Kathy's Cleo - Newly Diagnosed - Oceanside, CA

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Thanks you guys, really.

Ok, so I have only gotten about 1/4 of the honey into her so far. She really is not a fan and is fighting pretty hard about it. I will see if I can find a syringe from when we had to give her amoxycilin a few years back.

I've been getting blood on first or second try. I think I'm getting the hang of it already. One time I definitely poked too hard on a 2nd try and got a huge drop of blood. Had to hold some pressure on it for 30 sec or so to get it to clot.

I'm almost out of the lancets the vet gave me, but I have a bunch I bought that are only one gauge finer (26 g instead of 25g). I'll retest her in 10 minutes, which is +4.25 from when I gave her the insulin.

Alright, gave her 1.5 mL of maple syrup (yes, she's now had some of every sugar in the house I think). I also administered 1.5 mL of maple syrup to my couch. Oops.

Oh, and I have lots of strips. I had bought a pack of 50 today when I bought the meter. Who knew I'd be going through them this fast?

Going to retest her now since it's been an hour of excitement already...
 
Kathy-and-Cleo said:
Thanks you guys, really.
Ok, so I have only gotten about 1/4 of the honey into her so far. She really is not a fan and is fighting pretty hard about it. I will see if I can find a syringe from when we had to give her amoxycilin a few years back.
I've been getting blood on first or second try. I think I'm getting the hang of it already. One time I definitely poked too hard on a 2nd try and got a huge drop of blood. Had to hold some pressure on it for 30 sec or so to get it to clot.
I'm almost out of the lancets the vet gave me, but I have a bunch I bought that are only one gauge finer (26 g instead of 25g). I'll retest her in 10 minutes, which is +4.25 from when I gave her the insulin.
Alright, gave her 1.5 mL of maple syrup (yes, she's now had some of every sugar in the house I think). I also administered 1.5 mL of maple syrup to my couch. Oops.
Oh, and I have lots of strips. I had bought a pack of 50 today when I bought the meter. Who knew I'd be going through them this fast?
Going to retest her now since it's been an hour of excitement already...
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You're doing beautifully, Kathy.

Don't worry about larger drops of blood. That just happens :-) On the next test, it'd even be useful to have a large drop of blood.

I think you'll do just fine with the 26-gauge lancets - you're getting lots of poking practice right now, after all :-)

Good job on having lots of strips! Remember to buy more tomorrow, so you've got them when you need them.

Off you and test. I'll be here.

If you can, post another proper time sequence from beginning of cycle (Shot time) through the (+2) and (+3) to where we are now, noting in between when you gave what food/sugar/syrup (say, at (+3.5) gave drop of karo on treat). Thanks! Keep breathing.
Jane
 
Local time now is 12:51 AM (I'm PST).

Let me see if this helps summarize where we're at:

Pre-Insulin Level at 6:30 PM PST (-1.75 hours): 161
Dinner at 7:30 PM PST (-.75 hours)
Insulin Shot (3U) at 8:15 PM PST (0 hours)
Level at 10:30 PM PST (+2 hours): 84
Level at 11:30 PM PST (+3 hours): 69
Tiny bit of karo syrup and 2 big tsp ice cream given at 12:00 AM (+3.5 hrs)
Level at 12:15 AM PST (+3.75 hours): 58
1/4 tsp honey and 1.5 mL maple syrup given at 12:25 AM (+4 hours or so)
Level at 12:45 AM PST (+4.5 hours): 106 (HURRAY!!! Going back up!)
 
