Increasing dosage for Fistuk & post ultrasound update

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Fistuk & Shelly

Fistuk & Shelly

Member Since 2023
Fistuk had his ultrasound today and it came very good. There are no other problems besides diabetes.

But the vet suggested increasing insulin dosage to 2.5 units.

She said the human meter I'm using is not reliable, and that it gives too low readings compared to the FreeStyle Libre sensor they put on him.

I said that in the past couple of days, his BG came below 20 while she referred to the curve she's had from at least a week ago (I took off the sensor on the 14th) she repeated that still his BG is high.

She said that the aim is to get high, to 3.5-10 BG. I understand that. I'm so so afraid of hypoglycaemia and it's tough when I don't trust the person that instructs me on these matters.

The vet who called to give the report is one of many from that hospital, the one who admitted us two weeks ago who had a smug and anxious attitude so I find it very difficult to trust her. When I asked to speak to the vet I preferred she became very hostile and said she was not there and will be only next Wednesday.

I've lost 4kg in the past two weeks out of stress and worry and not having enough sleep.

I wonder if I could get advice on the dosage.

And perhaps some understanding of how figuring out dosage works. I was never even instructed how to give insulin injections. Was just sent home with a syringe and told to give him this and that. Not having any understanding of how dosage works feels like having no agency.

Thank you for your help!
 
FreeStyle Libre is a human meter too (it just measures interstitial fluid glucose as opposed to blood glucose, and which number "lags" 15-30mins behind actual blood glucose numbers), therefore their argument on his blood glucose numbers given by your hand held monitor being too low stands on absolutely no ground, whatsoever! (Especially since taken with the same brand of monitor, from the same manufacturer, to ensure more reliability - FreeStyle).
If anything, the numbers should match, as in let's say you'd ear prick him with a BGM and you see a certain number, let's say 15 mmol/L. You then scan the Libre/CGM 15mins later, and it should give you the same (or very close to) number to that 15 mmol/L.

Whichever protocol you follow, the increments should be done in quarter units (as in 0.25 IU) as opposed to 0.5 IU. Most vets don't support this, because in their eyes we are presumably incompetent to fine tune and microdose, thus they advise us to go by the markings on the syringe - which is 0.5 IU. I have faced this issue with my initial vet too.
You are using Lantus, which is a strong, U100 human insulin - therefore you have to be extremely careful, and I'd urge you to increase strictly by 0.25 IU.

(With that said there are exceptions to this rule, but only/mainly when the cat has been on insulin for a prolonged time and/or you have enough data to know that he can take such a high increase (0.5 IU) without his BG dropping too low too fast, and when the cat is on a much higher dose of insulin, to begin with. Neither of these conditions apply to Fistuk!)
 
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.:. in.active .:. said:
from the same manufacturer - FreeStyle).
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That's interesting! So all FreeStyle are human monitors?

.:. in.active .:. said:
(as in 0.25 IU)
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This makes sense to me. Though I do find it difficult to find the 0.25U because the lines are so close to one another. DO you have a suggestion?

.:. in.active .:. said:
without his BG dropping too low, too fast
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That's exactly what I was afraid of! I did give him the 2.5 this evening. His eyes looked so glazed. I hope I can relax now from the stress that I harmed him. I've never in my life experienced such stress.
 
I can see you already given him 2.5 IU tonight.
First things first: do not panic. He will be fine. You will be fine. It will all be fine.
Secondly: Please check his BG hourly for the upcoming 3-4 hours, if you can. Lantus' onset (when it starts to work) is around the +2 mark, however, I have noticed on my boy sometimes it kicks in sooner - especially since it's a depot insulin, so the dose given in the pervious cycle usually is still in their system as it has a carryover/overlap effect.
Thirdly: When you see his BG dropping rapidly (as in more than 4 mmol/L per hour) give him medium carb food, to prevent him dropping way too low, way too fast later on the cycle. Depending on how big the hourly drop is, maybe even give him high carb instead of medium. We cross that bridge when we get to it.
Lastly: Leave some food out for him overnight for the peace of your mind, so you can get some rest later. They're intuitive eaters, and when they feel that something is not OK/their BG dropping too fast, they head straight to their bowls.
I'll be up with you tonight. That's one of the "rules" here - whoever advises you on dosing, stays with you. Although I would have you given him 2.25 IU, it doesn't matter. You've got this, and I've got you ;)
 
