Need Help With My Dosing

[bagheerathediabeticcat]

Hello, everyone. Dale 'n' Chip was nice enough to direct me here. I am looking for some help because my blood sugar levels, while nowhere what they were like back when I first started getting treated with insulin, are not where my human wants them to be.

I was diagnosed with diabetes in last summer, and initially the vet started me on Prozinc. We started with two units, then went up to three, and then to five. It did not get my blood sugar levels under control, so the vet referred me to a specialist.

That vet taught my human how to do blood sugar testing better and she also moved me off of Prozinc to Levemir. I have endured two ear sticks a day since then, and my human sends them reports of my blood sugar on a weekly basis. At first, they were using the AlphaTrak software to track things, but since they they have moved me to a Google Docs spreadsheet.

For the past month or so, even though my human has wanted the vet to change my dosing because my blood sugar isn't where we want it, they have kept the dosing consistent. So I am turning to you wonderful humans to see if I can get some help.

I have already learned that I will have to endure an extra ear stick or two when my human can get that in. He's only able to do this a couple of times a week. I've also learned that we need to track my blood sugar readings over the course of several days to determine what to do with dosing, because Levemir accumulates and when he tests, he's not just seeing the effect of the last dose, but also of the past four or five.

So with all that in mind, here is a screenshot of the Google docs spreadsheet for the past few weeks. You can add in a reading of 301 at 6:54 AM, 282 at 2:41 PM and 320 at 6:04 PM today.

Head bonks and paw taps to all of you for being so kind!

 

[Blue]

Hello, everyone. Dale 'n' Chip was nice enough to direct me here. I am looking for some help because my blood sugar levels, while nowhere what they were like back when I first started getting treated with insulin, are not where my human wants them to be.

I was diagnosed with diabetes in last summer, and initially the vet started me on Prozinc. We started with two units, then went up to three, and then to five. It did not get my blood sugar levels under control, so the vet referred me to a specialist.

That vet taught my human how to do blood sugar testing better and she also moved me off of Prozinc to Levemir. I have endured two ear sticks a day since then, and my human sends them reports of my blood sugar on a weekly basis. At first, they were using the AlphaTrak software to track things, but since they they have moved me to a Google Docs spreadsheet.

For the past month or so, even though my human has wanted the vet to change my dosing because my blood sugar isn't where we want it, they have kept the dosing consistent. So I am turning to you wonderful humans to see if I can get some help.

I have already learned that I will have to endure an extra ear stick or two when my human can get that in. He's only able to do this a couple of times a week. I've also learned that we need to track my blood sugar readings over the course of several days to determine what to do with dosing, because Levemir accumulates and when he tests, he's not just seeing the effect of the last dose, but also of the past four or five.

So with all that in mind, here is a screenshot of the Google docs spreadsheet for the past few weeks. You can add in a reading of 301 at 6:54 AM, 282 at 2:41 PM and 320 at 6:04 PM today.

Head bonks and paw taps to all of you for being so kind!

OK first off, I am not sure about the sheet you have posted in the image but it's really not a sheet that others are using. I don't know what the columns are for, and can only guess. the last is dose, but what is the 2nd last column?

Next, you are testing only at shot times? If yes, that's not going to let you know what the cat's nadir is, and dosing for Lev is based on the nadir. How are you deciding on the doses? Your cat could be going VERY low at nadir and then bouncing, day after day, or the dose may not be high enough and the cat has solid high 300s all the time. How can you tell if testing only twice a day?

Your dosing below is all over the place; Prozinc/PZI may be dosed like that, but not Levemir or Lantus.... can't jump all over with the dosing.

Your shots are given 10/14, not 12/12? You are going to have a very tough time regulating with Levemir or Lantus because they like consistency. Can you explain why the odd dosing? Maybe others can offer better assistance if it's known your limitations.

If you can populate your data into the same spreadsheet as others are using, it will be easier to help you because right now, your sheet can be easily misinterpreted.

Finally the food? I think the 1.38oz is food? If you are feeding only about 3oz a day, the cat's likely starving. You need to feed diabetics more.

What is the column with the 100s and 75s? Are you giving subQ fluids or something?

 

[bagheerathediabeticcat]

My apologies. I should have explained. Some of the columns are self explanatory, but the 1.38 oz is the amount of food I got at the time of the reading, and then the column with the 100 most of the time is the amount of food I ate.

Also, while the blood sugar readings may be 10 hours apart, the dosing is done every 12 hours. You see, when my human gets home, I tell him, feed me. So does my girlfriend Jacey. So my human does, and he takes the reading either before I eat or while I am eating. He prefers to do the latter, because that means I am distracted by the food and am not fighting him.

He gives me a quarter can each feeding session (1.38 oz) and I know you will hate him for this, but he gives me Nutro's weight management dry food. It has a higher protein content and lower carbohydrates than a lot of the stuff that vets sell for diabetic cats like me! At each feeding time, I get about a half cup of dry food. I don't eat as much of it. Jacey eats most of the dry food. She doesn't like wet food for some reason. So my human has to have some of both.

