Help with Dose/Numbers

Status
Not open for further replies.
N

nam1026

Member Since 2013
Ok so tomorrow will be 2 weeks since I started giving 1 unit of Lantus 2x day. I've been checking her BG 1x day alternating between before her 2nd shot and about 2-3 hrs after the 2nd shot. I had some BGs in the high 100's a couple times but last few days have been 300-400. So last night I upped her dose to 1.5 units. I'll check it later today and see how she is going. I'm supposed to bring her into vet next week for another run of Fructosamine which was close to 600 3 weeks ago. She has put some weight back on after losing 2 lbs and seems to be feeling better but is finicky with food. I have to put tuna on practically everythign to get her to eat it, even with heating it up. She likes Authority the best. I have CRF cats too so I'm buying food that meets both requirements-mostly Authority, Wellness, Newman's, Halo and Hi Tor Neo. Of course she likes the cheap crappy food best.

I'm going to try and test the nadir tomorrow when I'll actually be home for it but it seems her numbers are getting worse instead of better.

Thanks.
 
Hello Deb,

I don't use the same insulin as you but I understand that Lantus dosage is worked out according the the nadir numbers.

Can I just check that I've understood you correctly about when you are testing..?
Are you saying you are doing one test a day? Alternating between testing before the evening shot, and testing 2 hours after the evening shot? (It is important to test before each shot (sorry if I've misunderstood you...))

If you're not getting nadir numbers then we don't know how low the current dose is dropping her. And there is a possibility that she is dropping low and then swinging up high (bouncing).
It would be great to have some more data about how she is responding.

Eliz
 
That is correct. I leave for work at 6:30am and I'm not home again until after 5. Getting 3 cats to eat in the morning and shooting her with insulin as well as getting myself ready and lunch packed in the am is stressful enough. I just cant' deal with testing BG too. So I test when I get home-yesterday I did manage to test before the shot and 3 hrs after the shot, but I have not been home to test the nadir. I will try and do that tomorrow. Each time I test BG results in 3-4 pricks so I'm not comfortable testing her more than 1-2x day. As it gets easier maybe I will. I didnt' even know if I would be able to test her at all. She can be quite difficult.
 
Hi Deb,

Well done for learning to test, it sounds like it hasn't been easy for you, but it does get easier - I promise you!

I'm hoping some experienced Lantus users will see this thread soon and be able to help you (I use a different insulin). But I do believe dosage adjustments for Lantus are made according to the nadir number. So, maybe it would be prudent to wait to get a nadir number tomorrow before increasing the dose..?

Sometimes, what looks like too little insulin can actually be too much. That probably sounds daft, but both of those can cause the blood glucose numbers to appear high.

It may well be that Suki does need more insulin, but without knowing the nadir numbers it's not possible to tell...
If too much insulin is given then the cat's blood glucose can drop too low, and the body responds to that by pushing glucose out into the bloodstream as a protective measure. So, sometimes all the care-giver sees is the high numbers and assumes that more insulin is needed, when in fact less is needed.... (If that makes sense...?)

Eliz
 
Hi Deb,
I am a Lantus user. I encourage you to visit the "Insulin Support Groups" section of the site and then click the "Lantus Tight Regulation" page. At the top of the page, you will see several posts that provide basic information about using Lantus, watching the nadir, and understanding the Lantus insulin depot (Lantus is stored in the body and dose increases or decreases are not usually manifested in the blood glucose levels for a few days). The information will really help you!

For now, I would say that you should do a curve soon to test for the nadir. Perhaps this weekend, like you said. Once you know the nadir time, for the rest of the week you can just check the BG around the nadir time instead of doing it every two hours. But if you can't test during the day, test at least twice per day - once before the AM shot and once before the PM shot. This will give you a good idea of how the dose is being tolerated.

As for a difficult tester, my cat was not easy at first. But when I started using the lancet pen, it was MUCH easier. You only prick once and it's quick! See this video...
http://www.youtube.com/watch?v=nG_vhQzvL10

When I test, I always put my cat on my lap while sitting in the same chair in the kitchen every time. If you test BG in the same spot at the same time every day, even the most difficult kitty gets used to it (especially if they get to eat afterward!). Our furry friends like their routines!

