Need help with insulin now that numbers are finally low!

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kagee75

kagee75

Member Since 2014
Hello everyone,

I'm relatively new to this board although I've gained quite a bit of knowledge just by reading all of your posts. Even though every kitty is different, I get so much information from you all that helps me when it comes to my Tooter. I think this website should be included for all newly diagnosed kitties! We've been riding the roller coaster for about 3 months now and have FINALLY gotten to some good numbers. We dropped some when we switched to Lantus and we dropped significantly when we switched to lower carb food. He's on canned m/d right now - no dry. I should tell you that he is also prone to crystals in his urine and has had two long stays at the vet for it, although the last was four years ago. He also has neuropathy in his back legs and I'm giving him weekly B12 shots for that. I've seen some small improvements and I'm sure it will continue to improve as his levels are regulated. My question is about dosage now that he's hitting lower numbers. I don't give him insulin when he's below or very near 100, but then when he hits higher numbers in the afternoon, I have to give him 3 to 3.5. That seems like I'm shooting myself in the foot though because I'm really causing him to rebound aren't I? If I need to give him the same units each time for best results, how do I manage that when he's so low particularly in the morning before I go to work? I'm out all day so I have to be careful about that morning dose. On weekends, I can test him all day if necessary. I've noticed that the insulin lasts about 10 hours in his system. That's when he's lowest.

It's funny. I was feeling pretty confident in what we were doing to get his numbers down when they were so incredibly high, but now I feel like I'm starting over again. Any advise you can give would be appreciated.

https://docs.google.com/spreadsheet/pub ... utput=html
 
I am so new in this forum, but all I can say is that everyone on here has said that Lantus needs to be given twice a day and in equal amounts. So if you are needing to give 3 or 3.5 units at night but none in the morning it seems it might be better splitting it and giving 1 or 1.5 am and pm?

Someone with more knowledge that me will jump in I am sure.

I agree with you re having this forum included with new diagnoses. I would be lost without it.

Juliet and Silver
 
Okay before I start I just want to say I've only been here a month and so can't really give dosing advice but as Juliet said lantus needs to be given twice a day and at the same dose. It likes consistency.

Looking at your spreadsheet the high dose in the evening means that you are too low to shoot in the morning. More worryingly with no additional blood tests past the preshot reading you don't know how far your cat is dropping through the night for her to end up that that low in the morning.

Personally I feel you need to drop the dose down a fair bit but I don't want to put a figure on it as I may be wrong. I hope others will pop on an give you more info. I know if is difficult but is there any way you can get more readings in the evenings?

Best wishes

Sarah
 
What has your vet advised? Usually that will give you a good starting point. Mine advised 1 unit morning only to start with and after reading this forum and finding out that its needed twice a day, I started giving one at night too. He is now on 2 and 2.

Just from observing your SS - it seems a lot of dose changing from day to day. My vet told me that it takes a week or two on one dose to know how its going to affect him - and Mel has talked about new dose wonkiness that messes them up a bit for a couple days after a dose change. Maybe try a consistent low dose for a few days and let his body settle. I think the start low, go slow mantra might help?
 
Thank you all for your input! The vet really hasn't said anything about the new doses, other than if he's in the normal range, don't give him any. He'd rather me skip a dose than give too much. The dosage jumping just started because I got spooked about giving him too much when he's low and the low-carb food made such a big difference so very fast. I may have panicked. :oops: I'm not sure why I didn't think of splitting up the 3 - 3.5 units - I think sometimes I get so focused, I lose my common sense. It seems that everyone has the same consensus to drop the dosage down and split it, so maybe 1-1.5 twice a day to start for a week or so and see what happens. It really is almost a starting over of sorts I guess. But after hitting a high of 704, I feel so much more hopeful for him now.

During the week I have a hard time getting evening tests because of work. I get one in the morning before he eats, the minute I get home in the evening before his dinner and then again at bedtime. Sometimes I can get a middle of the night one, but that's hard to do. On weekends, I can test him anytime. It's a vicious cycle: need to work to pay for the Lantus but don't want to work so I can stay home with my little buddy.

