Need advice--Heidi's bg down to 156 after only a week

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heidismom

Member Since 2012
Last Friday Heidi's bg was 309. Yesterday it was 218, after one week of 1 unit of Lantus twice daily, and this morning I tested her before giving insulin and her bg was 156. This alarmed me because I thought the levels were dropping too fast and 150 is the top of normal bg range, according to my vet. So she is just slightly over normal. I was afraid to give her the usual 1 unit because I didn't want her to go into hypoglycemia.

I called the vet's office, and Heidi's vet is not working today so I talked to a different doctor. She said to not give the morning insulin, and wait and test her at night to see if her insulin is over 200, then give insulin. Actually she said the rule is "over 170, give 1/2 unit; under 170, do not give" . Does this sound right to you? I guess she is leaving it up to me whether to give it at over 200 or over 170.

Thanks!
Corinne, heidismom
 
Hi Corinne,
I'm no Lantus expert, but I don't think they typically use a "sliding scale" like the one your vet described. The Pre-Shot BG data is valuable, but Lantus is primarily dosed based on the nadir number (the lowest point in the 12 hour cycle) rather than on the BG at the test when you give insulin. I'm going to try to get someone with lantus dosing experience to help out....
We do normally recommend that you withhold from shooting (at least at the beginning of treatment) when the BG is under 200, just for safety. Eventually, when you have enough data collected, you will be able to confidently shoot on a number under 200, but for now, you did fine. And again, not a lantus user, but the drop in numbers after just one week is a very encouraging sign!
Carl
 
Hi Corinne,

Has anyone spoken with you about setting up a spreadsheet for Heidi's BG numbers? It's practically impossible for anyone to advise you on dosing without seeing your spreadsheet first.

Lantus is a depot, or "shed", insulin. Typically, it’s better to give a reduced dose than no dose at all...but again...without a spreadsheet, folks won't really be able to comment on dosing. Since Heidi has been on insulin for such a short time, I would listen to your vet for now (or to Carl regarding the don’t shoot under 200), at least until some Lantus folks show up.

In the meantime, can you please post your BG numbers for the past week...maybe something like this...

Example
5/19 AMPS:192 / AM+2:178 / AM+6:164 / PMPS:182 / PM+3:151
5/18 AMPS...etc., etc.
 
We need more data to advise you!

Especially, we need to know HOW LOW does the glucose go at 5-7 hours after injecting insulin?
Lantus dosing is adjusted based on this low point, called the nadir. If she hits a 40 at the nadir, with a human glucometer, she earns a dose reduction of 0.25 units.

Have you read and printed How to treat HYPOS - THEY CAN KILL! Print this Out!!? Do it now and get the supplies to have on hand, including an oral syringe (in pharmacy or baby section of large pharmacy/multipurpose stores)

Without collecting enough data, you have no way of knowing how Heidi responds to Lantus throughout the day.

Also, Lantus is not dosed on a sliding scale, because it is a depot insulin, ie, it builds up a storage level that gradually is absorbed. Sudden alterations in dose don't work well with depot insulins like Lantus and Levemir.
 
Thanks for your replies, everyone.

I did print up the information on hypoglycemia.

Since I just got the AlphaTrak last Tues, and my vet didn't suggest tests before each dose, I put off testing until Thursday. I couldn't get a reading because I had trouble using the glucometer. Yesterday (Fri) I finally got a reading, 218 but that was a couple of hours after the insulin and eating. This morning's reading of 156 was around 8 a.m., 12 hours after her last insulin dose and before the morning dose, which I did not give her.

Are you saying that because I'm using Lantus, I need to keep giving her some insulin, even a small amount? This is all completely new to me. It sounds as if her bg needs to be measured at 5-7 hours after insulin to find out if a decrease is warranted. But I didn't know that so I didn't do the test 5-7 hours after insulin.

Heidi may be in an unusual situation, since she is currently being weaned off prednisone which I am sure caused the diabetes. She was on a very small dose, 2.5 mg every other day for a few years, now only twice a week. Tomorrow she gets prednisone again and I wonder if that is going to make her bg go up.

Thanks again for trying to help.

Corinne
 
Corinne

Vets like to be cautious as they don't have too many clients that hometest and they don't want the liability if your kitty hypos. However, in the Lantus TR ISG, we follow a tight regulation protocol and we teach our new members to gradually shoot lower and lower. The goal is to shoot low to stay low. Of course, we do not encourage anyone who is new at this to do that because you have to build data to see how your kitty will react to food management if they do start
to go lower. Normal BG in a cat is 50-120 on a human glucometer although many non-diabetic cats and cats who are diabetic but are now off insulin will test below 50 routinely.

