newbie - Lilly's first curve - dosing advice requested..

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mbeach

mbeach

Member Since 2011
I'm a newbie - and posted this on the main board and they told me to post it here...

OK - I did my best with this today - We had to haul Lilly around with us in a soft carrier so I could get her blood sugars at various times... (we had a boy scout flower sale to help with, and deliver flowers)

AMPS 240 (2u Lantus)
+3 183
+6 91
+8 99
+10 138
+13 251 (2u Lantus) - I know it's late but we were out with my inlaws... :roll:

We feed purina & fancy feast wet food - I do keep about .5 cup of dry food out when we are gone (I wonder if this is the cause of the 251..-

I have to say I was surprised to see her in the 90's when I had tested mid-cycle earlier in the week she was still around 220...

Ok - so based on these numbers - should I ask the vet to reduce her insulin?

Also - at what blood sugar do you not give the insulin - she was 190 this morning and I was afraid to give it to her prior to church - (after 251 last night!)

Thanks all...
Michele & Lilly Mae (with sore and bruised ears now)
 
Welcome Michele and Lilly! You've come to the right place for help. A few things would help us immensely. We all post spreadsheets and keep track of BG numbers that way. That helps us look quickly at Lilly's cycles as dosing suggestions are usually based on looking at several cycles. Here is the information on how to set up your SS where we can all view it. Please let us know if you have any problems:
How to Create Your Own SS and Publish It in Your Signature

We typically suggest that you do away with the dry food totally. It is only going to keep her numbers higher than you want and may keep her from going off the insulin (off the juice). Dry food is extremely high in carbs; often it takes a while to see its effects on the BG and the effects often play havoc on the BG numbers for quite a while. It is very important to monitor her closely as you take away the dry food and switch to a low carb canned food as often times just getting rid of the dry really makes a difference in their BG numbers. Most of us use Janet and Binky's food charts to determine which canned foods are low carb and are acceptable to feed your kitty. Here's a link to those food charts:
Janet and Binky's food charts

We also recommend you closely read all the "Stickys" at the top of our forum. They contain very important information on dosing, on the protocol we follow, etc. It is possible that what you are seeing from Lilly with the 251 is a "bounce" from lower numbers that she is not used to. When the liver senses these lower numbers, it releases glucagen and counterregulatory hormones into the system thus bringing up the BG numbers. I'm assuming you did not shoot this morning with the 190? That was a smart decision since you don't yet have the data to shoot a number like that. Here's some info about shooting lower numbers than you are used to:

There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Click to expand...

I've given you alot of information to start with. I think some of the folks who know alot about dosing would probably like to see a SS and I'm hoping one will come along to give you some suggestions on Lilly's dose in consideration of the dry food factor. While her dose looks fine in terms of the nice nadir she is getting, if you pull away the dry, it might be too high of a dose so it's important we get some other more experienced eyes on that for you.

Please let us know any time you have questions so we can help. There's almost always someone around 24/7 who can help out....we are a very close support group. Glad to have you with us!
 
Welcome Michele and Lilly! Marjorie has given you some great information to start with, and Lilly is giving you some very nice numbers already!! Her little ears will get used to all the pokes. One little tip to help reduce the bruising is to apply gentle pressure the poke area right after getting the sample. I just hold a piece of tissue over Trixie's poke while the meter counts down, and it helps tremendously. If you were able to take you to a flower sale and still get successful tests in, it sounds like she is a very easy going kitty!

I'm sure more experienced folks will come along to help with your dosing question. Believe me, we've all been where you are now, so keep asking questions, and keep up the great work!

Amy & Trixie
 
Welcome! I'm sure one of our more experienced dosing advisors will be along soon to answer your specific dose-related questions. Lilly has a beautiful curve going for a newly diagnosed cat! If you haven't done so already, please read the stickies at the top of the forum. There is a great deal of valuable information to be found. In particular, you'll find the tight regulation dosing protocol that virtually all of us follow here. there is also great info on lantus itself... how it works, how to handle it, etc.

There are several factors, any combination of which could have led to Lilly's higher numbers.

1. Dry food. Unfortunately, continuing to feed any amount of dry food will hamper your ability to regulate Lilly properly. It doesn't raise BG levels right away, but when it does, it sticks around in the system for awhile. She likely did see an increase off both the dry food. You can definitely leave wet food out during the day. Some folks use automatic feeders, I personally let Willie graze, and just mix his wet food with some extra water which will keep it from drying out while I'm gone. If he is getting raw food that day, I put the food in glass bowls and keep it on long-lasting ice packs to keep the temperature appropriate. If you eliminate dry food, I think you will find more stable, consistent numbers. However, before doing so, please discuss with our dosing advisors. Eliminating dry food can have a significant downward effect on BG#s, and with Lilly already hitting the 90s mid-cycle, you may need to decrease the dose before taking away the dry food altogether.

2. Shooting an hour late. Life happens, we all know. :-D For me, it was an hour and a half line at a trendy new food truck on Friday night which led me to have to do the same. Whenever you shoot late, Lilly's body will treat it as the equivalent of a decrease in her dose (and early shots are treated as an increase).

