Newb Here - Meet Carson - Relapsed Diabetic

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Carsonsmom

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My 15 year-old cat, Carson, was first diagnosed with diabetes in 2006. He's been on again/off again with the most recent honeymoon lasting for 2 years. At the time of the DX, his BG was around the 28 - 30mmol/L mark. He is on Lantus again (b.i.d.) as that worked really well (and quickly) in regulating him 2 years ago. He has lost a lot of weight (is around 8.8lbs) so the vet decided to SLGS. In a week, we upped him to 2u. His BG average on 2u was still around 21mmol/L so we very recently (Wednesday) upped the dosage to 2.5u. He eats Purina DM canned

He is reacting VERY well to the 2.5u (see the last 48 hours below) and this morning his AMPS was 4.4mmol/L. I was too nervous to give him a dosage as I was going to work, but tested him at +1 4.7mmol/L and +2 4.8mmol/L. I was playing all the scenarios in my head and why I should give him the full 2.5u, but caved and decided to leave him until I get back home.

Carson's BG -

11/30 - AMPS - 22.4 (2u)
11/30 - PMPS - 21.8 (2.5u)
11/30 +2 - 18.3
12/01 - AMPS - 15.7 (2.5u)
12/01 - +1.5 - 10.7
12/01 - PMPS - 18.9 (2.5u)
12/01 - +3.5 - 9.9
12/02 - AMPS - 4.2 (no shot)
12/02 - +1 - 4.7
12/02 - +2 - 4.8

Note: Carson is always fed 3.0oz of canned Purina DM, pre-shot.

So, my question is - should I have given him the full 2.5u of the Lantus, leaving HC food down, knowing that he was on the rise (albeit slowly) or was I right to keep him off the dose? Time will really tell this evening when I get home, but I thought it was better to be safe than sorry.

Any advice would be much appreciated!
 
Better safe than sorry is always the best idea. You can always up the dose next time, but you can't the insulin out of the cat once it is shot. If you weren't going to be home, sounds like the best option.

Can we help you set up a spreadsheet? Then if you need dose help fast, everyone can see your dosing history. Sign onto Goggle docs, then templates, then fdmb spreadsheet. Choose the World version and it will convert your metric numbers for us. Then follow these directions: viewtopic.php?f=6&t=18207

If you need help, just ask, It is complicated.
 
Carsonsmom said:
My 15 year-old cat, Carson, was first diagnosed with diabetes in 2006. He's been on again/off again with the most recent honeymoon lasting for 2 years. At the time of the DX, his BG was around the 28 - 30mmol/L mark. He is on Lantus again (b.i.d.) as that worked really well (and quickly) in regulating him 2 years ago. He has lost a lot of weight (is around 8.8lbs) so the vet decided to SLGS. In a week, we upped him to 2u. His BG average on 2u was still around 21mmol/L so we very recently (Wednesday) upped the dosage to 2.5u. He eats Purina DM canned

He is reacting VERY well to the 2.5u (see the last 48 hours below) and this morning his AMPS was 4.4mmol/L. I was too nervous to give him a dosage as I was going to work, but tested him at +1 4.7mmol/L and +2 4.8mmol/L. I was playing all the scenarios in my head and why I should give him the full 2.5u, but caved and decided to leave him until I get back home.

Carson's BG -

11/30 - AMPS - 22.4 (2u)
11/30 - PMPS - 21.8 (2.5u)
11/30 +2 - 18.3
12/01 - AMPS - 15.7 (2.5u)
12/01 - +1.5 - 10.7
12/01 - PMPS - 18.9 (2.5u)
12/01 - +3.5 - 9.9
12/02 - AMPS - 4.2 (no shot)
12/02 - +1 - 4.7
12/02 - +2 - 4.8

Note: Carson is always fed 3.0oz of canned Purina DM, pre-shot.

So, my question is - should I have given him the full 2.5u of the Lantus, leaving HC food down, knowing that he was on the rise (albeit slowly) or was I right to keep him off the dose? Time will really tell this evening when I get home, but I thought it was better to be safe than sorry.

Any advice would be much appreciated!
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You did the right thing by skipping the shot. And although your vet wanted to start low and go slow, that is not what happened if his dose was increased to 2U within the first week!! That is not how Lantus should be increased, especially if the starting dose was 1U. Please visit http://www.tillydiabetes.net/en_6_protocol2.htm

The 2.5U is probably a little too much, which resulted in numbers too low to shoot this AM. Lantus can be dosed at normal blood glucose levels, but only after regulation has been achieved and there is evidence from BG testing that the dose will not bottom them out when given below 5.5mmol/L.

Lantus works by building up an overlap or "shed" over time. The numbers you saw this morning were the result of a full shed that's now overflowing. The idea is to keep the shed full at all times, but not overflow it.

How long was he at 2U?
 
Thank you both!

I have attached his spreadsheet to my signature for a more accurate picture of the last couple of weeks. We raised the dosage to 2.5 after four days of 1.5 and 2.0 each, as his BG would just not come down, as the website you have provided to me also indicated).

As I'm not familiar with the terms (and the glossary didn't show overlap or shed), do you mean that the Lantus stores the insulin and releases when needed "the shed", when there is too much insulin injected, said shed overflows and there is more insulin than actually needed, causing the BG to drop?

If so, this causes me to ask two questions (sorry, but I have many!)

1) Tonight, if the BG has stayed relatively the same, what should I do? Feed, test and not dose as I did this morning?
2) If the BG is higher than this morning's reading, should I continue to the 2.5 dose or drop down to 2u?

Thanks so much for the patience found by responders on this site, I am such a fan of the great help provided.
 
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