Shantismom
Member Since 2014
I have posted all his number for the last week on relaxed protocol if you could take a look and give me some advice. He had some real issues yesterday with not eating etc. All the information is on the other thread.
Need help with Shantis dose
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Hi Marlene - and welcome to the TR forum. Is there any way you can put your data in an online spreadsheet for us to look at. The instructions are here to set it up. It's a very important document we all use to spot trends and help us with our dosing decision.
Here is your post on Relaxed today: http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=125413 and for other's here is the first post on Health: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=113679&p=1197562#p1197562. We do have several other kitties here on prednilisone and with IBD and asthma like Shanti.
We dose Lantus based on the nadir, or how low the insulin can take Shanti. We don't change the dose based on the preshot numbers. It is possible when he's seeing higher mid-cycle numbers that he is bouncing, see the second post on this one.
Here is your post on Relaxed today: http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=125413 and for other's here is the first post on Health: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=113679&p=1197562#p1197562. We do have several other kitties here on prednilisone and with IBD and asthma like Shanti.
We dose Lantus based on the nadir, or how low the insulin can take Shanti. We don't change the dose based on the preshot numbers. It is possible when he's seeing higher mid-cycle numbers that he is bouncing, see the second post on this one.
Shantismom
Member Since 2014
I have set up my shread sheet now.
Shantismom
Member Since 2014
I haven't seen any low number but for a while I didn't test at night. Sunday and Monday this week I did but maybe my doses were so high he just kept pumping out sugar. I did reduce his dose as you can see for four cycles. Starting Sunday morning through last night. But yesterday was a bad day because he wasn't eating well so maybe they were just not low enough.
What do you suggest I do, is there a dose I should start with and see how he does?
What do you suggest I do, is there a dose I should start with and see how he does?
Thanks so much for setting up the spreadsheet. That makes is easier to see what's been happening with Shanti. Did you give a shot on the morning of the 13th? There's nothing in the units column there. Lantus is a depot insulin so works best with consistency in dosing so it's best to stick with one dose for a while. The TR Protocol we use here says you need to get at least 4 tests a day, one before each shot (as you've started to do) and at least one other test some where mid cycle. Since we don't have enough data on Shanti yet, it's hard to say where his nadir or low point is, so continue getting random spot checks throughout the cycle to help fill in the picture. I've seen cats nadir as early as +2 and as late as the next preshot. Tests at night are very important. Many cats (like my Neko) prefer to go lower at night.
Since Shanti is eating higher carb food, I think the Natural Balance you are feeding is 12%, and he's getting prednilisone, he might need a little higher dose. The 2.8U dose seemed to be getting some nice blues in the middle. If you can get at least 4 tests daily and he is eating, how about sticking to that 3.0U dose that you started today? According to our protocol, you'd stick with that for at least 6 cycles before increasing, unless he went below 50. If you see a higher number mid cycle (like you did today) it could be from the New Dose Wonkiness which is explained in the post on bouncing that I gave you before.
How is he eating today? Normally we test, feed, and shoot insulin all within 15 minutes.
Since Shanti is eating higher carb food, I think the Natural Balance you are feeding is 12%, and he's getting prednilisone, he might need a little higher dose. The 2.8U dose seemed to be getting some nice blues in the middle. If you can get at least 4 tests daily and he is eating, how about sticking to that 3.0U dose that you started today? According to our protocol, you'd stick with that for at least 6 cycles before increasing, unless he went below 50. If you see a higher number mid cycle (like you did today) it could be from the New Dose Wonkiness which is explained in the post on bouncing that I gave you before.
How is he eating today? Normally we test, feed, and shoot insulin all within 15 minutes.
Shantismom
Member Since 2014
I will try 3 units for the six cycles. Now I have a few questions:
1. What if his AMP is low, like 118 or 130, do I still give 3 units? For that matter same at PMP .
2. What if he won't eat, like yesterday, I stalled with the shot but had no one to guide me so lowered the dose to avoid hypo. Is there a rule of thumb about that?
