Sarah & Jackie
Member Since 2015
I remember reading somewhere back when Jackie was first diagnosed that some cats run normally in the 300 range. Soooo, how do you determine if that is the case for your cat?
How do you know if your cat is just a 300 guy?
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Shiloh & Rhonda (GA)
Member Since 2015
@BJM and @Sarah & Jackie , my concern from looking at Jackie's SS is that the Lantus dose isn't consistent, either in time or amount. Sarah, I haven't looked back at your other posts, but does your vet have you doing a sliding scale on the dose?
BJM
Member Since 2010
The Prednisolone doesn't help the glucose levels either.
As you work up the dose 0.25 units at a time, you may get to a point where the day off prednisolone is lower than the days on. In that case, what may work is adding in a tiny amount of a short acting insulin (Regular, ie R insulin) to help bring him down on the prednisolone days.
Whenever you have several days in a row when you can get more mid-cycle tests done, you might choose to increase a little faster than SLGS normally does, so you can increase a bit faster.
As you work up the dose 0.25 units at a time, you may get to a point where the day off prednisolone is lower than the days on. In that case, what may work is adding in a tiny amount of a short acting insulin (Regular, ie R insulin) to help bring him down on the prednisolone days.
Whenever you have several days in a row when you can get more mid-cycle tests done, you might choose to increase a little faster than SLGS normally does, so you can increase a bit faster.
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Sarah & Jackie
Member Since 2015
My vets haven't been as involved as would be ideal. And my schedule this time of year is absolute madness as far as being able to be consistent....so I have been doing the best I can to make adjustments because of that. Additionally, Jackie seems to hit his lowest #s at the end of his cycles, which further complicates things.
Sarah & Jackie
Member Since 2015
Jackie seems to want to run on the high end, and doesn't display typical symptoms when doing so. That got me thinking that maybe he is just one of those cats that run higher at "normal". This has all been so frustrating, as he doesn't seem to fit the "norm" for most cats. He IS a very high strung guy......And I usually can't be home often enough for long enough that I feel comfortable pushing my luck.
Sarah & Jackie
Member Since 2015
"That may be where they start, but baring some other medical condition, that wouldn't be a good place to leave the glucose."
What other medical conditions would those be?
What other medical conditions would those be?
Sarah & Jackie
Member Since 2015
Shiloh & Rhonda (GA)
Member Since 2015
Understood. I hope I didn't offend. Was just curious about the fluctuations.
Sarah & Jackie
Member Since 2015
No offense taken
.....I am quite frustrated by the inability to maintain consistency.
Sarah
We have lives we have to live and we do the best we can because safety is first. But there are a few things I'm seeing and no judgments here at all....just observations.
First, I don't necessarily think the ups and downs are due to pred/no pred days. There are plenty of days he hasn't gotten pred that he's still high. Lantus is a depot insulin and it does best with consistency. So a lot of skipping shots and dose hopping is definitely going to affect how he does. I'm not suggesting that you switch to the TR protocol at all but this post on Is Tight Regulation Possible with a Full Time Job might give you some ideas.
I've found that being off 30 minutes on a shot time is normally not a huge deal. If you absolutely have to skip a shot, then I would focus on trying to hold the dose steady as long as he doesn't dip below 90. I'd also try to stick to increases and decreases of 0.25u instead of getting into these in-between doses.
On the skipped shots, yes....safety is the most important thing but he's had high ketones and so it's really important to try and get insulin in him. Is there anyone at home during the day (e.g. Aunt Becky) to test him and who could give him his insulin if you aren't there on time?
If you'd like to post in the Lantus/Levemir forum, there are a lot of very experienced members there that could help you with dosing.
We have lives we have to live and we do the best we can because safety is first. But there are a few things I'm seeing and no judgments here at all....just observations.
First, I don't necessarily think the ups and downs are due to pred/no pred days. There are plenty of days he hasn't gotten pred that he's still high. Lantus is a depot insulin and it does best with consistency. So a lot of skipping shots and dose hopping is definitely going to affect how he does. I'm not suggesting that you switch to the TR protocol at all but this post on Is Tight Regulation Possible with a Full Time Job might give you some ideas.
