Newbie dosing question...PMPS 199, what should I do?

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my Casey bear

my Casey bear

Member Since 2011
I am not sure what I should do for my 8/1 PM shot.

Leading up to this point:
I started to home test Casey even before I found a new vetthat was not insistant on prescribing only Humulin H. While in search of the new vet Casey's BG#'s were in the mid - upper 200's. I found a new vet whom prescribed Lantus (1u bib) and told me I should change my cats' feedings from freestyle to only 1/2 hr bid. While waiting to receive the Lantus, I desided to start on the new feeding regiment...Casey became stress about food (or the lack there of) and her BG#'s rose into the 300's. I gave Casey her first shot of insulin 6 days ago, 0.5u Lantus. By the nesxt morning I believed I was not give her enough so I upped her dose to 0.75 and maintained that for 8 cycles. Casey's PS #'s remained there until I when back to a semi-freestyle feeding - dropping her #'s back into the 200's for 3 cycles before they started going into the #00's again. So I upped her dose yesterday morning to 1.0u and finally started to see the numbers go down, however there dose not seem to be much of an upswing to it. Which leads my to my question.

I believe her PMPS BG will be below 200, or at least a very low 200, and am not sure what to do. I have read that newbies should skip shooting in this situation, but I don't really think I should do that. :?: Should I skip a dose, reduce it, or maintain the course? If reducing, how much?

Ok...it is know time get her dinner ready and her PS test, I will add the results afterward...

Roberta
and Casey
 
Well, I am not sure if I did the correct thing or not, but I went ahead and gave her a skinny 1u. I will watch and test her more tonight.
 
Hi Roberta,
Sorry I missed this earlier. This ISG doesn't get alot of traffic like the other boards, so please, please, please post on Health if there isn't anyone on here. Please get a few before bed tests in tonight.

What are you feeding Casey Bear? I free feed Klinger because he's always been a grazer. If I picked up his food when he's done in the morning, he probably only eats a 1/4 of a can. That's definitely not enough for 12 hours. I think the majority of folks on here free feed, but I'm sure others will chime in.
 
Looking at your spreadsheet I would say you did fine with that skinny 1u, in fact you probably would have been fine with a full 1u, but when in doubt error on the side of caution is kind of my personal motto. :-D She got a really nice blue surf off of 1u this morning and that 199 was a rising number. Just keep testing her and gather the data so you can get a clear picture of how she handles that dose. Unless one of the ladies with more dosing experience disagrees with me because I am by far no dosing expert, I would say you did good.

Mel, Maxwell , Musette & The Fur Gang
 
Hi Roberta,
First off, I want to make sure you meant to post here, in the Levemir ISG. It's fine if you did because Lantus and Levemir are similar in action, but you must understand 1 thing - very few of us here are experienced with Lantus itself. None of us long term board members, who are myself, Sheila, Beau & Jeddie and Pamela & Tigger have used it. We have a couple Lantus users posting for input, so it's fine if you'd like to join us here. Our stickies are specifically for Levemir, however, some points crossover between the 2 long lasting insulins.

Just want to make that clear right away. Also, this ISG is not nearly as active as the Lantus ISG, so like today, you probably won't get a very quick response.

I need to go look at your spreadsheet yet, but I think you did alright to give the skinny 1U on a preshot of 199. Yes, please get a few spot check BG checks in before you go to bed, but the longer acting insulins are usually gentle enough that full blown symptomatic hypos are rare and take a substantial overdose to cause. That does not mean the cat may not go low, that is why it's important to have food available.

The longer acting insulins don't necessarily need as drastic of food cutback as your vet is advocating. As you saw, it can stress a cat who is used to free-feeding. The more important thing with food is to make sure it is low carb canned food. I know you've been on Health board section enough times to have heard that, so I won't go over it again. As long as you're feeding a food less than 7 or 8% of calories form carbohydrates, you can leave it out all day long. Also, if you'd rather do meals, lots of us use timed feeders, which are very helpful to make sure cat gets something to eat later in the day but doesn't have so much food available that it's gorging itself.

I also think you did very well by starting so low on the dose and working up to the 1U. And lookie there, you're seeing results! Good job!

Proactive, willing-to-learn members do well here. Our input is to help you learn how to determine dosing needs on your own. There are a lot of factors involved, and sometimes it's confusing, but ask whatever questions you can't find the answer to or need explained differently than you may have read on other sites.

