? Help! Should I give a shot?

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GinnyBarr

GinnyBarr

Member Since 2017
My Kitty was diagnosed just last week. I was advised by someone in the Lantus threads to not shoot under 200. So, I haven't shot since wed morning. These are her numbers since.....4/7 am 123 4/7 pm 145. 4/8 am 139 4/8 pm 146. Now this morning she's at 151. Her highest morning yet. Should I shoot? Should I wait? I'm so nervous.
 
Hi Ginny--

Welcome to Lantus!

Remind me-- it's not on your spreadsheet, but you were giving insulin for a few days before you started testing, correct? Was the dose 1.0U twice a day? it would be good to fill in the spreadsheet with that information, and the tests you've done since then, so that people can see the story at a glance.

Pia is likely to need a little more insulin support, but boy, she is looking good right now! :)
 
Nan & Amber said:
Hi Ginny--

Welcome to Lantus!

Remind me-- it's not on your spreadsheet, but you were giving insulin for a few days before you started testing, correct? Was the dose 1.0U twice a day? it would be good to fill in the spreadsheet with that information, and the tests you've done since then, so that people can see the story at a glance.

Pia is likely to need a little more insulin support, but boy, she is looking good right now! :)
Click to expand...
Yes yes and yes, lol. I'm gonna fill in now.
 
Nan & Amber said:
Hi Ginny--

Welcome to Lantus!

Remind me-- it's not on your spreadsheet, but you were giving insulin for a few days before you started testing, correct? Was the dose 1.0U twice a day? it would be good to fill in the spreadsheet with that information, and the tests you've done since then, so that people can see the story at a glance.

Pia is likely to need a little more insulin support, but boy, she is looking good right now! :)
Click to expand...
Ok. So I find the as a little complicated, lol. Especially on a phone. I think infilled it in. Can you check for me? I'm such a noob.
 
Almost there! I see the BG readings, but not the previous doses (number of units should be marked in the light blue "U" columns).
 
Next question: how much monitoring are you able to do on a typical day/night? If you are mostly working, are there some days where you could, if necessary, monitor all day (like on a weekend)?
 
Right, but the notes say "started Lantus" on 4/3, so I'm guessing she did have shots on 4/3-4/6?

Hmmm, that is tough. I am not sure I am comfortable suggesting a trial dose for today-- the dose should definitely less than 1.0U, but I'd like an expert to weigh in on how much less, and I don't know who else is online right now to do so in time. Given where her numbers are, I don't think I'd suggest having you start insulin on any day but Sunday (or, if you could monitor overnight, the previous Saturday night) because you'd definitely want to be able to monitor her progress at first.

How much time before your preferred shot time? Perhaps someone can weigh in before then, but if not I would lean towards continuing to track her numbers until next weekend, by which time you should have a specific dose recommendation and a plan of attack.
 
Nan & Amber said:
Right, but the notes say "started Lantus" on 4/3, so I'm guessing she did have shots on 4/3-4/6?

Hmmm, that is tough. I am not sure I am comfortable suggesting a trial dose for today-- the dose should definitely less than 1.0U, but I'd like an expert to weigh in on how much less, and I don't know who else is online right now to do so in time. Given where her numbers are, I don't think I'd suggest having you start insulin on any day but Sunday (or, if you could monitor overnight, the previous Saturday night) because you'd definitely want to be able to monitor her progress at first.

How much time before your preferred shot time? Perhaps someone can weigh in before then, but if not I would lean towards continuing to track her numbers until next weekend, by which time you should have a specific dose recommendation and a plan of attack.
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I did start then, but I didn't have BG tester yet. So I was blindly shooting. Her lab numbers were 435. I totally forgot, I can do another curve on Tuesday. I'm off. My preferred time is 9:00. So I'm gonna wait. I'll test every 2 hours today, without insulin. I'll post the numbers. Then on Tuesday, you guys can tell me what to do. My bf will be home with her tomorrow. He doesn't do the shots yet, but he can at least monitor her behavior. She is great. Purring, eating. Her fur seems less greasy too.
 
