Increase in Dosage

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Robyn and Penny

Robyn and Penny

Member Since 2013
Hi, all! I'm still new and tend to use the FB page more than the message boards b/c I'm just more comfortable with FB...but my cat is getting a dose increase tomorrow morning so wanted to run by y'all her situation.

She is currently on .5 units of Lantus once per day because the first day she was on insulin and got a full unit, she was acting very lethargic and sleepy all day. I was not home testing at the time b/c she was newly diagnosed, not an easy cat to handle, and we were slowly working on that. The vet and diagnostic specialist both agreed on this dose.Two weeks later and I'm still not home testing exactly when I want, have unsuccessful attempts, but we are getting better and I'm getting some readings. So, no, I cannot do a whole curve yet. I'm lucky if I get two readings in a day without completely stressing her out, and I know with Penny, I need to go at her pace!

Anyway, her nadir for 3 days in a row, 2 hours after she ate a little, +8 after Lantus, were 306, 306 and 312, so def not well controlled. I have not been successful in getting an evening reading (7pm, which would be +12 for her) from Penny yet, although every night I try! When I presented my vet with her numbers today, he wants to do 1 unit of Lantus once per day for the next week and see if I can continue to get numbers and get her +12 and maybe even +14 numbers so that we can see how quickly she is metabolizing the Lantus.

This all being said, the last time Penny eats at night is some kibble (she eats MOSTLY wet but free feed Young Again kibble) because she WILL NOT eat on her own...she will only eat if one of us humans are present with her, so she usually only eats once or no times between 11p-7a. And since I haven't been successful in getting an evening reading and she is hypersenstive to insulin, I'm not exactly arguing with my vet, and home testing training and getting that 7pm routine to get a number out of her continues. She is great about the diastix and me catching her stream while she goes to the bathroom, and as of yesterday she is still negative to maybe trace ketones.

My question is..I know Lantus dosing is typically twice per day and I know FDMB usually recommends a .25 unit increase, but this would be twice per day rather than the once that her vet wants to keep her on this next week. Thoughts on this?

Thank you all so much. Already, if it weren't for this board and the people on the FB page, she woulda died with the 3 units of Vetsulin she was originally prescribed, but I read a lot of stuff on her and talked the vet into the Lantus and lowering the dosage! I also don't think I'd be going nuts trying to home test her, but I agree with what I've been told that it's not only crucial to her management, but also for her own safety and health!
 
Hello there

Thats great you are testing - make sure you give treats and she will eventually get used to it!

Perhaps print and show this to your vet - you really want to dose twice a day - thats probably your main problem here and why she is still high. Lantus only lasts 12 hours in the cats system.
The American Animal Hospital Association published diabetes treatment guidelines in 2010. http://www.felinediabetes.com/AAHADiabetesGuidelines.pdf

You want to test if you can 3-4 times a day to get a good idea of whats going on

- always before each shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low she is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after evening shot) to get an idea of what her overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Wendy
 
Thanks, Wendy!

we are still testing on her terms so I'm working on a pre-test 7pm shot, but that seems to be her most difficult time, but I think with her initial reaction to the insulin and the fact that she won't eat at night time and the vet is going conservative till we can get more regular with testing is why he was sticking with once per day. She had the reaction to one unit, so I guess he wants to make sure she don't act funny again before getting more aggressive.

My though was to stick with the half unit in the morning and add a 7pm half unit and see how she does with that, but he insisted on doing one unit but once per day and let's see what her numbers are. Her numbers have been while she was on Lantus, and since she was only dosed once per day, it's not like it would build up in her system, right?
 
And to help you understand the numbers you get:

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
With her reaction though, you never got any blood readings did you? So we dont know for sure what went on.

Anyway I am thinking 0.5 twice a day (every 12 hours) instead of 1 unit once a day. because giving it once a day means she has high blood sugar for 12 hours and no insulin. But 1 unit twice a day (or even once) may be too much.
 
No...it was her first day and as much as I tried, we were not getting a reading out of her. She was responsive, but barely, and she's usually awake for the better part of the day following me around, etc.

Interesting, though, and my vet may be on to something, because he got the idea of the once per day dose from the diabetic specialist at the lab where her bloodwork went, who concurred with everything I had heard on here...I finally got a 7pm reading tonight, which is +12 from her shot, and her reading was 320 (this is still on the old dose of .5u q 24h)...her nadirs at +7 and +8 had been 306, 306 and 312....but based on this reading tonight, and of course I'm gonna get more +12 readings, she metabolizes it slowly...
 