Hope this info makes you feel better about giving the shot tonight.
 
Marcy & Klinger said:
Hi Roberta,
Sorry I missed this earlier. This ISG doesn't get alot of traffic like the other boards, so please, please, please post on Health if there isn't anyone on here. Please get a few before bed tests in tonight.]

I wasn't sure where to post, so know I know, thank you. And I was planning to test her every 2 hours or so.

[What are you feeding Casey Bear? I free feed Klinger because he's always been a grazer. If I picked up his food when he's done in the morning, he probably only eats a 1/4 of a can. That's definitely not enough for 12 hours. I think the majority of folks on here free feed, but I'm sure others will chime in.
Click to expand...

I have been feeding her a variety of canned foods, seeing what she likes or not. She has been feed friskies, FF, sophisticat, and special kitty...most of which have been 7% or less carbs (I may have accidently given her an 8% once)

So, to wrap it up: I will be testing her every couple hours and if there are any issues, I will post it on the health link.

Thank you,

Roberta
and Casey
 
Tested her at +2 ~ 172, and now +4 ~81

I am telling myself it will be ok, perhaps Casey didn't eat enough. She still had ample food in her dish, so I sprinkled some flakes of freeze dried chicken treats on it to get her to eat more food.

Now for the new question...At what point would I be able to allow myself to get worried? (Instead of trying reasoning myself out of it.)

If I do not see many new eyes on this, I will also post on the health forum.

Roberta
and Casey
 
Ok,

This is something...maybe false alarm?? Or the incouragement to get her to eat more did the trick...

Her +5 BG is 112 , but will still keep checking and posting. I definitely will need guidance re: tomorrows dosing!!

Roberta
and Casey
 
Roberta,

I'll try to keep an eye out for you over here.. :-D

But to answer your question, you really don't need to start freaking out unless she drops into the 40 to 50s early in the cycle. And I tend not to panic with Musette unless she is way low, like the 30s, but then again I have several months of data to work with, I know she can go lower than most and she will eat to level herself out. Where you are pretty new to this with Casey, I wouldn't start worrying until the 50s, and even then, keep an eye on her, test every couple hours until you see her starting to rise.

It might help to remember if no one as told you that on a human meter (they read slightly lower than pet only ones), that normal for a cat is between 40-120. Maxwell who is diet controlled is routinely in the mid to low 50s. Now if I would test Musette and get the same numbers since she is on insulin I would be testing a little more often and keeping an eye on her.

An 81 at +4 is a really nice number and right about where you want her to be. ideally you want to try to find her a dose that allows her to stay in the 60-100 range for most of the day. Now don't worry if she suddenly jumps up tonight before her evening dose, as if I remember her spreadsheet, this is the first time in awhile that she has come down to those low numbers, and her body may freak a little bit and not understand that normal really is normal. Right now it thinks high is the new normal.

What time is she do for her evening shot? And what time zone re you in? If I know about when you will be posting this evening I'll try to make sure I'm around to help out. I'm no where close to a dosing expert, but I do understand Lantus and what worked with Maxwell, which will help as Casey looks to be more like Maxwell than Musette...lol...Musette is another type of dance altogether. But then again she had a few more health problems when I adopted her than Maxwell did, so I'm fighting against those as well. But even with that said she is doing really well for little girl that was up to 2u a day twice a day only 2 months ago, battling DKA and a UTI, as well as negect by her last owner. Today, she is over loved, over fed, over pampered and down to .4u of insulin.

Mel, Maxwell, Musette & The Fur Gang
 
I do not have much time to write at the moment...but want to say thank you. Mel, I will write more after work, again thank you.

Roberta
 
Your welcome hon,

That is what we are here for, if you have questions just ask.

Mel, Maxwell, Musette & The Fur Gang
 
my Casey bear said:
Tested her at +2 ~ 172, and now +4 ~81
Click to expand...

The long acting insulins, Lantus and Levemir, are the most successful at getting a cat into remission. The reason, no doubt, is the fact that we try to get our cats into normal numbers and keep them there through as much of their cycles as possible. A BG of 200 is a diabetic number. Casey bear's pancreas is under stress, trying to produce insulin to reduce his blood sugar. If Casey bear has a BG of 81, his pancreas is completely at rest, hopefully healing itself. The normal BG range for a cat (on a human meter) is between 40-50 and 150-160. Within that range, the pancreas can rest and heal. It is not always easy to get into that range but the longer amount of time during the day you can be in that range, the better it is for the Casey bear's pancreas.