For now, I would not increase the dose until you do a curve. Also, please check out the Lantus page and read all the great general info about Lantus.

Also, some of the food brands you are feeding are not low carb. For a full list of low-carb cat food, see the list below. I have had the best luck with 1-2% carb foods (anything above that would raise my cat's BG too much) but try different foods and see what works for your kitty...
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=94685

Best of luck to you!
Jess
 
wow I was choosing all foods <10% carbs-I thought that was low carb-I also need them to be 1% and less for phosphorus for my kidney cat-that is a problem

My concern the using the pen is the noise-she already startles when I prick her and sometimes smears the blood which of course means I have to prick her again.

I did already up her dose last night and this am-what should I do now? I will try and do a BG every 2 hrs tomorrow if she will allow it.
 
We recommend under 10% but some cats do better on lower numbers. Its what works for your cat.

Lantus is dosed based on the nadir - because it works on a curve and the pre shot number if the highest number of the day. You don't want to increase the dose based on pre shot because thats the highest number of the day. And increasing dose will bring the lowest number (nadir) down too - maybe too low depending on what the nadir is.

How about
6.30am test shoot feed
6.30pm test shoot feed
8.30 or 9.30 or 10.30pm test - before bed test is always useful because if its less than the 6.30pm test you might want to set your alarm for a mid night test as this implies an active cycle!

Then mid cycle spot checks would be useful too.

The ears learn to bleed over time. It does get easier.
Wendy
 
Hi Deb-
The noise of the lancet pen is more like a click and it doesn't bother my cat at all. I usually hold a folded napkin on the other side of the ear when I use the pen (I poke the outside/furry part of the ear but see what works for you) to stabilize the ear and create a firm surface for the pen to go through. It does take time for your cat to get used to it. Mr.Cat ran away, shook his head, and did all kinds of feisty things in the beginning. He used to hate ear testing, but I just kept going (I also scratched his favorite chin spot afterward and he would start purring immediately). Rewards afterward are key. :-D

I agree with the posts here. Testing twice per day (at least) is a good start. And definitely switch to low-carb food ONLY when you are home testing regularly. Lowering carbs can cause your insulin dose to drop pretty quickly, so keep an eye on your kitty during the switch. You want to avoid a hypoglycemic event from over-dosing insulin.

As for the dose, the folks here recommend that you stick with the same dose for at least one week before raising the dose. Now that you are at 1.5U, you might as well stay there for the week and see how it goes. If the BG goes below 40 at any time, immediately lower the dose .25U.

There are several low-carb brands with low phosphorous. Don't worry, you can find one that meets all your kitties' needs. Hang in there! :-D
 
Ok well we will see how it goes checking every 2 hrs tomorrow. I have only been feeding wet food now to all my kitties using the food chart and only feeding food that meets less than 10% carbs and close to 1% phos. Her preshot tonight was better than last night-over 400 last night and high 200s tonight so I'm hoping the 1.5 units is better but I'll try and do curve tomorrow and see. Thanks everyone.
 
That's great. Let's see how your curve goes this weekend.

Also, it would be great if you could set up a spreadsheet. Folks here are very knowledgeable and supportive but without a spreadsheet, they can't really advise dose increases or decreases without seeing the overall picture. For help setting up a spreadsheet, go to this page....

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0

Your cat's spreadsheet link will go in your signature line. You can see my signature line below that says "Mr.Cat SS" If you click on that, you will see my cat's spreadsheet with all the numbers. That is what we would like you to have.

Also, can you tell us a little bit about your cat? My signature has the basic information that everyone wants to know, cat's age, weight, when diagnosed, what food you give, what meter you use, etc. A photo of your furry friend is also nice. :-D

Welcome to the forum!
 
Got some work done on my sig but the spreadsheet will have to wait til I have some time next weekend. I can't seem to get an image small enough to post on here.