3. Bouncing. One other variable... the 251 could also be part bounce. When cats first go on insulin, their bodies are unable to properly assess what "normal" blood glucose levels look like... their livers now interpret high numbers as normal. So when numbers go lower, the liver panics and releases a form of stored glucose and hormones that will raise the BG to what it thinks of as normal, and thus the numbers "bounce" upwards. It can take up to 72 hours for a bounce to clear, and it is a normal (if at times incredibly frustrating!) part of the process. As Lilly's body grows more accustomed to more normal numbers, her liver will react better, and the bounces will be less severe and last for shorter periods of time. This is why spot checks are important when hometesting, because it allows you to see how Lilly is handling the insulin, and it allows you to determine if she is high because she is bouncing, or if there is some other potential cause. The more data you have, the more informed dosing decisions you can make.

4. Lilly is a cat. 'nuff said. :lol: :lol: :lol:

Once again, welcome to lantus land! I look forward to learning more about you and Lilly.
 
One more thing... low carb treats make poke time go MUCH easier. Freeze dried chicken and bonito/tuna flakes are two popular choices that will not affect Lilly's BG#s. If you're going with the chicken, check out the dog treat aisle... Purebites is one brand that uses the same formula for dogs and cats, but the dog ones are much more affordable, and the bag lasts much longer!
 
And I also want to add for her ears: make sure you are poking at the edge and not the vein AND you can get Neosporin Pain Relief OINTMENT (not cream) to put on her ears after you poke. That not only helps with the soreness but it will also help pool the blood next time you poke and it keeps their ears a little softer.
 
I just wanted to pop in and say "welcome." You are doing a great job getting curves and numbers. I don't have a lot of dosing advice for you, but wanted to say hello. Hope to see Lilly react quickly and nicely to her insulin. Great job cat mama!
 
I, too, just wanted to welcome you to LantusLand. I've been able to stay sane with the help of all the wonderful people here. They are truly amazing. You'll find that the dosing experts here are far more knowledgeable than your own vet concerning feline diabetes, mainly because vets don't see many diabetic cats while our dosing experts have been dealing with their own (and others) diabetes cats for years. Sienne and Libby, just to name two, are so knowledgeable about feline diabetes; what to expect, what to do, when to increase or decrease doses, etc.; that I rely on them to help me manage Champ's diabetes, not my vet....and my vet agrees!!!

If you look at all of our signature blocks at the bottom of our posts, you will see a link to our spreadsheet for our cat. You might want to look at several so you can see what we are each experiencing. It has helped me tremendously to look at other cats SS's so I can compare what's going on with Champ at any given time.

Again, welcome. You'll come to depend on this site, I'm sure.
 
Welcome Lilly and Michele!

Can't wait to see Lilly's spreadsheet and her picture!

Keep up the good work! I think Lilly's numbers look good so far!
 
Welcome to Lantus Land!

Here's the link to your first post on Health and the background you provided about Lilly.

I suspect you will find managing Lilly's diabetes will make a great deal of sense to you given that you're a diabetic. You don't happen to use Lantus, do you? As others have noted, a spreadsheet is a very useful tool in helping you to keep track of your cat's test data. Since I'm not sure what you do and don't know, I'd suggest taking a look at the starred, sticky notes at the top of the Board.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.

I think Lilly's numbers look very good. I do suspect that the 251 could at least in part be influenced by the availability of dry food. For those people here who have kitties that free feed, they still leave out canned food. I'm hoping that the Purina that you're feeding isn't DM. It's a very poor quality food.

As for lowering Lilly's dose, if you look over the Tight Regulation Protocol, you'll note that based on that protocol, we don't suggest lowering the dose unless a newly diagnosed cat's numbers drop below 50. I suspect that if you remove the dry food, you will see even better numbers, or at least the flat curve that Lantus is known for. However, it's also important that you have high carb (i.e., gravy-type) food in the house as well as a good supply of strips. These are tools, along with your glucometer, that give you very good control over Lilly's numbers.

Please let us know if you have questions. We're here to help.
 
Hi, welcome- you've received some great advice. The people here are fantastic. They've hand hands on experience working with every situation, so ask questions- they have a real investment in education, and their knowledge is vast.

When I first started I was also on dry food, and transitioning to wet dropped the BG levels significantly (even though our dry food was low carb), so as you make the transition from dry to wet, make sure you monitor closely- you may start to see a change in the numbers.
 
I'm glad Sienne linked your first post so I could read all your info. You got a lot of good advice about testing his ears. I've found that Champ will actually sleep through me testing him now, with just the slightest opening of one eye. I notice one person told you her cat would do anything for a Temptation treat. Well, please, please, please do not give these to your Cat. They are so high in carbs. Champ was completely obsessed with these treats, had to have them every night as a snack, until he was diagnosed with diabetes. Now, he absolutely loves freeze-dried chicken breast, which he will inhale, or, what I've started doing (cuz it's cheaper and cleans his teeth at the same time) I give him parboiled chicken breast (boiled so it's still raw on the inside). I give him a few pieces of chicken breast and he's so engrossed in that, he doesn't even care that I'm messing with his ear. Making sure the ear is warm is the most important part of testing. If it doesn't feel really warm to the touch, you won't have good blood flow and will end up having to poke him multiple times...hard on you and the kitty.
 
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