Having trouble with insulin dosage, really need some input

[Michele M]

I posted this in the main health forum and thought Id post a copy here too. Any thoughts would be helpful


HI
Crushy was diagnosed last month with Diabetes. The vet started him out with 2 units twice a day and his #s were still in the 300s, we tried 3 units for a while, and we spent some time chasing his numbers around with different doses. HIs BG #s just seemed to be all over the place. I decided to hold at 1 unit twice a day to see if he would level out. Its been almost 2 weeks on that dose and his # still keep going up and down. All the BG tests Ive done are in his SS in my signature (as well as the link for basic info on him.

He's been raw fed for the last 10 years so there was a lot of surprise when he turned up diabetic.

I was going to try to do a curve today. Hopefully that will shed some light.

I just dont know if this is normal, abnormal, an indication that something else might be wrong, or that something needs to be changed! Im very new to this. My vet wants higher doses (and he was the one who suggested chasing his BG #s with different doses) but his #s have hit some low points. And from what Ive gathered on this list its better to start low and go slow. I was waiting for his #s to level out but they are just NOT doing that!

I did just start giving his shot in the side and not the scruff of the neck in the last 2 days....not sure how much of a difference that actually makes, but his BGs #s shot into the 400s

I got an automatic feeder to try to give him smaller meals throughout the day but Im not using it for meals because he hasnt figured it out yet (it doesnt make any noise when it opens) Ive put treats in it but every time I try to show him that it opened he thinks it was me that just gave him a treat. He'll figure it out...Im just not ready to put his main food in there till he does.

any thoughts welcome

Michele

 

[Ann & Tess GA]

Re: Having trouble with insulin dosage, really need some inp

Here's the link for your Health condo so others can see what had already been said.

I agree that a slight increase would be a good idea. We use the .25 increments so you don't bypass a good dose. It is amazing on how much difference such a small amount can make in a cat. Here's a good discussion on using calipers to measure the dose. Have you read through the stickies (permanent starred posts) at the top of this forum? They give a lot of infer on using Lantus. If not read the Tight Regulation Protocol first. It explains the guidelines we use for increasing and decreasing doses.

So after you increase hold the dose for at least 6 cycles (3 days), see where you are and adjust the dose if needed. Lantus is a depot insulin, it builds up a reserve in the body which is slowly released. Every time you change the dose that reserve needs to readjust and numbers can fluctuate wildly during this period. It often takes up to 3 days. Changing the dose again too soon just starts the whole erratic numbers thing up again.

Someone mentioned feeding in the Health condo, but no link. What are you feeding and how often?

 

[Michele M]

Re: Having trouble with insulin dosage, really need some inp

Here's the link for your Health condo so others can see what had already been said.

Have you read through the stickies (permanent starred posts) at the top of this forum? They give a lot of infer on using Lantus. If not read the Tight Regulation Protocol first. It explains the guidelines we use for increasing and decreasing doses.

So after you increase hold the dose for at least 6 cycles (3 days), see where you are and adjust the dose if needed. Lantus is a depot insulin, it builds up a reserve in the body which is slowly released. Every time you change the dose that reserve needs to readjust and numbers can fluctuate wildly during this period. It often takes up to 3 days. Changing the dose again too soon just starts the whole erratic numbers thing up again.

Someone mentioned feeding in the Health condo, but no link. What are you feeding and how often?

I have read the stickies and the guidelines for increasing and decreasing the dose. The advice I was getting was to hold the dose for several cycles until his numbers leveled out a bit. He seemed to be bouncing a lot. But its been two weeks and what we thought was bouncing never stopped. Hence the confusion.


He is raw fed, twice a day. evening meal is 1/3 cup (~2.65 oz) mix of ground chicken, ground liver and ~7% cooked butternut squash. Morning meal is 1.75 ounces of frozen mice. He has been on this diet for years and the vet said not to change it. I do think its probably good to switch it so each meal is the same though (ie some ground raw mixture + some mice) He also gets .75 oz of treats during the day with shots and BG checks (uncured cooked bacon or dehydrated beef, no carbs)

His food info is also in his profile in my signature.

