Introducing Leo & Me

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Lacie

Lacie

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Hi everyone - I had hoped I wouldn't have to join this board, but my boy kitty Leo said I'd better.

Leo is an adopted stray of unknown age whom I've had for 3 years. In August he had dental surgery for severe gingivitis and had five teeth extracted. Ever since then he's been losing weight, drinking about 8-12 ounces per day of water, and urinating more than I would like (3-4 softball size clumps per day). He's started missing the litter box now and then, which he never did before. He's not overweight, has always been skinny (12 pound male with a huge head and long legs).

I've always fed my kitties canned Innova EVO, but after the surgery I had trouble getting Leo to eat the wet EVO, so I tried the EVO dry cat and kitten food. This is a very low carb dry food but of course it made his water consumption and urination worse. He was still losing weight (went from 12 to 11 pounds between August and December) so I took him to the vet a week and a half ago. His labs were confusing, to say the least:

Urinalysis
SG 1.036 (a bit dilute but within normal range)
Glucose 1000mg/dl (high!)
Negative for ketones

Bloodwork
Glucose 385 (indicates diabetes, but could be stress response from car ride and vet visit)
Cholesterol 309 (indicates diabetes?)
WBC 6.85 (low end of normal)
BUN 35 (high end of normal)
Creatinine 1.9 (normal, vet says CRF unlikely because of this)

My vet says he's leaning toward a diabetes diagnosis because of the 385 blood glucose and the glucose in the urine, even though the specific gravity isn't all that high. Since he wasn't sure, I asked if we could try a round of Clavamox for a week in case we didn't drive out all of the infection after the dental surgery (his jaw was really bad). The more I think about it, though, the more I think this is a case of doh! he's diabetic.

Since then I've switched Leo back to wet food (Friskies pate type, low carb) and he's eating better but still not gaining weight. Vet wants to do a second blood and urine test before starting insulin, and I'm thinking I should do it this week even though the Big Guy is doing better since I switched his food (more energy, putting on a bit of padding but not enough). He drank and peed less for a couple of days but today it's back to previous levels, and I don't want a diabetic crisis on Christmas with no vet's office open.

So I need help:
1. Should I ask for a fructosamine test too? What will it tell us?
2. Should I take my own BG reading at home with a hometest meter before believing the vet's office blood work?
3. Should I test him for ketones while I'm waiting to get into the vet's office?
4. Should I start with a Lantus pen if we start him on insulin? (I'm off to the insulin forum to start studying as soon as I finish posting this?) I'm short of cash right now but overall I think I can support treatment for him.
5. With that high glucose in the urine, should I be in a big hurry to get him back to the vet for a retest?

Thanks for any guidance you can give me as I start down the sugarcat road!
 
Welcome, Leo and Lacy, to the club you never wanted to join. You will find outstanding support here in helping to get Leo feeling better and staying healthy.

When Leo's dental work was done, was he put on steroids? There is frequently a link to diabetic episodes/periods and steroid use.

The glucose readings do indicated diabetes as I read them. It also sounds like you haver really done your homework and know what to talk to your vet about. I commend your being so proactive.

You are so correct to try and get Leo back to eating canned food. EVO is a good canned food and the diet switch should help.

Yes, I would ask for a fructosomine, and would also recommend you take Leo's blood glucose readings before each meal and chart them, so that when you go into your vet you have a good indication of what his blood glucose is doing at home.

Hope this helps you both chart a good treatment regimine to get Leo feeling a - o.k.

The symptoms seem to indicate diabetes also.

You can pick up ketone sticks at the pharmacy and keep an eye on his ketones at home also.

When is he due back at the vet? I would pursue this sooner rather than later, if you can. Why delay the treatments that can get Leo feeling better sooner? And as you say, the Holidays can be a dangerous and expensive time to have a sick pet. Sounds to me like you know what you need to do and have researched this all well.
 
Hi and welcome.