You know what I love most about this board? You all are teaching me without making me feel like an idiot. Thank you for that!
 
kagee75 said:
Thank you all for your input! The vet really hasn't said anything about the new doses, other than if he's in the normal range, don't give him any. He'd rather me skip a dose than give too much. The dosage jumping just started because I got spooked about giving him too much when he's low and the low-carb food made such a big difference so very fast. I may have panicked. :oops: I'm not sure why I didn't think of splitting up the 3 - 3.5 units - I think sometimes I get so focused, I lose my common sense. It seems that everyone has the same consensus to drop the dosage down and split it, so maybe 1-1.5 twice a day to start for a week or so and see what happens. It really is almost a starting over of sorts I guess. But after hitting a high of 704, I feel so much more hopeful for him now.

During the week I have a hard time getting evening tests because of work. I get one in the morning before he eats, the minute I get home in the evening before his dinner and then again at bedtime. Sometimes I can get a middle of the night one, but that's hard to do. On weekends, I can test him anytime. It's a vicious cycle: need to work to pay for the Lantus but don't want to work so I can stay home with my little buddy.

You know what I love most about this board? You all are teaching me without making me feel like an idiot. Thank you for that!
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Its the same with me - I can get more tests at the weekend but only preshot and a +2 in the evenings during the week. Make sure others jump in before you make a decision - try and message Mel?
Juliet
 
Hi Kagee and Tooter, and welcome to the group! :smile: cat_pet_icon

What a great improvement Tooter has made with the change to wet food only! :thumbup

I'm only a novice sugar kitty parent as well, but I've been reading the posts on this board for a few months now and there are some things I've read that may give you something to follow up on, although I can't help with insulin dosing specifics. I apologise in advance if I'm covering stuff you already know. :oops: As Sarah says above, in general Lantus works best with the same dose on a 12/12 dosing schedule. Lantus is a depot insulin so each dose overlaps the next. The objective is to get kitty onto a nice smooth curve over the whole day. As you've already observed, giving a large dose on one cycle may lower the numbers OK for that cycle but it will not give a safe PS number for the next cycle. The large dose may also drop kitty's numbers too fast or take kitty too low in the cycle resulting in bounces back to high numbers as a result of the liver dumping glucose into the bloodstream. (It can 'panic' when it sees either a low-ish number that it's not yet used to, or when a number is genuinely too low and the cat is at risk of hypoglycaemia).

The key thing with Lantus is that dose adjustments are based on the nadir value (lowest BG in the cycle) and not the PS value (although some of the dose adjustment rules in the TR protocol also factor in the pre-shot number as well). If you click on this link below, you can find a copy of the Roomp-Rand published TR protocol document under the PDF link "Management of Diabetic Cats". I found it helpful to print off a copy of the document because it contains a table with clear rules for dosing adjustments. I found that it helped me to get my head around what milestones to look for and what to do when Saoirse reached them. I also found it helpful to discuss the document with my vet.

Doses are adjusted in tiny increments typically 0.25 IU to keep kitty safer and to reduce any possible overreaction to too big a change in the amount of insulin in kitty's system. Once the Lantus dose is set it is then held for a number of cycles to allow the insulin depot to reach equilibrium and also to allow kitty's body to adjust. During the adjustment period - particularly with dose increases - some odd numbers may appear (known as NDW - New Dose Wonkiness). BG spot checks and curves help to determine kitty's nadir on the new dose and how effective the dose is overall. If the nadir is too high after the appropriate number of cycles, a dose increase is indicated. Too low, and a dose reduction is required. A special case is where the nadir goes to too low a number within the cycle in which case an immediate dose reduction is earned. Depending on what protocol you are following, the amount of time a dose is held may vary. Start Low Go Slow (SLGS) protocol followers generally hold doses longer than TR protocol followers, but TR requires more testing in order to keep kitties safe.

When you get to a good BID dose, you should end up with both AM and PM PS numbers that are above the no-shoot number. Initially the numbers may be higher than desirable but the idea is to get a fairly smooth range each day and then tweak the dose to lower the numbers. As kitty's pancreas starts to recover, it can start producing more insulin thus moving kitty closer to possible remission. Also, as you gather more data about how Tooter responds to insulin you will eventually be able to give insulin at lower numbers to improve his regulation. It does take time and patience. I'd suggest having a look at Remi's spreadsheet (link in Sarah's signature). Remi has responded really well and it's really easy to see how with gradual dose adjustments Remi's numbers gradually moved out of the reds and pinks through the yellows into lovely blues and greens. It really is a great real-world example of how Lantus treatment can work.