Kathy-and-Cleo said:
Local time now is 12:51 AM (I'm PST).
Let me see if this helps summarize where we're at:
Pre-Insulin Level at 6:30 PM PST (-1.75 hours): 161
Dinner at 7:30 PM PST (-.75 hours)
Insulin Shot (3U) at 8:15 PM PST (0 hours)
Level at 10:30 PM PST (+2 hours): 84
Level at 11:30 PM PST (+3 hours): 69
Tiny bit of karo syrup and 2 big tsp ice cream given at 12:00 AM (+3.5 hrs)
Level at 12:15 AM PST (+3.75 hours): 58
1/4 tsp honey and 1.5 mL maple syrup given at 12:25 AM (+4 hours or so)
Level at 12:45 AM PST (+4.5 hours): 106 (HURRAY!!! Going back up!)
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Thanks Kathy! You're (+ Hour)-Sequence is a tiny bit muddle, but that's totally understandable after a cycle like this! I'll re-post your sequence in a minute, according to your Shot time as a starting point (*;15 PM your time).

For now - don't go to bed just yet, ok? Try for one more test in 30 minutes, can you do that?
Jane
 
Super!
Now you want it to stay up. The problem with sweets is that the boost can be short-lived. If you test in 20 and it falls at all, that would be when you want to give a spoonful of food, I believe.
Jane, is that right?
Carl
 
Re: Kathy's Cleo - 1st Ever Lantus Cycle, Time Sequence

Cleo's First Lantus-Cycle: Time Sequence (Starting Time = Unknown PMPS = 8:15pm Local Time)

1.75hours before PMPS: BG 161
0.75 hours before PMPS: Fed.
PMPS - Not tested. --- 3u Lantus shot.
(+2.25) 84
(+3.25) 69
(+3.75) Fed tiny bit karo and 2 tsp ice cream.
(+4) 58 --- This was 12:15am Local Time.
ca. (+4.25) Fed 1/4 tsp honey and 1.5ml maple syrup.
(+4.5) 106
 
I can stay up as long as is necessary. It's a weekend, and even if it wasn't - Cleo is more important to me than a little lost sleep. Also, I'm a night owl anyhow so this isn't too bad.

Tentatively planning to do another glucose level test at + 5 hours (although that will only be about 30 min from when I took the last one)...
 
Carl & Bob in SC said:
Super!
Now you want it to stay up. The problem with sweets is that the boost can be short-lived. If you test in 20 and it falls at all, that would be when you want to give a spoonful of food, I believe.
Jane, is that right?
Carl
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Yes, Carl. If BG falls to between 40-60 again after another 30 minutes (which would put Cleo at her +5 in her cycle, which is local time 1:15am), Kathy should feed that number again. If possible, combine a (possible) repeat-karo/syrup with a bit of canned food, since the sugary syrups etc. don't last that long and the idea os to *maintain* a safe BG until past nadir. Ideally, since this was Cleo's very first cycle, and we're not sure where her nadir is, we'd like to see her get past the (+6) without a falling BG. That's what I'd do.

Compare the FDMB Hypo-Treatment Doc: HYPOS


Let's use the *revised* time sequence, everyone, ok? It'll make it easier for all of us to keep track :-) I.e. the upcoming test at 1:15am would be the (+5).
Jane
 
Kathy-and-Cleo said:
I can stay up as long as is necessary. It's a weekend, and even if it wasn't - Cleo is more important to me than a little lost sleep. Also, I'm a night owl anyhow so this isn't too bad.

Tentatively planning to do another glucose level test at + 5 hours (although that will only be about 30 min from when I took the last one)...
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Great, Kathy!
Regarding next BG test: You need to be comfortable. If you're not happy waiting 30 minutes, test before :-) Just note the local time and correspond to cycle hour. Though as I'm posting this, I think we're only a couple of minutes away from (+5) if I'm seeing the clock correctly.
Jane
 
Jane, can you take it from here? I don't have to get up in the morning, but I do need to get up at some point today :lol:
Kathy, you're in great hands, and there will be others around at your next shot time, so if you need advice, please post here. You might want to start a new thread for that one, but point people to this one so they can catch up.

Carl
 
No problem Carl. I'm sticking around until Kathy feels ok to go sleepus. And I'm calling in some eyes (sounds gross, but is great) for tomorrow's AM-cycle to help with decisions regarding shot or no-shot and so on.

Kathy, have you got the (+5) yet? It's about that time :-)
Jane
 
Newest reading is 177 - way up. I updated the timeline.