3. If I see a low nadir during the day do I lower his evening dose?
4.If it seems he is having a bounce do I stay the course and let his body adjust?
I saw somewhere, under 200 don't shoot.
Also a guideline for nadir
above 150 increase 1/2 unit
90-149 stay
below 90 decrease by 1/2
Are these correct?
Thank you for helping me, I have become so upset with his numbers, ups and downs, and not eating that I can't even make a reasonable decision about dosing anymore.
1. What if his AMP is low, like 118 or 130, do I still give 3 units? For that matter same at PMP .
2. What if he won't eat, like yesterday, I stalled with the shot but had no one to guide me so lowered the dose to avoid hypo. Is there a rule of thumb about that?
3. If I see a low nadir during the day do I lower his evening dose?
4.If it seems he is having a bounce do I stay the course and let his body adjust?
I saw somewhere, under 200 don't shoot.
Also a guideline for nadir
above 150 increase 1/2 unit
90-149 stay
below 90 decrease by 1/2
Are these correct?
Thank you for helping me, I have become so upset with his numbers, ups and downs, and not eating that I can't even make a reasonable decision about dosing anymore.
Shantismom
Member Since 2014
Should I try to get a BG after his PM shot, normally I don't because I am in bed by +2, but if I take it just before I go to bed at +2 would that help, or could I just add another test during the day.
julie & punkin (ga)
Member Since 2011
Hi marlene! glad you found your way here! As wendy said, we have several kitties with the same medical issues.
I'll try to tackle your questions - and Yay for asking them!
1. Because Lantus dosing is based upon how LOW the dose takes a cat, we don't usually change the dose just because the preshot is lower. Experienced people will shoot everything over 50, provided their cat is eating, they have plenty of strips and can monitor, and they have something like karo syrup or gravy canned cat food to pull up blood sugar if needed. Even so, we encourage people that are posting here on the TR forum to ask for help the first time the cat is below 150 at preshot. Main health uses 200 as their "get advice before you shoot" number. That's why i mentioned 200 to you yesterday. So the short answer is yes, you still would give 3units as long as he's eating and you can monitor.
2. If he's not eating, we're more cautious. You don't want a cat to have their blood sugar go low and not be able to get them to eat. There's no formula if you have to reduce we go on a case by case basis. If he's eaten 1/3-1/2 of the normal volume of food, you're likely to be ok giving the regular shot and just encouraging the cat to eat. If you can't get any food into them, then the answer is "it depends." if the cat has a history of ketones, we'd probably have you shoot. We might suggest reducing the dose a little bit - but if a cat is sick, they still need the insulin so we avoid ketones developing. It's really a case by case decision.
3. If he goes below 50 at any point, you would reduce his dose by 0.25u with the next shot.
4. yes. we re-evaluate the dose every 6 cycles and decide if it should be held longer or increased. you look at the nadirs (low numbers) during those previous 6 cycles and compare them to the protocol guidelines. we can help you do that for the first little while - it can be tricky until you've gotten the hang of it. we often suggest people ask if they should change the dose for the first few weeks til you understand things.
5. that "if he's x blood sugar do this, if he's that, do that" doesn't apply to the long lasting insulins, Lantus and Levemir. The doses are held until the cat either gets an increase or goes below 50, earning a reduction in the dose.
Great job getting the spreadsheet going - they are an essential tool for us! I agree with Wendy's suggestion about sticking with 3.0u.
Also, if your goal is to get Shanti into remission, Tight Regulation is his best chance. The research shows that getting a newly diagnosed cat into normal blood sugar numbers as quickly as possible (from 50-120) increases their chances dramatically for becoming diet-controlled and going off of insulin. Keep asking questions and we'll keep teaching you.
Here is the Tight Regulation Protocol page. Lots of reading to do, but don't worry if it's confusing at this point. Starting out on this is like a college crash course - just hang in there and ask what seems confusing.
welcome to Lantus/Lev Land!