It's great that you've got your spreadsheet up and running. :thumbup I just had a quick look and I like to read the comments as well as looking at the numbers. I noticed that during the week you do a 7am/7pm dosing schedule but at weekends you do 8am/8pm. The change in schedules will affect how the Lantus works. In particular, if you dose at 8pm on Sunday night and then 7am on a Monday morning it can act like a dose increase. Would it be possible for you to stick to the 7am/7pm schedule at the weekends as well? It would help with the consistency of action of the Lantus, and hopefully give you better - and safer - numbers. If you need to alter dose times, from what I've read here it is recommended that you not move the schedule time more than 30 minutes on one dose in a given 24-hour period, or by more than 15 minutes on both doses within a 24-hour period. I hope that makes sense. :?

What glucometer are you using? Human or pet-calibrated? When you get a chance, it's really helpful to add Tooter's insulin, food, meter type and spreadsheet link to your signature. (Go to User Control Panel then click on the Profile tab and you'll see the Edit Signature option.) That way, anyone reading your posts will be able to tell at a glance what Tooter's set-up is. It's also helpful to add info about any other health issues and any medications that Tooter may be taking for them.

Hopefully a more experienced member will chime in and help you with determining a dose that will be safe to give Tooter on a 12/12 schedule and help him get more consistent numbers.

I really feel for you having to go out to work when Tooter's on insulin. I'm at home all the time (health issues) but I was always petrified of going to sleep until I knew for a fact that Saoirse had passed her nadir and my own health got worse. This process isn't easy, but seeing our little ones feeling better a little bit at a time makes every last bit of the stress and worry beyond worthwhile. :YMHUG: (Sorry for the long post. I fear I have a terminal case of verbal diarrhoea. :oops: )
 
Thank you Phlika for the link - I printed it out for future use. I have a pantry shelf just for Tooter stuff and I keep all my need-to-know things in one place.

And thank you Aine for all of the information. There's no such thing as too much in this instance! All of the things you said are things that my vet has said in various visits, but somehow you made it more understandable. I love my vet, but he speaks like a doctor. I don't think we need the TR protocol but there was a lot of good information in that link and I'm printing it as well. What is the ultimate goal for the nadir? Is the ideal that it will be in the normal range and the insulin will be regulated to keep the other numbers in close proximity?

When you get to a good BID dose, you should end up with both AM and PM PS numbers that are above the no-shoot number. Initially the numbers may be higher than desirable but the idea is to get a fairly smooth range each day and then tweak the dose to lower the numbers. As kitty's pancreas starts to recover, it can start producing more insulin thus moving kitty closer to possible remission. Also, as you gather more data about how Tooter responds to insulin you will eventually be able to give insulin at lower numbers to improve his regulation.
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And these sentences caused the light bulb to go off! AHA! ohmygod_smile In answer to your question, I use the AlphaTrak calibrated for kitties. So far, I've been really happy with it and it matches my vet within about 10%. I added Tooter's information in my signature as well as his picture in my avatar. He was resting in the tent that I made him. With his neuropathy, he can't get in a lot of his favorite places so we had to compromise. Thanks again for your help!
 
Welcome to the group Tooter's and your personal slave (What do we call you?)

I haven't had a chance to look at his spreadsheet,yet, but will here shortly.

Just wanted to run over the basics of Lantus first. As others have said it likes consistency, the same dose given every 12 hours. (Don't look at my girl's SS she's an odd cat..lol)

If he's too low to shoot in the mornings when you need to shoot but high in the middle of the day when you do shoot, you have in effect set your shooting schedule up for the middle of the day. Now if you want to get back to shooting in the mornings and then again in the evenings you have to do two things. First is skip a dose and just let him ride higher for that day, then the next morning when you want your shot schedule to be, shoot a reduced dose. Since it looks like just from your post that is when you normally give 3.5u break that into 1.75 am and 1.75 pm that should give you a shootable number at both am and pm shot times. That dose you are going to want to hold for 3-5 days to let him settle in on it. After 5 days of getting the same dose at the same time, when you have a day off if you can run a curve where you test every 2 hours or a mini curve testing every 3 hours, while not as good as getting multiple spot checks every day, it can complete the picture and let you know if his dose needs to go up or down.