Aha. Tuesday might be a good day to start with a low dose then-- hopefully someone will be able to suggest a proper starting dose by then. Or, who knows, maybe before then her numbers will have turned decisively in one direction or the other, making the course of action clear!

I don't think you need to test multiple times in a day if she's not on insulin, unless you'd like to get in some testing practice for you or for Pia's ears. :)
 
Nan & Amber said:
Aha. Tuesday might be a good day to start with a low dose then-- hopefully someone will be able to suggest a proper starting dose by then. Or, who knows, maybe before then her numbers will have turned decisively in one direction or the other, making the course of action clear!

I don't think you need to test multiple times in a day if she's not on insulin, unless you'd like to get in some testing practice for you or for Pia's ears. :)
Click to expand...
Ok. I'll wait for more ppl to respond. Ty :)
 
Hello & Welcome.

Can you add a couple of things to the SS to help make it clearer for people offering advice? Can you add NS (for No Shot) in the U column so people will know you didn't give the shot. Also, you may want to add why in the Notes column. For example, Unable to monitor so didn't give shot.

I think getting some extra tests in today will give us an idea of what dose to suggest. Maybe every 3 hours instead of every 2 hours. It's especially important to get a test around mid-cycle (+5 or +6) to see how low Pia goes. Dosing is based on the nadir (lowest number in the cycle).
 
carfurby said:
Hello & Welcome.

Can you add a couple of things to the SS to help make it clearer for people offering advice? Can you add NS (for No Shot) in the U column so people will know you didn't give the shot. Also, you may want to add why in the Notes column. For example, Unable to monitor so didn't give shot.

I think getting some extra tests in today will give us an idea of what dose to suggest. Maybe every 3 hours instead of every 2 hours. It's especially important to get a test around mid-cycle (+5 or +6) to see how low Pia goes. Dosing is based on the nadir (lowest number in the cycle).
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Ok. Will do. She hasn't had a shot since wed morning. I'll do everything 3 hours.
 
carfurby said:
I know she hasn't had a shot, but it is still good to see what her numbers are without any insulin in her system. That will help us decide what dose to suggest when you are able to monitor. Thanks for updating the SS.
Click to expand...
Ok. I updated it some more. I added in the remarks. Ty.
 
You might also add in the NS for the afternoon cycles. Were there any days when you did give a shot? Even without any tests - if so, putting in the dose on those dates may be helpful.
 
Djamila said:
You might also add in the NS for the afternoon cycles. Were there any days when you did give a shot? Even without any tests - if so, putting in the dose on those dates may be helpful.
Click to expand...
Ok. I updated the ss. If you wouldn't mind when yo have a free second to make sure I'm doing it right. It would be much appreciated.
 
Now that the spreadsheet has been filled in, I can see that the 65-75 were midcycle on a day when there had been a 1.0U shot in the morning. I don't know why, but I'd been thinking they were much longer after the last insulin shot. This makes me feel much more confident about re-starting insulin safely-- looks like that 1.0U dose was actually doing a great job, at least on that day!

I'm going to go ahead and tag @Marje and Gracie on this-- I know she's not on currently, and usually she has a ton of tags to answer because she's quite popular :), but when she does get back on, she is one person who I think could either give you advice on a starting dose or else rope other folks into the discussion, if the question hasn't been answered by that time.

Marje, thanks for any help you can offer, and here's a quick recap: very recent diagnosis, shot 1U Lantus bid for a few days without testing, started testing and has gotten sub-200, and mostly sub-150, pre-shot numbers ever since for the past several days. Newbie and limited monitoring ability on most days mean that we've been advising no-shoot on those numbers, but it's clear that there will be a need for some insulin since numbers without insulin are blue, not green.

So, the question is, what will be an appropriate (re-)starting dose, and when should she start?
 
