Help! do i give the next insulin dose or not? still so new

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Knotty dee and Jaxon

Knotty dee and Jaxon

Member Since 2012
Hello,

My Jaxon Cat has had difficulty regulating his blood sugar. we started insulin injections Aug 20, 2012 1 unit of lantus twice daily. now we are up to 3 units twice daily. I am doing a blood glucose curve today and his blood sugars were the following. FYI we are in Canada...
8am 16.8
10am 18.1
12pm 13.3
2pm 9.4
4pm 6.6
6pm 3.4

His next dose if insulin is scheduled at 8pm. i am going to do his blood sugar again before i give him the insulin. however, i am worried that if his sugar is lower or still around 3.4 that the insulin will send him too low. Should i still give the insulin or wait for awhile and continue to test his blood sugar.

Please help!

Thank you,

Knottydee and Jaxon Cat
 
Re: Help! do i give the next insulin dose or not? still so n

Those are pretty good numbers :smile: If the bg is under 11 mmol at insulin time, do not give any insulin. You do not want to risk a hypo. Your cat will be fine tonight with an insulin shot if you skip it. You may want to get a few more bg tests in tonight to see how low your cat goes before numbers go up again.

Reposting your numbers so they make more sense to members:

AMPS 16.8 (302) 3 units Lantus
+2 18.1 (325)
+4 13.3 (239)
+6 9.4 (169)
+8 6.6 (118)
+10 3.4 (61)
 
Re: Help! do i give the next insulin dose or not? still so n

I agree. No shot if under 11. Not without lots of data showing what could happen.
You said you started on 1u BID on 20 August, and now you're up to 3u BID. Can you tell us how those increases were done? Were they based on "curves" run at home? What sort of numbers have you been seeing at nadir time along the way?
Is Jaxon on an all-canned low-carb diet?

Carl
 
Re: Help! do i give the next insulin dose or not? still so n

Thank you squeem3,

this is the first time that we have had numbers that low. The highest he has had since we started insulin and testing was bgl of 28.0 on sept 16, 2012. Do i skip this dose and resume at next dose time if he is below bgl of 11.0? He has only recently ( Sept 20, 2012) was increase to 3 units twice daily. to me this dose seems high? but i really don't know.
 
Re: Help! do i give the next insulin dose or not? still so n

Knotty dee and Jaxon said:
Thank you squeem3,

this is the first time that we have had numbers that low. The highest he has had since we started insulin and testing was bgl of 28.0 on sept 16, 2012. Do i skip this dose and resume at next dose time if he is below bgl of 11.0?
Click to expand...

Only give insulin if the bg is OVER 11 mmol.

If you skip insulin tonight, you can resume tomorrow IF the morning bg number is over 11 mmol which is most likely will be but do check to be sure. I'm not sure if you should give 3 units tomorrow, though. More experienced Lantus users will be along soon to advise on that.


He has only recently ( Sept 20, 2012) was increase to 3 units twice daily. to me this dose seems high? but i really don't know.
Click to expand...

3 units isn't terribly high, IMO. Some cats need that much insulin before they need dose decreases.
 
Re: Help! do i give the next insulin dose or not? still so n

Hi Carl,

yes i can tell you how the increases were completed. We do in home blood glucose testing which was recommended by our vet. Jaxon started injections of 1u BID on Aug 20 at 5pm. We completed a random test 5 days later at 5pm and he was bgl of 11.4. On August 30 we completed a curve at home and had the following results

8am 22.7
10am 23.7
12pm 23.6
4pm 20.2
6pm 20.3

the vet was contacted and increased the dosage to 2 units BID on Sept 4, 2012 8pm. Sept 7 random bgl of 21.4 at 5pm. Sept 15 pre-insulin bgl of 21.8. On Sept 16, 2012 we completed a 2nd curve at home the results were the following:

pre-food/insulin 8am 28.0

10am 22.7
12pm 22.0
2pm unable to get a reading
4pm 20.6
6pm 21.3
8pm 19.1 (pre-food and insulin)

On Sept 16, 2012 i switched Jax to an all wet food low carb diet.(he had been eating an 80% protein 20% fruits and veg diet) i found the carb calculator and found that his dry 80/20 food had 18.5% carbs from potato and sweet potato. His food was switch prior to the 8pm reading of bgl 19.1

On Sept 17, 2012 i checked bgl pre insulin/food at 8am 13.2 and 4pm of 18.7. Sept 18 8am bgl 13.6 8pm 18.3.

On Sept 19, 2012 the vet increased his dosage to 3 units BID based on the curve from sept 16 and i informed her of the lower levels since the food change. She still wanted to go ahead with the increase. I completed an 8pm bgl this day 16.1

Sept 22, 2012 random test @ 4pm 9.8
Sept 26 pre insulin/food 8am bgl 18.7
Sept 27 pre insulin/food 8 am bgl 22.3 7pm bgl 7.1(insulin given)
sept 28 pre insulin/food 8 am 19.6 8pm bgl 10.7 (insulin given)

October 1 today was curve day:

AMPS 16.8 (302) 3 units Lantus
+2 18.1 (325)
+4 13.3 (239)
+6 9.4 (169)
+8 6.6 (118)
+10 3.4 (61)
 
Re: Help! do i give the next insulin dose or not? still so n

The dose isn't terribly high. Are you testing both before you shoot and at other points during the cycle? Lantus dosing is based on the lowest point of the cycle -- not on your pre-shot test numbers.