Okay, Wendy...I read the links...

She's only once per day, but say with the increased dose of 1 unit tomorrow and I take her preshot BG at 7pm (+12h) and she is below 200, IF SHE WAS on b.i.d dosing, you would recommend not shooting, correct? Because she and I are both newbies?

Just trying to get an idea of what could happen next week if there is some carryover and vet decides to dose her b.i.d....she won't eat at night so her numbers would be lower on the same dose as the morning...
 
Yes as a newbie I would not shoot under 200 especially since I am worried she could go to low. We usually only increase in 1/4 unit increments.. But of course we usually dose every 12 hours.

I hope your vet reads the paper I gave you, dosing like this isn't giving her the best chance for remission.

Wendy

Ps what is the wet you are giving her.
 
She is on Weruva tins (Med Harvest and Mideast Feast, I believe around 7-8% carbs on the list) BFF under 7% carb, Petite Cuisine which are around 7-9% carbs, one Applaws flavor that is lowest in carbs (6% I believe), Earthborne Holistics but only 2 of those flavors (still need the carb content), Fancy Feast tuna appetizer but she cannot hold down FF pates for some reason, probably b/c she's used to be on the all natural stuff, and Young Again kibble just to snack on...they both eat very little of the YA so they consume about 80% wet.

She's still one one shot per day and I finally got a 7am pre-shot number, which was 308 and lower than her nadir yesterday afternoon. When she was on NO insulin, her numbers were in the 500s and 400s, on half unit she was in high 300s, when she went to one unit we had a few readings in high 200s but mainly between 300-350 now, even +24hrs after shot.

So I know she needs an increase. He's gonna want to go a whole unit but I keep reading start low, go slow. Yesterday urine showed negative for ketones but I didn't catch her in the box today lol. I also know she needs to go on an evening dose, but with her pre-shot being lower than her nadir and knowing she won't eat at night while we are sleeping (she won't eat unattended no matter how many times we try to encourage her), should I be doing a full dose at night with whatever increase he gives her? Her eating times are as follows: 7a with shot, 11:30ish am, 4ish pm and 7:15ish pm. She will much on kibble before I go to sleep but will only eat a little kibble overnight if she wakes me up to go sit with her. I have no idea why lol
 
It would be better to give 0.5 units twice a day, about 12 hours apart. There would be much more even insulin and glucose amounts in the body.

Something that might help with the eating is some associational learning. You pair a sound with putting down the food and eating every time you feed and sit with her. Eventually, an association between the sound and eating is made, and making the sound may then trigger eating behavior.
(This is the equivalent of Pavlov's dog research. ;-) )

Take a look at my signature link Secondary Monitoring Tools; those will help you monitor him, too, and provide good information to discuss with the vet.
 
Interesting...I used eating to train her for shots and home testing, maybe I can use eating to train her to eat on her own? lol She's currently on 1 unit once per day. With numbers between 300-350, you're suggesting starting first and .5 units twice per day and see what happens for a week?

That's what I wanted to do last week and he said one unit once per day. He's not very familiar with Lantus as he normally prescribes Vetsulin and I told him my reasons for having her previous vet switch her. (this is my "2nd opinion vet" I'm working with now lol)
 
That's good on the food, can you send me the website where you saw those % calories from carbs as fed numbers? I have seen research and the BFF is good as is the weruva Mideast feast, but I can't find the rest.. All I could find was %carbs per volume or dry weight, which as you know is not what we need.. I can't find %calories from carbs as fed for these...

It still would be better that you do dosing 0.5units twice a day instead of 1 unit once a day. What did the vet say about the report from the AAHA I gave you?

Let me know
Thanks
Wendy
 
I would definitely do 0.5 units am and pm, hold that steady for 3 full days/6 shots, then check around +5 to +7 of the 7th shot to see how low the glucose gets.

I'd also suggest checking for urine ketones.

If the lowest mid-cycle value on the 7th cycle is above 300 mg/dL, then you may raise the dose to 1.0 units every 12 hours.
If the lowest point is between 150 mg/dL and 300 mg/dL, then you would increase to 0.75 units morning and night.
 
