work to correct it before the semester starts next week. So bear is doing well. The other night he had a lower BS reading so Lindsay and I went with a 1 unit dose to see how he would react and left his food out a little longer. The next morning he was back into the 400's. He usually seems to have a higher BS reading in the morning then in the afternoon which was very noticeable once the spreadsheet was up. I'll have to see where this goes once we switch to the wet food in the next few weeks.
Thanks again Everyone!!!!!!
 
Great job on getting your spreadsheet up! Now you can head over to the Lantus forum for dosing advice when you need it: http://felinediabetes.com/FDMB/viewforum.php?f=9

Would it be possible for you or Lindsey to get a test in around the +6 every day? This is the test that you will determine your doses from. Lantus is dosed based of the nadir, or lowest number of the cycle, which usually is somewhere around 6 hours after the insulin shot.

It looks like Bear had a hypoglycemic episode on 8/14. That's why getting tests in the middle of the cycle is very important. That's also why you are seeing some high numbers now--when a cat's blood sugar drops too low their liver will release glucose into the bloodstream to combat the low blood sugar. This is how they survive hypoglycemic incidents.
 
I should have some time to do that but with school starting up It may be difficult for his +6 after the morning dose. I will do my best to get more numbers through the day though. I have a feeling that the low number was in conjunction with the increase in dose along with the missed shot the night before. he seemed fine though, no out of the ordinary actions. In fact he was quite active that night if I remember correctly. This is really good, this is really helping Lindsay and I to learn a lot more. Now we just have to change the food and do our best to get bear to cut down his water intake. We'll get there though, I'm confident in that. We'll start moving over to the Lantus board also to read and ask questions now too.
 
If you can get a +6 during the PM cycle, that works, too. I work all day, too, and I go to school, so I can't get a +6 in the AM cycle (well, until my boyfriend started helping me out). So what I would do is set an alarm and get up and test, and go right back to bed.

Most cats do not show hypoglycemic symptoms unless they are in severe hypoglycemia. So you won't be able to catch most hypoglycemic episodes unless you're testing frequently. But that low preshot number means Bear was probably coming up from a much lower number earlier in the cycle. The lowest number of your cycle is going to be around 6 hours in.

I am very concerned that 1.5u is too high a dose for bear, and that is what your high numbers are reflecting. Too much insulin will keep a cat's numbers just as high as too little insulin if you're only looking at the preshot numbers. Also, if most of bears lowest numbers are in the 100s or 200s, the dose should only be increased by .25u, not .5u. Here's a link to the Lantus dosing protocol: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Please post in the Lantus forum for dosing advice tonight, because I think 1.5u is too high and you need to lower the dose.
 
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