I'm glad you joined the board, although I wish you didn't have to also. It sounds like Leo is going to get the best care :)

I would start hometesting immediately, not to confirm the vet's numbers, but because at home, at rest, the numbers are going to be lower. The Friskies canned is great, but if you want to try going back to the Evo canned, I've recently started using FortiFlora after reading about it so often on this board and it really does work. Sprinkled on the food, the ones that sometimes turn their noses up at a flavor eat everything up.

A fructosamene test will tell you what Leo's BGs have been averaging over a few weeks. I don't do them, but some vets insist on it. It wont hurt anything. I would consider Lantus a great insulin to start off with. With sugar in the urine, I would want to start hometesting quickly and start insulin to help my kitty start feeling better. If you do go with the antibiotics, that may raise the blood sugar so I would not pick a dose based on possibly higher BGs than normal. Also, if this is a left over infection from the dental, the BGs may come down on their own after the ABs and the infection clears up, another reason hometesting would be important right now.

Did your vet run a hyperthyroid test? Weight loss, increased urine and eating, that could also indicate hypert.
 
Wow, Leo is very lucky to have an advocate like you. You seem very knowledgeable and are doing all the right research. I have only been on this board for a couple of months, and in that time I got Schroeder up and running on insulin, started home-testing, got him stablized, and then OFF the insulin! One more day until I can officially call him OTJ (off the juice). The feedback you get here will be invaluable.

Schroeder also had dental surgery about 6 months ago, prior to any FD diagnosis. Information that I've been reading says that diabetes and infections are correlated, and can sometimes only require short-term insulin course. When his BGs come down into the normal range, the pancreas' of some cats are able to heal themselves, and begin to produce their own insulin again.

Home-testing is the single best thing you can do for Leo. The numbers are far more accurate that after the stress of a vet visit. It will help you get him regulated faster when you can fine-tune his dose, and of course help prevent hypo episodes. I have a great list of resources that I used to learn how to do the home-testing, and info on getting your cat regulated. Let me know if you'd like it. The more you can do at home on your own (while keeping your vet in the loop, of course), the more money you will save, and the less stress on Leo. I found I had to educate my vet on a lot of FD treatment, but he was willing to learn.

The cheap low-carb pates are just fine. No need for the expensive stuff.
At that, I will leave the feedback to the more experienced members. Good luck!
 
Hello and welcome!

I assume that the blood work numbers you listed are only the ones that are out of range, or close to it, and not the only tests that were run, yes?

The glucose spilling over into the urine along with the symptoms you mention strongly suggest diabetes to me. The elevated BUN could be due to him not processing food properly, which leads to malnutrition and dehydration. My siamese rescue kitty, Yoda, was offered plenty of food at his previous home, but his mouth problems and diabetes lead to him not eating enough and not properly processing what he did eat. He was malnourished and dehydrated despite being offered food daily. After a dental and regulation of his glucose, his kidney values all went back to well within normal ranges.

I would also recommend an antibiotic for his mouth. Between a mouth infection and possible steroids given during the dental, he may be quick to go into remission with treatment and insulin!
 
Wow, what great answers--thanks all of you!

We did get a thyroid panel done (I had my suspicions as well) and it came back normal. And yes, we had a full CBC and electrolyte panel done, but I only listed the numbers that were out of range.

I didn't know that gingivitis and dental surgery could aggravate diabetes--it would explain why Leo could have high blood sugar despite the low carb diet, and it gives me hope that the insulin won't be a long term thing. And I agree that the long term starvation and dehydration due to the gum disease probably stressed Big Guy. Learned my lesson--pay now or pay later.

My glucose meter is on its way by mail order, and I've already spoken with my vet's office about home testing. They're open to it, which is good, since they're five minutes from my house--less stress on Leo and me too. I just bought a box of ketostix and am going to monitor his urine until the meter gets here so we don't get ambushed by an emergency. Vet appointment is Thursday and since I'll be testing at home too, I'm going to forego the fructosamine test if they'll OK it--I've had a lot of vet bills this month already!

Can't wait to do that first ear stick! I'm off to the insulin section of the forum to get myself educated. Thanks again for the great support.
 
Lacie said:
Hi everyone - I had hoped I wouldn't have to join this board, but my boy kitty Leo said I'd better.

