Foster cat Shadow... meter only ready HI

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Shadowboy

Member Since 2013
Good morning,
As you can see by Shadow's SS, numbers have still been high. This morning the meter only read HI- I checked twice. I went up to 3 units from 2... Was that a really bad idea? We had been at 2units for 4 cycles.

Some of you may remember that Shadow had been on 3 units twice a day for a while then switched to 1unit twice a day because there was some question of if he was bouncing on the 3units. We've never gotten "good" numbers so have been working our way back up in the dose.

Of course I'm working today so won't be able to test him again until I get home. I'm feeling very stressed. What's the "usual" amount of time to get a kitty regulated? At what point/dose do you start to think about insulin resistance?

Thanks for any adivce....
 
When you're under 3 units per shot, dose changes do better if small - 0.25 units at a time - so you don't miss the optimal dose.

Plus, with Lantus, unless too low or a failed reduction, you wait before adjusting - 10 shot cycles if it is the first ever dose and 6 shot cycles after that.

Regulation happens when and if it happens. You do the best you can with schedules, tests, and other parts of your life.

And you've a ways to go before considering resistance.
 
Shadowboy said:
Good morning,
As you can see by Shadow's SS, numbers have still been high. This morning the meter only read HI- I checked twice. I went up to 3 units from 2... Was that a really bad idea? We had been at 2units for 4 cycles.

Some of you may remember that Shadow had been on 3 units twice a day for a while then switched to 1unit twice a day because there was some question of if he was bouncing on the 3units. We've never gotten "good" numbers so have been working our way back up in the dose.

Of course I'm working today so won't be able to test him again until I get home. I'm feeling very stressed. What's the "usual" amount of time to get a kitty regulated? At what point/dose do you start to think about insulin resistance?

Thanks for any adivce....
Click to expand...

Follow the protocol here, with increases of .5u, until you are seeing steady numbers lower than what you have now.
Hold a dose for at least 5 shots, then up the dose by .5u.
You have already done that restart because of starting at a high dose, so I would say your current dose has been earned.
If you increased to 3u this morning, hold that dose for at least 6 shots so that the shed can fill and you will realize the full benefit of that dose.

If you take it slow, upping the dose by 0.5u every 6 shots, and you are not seeing improvement in the numbers, you could think about resistance around a dose of 5-6u BID, provided that you are feeding a low carb wet diet and there are no other health issues or meds that can account for the higher, unstable numbers. You do NOT need to wait to get up to a dose of 10u BID to think about resistance as some may claim.
 
Here is the Lantus TR protocol as it pertains to holding and increasing doses.

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
 
Thanks. So, I will hold at the 3units even though I jumped a whole unit instead of 1/2 a unit.

I'll stay here for 6 cycles and see where we're at.

Shadow is acting ravenous. Should I try to switch to the automatic feeder and give him a meal midday? Or, do you suggest waiting things out with the increasing insulin first?

Thanks again
Jen
 
Let Shadow eat.
My two were up to 30oz and 24oz a day at their highest when not regulated, but later on, they got down to 10oz and 5oz a day.
 
Jen, You posted over on the Lantus Tight Regulation forum this morning. Sienne had this to say:
Sienne and Gabby said:
I wouldn't be concerned about Shadow following a particular pattern. Even a cat that's well regulated can be full of surprises. (After all, we're dealing with cats and they believe it's their job to keep us confused.)

As for tonight, I'd probably bring the dose to 2.25u. Let's see what others have to say, as well.
Click to expand...

Sienne is one of the most experienced members on this board. She has advised you to bring the dose to 2.25U.

You jumped the dose directly from 2U to 3U after only 4 cycles. Not sure why you decided to stay at the 3U you jumped to this morning. Increasing by a whole unit at a time can skip over the good dose for your cat.

Would you please explain your reasoning for staying at the 3U?
 
Blue said:
Follow the protocol here, with increases of .5u, until you are seeing steady numbers lower than what you have now.
Hold a dose for at least 5 shots, then up the dose by .5u.
You have already done that restart because of starting at a high dose, so I would say your current dose has been earned.
If you increased to 3u this morning, hold that dose for at least 6 shots so that the shed can fill and you will realize the full benefit of that dose.
Click to expand...

I was going to stay at 3units because I thought that was what Blue was saying to do....
 
Dose increases are based on the nadir or low BG number, usually around +6. Last night, you were able to get a +3 of 261. Shadow probably dropped even lower than the 261 at +3, possibly under 200. We don't know.

The numbers were HI this morning, so that is indicative of a lower number, we just aren't sure how low.

I know you probably increased to 3U this morning, thinking because he was HI, the insulin dose should be increased. Yes, Shadow probably should get an increase in dose. But not a whole unit.

Those higher numbers are scary when you are learning this sugardance. But they are not an immediate danger. The really low numbers, below 50 are the immediate concern, life threatening perhaps if not managed with food to bring the numbers up. "Better too high for a day than too low for a moment." As Harry cat said over in Lantus TR ISG,
by Harrycat » Tue May 14, 2013 8:07 am
Don't panic - a high number is not as dangerous as a low number, a HI is frustrating but not life threatening.
Click to expand...