Many vets use Alpha Trak meters (I'm not sure what meter you are using). The AT meters "can" run about 30 mg/dl over a human meter; there can also be up to a 20% variance in meter readings. So if your vet is saying that 150 is top of the normal range, that could be totally in line with the human glucometer top of normal being 120.

We do not have the rule "over 170, give 1/2 unit, under 170, do not give". Like I said, we work with new members on shooting lower gradually once they have built up some data. Lantus likes consistent dosing but we also err on the side of caution and safety. Here is some information about Handling Low Preshots but I strongly urge you to ask for help before you shoot a number lower than you have shot before: Dealing with Low Preshots

What I would suggest is that you do a Spreadsheet for us with her numbers. Here is the link for setting up a SS: Creating a Spreadsheet
A SS helps us help you. If you can then come over to the Lantus TR ISG, there is usually always someone there who can walk you through shooting numbers.

The vast majority of the members of the TR Insulin Support Group are using a dosing protocol that is based in clinical research and that has been published in leading veterinary journals. It is referred to as the Tight Regulation (TR) Protocol (or by other names as well, the Tilly Protocol or the Rand/University of Queensland Protocol). They are all the same. A modified version of the protocol and links to the formal versions is available in the Tight Regulation sticky. This approach will give your cat the best chance of going into remission or keeping his/her blood glucose numbers in a range that will prevent organ damage.

It is not mandatory that you follow this approach. However, you should be aware that most of us do and it is how we approach dosing decisions. As a result, we are very numbers oriented.

In order to follow a TR protocol...which has been shown as the best way to get a kitty into remission, you will need to do the following:
• You will need to test the blood glucose levels of your cat at least 4 times per day. (A human diabetic typically tests at meal times – 3 times a day.)
• You will need to know about hypoglycemia and be prepared to deal with it. It’s important that you know how to keep your cat safe.
• You will need to test for ketones regularly to start with and know about diabetic ketoacidosis (DKA). Be aware that ketones don't occur once a cat is (and remains) properly regulated.
• You will need a brand-name glucometer made for human diabetics that measures whole blood (not plasma-equivalent) and which preferably uses 0.6 µL of blood per test or less
• You will need to use syringes which allow you to measure tiny doses: U100-type, 3/10 cc = 0.3 ml volume and with the half-unit increments printed on the barrel
• You will need to feed the right diet: high-quality low-carb canned food or raw food exclusively
• You will need to feed your cat lots of small meals spread over the day, free-feeding canned food can be an option for some cats.

Please let us know how we can help.
 
Marje, Mike and Gracie,
Thanks so much for taking the time and effort with all that information. It sounds as if I have all the wrong equipment--I have a human glucometer but bought the AlphaTrak; my syringes are wrong. I've been giving her the right food, but not regulated meals, I leave food out so she can graze. I would love to see my cat go into remission but I don't even know if my vet is aware of the TR Lantus approach. That's a lot of testing, and after this experience I can see why it is a good idea but I don't know if my cat will go along with it.

I'm feeling overwhelmed right now! Are you saying that not everyone who uses Lantus uses the TR method? I sense your dedication to it and you certainly have good reason to feel it's the best way.

Thanks again so much. I wish my vet were working today so I could discuss this with him.

Corinne
 
Corinne,
Some of those things Marje listed are not "absolutes"...

You can use the Alpha Trak since you already have it. You just need to note that when you post numbers so that people understand you are using a meter that is different than what most people use. The reason most of us don't use one is that they are expensive, and the strips are too. But it's fine to use what you have.

The syringes Marje listed are the best to use because they have 1/2 unit markings, and many times, doses less than whole units are just easiest when you have more divisions on the scale. If you are using Lantus, you should already have the U100 syringes, but maybe not the ones with the 1/2 unit scale?

You are feeding the right food, which is good, and the scheduling and portions can be adjusted as needed. There's ways to do that, like auto-feeders for example. We can all help you to figure out how to fit this new world into your existing one. :smile:

Please, don't be discouraged! Everyone is overwhelmed at first. We all were! It's a huge amount of info to try to soak in at once, so do it in small pieces.

The Lantus TR that Marje linked you to offers the best chance of remission, but other kitties have gone into remission while not strictly following the protocol. We work with people to figure out what works best for them. No matter which protocol you use, people can help you out with it and will help you make sense of it. You don't have to make major decisions today, so take some time, do some reading, ask any questions that pop up.

