Putting my kitty Casey back to 1 unit...

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ohiogal

ohiogal

Member Since 2012
...after my vet told me to put her on 4 (up from 3 in December), but NOT to change her high-carb diet which included a low-residue dry food to treat her constipation.

Here's a link to the original thread I posted in the Health forum:

viewtopic.php?f=28&t=62256

Any tips or tricks or thoughts are appreciated, thanks!! Casey's spreadsheet is linked below.

Sarah B.
 
Good Morning, Sarah & Casey ~

When you get a chance, Sarah, could you give us a quick update on a couple of things (and I did read through your original thread on Health): 1) Is Casey now totally off the dry Iams low residue food and eating only low carb canned food? 2) Are you using Miralax now and no Lactulose?

One of the hard things about treating our cats, your cute Casey, with Lantus is getting higher numbers after bounces and then having to wait out those bounces. At the 1.0U dose, you're starting to get more lower yellow numbers for Casey which her liver senses as too low since Casey has been in higher numbers for a while. Her liver responds by converting stored glycogen into glucose which is causing a rise in Casey’s bg numbers. Here on FDMB, we call that a bounce, and it can take up to 72 hours for a bounce to clear, not always so long since ECID (Every Cat Is Different). Sarah, you need to wait out that bounce to see how the 1.0U dose is working for Casey.

Casey had a yellow AM preshot number on 1/30, and it’s possible that she had a lower mid-cycle number, too, but we don’t know that. That higher AM number today is likely a bounce off the lower numbers yesterday. My suggestion would be to hold the 1.0U dose for a couple more days, allowing the bounce to clear, and then make a decision about whether or not a dose increase is needed.

Let's see what some other Lantus members have to suggest/recommend.

Thinking of you and Casey this morning, Sarah. I used to live in Dayton, OH, many years ago...I really like Ohio.

Eva
 
Besides the questions that Eva posed about diet. Are you testing at the time of her shot for those amps and pmps or are you testing before you feed the hour before hand?

If you are feeding and then taking a reading an hour later that is why you are seeing the higher numbers on the preshots. The order should be test, feed, shoot and all should happen within about 15 minutes. A lot can change with a kitty in the space as small as 30 minutes. And if you are feeding an hour before and then testing you are looking at a food induced number.

It looks like at this point Casey is still bouncing a lot when she hits those 200s, some cats take longer to settle into a dose and stop bouncing like they think they are part superball. Musette is the Queen of the Bounce, it takes her a good couple of weeks to finally decide what she is going to do with a set dose. Plus Casey has an awefully big shed right now to drain so some of those bouncy numbers could be part of the shed still kicking in as it drains. Just like it takes a good week to fill her shed it is going to take awhile to drain off too and stop influening that 1u dose.

If Casey was my Musette I would continue to hold at that 1u for a couple of weeks and then when you can run a full curve on her and go from there, she may need more insulin and she may not it is really hard to tell at the moment because she is still fighting through that enormous shed draining which is giving her the effect of somewhere between 1u-3u instead of just a straight 1u that you are giving her now...just going to take a little patience to see where she finally settles in on this dose.

Mel, Maxwell, Musette & The Fur Gang
 
Hi all,

To answer the questions: Yes, Casey is on an all-wet-food, no Iam dry food diet; and yes, she's off the Lactulose and on the Miralax. My vet doesn't know I'm doing any of this.

Regarding the feeding - the thing is, I usually feed the kitties around 6 p.m. when I get home, and around 7 a.m. when I wake up to go to work. Therefore, if I dose Casey when I feed her, it won't be a solid 12-hour cycle. Would that be OK?

My other choice is to wait until 7 p.m. to feed them at night (try telling 2 hungry kitties they're not getting supper when they expect it!) OR get up at 6 a.m. to dose in the morning (I wouldn't trust me groggy with a needle.) Any suggestions?
 
Oh I know the pain of telling hungry kitties that dinner will be late! When we first adopted our two diabetics I had to tell 11 cats that not only had they just gotten a new housemate, that food would now be delivered on a schedule. Now 3 of those that I had to break this news to are Siamese! Hungry cats are bad enough but hungry siamese are like wailing sirens.

But you know what ....they lived through it, we all survived and it didn't take them very long to figure out that meals now arrive at 7am, 1pm, & 7pm. Yes, at first it was rough listening to them tell me that I had obviously forgotten how to tell time, because it was past their meal time and their dishes were still empty.

You are going to get truer preshot values if you can test, feed and shoot all together. Right now that isn't terribly important since your preshots are so high, but once Casey starts coming down into the lower numbers, it is going to be critical to have true fasting preshots, because you don't want to get say a 215 on a pm preshot an hour after she has food in her tummy and think it is safe to shoot, when in fact she was only at 150 before the food, so when the food wears off, and the insulin kicks in it drops her Bloodsugar like a stone and you end up with a kitty trying to hypo at night.

You may have a couple unhappy cats for a few days until their tummy clocks reset but if you can move it so that they are getting fed at the same time as Casey's shots you will be getting much better readings on how safe she is to given insulin to.

