Low BG at just +2 on Lantus?

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MikeysMom

MikeysMom

Member Since 2011
This hasn't happened before, so I'm putting it out there for a little support. PMPS was 216, injected 1 skinny unit of Lantus, BG at +2 was 40. He's gone low before at around +6, but never this early. I gave him 5cc Karo and a third of a can of Merrick Cowboy Cookout and will test again at +3. I'm curious as to what would cause such a rapid drop since he's on Lantus. He played hard for about 10 minutes after dinner and injection, could that have sped up the insulin? I'm going to go ahead and cut his insulin tomorrow to .75 in any case, even though he hasn't had a full curve on 1U because he's dropped to 38-50 a few times now.

Wow, these early days are tough. I feel like we're pointed in the right direction, but we definitely need fine tuning and momma needs to relax!
 
You know, I didn't this time. I usually do if it's under 60 (as instructed on the great printout that's floating around these parts) and this time I did not. In the past when I've retested, it's been within 5 or so, though.

He seems fine; just attacked the snot out of his toy and now taking a nap (very normal this time of night) I will test again in a few minutes.
 
You are right Mikey has definitely earned a reduction. And this is after a skipped shot this morning?

You handled it very well, keep testing every 15 to 20 minutes. You might want to use MC or HC food as it lasts longer and will keep him up better once the new shot really kicks in.
 
Larry, Ann, Marje and whoever else flew over here.....
You guys are awesome.

I removed the 911 in LL.

Thanks so much,
Carl
 
Please do not over feed. 5cc of Karo plus all the food you gave your cat after his PM meal could cause him to vomit which would not help things. A few drops of Karo (if needed) or, preferably the gravy from HC food and testing in 20 - 30 min is a much better approach. Please get a test at your +2.3 or +2.5. While I doubt numbers will still be low, you will need to continue to monitor since the Karo will wear off.

I want to look at your SS and I'll be back.
 
I just reread your first post. 5cc of karo is a lot , usually just a drop or two will work.

Yo skipped both shots yesterday , too. I think you are to the point on needing to shoot lower numbers, it should help to keep things more even and you can work the reductions down. How able are you to monitor after the shots?
 
I think there may have been a few things that have contributed to the low at +2.

First, some cats do have an early nadir or will drop early in the cycle. If you look at Gabby's SS, she's one of those cats that will do this. As a result, I test (a lot) early in the cycle.

Your cat dropped into 30s on 12/1. That warranted a dose reduction that you did not take. You dose from that point on should have been 0.75u.

On the Lantus board, when we see lower pre-shot numbers that a newbie is uncomfortable shooting (e.g., numbers below 150), our strategy is to suggest that you reduce the dose so that you can more comfortably shoot twice a day. I suspect that here on Health, the recommendation was to skip the shot. While that is certainly feasible, Lantus dosing is best when you are consistently shooting twice a day. Lantus is a depot-type of medication and you need to maintain a reasonably constant dose in order to get the best results.

One strategy for tomorrow is to drop the dose to 0.5u so that you should be able to begin giving insulin twice a day consistently.

I'd like to encourage you to take a look at the starred, sticky notes on the Lantus board. They will help you to better understand Lantus and the dosing protocol that we use.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
 
I've read the protocol on the Lantus section as well as from my vet, and am using her instructions not to shoot at under 180. I'm not yet comfortable adjusting his dose daily on my own when I don't even fully understand the data I'm getting (see my thread on needing Spreadsheet 101). In the future, I'm sure I will, but for now I'm doing the best I can with what i can manage and understand. I'm so overwhelmed at this point with just getting started that I really can't comprehend that tight regulation yet. There is no way I'm comfortable shooting anything when he's under 150 right now, at least until he's had a curve or two. This is just too new for me to get that technical.

I've been going by the treatment printout that was recommended on here (Melissa & Popcorn's), and the 5cc was actually half of what that said to give.

Right now, I work from home, so I can monitor as often as necessary, but that's not practical on a daily basis (I do get out occasionally, lol) Once I get a full-time job, that will change, so getting regulated is a priority, especially as a new job may involve extensive travel.
 
Feeling overwhelmed at this point is completely understandable and to be expected. It really does get easier -- I promice. If you feel like you need to discuss dose with your vet, I'd encourage you to do so. I'd also suggest you point out that you're having to skip a fair number of shots due to low pre-shot numbers. You might gently ask if lowering the dose would help so you can shoot twice a day with a greater comfort level.