As you continue to collect data, you will begin to get an idea where Casey's nadir is, how much he is likely to drop from hour to hour. You will get a feel for an 81 @ +4 and what his BG might be at +6. So, experience will solve a lot of your "frights."

I have experience with both Lantus and Levemir. They are very similar. One difference. . .

Levemir, I think, has its greatest effectiveness in hours 3 - 12. You almost invariably see a rise in BG during some or all of the first three hours after a shot. It really reduces the stress of shooting insulin on a low number when you have enough data to know your cat's BG will continue to rise.

Lantus, I think, has its greatest effectiveness in hours 1 - 9. What will happen to blood sugar following an injection is much less predictable.

If you have job schedule pressures (not being able to nursemaid a low number), you might consider switching to Levemir after you finish your current vial of Lantus.

Lana
 
Ok....back home from work...

I agree, I did get quite nervous last night and this morning, It has only been about a week since I started giving Casey insulin and was basing things on what her limited track record had been. Other than right after the increase in dose, her curves had been relatively gentle.
my Casey bear wrote:
Tested her at +2 ~ 172, and now +4 ~81
Click to expand...
When I saw the rapid decline, compared to the previous 2 cycles, I was not sure if that was normal or not and if she was just on a curving or heading into a nose dive. I was happy to see her at 81, but the big drop in getting there and not being sure how much lower she would be going scared me.

I plan to resume her full 1u tonight.

Mel, I am in central time zone and I give Casey her shots at 7am/pm.
 
my Casey bear said:
Ok....back home from work...

I agree, I did get quite nervous last night and this morning, It has only been about a week since I started giving Casey insulin and was basing things on what her limited track record had been. Other than right after the increase in dose, her curves had been relatively gentle.
my Casey bear wrote:
Tested her at +2 ~ 172, and now +4 ~81
Click to expand...
When I saw the rapid decline, compared to the previous 2 cycles, I was not sure if that was normal or not and if she was just on a curving or heading into a nose dive. I was happy to see her at 81, but the big drop in getting there and not being sure how much lower she would be going scared me.

I plan to resume her full 1u tonight.

Mel, I am in central time zone and I give Casey her shots at 7am/pm.
Click to expand...

Roberta, I think you are doing a great job. You are already waaaay ahead of where most people are at this stage of the game. And Casey seems to be responding to the insulin well. :) Just remember that you have your hypo tool box and your meter, and that you are in control. It really does get easier and easier and we will all be crossing our fingers and paws that Casey will be one of those kitties that goes into remission soon.

You mentioned something in one of your earlier posts about Casey's back legs and having trouble in the litter box? Has that issue improved or resolved?

Oh, and welcome from just south of you in northern Illinois. I live just south of Rockford and we are big Green Bay Packer fans. :)
 
Hi Pamela,

Go Pack go....lol Thank you for the encouraging words! It was funny that you asked about Casey's hind legs...I just mentioned to my brother that she seemed to to be walking a little better, that was before she got stressed from my giving her shot. When she gets stressed, she walks on her hocks even more. As far as the litterbox, I have been trying not to police her doing her business, but her scratching in the litter sounds more rythmic and steady verses a struggle now. So I think the neuropathy getting a little better, but she has a way to go.

Thanks again,

Roberta
and Casey
 
Lana & Yoyo said:
I have experience with both Lantus and Levemir. They are very similar. One difference. . .

Levemir, I think, has its greatest effectiveness in hours 3 - 12. You almost invariably see a rise in BG during some or all of the first three hours after a shot. It really reduces the stress of shooting insulin on a low number when you have enough data to know your cat's BG will continue to rise.

Lantus, I think, has its greatest effectiveness in hours 1 - 9. What will happen to blood sugar following an injection is much less predictable.

If you have job schedule pressures (not being able to nursemaid a low number), you might consider switching to Levemir after you finish your current vial of Lantus.

Lana
Click to expand...

Lana, that's excellent info. Thank you for detailing those differences. I agree on the rise after a shot on Levemir, in fact it's one thing I tell new users to do if they've shot a low number - get tests in at +1, + 2 and +3 or at least 1 of those 3 times and they will see the BG rises. It makes them more comfortable shooting low numbers in the future. Also shows what happens if you reduce the dose too much for a low preshot.
 
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