need help with dosage

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terri1962

terri1962

Member Since 2011
My cat Lilly is on 1 and half units of Lantus per the vet. They told me not to check her BG levels they will do it and they will not show me how. The most I have figured out is what I have learned here from people. I have a meter a Accu Check Avia and strips. I have been for the last two days trying to poke her ear(not having an easy time with that even though I have watched videos).
Last night her BG was 102 according to the meter I did not give a shot. This morning it was 218 at 8:00 I gave her 1 unit. As the vet would have it I would just be blind shooting insulin. Had I given her a shot last night it would probably not been a good situation with BG at 102 and 1 and 1/2 units.
Anyhow I think these vets do not have many diabetic cat as patients and possibly don`t know what they are doing. Today I took my mom`s dog in and told the vet about the readings I had gotten from the ear pokes and he said we have been getting strange readings from the ears so we are poking elsewhere when we test. Is this correct? Don`t most people here earpoke?
I need to know in detail if someone can explain do you adjust Lantus according to BG levels and if so how, please explain to me like I am a third grader. I am getting no help from the vet at all with this.
Thank god someone was on this board for help last night for me ask whether to give the shot or not, otherwise I had no idea what to do.
 
Hi Terri (I think that's your name from your id, please correct if not),
Welcome to LantusLand! You have come to the right place to get advice on treating your kitty. We are fairly new and have gotten a ton of good advice. There is sure a lot to learn but we have read and re-read things to understand and the other beans have been more than generous in helping us out.

Good for you for home testing! It is difficult at first but it does get easier. We do ear pokes and that seems to the best place for Zener. Unfortunately, one ear is very difficult to poke so the other one gets double duty.

There is a dosing protocol for Lantus where you keep the dose very consistent and only change after 3 days at a minimum, based on the guidelines. The best place to get information is the stickies at the top of the message board. The dosing experts will also visit your condo (your daily message) and answer your questions. You have to flag the message with "question" or "help".

Liz, Zener's other bean, as in human bean :lol:
 
Hello and Welcome!

Glad you found us, you have come to the rght place.
Lot's to learn , however plenty of folks to help out. A good place to start is the "New to the Group"' sticky:
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

Good for you for deciding to home test - It's the foundation for properly treating your kitty. It will get easier and yes, most of us poke the ear.

Most vets unfortunately don't' have much experience with feline diabetes. Here in Lantus Land we live and breath it!
 
Welcome, Terri & Lilly!!

you have found the right place for help.

the folks here are very experienced, extremely willing to share their knowledge, and unbelievably supportive.
We found this board at 3am when my guy was desperately ill, and i can honestly tell you he would not be with me today
without the help of the kind souls here.

Glad to see you here...

Celi & Binks
 
(((((terri)))))) you found us! wahoo!

lantus needs consistent dosing - so if you shot 1 unit this morning, shoot the same again tonight, 12 hours after this morning, unless lilly drops too low (less than 50) during the day today. good choice to drop it this morning, i think, and to skip last night.

here's the information on dosing: Tight Regulation Protocol
"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.
Click to expand...

instead of trying to figure out dosing on your own - and it's complex to learn, that's why you're feeling like a 3rd grader about it - what you can do is post here everytime you think you might need to change a dose. if you post daily, use the format we've all got going in the subject lines. that lets everyone see at a glance who might need help. for example, if you're posting numbers too low, someone will take a look at your spreadsheet and might suggest what you should do. if you are posting numbers that are too high, same thing. there are times when numbers can be high for other reasons besides the kitty needing more insulin - people who are experienced can teach you what that looks like when it happens.

for the next several days (10-14 cycles as above) you want to hold the same dose and be as consistent on timing and measuring as possible. make sure and read that "new to the group?" sticky that sandy gave you the link for. it's full of good information for you.

and then just ask, ask, and ask when you have questions. that's what we've all done and that's how we all learn.

you need to get a spreadsheet going. the patterns on the spreadsheet tell us a ton about how lilly's responding to the insulin. soon you'll learn to "read" it too. here are the directions.

*** Spreadsheets ***
http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0
How to Create Your Own Spreadsheet and Publish It in Your Signature
Please note: There are two spreadsheet templates, one for members in the USA and a World Insulin Template for members who do not reside in the USA. Complete instructions can be found in the link above.

Please set up a Google Spreadsheet as soon as possible. Always keep spreadsheets up-to-date! Valuable time may be lost looking for information when a spreadsheet is not up to the minute.
Click to expand...

as far as the testing goes - there are a couple of people who test on feet pads, most people test ears. the information from ears or feet is fine. your vet office just sounds like they have no experience with home testing. i don't want to say "so ignore them" but perhaps instead it would be nicer if i said "people here have tons of experience with feline diabetes and home testing, so get your advice on it here instead."

welcome to Lantus Land. it's a nice neighborhood. :-D
 
I just wanted to echo the welcome! Smokey and I have only been here for a few weeks but it has been wonderful! Testing the ears will get much easier- the more you poke, the more they will bleed- Smokey waits for it now, because he knows that he get's a freezedried shrimp treat afterwards and they are his favorite! I know it seems overwhelming- there was much crying and gnashing of teeth in my apt when Smokey was diagnosed... but it gets better and easier!