Oh, and one more thing I think I need to share with you. My human mixes my wet food with lingzhi tea, which has been shown to reduce blood sugar levels.

 

[Blue]

My apologies. I should have explained. Some of the columns are self explanatory, but the 1.38 oz is the amount of food I got at the time of the reading, and then the column with the 100 most of the time is the amount of food I ate.

Also, while the blood sugar readings may be 10 hours apart, the dosing is done every 12 hours. You see, when my human gets home, I tell him, feed me. So does my girlfriend Jacey. So my human does, and he takes the reading either before I eat or while I am eating. He prefers to do the latter, because that means I am distracted by the food and am not fighting him.

He gives me a quarter can each feeding session (1.38 oz) and I know you will hate him for this, but he gives me Nutro's weight management dry food. It has a higher protein content and lower carbohydrates than a lot of the stuff that vets sell for diabetic cats like me! At each feeding time, I get about a half cup of dry food. I don't eat as much of it. Jacey eats most of the dry food. She doesn't like wet food for some reason. So my human has to have some of both.

Oh, and one more thing I think I need to share with you. My human mixes my wet food with lingzhi tea, which has been shown to reduce blood sugar levels.

Hi Tony,
You need to test your cat's BG at the time of the shots, not before or after. The reason for testing is to be sure it's safe to give a shot..... the test at 5am is meaningless at 7am - actually, by 515am, the test number is too old to be valid.

What times are your shots? 7am/7pm? If yes, then the earliest you can test to have a valid number to call a preshot would be 645am/645pm.

Dry food is no good; it should be removed from the diet of a diabetic cat or you won't be having luck to get the cat regulated. If you are feeding only 3oz a day of wet food to the diabetic cat, it's not enough, and the cat will be hungry.

You want to test the cat on an empty stomach, so if the shots are at 7am/7pm, you don't want to be feeding during the 2 hrs before the shots. Take up all food at 5am and 5pm, then test the cat just before the shot. It doesn't matter what the blood sugar is at the time the cat is eating, but it is VITAL that you know what the blood sugar is just before you give a shot.

What protocol are you following for dosing Levemir?
Here's what you should be following:
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 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 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 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 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 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.

Random Notes...
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.

Now, you switched to an insulin that works differently than the other one, and this one must have dosing adjusted seldom, only as needed. See the above guidelines. You need to know what is the lowest number in the cycles..... what is the number at the mid point of the cycles? At a day when you are able, you need to do a curve to find out what's going on because shooting a cat with a dose of 5.5u then 2.5u then 5.5u is dangerous and harmful to the cat. A dose of 5.5u is considered fairly high so if your cat really needs that high of a dose, you may want to consider testing the cat for acromegaly.

You will need to do a curve, but until that time, give one dose, every shot, every 12 hours, and test just before giving each shot. You can pick a dose that's something like 2units am and pm and hold that same dose until you can do a curve because the 5.5u shots look to be way too much.

Last, feed more than 3oz a day, and no dry food.

 

[Sheila & Beau GA & Jeddie GA]

Tony, I am so glad you are asking for dosing suggestions here. Frankly, IMO, what your vets are suggesting is WAY less that optimal for the best treatment of diabetic cats (dry food) and could border on seriously dangerous (sliding scale with lev).

You have learned some good things though, like home testing. That is the key to managing diabetes. When Beau was first diagnosed I only got ONE test per week, at the vet, and of course it was useless but I didn't know that.

You are learning some other key things to managing FD (feline diabetes) here from the posts on Health last week: phasing out the dry food, testing more often, setting a steady dose and staying with it for several days before changing a dose and using the mid-cycle numbers as the guide to dose changes, not the preshot numbers.

Gayle is correct that you need to test within 15 mins of giving the shot. BG numbers will change over time, the more time the more change, but you can sometimes see a big difference in 30 mins. Two hours between test and shot is too much and could be dangerous. For instance, when you get a 128, is that a rising or falling number? If it is rising then a shot two hours later is safe, but if it is falling it isn't. You will only know that if you test again. And those +10 numbers are important ones to get sometimes, especially in the beginning, as they tell you how Bagheera is trending and responding to insulin. Some cats nadir at +6, most on lev closer to +8, but some are at their lowest at +12 or just before or after. You need to learn about YOUR cat.

While I applaud your testing efforts, unfortunately your data is not too useful yet. With the tests too far from shot times and the dose changing it is really hard to know what is going on with Bagheera. Therefore, I would suggest "starting over". If Bagheera was not getting any dry food I would say drop to 1u and hold that for 3 days, but because he is on dry food, and that can make a 100 point difference, I would say to try 2u. The caveat to this is that if you get a number below 150 at shot time you might want to wait 30 mins and test again to make sure his BG is going up before giving insulin. And if you get an even lower number, same thing, and drop the dose to 1u and in either case try really hard to get another test in after 2-4 hours. That is probably easier at night or over the weekend/days off. If you are in doubt, post on Health and ask for input, or give him a nominal dose like .5u or skip it if you have to leave for work and no one will be home to monitor him all day. Better to lose a little ground/momentum than risk him dropping too low.