Leo is an adopted stray of unknown age whom I've had for 3 years. In August he had dental surgery for severe gingivitis and had five teeth extracted. Ever since then he's been losing weight, drinking about 8-12 ounces per day of water, and urinating more than I would like (3-4 softball size clumps per day). He's started missing the litter box now and then, which he never did before. He's not overweight, has always been skinny (12 pound male with a huge head and long legs).
Click to expand...


Huge head ? Hmmmm....could he have acromegelay ?


See:
http://catacromegaly.com/573.html?*sess ... on*id*val*
 
Karen & Smokey(GA) said:
Huge head ? Hmmmm....could he have acromegelay ?
Click to expand...

That's very interesting. His lower jaw has been getting larger over the past year, gorilla style, but I assumed it was because of the severe gum infection. The vet said it was actually hollow underneath the lower canine he pulled.

I'm going to bring this up with my vet, although it sounds like the first step in any case is to get the diabetes under control.
 
Sorry you guys are here, but welcome!

OK here is my take on your questions:
1. Should I ask for a fructosamine test too? What will it tell us?
Yes, have one done before you start on any insulin because it will let you know how Leo's been over the last little while. Sure his numbers at the vet's office could be from stress, but the fructosamine test considers all times, so it's a great indicator. Once you start insulin, just home test. You will not need to pay the vet for any more fructosamine tests because you will be able to get your own averages from your home meter.

2. Should I take my own BG reading at home with a hometest meter before believing the vet's office blood work?
I use my meter for my cats at home and also take it to the vet office when they go for any visits. That way you will not wonder about the differences between your own monitor and the vet's. The blood work at the vet is likely valid for Leo at that point in time, but it's not the same as what Leo's numbers would be if he is lounging at home in his favorite spot. Get a regular meter from the pharmacy, Relion is what many use as the strips are cheaper, but others are good. I like Bayer Contour and my backup is the OneTouch.

3. Should I test him for ketones while I'm waiting to get into the vet's office?
Yes! Most definitely pick up ketostix at the pharmacy and test Leo's urine daily and be sure to mention if you see even a trace register on the stix. You want to react quickly if they are present.

4. Should I start with a Lantus pen if we start him on insulin? (I'm off to the insulin forum to start studying as soon as I finish posting this?) I'm short of cash right now but overall I think I can support treatment for him.
I use Levemir but did use Lantus before for both of my cats. I don't know which is cheaper, but get the pens or the cartridges as there will be less or even no waste. I prefer Levemir but it's up to you.

5. With that high glucose in the urine, should I be in a big hurry to get him back to the vet for a retest?
You don't need to get back to the vet to retest because you can test yourself at home. You would want to get Leo started on insulin if you are finding his BG numbers are high when he is at home and relaxed.

Karen, the head is something to keep in mind, but first to get Leo settled on insulin if needed.

Lacie, if you have some pictures, would you be able to post them?
 
Here's a picture of Big Guy before he got sick. I'll try to post some other images later when I get time.

Gayle, thanks for the great information. I have a Novamax meter (used to be BD before they changed their name) coming by mail. The sample size is really small (.3) so I'm hoping testing will be easy, and I'll get a result in my vet's office to make sure they match up. I'm thinking the vet will want a fructosamine test to start out with.
 

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The large head could be acro, or it could be because the rest of his body is so skinny. The protruding jaw thing with it being hollow under the extracted tooth makes me wonder if he has an infection in his jaw bone too nailbite_smile
 
Kelly & Oscar said:
The large head could be acro, or it could be because the rest of his body is so skinny. The protruding jaw thing with it being hollow under the extracted tooth makes me wonder if he has an infection in his jaw bone too nailbite_smile
Click to expand...

I agree--that's why I wanted to do an initial round of antibiotics when he started looking sick. After the dental, I wasn't able to finish the first round of liquid clinimycin (sp?) because he flat out refused to take it after four days. I now realize that this was a mistake, because his jaw had got to be a real mess by the time I got him in for the dental work. This time around with the Clavamox, I've split the dose into 1/2cc 4x a day instead of 1cc 2x a day, and it's a lot less struggle. He hops up on the shelf next to the counter (he still jumps great), I shoot the dose into his mouth with a syringe, and then immediately set a big dish of food in front of him. Works like a charm.

