lantus dose question (dose due now)

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dollsinmyeyes

dollsinmyeyes

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kittys amps is 140, usually we're in the 300s, or 400s, last night i bumped him up to 2 units. after a few days at 1.75 after a hypo-kitty should i give the 2 units again, with this 140 blood sugar, or reduce the dose back down? his blood sugar numbers don't seem to come down on 1.75 units of insulin, as far as i can tell?


any advice would be great. or i'm gonna go for 1.75 units i think.
 
give me just a sec to get you some help from the lantus forum.

i want to say you're probably not going to give the 2 units again this morning unless you are going to be staying home today but as to how much less to give, we need more eyes.

brb
 
It looks like you've not shot this low before. Will you be around to get some early tests? If so, do you have a supply of strips and HC food in case it's needed?
 
ahhh sorry i wandered off from teh laptop,

i am home, and ill be around, i have test strips and high carb food, so i went for shooting 1.75 i didn't want him to get too far off my already chaotic schedule, this week shots ahve mostly all been on schedule for once (i work long overnight shifts usually), and i'll be testing every hour... unless we go low. -too low i guess, his trend over the past few days has seemed not to drop too much at all. which is why i was thinking he needed higher insulin doses. cat diabetes blows my mind. people respond much better to insulin in my experience than my cat man does.

thank you guys.

sorry if i am bad at message boards sometimes. i ask for help and than disappear for an hour or so... ill try and keep the window open. and i'll update as the day goes on.
 
thank you sienne,

and in case you are worried about leaving me- i'm usually pretty calm and collected, and i am a nurse, and i'm okay to wrestle the cat and shoot syrup down his throat if needed ha.
and well maybe his sugar is gonna drop ugh. he's 119 at 9:25. but we'll just keep checking.

thank you!
 
Hi Melissa,
I am sorry you're struggling with getting Satan's BGs under control.

After taking a look at his spreadsheet it looks to me as if you are dosing based only on the higher values, giving more when they don't go down, rather than letting those severe lows guide you.

Nadirs are the guide when using Lantus or Levemir. A low of 28 means a serious dose reduction is needed. Going back to the same dose which caused the 28 within 5 days of it happening is going to repeat the cycle. Please read the Pet Diabetes Wiki page on Rebound. http://petdiabetes.wikia.com/wiki/Rebound The graph there should look familiar. There is also this page http://www.indulgedfurries.com/petdiabetes/somogyi.htm with another helpful graph.

The safest and best method with Lantus or Levemir use in cats is starting with a low dose and increasing the dose gradually if the nadirs indicate an increase is necessary. If you lower his dose to 1U and hold it for 5 days, you should be surprised with the results.

One thing which might be helpful is to set aside what you know/have learned about human diabetes. While it may seem logical to increase the dose when blood glucose values are in the 300s and 400s, those values aren't as dangerous for cats as they are for humans. Although not desirable in either case, when we desperately think we need to get high BGs down by raising the dose, the result is often counter-productive because the cat's body reacts so extremely to even a small overdose. The rebound hormones involved is why you saw the 500 on Wednesday, 500s rarely occur without them when a cat is on insulin, especially when using either Lantus or Levemir.

Yes, that means he had a low overnight that night. The downward trend was evident at +5 because the 457 preshot was another "bounce" from rebound hormones.

Some may argue that you have to keep raising the dose in order to break the cycle of rebounds. In this case I think that would be dangerous. He is obviously responding well to Lantus and just needs some fine tuning in order to level out the response.

The diet changes you have made have a lot to do with why he's responding so well to the insulin. You have removed his carb load and now his body doesn't have to fight that battle and the insulin has an easier job to do.