Nan & Amber said:
Now that the spreadsheet has been filled in, I can see that the 65-75 were midcycle on a day when there had been a 1.0U shot in the morning. I don't know why, but I'd been thinking they were much longer after the last insulin shot. This makes me feel much more confident about re-starting insulin safely-- looks like that 1.0U dose was actually doing a great job, at least on that day!

I'm going to go ahead and tag @Marje and Gracie on this-- I know she's not on currently, and usually she has a ton of tags to answer because she's quite popular :), but when she does get back on, she is one person who I think could either give you advice on a starting dose or else rope other folks into the discussion, if the question hasn't been answered by that time.

Marje, thanks for any help you can offer, and here's a quick recap: very recent diagnosis, shot 1U Lantus bid for a few days without testing, started testing and has gotten sub-200, and mostly sub-150, pre-shot numbers ever since for the past several days. Newbie and limited monitoring ability on most days mean that we've been advising no-shoot on those numbers, but it's clear that there will be a need for some insulin since numbers without insulin are blue, not green.

So, the question is, what will be an appropriate (re-)starting dose, and when should she start?
Click to expand...
So she just tested 104 at the 9 he Mark :)
 
Bwahahah! I'm telling you, one way or the other, she's going to do something decisive about this while we dither!

C'mon, Pia, how about a little more green on that spreadsheet???
 
I'm not Marje, but will give it a try. These numbers, while good, are still diabetic. A diabetic cat in remission is described below:
REMISSION:
From Tilly's Diabetes Homepage, Phase 5: Remission

14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible.

Test the cat's BGs once per month.Approximately 25% cats that achieved remission using this protocol relapsed and required insulin again (frequent causes are hyperthyroidism or bouts of pancreatitis). Therefore, it is important to keep your diabetes kit up-to-date. Then you can react immediately by giving insulin and home testing. Importantly, the sooner you react to a relapse (i.e. preventing hyperglycemia and initiating other necessary veterinary treatment), the more likely a second remission will become.

The longer a cat has had diabetes, the less likely it will go into remission. Many long-term diabetics get stuck in Phase 3 or 4. Yet there is a benefit of using this method for such a cat as well: keeping the cat's BG levels as normal as possible is much healthier for it long term. Insulin requirements will often decrease to very low levels too."


Glycemic Status and Predictors of Relapse for Diabetic Cats in Remission
​
That info is on both the Tight Regulation Protocol and Start Low Go Slow stickies.

I do think you need to restart insulin. We know that the strongest remissions occur - and I'm sure you want it to stick once you get her there - when insulin support is given as long as Pia will tolerate it. She will tell you when she is done because her blood sugar will drop below the reduction point on her dose. Usually the best success is when the dose is held until the cat "earns" a reduction by dropping below the reduction point, then the dose is reduced by 0.25u and held until it occurs again. The dose reduction we would typically follow would go 1.0u to 0.75u to 0.5u to 0.25u to 0.1u. It's not uncommon for people to stop the dose at a larger amount, like you did at 1.0u, but when a cat is being hometested adequately, it's safe to keep reducing the dose to 0.1u as I described above.

Is Pia eating any dry food at all?
 
julie & punkin (ga) said:
I'm not Marje, but will give it a try. These numbers, while good, are still diabetic. A diabetic cat in remission is described below:
REMISSION:
From Tilly's Diabetes Homepage, Phase 5: Remission

14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible.

Test the cat's BGs once per month.Approximately 25% cats that achieved remission using this protocol relapsed and required insulin again (frequent causes are hyperthyroidism or bouts of pancreatitis). Therefore, it is important to keep your diabetes kit up-to-date. Then you can react immediately by giving insulin and home testing. Importantly, the sooner you react to a relapse (i.e. preventing hyperglycemia and initiating other necessary veterinary treatment), the more likely a second remission will become.

