HELP - Can't Figure out Correct Dosage - Still High Can I give extra shot in between?

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Sissy's Mom

Sissy's Mom

Member Since 2021
I am at my wits end. I can't get the right dosage. My baby is either yo-yoing or high. Today I gave .75 units of Lantus at 10 a.m., BG was over 500. It came down to 399 but is now at 500+ again - I have a Freestyle Libre inserted. Can I give her a dose in between or should I wait until 10 pm. Also, I've tried to do the curves, but with the yo yo's its impossible. HELP!


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dinc said:
Can I give her a dose in between or should I wait until 10 pm.
Click to expand...
Absolutely DO NOT give another dose of insulin.

More to follow. Just want to get this reply to you urgently.

>>> Please confirm you haven't given an additional dose. <<<


Mogs
.
 
Hi again,

This reply's going to be a little on the succinct side because I'm in the UK, it's after 1am here and I'm not able to stay online to explain things more fully at this time.

It's not possible to say for certain without full dosing information and only a few days of readings what is happening with your cat. That said, and applying very broad principles, it is *possible* (though by no means guaranteed) that your cat may be heading up to higher numbers in response to a drop to a lower number that its body hasn't seen for a long time (cat's system isn't used to running in a good range, thinks the cat is going too low and temporarily increases the amount of glucose the liver releases into the bloodstream - referred to here as 'bouncing').

You will often see here that diabetes management is a marathon, not a sprint. Your kitty's body will need to get used to better numbers and that takes time. You're already seeing quite low numbers (72, 90). With those numbers I would not look to increase the Lantus dose at the moment.

I'm glad to see that you've started up a spreadsheet. That will help us to help you much better. It's not yet visible to us. You need to set the sharing permissions to allow others to view it (directions to follow in a moment).

I'm going to tag one of our members in Australia, @Bron and Sheba (GA), to ask her to keep an eye out for your spreadsheet if she comes online.


Mogs
.
 
To set spreadsheet sharing permission:

* At the top right of the spreadsheet screen click on Share.

* In the pop-up dialog box click on the Get Link section.

* Change link access from 'Restricted' to 'Anyone with the link' and make sure that the permission on the right hand side is set to 'Viewer'.

* Click Done to save the changes.


Mogs
.
 
Here is the link to your first post https://www.felinediabetes.com/FDMB/threads/sissy.243895/#post-2751452
It would be helpful if you could set up your signature
Instructions for it are in the link Wendy sent you in your first thread. It will then appear at the bottom of all your posts and will tell us about Sissy and we won’t have to keep asking you questions.

You mentioned in the first thread that the vet was changing the dose of the Lantus everyday depending on the BG............Lantus like consistency, so by chopping and changing the dose everyday, you will get wonky numbers.
Also you need to have the same dose for the am and the PM dose. Otherwise you will get the same wonky effect.

From the little I can see from the graph, Sissy is responding to the insulin, and she could be bouncing a bit as well.
We need to see the spreadsheet and a few days of numbers before we can really help you.
I’ll look forward to seeing the SS.......OH I can see it now..well done
What type of meter are you using?
Il have a look and get back to you,
 
And the SS is up!

Can you possibly color the columns thats white to the right colors?
It's done manually.
 
This 24 hr SS may help. The units given are aligned a little to the right to the actual time. I have lots more data, but primarily high numbers - based on units my vet was giving me twice a day. Times where units are given are indicated with a U after the time.

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Part of the problem is you are changing the dose all the time. Lantus needs consistent dosing. Here is a guide to the dosing protocols used here for Lantus:

Dosing methods: 'Start Low, Go Slow' and 'Tight Regulation'

The above will give you a better overview of effective dosing of this insulin. Now that you've got a spreadsheet up and running members will be able to give you more specific help you with that side of things.


Mogs
.
 
Are you able to put the writing in black for the 2/26 in the pm cycles +3 please?. It’s white on a lime green background and I can’t see what the BG was?

Looking at the SS I can’t figure out how your vet worked out the doses.
Lantus dosing is based on the nadir or the lowest point in the cycle not the preshot number.
I’ll wait to hear what the lime green number was.
 
