Please advise: BG monitoring and Lantus amts for free feeder

[FeelingMN]

Hello,
It's been a few weeks since my first posts and we're slowly getting into the swing of things. There have been a few bumps with Levon, who is making it his mission to keep me on my toes. Now that I'm getting better at the BG monitoring and administering insulin (Lantus), I am looking for some specific advice.

AMPS and PMPS readings: I've read on posts here on the board that most take the AMPS and PMPS when the cat hasn't eaten for 2 hours. They take the reading, then feed and administer insulin.

I'm not sure this approach will work for my free feeder. His GI tract is so touchy and it's been so hard to get him to eat at all, that I just don't think that I will ever be able to get him on a meal schedule. He truly picks at his food throughout the full day. It's not unusual to hear him at his food dish at 4 a.m. picking at the last of his p.m. meal. I cannot take his food away -- even hours after his meal time, as he has only eaten a quarter to a third of it (and I wouldn't be around in the day time anyway). It is not realistic for me to remove the dish -2 hours from AMPS and PMPS, as I am at work or asleep at these times.

If he's on a slow acting insulin like Lantus, is it OK to just take his AM and PM PS readings, and not be overly concerned about whether or not he has recently eaten? Even if he has just eaten, it surely wouldn't be much, as he never "scarfs" his food. He eats just a tiny amount at any one time before he wonders away from his dish.

As you can see from his sheet, he is still very much unregulated. At the advice of his vet, I increased a.m. insulin to 1.5U, but this seems to be too much, looking at his p.m. numbers. I'm going to give it a few more days, and perhaps attempt a curve. If his PMPS numbers are low, how low is too low to shoot? I've been following the advice of not shooting below 200, but if he were in the high 100s to low 200s range in the p.m., should I consider giving him .5 U to get him through the night?

I'm kind of at a loss as to where to go from here, his nadir seems to be very, very late in the day. I assume this means he's getting too much in the a.m....but what's next? Do I ask the doc about going back to 1U BID?

Thank you, thank you. Because of all the great advice on this board, picky ol' Levon is eating better each day, and we've been able to nip some nasty tummy troubles in the bud.

 

[dirtybirdsoaps]

Re: Please advise: BG monitoring and Lantus amts for free fe

Hopefully someone with more info on Lantus will post soon, but from what I have read from other posts is with Lantus you have to stick with a dose for several days and it seems your bouncing back and forth between 1 unit and 1.5 units. You need to find a happy number that you can stick with twice a day at the same time everyday. You have several nights where your too low to shoot and then during the night he's bouncing up, and its starting all over again.

As to the issue with the food, I'd assume as long as he doesnt eat a LARGE amount before you test bg you should be ok.

 

[Tisha's_Person]

Re: Please advise: BG monitoring and Lantus amts for free fe

According to my vet, it's okay if your cat has eaten within 2 hours of getting his pre-shot sugar levels. We also have a free feeder and were worried about this issue. It is, however, very important to make sure he eats at least 2 tablespoons of food prior to the Lantus injection. Our vet said that 2 tablespoons can be within an hour or two of the shot, but certainly no more than that. We don't give our cat her shot unless she's eaten within the last hour.

For dosing advice, I will defer to those with more experience, but I have been told that it is very important to give the same dose 12 hours apart for at least 3 days before you change doses. Tisha has had a similar pattern with Lantus, and one of the more experienced members suggested reducing her dose by .5 units, but again, I would defer to those who have more experience.

 

[Barb & Mr. Frog]

Re: Please advise: BG monitoring and Lantus amts for free fe

Hi, I'm not a lantus user, but I have learned a few things about it here. Lantus is a depot insulin, the dose is based on the nadir more than the pre-shot numbers (typically somewhere between 5-7 hours for most* cats) so if you want to find out if the dose is too much (or too little), those are the tests you need to aim for getting in addition to the pre-shot values. With lantus, the idea is to find a dose that you can always give the same amount, with a nadir in high two digit, or low three digit numbers. I would tend towards agreeing with you that 1.5 is probably too much based on what I can see, although, as I said, the nadir is the value you really need to know to be sure of what is going on.

I personally think, as long as you are sure he IS eating, that it isn't a big problem for him to eat before the pre-shots (or not eat). What I do is just keep an eye on the food bowls and if I see frog eating within that two hours before his shot is due, I just mentally keep note of it and don't adjust the dose if it is higher than I would normally expect (since I know it is food related)
In your situation you wouldn't adjust your dose anyway, since lantus and prozinc work a bit differently, but the charts are for tracking trends, not exact numbers, so if you just note that he had food prior to a particularly high number or something, it still gives a good picture.

On the insulin, shooting below 200 is ok ... AS LONG AS you have the data and know how your cat will respond to a given dose, so you really need to try and get some nadir tests in, even if not every cycle. It doesn't need to be a full curve, just get some numbers in the middle so you can see what each dose actually does. Try not to skip or alter your dose randomly with lantus, it is a very long acting 'depot' insulin (it works for longer than your 12 hour cycle, so the doses basically 'overlap'). There is a lot of information in the lantus forums, if you haven't checked out the stickies over there.

 

[RobinCot]

Re: Please advise: BG monitoring and Lantus amts for free fe

I agree with Barb that if you have a sugar cat who is not eating well, then those circumstances should be considered when studying your PS numbers. With Lantus, you do want your sugarcat to eat soon after their shot so they don't go too low during the onset of insulin. As a depot insulin, Lantus needs six cycles (or three days) on a dose to settle. My sugar takes longer - like 8 to 10 days on one dose to see if it is a proper one for him. We usually start a Newbie on 1.0u twice a day and then up incrementally by .25 if the nadir range is still high. I see you have dropped back to 1.25u. So let's sit on 1.25u for the next few days and consider getting some mid-cycle numbers. We don't consider dosing changes based on PS numbers, but on the nadir number which with Lantus is anywhere between +5 and +7. Can you get some mid-cycle numbers in the next few days?

It does take a while for some sugarcats to get regulated. It took my Alska about a year so put on your patience pants and lets keep an eye on Devon's numbers.

 

[FeelingMN]

Re: Please advise: BG monitoring and Lantus amts for free fe

Yes, with the US holiday weekend, I should be able to do some mini curves and see where he's really at.
Thanks for the advice.
He's getting more and more testy about the pokes, which is a good sign...he must be feeling more like his old self.

 

[Hillary & Maui (GA)]

Re: Please advise: BG monitoring and Lantus amts for free fe

OK - I didn't read your whole post... :shock: however, I'll tell you that Maui was free fed too and I didn't go by the 2 hour no food rule at all. I let her eat when she wanted and the amount she wanted.

I tested her throughout her cycles and didn't get concerned if any of her BG tests had food in them. Hopefully that will help put your mind at ease about the 2 hour rule. it's really more of a guideline than a hard and fast rule. You do what is best for your cat and with testing, you will know if it is safe to give insulin.