1.75hours before PMPS: BG 161
0.75 hours before PMPS: Fed.
PMPS - Not tested. --- 3u Lantus shot.
(+2.25) 84
(+3.25) 69
(+3.75) Fed tiny bit karo and 2 tsp ice cream.
(+4) 58 --- This was 12:15am Local Time.
ca. (+4.25) Fed 1/4 tsp honey and 1.5ml maple syrup.
(+4.5) 106
(+4.75) gave about 1 tbsp. ice cream
(+5) 177

Her glucose levels are going way up now - all the sugar hitting her system. Should I try to get her to eat some low-carb/high protein wet food, or just leave her be?

Also, for the future, I'm not clear on when I should be testing her glucose prior to giving her insulin each time. I'm very clear that the insulin comes 30 min or so after eating, however does the glucose reading get taken before eating, or after eating but before insulin? If after eating, how long after eating - 30 min, so it's JUST before insulin to make sure it's safe to give her the insulin?
 
Kathy-and-Cleo said:
Newest reading is 177 - way up. I updated the timeline.
1.75hours before PMPS: BG 161
0.75 hours before PMPS: Fed.
PMPS - Not tested. --- 3u Lantus shot.
(+2.25) 84
(+3.25) 69
(+3.75) Fed tiny bit karo and 2 tsp ice cream.
(+4) 58 --- This was 12:15am Local Time.
ca. (+4.25) Fed 1/4 tsp honey and 1.5ml maple syrup.
(+4.5) 106
(+4.75) gave about 1 tbsp. ice cream
(+5) 177
Her glucose levels are going way up now - all the sugar hitting her system. Should I try to get her to eat some low-carb/high protein wet food, or just leave her be?
Also, for the future, I'm not clear on when I should be testing her glucose prior to giving her insulin each time. I'm very clear that the insulin comes 30 min or so after eating, however does the glucose reading get taken before eating, or after eating but before insulin? If after eating, how long after eating - 30 min, so it's JUST before insulin to make sure it's safe to give her the insulin?
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WELL DONE, Kathy! That (+5) is a very nice number. Now let me try to respond to your questions. I"ve also asked that others come and review this thread, so that you can get help on how to proceed for Cleo's next cycle. (I've made the request in Karre's daily condo in LL.)

It's normal to see the BG rising after this kind of cycle - Cleo did get a good amount of sugar. Don't worry. It will clear. Many of us have been through this sort of event! You did great. Personally, I would probably still feed a little regular food, just because the nadir (lowest point) *may* still be an hour away. 177 is a good safe number, but as we know, sugar-rises don't last long, and I myself tend to err on the side of being-too-cautious. So, yes, I'd still give some regular food. I suspect some of the BOS-crew (BOS = Balls of Steel :-) may have thought it'd be alright not to feed, but I think most people are still in bed right now, so perhaps, best to be extra-cautious.

Okay, now about testing BG before giving insulin. The basics:
The pre-shot BG test is called the AMPS (morning) and PMPS (evening) and is taken every 12 hours, because Lantus has a 12-hour effect (give or take a little, but that's how we calculate cycles).
In the beginning, when there's not a great deal of data (BG tests complied into a spreadsheet, shortened to SS), it's important to get more than just the pre-shots, because with Lantus insulin, dosing decisions are not made so much based on pre-shots but on nadir (lowest cycle BG). That's why mid-cycle tests are so useful, especially at the start, when we're trying to figure out Cleo's "Lantus-Personality", as it were. ECID (every cat is different), and we want to know what Cleo does with Lantus, so we can help you make the safest choices for her dosage and help you assess her progress.

Ok, now food in relation to insulin. We (with our cat Karre) stuck to the routine we adopted on our first time on FDMB (in 2008), which was "Test, Shoot, Feed". Lantus is a gentle insulin, and usually we see the nadir (lowest point in BG cycle) around the middle of the cycle, about at (+6). (Again, ECID: Karre is an early-onset kitty, for example, and his nadirs are early too, at around +3!) That's why it's normally considered safe to test, then to shoot (BG permitting), then to feed as normal (BG permitting). In the beginning, like for a Lantus-Newbie like Cleo, we like to encourage testing a bit more frequently wherever possible, so that we have more data and more safe ways to give advice.