SashaV said:
And the SS is up!

Can you possibly color the columns thats white to the right colors?
It's done manually.
Click to expand...
Colored i
Bron and Sheba (GA) said:
Are you able to put the writing in black for the 2/26 in the pm cycles +3 please?. It’s white on a lime green background and I can’t see what the BG was?

Looking at the SS I can’t figure out how your vet worked out the doses.
Lantus dosing is based on the nadir or the lowest point in the cycle not the preshot number.
I’ll wait to hear what the lime green number was.
Click to expand...
Done - lime green number is <60. Her numbers were headed down drastically so I gave her sugar. Not sure how to annotate that.
 
Critter Mom said:
Part of the problem is you are changing the dose all the time. Lantus needs consistent dosing. Here is a guide to the dosing protocols used here for Lantus:

Dosing methods: 'Start Low, Go Slow' and 'Tight Regulation'

The above will give you a better overview of effective dosing of this insulin. Now that you've got a spreadsheet up and running members will be able to give you more specific help you with that side of things.


Mogs
.
Click to expand...
I agree 100%. After reading about FD I decided to take over the dosing myself - vet was changing twice a day based on the high number - which led to drastic lows. I fear I am not doing much better. I, however, am cautious and numbers have been high. From what I've read, Sissy may have adapted to a higher number, so anything a lot lower is not good for her right now.
 
Yes, thanks for changing the colour of the writing..easy to see now.
Re how to put in sugar given ....In the remarks column of that day 2/26 put ....gave sugar as numbers dropping at +3 pm cycle
We normally suggest giving a drop of honey or Karo if the numbers drop below 50 for TR or 90 for SLGS, not sugar.
Do you have your hypo kit set up yet? Instructions in the link Wendy sent you in your first thread.

After looking at your SS and the doses given and the skips and the bounces, I would reduce the dose to 0.5 units for both the am and the pm doses.
Stay with that dose for 5 days to let the depot settle and stabilise and only reduce the dose if the BG drops under 90.

I would also test daily for ketones in the urine if you are not already doing so. You will need a bottle of Ketostix from Walmart or a pharmacy. Collect a urine sample and dip the test strip into the urine and read exactly 15 seconds later against the colours on the side of the bottle. Anything above a trace needs vet attention.

Are you feeding before the shots and giving snacks during the first half of all the cycles? It is better for the pancreas if you are giving snacks as well as the main meals.
If you could write in the remarks column of the SS what food you feed and when eg AMPS LC, +3 LC snack, +5 LC snack etc that would be very helpful for us.

Always test before every dose of insulin to see it is safe to give it.
Post every day and we will watch for your updates.
If you are unsure about anything, post and ask for help.
Bron
 
Bron and Sheba (GA) said:
Yes, thanks for changing the colour of the writing..easy to see now.
Re how to put in sugar given ....In the remarks column of that day 2/26 put ....gave sugar as numbers dropping at +3 pm cycle
We normally suggest giving a drop of honey or Karo if the numbers drop below 50 for TR or 90 for SLGS, not sugar.
Do you have your hypo kit set up yet? Instructions in the link Wendy sent you in your first thread.

After looking at your SS and the doses given and the skips and the bounces, I would reduce the dose to 0.5 units for both the am and the pm doses.
Stay with that dose for 5 days to let the depot settle and stabilise and only reduce the dose if the BG drops under 90.

I would also test daily for ketones in the urine if you are not already doing so. You will need a bottle of Ketostix from Walmart or a pharmacy. Collect a urine sample and dip the test strip into the urine and read exactly 15 seconds later against the colours on the side of the bottle. Anything above a trace needs vet attention.

Are you feeding before the shots and giving snacks during the first half of all the cycles? It is better for the pancreas if you are giving snacks as well as the main meals.
If you could write in the remarks column of the SS what food you feed and when eg AMPS LC, +3 LC snack, +5 LC snack etc that would be very helpful for us.

Always test before every dose of insulin to see it is safe to give it.
Post every day and we will watch for your updates.
If you are unsure about anything, post and ask for help.
Bron
Click to expand...