Carl
 
Some of the members of the Lantus TR ISG follow the Start Low Go Slow protocol. It has you holding doses much longer but testing four times a day is not that much and even with SGLS, that is what we would recommend. You should never shoot without doing a test right before shooting and you should always try to get a mid cycle test when you can or, if you are leaving, an out the door test or at night, a before bed test.

You can use the AT but the strips are more expensive for you. Many of our members use the Relion Confirm and order strips off of AmericanDiabetesWholesale.com (the Arkray strips work with the Confirm). It's much cheaper and that way you don't get stuck without strips for the AT when you need them. What syringes are you using? I hope U100, .3 cc. We recommend the half unit markings because it just makes it so much easier for you. But you should not be using U40 syringes with Lantus! :shock: We have had some members whose vets gave them the U40 syringes.

If you notice, the line on feeding says you can free feed so scheduled feeding or regulated meals is not a requirement. If that is how Heidi likes to eat, I'd not change it if there is no reason to. Many of our members free feed their kitties low carb canned food.

Many vets do not support the TR protocol. Most of us love our vets but we do not depend on them for help with managing diabetes. We all live and breathe FD 24/7. Vets do not and many of them have really very little experience managing it. My vet knows I know more about FD than she does and I actually gave a presentation to all five vets in our clinic on FD; they were stunned at what they didn't know. And they are excellent vets. But when you think about it, a general practice vet is treating, usually, dogs and cats and lots of conditions and they don't have the chance to really become experienced with FD. I'm not saying that applies to your vet...he may be very knowledgable about FD. And you have to be comfortable with how you treat Heidi's FD.
 
Thanks, Carl.
Actually, I just talked to the vet because I thought I needed different syringes and I found out, I do have the right ones!
Thanks for your encouragement. I feel less overwhelmed!
I am going to test her bg again now, and then again in a few hours.
I feed her EVO and Nature's Variety Instinct although I know there are other low carb canned foods out there which might be less expensive and just as good.

Marjorie, thanks to you, too. After this experience (not that there was any disaster, but such a big change in numbers) I can see why testing each time is important. I found that warming Heidi's ear for 20 seconds with a rice sock really made the blood flow easier and the test was effortless. The test strips for AlphaTrak are pretty expensive, but maybe I can get them online for less than $1 apiece.

It's wonderful that you have found vets who are open-minded enough to admit they don't know as much about diabetes as you do, and who will listen to what you say. I feel that my vet (and the whole clinic) is probably open-minded also, but right now I don't know much at all!

I really appreciate all of your input and will keep you posted.

Corinne
 
I just tested her bg again (she ate a bite of food about 5-10 minutes beforehand) and it's back up to 235. This morning it was 156

??????
 
Corinne

It's really tough to put these numbers in perspective without a SS or knowing when you tested. There are twelve hours to a cycle so two cycles per day. Your PS is usually +12....that is normally 12 hours after you last shot. Once you shoot, we start over with +1 so if you test her one hour after you shoot, that's +1; two hours after is +2, etc. Because we are all in different time zones, that's how we know where you are in the cycle. So to tell me she was at 156 and now you've tested again and she's up....I don't have any way to put that into perspective with where it is in her cycle.

Here's what a typical lantus curve looks like:

Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
Click to expand...

The SSs are so important because you would be amazed at the trends we can see from a SS. It will also help your vet.
 
Okay, I can see, my "stats" are just like throwing out random numbers. The 156 reading would have been a +12. But since I didn't "shoot" her at all today, I don't know what the second number, 235, would represent. Just that she didn't have any insulin today and now her numbers are back up, for whatever that would indicate. Unless I test 4X daily I guess there's no point in making a spreadsheet, though ?

Do you have to test every hour for 12 hours to get the Lantus curve? I'm so confused....

Thanks!!! I'm trying to work with the stand-in vet on this, too. I really appreciate your input.

Corinne
 
That's okay, Corinne. At this point, she's not "regulated" and you will see number swings over the course of 12 hours. That's not a huge swing, actually. It just measures her BG at one instant in time. My cat went from 400 to 100 and back to 400 in a 12 hour period after he'd only been on insulin for one week. All the numbers you have posted so far are not bad at all. The important thing is when those numbers appear over the 12 hours between shots, not necessarily the numbers themselves. When you see when the numbers are high or low, and how that relates to when the shot was given, and when the food was eaten, that's when they start to make sense.
I promise, this won't feel near as overwhelming in another week once you understand a little bit more about blood glucose ranges, and how your specific insulin works over time. Promise. :smile:
Carl
 
But since I didn't "shoot" her at all today, I don't know what the second number, 235, would represent. Just that she didn't have any insulin today and now her numbers are back up, for whatever that would indicate. Unless I test 4X daily I guess there's no point in making a spreadsheet, though ?
Click to expand...