So I've been doing BG every 2 hrs today-not looking good and not much change throughout day.

6am AMPS 256
8am +2 230
10am +4 213
12pm +6 207
2pm +8 217
4pm +10 218

She has eaten probably half 5.5 oz can of Authority Chicken and half 5.5 oz of Authority Catfish today. I'll be doing PMPS in 1/2 hr or so. She has been at 1 unit sx day for 11days and at 1.5 units since Thurs night.
She seems a bit lethargic today, but maybe i'm paranoid cause I know her BG has been high all day.
 
Great job on the spreadsheet and excellent curve yesterday! Please continue to test before the AMPS and the PMPS so we know where your kitty starts before you shoot. If you have a low pre-shot number, you may have to hold off or check the BG at +2 and +3 to make sure you don't get too low.
The 300+ at today's +6 is a surprise. But it's just one number so let's see what the PMPS number is.

Great job so far and hang in there!
 
wait so that curve was good? I thought it was bad cause it was all in the 200's and there wasn't much of a drop in numbers. This is so confusing!

Thank you so much for the help!

When I checked her BG at +6, I poked her ear once from the inside of the ear and was waiting for the blood drop when I realized she was pouring blood out the backside! I felt horrible-I went thru the ear!
 
I apologize for not explaining what I meant. ;-) When I say the curve looks good, I meant that you did a good job checking every few hours and also it was a steady curve (numbers not all over the place) so it was easy to see where the nadir is. No, the 200's are not great, but the curve was nice and round which is helpful in determining where the nadir is... and that's important!

If you are testing with a lancet pen, you may want to check the number on the pen (it is usually 1 - 4). That number gives you the depth of the needle. If it is set to 4, you may be going too deep. My cat does fine at 3 and it doesn't go all the way through. But every cat is different so give 3 a try and if it's too deep, go down to 2. I have tried 2 on my cat and the needle is too shallow (doesn't get much blood). Don't worry about going all the way through - it happens. Just make sure to pinch the ear between your gauze/napkin for a few seconds after collecting the sample. It will help keep bruising down and will stop the bleeding immediately.

Keep up the good work! :-D
 
The curve was a good one.
Flat yellows sometimes come before an active cycle. You might have missed some lower numbers last night. I don't mean dangerously low, just lower than Suki's body is used to right now.
That pink may be a bit of a bounce from a blue or even a green.
Try to get those pre-shot tests. They are very important. You don't want to shoot insulin blind.

Now we can see how quickly or slowly Suki comes down from that pink.



Edited: sometimes I got a wonky number if a blood sample was too big. And more than a few seconds passed before I got the sample to the strip.
I always hated getting those big blood drops because mine would shake her head before I got to it and splatter blood everywhere.
 
So she didn't have an active cycle.

An active cycle is where they can drop and you need to monitor more.
A flat yellow cycle can sometimes indicate an active cycle.
Also... if there is a sizeable drop from your pre-shot number to your +2 number, that can indicate a possible active cycle.

The first time you shoot a lower number ( 200 on main board) , you would want to get a +2 ....
you are collecting data to learn how your cat responds. ( Each cat is different)

As you collect more data, you can help your cat stay in a lower range.... numbers between 50- 120 ( on a human meter) are healing numbers for that pancreas.
 
Your dose has been 1.5 u.... for 13 cycles.

Other than the day you did the curve, your testing is minimal ( imho)
I think you should go with the 0.25 increment increase and not jump up by 0.50 u increment. You might miss the breakthrough dose.
And I would love for you to be getting those pre-shot tests. Especially if you are increasing the dose.
On the main board, we would tell you to ask for help the first time you shoot a number less than 200.

You might already have done that without knowing it.

It's hard to feel comfortable telling you to increase if you aren't going to monitor, especially if you decide to increase the dose.
I myself, am barely comfortable with just the pre-shot tests and one other test during each cycle. ( a cycle is every 12 hours- thus am cycle and pm cycle)

I was one to test more than the minimum ( twice a cycle) .
 
