New to Lantus - Yoyo BG results today

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JackBlack

JackBlack

Member Since 2014
New to Lantus..

My intention was to go with 0.5 units for 6 cycles BUT..

Jack tested 6.2 mmol/L (111 mg/dL) this morning should I shoot 0.5 or reduce to 0.25?
 
No answer for you, Merrin. Jack's pretty new to this dance and there's not that much data on your spreadsheet. I am NOT one of the experienced members. Have you read the sticky "How to Handle Low Numbers?"

Good info there.

Link: http://www.felinediabetes.com/FDMB/threads/sticky-lantus-levemir-shooting-handling-low-numbers.147/

Three options pop to mind immediately:

1. Stall. Retest in 30 minutes to see if he's coming up.
2. Shoot a reduced dose.
3. Skip.

First of all, though, you have to be comfortable with your decision. Nothng wrong with being conservative. Safety first.

Marilyn and Polly
 
Another thing to consider is whether you are able to closely monitor jack in case he does go low and have the right equipment in stock in case he does go low. Again not giving advice but just something else to consider
 
thanks, yes I will be going out during the day so I am nervous.
I re-tested and it looks like he is going up, but will test one more time and if it's still going up I need to decide whether to give him the 0.5 or reduce to 0.25 or none! arggh decisions..

due for shot 8am
8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
 
Then whilst I don't want to advise you if this was my cat I don't think I would shoot because

A) you are off out and can't monitor him
b) this is a low number and you are not yet data ready
C) the insulin is still building up in his. System
 
It is hard to tell, since you have whole cycles where I don't see any test data. I can't tell if he went lower last night or not. Cat's often go lower at night time, and Lantus dosing is based on the Nadir of the cycle (the lowest point). Do you have lots of test strips, are you going to be home to monitor, do you have high carb food and or syrup, if needed? Those questions need to be answered first.

ETA (as I saw some other posts done by faster typers than I). if you're not going to be home to monitor him, then giving a one time reduced shot (the 0.25) would be fine, or for maximum safety, skipping the shot would be fine too (better high for a day/cycle than too low for a minute). When do you have to leave? Can you at least get a +2 or +3 to see how the cycle is going?
 
I think I will skip the dose and err on the side of caution. Thanks for your advice though, if I was going to be home I would give a dose and monitor. I do have honey that has helped him come out of low BG before.
I am keen to get some solid data going and I imagine keeping him on one dose for a period of time will help. That is my intention ASAP.
 
I definately agree with skipping, and also with a very tiny dose until we see how he does. That .25 is hard to do, but possible. What does Jack eat?
 
When you get down to tiny doses, magnifiers can be very helpful. There are visors with the magnifiers if you don't wear glasses and there are clip on magnifers if you do (Carson Clip and Flip work great).
 
Hi Merrin! I haven't met you yet and wanted to stop by and see how you're doing.

Looks like you worked through this morning's issue and decided to skip. Good call - Jack hasn't been on the Lantus long enough for you to be able to safely shoot him low and then leave. Jack looks like he's responding very well to his insulin. As you move forward, it's going to be helpful to you to understand how Lantus works. I see you're only on the 4th day of it and you're getting a bit of a baptism by fire! :)

Here's some information that explains a bit: http://felinediabetes.com/FDMB/threads/sticky-lantus-levemir-what-is-the-insulin-depot.150/
And here's one more about how to take care of it so it lasts you as long as possible. It's expensive enough that most people want to be able to use it til the end: http://felinediabetes.com/FDMB/threads/sticky-lantus-levemir-info-proper-handling-storage.151/

Because of Lantus' cumulative nature, ie, it builds up in the body over the first week or so of shots and the amount built up in the body is in equilibrium to the amount being slow-released, it works best if we can help you get to a dose that is the same every 12 hours or so without you having to skip. What you did this morning was fine - but it looks like he needs a smaller dose so that you can give it regularly for a while.

