? Help - dosing for BAILEY

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Hello Dana, and welcome :)
I just read your other post on the Health forum. Bailey is so cute!
When are you leaving for your trip? I wish you the Best Of Luck in getting a great cat sitter that can test and shoot on schedule. Hopefully, someone who can stay at your house to monitor how your kitty is doing with his insulin.
I looked at your spreadsheet, and it looks like you are adjusting the dose by the PS (pre shot) test numbers. That is how some of the non-depot insulin doses are adjusted. Lantus works best with consistent dose amounts given every 12 hours, and the dose is adjusted (in most cases) according to how low the insulin is taking your cat's blood sugars, and that low point (nadir) would normally happen around 5 to 6 hours after the shot was given.
Who has been guiding you to change the dose around so much? If you're going to be around this weekend, maybe you can do a curve and then see more data about how low he is actually going on the insulin.
 
Well, it started with my vet having me shoot without testing. We started at 1 unit, she retested on her end, moved to 2, retested, moved to 3. And you are exactly right, I am adjusting based on the pre-shot value because I am rarely around at +6 so I don't want him to go hypo. Both times I've done curves have coincidentally been low days. So I've stuck with the 3 units, except when the pre-shot number is low and I've reduced. Those are the situations I don't know what to do with. And he was at 3 units for at least a month before I started home testing. So I moved up to 3.5 to try to get his numbers down, overall. So, shorter answer to your question is, I haven't really had much guidance. Which brings me here!
 
Welcome! We can help you. :) First step: go have a look at the yellow Lantus/Levemir info stickies listed at the top of this forum's page. It seems that SLGS would be easier for you so focus on that. Come back here with any/all questions you have.
 
Thank you! I've actually read it multiple times. What I'm still confused about is what to do when the preshot value is low. So right now I'm at 3.5 units. If I do a preshot and the value is 88, for example, I'm still supposed to give him 3.5 units? Even if I'm not going to be home?
 
danam531 said:
Thank you! I've actually read it multiple times. What I'm still confused about is what to do when the preshot value is low. So right now I'm at 3.5 units. If I do a preshot and the value is 88, for example, I'm still supposed to give him 3.5 units? Even if I'm not going to be home?
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The key is accumulation of a lot of BG data so you can refer back to how he responded in the past. With a PS of 88 you can stall 20 minutes without feeding and retest to see if BG is rising. If it is you can likely give the usual dose because Lantus is slow in onset. By the time you've fed and given time for the insulin to take effect the usual dose wouldn't likely cause a huge drop. However, DATA rules! That's why we advocate setting up a spreadsheet like to one we use here. It's viewable by all members and is the first thing we look at when offering advice.

If you aren't going to be home you can leave out higher carb food if you're worried. Again, tracking data will allow you to see how he responds in the dosing situations.
 
danam531 said:
Thanks! I actually did post the link to my spreadsheet in the post.
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Oops! I usually look for that link in the signature area - the light grey text you see under our posts. If you could set up your signature (look in the menu under your name upper right on this page) it would allow us to find it right away. Other info to include in your signature:
  • Bailey's age and date of diagnosis
  • other health issues or meds he has
  • insulin used and whether you're on TR or SLGS
  • meter you use.
 
Looked at your SS. As others have said we recommend consistent dosing for Lantus. How long you hold a dose depends on whether you follow TR or SLGS. If SLGS it would be held a week. I suggest you pick a reasonable dose and try SLGS for a while, get those very important weekly curves done and go from there. Lantus dosing is decided based on how low the BG goes, not on the pre shot BG. You need those mid cycle numbers. Maybe try 2 u? I'm basing that suggestion on the curve data I see.
 
Hi again.

Are you able to get any midcycle tests say a +1:+2,
Or a +10, +11?

If you are able to get a couple of tests in each cycle as well as your ps then it is feasible to do TR, another great sticky for you to read is the one on doing tr on a full-time job.

In answer to your question on whether to shoot when you get a low ps, is a difficult one to answer, whether you shoot or not depends on many things.
1) how you arrived at the dose, ie are we sure that the dose is not too high
2) can you monitor, have supplies to keep kitty safe.
3) are you data ready to shoot
4) are you doing g TR or slgs, slgs you wouldn't shoot below 90, but on TR most of us gradually get to shoot anything above 50 once we are data ready and we know our kitties cycles, when they inset, nadir and what duration they get.

You are not data ready to be shooting low for now, and I would say that when you do shoot a number that is lower than you have previously it's advisable that you should be able to monitor.
 
Looking at the question of dosing, with your limited data and if you are unable to get those midcycle tests in with your schedule I think that the 3.50u might be a touch too much insulin. I keep looking at that 87 the other day (that would have earned you a reduction to 3.25 on SLGS)
Ideally you want to find a dose that you are able to shoot consistently, I see that you went with a 2.5u this morning since he was in blue. Looking back at what numbers you have 3u was getting him into blue so I might be tempted to take him back to that and see if that enables you to dose more consistently.