I've found that being off 30 minutes on a shot time is normally not a huge deal. If you absolutely have to skip a shot, then I would focus on trying to hold the dose steady as long as he doesn't dip below 90. I'd also try to stick to increases and decreases of 0.25u instead of getting into these in-between doses.
On the skipped shots, yes....safety is the most important thing but he's had high ketones and so it's really important to try and get insulin in him. Is there anyone at home during the day (e.g. Aunt Becky) to test him and who could give him his insulin if you aren't there on time?
If you'd like to post in the Lantus/Levemir forum, there are a lot of very experienced members there that could help you with dosing.
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BJM
Member Since 2010
While there are some conditions which result in high glucose levels, until he's stable on a dose and consistently getting insulin, I wouldn't worry about them yet. Stability in dosing with Lantus is very important.
After you have that, you'll be able to determine how much impact the prednisolne is having, and whether or not it is enough of an effect to do anything special for it.
After you have that, you'll be able to determine how much impact the prednisolne is having, and whether or not it is enough of an effect to do anything special for it.
Sarah & Jackie
Member Since 2015
Thanks to you both. My husband did say tonite that maybe he should have me teach him how to help this weekend. That would be sooo helpful. My workdays this time of year are only going to get longer and hitting those 12 hours consistently will be next to impossible......
That hasn't happened very often at all. Usually, he is running high. So, when I DO need to skip a shot, when it is time for the next one, what do I do, since I usually can't be there to monitor him?
That has really only happened the one time he stopped eating and ended up overnight at the vet and I'm still not sure how those 2 things relate to each other.
I have done that as well and haven't come away with any clear direction. My biggest dilemma is when he is in his lowest #'s when he is more than +12 and I'm unsure what to do. We are closing in on 6 monthes since diagnosis(which I'm sure, now. came later than it should have). I'm really feeling pressure to get to some regulation, with the clock ticking, ticking, ticking.....
Sarah & Jackie
Member Since 2015
As a long experienced R user, I would recommend against it as you have to be there to monitor him closely. We do use it for bouncy cats after the caregiver has some experience but they have to be home and testing. You can't shoot R and leave. Yes...it can be dangerous to use if you don't use it at the right time and the right dose. It can also start a bounce/dive cycle that is hard to get out of.
I also think R is a bad recommendation because I think there are too many other things going on, as I outlined, that are helping to contribute to his numbers and cycles.
Usually when you skip a shot, it drains the depot somewhat. In fact, when you skip a shot or shoot a reduced dose for safety, you might not see the effects until late in the cycle you skipped/reduced but might see it more in the next cycle. While I don't like giving blanket advice because ECID and each cycle is different, quite often, it would be safe to shoot his regular dose the cycle after you skip because the depot has to refill.
High ketones can occur at any time....even in cats with normal numbers. It can be a precursor to diabetic ketoacidosis which is caused from not enough insulin + infection + not enough food/water. I say "can" because high ketones don't always develop into DKA. Sometimes our kitties have infections of which we aren't even aware. So it's important to try and get to the right insulin dose and be sure kitty is drinking and eating....and ketones stay normal. I'd be checking his ketones every
I read back through all your condos there and it seemed to me you were getting some good advice. And that's where I normally help out. If you need help and don't think you are getting a response (it's an active forum and it's possible things do get missed but all of your condos were responded to) then bump your condo up by just typing "bump" up in the text box and hitting submit. You can also put the "?" up which is in the box to the left of the subject line and don't be afraid to add "need help" to the subject line. There is usually someone that can help you with low numbers or they'll find someone who can.
One thing I would suggest is that you not feed him before his shot and after his nadir unless he's got low numbers dropping into PS which I see once. It slows the effects of the insulin down when you feed after nadir...at least for most cats. Sometimes it is an effective tool to feed some LC at +10 if kitty is coming into the PS low but I don't see that a lot on his SS.
We have many tools to help you. If your husband can help with testing...great. You can also get an autofeeder and set it up for timed feedings so he gets consistent meals when you are at work. But it's really important to stop shooting so many doses....in four cycles, you shot 2u, 1.75u, 1.87u, and 2u and I don't see why you weren't just shooting 2u.
