Is Martha hypo-ing?

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Hosanna

Hosanna

Member Since 2012
She won't eat, maybe she's just full, she ate a good bit this morning after her insulin. But she is not right, walking in slow motion, drinking a lot of water. Running away from me, looking like I'm going to beat her up. She tested 94 at 3 hours. Down from 240--
I just tested again at 4 hours and she's down to 66-- quick drop!
Should I give some Karo syrup?
 
That's a big drop, so you're right to be testing, but as long as she stays above 50, you're doing fine

IF she does drop below 50, you should go ahead and give her a little high carb food (like a teaspoon of the gravy off a "Gravy Lovers" food) and a little bit of her regular low carb food and then retest in 30 minutes. You will want to keep testing every 30 minutes until it's been 2 hours since you gave any food and the numbers are rising
 
Good job testing again at +4.5. It looks like she's evened out and has stopped dropping. 66 is okay, and not too low.
I would test again in 30 minutes, and try again to see if she will eat a little bit (2 teaspoons) of low carb food. You don't want her too full, just in case you need her to eat higher carb food later. You're doing fine.
 
Later, once you've had some time to relax, can you fill in all the missing units in your spreadsheet?
I am guessing you know that Lantus works best when the dose is the same amount every 12 hours.
 
Dyanna, I am starting to relax a bit. She just ate for me, her usual low carb FF, plus a few higher carb treats. I am not sure what you mean by the missing units? I have filled them all in for today.
I would like for the amounts of insulin to be the same each 12 hours but she fluctuates so much, as you can tell from her s/s. I just can't in good conscience give her a whole unit when she tests at 166, for example. I made a mistake this morning giving that extra .25 -- She is so sensitive.
 
I think she may mean the times it looked like you skipped shots, like 11/8 at PMPS, and several PMPS values the last several nights. IF you skip shots, still put the Pre-shot value in and then put "NS" in the "U" column (for No Shot)

What you need to do is find a dose you CAN give every 12 hours that doesn't take Martha too low and doesn't cause her to have pre-shot numbers that are too low to shoot, but eventually, you'll need to learn to shoot those lower numbers. I routinely shoot China when her pre-shots are in the high 50's and low 60's, but I test a lot and know how she reacts really well

Lantus needs a consistent dose, so we need to find one you can give every 12 hours, not changing it depending on her pre-shot values. If I were you, I'd probably go back to 1 unit, or even .75 and then test as much as you can for several days so you can really get to know how Martha responds. We'll always put her safety FIRST here, so if we see anything we feel uncomfortable with, we will advise you!!

There's really no such thing as too much data, and the more you have, the better prepared you're going to be. It's really important to get the Pre-shot tests done, as well as (If at all possible) a mid-cycle during the AM cycle and a "before bed" test on the PM cycle. If you absolutely can't do mid cycle testing during the week due to work, it makes it even more important for you to get as many tests as possible on weekends and during that PM cycle.

Keep asking questions, and we'll be happy to help you along this journey!!
 
Chris, it seems like when I give her .50 or less, her bg's soar again next testing period. And as I said in my last response, 1 unit often seems too much. Today when I gave 1.25 she was dropping too fast. That was at a bg of 240. So if I gave 1 unit at 200 or less, wouldn't it be the same? Drop too fast?
 
Not necessarily. Lantus doesn't work like that. It's a "depot" insulin and every time you change the dose, you're either draining the depot, or adding to it. That's why it needs the same dose given consistently so you can REALLY see how Martha reacts

If you're not comfortable giving 1 unit, go back to .75 or even .5...the important part is to give the same dose, every 12 hours, test as much as possible, and then wait for at LEAST 6 cycles before changing the dose again.

The only time you don't wait at least 6 cycles before changing is IF they drop below 50 during any cycle. That's an automatic reduction of .25...so if you were to give 1 unit every 12 hours and on the 5th cycle, Martha dropped below 50, you'd give .75 on the next cycle, and the 6 cycle "timeclock" would start over again

I just noticed you say you're doing the SLGS protocol....I'm not as familiar with that protocol, but I think you hold the same dose for 10 cycles unless they drop below 90 and then you reduce by .25. It's a little less aggressive to use that protocol, but also probably a little safer if you can't test more often. The Tight Regulation Protocol uses the "below 50" for reductions..but it's the most likely to get them into remission and OTJ
 
Chris, it seems like when I give her .50 or less, her bg's soar again next testing period. And as I said in my last response, 1 unit often seems too much. Today when I gave 1.25 she was dropping too fast. That was at a bg of 240. So if I gave 1 unit at 200 or less, wouldn't it be the same? Drop too fast?
 