Right now I'm grading papers (I'm a college English teacher) and hanging out with him in the litter box room with a ketostix ready to go when he is!
 
Are the ketostix/glucose stix combo strips accurate for glucose if you catch them right at 30 seconds?

Just took a sample. No change from the vet's office 10 days ago: glucose 1,000, no ketones. Let's hope the ketones stay down until Thursday. :-|
 
I have not used those combo strips, but the glucose in the urine has already passed through Leo's body so it's really old news that is telling you what his glucose WAS, not IS. Getting your numbers from the blood tells you what's happening right now.

No ketones is a great result. Let's hope it stays that way too!

For the meds, if it's a liquid that tastes horrible, you can use a syringe and also mix in some tuna water.
After Shadoe's dental, she had Antirobe drops and she did NOT like that stuff but what I did was syringe up some tuna water and then add the antirobe in the syringe. That way there was a tuna water chaser so the lousy taste of the antirobe was washed away. She still got the crappy taste first but most of it was washed away with yummy tuna taste.
 
OLM Catnip Cottage said:
When Leo's dental work was done, was he put on steroids? There is frequently a link to diabetic episodes/periods and steroid use.
Click to expand...
Any idea what particular steroid would have been used for the surgery, and for what purpose? Also, I've heard that different anesthetics can have different effects.
 
As Gayle said, urine glucose measurements are not the same as blood glucose measurements

WHen blood glucose levels go above renal threshold, which is somewhere in the mid 200s, the kidneys start to filter out the glucose and dump it into the urine. So glucose-laden urine starts to build up in the bladder and then is eliminated the next time the cat pees. The level of glucose is an indicator that something is going on but is not precise enough at all to dose.
 
I called this morning and got him into the vet today. Blood test glucose in their office was 385 again, glucose in urine again 1,000, so we have a diagnosis and are starting insulin tonight. I did a couple of placebo shots with saline and I guess I'm ready if Leo is. He was good about it.

The wonderful thing is I didn't have to fight with this office over the right protocol. They didn't push "diabetic kitty krunchies" on me, and when I asked about Lantus they said, oh yes, that's what we like to start newly diagnosed cats on. Very supportive of meter testing at home, too; they actually asked me to get a curve for them in about a week.

Some things that don't match the protocol at FDMB:
- They're having me shoot into the scruff. I know this is problematic over time, but would there be any harm starting out with the scruff? I'm feeling a bit unsure of myself for the first few shots, and the scruff is easier.
- Starting dosage is 1.5 units Lantus, 11.6 lb. cat (ideal weight is 12). I know people here like to start at 1 unit. The 1/2 unit difference looks so tiny in the syringe that I'm afraid of not getting it right using the visual scale.
- They recommend overfilling the syringe a bit and shooting the excess back into the bottle

I'm starting out with a vial, just in case Leo's diabetes was steroid induced and treatment turns out to be short. If it's long term, I'll go with a pen.

After the initial stick, the vet has me pulling back very slightly on the plunger and looking for air before injecting to make sure I don't get a fur shot. Is this good practice?

Glucose meter will be here tomorrow, first shot is tonight. I have my hypo kit ready and am continuing to test for ketones. My vet said I might not see any improvement in his symptoms for the first week.

I'm so glad I started this a few days before the holiday so there's time to get problems ironed out before the long holiday weekend.
 
I would start with a lesser dose of 1u. I know that the half a dose looks tiny but that insulin is pretty powerful and even an increase of .25u can make a huge difference to some cats.

It's better to start with a lower dose and work your way up. That way you know you did not start at too high of a dose.

It sounds like you got yourself a pretty fine vet there too, so good luck on starting on the insulin. See if you can get a spreadsheet started so that you can record your testing and others can give you a hand on advice and also help you to understand the numbers you are getting.