Just to be certain.....the SS is correct that you are using the Alpha Trak and not the ReliOn, right?
Thanks, Sarah. We are all here to help.
I also think R is a bad recommendation because I think there are too many other things going on, as I outlined, that are helping to contribute to his numbers and cycles.
Usually when you skip a shot, it drains the depot somewhat. In fact, when you skip a shot or shoot a reduced dose for safety, you might not see the effects until late in the cycle you skipped/reduced but might see it more in the next cycle. While I don't like giving blanket advice because ECID and each cycle is different, quite often, it would be safe to shoot his regular dose the cycle after you skip because the depot has to refill.
High ketones can occur at any time....even in cats with normal numbers. It can be a precursor to diabetic ketoacidosis which is caused from not enough insulin + infection + not enough food/water. I say "can" because high ketones don't always develop into DKA. Sometimes our kitties have infections of which we aren't even aware. So it's important to try and get to the right insulin dose and be sure kitty is drinking and eating....and ketones stay normal. I'd be checking his ketones every
I read back through all your condos there and it seemed to me you were getting some good advice. And that's where I normally help out. If you need help and don't think you are getting a response (it's an active forum and it's possible things do get missed but all of your condos were responded to) then bump your condo up by just typing "bump" up in the text box and hitting submit. You can also put the "?" up which is in the box to the left of the subject line and don't be afraid to add "need help" to the subject line. There is usually someone that can help you with low numbers or they'll find someone who can.
One thing I would suggest is that you not feed him before his shot and after his nadir unless he's got low numbers dropping into PS which I see once. It slows the effects of the insulin down when you feed after nadir...at least for most cats. Sometimes it is an effective tool to feed some LC at +10 if kitty is coming into the PS low but I don't see that a lot on his SS.
We have many tools to help you. If your husband can help with testing...great. You can also get an autofeeder and set it up for timed feedings so he gets consistent meals when you are at work. But it's really important to stop shooting so many doses....in four cycles, you shot 2u, 1.75u, 1.87u, and 2u and I don't see why you weren't just shooting 2u.
Just to be certain.....the SS is correct that you are using the Alpha Trak and not the ReliOn, right?
Thanks, Sarah. We are all here to help.
Actually, that isn't what you said and I did read it very, very carefully. Maybe it's what you meant, but what you said was:
BJM said:
ETA (sorry, I was posting from my phone earlier): using R isn't only a matter of stable and consistent dosing of the basal insulin. It is, most importantly, a matter of a caregiver who understands how the basal insulin works and their own cat's onset, nadir, and duration. It's also a matter of whether they understand how a bolus insulin, like R, could affect the action of the basal insulin. And also extremely important, is that the caregiver has the availability and ability to draw the correct dose, shoot it, and monitor it.
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julie & punkin (ga)
Member Since 2011
I'm just wondering if perhaps you're adjusting your dose based upon the preshot number. There are many folks who do that, not realizing that Lantus dosing is based upon the low points. It might help to think "how low is this dose right now taking my cat?" and look back over the previous several days to answer that question, before you increase the dose. The non-depot insulins do have their dose changed based upon the preshot numbers, and we see some vets still telling people to do that, but depot insulins are handled a little differently. Typically the preshot number is the highest point of the cycle. What you want to know with a depot insulin is how low the cat will go when the insulin is at its peak strength. That's the safest thing for the cat.
I think with some consistent dosing and increases as needed, you'd be able to get him a little flatter and out of some of those higher numbers. A timed feeder is an absolute blessing to those who work and are gone significant amounts of time during the day. That thread that Marje linked for you about how folks manage Tight Reg and working has lots of tips that could apply to anyone using Lantus or Lev (and probably some that would help with any insulin), whether they are using SLGS or Tight Reg. for their dosing.
Just wanted to throw that out there with a little encouragement for you, Sarah.
I think with some consistent dosing and increases as needed, you'd be able to get him a little flatter and out of some of those higher numbers. A timed feeder is an absolute blessing to those who work and are gone significant amounts of time during the day. That thread that Marje linked for you about how folks manage Tight Reg and working has lots of tips that could apply to anyone using Lantus or Lev (and probably some that would help with any insulin), whether they are using SLGS or Tight Reg. for their dosing.
