Help with Henry's numbers

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ramonaghan

ramonaghan

Member Since 2014
After much struggling, we've gotten two successful consecutive home BG tests for Henry now (last night's PMPS and this morning's AMPS), both of which were blue on the SS. The two prior tests I was able to get earlier this week (at AMPS +10 and PMPS +1) were also blue, so while at the time I questioned their accuracy due to my newbie lack of confidence, now it seems like maybe they were fairly correct. I have seen a lot of advice not to shoot under 200 but have been giving the prescribed 1U consistently since last Friday when Henry started on insulin (other than a suspected couple of fur shots); yes, this has made for some sleepless nights. I know I need to get a good mid-cycle value and will attempt that today, but I'm looking for input on his numbers so far. He has his first glucose curve tomorrow at the vet's office. Is it too soon to hope for an insulin reduction? He was 465 at Dx on Nov 28, so to me this seems like major progress for one week on insulin.
 
Lantus is a depot insulin. When you inject it, small crystals form under the skin. These slowly dissolve to release the insulin. We call these crystals the depot or the shed.

There is a small amount of overlap from shot to shot and when you stick with the same initial dose for 5-7 days it hits a nice smooth level. Now comes the tricky part - figuring out if the dose is optimal by getting the mid-cycle tests between +5 to +7 and evaluating if the dose needs tweaking.

We have 2 protocols for using Lantus.

Tight Regulation
Start Low, Go Slow
 
It looks like Henry is probably responding to the insulin pretty well! Its hard to know how well without seeing the mid-cycle tests, but blues instead of pinks or reds are promising.

I wouldn't expect a dose decrease at this point myself, you want cat's consistently under 120 before doing that (preferably under 100). Usually we get a small increase at first to continue to bring down the numbers to that level before going down.

Keep working on that testing!

I see your spreadsheet notation about a possible fur shot. I've seen quite a few new members bring up fir shots and questioning whether they gave one or not. In every case of a missed shot I've had, I've strongly smelled insulin on the cat. Even at very small doses. Insulin has a very potent smell and if someone gives a fur shot, they should be able to smell it.
 
Thanks for the input! I had a hard time with today's mid-cycle test as I was attempting it alone for the first time. I'll keep practicing. I know those values are especially important. :oops:

Melanie and Smokey said:
I see your spreadsheet notation about a possible fur shot. I've seen quite a few new members bring up fir shots and questioning whether they gave one or not. In every case of a missed shot I've had, I've strongly smelled insulin on the cat. Even at very small doses. Insulin has a very potent smell and if someone gives a fur shot, they should be able to smell it.
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Yep, that's exactly what made me suspect one a couple of days ago, even though I did not feel anything on him. This morning, though, I both smelled it and felt a bit of wetness. D'oh! I know that will probably throw things off for his glucose curve tomorrow.

I have to remind myself it's only been a week since we started insulin...unfortunately, patience has never been my strong suit. I am also a terrible worrywart; I don't think I've slept through the night at all this week. He's totally worth it, though.

2728432542_72517bdcc4_n.jpg
 
What a beautiful picture- I was going to say on my other post, I had two kitties growing up that looked just like your Henry, they were the most beautiful, mellow and sweet kitties ever! :-D Don't beat yourself up over the furshot either, you are so ahead of the game already by successfully home testing and setting up that spreadsheet! Get a good night's sleep! :YMHUG:
 
Tiger and Ruth said:
What a beautiful picture- I was going to say on my other post, I had two kitties growing up that looked just like your Henry, they were the most beautiful, mellow and sweet kitties ever! :-D Don't beat yourself up over the furshot either, you are so ahead of the game already by successfully home testing and setting up that spreadsheet! Get a good night's sleep! :YMHUG:
Click to expand...

Thank you. :-D He's my snuggle buddy and a total mama's boy. I really appreciate your kind words and support.
 
