Hypo yesterday/Dosing guidance

My cat had hypo yesterday which I pulled her out of. She’s been on 3 units of Lantus every 12 hours. Her numbers have been totally wonky and then the surprise hypo yesterday. I don’t know what is happening and how to dose her. Could she be on too high a dose now and bouncing from hypos I didn’t catch? I reduced her to 2.5 units yesterday PM but am not sure if that was the right thing to do. Her diabetes is unfortunately steroid induced - she needs them for small cell GI Lymphoma/general GI issues but the dose has not changed recently, nor has her diet, other than yesterday when I gave her medium carb food for the hypo. Her appetite has not been great lately and I wonder if the up and down BG could be making her feel nauseous. She is eating enough but not a whole lot at one time- it takes her a long time (hours) to finish her food. Any dosing advice? Thank you in advance! Spreadsheet:
https://docs.google.com/spreadsheet...RqU5PiQvetGWQ/edit?ts=601240b2#gid=1526124902

 

If you are feeding any kibble at all you have to follow SLGS dosing method
I see you said he is eating some kibble

Might be a good idea to set up your signature, it's at the end of everyone's post in gray

Click on your name upper right hand corner , a drop down will appear , tap in signature , fill out info

• On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback. There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
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https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Please read the dosings methods,
Can you please fill out your signature it's important so that members can see this information first

You need to be testing more during the night cycle just not the pre shot so we can see what's going on
Also I see you are increasing by half units, we increase by 0.25 units

I'll tag some members for you to help out

 

@Wendy&Neko

@Sienne and Gabby (GA)

@tiffmaxee


Here is her previous post , it's the only one, Until she sets up her signature I thought I would include this from her previous post
https://www.felinediabetes.com/FDMB...adsheet-seeking-guidance.248616/#post-2804107
Hello,
My cat Bea, who will be 15 in early July, was diagnosed January 2021 and her diabetes is believed to be steroid induced. She has small cell GI lymphoma (diagnosed May 2019) believed to be in remission at this time and she still needs to take a steroid to control GI issues. She is no longer on chemo

@Wendy&Neko

 

Thank you. Okay I can try that signature. This forum takes some getting used to. I just somehow posted your reply I think? My cat eats some kibble, Dr. Elsey’s, which is low carb and I am told safe for diabetics. I’d remove it completely but with her lymphoma, she needs to be eating first and foremost and it is something that she’ll eat. It does not seem to have affected her BG. I don’t know what SLGS is but will look into it. I was told Lantus needs consistency

 

SLGS

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

 

Hi and welcome. You are not using our spreadsheet so when I click on it, it disappears. Tge one you have is from another group that copied ours. From what I briefly saw before it disappeared it looks like his bg when down to 80. That is not a hypo number. Are you using a human or pet meter? On a human meter 50-100 s normal bg. If you are feeding any dry food, even if low carb, here you would follow SLGS and a reduction of .25 was earned for having a bg under 90 regardless of which type of meter you have. If using a pet meter normal bg would be 68 and above. I think your cat was simply in lower numbers than used to unless you saw symptoms of a hypo. That should not have been with a bg of 80. Did hour cat have symptoms that concerned you?

 

Hi Elise on her SS
62, 68, 52, 59. This is what she has in the +6 cell
I saw it's not our SS , it didn't disappear on me so I got to see it
Says Alpha Trak on her SS

I'll tag @Bandit's Mom to see if she can fix it

Since it crashed for you Elise I copied what she had in the remarks column about the hypo

It took her a few hours to finish 3 ounce can fancy feast this AM. +6 bg 62, 68. Waited fifteen minutes and was 52. Gave her medium carb food and fifteen minutes later she was 59, gave her honey on gums and more food and fifteen minutes later she was at 92. Thirty minutes after that she was at 80 (+8). She was hungry so gave her dry dr. elseys; and right after she ate that at +9 she was 103.

 

Hi. Is she using a human meter? If so not hypo unless symptomatic. The low numbers will not make him more sensitive to insulin.

 

She went from 62 to 52 on a pet meter (alphatrak) in 15 minutes. Then I started giving her foods and she was ravenous. She wasn’t acting weird for the most part but her numbers have been so up and down I checked her and found the low number at +6. Maybe I won’t be able to get help here. I don’t have time to do another spreadsheet. I got the one I’m using from a FB group. I appreciate if the help I’ve gotten so far though. Thanks!

 

When the bg is lower they get ravenous. Bhooma will be able to convert your spreadsheet to ours. She’s in India but will be on line tonight.

 

Elise see #9

 

You need to reduce by .25 for dropping under 90. That is too low for an AT.

 

That’s really nice. I would appreciate it so much! The spreadsheet crashes on me too and I didn’t know why. I can only use it on my desktop computer

 

You will be able to get help, We have someone who can convert you ur spreadsheet to ours , she'll be in n later tonight and will most likely send you a private message ,so look for it where it says inbox up top

Thanks for setting up your signature


Bea look at post #7. I gave you a fast run down about SLGS , but please read the entire life k I gave you

 

I will send Bhooma a pm. She will have you up and running in minutes. We can help you. We have others with steroid induced fd and SCL.

 

Thank you so much. I know you can’t see the spreadsheet but I had been giving her 3 units before the hypo/drop yesterday. I didn’t know what to do and gave her 2.5 in the pm last night to lower it a bit. So it sounds like 2.75 is what I should be doing now

 

Thank you!

