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ZoeyMaineCoon

Member Since 2010
We are using a bayor contour USB meter which I usually really like and feel like it reads pretty accurately. But I have noticed that when it registers a low sometimes it can read really low and not always correlate with symptoms. Does anyone notice that with this meter? The previous day Zoey was 409 (quite high for her... usually I don't see much higher than 300) and so I gave her 3 units and tested her 2 more times during the day to make sure she was coming down. 2 Hours in she was 380, 5 hrs in she was 279, and that evening my husband tested her and she was maybe 180 and gave her her corresponding insulin (1 unit) and this AM she was 37. I was like holy cow! but she was running up to me and meowing and seemed totally fine. So I obviously gave her nothing in terms of insulin.But I felt like the meter read pretty low. I felt it was good sample. She remained fine during the day. My husband is going to test her again this PM. I just felt like if she was really 37 she would be symptomatic. Thoughts?
 
Every cat is different as to how low they can go and no symptoms show. Even without symptoms showing with a 37 you would still want to give a little food to be on the safe side.
 
may i ask which insulin you are using? i noticed that you vary the amount of the dose quite often so i assume you are using pzi or humulin? fwiw, back in the day when we used pzi we did that in the beginning and was up down up down up down. i actually got tired of thinking about diabetes 24/7 and decided to shoot a steady dose and low and behild, Mousie evened out.

and i agree with what Hope said, some cats show symptoms that low, some don't, but you want to make sure they don't go any lower and keep an eye on them in case symptoms do appear as they can come on quick
 
My cats have been down to 34 with no symptoms but almost comatose at 20. Every cat is different and you have to be careful. I use the same meter as you. I would always be really careful when they go under 40 and work to bring them back up with higher carb food.

Given she dropped so low you should lower her dose by 1/4 unit at least however I do note you have been bouncing around on dose quite a bit.. thats not ideal - the key to Lantus is consistency since any dose needs a few days to settle in before a change is made...

Any chance you can update your SS to one we can use? ( we have a template that helps us see things easily and advise better) http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

I assume she is still only getting friskies pate and still on lantus?
 
Yes, she does lantus and still does friskies pates. We usually have made the schedule for doses to be <200 no insulin, >200 is 1U, and if closer to 300 we give 2U and over 300 give 2U. I gave her 3U with the >400 just because she was so high. That wasn't typical for her so I figured that maybe she got into something with some more carbs. And I fed her immediately after getting the 37. My husband said her evening BG was good but didn't give me the number (I'm working). We have been having problems with her numbers where some will drop her down but we have a hard time getting smaller dose increments into her (i.e. 1.5). So there are days when she doesn't get any insulin because she has numbers that are 100s.
 
Can i ask where you got this dosing regime from? It might be why her numbers are kinda wonky.

All the research I have seen says you are better to do consistent dosing where you hold it for a few days and look at the numbers before making a dose change... Because lantus takes a while to build up and develop its store... The more consistent you are , the better chance of remission...

Are you willing to consider a change?
 
We are certainly up to making changes if anyone has advice on where to start for her. We had previously been giving her large amounts of lantus while on dry food so when we changed to wet we just kinda tried to change her dose. Like I said, we have trouble giving smaller doses and for some reason our walmart keeps telling me they can't get the smaller increment needles so we are stuck with the larger increment ones which makes dosing her hard. Our vet here doesn't carry supplies and would be too expensive for us anyway.
 
How many times a day do you test? It's great that you set up a spreadsheet, but with Lantus you really need to know what BG is like at certain times during the day. I would highly recommend setting up a spreadsheet like this: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207. It will not only help you understand your cat's BG levels better, it will also help you get better advice from the experienced people here on the boards.

From your spreadsheet, it looks like you are only testing Zoey twice a day, before each shot? If so, that's not how Lantus is dosed. You need to test at least 3 times a day with Lantus, because dose adjustments are based off the Nadir, or the lowest number of the cycle. This usually happens about halfway through the cycle (6 hrs in, or +6), Because of this, you need to test at least 3 times a day...once before each shot to make sure it's safe to give insulin, and then the mid-cycle number to make dose adjustments from. If you don't think this will work because of your work schedule, please, say something and I would be happy to give some advice. I managed this with Bandit working two jobs (one full time with a 2hr commute) on my own and we did great. It may involve making some sleep/scheduling adjustments, but it is very doable. I would be happy to give some advice if you need it! :smile:

If you're only getting preshot tests, you're only getting half the picture, and not the part that will help you get the BG under control. Trust me, once you are able to accurately judge dose adjustments, things will get much easier.
 