.50 may not be enough for her...Or it may be a "perfect" dose. Until you can give the same dose every 12 hours and keep it up for at least 3-5 days, there's just no way to know

Lantus isn't like some other insulins that work quickly during that cycle and then are gone, so you change doses depending on the Pre-shot numbers. With Lantus, the Pre-shot numbers only count a tiny bit...it's the nadir numbers that count (the lowest number they get during the cycle)

Dosing is based on that nadir number, not the Pre-shot number. We understand that when you see a lower than normal Pre-shot value, you're first instinct is to lower the dose, but that's just not the way it works.

If Martha were my cat, I'd probably try .75, and then HOLD it for at least 3-5 days, unless she drops too low during the cycle. IF she had a pre-shot under 150, I'd stall, don't feed, and ask for help, with the goal being to eventually shoot lower and lower pre-shot numbers so she stays in those lower numbers that can heal the pancreas
 
I'm not sure what to suggest. If you did, in fact skip shots for the PM cycles from 10/28 - 11/5, it has a significant effect on Martha's insulin depot. Likewise, shooting different amounts each cycle usually results in wonky numbers.

Lantus works best when you shoot the same dose twice a day barring the need for a dose reduction or increase. When you change the dose, like Chris indicated, you hold that new dose for at least 6 cycle with the TR protocol and for a week with SLGS.

The other issue which makes it hard to provide truly helpful input is the lack of testing. If you're working, it's understandable that you're not home to test. What it does mean, though, is you need to get sufficient tests when you're home so you have an understanding of how Martha is doing and how Lantus works for her. Many cats experience lower numbers at night so not having PM tests is problematic. In addition, it also means you are missing half of your data.

The other concern with the lack of testing is that Lantus dosing is based on the nadir -- not on the pre-shot numbers. There's no way to really know if your observation about Martha's response to 0.5u vs. a larger dose is accurate. You would need tests, especially around Martha's nadir, to truly know how she's responding and whether that response is typical or atypical.
 
i agree with sienne and chris about finding a dose and sticking with it twice a day for several days, then re-evaluating the dose based upon the nadirs that you're getting.

you don't need to worry about a hypo with anything above 50, but it might be that martha doesn't feel good because her blood sugar is all over the place. that might've been what you saw today that scared you. she'll feel better if it's flatter. i think i'd try the 0.5u, perhaps, then get the preshot and mid-cycle tests in so you can see what's going on. we'll be glad to help you interpret what you're seeing on the tests.
 
A stall means to wait without feeding and retest again in 20-30 minutes to see if the BG is on the rise. This has the effect of delaying your PS time.
 
As Wendy said, "stalling" is when you get a Pre-shot number you're not comfortable shooting, so instead of skipping, or reducing to just anything, you DON'T feed and retest in 30 minutes.

During that 30 minutes, I'd suggest you post and add "STALLING" to your subject so you can find someone to help advise you, but generally, if you stall, you retest every 30 minutes until you get a rising number (so you know they're on the way UP) and then give the scheduled dose for that shot. You want to NOT feed so the number is really going up without the influence of food

The only thing you have to remember is if you stall for 30 minutes, you have to change the next shots schedule so it's 11 hours 45 minutes apart ( you can shoot 15 minutes early per cycle until you're back on your normal schedule). So when you stall, you have to think about those "next shots" and if you can move your shot schedule

If you stall, you'd shoot no sooner than 11 hours, 45 minutes later at the next shot time, so (for example) your normal shot times are 8am/8pm but you stalled until 9am this morning. Your PMPS time would move to 8:45pm (12 hour cycles minus 15 minutes per cycle until you're back to 8/8)
AM cycle would be at 8:30am, PM cycle would be at 8:15pm
AM cycle back at 8am...back to your original schedule of 8am/8pm
 
Just to correct Chris, with stalling, you test in 20 - 30 min. The idea is to catch the numbers as they start to rise and then you shoot. Between the numbers rising, feeding, and Lantus onset not occuring for an hour or two, numbers should continue to rise. You still want to get a +1 and a +2 test to make sure that Martha is going with the program.
 
As Sienne said in a previous post, the different amounts of dosing is giving you wonky #s. The doses need to be consistent in order for Martha to respond better. You can't be giving 1u at 1 cycle, and then nothing the next, and then 0.25u the next and so forth. Lantus works best if it's consistently given.

Also, if you're finding that 1.25u is too much, and yet 0.25u isn't quite enough, try shaving the 1.25u to a skinny 1.25, or even try a fat 1.0u (a fat 1.0u is just a hair below the 1u line, which I think results in an extra small drop, or something). That may work best for Martha, and if you're consistently giving that amount each and every cycle, you may find that she'll respond better, and perhaps flatten out. Try and be as consistent with dosing as much as possible, please. And try and get more mid cycle tests, too, so that everyone on here can see how she's doing, and can advise if they see something amiss.

With regards to Martha running away, try a simple trick... If she's on a feeding schedule, and if you don't have any low carb treats available, try brushing her as a treat instead. She'll quickly learn that the testing isn't a bad thing and she'll be rewarded afterwards with being brushed.

Good luck!
 
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