Remember, Harrycat also told you:
The thing is (the really ANNOYING things about diabetes) is that a higher dose can actually produce the higher numbers - so although you think you're doing right by increasing (and so do lots of vets!!) you could actually be making it worse because you're inducing a bigger bounce - which is why it's best to go steady away and watch the numbers, and why the nadir is so so important. Additionally, the more you give, the less effective it can be (ironically!!) so when they're high, the insulin can be less effective than if they're lower to start with (% wise). It's tempting to give them more, especially when the meter says 'HI' but to start with, you might be better off just watching, and observing the pattern your individual cat throws out.
Click to expand...


Sienne said over in TR ISG - If you can get the tests in like Libby suggested last night, then you could raise Shadow's dose after 2 days/4 cycles. It's very likely that Shadow is seeing nadirs that are below 300. It's just as likely that he's bouncing off of those numbers.
Click to expand...

by Libby and Lucy » Mon May 13, 2013 2:36 pm if you're going to fast track, it is going to require getting at least one spot check EVERY day (either during the day, or at night, or both). Can you do that?
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that spot check should probably be at the +6. Which may mean setting an alarm to wake you to do that at night.

Sienne had indicated, a 0.25 increase from the 2U you gave last night.

Based on the +3 number last night, even though you have only held this dose for 4 cycles, Sienne thought you could increase by 0.25units for tonight. The protocol says if nadir is >200 but <300 than increase the dose by 0.25U. The increase would be from the 2U last night to 2.25U tonight.

ETA: I do see where Blue said to increase by 0.5U. That is not following the protocol, at least not based on the low number you got last night at +3.
 
Thanks Deb. I think I lost my patience.... I'll go to 2.5 tonight ( I think the 2.25 will be difficult to judge without having the syringes yet) I'll stay at the 2.5 for 6 cycles and keep posting...

Part of my inpatience I think is that my vet wants Shadow back up to 3 units... I decided to go slower than the vet wanted... but I'm feeling a little nervous about when she calls and asks how things are going.

I've taken a deep breath, reread everything, and will start again tonight.

Sorry =(
 
It's ok Jen. We were throwing lots of conflicting information at you, in two different forums, and that only made matters worse. Our apologies for that. We are here to make your life easier, not harder.

What is your favorite color? I have patience pants in various colors to lend to people. ;-)

Have you seen the pictures with the position of the syringe plunger on those 0.25 unit doses? Would that be helpful?

I'll be watching to see how Shadow does over the next 6 cycles.

Were you able to get a test when you walked in the door tonight? We sometimes call that an "in the door test". I think Libby or Sienne asked if you would be able to get that test. Even a test now, if it is at least 1 hr before your preshot test would be helpful.

If you can't, we understand. You do have all those wonderful droolers to take care of besides Shadow. :-D
 
Got home from work tonight at 8pm and did a check. This was a +2.... my husband gave the 6pm insulin 2.5 units (he doesn't check BGs yet). So +2 read HI- repeated with a different meter and got 536. Then I started to worry about DKA. Was able to check for ketones and they were negative. Yay!! I'll do a +4 then will have to go to bed- working again tomorrow.

Thanks again for everyone's help!
 
Shadowboy said:
Thanks Deb. I think I lost my patience.... I'll go to 2.5 tonight ( I think the 2.25 will be difficult to judge without having the syringes yet) I'll stay at the 2.5 for 6 cycles and keep posting...

Part of my inpatience I think is that my vet wants Shadow back up to 3 units... I decided to go slower than the vet wanted... but I'm feeling a little nervous about when she calls and asks how things are going.

I've taken a deep breath, reread everything, and will start again tonight.

Sorry =(
Click to expand...

You have no reason to say sorry; more people should appreciate that you are doing your very best.
A few should think back to the days when they were as new as you, and they were struggling over what was being said by this person and that one, and balancing with what your vet wants.
You are doing fine, OK?

Now, jumping in dose up and down and all over and frequently is bad for insulins like Lantus and Levemir as they have that shed and it needs to settle, so dosing 2u, 3u, and then down to 2.5u will likely need to do a good bit of settling and 'the protocol' dictates one holds a for 6 shots, watching how the numbers are trending, and if you have MOST nadirs between 200 and 300, up your dose by 0.25u, but if you are not seeing any yellows, 200s, up the dose by 0.5u.

Be sure that you ate testing urine for ketones. I hope that it's already been mentioned to get KETOSTIX at the pharmacy and if you get even a trace of ketones, post online for feedback.
Ketones are NOT just at high BG numbers; either cats are prone to them or not, so best to do daily checking and it will set your mind at ease about being sick from all these high numbers.

And be sure to let him eat more than usual; it's common for many to use an auto feeder so that they can space out the cat's food through the day..... feeding frequently helps to level off the cat's numbers.

Good luck with whatever dose you follow. You can send a link for your speadsheet to your vet and attach a note to explain you want to try the 2.5u just for a few days and then if no progress, you will go to the 3u dose again.

Gayle
 
Thanks, I really appreciate everyone's support. I didn't get to update Shadow's SS this morning- will do it when I get home tonight.

I went with 2.5 units and will stay there for 6 doses. I did check ketones last night- he was negative!!
 
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