Paw 202 pm, Now what?

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Looks like you've had a number of skipped pre-shots, yes?

What you want is a dose you can give every 12 hours - 1.25 appears to be too much. From the last 4 days with apparent skipped shots, I'd say token dose of 0.5 units.

Has anything else been happening?

Can you try to do a curve this weekend?
 
Also really important: Lantus dose adjustments are generally made based on the middle cycle lowest number, the nadir. Please read the Lantus stickies thoroughly.
 
BJM said:
Also really important: Lantus dose adjustments are generally made based on the middle cycle lowest number, the nadir. Please read the Lantus stickies thoroughly.
Click to expand...

I know, I know, I know! With 4 kids (one only 3 months old & still nusing constantly 24/7) and now a diabetic cat, I am EXHAUSTED!! and haven't been able to do any more BG's than what I've charted. As it is our shots & feedings are around 11am & 11pm which is probably too late as I'm reading their #'s decrease at night naturally.

1u didn't seem to quite do it & at 1.25 it seems to be a little much (here I was thinking this was probably our magic number). Our morning #'s are great w/a 1.25 PM shot though, we're just going a little higher than I'd like to see at night with no AM shot.

I can try to get a curve in this weekend (zombies seem to be in right now anyway :mrgreen: ) I can give the 1/2u now as you've recommended, just afraid of having a hypo cat on my hands later!
 
tarams said:
... I know, I know, I know! With 4 kids (one only 3 months old & still nusing constantly 24/7) and now a diabetic cat, I am EXHAUSTED!! and haven't been able to do any more BG's than what I've charted. As it is our shots & feedings are around 11am & 11pm which is probably too late as I'm reading their #'s decrease at night naturally.
Click to expand...

Can you get any help with the kids? Or, can you maybe get a high school student interested in vet tech/med to come learn how to help with testing?

tarams said:
... 1u didn't seem to quite do it & at 1.25 it seems to be a little much (here I was thinking this was probably our magic number). Our morning #'s are great w/a 1.25 PM shot though, we're just going a little higher than I'd like to see at night with no AM shot.

I can try to get a curve in this weekend (zombies seem to be in right now anyway :mrgreen: ) I can give the 1/2u now as you've recommended, just afraid of having a hypo cat on my hands later?
Click to expand...

Would it help to use some of the secondary monitoring tools in my link? For example, if you measure the water you put down each morning and subtract the water remaining the next morning, you can calculate mL of water drunk (plus some evaporation, of course). This is one of the measures which can be used for a non-blood testing protocol for fractious cats written up by Dr Rand.link3.pdf (look at bottom of file)
 
Generally, we have all of the 5 P's - he is urinating so much less than before insulin, he's happy to be out with us instead of lying on the floor near his water bowl or near his litter box, he's purring every night (although he never stopped), he seems to be gaining weight back, & overall I'm pleased that we're doing so much better. Just can't get this regulation thing down yet!
 
You've been giving insulin for less than a month. You're only adding to your stress by expecting to achieve regulation in a very short period of time. If nothing else, Lantus will teach you patience! It also helps to remember that it's Paw that is leading in this sugar dance.

I think what BJ is suggesting is that if you are frequently needing to skip a shot because of a low pre-shot reading, it may make sense to lower the dose so you can consistently shoot twice a day. You might want to think about going back to 1.0u. Lantus works best when you are able to give the same amount of insulin and shoot at the same time daily. Getting spot checks (at least one in both the AM and PM cycles) will also help you know if your dose is effective.
 
Thank you :) I'm afraid to give 1u right now with his #'s being so low in the am. When we were on 1u it didn't seem to quite be enough. But you're right, Paw leads this dance! Will have to see what he does, I imagine we'll be back to 1u within the week. Thanks so much for replying, I appreciate all of the help everyone here offers!
 
If you feel like 1.0u is too much, then shoot 0.75u or whatever makes you comfortable. The strategy is to be able to shoot the same amount twice a day so that you don't have to keep skipping shots. (The only caveat is if Paw has a history of ketones, then you need to make sure you are giving enough insulin.)
 
OK, I see you went back to 1 unit.

Next challenge - hold it steady for at least 3 days unless
a) you test below 50 at mid-cycle or
b) see evidence of hypo behavior or
c) you have to skip more than one shot due to preshot tests below 200; having to skip suggests reducing the dose is warranted, unless there is an obvious reason for the low level (ex vomiting, not eating)

If a pre-shot is between 150-200, you can follow the suggestions in STICKY: LANTUS & LEVEMIR - SHOOTING & HANDLING LOW NUMBERS

And remember - in general, no dose changes unless they are based on the nadir test values.
 
Re: Paw 168 now

Yes, a higher AM read made me feel better about giving 1u today :) And we got to monitor some today too! Only now it's time for PM shot & we're at 168 which makes me nervous about giving anything incase he drops too low overnight. What would you do?
 
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