Please Help regarding Mercedes

[danielle]

I started the lantus at 1 Unit this past Sunday and my cat merceses sugars have been very high. This morning before insulin it was 500's so I decided to give him an increase to 1 1/2 units. This evening it was in the 300's but I also stuck with 1 1/2 Units. I've read over all the notes about starting slow going slow however since I started the lantus his numbers went up?? I am a little concerned if I am giving him to much or to little. Please help

 

[Marje and Gracie]

Hi Danielle

Welcome to Lantus and levemir land. I read back through your other posts and see you were given the information on Start Low Go Slow and Tight Regulation. It sounds like you prefer to do SLGS? If so, if you can just put that in your signature block, that would be great ...that way you get the correct dosing advice.

It's very important for us to see a Spreadsheet. It's difficult to advise just based on a couple numbers here and there mentioned in a post. SLGS does have you holding the dose for at least a week unless numbers drop below 90 mg/dL.

If you are able to do the SS, that would help very much. If you are having problems creating one, please send me a private message and I'll do it for you.

 

[phlika29]

Hi

It can take a whole to get the numbers under control but it is important you don't panic but just follow the chosen protocol. Have a look at @manxcat419 her kitty rosa took a while to drop from high.

Dosing is adjusted based on the lowest that blood glucose falls during the cycle so although the readings might be high before each shot of insulin have you managed to get any mid cycle readings to see how far Mercedes is dropping.

Hold the dose for at least a week

• Unless your cat won’t eat or you suspect hypoglycemia

• Unless your kitty falls below 90 mg/dL (5 mmol/L) if kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit

• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose

• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

• As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Can you get some more mid cycle readings this weekend ?

If you can fill out the spreadsheet that would help people to advise. See link below.

http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

 

[manxcat419]

Hi Danielle and welcome. I'm actually about to go get some sleep as it seems Rosa's giving me a night off from having to monitor right through until +8. But please do take a look at her spreadsheet - and if there's any information you think I might be able to help you with, let me know and I'll get back to you in the morning.

I do understand only too well how frustrating it is when it seems like things are going from bad to worse over the first week or so, but things will improve and you will get those numbers under control - if Rosa can do it after starting out with a BG of 680 then Mercedes can do it too!

 

[Sienne and Gabby (GA)]

Welcome to Lantus/Lev land!

I want to jump on the spreadsheet bandwagon. Not only does it help us to help you with regard to any trends in numbers and dosing, it also will allow you to see the progress Mercedes is making. If you need help, please let us know. Marie is great at helping get spreadsheets set up.

It can take 5 - 7 days for you to see much of an effect when you're starting Lantus. This is because Lantus (and Lev) are depot-types of insulin. It can take up to a week for the depot to form. If you've not already done so, I'd encourage you to read the sticky notes at the top of the board. There's a huge amount of information there and it will help with regard to allowing you to have an understanding of how this kind of insulin works.