Mel and The Fur Gang
 
kagee75 said:
What is the ultimate goal for the nadir? Is the ideal that it will be in the normal range and the insulin will be regulated to keep the other numbers in close proximity?
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The primary consideration is to to always keep all of kitty's numbers above the hypo threshold. FDMB puts this at 50 on a human meter but the hypo threshold value will be higher on the Alphatrak. I have seen the number 68 as measured on Alphatrak quoted on this forum as the hypo threshold but I would strongly advise you get confirmation of the hypo threshold on Alphatrak from your vet and more experienced members here. For me, I don't feel comfortable if Saoirse goes below 80 on her Alphatrak meter.

When moving kitty towards a regulated state, the first goal is to get all of kitty's numbers below the renal threshold (the level at which blood glucose is so high it spills into kitty's urine). The renal threshold is at about 250 but it varies from cat to cat. It is a good idea to regularly test for glucose and ketones in the urine until kitty becomes better regulated. (A lot of members recommend Ketodiastix for this.)

If your aim is to try for remission (keeping kitty diet-controlled and off insulin) then you need to keep kitty's numbers "tightly regulated" within the range that will give the pancreas the opportunity to heal and start producing insulin again. For that, FDMB recommends following the Tight Regulation Protocol for kittys on Lantus and Levemir insulins. An alternative is the Start Low, Go Slow protocol. The Roomp-Rand scientific study supports the position that following the TR protocol gives recently diagnosed kitties the best chance of achieving remission. The goal for people following TR is to keep kitty in normal blood sugar numbers, 50-120 on human glucometers. (I think that's approximately 70-150 on an Alphatrak but again I strongly advise getting confirmation of this from your vet or from more experienced FDMB members.) As I mentioned above, it does require more testing to keep kitty safe.
 
Thanks Mel! I appreciate your insight now and anytime you want to throw some my way. You could call me "Tooter Mom" but that brings to mind something else less flattering so let's go with Kim. :lol: Tooter's name actually came about because when he was a kitten, I followed him around constantly saying "Quit it, you little toot" or "Get out of there, you little toot" and it just stuck even after he grew into a pretty mellow, albeit slightly crabby old boy.

I think getting him on a reduced dosage for a week or so is our plan now and I've printed out several pages to help me along thanks to everyone here. I can start it in the morning and by the weekend, I'll be able to run a good curve and see where were are. I just have to remember to breathe. That's hard when it comes to the kids!
 
LOL Oh don't I know it....I feel like I run a daycare where the kids never go home. Just all of them have 4 feet and fur. There are 16 cats, 127 lb drooler and a husband here..lol God no wonder I'm always tired. :lol: :lol:

Mel and The Fur Gang
 
Thanks Aine! I called my pharmacy and they have the keto-diastix so I'll do that too. Tooter can't get in a normal litter box right now because of the neuropathy so we're using puppy pee pads on the guest bathroom floor which is very close to where he likes to sleep. You do whatever works! And they do work wonderfully but at least once a day, he misses so getting a sample won't be difficult. I swear if my hands aren't dipped in urine and blood at least three times a day, something is wrong. ;-)
 
kagee75 said:
I swear if my hands aren't dipped in urine and blood at least three times a day, something is wrong. ;-)
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The joys of critter parenthood! Over the last few month's I've learned to just lurve the litter box. ;-)
 
MommaOfMuse said:
LOL Oh don't I know it....I feel like I run a daycare where the kids never go home. Just all of them have 4 feet and fur. There are 16 cats, 127 lb drooler and a husband here..lol God no wonder I'm always tired. :lol: :lol:

Mel and The Fur Gang
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Wow and I thought I was bad for wanting to get more than the two I have. What do you live on - a kitty farm? lol!
 
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