We tested more than most people can - I work from home, so it's no trouble with timing etc., and I'm also a bit of a chicken :-) SO I always felt I needed to have as much data as I could get without being too mean to Karre's poor ears :-) A good starting routine for testing would of course incluce the AMPS and PMPS, without fail - *IF* Cleo was ever quite low, for whatever reason, and you shot insulin without testing, she could be indanger of HYPO. Which is why we put you through all that drama tonight :-)
Further tests *can* include a (+1) and/or(+2) to get a sense of Cleo's onset, and a mid-cycle test (+6 is often done, but again, an hour before or after can come up as an option, to find out her usual nadir once she settles into Lantus), and a (+10) and/or (+11) to see how her late-cycle numbers are.

But again: That's a lot of testing, and many beans (humans) can't do that for various reasons. AMPS, PMPS, mid-cycle, I'd say, are the basic ones. More, if you can.

I hope that's helpful for now. Anything else, right now? Or are you off to bed? Well-earned, anyway! Well done again!
Jane
 
So it's just about 2 AM PST - about +5.5 hours from the insulin shot.

I'm going to do one more test (at around +6 hours) to see where we're at before I decide if I'm comfortable going to bed.

I'm planning to feed Cleo breakfast at 6:30 AM. Right now planning to skip doing any insulin regardless of levels at that point, until I can get a 2nd opinion from a vet on treatment. Going to be calling around for a referral for a specialist in feline diabetes and cross my fingers they're available to discuss treatment on a Sunday!

Just saw your reply before this went through Jane - thank you for all the info. I'm going to read through it again to make sure I got it all.

At least in the beginning, until I know how Cleo will be eating her new diet of all wet food, I'm a little hesitant to shoot before getting her to eat, as we're still sorting out what food she'll eat. Crunchies she loves and would gobble up as fast as possible. The wet food... well not so much her favorite thing.

In the meantime, I'm going to see if she'll eat a bit more of the diabetic friendly wet food to tide us through til the end of this Lantus cycle.
 
Remember, Kathy, your shot time (when we start counting) was 8:15. SO your (+6) would be at 2:15 am :-) I'd also test that one still. Good decision :-)

Your AM-Cycle, counting from last night's PM-cycle stating at 8:15pm, would be at 8:15am. Your breakfast-plan souncd a tad early to me - but I'm sure you'll have had some more feedback by that time, so not to worry. The numbers you'll get this coming AM-cycle and the next PM-cycle won't exactly be "typical" ones given the bounce (BG rise) that's begun already and that may continue for a bit.

I do understand and sympathise with your hesitation regarding food and Cleo's preferences, that you don't exactly have sussed out yet. In time, you'll be able to get her to a more "regular" routine. For now, you need to feel comfortable and Cleo needs to stay safe :-)

I'm sure you'll receive input regarding the coming AM-cycle and the question of shot-or-no-shot. Hopefully, you'll feel comfortable trusting the advice here in addition to your vet - it can be incredibly useful to have input from more than one perspective, and FDMB is quite famous for that :-) My thoughts: Given how beautifully you managed Cleo's low numbers, and how well she seems to be rising, and given that the numbers you saw (58 was the lowest, and 60 is generally the threshold, so Cleo was *just* inside the "low numbers" bracket), and there were no reported Hypo symptoms, you may not need to skip the shot *completely.* Depending on her AMPS and whatever other data you gather before then, you *may* be okay to give reduced dose or a token dose (just to keep a little something in the in-body Lantus "shed"/depot, that gets filled/emptied as cycles progress and insulin is given). Let's see what the others think!

I'll look out for your (+6)!
Jane
 
Hi Kathy, I just saw the note in the Lantus forum and came over. You have been getting great advice. Boy! ohmygod_smile Baptism by fire!