I was thinking .5 units a.m. and p.m. too, but with her numbers are so high I was concerned she would develop neuropathy. It's a catch 22. I agree with you that stability is needed and will go with the .5. I feed her before shots each time and check her numbers before and after prior to shot. If she doesn't eat, I wait to give or no shot. She eats multiple small meals during the day. Will check on the ketones. She regularly visits the vet - will check if they have tested also. For the hypo, I have karo syrup, honey and high carb food. Thanks for your help. This has been a nerve wracking experience. I am so concerned I'm going to cause her to feel worse than she already does when her BG is too high or too low. Thanks much for your reply. It helps to have advice from people with experience.
 
dinc said:
I was thinking .5 units a.m. and p.m. too, but with her numbers are so high I was concerned she would develop neuropathy. It's a catch 22. I agree with you that stability is needed and will go with the .5. I feed her before shots each time and check her numbers before and after prior to shot. If she doesn't eat, I wait to give or no shot. She eats multiple small meals during the day. Will check on the ketones. She regularly visits the vet - will check if they have tested also. For the hypo, I have karo syrup, honey and high carb food. Thanks for your help. This has been a nerve wracking experience. I am so concerned I'm going to cause her to feel worse than she already does when her BG is too high or too low. Thanks much for your reply. It helps to have advice from people with experience.
Click to expand...
The high numbers are most likely from bouncing because she is dropping low from too much insulin at times.
It takes time to develop neuropathy. Hopefully with a consistent amount of insulin she will settle down to better numbers.
Most newly diagnosed cats take a month or several months to settle down after starting insulin.. A lucky few do it earlier.
Try not to skip a shot. Post and ask for help is you are unsure....make sure your subject line reflects the problem.

I am concerned you said she have DKA in Sissy’s signature, but looking back at your first thread it didn’t mention DKA that I could see. You mentioned pancreatitis and some renal issues. Can you clarify that please as DKA in the picture can chance how we do things. Thanks
 
Bron and Sheba (GA) said:
The high numbers are most likely from bouncing because she is dropping low from too much insulin at times.
It takes time to develop neuropathy. Hopefully with a consistent amount of insulin she will settle down to better numbers.
Most newly diagnosed cats take a month or several months to settle down after starting insulin.. A lucky few do it earlier.
Try not to skip a shot. Post and ask for help is you are unsure....make sure your subject line reflects the problem.

I am concerned you said she have DKA in Sissy’s signature, but looking back at your first thread it didn’t mention DKA that I could see. You mentioned pancreatitis and some renal issues. Can you clarify that please as DKA in the picture can chance how we do things. Thanks
Click to expand...
Corrected signature. No DKA. Thanks for responding.
 
I updated Sissy's spreadsheet with overnight numbers. 375 @ +8.5. Used the .5 dose and will use again this a.m. So so happy it's down a little from those extreme high numbers. To give you a little background, Sissy is a stray found in our backyard. She was/is a little on the feral side - strangers, loud noises make her disappear. We started with an open garage door, then started installing cat doors - one into the garage, one onto the back porch, one to upstairs rec room.

She's also a courageous, smart little girl. Three years ago we evacuated to a town 6 hrs from us to escape a hurricane. On the way back home, someone whose name i can't reveal, but who I'm married to) opened the carrier to check on her and she freaked. Escaped from the gas station where we had stopped to a wooded area across the street. Thankfully, a guardian angel in the area volunteered to help us look for her. 15 yard signs, 20 posters, 3 trail cams, 35,000 views on a paid FB ad, 4 trips back to the area handing out posters, daily calls to businesses (salvage yards, post offices). 35 days after we lost her we got a call from someone who had just fed her. I have never been so happy in my life. One lb. lighter, anemic - she was home. She's been through so much. I don't want her to have any more bad days. That's why this whole diabetes thing has me shaken.

Thanks much for your support. It helps to know others have been in the same boat.
 