I would probably stick with the 0.5u for longer so we can see what he does on it. At the moment, I don't think we can know if 0.5u is too much or not because his dose has been recently reduced from 1.0u. The depot from the previous 1.0u dose could still be influencing his blood sugar this morning. Following the Rand/Roomp Tight Regulation Protocol, you would not decrease the dose unless you saw a test below 50 on a human glucometer.

If you want to reduce to 0.25u, you could. It's up to you.

The biggest change you can make right now is to always get at least one test in the pm cycle. We know from experience that many, many cats have their lowest numbers at night. Start with a test right before you head for bed so you know what he's getting to. Because Lantus dosing is based upon how LOW the dose gets a cat, knowing that # is really important.

I do want to suggest before you get farther into this that you use the FDMB world template for his blood sugar records instead of using an excel spreadsheet. The reason is because our "common language" here is using US numbers, not the mmol world numbers. There are some folks that are fluent in world numbers, but i'm afraid that you won't get the help you need if you are only using mmol. Using the FDMB world template allows you to enter the numbers in mmol and then there is an attached page that translates in US numbers for everyone else to see. That template is in the process of being updated by Marje and should be ready in the next few days.

You're off to a great start! Hang in there and it will get easier.

julie
 
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aw, just saw BJM's reply. You can also stack drugstore reading glasses on top of each other and it will magnify things hugely.

Here is the part of the protocol that I'm referring to about adjusting the dose.


"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 by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • 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. See additional notes in the next paragraph about drops into the 20s and 30s. 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.
 
Thank you everyone .. just quickly .. I got home and tested Jack.

8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
8:30 am re-tested 6.6 mmol/L (118.8 mg/dL)

NO insulin this morning

3:30pm tested 5.9 mmol/L (106.2 mg/dL) (+7.5 after his 8:00am test)

He has gone down, not up. I will keep testing but would be nervous to give him 0.5 OR 0.25 if he is still low at 8pm.

So another decision to be made today.
 
PS - very strange Jack's spreadsheet used to be the World one where it calculated for the US on the other excel page?? I swear it had both pages this morning!
 
crazy about the ss. I think a few people have commented on weird things with the ss.

the CareSens is a human glucometer? If so, everything under 120 is normal numbers. If he stays in that range you can continue just waiting at this point and holding off on the shot until he is over 120 before shooting.
 
I can see both tabs at the bottom of the spreadsheet.

Stall 30 minutes without feeding and re-test. If rising and over 150 mg/dL on a human meter, a token dose may be appropriate.
 
oh and to answer the question about Jacks food, he is on raw meat mix (with offal and green lipped mussels) No biscuits anymore and this has been the case since diagnosed.
 
What she's saying is that when you get a preshot test that you think is too low to test, one option is to wait until the BGs are rising and then shoot. Typically if you wait til BGs have risen to 150 you would give the entire regular dose, as long as you were able to monitor as usual.

Here is the information on how to handle a preshot that is lower than you have experience with:
http://felinediabetes.com/FDMB/threads/sticky-lantus-levemir-shooting-handling-low-numbers.147/

Newly diagnosed cats have the ability to have their pancreas heal and to then become diet controlled and to go off of insulin. In your case, I'd be conservative because of the response you are seeing in Jack, because he is on such a low dose and because he is so newly diagnosed.
 
8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
8:30 am re-tested 6.6 mmol/L (118.8 mg/dL)
NO insulin this morning
3:30pm tested 5.9 mmol/L (106.2 mg/dL) (+7.5 after his 8:00am test)
7:00pm tested 8 mmol/L (144 mg/dL) (+11 after his 8:00am test) going up again

will test in 1 hour
 
sounds great.

By the way, one thing that is really helpful is to update the subject line of your first post in the thread as the day goes on. Many people scan the main page and watch for questions or requests for help. I don't know what the time difference with New Zealand is. How many hours from now is your +11? I'm up for about another hour from now.
 
ok, so i think you just posted his +11/144. Probably you can give his regular shot - he's unlikely to go down between now and the next hour.