It sounds like cleo has had lots of sugary carbs tonight, so no wonder her BG is way up. The thing w/ syrup or homey is they rise the BG fast, but wear off quickly (a couple of hours) so you need to be prepared for that. But each cat is different ECID, you will get to know how Cleo responds pretty soon. This is why we suggest some higher carb food too, that keeps the BG up longer.

On the schedule , we usually test, feed, shoot in the space of about 15 minutes. Lantus isn't like quick acting insulins where it is important to have food onboard before the shot. A Lantus shot generally doesn't start working until about 2 after the injection, but ECID. The lowest point of the cycle is usually about 6 hours after the shot, we call it the nadir, but, guess what, ECID and it can vary a couple of hours either way. Lantus dosing is based on the nadir, how low it will bring the cat's BG down not on the preshot test. The preshot test is to be sure BG isn't too low to safely give insulin, not to determine dosing.

it is also important to give Lantus exactly 12 hours apart if at all possible. More than 15 minutes difference either way can act like a dose increase (early shot) or decrease (late shot.)

In the morning you will probably be advised to lower the dose. Humans adjust their own doses all the time, there is no reason you can't do it for your cat. Try to get a test in an hour before the preshot test and post here asking for dose advice. This extra test combined w/ the preshot test tell us if the BG is going up or down and helps a lot in determining the dose. It also gives you time to get responses and plan out what to do.
 
Hi Ann :-) Thanks for recapping some of the theory points :-) ALways good to have things formulated a couple different ways, making sure the info hits home! Gotta love FDMB!
Looking out for the (+6), Kathy.
Jane

Edited to add: Kathy, Which meter do you use?
 
:-D :-D You posted while I was typing that up, but you are right a second voice is good. Besides after typing all that I wasn't going to delete it! :lol: :lol:

I agree w/ Jane that 6:30 is a little early to feed. A lot can change in the hour or two before the shot. Actually, we usually like to remove any remaining food 2 hours before the shot so that the preshot test is "clean", no food influence.

Many of us do the shot while the cat is eating it distracts them and they barely notice the poke. W/ Lantus you do have some leeway for getting the food into them, onset isn't immediate. With older, fast acting insulins it was important to get them to eat first, but not w/ Lantus.
 
1.75hours before PMPS: BG 161
0.75 hours before PMPS: Fed.
PMPS - Not tested. --- 3u Lantus shot.
(+2.25) 84
(+3.25) 69
(+3.75) Fed tiny bit karo and 2 tsp ice cream.
(+4) 58 --- This was 12:15am Local Time.
ca. (+4.25) Fed 1/4 tsp honey and 1.5ml maple syrup.
(+4.5) 106
(+4.75) gave about 1 tbsp. ice cream
(+5) 177
(+5.5) gave 1/3 can of Purina DM
(+6) 249

She's up quite a bit again, but better up than down. I'm a little worried that I went overboard giving her all the sugar and food and her glucose will just keep climbing since +6 is supposed to be the nadir...

What time do you think I need to retest? I'd like to give her poor ears (and myself) a break if you think she's at a safe point now with her blood sugar up. I know there's danger of it coming back down suddenly when all that sugar processes out. She is hanging out at her water dish right now, so I'm not sure if that's because her body is feeling the need to process glucose out in the urine or just because she's thirsty after all the sticky sugar and the stressful day at the vet and then me poking her all night.

I thought about what you said about her dinner time - we are trying to ultimately get her on a schedule of eating at 6:30 AM and 6:30 PM with insulin shots at 7:00 AM and 7:00 PM so we were trying to adjust her back toward those times a bit more. We were late this evening because Cleo refused to eat the first food I tried with her, which is why dinner time and thus insulin was administered later in the night than I would have liked. We will try to adjust a little more slowly and plan to give her breakfast at 7 AM now (although with all that I've given her overnight, we'll see what she eats). 7 AM is about 4.5 hours from now, so it would be +10.5 from when we gave her the insulin. I will post back then and figure out if we should give her any insulin at all in the morning. Right now I'm leaning toward not giving it until I seek out a 2nd vet opinion on this whole process.
 