I have an automatic feeder but Im still trying to get him to understand that it opens on its own. It doesnt make a noise. He is starting to get it somewhat. Ill start breaking up his meals and feed him through the day when he catches on a little better.

Michele

 

[Wendy&Neko]

Re: Having trouble with insulin dosage, really need some inp

Hello Michelle and Crushy and welcome to Lantus Land. I agree with Ann that it's time for a dose increase of .25 units. Here's the part of the Tight Regulation Protocol that applies, and I've highlighted the section that applies:

"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.

You have held the 1.0 dose for for than the 7 days and Crushy hasn't earned a reduction. So it's time to increase the dose by .25, because he has seen a number under 200. We don't hold doses until numbers level out a bit, because for some cats (like mine) I'd be waiting forever. :roll: Instead, we look at the nadirs that the cat is getting and make our dosing decisions based on that. Some cats like to bounce (like mine) and most cats will bounce a bit at the beginning. It's hard, but try to ignore the bounces, they will get better as Crushy spends more time in normal numbers.

One thing you'll often hear about feline diabetes, it's a marathon, not a sprint. It will teach you patience.

 

[Michele M]

Re: Having trouble with insulin dosage, really need some inp

We don't hold doses until numbers level out a bit, because for some cats (like mine) I'd be waiting forever. :roll: Instead, we look at the nadirs that the cat is getting and make our dosing decisions based on that. Some cats like to bounce (like mine) and most cats will bounce a bit at the beginning. It's hard, but try to ignore the bounces, they will get better as Crushy spends more time in normal numbers.

One thing you'll often hear about feline diabetes, it's a marathon, not a sprint. It will teach you patience.

aha!! this is where I was confused! thank you!! I thought you held the dose until he leveled out. ohmygod_smile I think I definitely have a bouncer!

Michele

 

[Sienne and Gabby (GA)]

Re: Having trouble with insulin dosage, really need some inp

There are a couple of observations...

It looks like before you switched to 1.0u, you weren't shooting any one dose consistently. Lantus likes consistency! Unless a cat that's within a year of diagnosis drops below 50, you typically hold the dose for 6 cycles/3 days. You then evaluate the dose and if nadirs are over 200, you would increase by 0.25u. If below 200, you would hold the dose a bit longer. Letting a dose settle for 3 days and doing your best to shoot at the same time, 12 hours apart, will help you to have good results with Lantus.

With regard to bounces, you do not want to increase a dose if a bounce is breaking. When a bounce breaks, numbers may drop. If you increase the dose at the time the bounce is breaking, there can be a good deal of momentum and if you're not experienced with steering your cat's curve with food, it can be rather unnerving. So, particularly when you're new to this process, we give bounces a good deal of respect.

 

[Michele M]

Re: Having trouble with insulin dosage, really need some inp

There are a couple of observations...

It looks like before you switched to 1.0u, you weren't shooting any one dose consistently. Lantus likes consistency! Unless a cat that's within a year of diagnosis drops below 50, you typically hold the dose for 6 cycles/3 days. You then evaluate the dose and if nadirs are over 200, you would increase by 0.25u. If below 200, you would hold the dose a bit longer. Letting a dose settle for 3 days and doing your best to shoot at the same time, 12 hours apart, will help you to have good results with Lantus.

I shoot at the same time every day and Yes Im aware that Lantus likes consistency. When I was giving him inconsistent doses I was working off the advice of my vet and it was before I found this List or had done any reading on Lantus.

With regard to bounces, you do not want to increase a dose if a bounce is breaking. When a bounce breaks, numbers may drop. If you increase the dose at the time the bounce is breaking, there can be a good deal of momentum and if you're not experienced with steering your cat's curve with food, it can be rather unnerving. So, particularly when you're new to this process, we give bounces a good deal of respect.