You know what her number was when you skipped the shot today. And how many hours it's been since then, right? And do you know what her number was the last time you did give a shot? Just those three numbers and times are helpful.

A spreadsheet is a great tool no matter how many times a day you test. Whether that is 2, 3, 4 or more times. The more data you have, the more sense the big picture will make. But any data is helpful.

Carl
 
Thanks, Bob & Carl in SC !!
Your words are very reassuring.
Actually, 3 days ago I didn't think I'd even be able to test for bg, and now it's a snap. So maybe things will get better.
I appreciate your help! Guess I'd better get working on a spreadsheet.

Take care,

Corinne
 
heidismom said:
Do you have to test every hour for 12 hours to get the Lantus curve? I'm so confused....
Click to expand...

No. The "typical Lantus curve" Majorie post is just gives a general idea of what happens to bgs in a 12 hour period. For a curve, ideally you should test every approximately every 2 hours. But if you can't because your cat won't cooperate or you have trouble getting blood, just get as many bg tests as you can in a 12 hour period. Try to get at least 4 bg tests so you can get a rough idea of how yoru cat's bgs are.

Before you attempt to do a curve, stick with one consistent Lantus dose for at least a week and get a comfortable routine down for bg testing. Learn what works and doesn't for getting your cat to hold still for bg testing and what works to get enough blood each time you poke.
 
Given you are using the Alphatrack, the lowest you'd want to see at nadir (it'll be +5 to +7 hours after giving insulin) is an 80, and hitting a 70 would result in a dose reduction.

Since you've gotten pre-shot glucose values that resulted in skipping a shot, might I suggest shaving the dose to 0.75 (you'll have to eyeball that) or even 0.5 units for 5 days of regular shooting and testing, so that you don't need to skip because she's going too low. It is likely to run higher on days she has the prednisone, but Lantus works best with consistency.

And, as mentioned, glucose tests!
AMPS - morning preshot to make sure it is safe to give insulin
As possible, snag 1 or more midcycle tests, somewhere between +5 to +7 hours
PMPS - eveing preshot to make sure it is safe to give insulin
before bed ... unless you're able to stay up until or get up at +5, 6, or 7 (I never was!)
 
Thanks for all that info, BJM.
It sounds like a good, and safe, idea to shave the dose to .75 or even .5.

I wish I understood this disease. I need to read more about it, I guess. I wonder how you'd know if the disease has gone into remission.

Corinne
 
We consider a kitty to be in remission when he goes two weeks with numbers in the "normal range" with no insulin given.
Carl
 
BJM said:
Since you've gotten pre-shot glucose values that resulted in skipping a shot, might I suggest shaving the dose to 0.75 (you'll have to eyeball that) or even 0.5 units for 5 days of regular shooting and testing, so that you don't need to skip because she's going too low. It is likely to run higher on days she has the prednisone, but Lantus works best with consistency.
Click to expand...

I'm sorry but I do respectfully disagree with this. For TR, dose reductions are given if the kitty is (a) in normal numbers for most of the time for 7 consecutive days OR (b) a newly diagnosed kitty goes below 50 (human glucometer) or 80 (AT). For SLGS protocol, a reduction is given if the kitty goes below 90 (human glucometer) or 120 (AT). Reductions are not given if the caregiver skips the shot because it is a lower number than they have shot before unless one of the above situations exist.

I would not reduce her dose at this time with the numbers you have. I suggest that you test 12 hours from when you were supposed to shoot this morning. If you are following your vet's advice and the number is above your "no shoot number" then shoot the 1u dose and monitor.

If you are past that 12 hour window...how far past? One hour? Two hours? If her BG is still above your "no shoot number", then you can still shoot IF you want to make your shot time your new shot time or if you can make up the time by shooting early 30 mins/day or 15 mins each cycle to get back to your normal shoot time.

I have to go take care of my kitties and give Gracie insulin. I'll be back after the hour to answer any questions.

We usually like to give kitties insulin as long as possible as long as their BG allows in order to support the pancreas. Under either protocol, the kitty "earns" reductions and you slowly take the dose down as the reductions are earned. We have some members giving .1u or a drop and once the kitty is in normal numbers on that dose for a week or earns a reduction one of the other ways (see above), then a 14 day trial without insulin is attempted. If numbers stay normal, the cat is in remission.
 