I did some visuals with green food dye a little while ago. Here:


0.5 - plunger top is aligned with the 1/2 mark line
0.25 - plunger top is half way between bottom of line zero and the 1/2 mark line (there is a hairline of greenery between the zero line and the plunger top -- although it looks more like a "skinny" 0.25 on this photo
empty - there is nothing in the syringe, plunger touches the top of the zero line (that empty hairline you see above the plunger is just the perforation - there is no space/air there)

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.:. in.active .:. said:
First things first: do not panic. He will be fine. You will be fine. It will all be fine.
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Thank you!!

.:. in.active .:. said:
check his BG hourly
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I will! and will update immediately in the SS

.:. in.active .:. said:
medium carb food
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I don't have any at home. I can ask my husband to try and get something from the supermarket. Thanks for all the info that's very helpful when I know what to expect and how to manage things.

.:. in.active .:. said:
Leave some food out for him overnight
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Yes, I've been doing that for a few days now. he does get up at least once or twice during the night to eat.

.:. in.active .:. said:
I'll be up with you tonight.
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I fell less panicky knowing there's someone out there for me. Though I hate the idea of stealing your night. I will make sure to post when I go to bed and if you don't hear anything then hopefully we're both asleep. And tomorrow I'll give 2.25. I'll just try to see between the lines

THANK YOU!!
 
Don't be silly, it's OK.

And never worry about stealing my night, I don't sleep. But even if I did, the US members will be here, because our "night time" is their "day time", so support will be available.

We regard foods "medium carb" that are between 6-8% dry matter carbs (more experienced members: please correct me on this if I'm wrong), not sure what brands are available to you in Switzerland, here we have Whiskas Kitten 7.5% dry matter carbs and Felix Adult 8% ish. Felix Senior is about 10% I believe, which would fall into the "high carb" bracket - anything above 10% are considered high carb. If you have Lick-e-Lix yoghurts, you may want to get some of those as well - they go crazy for it, and it has 25% dry matter carbs, so it's defo high. That's my go-to when my boy faces hypo and is reluctant licking honey or karo syrup - I just mix a tiny amount into the salmon flavour yoghurt and he devours it like it was his last ever meal.

Lantus likes consistency, both regarding dosage and time, so let's see how he is doing on 2.5 IU tonight - he may be fine and needing that dose, in which case you can keep to it tomorrow, I think (again, maybe more experienced members want to share their opinion on this, I could be wrong). Either way, we have to wait and see for now.

I'll keep an eye on your spreadsheet, but if I don't pick up your calls in time, definitely post here, so others can jump in and help you.
 
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I found Purina vital balance in the drawer :) there's no mention of carbs in the ingredients so it's hard to say.

I tried to upload a photo of my syringe but can't seem to be able/allowed to do so.
 
They don't list carbs on pet foods, only the analytics. You can calculate the dry matter carb % per 100g using an online calculator like this.

The upload file button has been broken for ages, the only way you can upload an image is to drag-and-drop it here from your desktop/laptop/tablet.
Ultimately you can find an image on Google and insert the link.
As long as you're using an U100 syringe with 1/2 unit markings, you're good to go. If it does not have 1/2 unit markings, fine dosing can become very tricky.
 
.:. in.active .:. said:
They don't list carbs on pet foods, only the analytics. You can calculate the dry matter carb % per 100g using an online calculator like this.
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using this calculator looks like the Purina is 12% dry matter carb (which I don't really know what that means lol)

but what worries me now is that I used it to put in the numbers from the Yarrah food u've been given him and I get 12.63% can dry matter!!! Am I giving him high carb food?? On the lable it says 2.4% carb soo thought this is a low carb food
 
Dry matter carbohydrate means the carb %, taken away the added water content of the food.

As of the Yarrah - I have no idea, I'm not familiar with the brand, I'm sorry.
 
so from the past three hour his BG is only going up! I think it's the stress of the day. I'm just going to let him be for now
 
so from the past three hour his BG is only going up! I think it's the stress of the day, going to the vet... I'll just let him be for today.
 