Re: Help with Henry's numbers (12/13 update + low numbers)

So Henry had his first glucose curve at the vet yesterday, and his numbers were much higher than the (admittedly spotty) ones we've been getting at home. I need to get a copy of all the numbers from them, but IIRC nadir was ~270 and right before we picked him up at AMPS +10, he was at ~400. We tested him at home one hour later at AMPS +11 and got a 210... So, a few factors here to consider:

- spike from vet stress
- possible spike from Thursday a.m. fur shot
- Vet's AlphaTrak 2 vs. our CVS Advanced Meter

The vet upped him from 1U BID to 2U BID, so he got 2U last night and this morning. When we tested him today at AMPS + 5.25, we got a 41! He has been acting completely normal, but I gave him 1/4 can of FF. At AMPS + 7, he tested at 51. It seems like he's treading that line between low and good control; does that seem correct? I'm already nervous about him dipping too low overnight.

I've ordered an AlphaTrak 2. I think in the long run the expense will be worth the peace of mind for me.
 
Henry's numbers were probably up because of the vet stress. With that 41 today, I would reduce his dose.
When I see a number below 60, I test every half hour until the numbers are going up, and if I saw a 41, I would be giving a higher carb food.
I'll try to flag some other Lantis people over to this post.
 
Re: Help with Henry's numbers (12/13 update + low numbers)

ramonaghan said:
...
The vet upped him from 1U BID to 2U BID, so he got 2U last night and this morning. When we tested him today at AMPS + 5.25, we got a 41! ...
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You vet increased him by too much. We typically make Lantus increases in the 0.25 to 0.5 unit range. You can see that 2 units is too much because in 1 day, he was too low. Lantus effects build over time, so you can't keep the 2 unit dose and be safe. I would take to 1.25 units (eyeballed as syringes don't measure 0.25 or 0.75 increments
 
Re: Help with Henry's numbers (12/13 update + low numbers)

BJM said:
ramonaghan said:
...
The vet upped him from 1U BID to 2U BID, so he got 2U last night and this morning. When we tested him today at AMPS + 5.25, we got a 41! ...
Click to expand...
You vet increased him by too much. We typically make Lantus increases in the 0.25 to 0.5 unit range. You can see that 2 units is too much because in 1 day, he was too low. Lantus effects build over time, so you can't keep the 2 unit dose and be safe. I would take to 1.25 units (eyeballed as syringes don't measure 0.25 or 0.75 increments
Click to expand...

OK, thank you. Unfortunately I only have the syringes with the full-unit marks; would it be better to eyeball 1.5 or drop him back down to 1 through the weekend? I'll call the vet first thing Monday. FWIW, I've gone to the practice for many years and am very happy with it, but we haven't worked with this particular vet before. So far, she's been really receptive to and supportive of our diet change and home testing.
 
Eyeball 1.5 units for now, but watch during the +5 to +7 hours post-shot to monitor for the low point (nadir).

If you don't need an Rx for them, just tell a pharmacy you want 3/10 U-100 syringes with 30 or 31 gauge, short or long needles. I prefer the short 30 gauge needles as I don't bend them nor stab myself as easily.

And get the pharmacy stuff asap due to the DKA risk.

Let your vet know about how low the cat dropped and that you weren't comfortable contiuing with the 2 unit dose because of that. Also see my signature link Glucometer Notes for some pet-specific reference numbers for human glucometers.
 
That is so good to hear your vet supports home testing and is not pushing their regime on you- so many people here are fighting not only feline diabetes, but their vet as well! No dosing advice from me, however, during the curve Henry had those 3 things going against him, and yes, vet stress is good for at least 100 pets, I have seen this with my Tiger! :YMSIGH: The alpha trak test strips are quite expensive- and worse, there could be a time that you will not be able to purchase them if you run out during a time when your vet is closed.

Regarding the syringes, what you need are syringes with 1/2 unit markings- I got mine from Walmart, they are Relion(and no I am not endorsing Walmart :lol: ) it is just they are $12.00 for 100 as opposed to $20.00 for the BD syringes I was getting from our neighborhood drugstore. The other thing that will come in handy for dosing are a pair of calipers such as these: http://www.harborfreight.com/4-inch-dig ... 47256.html. You could use a ruler in a pinch, the main thing you want the same dose everytime.