People are glad to help both you and your kitty- so Welcome, take a deep breath and dive in! :smile:
 
Hi Terri....you are definitely in the right place! I just wanted to Welcome you.....you have gotten tons of great info, so, I won't repeat it. I will say, our first vet discouraged home testing and shooting blindly.....his reasoning was that it "hurt" the cat.....all I can say to that is phooey! Zoe runs to her testing spot now and purrs through the whole process.........I will say we both had to learn about home testing, she didn't like it and I kept hearing the vet tell me how much it hurt her.......but I kept at it and Zoe learned to associate ear pokes with treats and grew to accept it......it will get easier, just keep at it. :mrgreen:
 
Thanks everyone for all the good info. I am so tired over all this guessing. I am not going to try to do a spreadsheet as of yet. I am just writing down her numbers in binder with the date, time, BG and units given. How many times a day do you guys test? She is not going to tolerate me testing her probably more than two or three times as she is very scared and skittish. I am pushing it at twice right now. I am really suprised she is tolerating this at all.
I think I know what happened. She was at the vet for two weeks and they insisted on feeding her Purina DM mixed with Fancy Feast trying to switch her to the DM. I told them she will not eat the DM when she comes home but they did not listen. Quite possible the stress of being at the vet and the DM might have pushed her BG higher resulting in them dosing her at 1 and 1/2 units twice daily.
Well she came home stress went down and she went back to eating fancy feast and BG might have dropped resulting in lower readings. Not sure about this, opinions would be appreciated.
 
I just wanted to add my Welcome, too! You've gotten hit with a ton of info, and the learning curve for FD is a bit steep - but with this fabulous group for support, you will never be alone!

I know what you're going through is overwhelming, but I did want to suggest trying to get your spreadsheet up and running sooner rather than later. All the folks who are more experienced with dosing will need to see Lilly's trends in order to give you advice and guidance. We're a very data-driven group, and since Lantus dosing is based on that data, it really helps when everyone can see where Lilly's numbers are.

The pokies really do get easier - I promise they do! (I know, I didn't believe it at first, either!!!) It sounds like you are really on the right track, with testing her and with removing that yucky DM. And yes, no doubt her BG was elevated while at the vet due to both the food and the stress of being there. Good for you, for being aware of these factors!!

Keep asking questions - everyone is here to help!

Amy
 
Welcome Terri!

A couple of thoughts...

If you think your vet is clueless about feline diabetes, there are members on the Board who are from Columbus. BJ (BJM) who was posting in your thread on Health yesterday is from Columbus. You could always ask him what vet he uses.

As for how often to test, the basic rule is 4 times a day is the minimum. You need to test before giving insulin and you need at least one test during each cycle. Lantus dosing is based on the lowest point in the cycle (the nadir) so tests during each cycle are important. The text below is from the Tight Regulation Protocol sticky:
WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.

It will be necessary to test kitty's blood glucose levels multiple times per day.

Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.

Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).

Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.

Feed a high quality low carb canned or raw food diet.

Feed small meals throughout the day. Some kitties adapt well to free feeding.
Click to expand...

You'll note that we suggest a mini-curve (testing every 3 hours) when you're starting Lantus. While keeping track of your tests in a notebook is a great first step, you may ultimately find it easier to set up a spreadsheet. It will be much easier for us to help you if you have all of Lily's test data in a place where we can look at it, along with you.

Many cats are skittish in the beginning and many of their caregivers are nervous about testing, as well. What will help is if you act confident and at ease, even if you aren't. If you're nervous about poking, Lily will pick up on your anxiety. Also, no matter whether it's a successful test or not, Lily gets a treat. The more she associates testing with treats, the easier testing will become. People here will tell you all about how their cats go running to their test spot, purr, etc. It will get easier. The majority of us do ear pokes. As for your vet suggesting you not test, there is published research along with the recommendations by the American Animal Hospital Association that support home testing. (Your vet needs to get with the program!)

Why was Lily at the vets for such a long period? Was she sick? Are there any medical issues, especially ketones (or diabetic ketoacidosis), that we need to know about?

While canned DM is not horrible with regard to carbs, Fancy Feast is definitely lower, though. It's possible that Lily's numbers are coming down as a result of lower carb food. Generally, we like to suggest a dose that allows you to give insulin twice a day. However, I'm reticent to make any suggestions about dose without medical information and more test data.
 
Testing is recommended before each shot (obviously)....you want to be sure she is at a safe number before you shoot and then a spot check or 2 during the day and before bed. A curve can be done every so often to see exactly what the insulin does during her cycle (the 12 hours between shots). Lantus dose is based on nadir (low point of the cycle) and not so much on pre-shot readings.

I know.....you are thinking "There is NO WAY this kitty will ever let me test her that much" - believe me, I thought that too. Make it a positive experience....treats after (whether you are successful or not), extra cuddles and kisses ...whatever she likes. Zoe doesn't even want the treat anymore...she would rather sit on the table for extra one-on-one time. Try not to let your stress over testing her show ....she will pick up on your anxiety and become anxious herself. Don't forget to give yourself a treat after each test, too!

With Lantus, we usually "start low and go slow"......so dosing would be 1 unit or less. I started Zoe on 0.5 units. Here are the general guidelines for Lantus.....

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.
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.
Click to expand...

Keep asking questions!
 
Hi Terri and Welcome!
You have received lots of good advice and I won't add to it. I just want to say that being here with all the support you will find here is the best thing that could happen to your kitty and you.

Try putting a little vaseline on the ear at the spot (near the edge of the ear) where you will poke. This helps the blood to bead up and makes it easier to get the blood drop on the test strip. If you are doing the ear poke free-hand, you might instead consider using a lancet device. They deliver a uniform and very quick poke. Blood flows down from the tip of the ear, so if you put a little pressure BELOW where you plan to poke (use the thumb and forefinger of the hand that is not doing the poke), it will act like a dam and help the blood drop to appear.

Ask as many questions as you need to, and start reading the "Stickies" at the top of the Lantus Forum. Don't worry about your vet right now. Taking good care of your diabetic kitty is something you can do. (But if your kitty has other health issues, please be sure that the folks here are aware of them. There are some things that only vets ought to do.)

Welcome, and don't be afraid to ask questions!

Ella & Rusty
 
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