Shooting the scruff is ok; don't worry about that. There are diagrams of other locations for shots, but to start, the scruff is most easy and cats don't seem to mind shots there. It's also convenient because you can give the shot while Leo is eating, and he won't mind one bit.
 
You absolutely do not need to pull back on the plunger; it is a bit of an antiquated process and can make shots more complicated.

Glad you had a good vet visit and please keep us in the loop as to how things go :)

Jen
 
- They're having me shoot into the scruff. I know this is problematic over time, but would there be any harm starting out with the scruff? I'm feeling a bit unsure of myself for the first few shots, and the scruff is easier.
- Starting dosage is 1.5 units Lantus, 11.6 lb. cat (ideal weight is 12). I know people here like to start at 1 unit. The 1/2 unit difference looks so tiny in the syringe that I'm afraid of not getting it right using the visual scale.
- They recommend overfilling the syringe a bit and shooting the excess back into the bottle
Click to expand...

I started in the scruff too. After you are comfortable with shooting insulin, then you can move to the sides of the belly. There is more room there to alternate shot locations and the insulin absorbs better there due to better blood flow.

There are still some protocols out there that start the initial dose of lantus by weight. We start here with 1u because there are many kitties that initially actually need less than that.

DO NOT SHOOT THE INSULIN BACK INTO THE VIAL ONCE YOU HAVE PULLED IT INTO THE SYRINGE. Sorry for the caps, but Lantus is a fragile insulin. You are shooting non sterile insulin back into a sterile bottle of a fragile insulin - you are risking the insulin going bad quicker than you would like. You will not use up the whole bottle before it goes bad anyway. Just squirt the extra unit into the sink to get the plunger to the correct dose.
 
Lacie said:
- They recommend overfilling the syringe a bit and shooting the excess back into the bottle
Click to expand...


Nope....don't ever put insulin back into the bottle. Don't roll or shake it either.




I think there are some things you can print out from the Lantus forum about handling lantus.

You can give them to your vet. I hope they are not giving this advice to all their clients.

If someone is shooting 'blind' not home testing, and contaminates the Lantus, it will stop
working. Then vet visit shows cat's BG is high. Vet increases dose (unaware that Lantus is
contaminated). Client gives cat too much insulin....dead cat.
 
I went over and read all the Lantus stickies in preparation for tonight's first shoot. Many things are different from what the vet showed me: don't inject air into the vial, don't send the excess solution back into the vial, and no need to pull out the plunger between the stick and the shoot. Considering the cost of this stuff, I'm doing it the way the stickies say to do it. :?

I just went out to the mailbox and my meter came by priority mail from Florida to Michigan in only 24 hours!! It's a sweet little Novamax kit in a black zip pouch with an adjustable lancet pen and some free lancets and test strips. I tried it on myself and the sample size needed is tiny--literally no bigger than the head of a pin. Amazon has it for $18.99 +$4 shipping if anyone is interested. Refill strips are $20 for a box of 50.

My vet said the curve won't tell me much for the first week until Leo's system gets used to the Lantus. Do you folks see any point in doing a curve with our very first shot? Seems like I would want to watch out for lows with that initial shot, especially if I go with the recommended 1.5u.

My vet is a small town practice and she said they only have two clients doing home testing (and one is a former vet tech who used to work there!). That's probably why they're not quite up to speed on some of this stuff. I'm just glad they're flexible and willing to work with me.

Spreadsheet is set up and ready to go. Now off to Walmart to squeeze some bucks out of the credit card for the Lantus.
 
Don't fault your vet too much...most vets are GPs and have to know a lot about a lot :)

A curve isn't necessary yet. Much better to do preshot tests and some spot checks and just take notes. The only time you'll change your course of action is if you get a preshot under 200, at which point if you can, ask for some advice from the board on what to do next. 200 is a rough line in the sand when starting out, for when it is safe/not safe to give insulin. The point being that you don't want the insulin to work TOO well and take Leo too low. Make sense?

Jen
 
Makes perfect sense. His blood glucose has been pretty consistent at 385 the last two times he's been tested, but I'll do a PMPS reading before the first shot tonight.