The longer a cat has had diabetes, the less likely it will go into remission. Many long-term diabetics get stuck in Phase 3 or 4. Yet there is a benefit of using this method for such a cat as well: keeping the cat's BG levels as normal as possible is much healthier for it long term. Insulin requirements will often decrease to very low levels too."


Glycemic Status and Predictors of Relapse for Diabetic Cats in Remission
​
That info is on both the Tight Regulation Protocol and Start Low Go Slow stickies.

I do think you need to restart insulin. We know that the strongest remissions occur - and I'm sure you want it to stick once you get her there - when insulin support is given as long as Pia will tolerate it. She will tell you when she is done because her blood sugar will drop below the reduction point on her dose. Usually the best success is when the dose is held until the cat "earns" a reduction by dropping below the reduction point, then the dose is reduced by 0.25u and held until it occurs again. The dose reduction we would typically follow would go 1.0u to 0.75u to 0.5u to 0.25u to 0.1u. It's not uncommon for people to stop the dose at a larger amount, like you did at 1.0u, but when a cat is being hometested adequately, it's safe to keep reducing the dose to 0.1u as I described above.

Is Pia eating any dry food at all?
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Zero dry food. 2-2.5 cans of FF pate only. So I should still wait? Ty for all that info.
 
And how much are you able to test? Can you test before shots and get one test in before you go to bed? I saw you said on Sundays and Tuesdays you can test more often if needed.

I'm thinking the Start Low Go Slow guidelines might be best for you if you're not able to get much in the way of testing. Have you read this SLGS sticky?
 
Ginny, 2 more questions.

1. In your signature line it says that she "switched" to all wet diet. Was she eating dry when diagnosed?

2. Also, it says she's a chubby monster, lol. Does that mean that she needs to lose some weight? Obesity is the #1 cause of diabetes in cats, and it would be good for her to get to a normal weight. Cats can develop a fatty liver (hepatic lipidosis) where their liver literally clogs with fat if they lose weight too quickly, so it must be done slowly. Exercise also makes the cells more receptive to insulin, which lowers blood sugar.

Some people have super lazy cats who won't move, so they might even carry the cat to the far side of their home and put them down. Then the cat has to walk back to the food bowl. Cats only eat a couple hundred calories per day, so even getting them to move some can help. There is great information on how to help a cat lose weight on www.catinfo.org. That site is operated by a vet.
 
Yes. Sundays and Tuesdays would be the only days I could do all day. I work very long hours all of the other days.

She was eating about 3/4-1c of dry indoor and half a can of wet a day. Sometimes no wet. I always knew it was too much, but I wouldn't actually feed her that, she eats from the other cats bowl. I have moved the other bowl so she can't get to it, but the other cat can. She was almost 19lbs when I took her last week. Now she eats almost 2 full cans of FF wet. She's doing great with the switch, but definitely eating less, as she prefers dry.
 
Take a look at the link to cat info about how to safely let her lose weight. Fat increases insulin resistance. She doesn't have too far to go to have her blood sugar in normal range, so making the switch to the canned food, helping her lose weight slowly, increasing her exercise - all of those might be enough to help her get into remission.
 
Nan & Amber said:
Now that the spreadsheet has been filled in, I can see that the 65-75 were midcycle on a day when there had been a 1.0U shot in the morning. I don't know why, but I'd been thinking they were much longer after the last insulin shot. This makes me feel much more confident about re-starting insulin safely-- looks like that 1.0U dose was actually doing a great job, at least on that day!

I'm going to go ahead and tag @Marje and Gracie on this-- I know she's not on currently, and usually she has a ton of tags to answer because she's quite popular :), but when she does get back on, she is one person who I think could either give you advice on a starting dose or else rope other folks into the discussion, if the question hasn't been answered by that time.

Marje, thanks for any help you can offer, and here's a quick recap: very recent diagnosis, shot 1U Lantus bid for a few days without testing, started testing and has gotten sub-200, and mostly sub-150, pre-shot numbers ever since for the past several days. Newbie and limited monitoring ability on most days mean that we've been advising no-shoot on those numbers, but it's clear that there will be a need for some insulin since numbers without insulin are blue, not green.

