Newbie at FDMB: Treating Diabetic Cat

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Shadows BGL at AM+3 is 171 so it's climbing again. It's close to AM+4 now so I'm inclined to test at AM + 6 or 7 and go with 0.5 units at PMPS and stick with that dose for three to five days.

P.S. I did the profile, info, spreadsheet link thing. This message will test whether it took.
 
You did great Steven! Now you won't have to constantly answer the same questions over and over, and once you get more used to using the spreadsheet, you'll start to learn a lot more about how Shadow reacts to Lantus and food

If starting at .5 is your comfort level, start at .5...I think you'd probably be fine at .75 too, but you hold the syringe...it's always your choice. Very tiny differences can make a big difference in the numbers. IF .75 is too much, you'd need to be able and willing to stay up testing/feeding (at least until he was up into safe numbers and staying there without feeding.) IF .5 isn't enough, he'll just run higher numbers for the 3-5 days and you'd end up increasing to .75...there's just NO way to know this early in the dance to know how Shadow is going to react.

The most important part at this point is finding an amount that can be given every 12 hours, and keeps him safe, and is comfortable for you to shoot.

I think the 118 at +5 last night, and the fact that he's only at 171 at +3 today says that he did NOT go too low overnight on the .75. If he had, we'd expect to see a "bounce" number..maybe up to the 300-500 range, but I understand your reluctance to shoot a 115 this morning. Again, there's just no way to know for sure where Shadow went overnight. ECID (every cat is different) and until you've got more results, we just want to keep him safe while we're taking these first steps.

In the future, if you get a Pre-shot number you're not comfortable shooting, stall, don't feed, and retest in 30 minutes...use that 30 minutes to ask for help....and make sure you edit your first post and put something like "Stalling Dose Help Please!" (and add the ? icon) so people can easily see that you're waiting for help

You're doing well Steven, and the fact you're already home testing is just awesome.
 
I once saw a friend's cat convulse due to hypoglycemia. The reason I searched for answers, and found this board, is that Shadow looked to be heading in that direction. The drop from 0.75U at 299 at PMPS last night to 118 at PM+5 gave me pause about another 0.75U at 115 at AMPS. It seems prudent and safer to be a little high than risk hypoglycemic numbers. Although my schedule is flexible this morning, this is not normally the case. Thanks for your encouragement and understanding.
 
I see your spreadsheet link but not your profile link.

No rush, but You may want to soon start posting in Lantus for dosing advice, etc..
 
I totally understand. Hypos are really scary! Nobody wants Shadow to go too low! As I said earlier, eventually you'll learn to shoot those lower numbers, but if you get a number under 200, stall, don't feed, and ask for help. That's how you'll start learning the more advanced steps in this dance.

Just one thing...a drop from 299 to 115 isn't out of the ordinary..especially when you're first starting. China had a lot of those kinds of cycles..she'd start at high numbers too, drop into double digits or low 100's at +5 or +6 and then climb back into the 300-400's by the next shot time. On 7/14 you can see where she started at 314, at +4 was 100, +5 69, and +7 92

What we want is for them to spend as much time possible at numbers between 50-130...Those are "pancreas healing" numbers. Cats are one of the animals that has a pancreas that CAN heal and start working to produce insulin again, but to do that, it needs rest and time. Keeping their BG too high makes it try to work. This is one of the big reasons why we don't recommend the Glipizide pills. They force the pancreas to try harder to produce insulin...we want it to rest and heal.

This is a "typical" 12 hour cycle on Lantus looks like.

+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.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+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.

If you go with the .5, that's fine too!! We want you to be comfortable with what you choose to do, as well as keeping Shadow safe. We can always add more insulin after we see how it's going after at least 6 cycles
 
Hi and welcome Steve and Shadow! :YMHUG:

steven james said:
It seems prudent and safer to be a little high than risk hypoglycemic numbers. Although my schedule is flexible this morning, this is not normally the case. Thanks for your encouragement and understanding.
Click to expand...

