insulin dose increases

[George&Bert]

All the years I have been on here and no matter the insulin type I have always read that you never increase in units only fractions of a unit.

yesterday, because of my guys high nadir my docs partner said double the dose from one to two units.

I hope I am not doing wrong, but I only bumped the Lantus .25 units to a now 1.25 units u100

Am I doing my cat a disservice? I was going to wait three days and check his blood again meanwhile watching the urine in the box and his behavior.

I can only test him periodically now so I don't upset him...long story for those who are not in Lantus

 

[Blue]

All the years I have been on here and no matter the insulin type I have always read that you never increase in units only fractions of a unit.

yesterday, because of my guys high nadir my docs partner said double the dose from one to two units.

I hope I am not doing wrong, but I only bumped the Lantus .25 units to a now 1.25 units u100

Am I doing my cat a disservice? I was going to wait three days and check his blood again meanwhile watching the urine in the box and his behavior.

I can only test him periodically now so I don't upset him...long story for those who are not in Lantus

it's impossible to say without seeing your cat's numbers.

As you have no spreadsheet, at least none attached here, I guess you can just go by the general guidelines many follow:
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

You can go up to 2u if you want, but how do you know if his dose should be 1.75u? You won't.
If you numbers at mid cycle are above 300, then increase by .5u after 6 shots.
If the numbers at mid cycle are between 200 and 300, then try a lesser increase of .25u.

This protocol has worked for so many and it's logical. One step at a time and you will reach your goal, the good dose.
By taking big giant steps you are more likely to bypass the good dose and possibly harm your cat by giving too much insulin.

slowly but surely wins the race.

 

[julie & punkin (ga)]

george, the advice given above is for those following the Rand/Roomp Tight Regulation Protocol. you've made it clear in multiple posts over the past several weeks that you are not following the TR protocol because you can't test him even once a day. testing is critical to following the TR protocol. this is not appropriate advice for your particular situation, in fact, it is dangerous to your cat.

here are the guidelines for the Start Low Go Slow Protocol. the one change we have suggested that is not reflected there is what you already know - make adjustments in dose by .25u instead of .5u. even following this protocol you have to be able to test him some, especially since you can't monitor water intake because of all of your cats. you also need to test him regularly for ketones. there isn't really a safe way to use insulin in a cat without these safeguards.

i know you've said your hand shakes and you have vision difficulties, not to mention that Andre is semi-feral. i wanted to suggest a couple of things for that which might be helpful.

there are magnifying glasses that clip onto something. i wonder if you began testing andre at your kitchen table, holding him on your lap with a magnifying glass clipped to the edge of the table. or a lamp table, easy chair combination. something like that so that you can see better as you test. even clipping the magnifying glass onto a large coffee table type of book that you could place where you can test. those magnifying glasses are often found at craft stores. some have lights on them - my mom had one that was a floor lamp/magnifier combo for doing hand-stitching.

you could get the test supplies ready before you get andre. i put the test strip partway into the meter before i get punkin. that way when i'm ready, i just push it the rest of the way in. leave it out far enough that it doesn't turn on your meter until you're ready.

as far as him being so fractious - i don't know if this would help or not, but to keep him safe it is worth a try. we wrapped punkin up tightly in a beach towel for about 2 weeks for all of the tests. that way he couldn't fight me and i had him contained while i fumbled around learning how to test him. the key to burrito-ing was to put the middle of the towel across his back, then pull it tightly across his chest, pinning his front legs downward. tuck it in under his body then wrap the other end of the towel around tightly as well. if the legs are up, he always tried to climb out. with his legs down, he gave up. he looked like a giant orange shrimp all bundled up in the towel. :lol:

after 2 weeks of doing that and giving a treat every single time, he accepted it and i haven't had to do it since then.

also, do you have neosporin ointment with pain relief to dull the ouch of the poke? i've used it on myself and the stuff is pretty amazing. that might also help him. use it liberally, but wipe off the excess before you test so it doesn't goo up your test strip.

i know you've got 20ish cats and this is a lot to manage - kudos to you for sticking with your little guy. i hope some of it helps to get andre a little more manageable so you can keep him safe.

 

[Robert and Echo]

Please, do not follow Tight Regulation (TR) dosing suggestions unless you can test frequently. Many of us cannot. I agree that the Start Low, Go Slow method is better in these instances.

_Rebecca

 

[George&Bert]

Thank you, i am working a plan and I'll let you know what is happening. Have made some failed attempts to test. In the meantime he looks and acts normally outside of a lot of litter urine. I am continually adjusting his diet down in carbs and to canned. It is scary not knowing where he is number wise. I am very uneasy and check frequently. Trying a new technique tonight.

On the other side my new Diabetic Matilda is being a doll allowing me to test. I am trying diet first with her.

 

[George&Bert]

Failed attempt, but so close....

I have a head set that jewelers wear for magnification I am now using. I have tried the wrap thing, but he goes berserk.

The problem really lies in the fact that he has been deathly ill for many weeks on end. I thought I was going to lose him. His congestion was horrid. All kinds of tests showed nothing except they saw his blood sugar and thought it was due to being ill.

So, he is recently better at last. When I start to push him he starts to cough and act a little funny. If it were another cat I would be able to control it.

I also have no way to separate him so when I start to stroke and sooth him all the cats want to get into the act and everybody is purring and licking everyone else including me. Andre's ears and face become soaked. Under other conditions this would be really cute. The minute I touch his ear...he knows and runs.

I should also explain that I was hit head on by an inattentive driver who was going 60 mph. I was airlifted to the trauma center near death. It left me less than agile and with nerve damage. I'm not crying the blues, just explaining my less than ideal condition.

Another try comes up at 2:00 a.m.

 

[Melanie and Smokey]

All you can do is keep trying. Going as slow as possible with the dose increases and watching the physical signs is all you can do until you can get the testing down.

I am not up on your posts so sorry if you have already addressed this, but one thing that can help a cat get used to the pokes a little more is to make them used to handling their ears without poking them. Do you hold him and rub his head and ears at times without attempting to get a test? That may help in getting him to not bolt every time you touch his ears. If the testing time becomes a kitty pile, try testing one of the least fractious cats to show him that the other cat doesn't mind it and gets some good pets and treats for being good about it.