FWIW, most of us, once comfortable with the Tight Regulation Protocol, do not rely on our vets for dosing. I have a great vet who I truly respect. She pretty much leaves me alone with managing Gabby's dose. She has access to my spreadsheet and has never made any suggestion about how to change my dosing strategy.

I've been here for over 2 years and have no idea what the treatment printout is that you're referring to. I wonder if those recommendations are for a full out hypoglycemic episode. Generally, we use a teaspoon of the gravy from HC food (e.g., Fancy Feast grilled or marinated style) and/or a few drops of Karo, honey, etc. Then, as I suggested, test in 20 - 30 min. and repeat if numbers are still below 60.
 
He was at 88 at +3 and 83 +3.5. I gave him a very small amount of HC food again and will keep testing.

I agree on not necessarily following the vet's protocol, but for now, I don't have much else to go on. Like I said, I'm VERY uncomfortable injecting anything at less than 180-200 when he hasn't even had a full curve yet. I asked twice on another thread about skipping shots and didn't get the info other than the link to the Lantus FAQ that's also in the above post, which I went by. I will decrease his dose to .5U, though and see what that does for him. I'm really, really not ready for much else yet, especially not shooting him when he's low. I haven't gotten a full night's sleep since he was diagnosed, I'm exhausted and really can't comprehend much right now.

The protocol I referred to is in the stickies at the top. It's divided into low (under 60) and very low (under 40) and also according to symptoms (which he never has). It's hard with him to look for neuro signs because he is very slightly neuro from a stroke when he was young.
 
I see Mikey is up to 88. Keep testing every half hour. That could just be the karo and it wears off fairly quickly. W/ my cat it only lasts about 2 hours. but, ECID.

Sienne is one of our best advisors in Lantus ISG. Think of dosisng this way. Human diabetes don't go back to see the doctor every time they need a little more or less insulin. They learn to adjust it on their own. In fact, for the shorter acting insulins, it is adjusted on a daily basis. As long as you are there to test Mikey is safe. You know how to use HC food and karo. He may bounce the next day from the extra carbs and a panicked liver, but that is temporary. You can do this, learning to understand what is going on will give you confidence in making the right decisions. And we are here to back you up, 24/7 some one is nearly always on this board.

I just saw your last post. I'm glad you are decreasing. If Mikey went 3 cycles w/out insulin and was only mid yellow, his shed was overly full. You will still need to monitor, and hey you are well on your way to getting a curve tonight! :-D
 
You don't yet have the data to shoot low. No one would suggest that you do so. On the Lantus board, we use a slightly different cut off bot for now, it's a matter of your comfort level and ability to monitor. What we suggest is that you gradually work your way down to shooting low. If you're able to shoot above 180, then the next time you get a 150, you can shoot that. Then maybe 120, etc. There's no rush.
 
At +4.5, Mikey is at 70. He had a HC snack a bit ago, so hopefully that will go up just a bit more (I know 70 is fine, but it's still only +4.5, and he should hit nadir at 6-ish) I gave him a small lick of Nutrical for his test reward to help as well. He LOVES Nutrical. Like would eat the tube if I let him. We'll keep testing at least until he levels off without snacks. I hope I can at least get a LITTLE sleep tonight before I have to get up at 7 to feed him....I haven't had more than 5 hours in I don't know HOW long and It's taking its toll. I'm exhausted.

Edited to add: THANK YOU ALL from the bottom of my heart, for your support.

One more question: Assuming he is at 180+ in the AM, I'm guessing I should shoot him (at the reduced dose, of course) so that he can regulate? Or should I hold off if it's not over 200 since he had a rough night? (Though I think it's been rougher on me. He's hating the pokes but not minding the treats and snacks)
 
If anyone is still up ;-) We're at 87 at +5. Is is safe to scale back to testing in an hour? Even with treats, Mikey is pretty sick of having his ear stuck.
 
:-D :-D At this point every hour would be fine. Once past nadir and if he is holding steady, you can even do 2 hours. Even w/ hourly tests many of us will nap between shots. In the winter when Tess comes to bed w/ us I just sit up, test and go back to sleep without even getting out of bed. :lol: Not the best rest , but it is something.