Bron and Sheba (GA) said:
Oh my goodness, what a story! I’m so glad you found her!
Click to expand...
By

I was a mess. I've never cried so much in my life. My baby was a brave girl, and smart. She rescued herself by going to a place that fed feral cats. Thankfully we had contacted him at least three times already so he recognized her instantly. Can't say enough good things about the people of Thornburg, VA, where she was lost - the entire town was looking out for her. I stay in touch with some of the people we met.

I'm posting changes to her numbers on the SS, along with comments about eating, etc.
 
Bron and Sheba (GA) said:
great the story had a happy ending!
The 302 @+7.5 needs to be coloured pink not red!
Click to expand...

Revised, thanks. This is where I worry - giving a shot in the past at lower 350s and under has caused a drastic drop. Will wait and see. I usually don't give her a shot under 250 due to extreme drop.
 
dinc said:
Revised, thanks. This is where I worry - giving a shot in the past at lower 350s and under has caused a drastic drop. Will wait and see. I usually don't give her a shot under 250 due to extreme drop.
Click to expand...
The big drops were probably because Sissy was bouncing and then dropping. She is now on a consistent dose and if you are giving snacks during the first half of the cycle and you are testing the BG, you should be fine to shoot if it is 200 or over.
If you get a number lower than 200, stall, don’t feed and test again in 20 minutes to see if the BG is rising...if this happens post and ask for help. You will need to change the subject line to reflect the issue you need help with.
In a couple of days I will get you to start posting over on the Lantus page where there are lots of people who can help you.
Keep asking questions.
 
Bron and Sheba (GA) said:
The big drops were probably because Sissy was bouncing and then dropping. She is now on a consistent dose and if you are giving snacks during the first half of the cycle and you are testing the BG, you should be fine to shoot if it is 200 or over.
If you get a number lower than 200, stall, don’t feed and test again in 20 minutes to see if the BG is rising...if this happens post and ask for help. You will need to change the subject line to reflect the issue you need help with.
In a couple of days I will get you to start posting over on the Lantus page where there are lots of people who can help you.
Keep asking questions.
Click to expand...

Thanks. So how much honey did you give Sheba to stop the rate of descent in BG. And how do you give it? I read to rub on the gums, but the drop was so steep it had no impact. Finally, I gave karo syrup with a syringe (no needle of course). I've also tried giving high carb foods to stop the steep drop - just bought some more with gravy today. No one told me I was going to lose this much sleep. Sometimes she likes to sleep in the garage so I just sleep downstairs and set my alarm if I'm worried about a hypo. Also, no one told me I would have karo everywhere.

If I give karo or honey does that automatically cause a steep increase - I thought honey and karo were short acting?

I so appreciate your patience and help.
 
dinc said:
Thanks. So how much honey did you give Sheba to stop the rate of descent in BG. And how do you give it? I read to rub on the gums, but the drop was so steep it had no impact. Finally, I gave karo syrup with a syringe (no needle of course). I've also tried giving high carb foods to stop the steep drop - just bought some more with gravy today. No one told me I was going to lose this much sleep. Sometimes she likes to sleep in the garage so I just sleep downstairs and set my alarm if I'm worried about a hypo. Also, no one told me I would have karo everywhere.

If I give karo or honey does that automatically cause a steep increase - I thought honey and karo were short acting?

I so appreciate your patience and help.
Click to expand...
If you see the BG dropping, you can feed a low carb food to try and stop the drop. Normally the BG will start to drop at onset...around +2 with Lantus and over the next couple of hours will continue to drop until it reaches nadir...lowest point. I think what you have been seeing has been bounces and then coming off the bounce. Sometimes coming off the bounce BG can drop quite quickly. A normal cycle goes down to nadir and then back up for the next preshot.

So try feeding low carb food first. Keep the higher carb food and honey or Karo for fast drops or numbers under 90.
Honey and Karo is fast acting and should bring the BG up. It only lasts for about 1 to 1 1/2 hours so you need to follow it with some low carb food.
I used to mix a drop of honey with the food. Sheba would eat that.
Hopefully once Sissy settles into this dose the BG will settle down and not go up so high and so low.

Get a +1 and a+2 for a few cycles to see when the onset of insulin is. Then you can give a snack before the onset starts to slow down any drop.
 
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