First full day with insulin AND testing -- a question

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Michelle & Dusty

Michelle & Dusty

Member Since 2012
This is Dusty's first day of being given two injections of insulin and being tested (1 unit of lantos twice daily). How often should I test? I don't think I want to do a curve since it's early for it and I don't want Dusty to think each time I'm approaching her I may be jabbing her ears. Should I test every three hours? Or just at the six hour mark and then again before her next dose?

Thanks!
--Michelle
 
Hi, Michelle,
There isn't a big benefit to a curve on the very first day. I'd recommend a +6 though.
Carl
 
You're welcome, and so is Dusty:-)
Have you had a chance to read the "new to the group" sticky thread at the top of the Lantus forum yet? There's a wealth of info in all of the sticky threads there.

Another good one is the one that explains the "depot" concept.
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150

What you are doing at the start is getting her body used to a certain level of insulin (the "depot"), so you'll want the keep the dose consistent for 3-5 days at least, test before every shot (always), and get spot tests now and then. I saw in your other post that you got a +2 today? That's great, all data is useful. And like I said, a +6 is always a good time. In theory at least, that is when nadir typically happens, and the nadir number is the number that the dose is based upon. It will tell you, over the course of several days, if the dose needs to be adjusted.

At this point, you want to stay at 1u, and not increase for at least 3-5 days. You would however, lower the dose if you see low numbers at any time (like under 50). If you ever test at shot time, and see a number under 200, you want to stall. Don't give insulin, and don't feed. Post either here or on the Lantus Tight Regulation forum and ask for dosing help. New members are encouraged to not shoot under 200, primarily for safety. Once you have more historical data, it wouldn't be a problem to give insulin below that line, and the longer you do this, the more confident you'll feel doing so.

Carl
 
Hi Carl,

Thanks (once again!) for the great advice. I hadn't read that before today. I was pacing myself a bit. :) But that was a great read and a nice insight into what's going on in Dusty's body.

To that end, I have a question for you. I think I messed up injecting Dusty this morning in that I didn't actually inject her. I saw a drop of insulin in her fur afterwords and am pretty sure that when she twitched the needle came out and I ended up dosing her fur instead. (But, because underdosing is better than overdosing, I just considered it a lesson learned and didn't dose her again.) But the numbers she's got are fairly strange. For today they are:
AMPS: 302 (7:45 am)
+6: 320 (1:45 pm)
PMPS: 268 (7:45 pm)
For context: the AMPS was before any food, really. Then Dusty had a about 3/4 a can of fancy feast and then about half a can later in the day. She also had a bit (4-5 small pieces) of boiled chicken.

Any idea why the PMPS would be lower than the +6? I'm just chalking it up to the fact that things are weird. I think I'll probably stay up late tonight and test Dusty a couple of times tonight, just to make sure that the unit of insulin I gave her tonight doesn't cause a crash. (Ahh, the joys of getting to work at home!)
 
hi Michelle

I just posted in your other post about not giving a 2nd shot if you think its a fur shot.

The numbers are probably going to be a bit weird until she settles into the dose and the depot is full.
Also, the food really throws things off - we call them food spikes. Generally we don't test until 2 hours after food to avoid this.

Also (and you will read this a lot!) Every Cat is Different (ECID) so she could have her lowest readings (nadir) later in the cycle.

268 is a pretty safe number but as you have very little data on how she handles insulin, it will be good to get another reading - probably at around +3 which is when it usually kicks in. If she's come down a lot, you can then give her a little food and test an hour later. You can test as often as you want, of course.

Also you can post any questions on this board or if its in the middle of the night, go to the Lantus Tight Regulation Board as that's pretty active.

Denise
 
Hi Denise,

Thanks! Yes, I didn't give a second dose and now know that was the right idea. I'll just do what I can to avoid those fur shots going in to the future. :)

I'll plan to check her at +3 and then, depending on the number, may stay up for the +6. I'm trying very hard to resist doing a curve until a week or so on this so she can get used to the dosage and the numbers will be meaningful. It's hard, though. I just hate all of this uncertainty. But I keep repeating that she's a resilient critter and there are a lot of lovely people on here to help if something happens.
 
Multiple possible reasons (of course:-) )

Meter variance - the FDA allows for human glucometers to be accurate +/- 20%. If you assume, for instance, that the AMPS was right on the money, the two readings you got after that? They're not that far off.

Food - The AMPS was a fasting BG. She ate breakfast, which would raise her BG. Did she eat again before the +6?

Possible fur shot - that might explain the +6, but not the lower number at +12.

Things are weird - :-) That is always a possible reason, because sometimes things are just the way they are and defy explanation. I call those "just 'cuz days".

One note - whenever you suspect a possible fur shot, do just what you did today. Chalk it up to experience and never try to make up the difference with another dose. Because there is no way to know if some of the insulin actually made it in.

Carl
 
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