I'll try to tackle your questions - and Yay for asking them!
1. Because Lantus dosing is based upon how LOW the dose takes a cat, we don't usually change the dose just because the preshot is lower. Experienced people will shoot everything over 50, provided their cat is eating, they have plenty of strips and can monitor, and they have something like karo syrup or gravy canned cat food to pull up blood sugar if needed. Even so, we encourage people that are posting here on the TR forum to ask for help the first time the cat is below 150 at preshot. Main health uses 200 as their "get advice before you shoot" number. That's why i mentioned 200 to you yesterday. So the short answer is yes, you still would give 3units as long as he's eating and you can monitor.
2. If he's not eating, we're more cautious. You don't want a cat to have their blood sugar go low and not be able to get them to eat. There's no formula if you have to reduce we go on a case by case basis. If he's eaten 1/3-1/2 of the normal volume of food, you're likely to be ok giving the regular shot and just encouraging the cat to eat. If you can't get any food into them, then the answer is "it depends." if the cat has a history of ketones, we'd probably have you shoot. We might suggest reducing the dose a little bit - but if a cat is sick, they still need the insulin so we avoid ketones developing. It's really a case by case decision.
3. If he goes below 50 at any point, you would reduce his dose by 0.25u with the next shot.
4. yes. we re-evaluate the dose every 6 cycles and decide if it should be held longer or increased. you look at the nadirs (low numbers) during those previous 6 cycles and compare them to the protocol guidelines. we can help you do that for the first little while - it can be tricky until you've gotten the hang of it. we often suggest people ask if they should change the dose for the first few weeks til you understand things.
5. that "if he's x blood sugar do this, if he's that, do that" doesn't apply to the long lasting insulins, Lantus and Levemir. The doses are held until the cat either gets an increase or goes below 50, earning a reduction in the dose.
Great job getting the spreadsheet going - they are an essential tool for us! I agree with Wendy's suggestion about sticking with 3.0u.
Also, if your goal is to get Shanti into remission, Tight Regulation is his best chance. The research shows that getting a newly diagnosed cat into normal blood sugar numbers as quickly as possible (from 50-120) increases their chances dramatically for becoming diet-controlled and going off of insulin. Keep asking questions and we'll keep teaching you.
Here is the Tight Regulation Protocol page. Lots of reading to do, but don't worry if it's confusing at this point. Starting out on this is like a college crash course - just hang in there and ask what seems confusing.
welcome to Lantus/Lev Land!
Shantismom said:
Getting a +2 test at night is helpful. If it's quite a bit less than the PMPS test, then you might want to set an alarm for later in the night as it could be an active cycle.
On this forum, we suggest that if you get a preshot test less than 150, do not feed, and post for help. Over time you'll shoot at lower and lower numbers. Check out some of the other posts on this forum.
Stay the course with bounces, it can take up to six cycles to get over them.
If you see a low, below 50, in the day or night cycle, that's when you reduce.
If he won't eat, post here for help. Reducing is a one idea. Just put a note in your spreadsheet as to why you reduced.
On this forum, we suggest that if you get a preshot test less than 150, do not feed, and post for help. Over time you'll shoot at lower and lower numbers. Check out some of the other posts on this forum.
Stay the course with bounces, it can take up to six cycles to get over them.
If you see a low, below 50, in the day or night cycle, that's when you reduce.
If he won't eat, post here for help. Reducing is a one idea. Just put a note in your spreadsheet as to why you reduced.
Julie beat me to it, she's not on an iPad now. :lol:
julie & punkin (ga)
Member Since 2011
I would get that +2. What some people who go to bed early do is to move their shot times earlier. I shot punkin at 7am/pm and don't go to bed til 11:30pm, so that let me get his +4.5 if i needed to.
The +2 is a great indicator of what might come next.
If it's higher than the preshot, that may signal that a bounce is starting.