Just wanted to throw that out there with a little encouragement for you, Sarah.
Sarah & Jackie
Member Since 2015
Yes, that was what I thought I understood to be the case. However, my guy's preshot number seems to be running toward the lowest point of the cycle, which is why I am so confused and uncertain about giving the shot.....what if he's still heading lower when the shot is given? For example, look at what should be his preshot number for tonight, and then +1 from there. After the +1, I pulled out the relion meter to get an idea if my alphatrak had just suddenly stopped working correctly. From what I can see, THAT doesn't seem to be it.
At some point, we might find he is a late nadir guy but I wouldn't say that right now. A couple things to remember:
--Lantus can take a second dip near +12. That means the kitty nadirs, comes up, and then at the end of the cycle, comes down a little but not as low as the nadir. At this point, we aren't seeing his nadirs (it wouldn't make any sense for you to be up testing at night when he's high)
--meter variance may be at play; he's came down a little more than meter variance, but not much. 406 and 368 are definitely within meter variance...so he's flat.
As long as he's this high, I wouldn't worry about shooting a little shift down at PS. If you are worried, post and ask for help.
--Lantus can take a second dip near +12. That means the kitty nadirs, comes up, and then at the end of the cycle, comes down a little but not as low as the nadir. At this point, we aren't seeing his nadirs (it wouldn't make any sense for you to be up testing at night when he's high)
--meter variance may be at play; he's came down a little more than meter variance, but not much. 406 and 368 are definitely within meter variance...so he's flat.
As long as he's this high, I wouldn't worry about shooting a little shift down at PS. If you are worried, post and ask for help.
Sarah & Jackie
Member Since 2015
Not sure where you are getting the 406 and 368. His latest numbers are :178 @ 6:51pm-PMPS SHOULD have been about 7:15pm. Then 131@ 8
4pm. And THEN 91@ 9:21pm....do you see my concern and does it seem reasonable?
You hadn't completed his SS yet when I looked at it so I was looking at last night's numbers.
On 9/12, he got into the 90s and then started a bounce. Bounces can take six cycles (and sometimes longer) to clear and today was the sixth cycle. He was clearing a bounce tonight. Bounce clearing cycles often have more momentum behind them and kitty can go lower.
It was probably a good idea for you to skip.
On 9/12, he got into the 90s and then started a bounce. Bounces can take six cycles (and sometimes longer) to clear and today was the sixth cycle. He was clearing a bounce tonight. Bounce clearing cycles often have more momentum behind them and kitty can go lower.
It was probably a good idea for you to skip.
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Sarah & Jackie
Member Since 2015
Okay. Thanks.
I should have added this last night but I was fading and it was too late for you to skip.
This is where posting on the L/L forum would have helped you. There were several of us on there last night who would have seen you post a low PMBG and we could have helped you decide whether to shoot or not. It is very beneficial for Jackie if you gradually start learning to shoot lower numbers. This Health forum as a "no shoot" number of 200 so they won't shoot anything below that. That's not going to help Jackie.
I think the outcome would have still been the same because you aren't data ready yet to shoot lower numbers but it needs to be a goal or Jackie will not get regulated. We work with you to gradually lower the number you feel safe (and is safe) shooting.
This is where posting on the L/L forum would have helped you. There were several of us on there last night who would have seen you post a low PMBG and we could have helped you decide whether to shoot or not. It is very beneficial for Jackie if you gradually start learning to shoot lower numbers. This Health forum as a "no shoot" number of 200 so they won't shoot anything below that. That's not going to help Jackie.
I think the outcome would have still been the same because you aren't data ready yet to shoot lower numbers but it needs to be a goal or Jackie will not get regulated. We work with you to gradually lower the number you feel safe (and is safe) shooting.
C
Carl & Polly & Bob (GA)
Personally, I would never suggest a caregiver introduce "R" into the equation without discussing it with, and receiving support from, their vet.
Nor do I think anyone else here should do so. Not unless you are willing to accept personal responsibility for anything that happens.
Nor do I think anyone else here should do so. Not unless you are willing to accept personal responsibility for anything that happens.
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