I think it's up to you if you give 0.25u or continue the 0.5u.

Has anyone suggested to you that it's very helpful to get a +2? In a typical active Lantus cycle, the +2 is about the same as the preshot number. If it is much lower than the preshot number, that's a giant heads-up that he's likely going to have a very active cycle and you've got to be on your toes.

From the New to the Group sticky:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

Example of an ACTIVE, but NOT necessarily typical Lantus cycle:

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. You'll probably see an active cycle if the +2 is the same/similar or lower than the preshot number. Continue testing!
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
 
Thanks so much! Just tested again

8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
8:30 am re-tested 6.6 mmol/L (118.8 mg/dL)
NO insulin this morning
3:30pm tested 5.9 mmol/L (106.2 mg/dL) (+7.5 after his 8:00am test)
7:00pm tested 8 mmol/L (144 mg/dL) (+11 after his 8:00am test) going up again
8:00pm tested 7.3 mmol/L (131.4 mg/dL) (+12 after his 8:00am test) going down again

up and down like a yoyo, I have shot 0.25U shot (fed him) and will test again +2.
 
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Thanks Charlene, Jack has gone out now that the sun is down, I think he is sick of being poked and prodded. Hope I can find him in an hour!
 
Found him, luckily it's raining and he came back, have locked cat door now..

8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
8:30 am re-tested 6.6 mmol/L (118.8 mg/dL)
NO insulin this morning
3:30pm tested 5.9 mmol/L (106.2 mg/dL) (+7.5 after his 8:00am test)
7:00pm tested 8 mmol/L (144 mg/dL) (+11 after his 8:00am test) going up again
8:00pm tested 7.3 mmol/L (131.4 mg/dL) (+12 after his 8:00am test) going down again
SHOT 0.25U (fed him)
10:00pm tested 5 mmol/L (90 mg/dL) (+2 after his 8:00pm insulin) LOW already - have honey standing by in case he gets even lower (at what point do you give honey/glucose?)
 
Hi Merrin

2.8 is generally when you want to start pulling jack up with honey etc. But......if you are uncomfortable break it out when you feel you want to.

You have a couple of options as I see it.

1 - test again in 60 minutes, and keep going until you see a rising number not influenced by food/honey.
2 - give a low carb snack (ziwipeak would be perfect, make it small so he will eat again later)

In your shoes, I would be inclined to give a little ziwipeak to try and steer him into a rise, or at least a hold.

Here is the sticky for shooting and handling low numbers. http://felinediabetes.com/FDMB/threads/sticky-lantus-levemir-shooting-handling-low-numbers.147/

What do you feel comfortable with?

C
 
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Java took awhile to adjust to ziwipeak too - tough love won him over!

LC gives the insulin something to work with - it can help steer into a hold, and can assist bringing on a gentle rise. Honey is a sledgehammer (a necessary one of course!). It creates a quick rise but wears off quickly.

If jack starts to fall further, you might like to start another post on the Lantus board putting the low number in the title.

:)
 
Do you have a plan from here on in? Are you testing every 60 minutes until you get two consecutive rise results? Do you have a number in mind that when reached, you start testing every 30? A little low carb food now to try and steer?

:)
 
8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
8:30 am re-tested 6.6 mmol/L (118.8 mg/dL)
NO insulin this morning
3:30pm tested 5.9 mmol/L (106.2 mg/dL) (+7.5 after his 8:00am test)
7:00pm tested 8 mmol/L (144 mg/dL) (+11 after his 8:00am test) going up again
8:00pm tested 7.3 mmol/L (131.4 mg/dL) (+12 after his 8:00am test) going down again
SHOT 0.25U (fed him)
10:00pm tested 5 mmol/L (90 mg/dL) (+2 after his 8:00pm insulin) LOW already
11:00pm tested 3.7 mmol/L (66.6 mg/dL) (+3 after his 8:00pm insulin) LOWER

I will feed him now and test again in 30 minutes.
 
