Mr Ripley Ten Days On The Juice

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MrRipley & Rick

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It's been ten days. I'm not testing several times a day, like it appears some do. I am seeing readings at plus 12 hours under 300. Readings at plus six under 200. I'm thinking we're doing OK. Had a problem last Wednesday. Was called out of town and couldn't get the PM shot until three hours past normal shot time. I've changed the shot time by 30 minutes a day to get to 8:00 AM and PM. Ripley eats four or five times a day, so it's going to be hard to get an accurate curve. Today, he was 266 at shot time, when he ate. He's had no food since, and at +6 he is 181.

I realize I don't have a lot of information, but I'm thinking the dose is about right. I don't feel I know enough to increase it. I'll be contacting the Vet soon, to discuss.
 
There's no way to know if this is the right dose for him because you haven't got mid-cycle tests, nor a curve. You need to test around +5 to +7, when the nadir (lowest glucose level) is expected, to see how low he is going. Lantus doses are adjusted by the nadir, not by the pre-shot.

For the complete protocol, read this STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL this explains what you need to do to use Lantus most optimally.

Also, you'll find it more useful to use our spreadsheet template herehttp://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207, as all of us are familiar with how that one reads. Patterns are easier to spot too, as test values are lined up with respect to the number of hours post shot.
 
The only thing I would add to what BJ said is that although the tests haven't been done at the optimum time to figure out the dose, any test numbers you can get are of value.
If you have a couple days that you can do more testing, you don't have to poke Mr. Ripley every two or three hours in one day. You can get a +2, +6 and +10 one day, and then a +4 and a +8 the next day. Over two days, you'll fill in the curve.
The two tests you absolutely should do every day are the two tests at AMPS and PMPS. The +6 is the best time (nadir) for your specific insulin as BJ pointed out. But all tests are helpful in figuring this out.
Carl
 
Thanks for the advice. I thought I was using the right spreadsheet. I think I'm on board now. I talked to the Vet today, and he too indicated we need to look at the lowest reading throughout the day. I'll do a +3 later tonight. PMPS was only 197. Will be watching him tonight. This morning he went down 87 points at plus 6.
 
There you go! Now, on the spreadsheet, I can clearly spot where the nadir is likely to be and how the numbers are around it. And you're getting some nice yellow and blue numbers.

Always test before giving insulin, for safety reasons. We normally suggest you not give insulin if below 200 when first starting out, although it looks like you could go with 190 for your "no shoot" level as you did last night.

Drops of 200 points can happen in some cats from pre-shot to nadir, hence the focus on testing to watch for these. The lowest values you've gotten so far are within safe levels. However, just to be prepared, please read How to treat HYPOS - THEY CAN KILL! Print this Out!! so that you are ready if its ever needed. If your cat has furballs, catches a kitty cold, gets an upset stomach, or diarrhea, the amount of food consumed may drop and then the insulin could be too much ... and these things happen, as many of us can attest.

Once you have some more data to fill in the different points along the day, you'll be ready to look at dose adjustments, using the protocols in the Lantus forums. Because you are giving a low amount of Lantus, any increases will need to be small - 0.25 units at a time. These must be eyeballed on a U-100 syringe, because the tiniest they can measure is 0.5 units (if you've syringes without half unit markings, I encourage you to get ones that have them).
 
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