What do you mean when the bounce is breaking? are you talking about when the #s are going down and before the bounce has gotten to its lowest point? Im new to this process but Ive never seen this cat NOT bounce. All the BG readings Ive ever taken on him are in his SS.

Michele

 

[Marje and Gracie]

Re: Having trouble with insulin dosage, really need some inp

Michele

Welcome to you and Crushy to LL! We have a close knit group with lots of members willing to help and support you and Crushy.

You understand what a bounce is correct? It's when Crushys liver responds to either a fast drop in numbers or getting to a lower BG then his body is used to (it doesn't have to be a low number...just lower than he's used to). The liver releases counterregulatory hormones and glucagon and brings the BG back up what the body deems as normal. It takes up to 72 hours for the bounce to clear which means for those counterregulatory hormones to quit affecting the BG. Crushy was clearing a bounce on the w.m. Cycle of 8/31 and it looks like he cleared overnight on the PM cycle of 9/3.

When they clear the bounce, you can see where the nadirs actually are. It's good you raised the dose tonight!

Let us know any questions you have.

 

[Lkldcatlady]

Re: Having trouble with insulin dosage, really need some inp

Hi Michele! Welcome to LL! I just stopped by to say hi. I don't really give advice, I just absorb it! :lol: There are a lot of really experienced people on this site, so I'm sure you will get some good advice. I have discovered they know a lot more than my vet on the treatment of diabetes.

I think you are the first person I've noticed who feeds their cat mice. Ewwwwwwwwwwwwww!!!! :shock: I think it's great because it's what they normally eat, I just can't get over the thought of it though...heebie jeebies! Are they whole frozen mice or is it mushed up?

 

[Michele M]

Re: Having trouble with insulin dosage, really need some inp

You understand what a bounce is correct? It's when Crushys liver responds to either a fast drop in numbers or getting to a lower BG then his body is used to (it doesn't have to be a low number...just lower than he's used to). The liver releases counterregulatory hormones and glucagon and brings the BG back up what the body deems as normal. It takes up to 72 hours for the bounce to clear which means for those counterregulatory hormones to quit affecting the BG. Crushy was clearing a bounce on the w.m. Cycle of 8/31 and it looks like he cleared overnight on the PM cycle of 9/3.

I understand what a bounce is but Im not that great at recognizing them yet I guess! Thanks for pointing that bounce out. It makes a little more sense looking at it now.

I think you are the first person I've noticed who feeds their cat mice. Ewwwwwwwwwwwwww!!!! :shock: I think it's great because it's what they normally eat, I just can't get over the thought of it though...heebie jeebies! Are they whole frozen mice or is it mushed up?

lol they are frozen. They're white mice, the kind you would feed to a snake or reptile. You can get them mashed though! (for some reason I thought that was a lot grosser than the whole frozen ones though, lol)

Its not something I jumped into easily or quickly. I was struggling with a raw food diet for my three cats for years. My cat Spikey had a bunch of allergies to different foods I was trying and between that and not being able to find any kind of heart muscle in my area for a taurine source (for reasons I cant remember now I didnt want to use a taurine supplement) I ended up with mice. Mice are freakishly high in Taurine (cats MUST have taurine in their diet or they run into all kinds of problems) There is also a lot of different vitamins in the various organs of whole prey like the liver, kidneys brains etc. that I was trying to replicate by adding supplements to their food (b vitamins etc.) After a while It seemed SO much easier to just toss them a mouse and not worry about it.

The cats love them too. They go absolutely bonkers over them.

There was a huge gross out factor for me when I first started, but you just kind of get used to it. It was a bit sad at first too because I actually think mice are cute. I felt bad for them. But the company I buy from euthanizes them very humanely and I figure for a mouse their lives are not so bad really.

but yea I get your eeewww reaction! I dont tell many people I do this, lol.

Michele

 

[Ann & Tess GA]

Re: Having trouble with insulin dosage, really need some inp

WOW! on the mice, I never thought of that! My Emma would be in heaven, but there is the gross factor! :shock: