Hobbs update and QUESTION (Confirmation re NO dose)

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HobbsMom

HobbsMom

Member Since 2014
Hello all,

Thank you for being so helpful with my previous post. Summary: Hobbs is 16yrs old male, 9.5 lbs for his entire adult life dropped to 8.25lb when diagnosed but now back to 9.5, raw food with a little a/d, human meter, diagnosed a month ago with a BG of 661. Since Saturday he's received two 1.1 doses of Lantus 24 hours apart. Prior to that, for a little over a week, he was at about 1.25 (give or take and on Saturday evening one of his doses was split up between two smaller ones or another time when I split his dose based on his numbers as I understood them at the time.) I have since learned a lot.

Since yesterday's dose his numbers have been
+2 = 129
+4 =46
+10=58
+12 = 50

HIs numbers were like this Sunday evening... rising again at the 14 hour mark. Prior to that he showed low numbers sometimes at 13 or 14 hours post dose.

I am NOT dosing this morning. Please confirm if you believe that is CORRECT. I understand what you guys are saying that it's the LOW number and not the predose number... but in his case I see BOTH as too low. I in no way like his low gb numbers (on human meter) What I am trying to figure out is HOW much will this mess things up? My thoughts are that the consequences of him getting too high ARE sooo much safer than when they are low.

PLEASE confirm or help me understand if I should do something different.

Thank you sooo much. I truly am trying to do that which is best for him... and if I am understanding depot properly... what likely happened is that his body released some of the stored insulin that I put in his little body before (and ESPECIALLY that which was given to him when I was under the mistaken belief that Lantus was a 24 hour acting one and that he should be given .25 for each kg of weight - at one time. I now know how wrong that was and will be informing my vet at today's appointment.)

Any help you can provide will be MUCH appreciated. (I will continue to test him to see his curve. Didn't check curves the last couple days because the house had unexpected workers which ALWAYS throw him off... and I didn't want to make decisions based on stress numbers.)
 

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HobbsMom said:
...I am NOT dosing this morning. Please confirm if you believe that is CORRECT. I understand what you guys are saying that it's the LOW number and not the predose number... but in his case I see BOTH as too low. I in no way like his low gb numbers (on human meter) What I am trying to figure out is HOW much will this mess things up? My thoughts are that the consequences of him getting too high ARE sooo much safer than when they are low.
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Hi,

So, the +12 is 50?
I don't use the same insulin as you but I absolutely agree with you: No shot.
According to those numbers you've given he seems to be surfing beautifully in normal numbers there. :smile:

(And if it does 'mess things up' for a cycle or two then that's no big deal in the scheme of things. We have a saying here: "Better too high for a day than too low for a minute." ;-) )

Eliz
 
Hi Jenn,

I'm a relative newbie on the board, so please take this advice for what it's worth.

According to the TRP, a kitty earns an automatic dose reduction when he/she falls below 50. It looks like there a couple of times on the 1.1 dose when Hobbs fell below 50. That indicates, to me, that the dose is too high.

Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
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I would encourage you to perhaps start posting on the Lantus Tight Regulation board. There are a lot of experienced users there who can help you with dosing and numbers. In the meantime, I'm going to ask someone from the Tight Regulation board to stop by and review your numbers.

I definitely would not shoot at 50.

Shelly
 
Hi Jenn,

No, you should not shoot at 50.

Question...so everyone is clear before giving you dosing advice...which protocol have you decided to follow? Are you following the one that we follow here or the one from the other web site that you mentioned in your previous condo?

If you're following the one we follow here, Hobbs earned a deduction several days ago.

This is from your last condo where I encouraged you to drop his dose to .75units because he had dropped below 50.

HobbsMom said:
Soooo.... even though I dropped him to 1.1iu on Saturday morning (just a smidgin under the 1 mark on my 1/2iu marked string), I should still drop him to .75?...
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cobbsmom said:
Yes, he earned his reduction by dropping so low.
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Is there any reason/concern that led you to keep his dose the same?

He's dropped below 50 twice now. He's telling you the 1.1unit is too high. He's earned his deduction. I would skip this shot and pick it up tonight, and drop the dose to .75unit. I know, based on his weight, that wS the recommended starting dose. That doesn't mean it is exactly what he needs. There has to be a starting point, and his body has said several times that the dose is too high.

Now, if you're following the protocol that you found on yourdiabeticcat.com, I don't know if what I wrote above is accurate. I'm not familiar with that protocol so I wouldn't be comfortable commenting on it.

~Suzanne
 
ForJersey

Thank you. I am a new bee too... doing it myself until Friday when I found you guys via Veneta :-)

YAY! Party for Hobbs! I see toys and string everywhere :-))
 
Cobbs Mom,

(I don’t know how to get the reply to work again?)

Yes, my dose was 1.25, I dropped to 1.1 after reading posts (before I saw yours) and I kept that thinking I needed to keep for the 3-7 days because of the depot. Then could reduce again.

I actually like his numbers to be between 50-130 as his brother never gets over 100 (except play and stress) and I think he seems the healthiest to me when in that range. I also think that because he is on a 70/30 raw diet of about 1% carbs mixed with about 1/3 a/d (15% carbs)I would expect his numbers to be on the lower range.. right?

I am home now, able to keep a good eye on him and freak when his bg is below 50.

His brother parks in the lower ranges… never in the 40s… but always giving me 50+ and less than 100.

I must have misunderstood, I thought another drop of almost ½ a unit (from where he just was) was going to do a counter-intuitive thing and act like an increase. (I must have read that wrong. Truly , I am trying to do the right things.)

I will happily drop him to .75 tonight or if his numbers stay like this… or if his numbers show the between normal ranges.. I imagine I don’t dose UNTIL his body tells me that he needs it.. then go straight to .75… or possibly .25 or.5… because his body is trying to figure it out??

(and the other place to post... I saw the note.. I'll work on finding that place on here.)

I'm truly not trying to be difficult.
 

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You're fine! You're not being difficult! It is a lot to learn. We understand that.

Typically you hold the initial starting dose for 3-7 days.

Here are the "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.
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In this case, Hobbs' numbers said otherwise.

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
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I bolded the part that applies to Hobbs.

As for giving the next dose, if you want to get him on a 8a/8p schedule, test him at 8p tonight and see where his number is. Since you have shot lower than 200 and if you would be comfortable doing so, and can monitor him, you can shoot the number you're comfortable at. The next dose after tonight's would be 12 hours later. But if he dropped below 50 during tonight's cycle, he would earn another reduction so you wouldn't hold the .75units. You'd go ahead and back it down to .5units.
 
CobbsMom

re:
"As for giving the next dose, if you want to get him on a 8a/8p schedule, test him at 8p tonight and see where his number is. Since you have shot lower than 200 and if you would be comfortable doing so, and can monitor him, you can shoot the number you're comfortable at. The next dose after tonight's would be 12 hours later. But if he dropped below 50 during tonight's cycle, he would earn another reduction so you wouldn't hold the .75units. You'd go ahead and back it down to .5units."

THANK YOU!! I kept thinking that I needed to hold the dose because I thought the 50 was from layover/depot... whatever the term from his 1.25 drop to 1.1. I'm getting it now - he ALWAYS earns a reduction :-)) (better to under dose than over dose)

YAY!!! (Your patience with me is astounding.. I truly appreciate it!)
So tested him and his numbers showed he needed a dose around 1:30pm, which means I WILL wait (no matter how high the number is) until 1:30am. (Yes, I know it sounds crazy to wake up for this... but I decided I would rather follow his numbers and give him all I had... versus trying to move him into my schedule right now.) I like the numbers I'm seeing. (Not the low ones... but that's a given.)

Yes - he did get up to 197 but that was only at +19... and now at +3 and +5 he's at 88 and 81 respectively.

AND he snored today - super cute.
 

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That is what the TR protocol that I've been taught here calls for.

But if you are still following his numbers and dose around and not establishing a 12-hour time period like the other protocol says to do, I do not know if that is the right advice to give. I'm not familiar with the other protocol.

If you were doing the Roomp and Rand protocol, then I would have waited until an hour of the day where I wouldn't be getting up in the middle of the night to shoot him. I would have skipped this mornings shot and then given .75units tonight at 8pm, not at 1:30 when the numbers were on the rise - which would be expected since the insulin was wearing off.

I really don't know anything about the other protocol that it seems like you're following by shooting when his numbers go above a certain level, instead of on a set 12-hour schedule. Mixing the 2 protocols and piecemealing them together could be dangerous. That's what it looks like to me, unless you're going to start giving Hobbs' his shots at 1:30 every morning. If you're going to follow his numbers instead of the every 12-hours, since that's not the protocol I follow, I wouldn't be comfortable offering any further opinions.

Have you decided which protocol you want to follow?
 
To CobbsMom,

Re which protocol I'm following. To be clear, I did research but didn't find a "per se" protocol. I was figuring out the details as I was going along (like Jill & Alex did in 2006 when Lantus was new.) I was sticking to a goal of 40-130 and adjusting doses according to his numbers as they were different than what I was learning was expected... which is why I started shooting at times his high and low BG told me (e.g., holding off when he had a low)... versus other things. Also, not knowing about depot hurt. (And believing Lantus lasted 24 hours and that we shouldn't inject prior to that, like they tell humans not to take 24 hour medicines more than ever 24 hours also hurt, etc.)

My goal now is remission. Plan B is a 12/12 schedule to get there :-) With him earning reduction after reduction :-)

Regarding the times for the 12/12... that's a little more complicated. I am able to be flexible right now with his schedule, I CAN follow his numbers if he is dropping and forming a 12 hour marks. (Of course, not injecting him BEFORE the 12 hour mark. But, if his numbers are :mrgreen: then I'm happy to wait. In fact, only one time during the normal day is a LOT easier on my schedule... even though it's effecting my sleep time right now... than two times during the day and one hitting rush hour/morning or rush hour/dinner. When he starts to settle, and I settle into a new job, I feel comfortable that then I will start figuring out a time better time that works for both of us. (However, I have been pushing off some required travel... and so if I can get him settled into a schedule for the next month, I'll have to go out of town for about 8 days. This means we will be working with 2 cat sitter's ensuring the exact dosing time is being followed. So... I'll likely have to move his injection time anyway.... that's another reason why I'd like to be kind to his little body now... because I am ABLE, not like I will be in the future when I will be in a more uncomfortable position.

Stuck with 1:30pm to 1:30am... and he was at 153..so I definitely think you are right that .75 is a better dose for him... Looking forward to how he does on that and hoping for another reduction need (but not too low because hypo scares the junk out of me... I'd like a nice 49 :-)) to tell me he's ready for another reduction :-))

(I made the chart with one day has 2 lines because of his messed up injection times... and do understand that in the future I will need to make it clearer his PM numbers and his day numbers.... but once again... I just can't take on all that at one time.
 

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oh, btw, I'm getting more test strips today and this afternoon the workers will be gone, so I'll likely find his nadir today or tomorrow :-)
 
Ok, if you're going to do the 12/12 schedule, then you probably won't have to wait longer than 12 hours to give another dose of insulin. You can shoot when he is under 130, if you're following the Tight Regulation protocol (found here: viewtopic.php?f=9&t=1581), and you are around to monitor Hobbs so he doesn't drop too low (too low is under 50). That protocol has been proven to get many newly diagnosed diabetics into remission. Some say "shoot low to stay low." Many people shoot in the low 100s, and I even shot Cobb at a 93 once, as soon as I was ready to do so. But you have to be around to see how Hobbs will respond to getting insulin when he is in that normal number range. It doesn't mean you necessarily have to skip that shot.

Let us know if you want to do the Tight Regulation protocol. There are a lot of people on the Lantus TR board that can advise you further.
 
Just a note: the nadir can move around, so checking during the probable time period is about as good as it gets.
For Lantus, often it falls between +5 to +7 hours after the shot for many cats
For ProZinc, the nadir seems most common between +5 to +6.
Levemir's nadir is later than Lantus - more like +7 to +9 after the shot.

... but ECID (each Cat Is Different), so randomly checking before or after the likely nadir may surprise you upon occasion!
 
cobbsmom said:
Ok, if you're going to do the 12/12 schedule, then you probably won't have to wait longer than 12 hours to give another dose of insulin. You can shoot when he is under 130, if you're following the Tight Regulation protocol (found here: viewtopic.php?f=9&t=1581), and you are around to monitor Hobbs so he doesn't drop too low (too low is under 50). That protocol has been proven to get many newly diagnosed diabetics into remission. Some say "shoot low to stay low." Many people shoot in the low 100s, and I even shot Cobb at a 93 once, as soon as I was ready to do so. But you have to be around to see how Hobbs will respond to getting insulin when he is in that normal number range. It doesn't mean you necessarily have to skip that shot.

Let us know if you want to do the Tight Regulation protocol. There are a lot of people on the Lantus TR board that can advise you further.
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As Suzanne mentioned, with Lantus and Levemir, due to the depot effect, it is extremely beneficial to shoot lower numbers once you have the data available to prove it is safe to do so. Ideally, what happens is you end up having a very flat and even curve of healthy, healing, low numbers. :mrgreen:
 
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