There's a great deal of information about Lantus and dosing in the starred sticky notes at the top of the Lantus board. The information contained in those notes is summarized below and there are links to the posts.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Roomp and Rand and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
 
Re: Help! do i give the next insulin dose or not? still so n

UPDATE!!!

8pm BGL of 2.9 insulin NOT given. Jaxon is eating his dinner now and i will continue to check levels until i go to bed tonight.

I appreciate all of the help and anyone else has suggestions on Jaxon's treatment i really could use the help! :razz:
 
Re: Help! do i give the next insulin dose or not? still so n

Sienne and Gabby,

i had not been testing before regularly until i did some reading on here. The vet had told me just to do random testing specifically at his known lowest points. I now test bgl before both dose times. but this is the first time since starting insulin that his levels have been low or close to "normal"
 
Re: Help! do i give the next insulin dose or not? still so n

Wow, so his BG continued to drop? Definitely no shot tonight.

Thanks for giving us all those numbers. Based on the curves you've done, I can understand your vet recommending that you increase the dose. HOWEVER - the increases were based on just the one-day curves. If you read the info that Sienne linked you to, you'll see that the protocol used by most Lantus users here includes getting BG tests in between shots every day, not just once a week. If you look at just about any SS kept by people here you will see that people get at least 3 tests a day, some people get a lot more than that. They also hold a dose for a specified number of cycles, and then looking at all of the data gathered over the course of several days, they determine whether an increase or decrease is indicated. That way, it isn't based on a single curve (you can't know for sure, the curves you got may have been Jaxon's "normal" curve, but he also could have just been having a bad cycle during that 12 hours).

The other thing, and I figured when I read that you had gone from 1u to 3u, that the increases were not as small as recommended by the protocol. We advise increases or decreases in .25u increments (occasionally as much as .5u at a time), but never in full unit increments. Several reasons for that.... one, when you go from 1u straight to 2u, you are doubling the daily intake of insulin. That can be risky. There's also a good chance when people increase by that much at a time that you will bypass a "good dose". For instance, what if the "right dose" had been 1.5u? You would have skipped right over it and not known it. It could be that Jaxon's "right dose" is 3u, or even higher, but most kitties don't seem to ever need that much insulin, or if they do, they get up to that level a lot more slowly.

No, 3u is not terribly high. But it might be too high for Jaxon nonetheless.

Tomorrow morning, you will most likely need to give him some insulin. Can you post the numbers you get between now and then here? We'll try to make sure that someone checks for your posts in the morning in case you need any advice on dosage. You said you're in Canada.... which time zone are you in?

Carl
 
Re: Help! do i give the next insulin dose or not? still so n

Hi Carl,

I will post more bgl on this post tonight and in the morning. I am in Canada yes, Central time i do believe.

I have tried reading the tight regulation protocol when i first joined the board but i admit i couldnt really understand it. I will read again and see if i can get more from it.

Thank you again for the help. I just want the best for my jacker man!
 
Re: Help! do i give the next insulin dose or not? still so n

UPDATE


Jaxon's bgl 8.0, 1 hour after eating dinner and 1 hour passed skipped dose of insulin.
 
Re: Help! do i give the next insulin dose or not? still so n

Most of that increase is probably from dinner. To us this is a 144, which is still a fantastic number an hour after eating.

The TR protocol, and all the stick threads in the Lantus forums are an incredibly large amount of information to absorb. Ask any questions as they come up. A lot of people here use the protocol, and they can help you out. Digest this stuff in small pieces. :smile:

Carl
 
Re: Help! do i give the next insulin dose or not? still so n

UPDATE

Jaxon's bgl 8.8 2 hours after dinner and 2 hours after skipped insulin dose
 
Re: Help! do i give the next insulin dose or not? still so n

Still a nice number. With Lantus, you have some residual effect from previous shots (the "depot" you may have read about). With skipping, his numbers shouldn't drop back down, they may stay fairly steady or rise slowly. It's not like a shorter acting insulin that gets all used up and is gone from the system 12 hours or less later.

If you see an increase by the morning, it'll be due to a couple of things. One, no insulin for 24 hours. But more likely, you might see his body's reaction to having pretty low BG numbers today. They weren't scary low, but they were lower than he's used to since becoming diabetic. That can cause his body to dump "glucose" and counter-regulatory hormones as he instinctively tries to raise his BG levels to what his body thinks of as "normal". Sort of a confusing concept, but it's what we call "bouncing" if you run across that term in your reading.

Carl
 
Re: Help! do i give the next insulin dose or not? still so n

UPDATE

Jaxon's BGL is 25.1 this am pre insulin/food 3 units of lantus will be given
 
Re: Help! do i give the next insulin dose or not? still so n

Nice catch on the lower numbers - whew!

Most folks here set up a handy spreadsheet to track their numbers. Then we link it in our signatures so anyone attempting to give dosing advice can easily get to it and look it over when questions arise. Here are the instructions on how to set it up. It is pretty straightforward, but please ask if you need some help.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Sounds like we can help Jaxon and support your efforts if you'd like to regularly post over on the Lantus boards. Honestly, I'm not sure if there's a special board for Canucks, but C'mon over to Lantus Land!!
 
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