Because the last time I spoke with him, it was over the phone. He's not making me come in since I'm home testing so I'm calling in the numbers every week. But I'm gonna tell him what you said and the .25u increase on each dose if her numbers don't go down in 5 days and tell him that's how the AAHA guidelines spell it out. When he tried talking me into using the Vetsulin the first vet gave me, I immediately shut him up by telling him the AAHA guidelines and he is a member so he's not gonna argue with that lol.

I can set my alarm for like 2 or 3 am, which would be +6 or +7 from her evening dose, to take her in for kibble, although it's the YA kibble, so it's no carb.

I think I may try .5u bid tomorrow rather than just the 1 unit in the morning and go 5 days on that before I call the vet. I want a pre-shot at 7am tomorrow just to see if it's lower than her +6.5 today, which was 322. Her +12 today was 343, which is the first time that number was higher than her nadir. Prior to today, her +12 number was always a little lower than her +6 to +7 number. Isn't that weird?
 
I didn't test for ketones today b/c I didn't catch her at the box, but yesterday she was negative, she was active and playing today and eating just fine. She changed her "pee times" on me so I have to catch her at her new times lol
 
Just a note, because your vet will bring it up: you have to eyeball 0.25 or 0.75 unit increments because syringes will mark no more than 0.5 unit increments.
 
Its great he supports home testing. Lol on the AAHA guidelines!

i would try 0.5 BID and see how that works - give it at least 3 days since Lantus is a depot insulin and takes a few days to build up in the cats system and you see the impact of the dose.

Meters have an error of around 20%, so 322 and 343 are within error - so she was pretty flat.

Wendy
 
Thanks, Wendy! I took your advice (against the vet's recommendations of course lol) and started bid dosing on Tuesday at .5u in the AM and .5u in the PM. I couldn't get her to bleed yesterday at +6, but today at +6.5 she was at 216. Her lowest number yet. I have the AAFA Guidelines here and some advice from the Feline Diabetes page on FB, but I cannot find on here what it says to do with dosage increases and also shooting below 200. I remember reading somewhere for newbies to not shoot below 200, and experience with Penny shows me that if she's 216 now, she could be under 200 when I test her before her 7:15pm shot tonight. Is that correct that if she is under 200 pre-shot tonight that I don't shoot?

Also, what I was told on the FB page with dosage increases is that if her nadir in the 7th cycle, which would be tomorrow, is above 300 to increase dose .5 units but if she's between 200-300 to increase dose .25units. Is that correct? I just wanna be prepared to make the right decision tomorrow.

You all are lifesavers on here. I seriously cannot say that enough!
 
After 3-5 days at 0.5 units BID, if the nadirs are still above 150 mg/dL and less than 300 mg/dL, you may increase 0.25 units to a dose of 0.75 units total. If the nadirs are really high, an increase by 0.5 units may be done instead. You'll have to eyeball it as no syringes measure in quarter unit increments, only in half unit increments.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Sorry I wasnt around for a few days. Thats great news on her blood levels - how is she doing now?.

Do not shoot under 200 until you have more data- without data to know what she will do when you shoot at lower numbers, its not safe to shoot under 200. However as you get more data, it will become important to shoot at lower numbers.


Can I ask you to set up a spreadsheet? It would help you track her progress and trends and would help us immensely - and prepare you for shooting low. Heres how but let us know and we can help if you run into issues: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207



Wendy
 
Sorry, Wendy...I keep forgetting to check here. I'm on the FB page a lot and I had completed the spreadsheet and a couple of people over there looked at it, but we have a new problem now. After almost a month of giving Penny her insulin no problem while she's eating, she's now having trouble. Sunday night I didn't get it in her at all, I did manage to get it in all week while she's eating, but last night she moved again, luckily after I was done the shot. I still do practice shots during her in between feedings, just to keep her used to the routine while she eats. This morning I tested her twice, pre shot, and got 107 and 157 (I had trouble getting blood from her ears) so I didn't shoot. She did rebound at 399 at 11:30am and back down to 283 at 2:15pm. We just had her 4pm feeding (God willing she will get her shot at 7pm) and during practice shot (first in the scruff to see if I can change her shot site, up till now I've always shot in the flank) and she wouldn't come over to eat an as soon as I started practice shots, she walked away from her food. As soon as I tent her skin now she walks away. I'm beside myself, because we finally got her used to home testing, she was doing great with shots, and now this! There's no way I can restrain her without freaking her out and I have nobody here that can help me. She's still on .75units bid b/c of missing Sunday night's dose and not shooting while she was low this morning. I use the short needle, 31 gauge, and do have the prepped syringe out for a few mins to warm up the insulin a bit. she def doesn't like the scruff of the neck, but she's reacting to her usual flank spots, too, and I'm worried sick about getting her 7pm shot in now. She don't even want to come to her usual spot to eat b/c she knows what's up now. HElP!!
 