We have a saying around here, "better high for a day than low for a moment." ;-)
 
Hi Steven and Shadow,
I've been reading your thread and see that you have gotten lots of good advice. It seems to me that the most important task you have to do is to determine what dose you can safely shoot every 12 hours. Skipping shots will certainly keep Shadow from getting hypos, but Lantus is a type of insulin that needs to be shot consistently. It is what we call a "depot" insulin. In other words, it builds a reserve "shed" or "depot" in the cat's body. When used properly this "shed" will help keep the cat in more stable numbers: ideally, he will not be diving and bouncing all over the place when the correct dose can be established. Some insulins are "in and out"--they leave no residue. When they are "out," the cat's numbers can soar. The "shed" Lantus builds helps to prevent this type of yo-yo effect.

Lantus dosing is based on the nadir--the lowest number in the cycle (usually appears somewhere around mid-cycle, but can move around). Pre-shot blood-glucose readings are important to determine whether or not it is safe to give the shot, but they only marginally figure into determining what the dose should be. At present you have had to skip so many shots that it is not really possible to figure out what dose you should be giving. Also--and this is important--when you begin using Lantus it takes 3 or 4 cycles of shooting a particular dose for the "shed" to build. While this building is taking place, some of the insulin is going into controlling the blood glucose, but the rest is going into forming the "shed" and therefore is not available to work on the blood glucose.

My suggestion would be for you to settle on a dose that looks to be safe. Perhaps 0.5 unit. This may be too little, but that can be determined and corrected later, if necessary. Try to shoot this dose consistently (every 12 hours). Keep track on your spreadsheet. You will see a picture begin to emerge. Give the dose a few cycles to "settle in" (the shed needs to be built--every time you change your dose, the shed will need to adjust itself and that always takes a few cycles). Go to the Lantus Forum and check out the "Sticky" that explains the TR Protocol to get an idea of how to go about adjusting the dose. You may not yet be ready to join the Lantus TR Forum, but you can learn a lot from reading the "Stickies" at the top of the index.

I have one question: Are you using the correct strips for your meter? It is unusual to have so many strip errors. The strips for the Relion micro/ Relion Confirm (both meters use the same strips) are not the same as for the other Relion meters. If you know that you have the correct strips, check the date on the plastic box.

You have come a long way in the last few days. Keep up the good work. Try to be consistent and try to be patient. Try not to panic. If you think you are in trouble, post a question in the subject line of your FIRST post of the day.

Ella & Rusty
 
I sent a reply 10 minutes ago but I guess it didn't work. I bought some new Relion strips for the Micro and it has been working without a hitch since. I won't use the first batch again and intend to call Relion for replacements. Both batches were for the Micro glucometer.

I just tested Shadow at AM+7 and got another unexpected result...131, down from 171 at AM+3 after rising from 115 at AMPS and 118 at PM+5. I erred on the side of caution and did not give him insulin this morning. I have to do some errands now and will retest at PMPS and feed him for the last time today after that. I was intending to start him at 0.5 units at PMPS but if the BCL is still down I am not sure that is prudent. If I have time I will read the TR stuff.

P.S. How do I rename the spreadsheet to something like Shadow's spreadsheet?
 
steven james said:
I just tested Shadow at AM+7 and got another unexpected result...131, down from 171 at AM+3 after rising from 115 at AMPS and 118 at PM+5. I erred on the side of caution and did not give him insulin this morning. I have to do some errands now and will retest at PMPS and feed him for the last time today after that. I was intending to start him at 0.5 units at PMPS but if the BCL is still down I am not sure that is prudent.
Click to expand...

It could mean a couple of things: the insulin dose from the night before is still at work in his system or maybe his pancreas is working some or a little bit of both. Depending on what his PMPS is tonight, if it's over 200, I suggest going with the .5u dose for the evening. If it's under 200, post here first and ask for help. I'd say Shadow is definitely trying to go otj_icon with numbers like those even after a skipped shot this morning. :thumbup

P.S. You should be able to double-click on the name and another window will pop up allowing you to change it.
 