So, the question is, what will be an appropriate (re-)starting dose, and when should she start?
Click to expand...
Thanks, Nan for the info and the vote of confidence :) Julie and I are chit chatting about it but we both are thinking 0.5u. We are hoping that dose will bring her nadirs down into green but still allow you, Ginny, to shoot every 12 hours.

What would you think about that, Ginny?
 
Marje and Gracie said:
Thanks, Nan for the info and the vote of confidence :) Julie and I are chit chatting about it but we both are thinking 0.5u. We are hoping that dose will bring her nadirs down into green but still allow you, Ginny, to shoot every 12 hours.

What would you think about that, Ginny?
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I'm comfortable with that. I can't monitor her tomorrow, but my bf will be home all day. What should her numbers be in the morning in order for me to shoot 0.5u? Or should I wait til Tuesday. I'm home all day.
 
Good.....Julie and I both believe that is a reasonable restart dose considering all things.

You might want to test at +11, if possible and see where she is.

Can your boyfriend test and feed? If so, I would suggest shooting anything over 150 at AMPS with 0.5u as long as he can test and feed and he has plenty of supplies.

If she's below 150 at normal shot time, don't feed her but post and ask for help. Be sure the subject line says something like
4/10 Pia +96 xxx restarting insulin need help shooting

where xxx is her BG.

How's that sound?
 
Marje and Gracie said:
Good.....Julie and I both believe that is a reasonable restart dose considering all things.

You might want to test at +11, if possible and see where she is.

Can your boyfriend test and feed? If so, I would suggest shooting anything over 150 at AMPS with 0.5u as long as he can test and feed and he has plenty of supplies.

If she's below 150 at normal shot time, don't feed her but post and ask for help. Be sure the subject line says something like
4/10 Pia +96 xxx restarting insulin need help shooting

where xxx is her BG.

How's that sound?
Click to expand...
Ok. I can give her the shot, but my bf can't BG test her, so should I wait til Tuesday?
 
If it were me, I'd wait until Tuesday or (if you can monitor during the night) tonight.

Did you get an AM BG number this morning? I don't see one on the spreadsheet.
 
OK, yeah. That would have been a stall-- don't feed and post for help-- situation anyway. With no monitoring ability on the day, I think unless she went way up after the stall you wouldn't want to shoot.
 
Nan & Amber said:
OK, yeah. That would have been a stall-- don't feed and post for help-- situation anyway. With no monitoring ability on the day, I think unless she went way up after the stall you wouldn't want to shoot.
Click to expand...
So she was 157 tonight. Should I fast her before the morning test?
 
You don't want to fast overnight, but we do recommend trying to keep the two hours before test time free of food, so that the pre-shot number isn't food-influenced.

All ready to re-start shooting this morning? :)
 
Nan & Amber said:
You don't want to fast overnight, but we do recommend trying to keep the two hours before test time free of food, so that the pre-shot number isn't food-influenced.

All ready to re-start shooting this morning? :)
Click to expand...
She just ate. I didn't read this first. I'm gonna test her an hour later than usual. 10:00. Is that ok?
 
When did she eat? And are you OK with a 10am-10pm shoot schedule? If you need to be on the earlier schedule, I'd just go ahead with testing at the usual time, and noting that it's food influenced.
 
Sorry if that wasn't clear: if you test now after she's had a meal, unless it's right after the meal (within 30mins), the numbers may be affected so the rules for shooting will have changed. I think in this case I'd still advise shooting as long as she's reasonably high, just because today is the day you can monitor and otherwise we'll have to delay re-starting insulin until the next Sunday, which isn't ideal. But it does depend on what "reasonably high" looks like.

When you get a pre-shot number, start a new thread for today (include a link back here for history), and if you need help put the number and your question in the subject line. I am going to be offline for the next couple of hours, a new thread will get some new eyes.
 
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