As per Sienne's advice, I think you can start to gradually lower you no shoot threshold. So, yes, 180 would be fine in the morning. Don't be too disappointed if he is bouncing though
 
Yes, you can wait an hour, then numbers permitting (higher) you can call it a night. Leave a bit of food out for peace of mind if you like.
Take the reduction on tomorrow mornings shot.
If his AMPS is under your current comfort zone, you have 3 options:
1-don't feed and stall for 15 ins. Recheck for a rise. If the rise is significant enough that you are comfortable, shoot the full 0.75u.
You can continue stalling/testing until you get what you consider a shootable number. One thing to consider when stalling is that your next shot will be 12 hours from the time you finally shoot. So schedules come into play.
2-shoot a reduced dose (make sure you can get a +1 and +2)
3-skip the shot (least desirable)

You may want to consider coming over to Lantus Land. . . ;-)
 
At +6 Mikey is at 172. Probably the beginning of a bounce? My plan for Sunday is to give the reduced dose in the morning if he's high enough and test a few times just as a precaution while trying to protect his poor little bruised ears. Right now I'm going to try and get a little sleep.

Changing the schedule is tricky, so if preshot values are low, so if I can't shoot within a half hour so I can work it back, that route won't work. If I end up working full time out of the house, that won't work. Also, if I ever have to go anywhere, my roommate will have to take care of him on her work schedule. For now, and I know it's not the best way, I'm going to skip the shot if he's below the threshold. I'm not versed enough to reduce doses and such yet when I don't even have a correct normal dosage to go by.

I will check out the Lantus group tomorrow. I read the stickies but haven't posted yet as I'm still trying to figure out what it all means.
 
Mikey was at 289 AMPS. I reduced his dose by .25 to .75U and will test through the day and add to his SS. Thanks again for all the support! It means so much.
 
Good job. Yes, this is a bounce, so you and Mikey's ears get a rest. :-D :thumbup

The next time you get a low number at preshot , post and we can walk you through it. I f you are home it is good to get a +11 test so you can see if Mikey is headed up or down at the time. That can help a lot in figuring out what to do. I know schedules are difficult, we all just do the best we can.

One thing to keep in mind, if you do skip a shot, the next shot can be reset to when ever you want. You don't need to wait 12 hours form the missed time.

You should start a new thread for today, either here or in Lantus ISG (aka: Lantus Land or LL ;-)) We usually use a standard format date, cat's name, AMPS~#. As you do more tests during the day you go back to the first post and edit the subject there. That changes what is seen in the list. Don't add to the text body, people usually don't reread everything. Once you have edited the subject, click submit and the post a reply if you want to say anything new. That will also bump you up to the top of the list.
 
Hi,
Noticed that you said this or something along the same lines a couple times in this thread

For now, and I know it's not the best way, I'm going to skip the shot if he's below the threshold. I'm not versed enough to reduce doses and such yet when I don't even have a correct normal dosage to go by.
Click to expand...

Good for you! Above all else, he is YOUR cat. Anytime you do not feel comfortable, trust your own "gut" feelings. This is a truly awesome site. You will get lots of advice, great advice, when you ask for any. But it's just advice, not something you should feel you have to do. We want what is best for your kitty. So do you. But he's yours.

Carl
 
Hi Mikeysmom,

Just read your response in the Think Tank thread about the ISG's. Maybe this explanation of how the longer acting insulins work will help.

It's probably been explained that they work on a depot or shed sort of overlap. As you continue dosing twice a day you are in essence filling up a bucket, so termed the shed. The shed reaches capacity quickly if too much insulin is being given and it overflows. That's what happens when you get 40s and 30s. That's why a dose reduction is in order when you see those kinds of BGs.

However, if the dose was not reduced enough, you will continue to see fairly high preshots as well as mid-cycle lows because the shed is still overflowing. You may even see rebound numbers in the 400s or 500s because the body reacts to those lows and dumps stored sugar into the system as a safety response. The body has to protect the brain at all costs.

The "trick" to finding the best dose is to fill the shed but not overflow it. That's why we often say start low and go slow because it's much easier to find a good dose by starting BELOW the best dose than starting too high and passing it by. Mikey's results so far appear to be that of doses which are still too high, because he's still having higher preshots and mid-cycle lows. I think he would even out a bit more if the dose was .5U/half a unit. He's luckily not rebounding too badly, so you're almost there, but going below what will turn out to be his best dose would empty down the shed somewhat and allow you to build it back up without overflowing it.

Diet may also be helping his numbers at this stage as well, as I saw you're feeding Cowboy Cookout sometimes. That is a good lo-carb food. And if it helps you relax and feel more confident, you are already asking questions and making deductions far ahead of where you think you are. You are doing very well for him.
 
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