Jane - I am using a ReliOn Confirm that I bought yesterday for my readings.

Incidentally, the +6 reading (249) was a nice big sample, so I'm pretty sure it was as accurate as possible with this meter. From what I read, this is a reasonable choice of meter (fairly accurate) and cheap strips, so I went with it. My vet, as I mentioned above, is really backing the idea of getting the AlphaTrak 2, but that's a whole other story, and something else I plan to ask about in a 2nd opinion!
 
Kathy-and-Cleo said:
1.75hours before PMPS: BG 161
0.75 hours before PMPS: Fed.
PMPS - Not tested. --- 3u Lantus shot.
(+2.25) 84
(+3.25) 69
(+3.75) Fed tiny bit karo and 2 tsp ice cream.
(+4) 58 --- This was 12:15am Local Time.
ca. (+4.25) Fed 1/4 tsp honey and 1.5ml maple syrup.
(+4.5) 106
(+4.75) gave about 1 tbsp. ice cream
(+5) 177
(+5.5) gave 1/3 can of Purina DM
(+6) 249

She's up quite a bit again, but better up than down. I'm a little worried that I went overboard giving her all the sugar and food and her glucose will just keep climbing since +6 is supposed to be the nadir...
What time do you think I need to retest? I'd like to give her poor ears (and myself) a break if you think she's at a safe point now with her blood sugar up. I know there's danger of it coming back down suddenly when all that sugar processes out. She is hanging out at her water dish right now, so I'm not sure if that's because her body is feeling the need to process glucose out in the urine or just because she's thirsty after all the sticky sugar and the stressful day at the vet and then me poking her all night.
I thought about what you said about her dinner time - we are trying to ultimately get her on a schedule of eating at 6:30 AM and 6:30 PM with insulin shots at 7:00 AM and 7:00 PM so we were trying to adjust her back toward those times a bit more. We were late this evening because Cleo refused to eat the first food I tried with her, which is why dinner time and thus insulin was administered later in the night than I would have liked. We will try to adjust a little more slowly and plan to give her breakfast at 7 AM now (although with all that I've given her overnight, we'll see what she eats). 7 AM is about 4.5 hours from now, so it would be +10.5 from when we gave her the insulin. I will post back then and figure out if we should give her any insulin at all in the morning. Right now I'm leaning toward not giving it until I seek out a 2nd vet opinion on this whole process.
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I'm not at all concerned about that (+6). It's the sort or BG I would expect to see in this sort of situation. You're right, it's likely that she'll rise a bit more during this cycle - that's another reason why you may be better off giving Cleo a reduced dose or even a token dose in the morning. (Again: Wait for some more feedback. But I think it's likely you'll get this sort of advice. Even a small amount of insulin would help to clear the bounce that is *normal* after a bit of a dramatic cycle.)

I would retest at (+11) (which would make it 7:15am your time), and then again the AMPS (at 8:15am your time), to see whether you've got a rising or a dropping number, which will influence the decision about the amount of Lantus you should shhot, *if any*. A cycle like Cleo just had can tire them out - as long as she's not displaying any worrying symptoms (and lying close to the water bowl isn't worrying *in itself*, I'd say), I don't think you need to worry about her right now.

About feeding schedule: Let's revisit that in your next thread, when some more people have had a chance to review this one. (Remember to post a link to *this* thread in your next one, ok? Do you know how to do that?) Like Ann said, it can be useful to have pre-shot tests that aren't "spiked" by food. But ECID, and your routine-idea may suit Cleo. Let's give her a chance to have a couple of more "regular" cycles and see where we are then. Just remember to LOG/WRITE DOWN whenever you do feed her, so that that data can be assessed in relation to her BG tests, alright? (You can start thinking about starting a spreadsheet, too - but I know this is a lot of info, and we'll help you, so don't feel rushed, ok? For now, summarizing cycles in posts, like we did here, is also ok until you have time to get a SS up and running.)