Well, with Lantus, the process is probably somewhat different because of the way it works, so a Lantus user who has had a cat that went into remission can answer best. But in my cat, Bob's case, (he was on PZI)...
As his numbers improved, and he started to give me better pre-shot numbers, I reduced his dose accordingly. It got to a point where at shot time, he was close to, or below my "no-shoot" number, so I had to skip shots because his BG was in the "normal" range. He went three cycles (36 hours) without needing a shot because his numbers were below 120. He went above that number the next cycle, I think maybe up to 130, so I gave him .25 units. Next morning, his BG was in the 90's, so I didn't shoot. After that, every 12 hours I would test him, and never saw a number out of the normal range. I continued to feed him nothing but low carb Fancy Feast and Friskees, and kept testing him twice, sometimes three times a day with no insulin, and after 14 days of that, he was "in remission". He's still a diabetic, and if I went back to feeding him dry food or high carb canned, he'd probably return to needing insulin. So now, he's considered a "diet controlled diabetic". Hopefully he will remain that way for the rest of his life. I still test him about once a month, just to make sure. Since last July, I've never seen a number higher than 90, or lower than 50. His pancreas has healed enough to regulate his BG on its own.

There is a definite process outlined in the Lantus TR protocol document that tells you what to do when you get to the point where you are reducing the dose (hopefully to "zero").
http://www.tillydiabetes.net/en_6_protocol2.htm
Here's part of it:
Phase 4: Reducing the dose

When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose. Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. If the cat drops below 40 mg/dl once, reduce the dose immediately! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further.

If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose. Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet. Try to go from 0.25 IU to a drop before stopping the insulin completely. Reducing the dose too quickly generally does not work: most cats do not go into remission with fast reductions.

Phase 5: Remission

14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible. Test the cat's BGs once per month.
Click to expand...

I would be willing to bet that right now there are people in the TR forum, and probably the "relaxed lantus" forum that are in the middle of what we call an "OTJ (off the juice) Trial, and you can look at those threads and see how it's done.

Carl
 
One quick thing I want to add is that if a caregiver is not able to monitor for any reason whether it be work, health, noncompliant kitty, etc, then it does make sense to take the dose down to one that can gpbe given safely twice a day. But if it is only because of one PS which was high enough to shoot but the caregiver did not feel comfortable shooting, then I would not reduce.

That decision, Corinne, lies in your hands as you hold the syringe.
 
Marjorie and Gracie,
Thanks so much, you are so helpful, Marjorie. It will have been 12 hours from the skipped-shot time when I test her again: around 7:45 p.m. At 4 p.m. I got a reading of 235 and I assume her bg will still be over 200 when I test then. I agree now about the 1 unit rather than .5 or even .75. The vet has also said to give 1 unit if the number is high. I'm trying to read and re-read everything I can at this site so I will understand the disease. It seems as if it's important to be consistent with dosage unless there's a hypo episode or numbers get too low (?).

Carl, thanks for that info, too. Very helpful. I look forward to Heidi getting to the place where Bob is! As far as the readings from the glucometer--are these from the human glucometer, without deducting 30 from the value to get the value for cats? Hope that makes sense.

Please don't anyone stay up too late (or later than normal) on account of me and Heidi! I'm pretty sure we will be okay.

Corinne
 
Marjorie, would you have considered 156 high enough to shoot? Possibly I was overreacting...but I thought she had been acting weird the night before and was suspicious that something was going wrong, like hypoglycemia.

Maybe I'm too scared of a hypoglycemic event. I guess if that happens I can give honey or Karo syrup, and keep testing, and she will recover automatically?

I know it's a good thing if her numbers drop but it seemed so fast and seemed like, if I gave her 1 unit again, she'd go hypo.

Sorry if I sound confused. I am still very much in the learning curve.

Corinne
 
Corinne,
Yes the numbers I used were from a human meter. I used a Relion Micro, where normal was 50-120. With an alpha track, I think normal is 80-150.
Carl
 
Corinne...you're welcome. We're here to help you and Heidi!! :-D

heidismom said:
would you have considered 156 high enough to shoot?
Click to expand...

Depends. For an experienced caregiver or even a rather new one who has shot around that number before, I absolutely think 156 is high enough to shoot. But without data or someone to walk you through it the first time, I think you did the smart thing to not shoot. And I don't want to sound like a broken record, but this is also where your SS comes in handy.....you can see numbers you shot, numbers you didn't, and what happened. Our SSs are color coded and it really helps alot to see it that way. If you need help with the SS, just PM me and I'll help you get it going....it takes only a few minutes.

When you get your +24 (since it will be 24 hours since you last shot), if it is lower than any number you've shot before, please post it. I'll be watching for you. If it's higher, then go ahead and shoot the 1u as long as you will be monitoring her. Because a skipped shot can drain the shed, I think you will most likely see her trending upwards tonight.

