Introducing Scully - Question about Dosage

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Tara and Scully

Tara and Scully

Member Since 2014
Hi! My name is Tara, and Scully is my 10-yr old girl who was diagnosed on March 22. This is my first post, but I have been on this site reading your posts for weeks now in an effort to gain as much knowledge as I can about the treatment and management of feline diabetes. At the time of her diagnosis, Scully was about 9.2 lbs. and she is maintaining her weight. She is also suffering from diabetic neuropathy. She was on an all dry-food diet (I now know the error of my ways) and was prescribed Humulin-N. After several weeks of unsuccessfully trying to regulate her, we transitioned her to an all-canned diet (Fancy Feast Classics - chicken, turkey and beef). That allowed us to reduce her insulin from 5 units in the morning and 4 units in the evening to 1 unit BID. We achieved good numbers at the peak of the cycle (ranging from upper 50s to low-to-mid 100s), but of course her pre-shot numbers were high (mid 300s to low 400s) because the insulin wore off way before she was due for her next injection. She also gets one tablet of Zobaline crushed into her food at dinner time. She free feeds and eats around 3 - 4 3.5 ounce cans per day. Other than the diabetes and neuropathy, she has no other health issues. She tested negative for pancreatitis, which her brother, Mulder, was diagnosed with in Sept. 2012.

We switched to Lantus and gave her her first injection yesterday at 7:30am. Our vet recommended 1 unit BID. I haven't created a spreadsheet yet, but the curve I did yesterday was as follows: AMPS 366, +2 353, +4 328, +6 266, +8 204, +10 130, +11 118, +12.5 136. Instead of a curve, her numbers dropped all day. Clearing a bounce? At that point, I was afraid to give another injection because I've never had a preshot number this low (136). Tested again at +14 and got 214. Fed her about 3/4 of a can and injected .5 units. At +2 she tested 299. Went to bed at that point.

This morning her AMPS was 287 so I gave her 1 unit, but because of the delay last night, her injection was about 2 hours early as I was trying to get back on her regular injection schedule, which I have to keep because of my work schedule. Her readings today have been as follows: +3 229, +6 67, +7 64, +8 60. I know these numbers are not below 50, but I am monitoring her. So far no visible signs of hypo, and she has had numbers in the 50s with no reaction before. I can see that the numbers now are dropping only slightly, and I expect them to begin to rise soon. Can anyone advise me about the dosage I should give this evening if her preshot number is low again? Also, tomorrow morning my husband and I will both be at work and she will be alone for about 11 hours. I want to give at least a partial dosage because I know her numbers will sky rocket with nothing. I did read the general guidelines about what to do with low preshot numbers, but any additional advice tailored to Scully would be much appreciated.

On a side note, I just want to say thank you to all of you who work so diligently to provide information, advice, comfort and encouragement to those of us battling this frustrating disease for the first time. Although I have never posted before, reading your posts and information these last few months made all the difference in the world and helped me leave the guilt and boo-hoo stages much faster. I feel so much more confident and empowered instead of helpless and confused. Thank you!!
 
You are doing a great job with Scully. We generally tell newbies not to shoot under 200 but to wait, without feeding, and retest. Which you did beautifully! The cycle went well today with your dose. I don't use your insulin. Let me see if I can get someone from the Lantus forum to advise youabout tonight.

It would be a good place to post now that you are testing and feeding low carb. But you do need a spreadsheet. Can we help you with that?
 
Yes, I would love help with the spreadsheet. Also, Scully tested 74 at +9, 95 at +10 and 115 at +11.5. I'm ready to give her next injection, but unsure of the dosage with this low preshot number. I was considering .5 unit instead of 1 unit. Please advise. Thanks!
 
Hi Tara! Welcome to you and Scully! You're doing an excellent job already with testing, food change, and a good insulin. I don't know much about Lantus, but I would hesitate to shot with a 115. Someone who is more experienced with that insulin could give you better advice...I see Sue posted on their board to get some eyes over here.

You have pretty much made my night by having cats named Mulder and Scully!! That's awesome!
 
Yay! A fellow X-Files fan! In order to keep her injection schedule, I fed her about a 1/2 a can and gave .5 unit at 7:15pm. I know if no insulin is given, her numbers will shoot through the roof. I will continue to test and monitor for the next several hours. I'm working on her spreadsheet now, too.
 
Hi Tara and Scully!

Welcome to FDMB!

Sue's given you some great info here. If that's your first time shooting that low, even with a reduced dose, I'd encourage you to get a test at an hour after the shot (+1), and also at two hours after the shot (+2) to see which direction Scully is going. Looks like you're doing a great job absorbing all the information here, and getting testing down pat!

You have probably seen this info in the Tight Regulation stickies section, but this is generally what a Lantus cycle looks like.

Example of an ACTIVE, but NOT necessarily typical 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. You'll probably see an active cycle if the +2 is the same/similar or lower than the preshot number. Continue testing!
+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.
Click to expand...

If your +1 and/or +2 is lower than your pre-shot number, you may be looking at a more active cycle, and will probably want to test a big more frequently earlier in the cycle.