I got some more today-unfortunately wasn't home for Nadir but numbers aren't changing much at all-staying in the high 200s.
 
oh sorry-I did get nadir-I was thinking +8. so my nadir today was 279 which was only 4 lower than the amps.
 
Pretty flat numbers. I'd suggest bumping the dose up another quarter unit, to 1.75U. We sure would like to see Suki in those blue or even green numbers.
 
I feel awful-this is why I hate taking her BG. I was just checking her +4 and since yesterday she won't stay still for me-all of a sudden-she was being so good before this. Well she whipped her head and her ear is completely torn and my finger is cut and her ear won't stop bleeding. I feel terrible. Of course I don't want to check it again today. Her numbers dropped a good amount with the 2 units though.
 
Sounds like you were using the lacet freehand. I tore my Gray Ghost's ear at the beginning when he moved and I was using the lancet freehand. I now use the lancet pen. My bathroom like like a crime seen with all the blood.
 
Yes I was. I just tried the lancet pen. Worked ok-just hard to see if you are getting right spot-I ended up shooting too far inside the ear.

So her PMPS is 197. This is the first we have gotten in the 100's since the first week on insulin. Am I ok to go ahead and shoot 2nd shot of day?
 
I would say yes but I would wait for others since you are not getting consistent BG and this mornings dose was the first at 2 units.
 
I took another 45 min later and its 245 so I went ahead and gave 2nd shot at 2 units.

It does feel like sometimes on this board, you can be made to feel guilty if you aren't taking 5 BGs day, and I really don't think that is right. My vet told me not to stress over it taking BGs at home at all-we would just base the dose on fructosamine-that most of her clients don't do BGs at home. So I feel like with all the BGs I've taken over the last 3 weeks and entered into a spreadsheet, I'm doing great and to tell people that are taking 2-3 BGs a day its not consistent or minimal is really discouraging. Honestly it makes me want to leave this board. I know everyone here has a lot of experience and that is great, but you shouldn't criticize people who can't do 5 BGs day for whatever reason.
 
Hi Deb,
We've had numerous debates about approaching those asking for help . The last thing any of us ever want is to scare someone away.
Everyone here is volunteering their time.
We do it because we've walked in your shoes and we want to help you just as someone helped us.

Our hope is for new folks to do at least the preshot test and one more test each cycle. ( a cycle is ever 12 hours)
Some of us test a lot. Some don't.
It is often determined by the bg numbers, the lower the number, the more frequent the testing.
But also in the beginning when you don't know how your cat responds to insulin yet, those numbers are feedback. It's the only way we know how the cat is doing.


My own vet told me the same thing.... and she was only seeking " regulation" for my cat's diabetes. (as most vets are)
Regulation is trying to get the bg numbers in the 200's all the time.
She told me that most clients are not willing to do much for their pets. They want to give a shot ( some don't even want to do that) and walk away for the day.
That is the type of client that vets are used to.
And we here, have witnessed many people accidentally overdose their cat because they weren't monitoring and solely listened to their less involved doctor.
The vet isn't going to help you 24 hours a day. But we will.
They tend to tell you to shoot an amount and we'll check in a few weeks. Sometimes it doesn't matter, but sometimes it does. It makes us all cry to see
that happen.


I wanted better than that. I wanted to get my own cat to remission. And because of all the experienced kind people here, I managed to be one of those
lucky ones.
Many of us here treat our diabetic cats just the same as we would a human child. We monitor and respond to what our cat needs and adjust the insulin.
You can't just pick a dose and stay with it.
I personally feel that vets who tell their customers not to monitor are playing Russian roulette with the cat.
The other reason they do this is because that's the way it's done with Canninsulin. ( dog insulin) It is much different than Lantus.
With that insulin, you give a shot and it wears off in a set amount of hours.

Lantus does not work that way and many vets don't seem to know that because they give advice just like your vet is giving.