I will tell you from experience that the first time your kitty's BG starts dropping, and sometimes they drop fast, it will be scary. You will want someone to help you through it and we do it all the time. So it's good to have a solid supply of test strips, HC food, karo, etc. The reason why we try to teach you slowly is so you can learn how Heidi reacts to food. Some cats are very carb sensitive and if you feed two tsps of LC food, they come right up. Others might need HC or karo...we just don't know....every cat is different (ECID) and you will hear that over and over. This is not 2+2=4. (Oh I wish it were). So we don't want Heidi to get into a situation where the first time she gets really low is the first time you find out what she responds to.

And while there are a lot of really great and helpful people on Health, the traffic in LL is steadier and there is almost always someone around 24/7 in case you wake up in the middle of the night, test her, and she's low.

Can any of us guarantee that any cat won't go low and hypo on a dose? No we cannot. But we are first and foremost about safety here. That is why dose increases are done very slowly in very small amounts and we let the dose settle before we decide if another increase is warrented.

Are you on the West Coast? I am in AZ on PDT and I'll be up until midnight but I can always stay up later to help someone if need be.
 
Bob, thanks for letting me know about the human meter vs animal glucometer.

Thank you so much, Marje. I signed up for Google so I can get a spreadsheet--I think I will work on it tomorrow--I have the data to fill in some spaces, anyway. I may have to PM you but it won't be until tomorrow. I go to sleep early! :oops: I'm on the West Coast, too--in California.

I gave Heidi 1 unit of insulin tonight, at 8 p.m. based on her bg reading a few minutes before. It was 233, so it was 2 points less than the reading at 4 p.m. today.

I've ordered more test strips from the vet and they should be here Tuesday; I better get some Ketostix and it sounds as if I need to get some high carb canned food, just in case she is a cat who needs high carb food if she should go hypo (?). I have honey and maple syrup, I hope those would be as good as karo, but I can get some of that, too. Have you had a kitty go hypoglycemic? I wonder, once you give them the syrup, do they sort of bounce back? There's so much to read and absorb here, and it's hard when I still feel kind of emotional from the diagnosis. Little by little it is sinking in.

Maybe I should go on over to LL, just in case. I'm not worried about tonight, for some reason--but if anything should happen I'll go over there. Tomorrow Heidi gets her prednisone and I think that may affect her bg readings. Poor thing, I wonder if she feels a little rocky--after all, "kicking" prednisone after 7 years, even though a small dose, requires some adjustments--her adrenals may be going through changes along with her body fighting the diabetes. I hope it isn't too hard--if only they could tell us. Seems like the insulin getting the diabetes under control can only be a good thing.

Thanks again.
Corinne
 
Remember there can be a 20% variance in meter readings so her earlier number and her 233 are the same number. I strongly suggest you get a +2 test on her. If it's much higher than her PS, then you can just get a before bed test. If it's the same as her PS, I'd set an alarm and get up and test her at +4. If it is lower than her PS, I'd check her at +3 and see if she's dropped. A +2 that is lower than the PS can be a signal of an active cycle where they might drop early.

Cats react differently at different numbers; some cats may be symptomatic at 30 or 40 while others may drop lower and not be symptomatic. My point here is the best and safest thing is to keep them from going that low in the first place. Lower is not better when it comes to normal numbers. That is why testing is your friend and keeps you in control. Will they all pop right up with karo? It depends on how long they have been low and how low they got. I'm not trying to scare you but we take it seriously here; we pay attention to numbers, we manage the curve with food and karo when we need to; we advise you to be cautious about sleeping for the night or leaving if your cat is low or dropping.

If they get in the 30s and give you karo, in a perfect scenario, she will come up but the problem with karo or honey is that it wears off quickly and the numbers can come back down on you. Food usually helps keep the numbers up better once you have them out of the low numbers.

Another mantra "know thy cat". The more data you are able to collect on her numbers at different times and in response to foods, the more knowledge you have.

BTW, we don't necessarily suggest you do curves every two hours once she has been on this dose a bit. We prefer spot checks. We can help you with that.
 
Welcome to FDMB, Corinne. I'm one of the people who spends most of her time on the Lantus board and Marje asked if I'd stop by.

You've gotten some great guidance already. Feeling overwhelmed at this point in the learning process is understandable and absolutely expected. However, just like you found that after a few days, testing became much easier, I suspect you'll get into a rhythm and dealing with Heidi's diabetes will also become much more routine. There really are a lot of people here who can offer information, guidance, and support. We've all been in your shoes.