OK. This thread is getting kind of long now but earlier I mentioned a belated phone call from my vet two days ago. I leveled with her about what I was doing, why I was doing it, and that I intend to keep doing it. She was cool with it; and after going over the events and what I was seeing, she felt the same as you; that he was trying to get off the juice. I've gotta run, but I'll be giving him his PMPS test in 3.5 hours. Thanks for your support.
 
Hi Steve...You're right, this thread is getting a little long, so why do we get you to come over to the Lantus Tight Regulation Board. This board is for us Lantus users and you'll get lots of experienced eyes to help you there.

Each day, we start a new posts (we call them condo's). The Subject line includes the date, cats name and your AMPS reading. As the day progresses, you add your test numbers until PMPS, and then you can either erase all the numbers from AM or just add PMPS and continue (until you run out of room)

Yours for today would be:
10/25 Shadow AMBG 115,+3 171,7 131 (In this case, since you didn't shoot this morning, it's AMBG (AM blood glucose) instead of AMPS (AM Pre-shot)

Then in the body of the condo, you give the WCR (Whole Cat Report)..how Shadow is feeling, acting, eating..anything you think might be helpful. We're interested in the 5 "P's" too...Purring, Playing, Preening, Peeing and Pooping. Anything unusual happen? Shadow not eating well? You have visitor in the house and Shadow won't come out from under the bed? ....whatever might help us know Shadow better as well as help you if there's a problem you're not sure how to deal with.

As for the link to your spreadsheet, do you just mean how do you make it work when you click on "Shadow's Spreadsheet" instead of the way it is now? It's not necessary to do that, but we can show you how if you want to learn.

Hope to see you in Lantus Land soon! You're not required to go to the Lantus board..if you want, you can continue posting here in Health but you'll find that in Lantus Land you'll learn a lot from just reading other people's condo's and seeing how and what they do when they deal with the same issues you'll be dealing with. (and I'll be watching for your PMPS number in about 3 hours too)
 
If I'm right in assuming you want to "name" your spreadsheet, here's how

If you would like a "word" link, such as Shadow's SS, use the following code: text. replace "link" with your spreadsheet URL, and replace 'text' with the name of your spreadsheet.

So you'd go to your Signature box, and click on the URL tab.

Immediately after the first [url put an = sign in ......then "paste" the link into it. At the end of the link, add the ]

Directly after you add the ] type "Shadow's SS"

That's all.

What I usually do is just put my cursor after the first and backspace once. Add the = and ...pic.php?f=6&t=50130]viewtopic.php?f=6&t=50130

Down where it says "B. Publishing your SS, aka Attaching to signature (directions by Squeem3)".... Look for line 7B
There's a picture there too
 
Shadow's PMPS is 183. Input please.

Ok. Shadow's PMPS test climbed to 183. Less than the 200 cutoff. Waiting for input before I do anything, including feed him. He hasn't eaten in awhile except for two tiny low carb treats. If I don't hear from anyone in by PM+2, I'm going to retest and let it ride if no change, 0.5U if >200...and feed him.
 
Wait 30 minutes and re-test. If rising glucose values, shoot.

Also, the FDA allows meters to read within 20% of what a lab would get.
80% of 200 is 160, so its likely safe to shoot, although helpful if you can be around to observe.
 
Wait 30 minutes and test again. If the number is "rising," I say it's safe to shoot the full dose. 200 is the cut-off number on the main board for people who are just getting started. If/when you move over to the Lantus forum, that cut-off drops to 150. If you feel up for it, you could even give the shot now without waiting. Just make sure you can get a +2 to see if he's already dropping because you might be in for a late night of testing if this is the first time you've shot lower than 200.
 
By the time I retested it was +1, but no matter. It dropped to 175 even though he was a little more stressed than usual this time. I'm letting it ride for now.
 