I totally understand your wanting to speak to a vet in regard to dosing. Please just try to keep an open mind as well, regarding the advice you can get here on FDMB. Some vets are great in many ways but err on the side of too much inculin, for instance (which is likely what caused tonight's dramatics for Cleo), so sometimes even vets don't get it excatly right, and people with years of dosing experience can really have valid feedback. :-)

Also: Remember that adjusting shot-times with Lantus needs to be done WITH CAUTION, and slowwwwwly. NOT more than 15 minutes change in one go, if you can avoid it. (Sometimes, life happens. We know. It's ok.)

For now, get some rest! You've earned it. I'll make sure people look into this condo before shot-time this AM, or into your new thread if you start one. And I'll link into this one if you start a new thread and don't know how to do the links yet, k?

Jane
 
Shooting early is like giving an increase in insulin! We try not to adjust times by more than 15 minutes a cycle. Especially after tonight I wouldn't change the shot time by that much.

I'm a little worried that I went overboard giving her all the sugar and food and her glucose will just keep climbing since +6 is supposed to be the nadir...
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As you noted at the beginning, better too high than too low. Yeah, there was a lot of sugar given :? , but it will clear out of her system quickly. You did great for having a situation like this your first day on insulin. :thumbup

There is a member in San Diego, she's the closest that I know of. Her vet insisted on the Alpha Trak, too, and she had really high readings w/ the new AT2. She finally decided to go w/ the Relion. I'll PM her to come over in the morning, she is an early riser.
 
Kathy, this link has two pdfs from veterinary journals on studies using Lantus for cats. The studies were done using HUMAN METERS!! the initial University of Queensland study by Roomp and Rand was also done using human meters. You might want to print them out and show them to your vet.
 
Well, the timing is being somewhat dictated by the fact that both my husband and I work Mon-Fri days, so we want to be able to feed her and make sure she's keeping the food down before we give her insulin and then stay with her for a little bit after the insulin shot before going to work... hence trying to move all the timing back a bit.

I will start a new thread in the morning to figure out if we should give her any insulin tomorrow AM or not and I'll link back to this one.

I adjusted the timing with your guys' advice in mind.

Currently, Cleo has no food available to her (just fresh water). It's 3 AM right now, or just about. I am going to do her next glucose test at 7:15 AM and I'll post the result on the new thread. I'm going to feed her breakfast around 7:30 and hopefully have some sort of idea on giving insulin or not, or an adjusted dose by 8:00 AM. So it's a move of 15 min in the direction I need to get it to move to be able to keep the schedule during the work week.

Thank you, ALL, once again for all the help tonight and in the future too, I'm sure! Special thanks to Carl, MJ, Jane, Ann, and my non-posting friend Elizabeth (who has gone down this road before me) for getting us through the night!
 
Kathy-and-Cleo said:
Well, the timing is being somewhat dictated by the fact that both my husband and I work Mon-Fri days, so we want to be able to feed her and make sure she's keeping the food down before we give her insulin and then stay with her for a little bit after the insulin shot before going to work... hence trying to move all the timing back a bit.

I will start a new thread in the morning to figure out if we should give her any insulin tomorrow AM or not and I'll link back to this one.

I adjusted the timing with your guys' advice in mind.

Currently, Cleo has no food available to her (just fresh water). It's 3 AM right now, or just about. I am going to do her next glucose test at 7:15 AM and I'll post the result on the new thread. I'm going to feed her breakfast around 7:30 and hopefully have some sort of idea on giving insulin or not, or an adjusted dose by 8:00 AM. So it's a move of 15 min in the direction I need to get it to move to be able to keep the schedule during the work week.

Thank you, ALL, once again for all the help tonight and in the future too, I'm sure! Special thanks to Carl, MJ, Jane, Ann, and my non-posting friend Elizabeth (who has gone down this road before me) for getting us through the night!
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Ni-Ni Kathy! See you later!
 