Oh geez, I just thought of another question: should I feed him before or after the shot? Vet said to feed first, then test and shoot. I guess if he was hungry, the BG reading would be artificially low, right?

I'll be glad when I don't have so many questions--whenever THAT is :!:
 
Everyone develops their own routine; lots of us liked to put food down and then 'shoot' while the cat was eating, especially when first starting out with the whole shot routine thing....
 
Welcome to both you and Leo! Sounds like you're starting in a great place, and you're in the right place to get good advice!
I've only been in for a couple weeks and the knowledge I've gained here has been invaluable... especially on the handling of the Lantus. I got the same advice at my vet too!

Just a tip... If you have a CVS in your area, keep an eye on their ads. They often will run the Novamax free after extrabucks, and the Novamax kits come with 10 strips in them. Nice way to pick up some extras at basically no charge. I had one sitting around forever that I meant to donate (before I had willie's diagnosis) and ended up opening it up to get to the lancet pen, only to find expired strips inside!
 
Test, then feed, then shoot.


Feed before you shoot, so there is food in the cat before giving insulin....something for
the insulin to work on.

If you cat is prone to throwing up after eating, wait about a 1/2 hour after he eats, to insure
the food stays in the cat.

You test before you feed, so you get the lowest number.

If you test after you feed (1/2 hour later)...the BG will have already gone up from the
food.

So test, feed (wait one half hour...optional), then shoot.
 
You want to take up any food for the 2 hrs prior to shot time so that all food is out of Leo's system.

You want to test just before his shots, and if his number seems low to you, do not feed yet. Sometimes a number may be low but could be rising, so if Leo tests low, wait 15min and then test again. Once you have decided if you are going to give a shot or skip a shot, then you can feed.

What I do is get their foods ready but don't put them down until I have tested them and decided if they are getting shots or not. Either way, they get their foods after I decide.
 
Must agree that it is a bad idea to shoot extra insulin back into the vial. I used to just shoot any extra into a napkin and throw it away. Although my cat was only on insulin for a few weeks, I shot it in the scruff all the time, just because it was the easiest place for me to "tent" the skin and ensure that the insulin actually went where it was supposed to go! Sounds like you are doing great. Lucky Leo!
 
Karen & Smokey(GA) said:
Gayle and Shadoe said:
You want to test just before his shots, and if his number seems low to you, do not feed yet.
Click to expand...

I don't understand why you would withhold FOOD if kitty is too low to shoot.
Click to expand...


Read the next two lines in my post:
You want to test just before his shots, and if his number seems low to you, do not feed yet. Sometimes a number may be low but could be rising, so if Leo tests low, wait 15min and then test again. Once you have decided if you are going to give a shot or skip a shot, then you can feed.
Click to expand...

I did not say too low, I said seems low. There's a big difference between too low and seems low, and many people have posted when they get a BG lower than ever before and want to know if it's OK to shoot or not. Food confuses the issue by causing rising numbers, and rising numbers due to feeding is no basis for a decision for a shot.

If the number is obviously too low, then feed and record as a skipped shot.
 
Just gave Leo his first shot, no problems, but it took me three strips to get a glucose test. BG was 390, so the effect of feeding isn't a consideration tonight, but Gayle's point is noted for the future, since I'm still hoping this is won't be permanent. My vet says she's seen FD cats in way worse shape.

Should I get up and test in eight hours to make sure his BG isn't too low on this first shot?

Thanks for all the great support, everyone. I might get the hang of this yet.
 
What you can do is get a before-bed test. That way you will be a few hours past his shot and you will get an idea how he is reacting.

Keep in mind that his shed's got to fill first so, barring any extreme changes in his BG like a big drop, you'll be holding for 5-7 days, and by then his shed is filled and you will be seeing how his numbers are affected. You will see improvements in Leo way before you see the numbers change, so don't be upset that the numbers may not be budging, but Leo's better.
Always look to Leo to judge how things are going. Urine changes, appetite changes, even coat changes, will happen first.

Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers
"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.


curve info in case you get some tests in
How to do a Curve
Example of a typical curve:
+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 (may dip around +10 or +11).
+12 - PreShot number.
 
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