Can you add the spreadsheet link into your signature so we can find and review it easily?

With shorter syringes you don't need to tent that much, just pull the skin up using the fur and inject at a shallow angle to the body. And no need to aspirate or swab with alcohol or anything. Should be over in seconds.

You don't want her to associate the injection with eating so she doesn't eat. Maybe try shooting when she is snoozing. Or shave a few places to make it easier to see.

Wendy
 
Yeah...I figured out that I was tenting too much with the short needles b/c we had started out with the longer needles. The problem with shooting while she's sleeping is that she never sleeps the same times but 12 hours apart everyday. She will sleep at 8-10:30pm, but never 8-10:30am, and if she sleeps at night, she gets up as soon as I get up. So the only way I can time she shots 12h apart is while she's awake. I don't get why all of a sudden she's giving me a hard time on the shots. She was great up till last week with them. Now that she's used to testing, she's giving me a hard time with the shots. I'm gonna try while she's eating tonight...got last night in after some trouble and got this morning in, but she jumped when I was just about done, so not sure how tonight is gonna go. I may try to get her used to it just after testing, but I originally tried to shoot her while she wasn't eating, and that was a disaster. I terrorized all and sundry that first attempt. There's GOTTA be a way to work this out!

Here's what I have so far...I haven't updated it the past few days b/c I have the flu or something rotten: Note that yesterday morning she was 107 and 157 so I didn't shoot (it's not on this sheet yet)...Last night she was 294 PMPS so I shot .75u and this morning she got .75u

https://docs.google.com/spreadsheet/ccc ... VclE#gid=0
 
I just updated her spreadsheet...the latest reading I got was 10:30 pm, but when I get up at 2:30am to check on her, I haven't thought to test her...some mornings Im not even sure I actually got up to check on her lol. I can try around 4am when she starts her serenade b/c she wants to take me in for kibble (she snacks on it at night but only when I'm present...she will not eat unattended and have no idea how to break her out of that).

Anyway, I remembered reading Lantus has as sting. A couple of girls over on FB helped me with some ideas, but I had researched on here and talked to a few people on the FB page last night about switching her to Lev from Lantus, since she seems to react after I push the plunger. I did warm it under my arm this morning and that went well, although she was watching birds and squirrels so I coulda done anything to her and she would have never noticed.

I see those who had switched said that their cats reacted better on Lev than Lantus, even at shot time. Her vet is agreeable to switching and calling Walmart to change her over, but what are your thoughts on it?
 
Levemir supposedly doesnt sting but Lantus isnt supposed to at small doses either. At what point does she object? When you insert the needle or when you push the plunger?

Any chance of a before bed test?

Wendy
 
For the feeding issue, I'm wondering if a gradual behavior shaping process may help.

How close do you have to be to her for her to eat?
What you might do is very slowly start moving further away from her, by inches.
Do 1 to 2 inches per week.
You go back a step if the step doesn't work.


Another thought - Do you always feed her in the same location? If yes, you might try changing that and see what happens. Does she refuse to eat? Become anxious and vocalize? Go back to the original location?
 
Can you add the spreadsheet link to your signature to make it easier to find?


Since you shot at 140 this morning can you get a test around +2 or +3?
Wendy
 
Wendy, I'm horrible at checking her for responses...