You might want to try and get at least one or two tests in after PMPS- say one at +2 or at least one before you go to bed to see where Henry is at. The one at +2 can be a gauge of where Henry is going.
 
BJM said:
Eyeball 1.5 units for now, but watch during the +5 to +7 hours post-shot to monitor for the low point (nadir).

If you don't need an Rx for them, just tell a pharmacy you want 3/10 U-100 syringes with 30 or 31 gauge, short or long needles. I prefer the short 30 gauge needles as I don't bend them nor stab myself as easily.

And get the pharmacy stuff asap due to the DKA risk.

Let your vet know about how low the cat dropped and that you weren't comfortable contiuing with the 2 unit dose because of that. Also see my signature link Glucometer Notes for some pet-specific reference numbers for human glucometers.
Click to expand...

Thanks--sorry, I'm just now seeing your response (didn't get the email notification for some reason). I have checked out your Glucometer Notes several times now--it is very helpful! On the day of Dx, I got four bags (all they had in stock) of BD brand 3/10 U-100 30g syringes, but they don't have half-unit markings. I'll call the pharmacy and ask about that.

Just took Henry's PMPS level and got a 70. That's the same reading we got for my non-diabetic cat. I'm thinking of skipping insulin altogether tonight. Thoughts?
 
Yes, skip!

No shot under 200 mg/dL on a human glucometer until and unless you have test data supporting the safety.
 
Its a process, not an event. :-)

Got a hypo kit prepared? Know they symptoms of hypo? Read this post and be prepared! With luck, you'll never need it.
 
BJM said:
Its a process, not an event. :-)

Got a hypo kit prepared? Know they symptoms of hypo? Read this post and be prepared! With luck, you'll never need it.
Click to expand...

Yep, that post is printed and bookmarked and the kit is ready. Glad I did not have to break out the Karo today. Henry's been acting completely normally, thankfully, and we're all getting better at the tests.

I see now on the Glucometer Notes about the <200. I knew I'd read that before, just couldn't remember where, and I hadn't consulted that second page today with where his values have been. I have it bookmarked now as well. :-)

Really appreciate your help.
 
As you get tests showing it is safe, you can drop the no shot limit to 150 mg/dL. You might drop by 10 mg/dL for every day you successfully get all pre-shots and at least 1 nadir period test that shows it is safe.
 
Hello and welcome from me too. You are doing a great job getting going on the testing. Good catch on that 41 today. You've gotten some good advice about lowering the dose. My non-diabetic cat has tested over 150 points higher at the vet than at home, which is why we prefer to do cuves at home instead of at the vet. Especially when it comes to deciding what a dose should be.

I also want to echo Ruth's comments about trying to get the occasional test in the PM cycle. Many cats (like mine) like to go lower at night. Getting a test before you turn out the lights at night can be a good one. Then you'll know whether you need to leave some food for him to snack on.
 
Wendy&Neko said:
Hello and welcome from me too. You are doing a great job getting going on the testing. Good catch on that 41 today. You've gotten some good advice about lowering the dose. My non-diabetic cat has tested over 150 points higher at the vet than at home, which is why we prefer to do cuves at home instead of at the vet. Especially when it comes to deciding what a dose should be.

I also want to echo Ruth's comments about trying to get the occasional test in the PM cycle. Many cats (like mine) like to go lower at night. Getting a test before you turn out the lights at night can be a good one. Then you'll know whether you need to leave some food for him to snack on.
Click to expand...

Thank you!

Looks like we'll be skipping another shot tonight. He was at 103 at PMPS (almost the same as his AMPS +7 value of 106...no clue how to interpret that). We tested him again 25-30 minutes later after he'd eaten a can of FF and he was at 120. I am going to call the vet in the morning to go over these numbers.
 
It's best to give the same dose of Lantus twice a day. If you find you can't do that because his numbers are too low to shoot, then lower the dose. It may be that Henry has to go back to 1 unit or 1.25 units (you eyeball that).
 
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