Sometimes they pull a "uno reverse" card on us with a dose increase. Meaning their system reacts to a higher dose of insulin with higher BG, also referred to as "panicky liver". Their system recognise that they've received a higher dose of insulin, and 'pre-panic' about dropping low, so produce more glucose 'just in case/to be safe'. They tend to stabilise on the current dose within 3 days tops, but usually less than 24 hours.
Given the fact you have increased with a higher, 0.5 IU tonight, you may be seeing that.
Generally it is advised to hold the dose and let the "panicky liver" phase pass. Looking at your sheet and the numbers from 17th onwards (so just accounting for the BGM/ear prick numbers) he does seem pretty high (minus that 9.5 AMPS on the 18th) so he may do well on the 2.5 IU...
But I can't confidently advise you to hold that dose, unless you can carefully monitor all his cycles in the upcoming 3-4 days and can act promptly if/when he drops fast and/or too low.
Hopefully other members will pop in to make suggestions on this front by the time your AM shot is due.
 
.:. in.active .:. said:
Sometimes they pull a "uno reverse" card on us with a dose increase. Meaning their system reacts to a higher dose of insulin with higher BG, also referred to as "panicky liver". Their system recognise that they've received a higher dose of insulin, and 'pre-panic' about dropping low, so produce more glucose 'just in case/to be safe'. They tend to stabilise on the current dose within 3 days tops, but usually less than 24 hours.
Given the fact you have increased with a higher, 0.5 IU tonight, you may be seeing that.
Generally it is advised to hold the dose and let the "panicky liver" phase pass. Looking at your sheet and the numbers from 17th onwards (so just accounting for the BGM/ear prick numbers) he does seem pretty high (minus that 9.5 AMPS on the 18th) so he may do well on the 2.5 IU...
But I can't confidently advise you to hold that dose, unless you can carefully monitor all his cycles in the upcoming 3-4 days and can act promptly if/when he drops fast and/or too low.
Hopefully other members will pop in to make suggestions on this front by the time your AM shot is due.
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What do you mean by carefully monitor? How often…
Reacting fast meaning giving high carb food?
 
I would test him at +2 to determine how fast he's dropping. E.g. if his pre-shot is 25 and his +2 is 15, you'll know he's dropping too fast and can act by giving him medium/high ish carb food to prevent him plummeting. Either way, it's a slippery slope, because as I mentioned above, their nadir varies and can be anywhere between +4 and +8. That's why you need to know your cat (which I'm sure you do :) ) and pick up on behavioural changes/cues too - some cats are asymptomatic hypoglycaemics, they just curl up and seem moody/sleepy (like... they sleep all day anyway, so it's not very helpful to us) and some only show the bare minimum of symptoms once they've already dropped dangerously low (mine is all of the above :rolleyes:).

Here's the link to How to Handle Low Numbers with added links on the top regarding a hypo "tool box".
 
Hi Shelly,

Like in.active said, we normally increase by multiples of 0.25U but since you've increased to 2.5U, hold the dose and see what he does on it. I would suggest that you follow the TR dosing method since you are testing enough. Do you feed him only wet food?

Can you share a link to the Yarrah food? I can try and calculate the carb% of the food for you. Here is another carb calculator: http://scheyderweb.com/cats/catfood.html
Look at dry matter carb% at the very end.

Low Carb is less than 10%
Medium Carb is 10-15%
High Carb is > 15%

You want to start posting on the LBL forum. There are many Lantus users there and you will hopefully get help round the clock there.
 
Bandit's Mom said:
Can you share a link to the Yarrah food? I can try and calculate the carb% of the food for you. Here is another carb calculator: http://scheyderweb.com/cats/catfood.html
Look at dry matter carb% at the very end.
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Bhooma, Scheyder and Caticles give the same results, Caticles are just a bit more precise with giving you decimals, whereas Scheyder rounds the number up. Balance.it is the one that gives you the ME carb % but I don't even want to confuse Shelley with that, because that stuff even gives me a headache, regardless of Nimi breaking it down to me in another thread :arghh:

Bandit's Mom said:
Low Carb is less than 10%
Medium Carb is 10-15%
High Carb is > 15%
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I stand corrected, thank you for this :bighug:
 
.:. in.active .:. said:
Bhooma, Scheyder and Caticles give the same results, Caticles are just a bit more precise with giving you decimals, whereas Scheyder rounds the number up. Balance.it is the one that gives you the ME carb %
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I haven't used Caticles, but I thought Scheyder gives ME carb%. Strangely, it calculates the calories from protein, fat and carbs, but the % carbs in the end is not ME%. So weird.
 