Please work at eliminating dry food. The Nutro food is not a good food. Yes, vets might sell it and other dry foods, but this is because they don't know much about nutrition and only what the food manufacturers tell them - and they make money on it. NO DRY FOOD IS GOOD FOR ANY CAT. Period. I know that you can't make this change over night. It took me a month or more to get Beau onto only wet food and I had to do some sneaky things with it, which I can share if you want. Best to get Jacey off dry too so you don't grow another diabetic - or worse cause kidney failure or IBD.

For some great, vet written, info on feline nutrition see here http://www.catinfo.org.

The protocols and methods we use and share here are tried and true. There are very few cats that don't end up well regulated and many end up off insulin. I have treated three and two are off insulin and the third was regulated on less than 1u. None of them had dry food except as treats (no more than 12 kibbles of grain free dry per day) and the two that went into remission have never needed more than .5u of lev. Beau was on a different insulin at first and had higher doses. he was also eating dry food. His BG was often in the 500s with dry food. After it was gone his dose was lower and his BG was in the upper 200s and lower 300s at the highest.

Oh, and one last thing about food. In general I don't feed (put down) more food within a couple of hours of shot time, but leave food down if it is there. I'm not getting up two ours early to take up food and I don't think it is critical. Some do. Difference of opinion maybe, but what I do has worked with my diabetics.

 

[hmjohnston]

Welcome Tony and Bagheera! I've been gone since Friday so I didn't see you arrive!

Have you got your new meter yet? And I understood the food column but not how much you ate- since Sneakers grazes on her plate over the course of an hour or two that wasn't anything I normally kept track of but it does give a good indication of how you are feeling- and how hungry!

I've matched Sneakers shot schedule to mine so that she isn't waiting when I get home for food- I can immediately test and shoot her when I get home for her PMPS. Yes, that means I wake up an hour EARLY in the morning but then that gives me 50 minutes to snooze in bed after that and allows for a +2 out the door check if I feel the need to do it.
That might not help if you both get home at different times and one is WAY earlier than the other though :roll: :lol: Testing while eating is okay as you are distracted, just make sure Tony tests you right at the beginning of your food so you have little chance of a food spike in your blood stream.

I know your human will do what is best for you in feeding and such. Since Jacey likes her crunch so it will take time for her to adjust until you can get rid of all the dry. She's just addicted to the flori flora they put in the dry food to make cats want to eat it. Have Tony try some parmesan cheese on her wet food and see if that helps. 0% carb and Sneakers doesn't eat much of her food without it.

The FDMB has its own spread sheet- http://felinediabetes.com/FDMB/viewtopi ... =6&t=18207 is where the instructions are located and it does help us to quickly figure it out. You post it to the web and it automatically updates and if you send a link to your vet they will be able to just hit the link and pull it up.

While we don't normally dose on weight and normally suggest a start with 1u or even .5u- as per the early thread discussion and seeing the swing I and the fact that you have been on this insulin since last summer at a higher than normal dose I would suggest 2u MAX, maybe even a 1.5 MIN unless your human has currently been and will be continuously checked for ketones as your dose is stabilized. Once he has a few weeks worth of checks and maybe even a curve day or two we would have the data to suggest lowering the dose. If ketones will be checked for daily a starting dose of 1u should be okay to do.

Welcome again and sorry I didn't find you sooner!

 

[Dale 'n' Chip]

Thanks Heather and Sheila.

Actually I sent them to consult with the TR Gurus because it's such an unusual situation and Bagherra's human is interested in aggressive dosing. But glad this was posted here and you responded with even more info. They are going to use the Tight Regulation Protocol for dosing. And hey don't look at me about the "aggressive dosing" wasn't my idea at all, even though I do agree with it. Provided it is safe and possible. Just because of all we went through here with Chip. @-)

Shelia, I didn't even think about Jacey eating the Nutro dry. I agree it is very important for her to be transitioned to wet. I think we can blame the specialty vet for presenting that food as appropriate for a diabetic. And thanks Heather for looking up the carbs on that because I was wondering. The first thing that happened when Chip was diagnosed was no more high carb food for anyone else, so I wasn't even thinking about Jacey. I suspect it is even more important for any cat NOT on insulin (certainly OTJ but also civvie) not to have all those carbs. And all cats generally benefit from less carbs.

Hope you will visit Bagheera in Lantus Land or perhaps Bagheera will make it over here for another visit.

And I imagine Bagheera appreciated the input from everyone in the original thread in health, especially once the Levemir is properly dosed and does it magic to help him feel better.

 

[bagheerathediabeticcat]

Hi, everyone. Thanks for helping out. I have moved over to the tight regulation board because it's got a lot more eyeballs. I'll be there, and would love to have you humans visit me there to see how I am doing.

My human just got home and I am not demanding food, so that's a good sign. All of the wet food is now gone, and most of the dry but he only gave us a half cup this morning. He doesn't know who ate what, but neither me nor Jacey are demanding food so that's a good sign that we both consumed a lot of the wet food.