Need help this a.m. re insulin amount

[Steph]

Stubbie is at 218 this morning 13 hours after his 3 IU of Lantus last night.

I was going to do a curve wit 3IU today, but that feels like too much insulin.

???????

 

[Larry and Kitties]

hard to tell since your spreadsheet has little data. Is there more data than the SS shows?

 

[Steph]

I don't have more data. Just getting started. He runs when I try to hold him. Working on that.

 

[Steph]

Also, I can open the spreadsheet this morning, but I can't enter any data. Not sure why.

Help?>

 

[LynnLee + Mousie]

Steph's only had Stubbie about a week so they're still getting to know each other and working out a routine.

if you're planning on being at home AND you think you'll be able to test him around +4 to +7, you could go ahead and shoot. you have high carb food and/or karo on hand right?

if you think you might have trouble getting him to cooperate for tests later or you don't have high carb food/karo or you'd prefer to play it safe, you could reduce the dose. it looks like he's settling in and coming down as he's getting to know your home so reducing some might not be a bad idea.

see what others think too

eta: as far as the spreadsheet, sometimes google docs signs me out on it's own. i just have to log back in and then i can edit my sheets. maybe it logged you out?

 

[KPassa]

if you're planning on being at home AND you think you'll be able to test him around +4 to +7, you could go ahead and shoot. you have high carb food and/or karo on hand right?

I agree; he hasn't "earned" any decreases yet, so keeping him on 3u while you're planning on monitoring is a good idea.

For future reference on dose increases/decreases:

"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.
Try to go from 0.25u to 0.1u before stopping insulin completely.

 

[Steph]

Thanks for this! Soooo helpful.

Steph

 

[KPassa]

And since you also shot an hour later than normal, the late 3u is considered a "decrease." From the same link above:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.
A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.
Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

So, he should be able to handle the 3u today (since he's been able to handle it just fine up till now). If he's under 150-200 at his next shot time (PMPS), let us know because we might suggest a decrease for tonight's dose.

 

[Wendy&Tiggy(GA)]

maybe you need to login again? Refresh the page and see if it asks for a login?

Do you have to hold him? I wait till my Tiggy is half asleep and do it then. He doesnt move from his spot.

Wendy

 

[BJM]

While you work on home testing, take a look at my signature link Secondary Monitoring Tools, particularly urine testing for ketones and/or glucose. These show what has happened since the previous void. More than a trace of ketones is an emergency. Glucose in the urine indicates the renal threshold has been exceeded.

Once you are home testing, the following may be helpful:

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first (mg/dL). Numbers in parentheses are for non-US meters (mmol/L). Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.