Hi merrin

Great to see you getting lots of fantastic advice as per usual. I would begin to go into 'honey mode' when remi got to 3.2. That was where I felt comfortable with. I would just add 2 drops of honey to his usual low carb food and then retest /repeat as per the protocol.
 
8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
8:30 am re-tested 6.6 mmol/L (118.8 mg/dL)
NO insulin this morning
3:30pm tested 5.9 mmol/L (106.2 mg/dL) (+7.5 after his 8:00am test)
7:00pm tested 8 mmol/L (144 mg/dL) (+11 after his 8:00am test) going up again
8:00pm tested 7.3 mmol/L (131.4 mg/dL) (+12 after his 8:00am test) going down again
SHOT 0.25U (fed him)
10:00pm tested 5 mmol/L (90 mg/dL) (+2 after his 8:00pm insulin) LOW already
11:00pm tested 3.7 mmol/L (66.6 mg/dL) (+3 after his 8:00pm insulin) LOWER - ATE FOOD
11:30pm tested 4.1 mmol/L (73.8 mg/dL) (+3.5 after his 8:00pm insulin) UP a little (perhaps the food helped)

will test again in 30 minutes

Thanks for doing this with me!

 
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No worries :).

Hopefully we can get a little surf going! (Where jack hangs around the lowest number in the cycle). On the bright side, these low numbers are good to get his pancreas to start the healing process!

I'll see ya in another 30 :)
 
8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
8:30 am re-tested 6.6 mmol/L (118.8 mg/dL)
NO insulin this morning
3:30pm tested 5.9 mmol/L (106.2 mg/dL) (+7.5 after his 8:00am test)
7:00pm tested 8 mmol/L (144 mg/dL) (+11 after his 8:00am test) going up again
8:00pm tested 7.3 mmol/L (131.4 mg/dL) (+12 after his 8:00am test) going down again
SHOT 0.25U (fed him)
10:00pm tested 5 mmol/L (90 mg/dL) (+2 after his 8:00pm insulin) LOW already
11:00pm tested 3.7 mmol/L (66.6 mg/dL) (+3 after his 8:00pm insulin) LOWER - ATE FOOD
11:30pm tested 4.1 mmol/L (73.8 mg/dL) (+3.5 after his 8:00pm insulin) UP a little (perhaps the food helped)
12:00pm tested 3.9 mmol/L (70.2 mg/dL) (+4 after his 8:00pm insulin)

will test again in 30 minutes. Still not sure that he won't go down again. It might be a while yet Charlene, I understand if you can't hang around I will give honey for 3.2 and under
 
Looks like +3 may have been a rise from the LC snack.

How bout you pop a new post on the Lantus board to see who's about to pick you up? If nothing doing, I'll hang with you some more :).

See you in 30 on your new post. Would be a good idea to pop a link to this condo so people can see the history :)

You're doing well!,
 
8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
8:30 am re-tested 6.6 mmol/L (118.8 mg/dL)
NO insulin this morning
3:30pm tested 5.9 mmol/L (106.2 mg/dL) (+7.5 after his 8:00am test)
7:00pm tested 8 mmol/L (144 mg/dL) (+11 after his 8:00am test) going up again
8:00pm tested 7.3 mmol/L (131.4 mg/dL) (+12 after his 8:00am test) going down again
SHOT 0.25U (fed him)
10:00pm tested 5 mmol/L (90 mg/dL) (+2 after his 8:00pm insulin) LOW already
11:00pm tested 3.7 mmol/L (66.6 mg/dL) (+3 after his 8:00pm insulin) LOWER - ATE FOOD
11:30pm tested 4.1 mmol/L (73.8 mg/dL) (+3.5 after his 8:00pm insulin) UP a little (perhaps the food helped)
12:00pm tested 3.9 mmol/L (70.2 mg/dL) (+4 after his 8:00pm insulin)
12:30am tested 4.1 mmol/L (73.8 mg/dL) (+4.5 after his 8:00pm insulin) good UP a little without food or honey
 
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