You're doing a great job getting those PS in, so glad you decided to start testing. Though I gather it's difficult to get tests in the am cycle, do you think you would be able to always get a before bed test? Any spot checks possible at any time in either cycles??
eg George would get shot at 7am/7pm schedule, and as I rarely go to bed before 11pm that meant I was always able to get at least a +4, and if push came to shove and I needed to I would get a +5, that was close enough to his nadir that it meant that more often than not I could get to bed and get a decent amount of sleep.
As testing during the day is difficult, if you are able to regularly get some pm cycle tests in, those will help build up a general picture of what sort of cycles he's getting and can be more informative than a once a week curve. Grabbing spot checks when you can will help build that picture and get you data ready to start shooting those lower numbers with confidence, so if you are home from work early, grab a +9 +10, if you are heading out to work later than usual, then grab a test as you head out the door, on days off, grab tests at times when you are not routinely able to, think of the ss as a puzzle, you are trying to build a picture scattering the tests at different times of day helps you see the picture more clearly.
I don't know what times you are shooting at, but sometimes adjusting the shot time can make it easier to grab those spot checks

Here's a link to the TR on a full time job,
http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/
Though it's intended for TR the tips are still useful even for slgs.
I've sent a message out for some veterans to come take a look at your ss, see what they think about the dosing, so hopefully you'll get some other opinions.
 
I'm not sure about the dosing either, is hard to say since you have been changing the dose too much, (totally understand it since my vet even now still asks for the am result and not the rest of the day, he was very accustomed to other types of insulin). But the thing is that Lantus is a "depot" insulin, so actually some of the insulin you inject kind of stays in the body for a little bit longer than the 12 hours, so when you change the dose from one shoot to another, for example you shoot 3u at nignt even if in the morning you just shoot 2 u at least part of the original 3 are still having an effect, that is why protocols tell you to stay with the same dose for a few cycles (unless he goes too low because that means automatic decrease ) so that you can really know how his body is acting with that specif dose how many cycles will depend on the protocol you choose.


Hopefully one of the very experienced can help

I too work full time so I went for the SLGS protocol but to be able to fill in the blanks what i did was try and get a +2 or +3 at night before going to bed, that also gave me an idea if he was not going to low which in Babu's case was important since he was a diver ( liked to go down a lot ) , this besides helping me keep him safe during the night (him diving meant be prepared for a long night awake ) also helped me know at least a little how would he behave with that dose next day when I was away (usually his numbers would be lower at night than they are during the day ) and I tried to test him as much as possible during the weekends, even more than the curve, if I could I would keep testing saturday and sunday
 
When you have a chance, can you update your spreadsheet with all the numbers you got this weekend? Also, adding your spreadsheet to your signature would be most helpful, so we can just click on it with every post and not have to search for it. Thanks.
Good luck with the new dose. Post if you need help or have questions.
 
Thanks for updating the ss. Dyana is not on the board today, her kitty is having a procedure, but she will sure appreciate the update.
:bighug::bighug::bighug:
:):):)
The skip last night (good call by the way), will hopefully have drained the depot.
Now you want to try and hold the dose, (unless he drops below 90) in which case you would be looking at another reduction. You've not said, but for the moment, unless you say otherwise, I'm making suggestions based on SLGS, as I gather that it may be difficult for you to get the sufficient number of tests to make following TR possible.

Because you've skipped a shot, and because he went low, he may run a little higher than you like, try to not get frustrated by it, he may be bouncing, from that 58 (that's when the liver panics because BG has dropped to a level that is lower than kitty has been used to, and this results in glucose being dumped into the bloodstream, nothing you can do about that, it will pass, but it can last up to 6 cycles/3days, so don't be alarmed by higher than normal numbers, you need to keep those patience pants on), additionally the depot will have drained, and it can take a while to refill, that's when you will see the true effect of the dose, until then numbers may run a little higher too, we usually consider that it can take up to 6 cycles for the depot to settle and adjust after a dose change, so again patience is required, as we like to say here, it's a marathon, not a race.

I like that you got a +2 last night, if you can continue to grab a test then, if you go to bed later than a +2, then a before bed test will be very helpful, especially if you are out all day at work and can't grab any tests in the morning cycle on a routine basis.

Paws crossed for safe surfs.
 
Hi there,
How's bailey doing g?

I thought you were running a curve today?

Just wanted to ask if you are able to get any tests in other than amps and pmps??

You need to try and figure out how low he is going, with some of those blue ps I am wondering if he is going lower than you are catching.

Did you shoot this morning?
 
Hello! @rhiannon and shadow (GA) - no, I didn't skip a shot, I filled that in now. My mistake! @Gill & George I wasn't able to do a curve because I have been out taking care of my ill parents, unfortunately. traveling this week and will get to do one on Friday. My spreadsheet is updated through this morning and I'm pretty nervous about whether or not I did the right thing. His PS was 110 and I still shot the 3 units. I think that's what I'm supposed to do....I'm just a little nervous because, well, it's Mother's Day, so I'll be headed out shortly. Will check again before I leave but just looking for some reassurance :)
 
Thanks. I left him with food, made sure he ate before I left. I will be home 12 hours from his first shot.
 
Hi sorry I wasn't around earlier, hope you had a nice day, sounds like you have a lot on your plate, good job getting that +2 this morning.

danam531 said:
His PS was 110 and I still shot the 3 units. I think that's what I'm supposed to do.
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We usually recommend that if you shoot lower than you have previously, that you are available to monitor the first half of the cycle.

That +2 being the practically the same as ps suggests an active cycle, theres an example of an active cycle in the new to the group sticky.
Your instinct to feed him something at +2 and leave food out was good, in a similar situation I might have left out higher carb food than he usually gets ( I can't remember now what he eats, perhaps you could add that to the signature).
He is running fairly low, which is what we aim for, but with the limited midcycle data I might have erred on the side of caution this morning, feeding higher carb to bolster his numbers as you were not going to be there to monitor.

Stay safe Bailey
 
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