 

I’d like to be able to see the spreadsheet before you decide to take her up. When is your next shot due?

 

Very soon. About 30 minutes

 

Very soon. About 30 minutes

 

Stick with the 2.5 then tonight. How low has it taken her?

 

Where are you located? What country?

 

So she was on 3 units before the drop yesterday and I did not know what to do so went to 2.5 units last PM and this AM to decrease it a bit. Sounds like I should be at 2.75?

 

USA, California

 

After the 2.5 I could only check her today at +3 (291) and + 7 (364)

 

Sorry all, if I am replying in the wrong places btw. Trying to figure this out. It’s busy and loud at my house too so I’m a bit distracted

 

Welcome to FDMB.

It took me a few minutes to get caught up. I can see your spreadsheet without a problem. It may be that I'm on a laptop, though.

I do have one question -- what steroid are you using for the SCL? Not all steroids are created equal. Are there any other medications that you're giving Bea? It can be helpful if you include any regularly given medications in your signature. (Not everyone will know that treatment for SCL can involve steroids.)

I'm also curio9us as to how you're dosing Lantus. We change doses in 0.25u increments. With SLGS you'll want to evaluate Bea's dose every 7 days and increase the dose if necessary. Given the drop below 90 yesterday, I would hold your current dose since it reflects a dose reduction. In response to your question, changing doses in less than a few cycles has a negative impact on the insulin depot. You need to let dose adjustments settle.

I'd also make two additional suggestions. Please get a test every night before you go to bed -- a "before bed" test. this will ensure that Bea is in safe numbers during the PM cycle. Many cats experience lower numbers at night. In addition, without the information from the PM cycle, you're missing half of your data. Second, we do to hold a dose for as long as you have held the 3.0u dose. If your cat isn't in closer to normal numbers, if you hold a dose overly long you risk glucose toxicity developing. (The term so9unds a lot worse than it is.) Basically, it means that your cat treats the higher range numbers as the new "normal" and it's harder to get the numbers into a better range.

When things are a bit quieter, you may want to take a look at the sticky notes at the top of the Lantus board.

 

The spreadsheet from that Facebook group crashes on an iPad and iPhone. . It happens with them all the time.

 

Okay I need to give her her shot now so will read this gain but are you saying “hold her current dose” at 2.5 which I dropped from 3 units last night and this am, yes? And hold there?

 

Yes to both -- shoot the 2.5u

 

Thanks. All the info you’ve provided is very helpful. Bea is 15 years old and takes dexamethasone. She had been on prednisolone but over a year ago the oncologist switched her to dexamethasone after feeling like she may have become resistant to the pred. She did an 18 month course of chemo (chlorambucil) and is no longer on that. The only other thing she gets is monthly b-12 shots and very occasional Cerenia if I think she’s nauseous. She has gone up and down on the steroid dose trying to get the bg down, and it does go down when we lower the steroid but then her appetite is affected so we’ve kept her at the lowest dose possible and adjusted the insulin around that. She sees an internal medicine specialist who has had me send in curves and makes adjustment accordingly. She also does occasional fructosamine tests which in the past have said she has periods of “prolonged hypoglycemia”. Her daytime numbers were usually never hypo so I think that you are correct, I need to see what is happening at night. Darn I guess I need to get up in the middle of the night? Bea was due to see the internal medicine specialist last Wednesday but had to miss that because my young son was coughing and I didn’t want to bring him anywhere or meet up with anyone until he got a covid test. Her next appt is Sept 15 and vet will do an exam and fructosamine. My vet has recommended half unit increases or decreases which is part of the reason I went from 3 to 2.5 units after the low yesterday. I left her a message and will probably hear from her Wednesday when she is in again. I’m curious what she says to do. Thank you for the help! I appreciate your time so much.

 

Most vets will tell you it's impossible to adjust a dose in 0.25u increments. (We beg to differ!!!) It's entirely possible to miss what is a good dose for your cat if you increase or decrease by too large of an amount.

Thanks for the info on the meds. We take a similar stance as your vet. Your cat needs the meds that she needs. You can work the insulin dose around the other medication.

You don't need to wake up in the middle of the night. We encourage a "before bed" test so you know if your cat's numbers look like they're dropping. If they are, then you may need to test a bit more. If you have to get up for your child or to use the bathroom, test your cat. (We refer to this as a sleep test -- test and go back to sleep.)

 

Hi Kirsten! Welcome to FDMB.

I will switch your SS to your format.
Will send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.

 

Link to the new SS. Bea dropped to 52 on an AT yesterday on a dose of 3U.
https://docs.google.com/spreadsheets/d/14Z9pUb5YFcvIfPcspfXAwLDVNFf11JNosYtSNVMO8xE/edit?usp=sharing

 

Do you have syringes with half unit marks? We take increases and reductions in mulitples of 0.25U, so after that drop below 68 yesterday on 3U, we would reduce to 2.75U. 2.5U may be too much of a reduction.

 

No, I don’t. I have not been able to find syringes with half unit marks.

 

You can get syringes with half unit markings at a Walmart. Their ReliOn Brand syringes of 0.3 cc (30 unit) capacity come with half unit markings. Cost $12.58 for a box of 100
This is what the packaging looks like:


You can also buy them online at www.adwdiabetes.com