I hope you will stay around and learn more and join our community.
We could actually create a signature for you ( at the bottom of your page ) that says " I am testing as often as I can" :smile: ;-)
 
I side with yo that sometime caretakers here recommend too much BG testings. I consider it a must to measure BG before each show and infrequently in between shots. Just this Tuesday, my Thunders preshot BG was only 45. However, At the beginning you need to take more in between BGs. I myself only take BGs between shots if my cats (I have four diabetic cats) act strange or I get an abnormal BG before a shot.
Regarding not stressing the cat, I have been BG testing my Patches at least twice a day for about eight years. She does not get stressed out.
 
As an advice giver I always recommend 3-4 tests a day but I am not sure I explain why sufficiently. Really it's for two reasons, mainly to keep the cat safe, but also to see how the dose is working.

Having had a cat have a hypo, and having known many newbie cats having had one, i am always worried about keeping the cat safe, like most of us here. We don't want anyone to feel guilty but at the same time, it's hard to say in writing how important testing is, when some vets seem a bit blasé about the whole thing. But some vets are out of date and don't consider remission, or the impact of a food change. My sister in laws vet said don't test, here's some insulin,and change the food to wet. The cat had a hypo a week later and didn't make it even though my sister in law rushed it to the same vet and spent over $1000 trying to save it... after having spent another $1000 on an insulin curve a week earlier. And that's not an uncommon story. And I blame her vet for that.

Anyway I agree with Larry and I think everyone says preshots are a must, because you don't want to shoot if your cat us too low.
And a mid cycle test is to check the insulin isn't taking the cat dangerously low. And this test also tells you how the dose is working.

However if your goal is remission or a tight regulation then a bit more testing is needed to really catch that low.
Wendy
 
Adding to what has already been said... I saw two different vets at the same clinic that have totally different ways of treating diabetes. One said that we didn't need to test at home and the other said he preferred home testing, if pet owners can and are willing to do it.

For the first little while, until you get comfortable with everything, you are likely to feel guilty about a lot of things and question if you are doing things correctly. It's hard to go from having a lazy, independent cat who now needs to lean on you for treatment that his life depends upon. And if you are anywhere near where I was when I started all of this... it is hard to be clueless and get conflicting information. Stick with it, though and things will get easier.
 
Thank you so much everyone-I feel much better knowing other vets say the same thing. I love my vet and have no intention of changing-I think she is great so I hope she supports me on this. I was supposed to take Suki in this week for fructosamine if I couldn't do BG at home. I sent my vet the spreadsheet. I've increased the doses on my own so I hope she isn't upset by that.

My vet is going for just that-regulation in the 100's-200s. She said if she goes into remission that is a rare plus. I'm sure she is just being realistic given most people don't do much for their pets-even putting them down just cause they don't want to deal with it.

Ive had 2 cats die of CRF and 1 of lung cancer. I did syringe feeding 3x day and fluids 3 days/wk for a year on my 18yo CRF cat and was using an inhaler on my lung cancer kitty so I don't shy from lots of cat care but it is stressful. Its very stressful now with Xmas coming up. I will be going to visit my family for a week so I'm nervous about that. I have a friend staying here who has worked as a vet assistant before but has never tested BG so with Suki not being regulated yet, I'm very stressed over that rapidly coming up.

I really appreciate everyone's advice.
Thank you for being there and hearing me vent!
 
This is a great place to vent. :-D

How wonderful that you already have someone lined up for your absence.
We have lots of tips for that too. Be sure and ask us as that get closer.
We often recommend a slight decrease in dose for an alternate caregiver to keep Suki safe.
 
So far, you are doing really well, Deb! Lucky for you, it looks like Suki's numbers are staying fairly even. Meaning, you aren't seeing big fluctuations like an AMPS=300 and a +3=45. Those moments are very scary and it's difficult to regulate a cat who is all over the map. But so far, it looks like Suki is not getting too low at the nadir (at least, not yet).

I understand your reluctance to test every few hours, especially in the beginning. I agree with most folks on this board that testing before the AM shot and PM shot (i.e. testing twice per day) is really essential for Suki's safety. That said, the folks on this site do like to see as much data as possible so that they can give informed advice. But you have to do what feels right to you.

