Harley hypo'ed, What now?

[Rob & Harley (GA)]

I'm at a loss. Ever since day one Harley has never reacted to Lantus like he should. Sometimes he gets a nice flat Lantus curve, but most of the time he drops fast and early like PZI. One of the reasons I switched to Lantus was so I could shoot lower numbers. The last few days his PS's have been in the blues. I have been nervous about shooting into them but he seemed to be doing ok.

Last nights PS was 160, I shot .4u. His +2.5 was 58, at +3 I called him to come test and he staggered over, he was shaking and when he tried to jump up on the couch he fell off, I tested and the meter read Lo, I fed 11% carb FF and he ate about 1/3 of the can, his +3.5 was 56, + 4 was 149 so the carbs had kicked in.

Where do we go from here? Should I switch to Lev? Why isn't he responding to the Lantus like he should?

Any help is greatly appreciated.

Robin

 

[MommaOfMuse]

No real advice, just hugs from someone else that has a difficult kitty who refuses to read the stickies on how lantus is 'suppose' to work.

Mel, Maxwell, Musette & The Fur Gang

 

[Lana & Yoyo]

Robin,

I think you might be moving your dose around too much. Can't tell if his hypo was a result of 0.5 units or 0.4 units. With insulins that work from a shed, it is best to stay with a dose for several days. It could well be that 0.4 is actually a good dose, but I would suggest that you drop back to 0.3 and hold that dose for 5 to 7 days -- let it settle in. Only change the dose before that amount of time has passed if his BG nadir falls too low. Then, after that dose has settled, if you need a change, make it then.

Lana

 

[Rob & Harley (GA)]

Thanks Mel, I think we need to send them to a Lantus 101 class.

 

[Marcy & Klinger (GA)]

I called him to come test and he staggered over, he was shaking and when he tried to jump up on the couch he fell off

Yikes! I hope he feels better today. It's so scary when they exhibit signs of a hypo. I'm glad you caught that early number!

Did you get a new vet? Have you talked them about Lev? I was lucky that ONE vet (out of 10) at Klinger's practice was even willing to rx it - all of the other vets had only experience with Lantus and Prozinc.

 

[Rob & Harley (GA)]

Thanks Lana, I can go to .3u and hold it for 3 to 5 days. I still don't understand the early steep drop though, why is that happening?

Thanks Marcy, yes I tried vet #4 who insisted that I go to 1 unit so on to vet #5. Carolyn (Latte) gave me the name and number of her vet so I'm going to try him next, he's kind of far away though.

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Robin,
If this was Levemir, I would be concerned that it's way too much insulin since you saw hypo symptoms. Symptomatic hypos are rare on Levemir. Not saying they can't happen, but to have symptomatic hypo on .4U of Lantus, well, that's a wowsah to me. ECID though. I believe Sheila saw hypo symptoms for Beau on a small amount of Levemir.

I think you should go down to even .2U and see what happens. Hold that dose like Lana said and get some nadirs. Even +2/+3 if you can, to see where he's headed. good that you were on top of it. So sorry he scared you like that.

You can always go back up with dose if needed. Did he eat OK before this episode, like did he eat at his normal time and normal amount in relation to the shot?

 

[Rob & Harley (GA)]

Thanks Vicky, I feel more comfortable with the .2u because I felt that the .4u last night may have been a little skinny, so much so that I wasn't going to test him thinking he didn't get enough anyway. Yikes!

Yes he ate at his normal time, normal amount, he is a grazer so he goes back every few hours to snack. His shot was maybe 10 minutes late, I got distracted.

I may have to move his shot time up a little so I can get some later test's at night.

Thank you.

 

[pamela and tigger]

Thanks Vicky, I feel more comfortable with the .2u because I felt that the .4u last night may have been a little skinny, so much so that I wasn't going to test him thinking he didn't get enough anyway. Yikes!

Yes he ate at his normal time, normal amount, he is a grazer so he goes back every few hours to snack. His shot was maybe 10 minutes late, I got distracted.

I may have to move his shot time up a little so I can get some later test's at night.

Thank you.

That was going to be my question...about the food. That is quite a drop on such a small amount of insulin! Glad you were there to catch it Robin. How scary! It makes you wonder how he did after the morning shot that day with almost the same preshot number.

 

[Lana & Yoyo]

Thanks Lana, I can go to .3u and hold it for 3 to 5 days. I still don't understand the early steep drop though, why is that happening?

