? HELP PLEASE!! 50.4 at 4 hours post shot!

Rosanna and Harvey

Rosanna and Harvey

Member Since 2018
Hello!!
I gave Harvey his 2u of lantus at 1830, tested at 2030 88.2 and now 50.4 (2.8mmol/l) at 4 hours...it's 2300 here, not sure if I should stay up and keep an eye on him or just embrace the nice green numbers?
He's okay, a little quiet but he had a meal at time of insulin and then a small meal at 2030...? I'm attempting to start TR...?
 
The dosing is not what we usually follow on this site with the different am and pm doses, but we can tackle this later.
He's had a relapse on the 12th april so that is just 4 days ago and looking at the ss it seems that today is cycle 6 of insulin.

I would give him a regular carb snack now and check him at +4.5 see if he is going to drop below 50.
 
Yes I was a bit worried that the 2units was too aggressive so given last time he only ever needed 1.5 so was a bit worried this morning but given he didn't go below 100 from the 1.5 figured 2 would be okay :|
 
Ideally you should have held the starting dose for at least 6 cycles, but more usually 5 to 7 days,

From the dosing methods sticky if you were to be doing TR

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.

Lantus takes a while to build so it is not unusual when starting a dose for it to take at least a week for you to see what it will really do, by taking the dose up and by flip flopping with dose it can lead to wonky numbers because every time you change the dose the depot has to re stabilise and that affects the amount of insulin available in the blood stream.

Not to worry though we can get you both back on the straight and narrow. But I am a little worried that by taking the dose up from 1 to 2u that you may have missed a good dose and she is potentially overdosed.
 
Have you got HC to feed him should you need it? Syrup or honey?

This is from the handling low numbers post http://www.felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/

So you can refresh yourself on what you need to be prepared to do should he drop below 50. I've linked the sticky above so you can take a some time to refresh yourself with the rest of that.

If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)
  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If numbers have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus, Basaglar, and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.
 
Yes, it was the vet, when I spoke to them and reported that his numbers were still high with not a great curve they said to increase to 2 since he was eating well and his toileting was fine, he also had ketones at the vet so I didn't want them to come back (I've been checking his wee with diastix). I thought I'd pull him back to 1.5 this morning just to see if that was better/just as effective. I really didn't want to leave him consistently with BG's over 17 to reduce the risk of glucose toxicity.
 
Rosanna and Harvey said:
when I spoke to them and reported that his numbers were still high with not a great curve they said to increase to 2
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With Lantus I would have said that the curves you were getting were promissing given that the depot hadn't filled yet and you weren't seeing the full effect of the dose.
If he was on an in out insulin then you might say that you needed to up the dose, perhaps the vet is more used to dosing that type of insulin. Additionally, I would agree with you doubling the dose after just three days was pretty aggressive.

You may have a long night ahead of you, sorry.
 
He was borderline DKA and dehydrated (It's a long story but essentially he went into the vets post being hit by a car, discharged home, then I took him back in with BGL of 19 as he hadn't had anything over 5 in well over a year) given this relapse was likely triggered by the trauma I'm not sure if he's going to pull out of quickly since he's now calm and I've taken away the 12% carb food.
He is having fancy feast (low carb) now with ziwi peak (12% carb) mixed in.
Wee is clear of ketones now.
 
Rosanna and Harvey said:
It's a long story but essentially he went into the vets post being hit by a car, discharged home, then I took him back in with BGL of 19 as he hadn't had anything over 5 in well over a year) g
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OMG poor guy.

Rosanna and Harvey said:
He was borderline DKA and dehydrated
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Guess that might be why he was being more agressive with the dosing.
Hopefully if he's feeling better at home, not stressed, DKA will be less of an issue, especially if he is eating, drinking and getting some insulin.
 
Rosanna and Harvey said:
He's up to 3.2 (57.6) now and only just finished eating but I'll keep checking :)
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That's good, if he's only just finished eating, the numbers are probably him just levelling out.
But yep defo keep an eye on him.
Are you OK if I leave you for a while, I can check bacck in in an hour or two. I've got my dogs to walk and cats to feed. Hubby can do it, but we usually do it together.
 
Rosanna and Harvey said:
Thank you thank you thank you for your replies :) :)
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You are welcome.:kiss:

I'm not to what to suggest regarding dose, given the history, but I do think 2u is too much. I feel that it could land you in trouble once the depot is full.

I'll ask some other folk to take a look at the dosing and see what their thoughts are.
 
I'm thinking I'll take him back to 1.5 tomorrow morning, and hold that consistently until our vet appointment on the 22nd unless he's sitting in the purples a lot? I don't have the proper 0.5 syringes (they're hard to get in Australia and international shipping is taking so long in the current situation), but I can eyeball 1.5 quite well with what I have.
 
Rosanna and Harvey said:
I don't have the proper 0.5 syringes (they're hard to get in Australia and international shipping is taking so long in the current situation), but I can eyeball 1.5 quite well with what I have.
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Given that you were so late in your PM cycle I did wonder if you were in Australia, that is a bummer about the syringes.

I think there is a template that you can use to help you measure the 0.25u but don't quote me on that:oops:
 
Wendy&Neko said:
The link to your previous post here, for continuity: http://www.felinediabetes.com/FDMB/...9-8-first-day-ss-worried-about-dosing.228330/

As I had mentioned there, enter your blood sugar values, such as 4.7, into the World tab on the spreadsheet. It will do the automatic conversion to the US numbers for you.
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Thanks Wendy, that doesn't seem to work for me and still comes up as the 'world' numbers, it's easy enough for me to convert though and then I use an app to track all the Australian numbers. :)
 
Rosanna and Harvey said:
Thanks Wendy, that doesn't seem to work for me and still comes up as the 'world' numbers, it's easy enough for me to convert though and then I use an app to track all the Australian numbers. :)
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Can you please send me a PM about the SS? I’ve not had anyone at all have any issues with the World SS not working. I can fix it for you so you don’t have to convert the numbers. If it’s not working, than it’s because the formatting has gotten totally deleted on the US SS. Again..an easy fix. Just PM me, please.
 
Here is the link to the site in the UK that will send out 1/2 unit syringes to Australia. It may take a bit longer than normal but I think you will find them very useful and worth while getting. Most people find they take 7to 10 days so it would probably be a bit longer than that ATM
This link is to the actual syringe you need.
https://www.hyperdrug.co.uk/BD-Micr...03ml-pack-of-100/productinfo/BDMICROFINE03ML/
 
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Rosanna and Harvey said:
Oh am I only supposed to write questions underneath my original thread? Sorry!!
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No. You can start a new thread when you like
We like to link threads. I added this thread so that people could see the whole story. It is much easier than trying to go back through all the posts looking for a particular post. If they are linked it is much easier.
 
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Hi Rossana,
Did you really shoot 2u again??
I really think that is too much for Harvey.

I know the pink must have been a shock, but in all honesty, not surprising given the steep drop last night we would expect a bounce, and if you fed HC last night then that would have contributed to the pink.
Have you tested again after that 99, he may not be done dropping?
Also that sharp drop of more than 200 points in this mornings cycle may well set him up for another bounce.

With lantus being a depot insulin if you endup overdosed with an overfull depot it can be a really hairy experience, trying to fight the numbers, which may result in him having to end up in ER on a glucose drip.

Trying to knock the high amps numbers down with a higher dose, is a technique that works well with a fast acting, in out insulin, but not advisable with the depot insulins. If your vet advised to stick to the 2u it may be that he/she is more used to dealing with the in/out insulins than with dosing depot insulins, the methods are different.

You must be into your pm cycle by now.... hope all is well
 
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