Once you get Scully's spreadsheet up and going, I definitely encourage you to post on the Lantus Tight Regulation section that Sue linked to below. You can get lots of experienced users to help interpret Scully's numbers and help give you dosing advise.

Welcome again!
 
Hi Tara!

Sounds like you are really on top of everything. I think dropping the dose given Scully's great response was a good plan.

As Jen said, get a test an hour after your shot to make sure Scully's not going down too quickly. I'd encourage you to post over in the Lantus/Lev Tight Reg forum as soon as you get the spreadsheet. There are more people who are experienced with Lantus there who will be able to help you. I'll check back in about 15 minutes, which I think is about an hour after your shot.

Great job doing your homework and getting on board with everything. We'll do our best to help you learn what you need to know to help Scully.

julie
 
Hello and Welcome. There definitely is a lot to read here. :-D

Lantus really likes to be shot 12 hours apart. When we move shot times, we move either 15 minutes per cycle or choose one of the cycles a day and move that 1/2 hour up. Shooting early, and you shot 2 hours early today, is like a dose increase. You could try a reduced dose tonight or a skip, as it's recommended not to shoot that low until you have more data. You could try .5U but may getting those early tests tonight is a good idea. Lantus also likes consistent dosing so finding a dose you can shoot day and night is a good idea.

For those that go to work, you could get a preshot test, and then a test one hour later before you go if you have the time and based on that you can decide to leave out food for Scully to eat should she go low. If the numbers concern you, you could leave out some medium or high carb food. A number of us have auto-feeders, programmed to open around nadir, especially if your cat likes to hoover food.
 
Thanks for the advice. I've finished the spreadsheet and it should be attached. I'm normally very good about keeping consistent dose times; however, these lower preshot numbers give me problems. Hopefully with more experience I'll be able to navigate them a little better. Scully tested at 224 +1 after her shot, so BG is definitely on the rise. I will test again in about 15 minutes. I'm not sure if I can do a tight regulation of Lantus given my work schedule during the week because I'm not around enough to monitor her, although I'd love to keep her numbers in that range. I agree that she should have a consistent dose morning and night. Any advice on what that dose should be?
 
You might put a blank row between the Humulin and start of Lantus or a thick black line so it is really obvious.

Lantus has a cumulative effect over several days when starting or changing the dose. It takes about 5 days on the initial dose to get to a nice stable level; after that, it takes about 3 full days for a dose increase to settle. Stick with the 0.5 unless he drops below 50 mg/dL. If that happens, drop to 0.25 (you eyeball it on a syringe).
 
Thank you for the advice! I will reduce her dose to .5 for the next several days. Also, I updated her spreadsheet, so the switch from Humulin-N to Lantus is more visible. Thanks for the feedback!
 
tara, great job on the spreadsheet!

just to clarify, even if you see high numbers in the next 3 days, you will continue to hold the 0.5u dose unless she goes below 50. Lantus dosing is based upon the low point that a dose gets the cat to.

Many people following Tight Reg also work. There are ways to manage things even when a person works. People get more tests in the night cycle & weekends to see how low a dose is getting their cat. Probably the best "helper" is to get a timed automatic feeder. When we see low numbers, food is the first tactic we use. So being able to set a feeder to open with food in it is a great strategy that helps when people need to be gone. I thought of it as insurance.

There are also times when a person might skip a dose, especially before you know how Scully typically responds to her shots.

Once you have some data on how she responds, you could gradually lower your no-shoot number - assuming remission is your goal. Experienced people will shoot most numbers over 50 if they are able to monitor. With both you and your husband working long days, you'd maybe want to look at weekends for shooting low.

Until you know how she responds, it's going to be safer to skip if you've got low preshot am numbers, or to shoot a reduced dose and leave plenty of low-carb canned food available.

The good news is that Scully is already looking great on the Lantus. Newly diagnosed cats (less than 1 year) have a pretty good chance to become diet-controlled if their blood sugar can get back into normal numbers (50-120) and be held there (ie, tightly regulated) as soon as possible after diagnosis. If you want to try for this, just say so and we can give you all the tips that we use to help make it work.

You might want to look at the PDF on the Tight Regulation Protocol here that's about 5 paragraphs down entitled "Management of Diabetic Cats Using Long-Lasting Insulins". Great information there that is the latest update on the protocol we follow in the Tight Reg group - and just all around good information that you might find helpful.

I went back to work about a year after punkin was diagnosed. Fortunately, my husband & I only work about 3 miles away. We always fed punkin at +3 from the autofeeder. If his numbers at amps were low, we set additional times for the feeder to open - at 3.5, 4, and 4.5. One of us drove home to check punkin if we needed to, and put more food and set more times on the feeder. As goofy as this was, it worked for us. The feeder that worked for us was the Petsafe 5 Compartment Feeder. The complaints online are about the feeder not opening all the way, but we found that if you made certain you had the feeding tray set completely in the base unit, it always opened. I bought ours at the local PetCo.

Keep asking questions! There's no guilt here - we fed our cats dry food because we didn't know we shouldn't. You have lots of company in that department. You're doing all the right things now, though, so just keep it up! :-D
 
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