She was objecting at injection but the jumping was happening when I pushed the plunger. I was tenting then. It seemed she started reacting when I increased her dose from .5u to .75u of the Lantus. I switched her to Levimir last Saturday night and brought her dose down from .75u to .5units just so I can see how she responds, and I've been making sure the insulin is warmed up. Also, I was talking to the ladies on FB, and one of them showed me how she pushes back her cat's fur and then picks up the fur to lift her cat's skin for a shot, so I've been doing that with Penny this past week. I tried changing sites from flank area to between the shoulders or the scruff and that did not go well. I tried to train her to take the shots after testing before she ate, and she caught on really quickly and resulted in her snapping at me and not even coming out for testing and feeding. Honestly it was making her a nervous wreck. So I tried the new technique of rolling back her fur and then lifting her skin by the fur, warming the insulin, and of course she's on Lev now and I don't wanna speak too soon, but for now we are back to shooting while she's eating. It's the only way I've been able to get her shots into her this past week.

I will try inching away...I need to be in her site to eat...sometimes I will walk further away and she stops eating and comes to me. She has some separation anxiety, too. You would think after me poking her like a pin cushion the past 6 weeks she would hate me by now lol

I will add the spreadsheet to my signature as soon as I figure out how to do that lol In the meantime, here's an update. I had decided to increase her Lev to .75u bid starting this morning, got an AMPS of 144 and got chicken shitty and ended up shooting roughly .6u into her this morning. I'm still getting used to lower numbers lol. She was acting funny around 9:45am, about +2h, so I did a spot check and got 109. This was after she ate low carb wet and a tbls or so of Young Again kibble and also about a tbls of Young Again low carb treats.

I know that at +2 her morning dose of Lev hasn't kicked in yet, but even when I did her mini curve the other day, her lowest point was around +3 or +15, depending on how you look at it. Is it possible that her nadir with Lev could be +14 or +15? I know I read that Lev has a later nadir of +8-+10 but she's consistently showing a low at +14-+15...Here's her updated spreadsheet. Am I right to increase her to .75u?

https://docs.google.com/spreadsheet/ccc ... VclE#gid=0
 
Also, SHE changes where she eats when her shots were going bad and she had developed an aversion to coming to her usual spot to eat. If I try to move her kibble, she gets confused and just won't eat it unless it's where it's "supposed" to be. Her sister Weeny gets very standoffish and skeptical if everything isn't in its right place. Yes, I have OCD cats with issues, alright! lol
 
Hey Robyn!!

Spreadsheet is working, so that's great! Not sure how you think you shot a .6 though...at those "in between" doses, if you don't use calipers, I doubt if you (or anyone else) can "eyeball" it.

When you're unsure whether to shoot at Pre-shot times, remember to stall, don't feed, and retest in 30 minutes. If possible, I'd suggest using that time to post here and get someone to help you through those first few scary times of shooting lower than your comfort level. We want to catch as soon as the blood glucose starts to rise (without the influence of food) so you can shoot as close to every 12 hours as possible. Remember though, if you stall for an hour (for example), your next shot has to be moved back an hour, so sometimes the decision to shoot or not shoot has to do with how flexible your shooting schedule is...but if you want the best chance for Penny to go OTJ, you need to do twice/day shots as much as possible.

You're doing a good job of testing during the AM cycle, but it would help to get at least a "before bed" test every night during the PM cycle. Without more tests during the PM cycle, you are only seeing half the data. Most cats also drop lower at night, so it's a good way to know if she might be going too low and you'd want to set an alarm to get some more tests in later.

All in all, she seems to be doing fairly well on this dose although I think there's room for an increase to .75 especially if you can get those PM tests in. I wouldn't do it until maybe tomorrow though....I always like to do increases on the AM cycle so there's less chance of a "surprise" at 4am...although we do have some fun PJ parties in here...LOL

I've never seen this chart specifically for Levemir, but this is a "typical" cycle for Lantus (and for a lot of people, Levemir...but ECID so you'll learn how Penny does with time and testing)

Example of an active Lantus cycle:

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

Keep asking questions...we'll help any way we can!
 
Thanks! I do have to get more PM tests with Penny, but I've found it curious that her Am +2-3 is lowest and the few PM +2-3s I've gotten have dropped from pre-shot level, and Lev doesn't work that fast.

Where you copied and pasted that Lantus cycle from the sticky (I forget which one but I copied and pasted it so I have it), right under that it has a typical Lev has onset at +4, nadir is +8 to +10 somewhere, but that's all the info I could find on here regarding Lev specifically. That's why I was wondering if it's possible that she could have a nadir that's later than +12, b/c according to that sticky, Lev's onset is +4 but her lowest number has been +2-3 from AMPS...
 