When I figured out Mr.Cat's nadir time, I usually tested at AM, PM and once around +4 during the day and that was it. I rarely got up in the middle of the night to test. My main reason was the fact that Mr.Cat's ears seemed pretty beat up after a while, so I decided to give him a break. Besides, Mr.Cat had very even BG readings so after a few months, I sortof intuitively knew where he was each day. I also had several months of data showing me that Mr.Cat almost never went below 70. So, my decision was based on a few months of experience and lots of regular testing throughout the day. I think the members of this site are hoping that you can collect that data in the beginning. It may lead you to do what I did, but it may not, depending on Suki's pattern.

Every cat is different and it is important to follow your intuition when treating your cat. I appreciated all the advice given on the site in the beginning, but I also did outside research and learned a few additional facts that helped me, too. Yes, some folks on this site are intense in their recommendations. But they are arming you with information so that you can make informed decisions, even if those decisions go against the grain, at least you know what the grain is! :-D Knowledge is power (and safety for Suki). Good luck! :-D
 
You might take a look at my signature link to Secondary Monitoring Tools. These are other assessments you can make which provide some info on how your cat is doing, besides blood glucose. While they aren't as precise, they are some of the questions your vet might ask you when you go in for routine checkups - eating, drinking, pooping, peeing, other behavior, and so on.

Thirst and urination are usually frequent and high volume when diabetes isn't controlled. As you get control, these will reduce (barring a second condition such as renal disease).

Eating and defecating may be high, too, until more control is established. The characteristics of the feces may provide clues to health.
 
I've looked at others spreadsheets and I'm wondering how people are giving insulin in units like 1.4 and 0.2.
 
There are quite a few of us in the lantus tr forum that have calipers. That is to get a more exact dose especially if your cat is sensitive to tiny changes
in dose.
We did some testing on our syringes and found the markings to be very off... even from syringe to syringe in the same brand.
they are all made in china these days.

So when you are working your way down the dosing ladder..... but want to continue to give support to their healing pancreas , you can wind up
giving tiny doses.

For example, there is 1 unit. but than there is a fat 1 unit or a skinny 1 unit meaning just a smidge on the other side of the 1 unit marking.

Since we generally increase or decrease in 1/4 ( 0.25 u) units....
you go from 1 unit to 0.75u to 0.50 u to 0.25 u to 0.1 u and the final dose before trying a remission trial is 1 drop.
It's something you learn as your go and get used to it after you've done it .

A cat is a small creature and the insulin was created for humans.... and we are using human syringes.

When I first got here, I would wish out loud that Mattel would start making syringes because I wanted one that was Barbie size.
And of course, I wanted nice clear markings for all the measurements. :lol: ;-)
 
Yes I tried to increase my dose 0.25 but I couldn't get it with the syringe so I jumped to 2 units instead. 1 drop - that is crazy. So eventually hopefully I will need this caliper thing?
 
Do your syringes have half unit markings? Going to 1.5 would have been better - the danger with one unit increments is you miss the good dose.

Also try and work the syringe a bit to ease the lubricant - it shouldn't jump then.
 
I did go up to 1.5 before-was there a week. So I went from 1.5 to 2 a couple days ago. yes they have 0.5 unit markings.
 
Ok sorry I must have been looking at the wrong sheet. I would try and get a few night time tests, many many cats go low at night and you don't want to miss that, even if it's one check a night.
 
This morning her AMPS was 134. so I waited to shoot and checked again in 1/2 hr-it was 117. So I didn't give her a shot. I am at work now so I don't know how much farther it will go. Did I do the right thing in skipping and what do I do later? Maybe 2 units is too much? All her other preshots have been high-why all of a sudden does it drop so low like that?

Thanks.
 
Would you update your spreadsheet when you are home again?

It's hard to say without seeing the data.
But since you are here on main forum, we typically don't advise to shoot under 200 .
It's best if someone is walking/talking you thru the first time you shoot a lower number.
So I think it was best that you skip.
 
Status
Not open for further replies.
Back
Top