If it's about the same as the preshot, that signals a "typical active" Lantus cycle, where it will gradually go down until mid-cycle and then go up. That often doesn't happen right away when you're just starting, but it can.
if it's lower than the preshot - that's a giant red flag that the cat is likely to need extra monitoring.
There's a great description of all of this on the "New to the Group" sticky.
The +2 is a great indicator of what might come next.
If it's higher than the preshot, that may signal that a bounce is starting.
If it's about the same as the preshot, that signals a "typical active" Lantus cycle, where it will gradually go down until mid-cycle and then go up. That often doesn't happen right away when you're just starting, but it can.
if it's lower than the preshot - that's a giant red flag that the cat is likely to need extra monitoring.
There's a great description of all of this on the "New to the Group" sticky.
julie & punkin (ga)
Member Since 2011
heehee yeah, typing on a laptop is only a zillion times easier than on anything else. i'm often on my nook at night, and YIKES - one tapped letter at a time. :shock: it's a pain in the neck!
Shantismom
Member Since 2014
The problem with moving my shot earlier is that twice a week I am not home until after 7:30 that is why I give shots at 8:00. If I saw a reduction I can stay up but really I am not worth much after 11:00, of course if Shanti had a crisis I would stay up. Last night when he wasn't eating I stayed up until 11:45 and got up at 2:00 to test.
How long does it normally take for someone to answer, in case there was a low number or Shanti not eating and is there something I should put in my title to grab attention.
You can probably tell I am nervous.
Shanti was diagnosed in February but my vet was very casual, I started testing at two weeks in but only once a week to start, then every three days, then mid cycle, slowly realizing that I needed more information to make good decisions.
Seems as though 6 weeks ago his numbers started to go up and down more frequently and I started to change his doses, without much success I might add.
I will try to stick to this protocol, I want to do the best for my boy, we've been through alot with all his issues but I couldn't love him anymore than I do.
How long does it normally take for someone to answer, in case there was a low number or Shanti not eating and is there something I should put in my title to grab attention.
You can probably tell I am nervous.
Shanti was diagnosed in February but my vet was very casual, I started testing at two weeks in but only once a week to start, then every three days, then mid cycle, slowly realizing that I needed more information to make good decisions.
Seems as though 6 weeks ago his numbers started to go up and down more frequently and I started to change his doses, without much success I might add.
I will try to stick to this protocol, I want to do the best for my boy, we've been through alot with all his issues but I couldn't love him anymore than I do.
julie & punkin (ga)
Member Since 2011
starting out with FD is about the worst. Vets don't have a lot of experience with FD (generally speaking) and some of what they understand is about the older insulins. I'm not blaming anyone - i can only imagine how many illnesses they have to be expert in, and FD is just one. I understand they literally get about 15 minutes in vet school about diabetes. And of course, new information comes out. FDMB is the best source that i could find, and even now when i know a lot, i think it's still the best and most accurate. The people who help out here are into looking for the latest research, so it's up to date.
As far as getting help - it just depends on the time of day. We're all volunteers who have used Lantus or Lev ourselves. Dyana, Sandy & Amy are east coast, Sienne is midwest, Marje, Wendy & I are west coast. But - besides the 7 of us, there are many, many people who post who will help, or who check in and out to see if people need help. There are 3 people in europe right now who are posting fairly regularly, so sometimes they are on in the middle of the night. We tell people if you're wanting help in the middle of the night, post both here and on the Main Health forum.
If you are scared with low numbers (less than 50) or a medical crisis, you can hit the 911. Then remove it as soon as someone comes to help. Editing your subject line throughout the day is helpful - you can put "HELP" in it and someone would see it. If it's just a routine question, you can either put the topic in the subject line "furshot?" or use the ? post icon on top of the window that you're typing in when you reply. If you need help deciding on a dose issue, some people write "dose help?" in their subject line.
In order for the subject line and post icon to show up on the main page, you have to edit the first post in your thread. If you don't get a timely answer, write a reply to bump up your own post.