When you're reading the information on the Tight Regulation Protocol (or the SLGS approach) please remember that the numbers you're looking at refer to a human glucometer. Like Marje noted, most of us use a human meter because the strips are SO much less expensive and more readily available than AlphaTrack strips. You will need to add 30 points to the numbers in the protocols. In other words, when we note that when a cat's numbers drop below 50 in order to reduce the dose, with an AT meter, the dose reduction number is 80.

It is very helpful to get a curve although getting a curve is by no means mandatory. If you can test either every 2 or 3 hours over a 12-hour period, it will give you an idea of when Heidi starts to respond to the effect of an insulin dose (i.e., Lantus onset) and when she reaches the lowest point (i.e., the nadir or peak) in her cycle. A curve will also give you an idea of the kind of duration you're getting from a shot. These are key points to look for. While BJ has noted that nadir is somewhere between +5 and +7, that is not necessarily the case. For example, my cat's typical nadir is around +4. And just to make life even more complicated, the nadir can change. This is why spot checks in the cycle can be important.

The bottom line is that you definitely need to get tests before you give a shot. The pre-shot tests are the only way you know whether it's safe to give a shot. You did exactly the right thing today by skipping. You did not have enough data to shoot. It's also important to get at least one test during the course of each cycle. This will let you know if Heidi's numbers are dropping and if you need to use food to steer her blood glucose levels. I know this sounds impossibly complicated. It's a nail biter the first time you encounter dropping numbers. After a few times it becomes second nature. I promise!

I also agree with Marje on two other points. A spreadsheet will help you enormously when it comes to keeping track of Heidi's progress. It will also allow us to help you to understand how she's responding and learn how to "read" her progress.

Marje's other point about Heidi's dose is on target, as well. We do not recommend reducing the dose when you skip a shot unless the pre-shot number is in the 40s. While you don't yet have the data to have shot tonight, it doesn't mean that it was an "unshootable" number. I would encourage you to hold the current dose.

Please let us know how we can help.
 
Hi Corinne,

heidismom said:
Marjorie, would you have considered 156 high enough to shoot? Possibly I was overreacting...but I thought she had been acting weird the night before and was suspicious that something was going wrong, like hypoglycemia.
Click to expand...
You know Heidi better than anyone. If you think she was acting weird...she may have very well been "too low". There's no way to tell without the data on the spreadsheet...so it's good that you're working on that. It concerns me that within a week on insulin, Heidi is giving you a 156 pre-shot on an AT meter. It's not that far of a stretch to think she could have hit 80 (AT meter) at nadir (lowest point of cycle), which would have earned a dose reduction in Lantus TR.

You already shot the 1u...which should be okay...since the depot, or "shed", has depleted some with the skipped dose. Are you able to wake-up a couple of times during the night to get some BG tests in? That would be ideal. If you feel she is going too low, you should post right away in Health, Lantus TR, or both.

I've only used Karo...but I believe honey or maple syrup will also do the trick. If for some reason she refuses to eat, or lick it, you will need to rub it on her gums.

Have a nice uneventful night!

Deb
 
Hi everyone and thank you so much for all your help.

I'm going to try to do a curve today and start my spreadsheet. Marje, I may PM you.

Time for her PS test and first insulin are coming up so I hope I don't sound brief here.

I will get back to you. I still have so many questions. Just wanted to let you know everything went fine during the night. Thanks again!

Corinne
 
Hi, I tested Heidi's bg @ 8 a.m. and it's 169 . So this is basically the same quandary I was in yesterday. The vet I talked to and emailed yesterday said to only give .5 units if her bg is under 200. So far I haven't given Heidi a shot this morning. I did hear from her regular vet but he isn't quite up to speed, since I didn't hear from him yesterday I didn't email him the readings from afternoon and evening yesterday, which were 235 and 233. He was judging by what I said about thinking her behavior was a little weird on Friday night, and the low reading of 156 PS on Saturday morning. He said don't give her anything if her bg is less than 200. confused_cat

I feel as if .5 units might be appropriate, but I just don't know. Would she need something just to keep the "shed" filled?

Corinne
 
Corinne

Sorry...I am just seeing this. You probably would have gotten a quicker response in the Lantus TR ISG...lots of folks signed on there this morning but we would really like that SS up and running.

So...three options when faced with a low number

1. Stall...do not feed...test every 20 minutes and as soon as she starts to rise, shoot the 1u. If we stall, we do not usually shoot a reduced dose because stalling acts as a dose reduction. Stalling works if you are able to be off schedule and slowly work your way back on schedule.