This is where the ECID (Every Cat Is Different) comes into play. No two cats are going to react the same, and we just have to give you "averages" or "usuals".

Again, another reason home testing is so important..just because "Spanky" reacted to 1 unit by going "here"..doesn't ever mean "Tigger" is ever going to react the same way. I only see 1 test at +3 on the AM cycle on your spreadsheet (on 10/16) and one +3 on the PM cycle (10/17) since changing from Lantus to Levemir, and it's just too soon to know when Penny's nadir is going to be...Also, just because Penny's nadir on one cycle is at +3, doesn't mean the next cycle it won't be at +4...or +5, +9 or +10..Nadir's can and do change from cycle to cycle.

We're working on getting the protocol translated into Meowese, but with all the different breeds it seems they all have their own dialect and it's not going well at all ..the fact our cats don't have opposable thumbs makes it hard for them to turn the pages too! :lol:

Keep testing...the more data you can get, the more comfortable you're going to feel about treating Penny..and getting a really good feel for where her numbers will go. This sugardance is a marathon, not a sprint, so don't get discouraged. It'll get better! :-D
 
Thanks! I'm just trying to figure out her nadir so I can make dosage adjustments. I feel like I should be increasing .25u each dose, but then I got the 109 at +2 this morning. I was basing that dose increase on her lows before today, which were mid- to high-100s. And I got chicken shitty with increasing this morning, so I shot out a little of her upped dose, and it ended up being just under the line for .5 units, which I eyeballed to be .6. Real scientific lol
 
We routinely eyeball fat, skinny, drops, and so on for the insulin doses. The important thing is consistency. You find some way to keep it consistent - calipers, making a reference syringe with colored water, etc.
 
Chris...thanks by the way! I gave her the .75 tonight, and since her lowest tends to be 9-10am the next day, I felt I could do that. Her PMPS was 266 and that has consistently been her highest during the day. I'm gonna try to get some more +3s and +4s both AM and PM when I can this week.
 
BJ..thanks! I was talking to Gayle on the FB page and she told me the "drop"method, but I quickly learned tonight that there are fat drops and skinny drops so I pretty much eyeballed it lol
 
With the drop method, you really have to practice to get the feel for it and be able to get uniform drops of whatever size.

Magnifiers help! I used Carson Clip and Flip magnifiers to add magnification for seeing tiny dose changes.
 
I'm not consistent with the size of drops coming out of that syringe lol. I already draw more than I need and push out the air bubble and do drops to get it up to the right dose. B/c I'm using the Flex pen I won't shoot the insulin back into the pen. But tonight when I tried the drop method, I had uneven sized drops lol

I have 20/15 vision so I have no problem seeing between the 1 unit and .5 unit line, but it's making that minute adjustment on the syringe and shooting out too much and then I get aggravated. It requires patience, which is so not my strong point! lol
 
What meter do you have? that 57 is a dose decrease if its an alphatrak.

Also I am thinking you might want to post on the lantus /levemir board.That board has lots of very experienced dosing members on it and is a great sense of community.Since you are now up to speed with testing etc I think they will really be able to advise you better on dosing etc. I post there myself every day or two to get their eyes on my cats.

There is no rush to post there. I like to suggest that people go over to their insulin specific support group and check it out. Read the Stickies at the top of the Topics section. Read a few condos posted by other members. Get a feel for how the forum works. See if you think it would be a good fit for you.

http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Wendy
 
Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Thanks, guys...I have the stickies in my favorites, tight regulation protocol and relaxed regulation, Lantus and Lev cycle...all of that.

We use the Relion confirm. That 61 and 57 wasn't not even two cycles into her dose increase, so I decided to do a fat .5 units for a couple of days and get more +4 numbers before I commit to .75 units, which would have been her increased dose. I know 61 and 57 aren't hypo, but they were close and we haven't even gotten two consecutive cycles at the new dose yet so I got scared lol. So I will do the fat .5u for 7 cycles and decide from there, I think, that will give me a few chances to get the +4 on the AM and PM cycle, since that AM +4 seems to be her lowest point on Lev (which, I'm guessing with how slowly Lev works, is actually a +16 nadir??)

And now, back to trouble with shooting after the past 5 days being smooth sailing. This cat is gonna drive me to drink for the first time in over 13 yrs lol
 
Good call - low glucose can kill quickly and going for safety first is being responsible.
 
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