I unfortunately work 12 to 13 hour days and can't test her more than 2x a day. I can do a glucose every couple of weeks but I only get 4 days off a month so it makes that difficult as well. So I don't know what to do with the middle number as we can't really test that very often. Would it work to do a curve every couple of weeks to see how the doses are doing?
 
What state/country are you in that Walmart doesnt have the right syringes? Maybe we can find someone near you that can get the ones with better markings. Or you could try the online walmart or ADW (American Diabetes wholesale) links above?

Its important to always test before the shot so I would definately do that no matter what. Can you set the alarm to get up every few days to measure 6 hours in ie 6 hours after the nighttime shot? and/or at weekends at 4-6 hours in? or train a friend/husband/family member to do spot checks? That would really really help.

What weight is she? (her ideal weight if she is over and under weight).. her dose should be based on that to start but usually is 1unit.

Starting dose = 0.25 units X the cat's ideal weight in kg
 
If your Walmart is anything like mine they are clueless that they have syringes with half unit marks..But if you go in and ask for their Relion 3/10cc 31gauge short needles they WILL have half unit marks. It is just those behind the counter are completely clueless. All their 3/10 cc fine gauge needles do have half unit marks, anything over 30 gauge for some reason don't but the 30 and 31 gauge do. I stopped a long time ago asking for the half unit marks because they would tell me they didn't have them while I was looking right at the box.

So what you want to tell them is:
I need insulin syringes 3/10 cc 31 gauge short needle..and presto they suddenly have syringes with half unit marks :roll:

Mel, Maxwell, Autumn & The Fur Gang
 
Perhaps you mean you can't find syringes with 0.25 unit markings. That is correct. You have to eyeball it and line up the plunger halfway between 2 half unit marks to get about 0.25 units measured.

Also, what about finding an enterprising college student who could learn how to test, then come in on workdays to test for you?
Maybe do it for field experience credit if interested in veterinary science.
 
Sorry for the late reply, I'm working nights right now and it was really busy. Thanks for the tip for getting the needles. We will try that next time. We have a lot of her other syringes left. Her ideal weight in pounds is 16. I think she is 17 right now. She's a large maine coon... we call her a walking carpet. So her starting dose would be 1.8, which sometimes that is not enough and other times pushes her too low. We always test pre shot, its the mid number I don't always have time for. We can try adjusting her doses more when I'm off on the weekend to do the q6hr. I'll have to request more test strips soon from DCIN soon too so we can do more adjusting of her doses.
 
One thing I noticed looking at her spreadsheet is that you keep changing her dose and skipping shots because of her being too low to shoot. Lantus needs consistancy in dose. Plus the starting dose is normally .5u to 1u given twice a day and held for normally about a week before changes are made. What looks like is happening here is you give her 2u she drops too low so you skip then shoot a lower dose that doesn't seem to touch her numbers so you immediately go back up in dose again, she goes low, skip shot rinse and repeat.

Ideally you are looking for a dose that allows you to shoot every 12 hours without dropping her too low...if she goes too low then the dose is too high and needs to be scaled back. You might want to pop over to the Lantus TR ISG and read up on the protocol there for finding the ideal dose. It will cover how to handle low numbers and at what point you raise or decrease according to the numbers that you are seeing.

Mel, Maxwell, Autumn & The Fur Gang
 
Mommaofmuse is right. Someone said to me today that insulin is like a big cruise ship, you turn the wheel but it takes a while for the ship to move. So you need to give it time to settle in. You start at 1.75units as the formula says, and it might be too low so then you increase. But you can't base the increase on the preshot, because really that's when the inslin is running out. During the day (or night) your kitty could be dropping low..and that's the number you base the change on.


Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Click to expand...


Wendy
 
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