2. Shoot a reduced dose on time

3. Skip

With options 1 and 2, you still must be vigilant in testing because of the shed. Her shed is still relatively full and may affect several subsequent cycles so be sure you get a +1 and +2 test to make sure where she is headed especially since we do. It know if you are shooting a dropping number.

Questions?
 
Thanks, Marje.
It's now one hour past shoot time. I wish I'd given a reduced dose right on time but I just didn't know what to do. I'll test her again and see what is happening. Could I give a reduced dose if she seems to be about at the same number?

I know I need to get the SS going. Will work on that.

I better get over to the Lantus site, too. Just went over to Lantus....people seem to post subjects with only the readings there, is that the way to do it? Like "Heidi AMPS169" ?

Corinne
 
Since stalling acts as a reduction we don't usually stall and reduce the dose.

Did you feed her and how long ago? You want to be careful about shooting a food spike....thus when we stall, we don't feed.

I'll wait here until you get a test so I can help you decide what to do.

Yes...in the Lantus TR ISG we do one thread (condo) per cat per day. And yes, you put the date, kitty name, and tests. If you have questions, click on the "?" button above the text box and you can also add it in your subject line.

When you go over, if you could please link this thread in the one you open there. Just copy the browser address from this thread, open a new topic in LL, put your cursor in the text box, click on the URL button above the text box, and paste the link in between the two boxes that are entered into the text box. It will look like this: your link here.

Tht gives everyone history without you having to retype it all. Standing by. :-D
 
Marje,
It's only 9:30 a.m. and I am stressed out. I tried to get Heidi for a +1 test but she is hiding in the closet with her claws hooked into the carpet and crying piteously...she doesn't want all these tests...She is a free-feeder, probably last ate after her test at 8 a.m.
I don't think we'll be able to do the TR Lantus, I really don't. She's already been showing signs of stress like pooping outside the box--she has done this in the past when there have been big changes, etc. And of course she's been going through a lot lately. I tried to PM you but just getting frustrated at that.

Honestly I don't know what to do. I feel that .5 unit would be appropriate but who knows........

Corinne
 
Corinne

Breathe..deep and slow. :-D all of us and our cats go through this initial stress. We can help you learn how to test her to keep the stress down. They adjust! FD friendly treats help.

Ok..you can't shoot her without a test. That is the priority. Remember the +1 is the test you take one hour AFTER you shoot so right now we just need her preshot test. Just focus on that...do not worry right now about protocol.

You need to be calm or she will sense it and she won't be calm. Talk to her sing to her, gently rub her ears. Warm them gently. If you have any freeze dried chicken or beef treats or bonito flakes..give her one when you are done. Calm is what we need. It's ok.
 
Okay.
So since she didn't have any insulin this a.m., this next test is also a PS test? That makes sense.

Thanks, Marje.

Corinne
 
You aren't going to test and shoot? I order for her to get better, you want to shoot as often as safely possible. By not shooting, you are putting her on a roller coaster.

Can you try again to test her and see where she is? Then let me know ok?
 
Marje, that's what I have been feeling--if i don't shoot, she's on a roller coaster....Okay, I'll see if I can dig her out of the closet and test again.
I finally figured out the PM, and sent you one.
I also transferred Heidi's history from Health over to Relaxed Lantus.

Corinne
 
Ok. I'm still here. Let me know when you get a number.

Also, if you can get some Neosporin ointment with pain relief ...not cream...and puta dab on her ears after each test, that will help. Be sure you are poking the outer edge and not the vein. Their ears do get less sensitive and they learn to bleed more. I barely have to touch the lancet to Gracie's ears and she bleeds. She also sleeps and purrs through tests so they do adjust.
 
I got a result, it was 190 at 10:05 a.m. So that's up from 169 at 8 a.m.

I thought I had posted this but don't know where my post went !?? Maybe I put it at the wrong site. or topic.
!
 
So you are two hours late but you can shoot early 15 mins each cycle until you make it up or 30 mins once a day starting tomorrow morning. If you can do that and be able to give her shot 12 hours from now and you can test her today with a +1 and +2, then I would shoot and try to feed her some LC food.

Remember that you will shoot tonight at 9:45 and tomorrow morning at 9:30 if you are doing 15 min makeups or at 10 tonight and 9:30 tomorrow morning if you sre doing 30 min makeups. Let me know which and I'll give you a shooting schedule.
 
That is my suggestion since you have stalled two hours BUT you hold the syringe so it is your decision on what you want to shoot. Again, remember if you shoot .5u, her cycle will be pretty much the same as shooting 1u due to shed. You would see the effect, if any, in subsequent cycles.
 
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