Need advise on when to skip dose

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Susan&Alex

Member Since 2012
Alex: Novalin N; ignoring vet's advice of 6U and shooting based on home numbers (ranging from 2.5U to 5.5U).

Last night: >500...he did not want to eat...gave 5.5U 1 hour early. He ate the smaller quantity of food I left out prior to 3:00.

This morning: 123 at +11. Very active and hungry; fed 1 hour instead of 1/2 hour pre-insulin since the number is so low. 137 at +12, no insulin given. 167 at +13, no insulin given. Looks like I'm going to have to skip AM and use this opportunity to change his shot time to give better leeway.

Yesterday AM, he spiked from 155 to 497 after eating. Today AM, he went from 123 to 137 to 167 after eating. Is it normal to see this kind of fluctuation?

I will check him at +13 to see if he's over 200. I need to leave for work...what do most people do in this situation...skip the dose? I have shot 2 hours late in the PM, but I can't AM weekdays.
 
I'm very new to this and we use lantus, but we had a hypo this week when I shot under 200. I don't anticipate doing that again any time soon because I don't have enough data to know how George will react and I spend a lot of time away from home. I think its a matter of knowing your cat, and I'm not there yet so for now I need to play it safe.
 
to be honest, with N, yes, big fluctuations are normal. they are not good, but they are fairly common with N. also, throw in the varying doses and that makes the roller coaster even bigger.

i haven't seen any of your prior posts but has anyone asked as to why the doses are that high and/or varying? just want to make sure that was covered because the doses you mention are pretty high already for a newly diagnosed kitty, if yours is newly diagnosed that is.

personally i would never shoot N on a 100something number of any kind if i were going to be leaving the house so i would skip at this point myself.
 
Yes, he's a newly diagnosed cat (almost 4 weeks ago). In that time, the vet has changed the dosage from 3U to 6U. Monitored at the vet's office initially for 4 and then 5 days, they had him on 3U and then 3.5U. The vet keeps upping it based on his weekly tests...now he recommends 6U. Based on what was going on, my goal was to give 3.5U consistently..but that has not worked out due the big highs and lows.

I know N is not good; Lantus is much better. I do have concerns about Lantus because of the really low numbers (<100) I've seen on charts though.

Diabetic people shoot based on a number (variably). Is the same not good for a cat? I'm changing vets soon, BTW.
 
This is such a steep learning curve at first and so overwhelming. You are certainly trying to figure this out as fast as possible. It is harder because very few people have recent (or any) experience with N.

I know you have heard that N usually gives the wild fluctuations you are seeing. Regarding a change to Lantus, we have two types of dosing methods on the site. One is Start Low and Go Slow. It would mean you would start with a lower dose of Lantus, get at home numbers midcycle and increase slowly. The other is tight regulation, when people do shoot at lower numbers, BUT ONLY when they have lots of previous data to guide them. If you want to start low and go slow, you could stay with the general rule of not shooting under 200.

The dose increases are worrisome. We think that cats are often stressed at the vet and stress raises bg levels. So we think using the numbers at home is much safer and more accurate to guide dosing changes.

IMHO, and I have never used N, I would lower the dose. Anytime you are getting a number that is too low to shoot at +12, it indicates the dose is too high. When you shoot in the am and then skip in the pm, you are likely to have this roller coaster of a higher number in the am. (because the cat has been 24 hours without insulin) and then, an unshootable number in the pm.

If I were you, I would reduce the dose, monitor carefully for bg levels and ketones and get to a Lantus friendly vet ASAP.
 
With some insulins, it is possible to vary dose based on numbers at test time, but not easy to figure out what to shoot on what number. I did that with PZI with Bob. I don't have any experience with Novilin. The only way to know what a dose does is to test a few times after a dose to monitor the drops and rises in BG level. It can become pretty labor intensive if you want to do it safely.
Don't let the <100 numbers you see on spreadsheets scare you. Those a perfectly safe numbers until you start dipping below 40. The goal is to have the numbers in the normal range for as many hours a day as possible safely. That 's a big advantage with an insulin like lantus - the numbers eventually remain flatter for extended periods because the insulin is designed to do that. It remains effective for a longer period over the course of the day and night than Novilin, Humulin and other shorter duration insulins.
Carl
 
With the wide swings that are possible with N type insulins , because of how hard it hits and how fast it wears off, the only safe way is to be monitoring at the nadir, to make sure the dose doesn't take the cat too low. You can't keep raising it based on pre-shot numbers alone.

That means testing around +3 to +4 hours after the shots to see how low he is going. If you're not able to do that, do not raise the dose or he'll likely wind up hypo on you, as did Yankee and lCrawford
 
What you guys are saying makes a lot of sense. The vet makes no sense. He's determining the increase on a weekly number at +5.

Since starting my consistent pre-shot monitoring on Sunday, I can tell he feels good for the first time since he became diabetic...except for him going too high last nigt and not wanting to eat. I left him at 9 am this morning at 167 with no insulin, so I hope he fares well today.

What I've been reading about Lantus looks very promising, but somewhat scary. I'm getting the nack of testing now, even when he's low and gets fiesty. We'll both be ready for the switch over.
 
Susan&Alex said:
What you guys are saying makes a lot of sense. The vet makes no sense. He's determining the increase on a weekly number at +5.

Since starting my consistent pre-shot monitoring on Sunday, I can tell he feels good for the first time since he became diabetic...except for him going too high last nigt and not wanting to eat. I left him at 9 am this morning at 167 with no insulin, so I hope he fares well today.

What I've been reading about Lantus looks very promising, but somewhat scary. I'm getting the nack of testing now, even when he's low and gets fiesty. We'll both be ready for the switch over.
Click to expand...

The use of N is much more scary to me because when it kicks in, your cat is jumping off a cliff with the numbers dropping fast and low, but with Lantus, it's a much less extreme drop, a more mellow curve.
I think of N like a bungee jump, but Lantus is like a swing.
 
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