Actually, hold the dose for 5 to 7 days --- if it proves possible. A 3 day hold is fine if you are in Find the Optimum Dose Mode. I think you need to think of yourself as in Get That Pancreas Working Mode. Harley was in remission until that unfortunate dental incident earlier in the year. I think he can get there again, but don't push him too fast.

The reason for giving a dose 5 to 7 days is to encourage his pancreas to help out. Changing his dose too often in this mode just causes further stress. I don't think Harley could be functioning on just the amount of insulin you are giving him -- he is producing some himself. Indeed that might be what happened with those low BGs that you saw so early in the cycle. I know how hard it can be to be patient with this stuff -- Lord knows, I have trouble following my own advice.

Also, maybe you could start now looking for someone who specializes in vet dentistry so he will be available to give Harley a checkup next year. Yoyo needed dental work this year and it sounded like it might be beyond the skills of the local vet. I finally found someone, highly respected, in an adjoining county that did the work for about $260. That was pulling 3 teeth, one of them decayed down to the jaw bone. He ended up having to have some of his jaw bone removed. I would have had to mortgage my house had I used a specialists here in Houston.

Lana

 

[Rob & Harley (GA)]

Thank you so much ladies.

Tonight I shot .2u and will hold it for 7 days.

When I look back (but with PZeyes) I think I see some warning signs. Tell me if I'm wrong, I'm still trying to learn Lantus.

8/21 +3 after PM shot he was rising to an AMPS of 166. Too much insulin?

8/22 both PS's were higher.

 

[Vicky & Gandalf (GA) & Murrlin]

Thank you so much ladies.

Tonight I shot .2u and will hold it for 7 days.

When I look back (but with PZeyes) I think I see some warning signs. Tell me if I'm wrong, I'm still trying to learn Lantus.

8/21 +3 after PM shot he was rising to an AMPS of 166. Too much insulin?

8/22 both PS's were higher.

You mean the 166 and 160 higher than the 147 & 142 preshots the day before?I don't think that's much of a difference. I would have looked at those numbers, including the 89 at +4 on 8/21 and said he was doing excellent on .4U!

It's funny how they can earn a dose reduction. You are lucky that you caught the low, I think often times people don't catch those kinds of lows then wonder where the following days higher numbers came from. You only have 200s as a result today, others see far higher numbers from a low like that. Might be because it was such a small dose that he didn't rebound hard off that LO.

Once this little bounce clears, you should see some good numbers on .2u dancing_cat

That's like 2 drops, isn't it?!

 

[Rob & Harley (GA)]

Thanks Vicki,

Ever since Monday night I have been second guessing myself, going over his ss to try to see if there was a sign that I missed that would have tipped me off.

Hind sight is 20/20 and I wanted to learn from it.

The only thing that I can think of that was different (and it didn't occur to me until I shot him last night) was I shot him in a different spot where the skin is thinner.

 

[Peggy and Mickey (GA)]

I hope Harley is feeling better today!
Was thinking of you guys.

 

[Vicky & Gandalf (GA) & Murrlin]

When you can get a couple mid cycle tests, please do so. His preshots are excellent even though they are higher. I suspect his cycle is not going down very much, which is fine. Until you can get some nadir checks, probably not a good idea to change the dose in any direction.

I'm not sure what you mean by this: "The injection felt thick the last 2 days."

Sometimes injecting a different location can alter BGs a little, better absorption.

Good job!

 

[Rob & Harley (GA)]

Thanks Peggy, Harley is feeling much better and has been more playful lately even with the higher numbers. You stay safe from Irene, I know you will be crazy busy at work, it's probably a good thing you are taking Micky with you.


Hi Vicki, Unfortunately I can't usually get any nadir tests until the weekends, I work about 10 hours a day plus travel time. Sometimes I can go home at lunch to test but the stars need to be in perfect alignment for that to happen. I struggle to stay awake for those +3's. I've tried setting the alarm but I sleep through it.

I can get some nadir tests tomorrow, then you can help me decide which way to go. I want the blue PS's back, whaaaaa!

The injections feeling thick is the thickness of the skin, I try to find the thinest skin to inject for better absorption but sometimes it ends up being thicker than I thought it was and then higher numbers.

Thanks all, hope everyone has a great day.

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Robin, I fully understand not being able to get midcycle numbers. I'm gone 10-11 hours a day too.
Will be interested to see what BGs he has today! Hope you give him plenty o' treats for all the pokies!