Good morning, Kathy! It certainly looks like you had an exciting introduction to FDMB. When I first arrived here, someone commented that this is the best place you never wanted to be! It is an incredible place where support and expertise are readily available as you have already, no doubt, discovered.

Several people posted on the Lantus board indicating that some help with adjusting Cleo's dose would be useful. I don't know that I'd want a repeat of last night's drama. I'd suggest using the formula in the Roomp & Rand article that Ann linked as a place to start for Cleo's dose:
initial dose = 0.25 x ideal weight in kilograms​
You mentioned that Cleo had gained about 4 lbs over time and that her current weight is 13 lbs. If approx. 9 lbs is her ideal weight, then you would want to drop the dose back to 1.0u if you use the above formula. I tend to think this would be a good starting dose especially since you have just switched Cleo to a more diabetes-appropriate diet.

I also agree with what others have noted about the sequence of testing, feeding and shooting. I test and then feed and shoot almost simultaneously. Gabby's pre-shot test is within a few minutes of my feeding her and once her face is in her bowl, she gets her shot. It all takes less than 5 min.

I like your idea of being able to give a shot and have time before you leave the house to monitor. If you can give yourself a couple of hours to get a test or two in, that would be great!
 
Sienne and Gabby said:
I'd suggest using the formula in the Roomp & Rand article that Ann linked as a place to start for Cleo's dose:
initial dose = 0.25 x ideal weight in kilograms​
 You mentioned that Cleo had gained about 4 lbs over time and that her current weight is 13 lbs. If approx. 9 lbs is her ideal weight, then you would want to drop the dose back to 1.0u if you use the above formula. I tend to think this would be a good starting dose especially since you have just switched Cleo to a more diabetes-appropriate diet.
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Sienne: I just posted that dose too, in Karre's condo, as what I'd recommend to Kathy. :-)

Kathy, I hope the dose of 1.0u sounds good to you. (If you look at Karre's SS, he also started on 3u, which was too much, and pretty quick was taken down to 1u through the advice I got from "Team J" as we called them then on LL (the Lantus forum of FDMB back then) :-) We also liked to refer to "Tilly's Diabetes Homepage", in case you want to have another read around the theory: Tilly's Diabetes Homepage

Let us know if you're not comfortable and we'll make sure you get some more input, k?
Jane
 
Thank you everyone who helped Kathy last night. I knew she would be in good hands.

Kathy, I am glad that you were here for the help. We usually see the result of this type of "first dose," after the fact and it's sometimes not a happy one. That's why I called for help for you.

For whatever reason, some vets seem to jump to the 3U starting dose on whatever insulin. For long acting insulins like Lantus and Levemir, that is too high. 1U is a good dose to start. I believe someone linked the AAHA guidelines for treatment with Lantus which recommends 1U or the formula, which Sienne outlined.

If not, here it is: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf You might want to print it out and present it to the vet, along with the results from last night. And forget about taking Cleo back for curves. They aren't necessary, you can do them yourself with more reliable results (not influenced by vet clinic stresses) and we will help you understand what the numbers mean and how to dose accordingly.

You learned a lot last night! Not in a fun way, but you are well on your way to helping Cleo. :-D
 
Just wanted to say to Vicky, Jane, Ann, Carl & MJ: You guys are amazing! What a phenomenal resource you all provide! Our vets are not available for calls at 2 am (or even 5:05 pm for that matter), but I continue to be impressed with the dedication of the senior members of this board. I assume the plan is that Kathy will update Cleo's preshot BG number when she gets up (pacific time) and if it's over 200, you will advise on appropriate Lantus dose for today (if any). Way to go guys!! I sure hope I never need you at 2 am, but glad to know you are out there in any case.
 
Hi Kathy. Your Cleo looks like Charlie's cousin. We're new here too and had a hard day. Trial and error and thankfully, a little bit of help from my new friends. We are not on lantus yet but are learning as you are. Just wanted to wish you guys luck and a lot of patience. Hang in there. ;-)
 
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