175 is really the same number as 180...the variance in the meter means it's going to be "within" certain limits....For now, if you didn't feed, you could go ahead and feed, shoot
 
Chris & China said:
175 is really the same number as 180...the variance in the meter means it's going to be "within" certain limits....For now, if you didn't feed, you could go ahead and feed, shoot
Click to expand...

Yep, it's a +/-20% variance if you feel like doing the math (although I could have sworn BJM had a crib sheet with the math already done; I just can't seem to find it now).

Just remember, Lantus works best on consistent dosing with only ~30 minute variances a day so if you don't give a shot till +14, tomorrow's shot will have to be given at least an hour and a half later than Shadow's regular shot time. Then Sunday, you only have to wait an hour later and by Tuesday, you should be back on track.
 
Re: Newbie at FDMB: 188 this morning. Input appreciated.

I did not give Shadow insulin last night as I counldn't follow up for 4 or more hours and his numbers were not climbing. At any rate he is cruisin' along right now just under 200 without juice. He tested at 188 a few minutes ago, ate his breakfast, and I'm leaning toward giving him 0.5 units soon. If I shoot him, I will test him early and maybe often to make sure he doesn't nosedive. I was advised to decrease in the morning but I've got to get him dialed in some time. I'll wait a little while for input.

Also, I am having trouble getting blood out of one ear now for some reason. I've tried to rotate ears and locations but last night and this morning I've had to stay with one ear. Any help here is appreciated.
 
I injected Shadow with 0.5U at AM+1 and will follow up with tests to monitor for potential hypo. I think I'll move this thread to Lantus forum as suggested. I don't think I will be able to consistently do the tight regulation so I will post in the relaxed Lantus forum.
 
Morning Steven, ~O)
I just have to come say hello to someone with a Shadow. :-D

One ear does generally bleed better than the other.
I find it helps to get just a little higher than the sweet spot, closer to the edge.
ear_web1_zps0bf45a17.jpg


If you are using a lancet, it sometimes helps to do a quick double poke in the same spot.
 
KPassa said:
...Yep, it's a +/-20% variance if you feel like doing the math (although I could have sworn BJM had a crib sheet with the math already done; I just can't seem to find it now).....
Click to expand...

I ran out of room in my signature! I'm going to have to make a page of links to the stuff I've pulled tgether!

You might find it helpful to review this table of Test Value Ranges It shows the FDA allowed +/- 20% around a test value which indicates the range in which the test likely falls.

The variability is kind of like ring toss - so long as the big ring is on the stake, it counts. With several rings, the area of overlap starts to narrow in on the stake ... at least, it is supposed to, based on measurement theory!

Glucose Value Ranges Graph
 
Good morning Steven!

What concerns you about doing the Tight Regulation protocol? I understand that you won't always be able to be home to test every 2 hours, but that doesn't mean you can't follow the TR protocol. If you can get 4 tests per day (If possible) and maybe curves on weekends, that's enough

If you do decide to go with the Start Low, Go Slow approach, that's fine too...just add SLGS to your signature...that'll tell use which one you're going to use. The only difference I can see between the 2 protocols is maybe how often you increase doses. You're still going to want to get those 4 tests in (If at all possible)

You always need the pre-shot tests. Then one somewhere around +5 and +8 during the AM cycle, and one "before bed" test at night.

No matter which you decide, it's fine to post on the TR board..it's much more active than the SLGS board is, and the main thing you'll need the boards for is advice..and all of us use Lantus

Glad to see you shot the .5 this morning! Let the dance begin! :mrgreen:
 
Hi Steven and extra sweet Shadow! Welcome from me and 'Da Sugarboyz', KT and Dakota.

Moving to Lantus group...not everyone that posts in Lantus Tight Regulation actually follows the TR protocol, some of us do 'SLGS' - Start low, go slow.... :) We still get lots of help and support even tho' I can't do tight regulation. Lantus TR is much more active than the Relaxed forum. There are still some very wonderful, helpful, caring people on Relaxed, just not nearly as often. Whichever you choose to post in is fine, just wanted to share the 'difference'.

You're learning this sugardance quite well!!!
 
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