Most of the time people won't give you advice on the dose unless they feel pretty confident about it. Giving advice for someone else's cat is a responsibility that not everyone is willing to take on. If you have doubt about the advice you're being given, ask for an explanation behind it. People ought to be able to pull out the protocol and quote it for you so that you learn to find things yourself.
For your shooting schedule, i think i'd rather have 2 shots a week be late instead of not getting a pm cycle test. I'd give the 5 days as early as 6:30am if you can, then you'll be able to get more information in the night cycle. So many cats go lower at night - it's not even funny. it's not uncommon for us to see cats with almost completely different cycles between the day and night cycles. Right now, Jenks is a great example of that. Look at his spreadsheet (in the last few weeks) and you can see how he does almost all of his low numbers in the wee hours of the morning. In Neko's 2013 ss, look at February and notice the difference between the am/pm cycles.
What days of the week are you late? We could suggest a shooting schedule for you that would minimize the wonky numbers.
As far as getting help - it just depends on the time of day. We're all volunteers who have used Lantus or Lev ourselves. Dyana, Sandy & Amy are east coast, Sienne is midwest, Marje, Wendy & I are west coast. But - besides the 7 of us, there are many, many people who post who will help, or who check in and out to see if people need help. There are 3 people in europe right now who are posting fairly regularly, so sometimes they are on in the middle of the night. We tell people if you're wanting help in the middle of the night, post both here and on the Main Health forum.
If you are scared with low numbers (less than 50) or a medical crisis, you can hit the 911. Then remove it as soon as someone comes to help. Editing your subject line throughout the day is helpful - you can put "HELP" in it and someone would see it. If it's just a routine question, you can either put the topic in the subject line "furshot?" or use the ? post icon on top of the window that you're typing in when you reply. If you need help deciding on a dose issue, some people write "dose help?" in their subject line.
In order for the subject line and post icon to show up on the main page, you have to edit the first post in your thread. If you don't get a timely answer, write a reply to bump up your own post.
Most of the time people won't give you advice on the dose unless they feel pretty confident about it. Giving advice for someone else's cat is a responsibility that not everyone is willing to take on. If you have doubt about the advice you're being given, ask for an explanation behind it. People ought to be able to pull out the protocol and quote it for you so that you learn to find things yourself.
For your shooting schedule, i think i'd rather have 2 shots a week be late instead of not getting a pm cycle test. I'd give the 5 days as early as 6:30am if you can, then you'll be able to get more information in the night cycle. So many cats go lower at night - it's not even funny. it's not uncommon for us to see cats with almost completely different cycles between the day and night cycles. Right now, Jenks is a great example of that. Look at his spreadsheet (in the last few weeks) and you can see how he does almost all of his low numbers in the wee hours of the morning. In Neko's 2013 ss, look at February and notice the difference between the am/pm cycles.
What days of the week are you late? We could suggest a shooting schedule for you that would minimize the wonky numbers.
Shantismom
Member Since 2014
Usually Wednesday I would be late, but could shoot by 7:15 most of the time. Saturday is different, I rarely get home before 7:30 sometimes later, but not past 7:45. That is why 8 always seemed a good time for me. Have to admit I don't get up until 6:50. So I could try 7:00 but it might be 7:15. That way 10:15 is +3 which could give me a better idea. Since he will get his shot tonight at 8:00 what time would be good tomorrow to avoid too much overlap? I could move up the times by 15 minutes until I get to 7:15, would that work?
julie & punkin (ga)
Member Since 2011
people have noticed that 15 minutes per cycle, or 30 minutes earlier once a day don't seem to make much difference in the BG numbers. So whichever works best for you.
You have some flexibility in the shot. If you're 1/2 hr late, i don't think that would matter. Then you could probably get back on schedule the next morning. So maybe 7:15 would be a good time for you.
You have some flexibility in the shot. If you're 1/2 hr late, i don't think that would matter. Then you could probably get back on schedule the next morning. So maybe 7:15 would be a good time for you.
Shantismom
Member Since 2014
I will start moving back in the morning.
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