And you do too!
 
alright, so read and digested, i was thinking his nadir wasn't dropping so low at all, but maybe he is and i miss it, or who knows,

cat diabetes makes me nuts, i feel like i understand and than i don't at all. or i'm wrong. i do not have a future in diabetes management.

i had halfway thought of trying cutting his insulin down and seeing how we did, just as an experiment, and your suggesting it as well, has lead me to think maybe i should give it a try. i've noticed he eats less when i feed him certain flavors of food, and i was wondering if that was influencing his blood sugars, but i havent been able to wrap my head around charting specific flavors of food.

fyi, the 28 happened at a +18 i was away, my mom gave him a shot at midnight for me, didn't test his sugar, fed him, left out frozen food, and i came home 18 hours later, so it wasn't quite a nadir shot, i don't even understand how that happened, bc i was/am often away for 15-16 hours at a time for work, so i wasn't too much terribly longer. i was thinking maybe he gobbled everything up as fast as possible. but he had an awful lot of food left out, and the frozen cubes usually stay last time when i am at work. maybe kitty really needs a lot less insulin and i'm still working off this crazy rebound thing that started in the first place from the vets 4 units bid thing.

i will give only 1 unit tonight, but i have to go out about 30 minutes after that shot, and than i don't work till tuesday so i'll get in as many as possible readings. i better order some more contour strips, although i've been thinking about switching to the walmart meter if its cheaper. between the new food and the insulin and the strips. i am a broke girl.

i am looking into how i can afford to get a pet sitter come on a more regular basis, but it might be out of my budget. babbling a bit, but i just applied to grad school i'd put it off but my state changed a law about nurse practioner's ability to practice based on when you graduate, so i gotta get crunching on that, as much as i don't want to.. and this is a lot to juggle. satan's dosing schedule is always gonna be off. like even today, i slept through my alarm and i was home to give the shot on time.

sorry i got so babbly here. i guess i'm venting. no one wants to hear about the cat. most people i know are. "put him to sleep". and i can't. i'm even horribly allergic to my fluffball. but. as i'm sure we all know this to be true about our cats. they are the best one in the world. my cat is devoted to me. more devoted than a dog. and we've gotten better all in all with regards to ear pokes. i just got some lancets he barely notices it seems and consistantly give me nice drops. yay for me. because he hated that.

again read and digested, and Vicky, thank you again. you have been most helpful, even if i am still totally lost. 1 unit here we go.
 
You have gotten good advice on lowering the dose from Vicky, so I won't address that (I also think he is rebounding).

I just want to address your comment about naysayers that tell you to have him PTS rather than treat his diabetes. Obviously, Please don't do it! There are so many other options and diabetes should not be a death sentence. Many cats live long, healthy lives on insulin after diagnosis. I say all that not to convince you, but to give you facts to tell these other people.

When Beau was diagnosed I called my mother because I was very upset - and she said I should have him PTS! I could NOT believe my own mother would say that. After all, she is the reason my family always had cats. Anyway, fast forward 2-1/2 years, diet change, two different insulins and Beau is OTJ (off the juice), diet controlled and in remission. He has not had insulin for over two years. I learned so much about treating feline diabetes here that I choose to adopt another FD that was going to be PTS because of his diagnosis. Jeddie is a wonderful cat, regulated on insulin and doing fine. He certainly did not deserve to be PTS because he was diabetic. In fact, I just told him yesterday that I could not believe anyone would have considered that option for such a sweet kitty. He had just been dx too, so no real effort to treat him had been taken on - no home testing at all.

We certainly support your decision to keep treating Satan. I love his black spots on his head! He looks like a Turkish Van cat.
 
oh my shelia

you may have figured out what sort of cat makes up my mutt

he does look like a turkish van, he's huge. around 20lbs and not so fat

satan's not getting put to sleep, i just hope i can get him under control so i dont need to feel so. time constrained about things. he's my baby cat man. hahahahah i worry about him dying because no cat will ever be as devoted to me.

i kind of. was used to sort of living fairly free and wildly.

lower doses would be good. that would mean he's not as bad as i thought.

so yes. 1 unit tonight. and hopefully well be good. i'll buy hes rebounding.

thank you.
 
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