.:. in.active .:. said:
I appreciate that, but still it wouldn't/didn't hurt no one, especially since Shelley was so worried and she increased with 0.5 as opposed to 0.25
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I can't tell you enough how much your presence gave me!! I was terrified yesterday and knowing that I'm not alone was a HUGE support.

Thanks to what happened yesterday I learned that the food I was giving him was not low carb and I now use the tool you've given me. I also use @Bron and Sheba (GA)'s link. I will need to learn more about it to understand ut but indeed for now I just use the simplicity of having a number and range to support my beloved Fistuk with the right food.

Here's the Yarrah I used:
https://www.yarrah.com/en/organic-cat-food-pate-with-fish-can/
it's 12.63 carb matter

I now have in the drawer low carb 0-5 varsity, medium and high carb for hypo and some lovely low carb treats for IV (which I need to brace myself for giving him soon. he really resents it and it raises my anxiety)

I now know that Fistuk's body is fading it difficult to digest the insulin and he's responded yesterday in the same way as when I gave him the first shot and then when increased from 1 to 1.5 etc.

I will post on the Lantus thread as well. For now, since I've already started with 2.5 I will keep it for the next 3-4 days and track.

Your support has made something very clear - how little support (close to nothing really) I've got from the vets. The sent me home saying Fistuk has diabetes, with a syringe and insulin to shoot twice a day. I had to watch youtube videos to learn how to do that, I wasn't even told it has to be every 12 hours, I wasn't given any information about what to do if...
Thank you all so much!!!!
 
@.:. in.active .:. posted:
I'll keep an eye on your spreadsheet, but if I don't pick up your calls in time, definitely post here, so others can jump in and help you.
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I hope this does not mean that advice is being given outside of public view. In the off chance this is the case, it is not permitted. There is too great of a chance for an error to be missed and an adverse event hurting a cat. All advice needs to be in the public thread.

Shelly -- can you please take a look at the information on dosing methods for Lantus. There are two methods -- Tight Regulation (TR) and Start Low Go Slow (SLGS). It will help us to know your preference in order to offer guidance with regard to dosing as there are differences between the methods with respect to how long to hold a dose, when to assess the effectiveness of the dose, and the parameter for increasing.
 
Sienne and Gabby (GA) said:
I hope this does not mean that advice is being given outside of public view. In the off chance this is the case, it is not permitted. There is too great of a chance for an error to be missed and an adverse event hurting a cat. All advice needs to be in the public thread.
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I told her to increase by 0.25 IU in post #2 of this thread?
 
Just realised I have only 11 testing strips left! I order and they should be here on Monday. I can try a couple of pharmacies open in the centre of town though I don't expect them to have them
 
It should get you through.
It is advised to test at least 4 times a day: AMPS +6 PMPS +6 (or the latest you can, before going to sleep)

Today: PMPS +one more in the PM cycle (2)
Tomorrow: AMPS, +6, PMPS, +one more in the PM cycle (4)
Monday: AMPS, +6 (hopefully you get the strips around here) (2)

You should have an extra 3 left to check him once or twice in any of tomorrow's or Monday's AM cycle.
 
.:. in.active .:. said:
It should get you through.
It is advised to test at least 4 times a day: AMPS +6 PMPS +6 (or the latest you can, before going to sleep)

Today: PMPS +one more in the PM cycle (2)
Tomorrow: AMPS, +6, PMPS, +one more in the PM cycle (4)
Monday: AMPS, +6 (hopefully you get the strips around here) (2)

You should have an extra 3 left to check him once or twice in any of tomorrow's or Monday's AM cycle.
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Great. I'll focus on that.
 
It never hurts to have a back-up meter and strips. It never fails that when you need to test the most, your meter dies or you run out of strips. If it were me, I'd call around and get a back up.
 
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