NEW MEMBER 2-18-2020 *NEED DOSING ADVICE* Newly dx'd on 2-13-20 / rx: Lantus pen / libre freestyle

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Heather and Khouklo

Member Since 2020
*only have the pen needles so I can't adjust his dose any lower. I need to either give him 1 unit or skip the injection.*

10am - given 1 unit lantus

9:30 pm - only ate about a TBSP of food

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it was 185 when i posted. it went up to 218. i went ahead and gave him the 1 unit ....wasn't sure how long it would take to get a response.

ketones were negative the day he was dx'd with DM and a very bad bladder infection (which the vet thinks is the cause of the insulin resistance)

no history of ketones that im aware of. last week was the first time he's ever had a problem with blood sugar.
 
OK you did great! At first, if they're under 200, we'll want you to stall, don't feed and test again in 20-30 minutes to see if the number goes up without the influence of food.

Use that time to post and make a good clear subject line like "STALLING! NEED HELP!" to get some eyes on your post ASAP. The first few times a new member shoots a lower than usual number, we like to have someone with experience who can agree to stay and watch out for however long is necessary to make sure everybody is safe and comfortable.

As you gather more data and experience, that "stall point" starts to come down. Lantus works best when it's not trying to "pull down" high numbers so it's important to gradually learn to shoot lower and lower numbers.

Keep asking questions! If you could transcribe some of your readings from your Libre into our special spreadsheet it would really help us to help you.

Here are Instructions on getting the FDMB spreadsheet

It will be important to be getting some insulin syringes with half unit markings ASAP. You've already discovered the problem with using the pen needles! They only give whole unit doses!
 
All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
B/D

They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)
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what does it mean to shoot a low number?

Give insulin even though the blood glucose is lower than you'd usually give.

Most vets will just dictate "No insulin if under ###" but their main concern is keeping the cat in a higher, but safe number. Here, we try to get our cats into remission (if at all possible) so they don't need to be on insulin the rest of their lives. If not remission, at least in normal blood glucose numbers for cats (50-120 on a human meter) so the damage to their internal organs is minimized as much as possible.

If you look at China's spreadsheet (in my Signature) you'll see that once I had enough data and really understood how she responded to both food and Lantus, I'd shoot anything over 50.
 
i started typing up recent history...here's what i have so far....

2/11/20 Tuesday
• dermatology appt f/u for allergies
• on and off steroids for the past year, tapered off dexamethasone, (last day taken 2/3/20 after tapering eod for a week)
• allergies are uncontrolled - very itchy and uncomfortable (atopica failed to control symptoms, tried to start apoquel but DM dx got in the way)
***began getting nauseous but not clear if it's the DM or possibly the apoquel or something else

• noticed something was wrong at the end of appointment, very lethargic, not himself
• ran blood work

2/12/20 Wednesday
• got results:
• BG: 463
• asked to authorize charges fructosamine test

2/13/20 Thursday
• got results
• fructosamine: 616 (from blood draw on Tuesday)
• refered to primary care vet as "emergency" visit
• BG today at appt : 509
• terrible bladder infection (suspect for the insulin resistance)
• prior steriods not suspected as cause of DM as he had been off dexamethasone for a week at that point)
• day 1 of 10 of antibiotic (orbax) 1.5ml 1x/day for bladder infection
• attach libre freestyle 14 day sensor
• day 1 of lantus pen (prescribed 2 units every 12 hours)
*****already discovered this dose is too much ^ *******

• Concerns:
1. my vet said sometimes, not normally, but sometimes a cat will do better with dosing once every 24 hours and *thinks* my cat *may* be one of those.
 
I'll work on trying to figuring out the spreadsheet. i still don't even know what most of the stuff being recorded means ...very overwhelming. I'm struggling with the forum as it is.
 
prior steriods not suspected as cause of DM as he had been off dexamethasone for a week at that point)

Wrong...it usually takes a lot longer than a week for the effects of steroids to clear the body

terrible bladder infection (suspect for the insulin resistance)

Pain, infection and inflammation can all raise the blood glucose, but usually not that high. I suspect it's more a mix of infection and steroids.....but the good news is "IF" you can keep him comfortable without going back on the steroids, he has a better chance of going into remission. Cats that become diabetic due to steroids have a better chance of remission. However, if his quality of life is awful because he's itchy and steroids are the only thing that works, we just adjust the insulin around the steroid use. Sometimes there is no choice.

my vet said sometimes, not normally, but sometimes a cat will do better with dosing once every 24 hours and *thinks* my cat *may* be one of those.

Nope...a cat's metabolism is much faster than a humans. In humans, Lantus is a once a day insulin, but cats do better with every 12 hour shots.

I'll work on trying to figuring out the spreadsheet. i still don't even know what most of the stuff being recorded means ...very overwhelming. I'm struggling with the forum as it is.

You're doing fine!! You don't have to learn everything tonight and you don't need to do it all tonight! Your cat didn't become diabetic overnight and it's going to take time to get him better! If you have any trouble getting the spreadsheet set up, just click on my name and choose "start a conversation" and I'd be happy to set it up for you.

You don't have to transcribe all the numbers from the Libre either. If you can get the Pre-Shots (AMPS is the AM Pre-Shot...PMPS is the PM Pre-Shot.....those are the tests you get immediately before feeding/shooting) and a couple of tests in between the shots, that's enough for now.

We were all where you are once. Take it one step at a time, keep asking questions, and believe in yourself. You can do this!
 
the dermatologist office said he can't take steroids if he's diabetic.

wrong again....yes, it's not recommended, but if it's a matter of their quality of life, you give the steroids. We have cats fighting cancer and other serious diseases and the only choice to give them a good life is steroids so we just accept it and understand that remission from diabetes might be out of the picture, but as long as they're happy and comfortable, that's the best we can do.

We just adjust the insulin around the steroids.
 
All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
B/D

They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)
View attachment 51380

going to Walmart later...

how do i choose which size?
30 or 31 gauge, 6mm or 8mm insulin syringes
 
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