Mel, Maxwell, Musette & The Fur Gang
 
OK - but here's what I'm doing now:

When I get home, before I give Casey anything to eat, I do a BG test. So I know what her number is before she has food in her tummy.

Then I feed her; and about an hour later (or whenever 7 p.m. is), I give her her shot.

So, that's wrong? As long as I know what her pre-feeding BG is, what difference does it make when I actually give her the shot? Is there a reason it has to be within 15 minutes of feeding, etc.? My understanding was that as long as you knew what the level was before she ate, you were OK...of course I also take her BG right before I give her her shot, but in the evening I expect to be higher because she just ate a while ago.

Also - do snacks count as eating? I can hold off giving dinner until 7 if I have to, but I don't want to think about me trying to get dinner for myself while telling my cats they can't have ANYTHING until 7 p.m.! And if I give Kennedy something, I have to give Casey something or she'll go after whatever I'm giving Kennedy and wolf it right down. Especially if she's hungry.
 
Hi, Sarah and Mel ~

In 2007 with our first diabetic cat, Willie, we did pretty much what you're doing with Casey now, Sarah. In fact, the times were even about the same. When I got home, I'd test her around 6 p.m. and then feed her. And then when my husband came home from work, he'd give her the shot at 7 p.m. (I was too nervous to do the injections then, but I've since learned... :smile: ). That seemed to work well for us. Often, my husband would retest Willie before giving her the shot, but not always. Willie's nadir (low point in the cycle) was fairly consistent at +6 and her +11 (without food) was close to her PM preshot number.

Don't know if this helps or not. With Butters, we test, feed, shoot....mainly because I'm not afraid to shoot him now.

Eva
 
Eva & Butters & 5 Others said:
Don't know if this helps or not. With Butters, we test, feed, shoot....mainly because I'm not afraid to shoot him now.

Eva
Click to expand...

Don't shoot him now! Wait 'til you get home!

Sorry. Looney Tunes fan. :smile:
 
Good Morning, Sarah & Casey ~

Love seeing that 272 for Casey at AM +10.5 yesterday, Sarah! Just stay the course with the 1.0U dose to see where it takes her numbers.

Enjoy the day,
Eva

P.S. How's the Miralax working for Casey? One of our nondiabetic cats has megacolon and has been on a high dose of Miralax safely for a few years.
 
Eva & Butters & 5 Others said:
Good Morning, Sarah & Casey ~

P.S. How's the Miralax working for Casey? One of our nondiabetic cats has megacolon and has been on a high dose of Miralax safely for a few years.
Click to expand...

So far so good with the Miralax! She pooped yesterday afternoon, it looked normal except for being very dark, which I assume is a side effect of the Miralax. I bumped her up to 1/4 tsp mixed in with 1 can of FF and LOTS of water. She loves it!

Speaking of FF, is there anywhere to get coupons for the 24-packs? I'm going through 4 cans a day between the two kitties, and at $13 a case this is gonna add up pretty quick!!
 
I'm sure there are coupons for Fancy Feast as well just never looked for them, but I can usually buy coupons for Friskies off Ebay pretty cheaply.

Mel, Maxwell, Musette & The Fur Gang
 
"Speaking of FF, is there anywhere to get coupons for the 24-packs? I'm going through 4 cans a day between the two kitties, and at $13 a case this is gonna add up pretty quick!!" -- Sarah, we used to buy Fancy Feast coupons on Ebay. Haven't done that in a while, but you might want to check there. Do a search for "24 cans Fancy Feast coupons" or something like that to see what's available. Just be sure it's a reputable seller.

Our cat, Bob, has been taking 1 1/2 teaspoons of Miralax every day for the past three years with no problems. Bob has megacolon. Surgery was being recommended for him in 2008, but we thought that was extreme and found out about Miralax instead on the Yahoo Feline Megacolon forum. Miralax is called Miraclelax on that forum for the way it helps constipated cats. :smile:

Eva
 
Eva & Butters & 5 Others said:
Mel, I see that you've mentioned Ebay, too. Was typing and just got a chance to post. :-D
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:-D Thanks for the advice, everybody! I see some eBay shopping in my future...

OK, I've had Casey on 1 unit for a week and her numbers have come down, but not by enough. Since I can be home tomorrow to do a curve, I'm going to try 2 units tomorrow and see what happens. I'll keep you all posted!
 
Good Morning, Sarah & Casey ~

I admire your patience, Sarah, in waiting a week on the 1.0U dose for Casey. And I agree that it's time for an increase in dose, but I'd suggest moving Casey up to 1.5U instead of 2.0U. We like to do increases in smaller increments than 1U to avoid bypassing a good dose for Casey. Let's see what other members suggest, too, Sarah.

Have fun eBay shopping...just not too much fun :-D .

Eva
 
I also agree that it is time for an increase, but with Lantus you want to raise slowly by either .25u or .5u at a time. So that you don't go by the right dose, a little bit of this stuff goes a long ways. You don't want to raise by whole units at a time, because while it feels like you are just adding another unit you are in fact by going from 1u to 2u doubling the dose.

It also looks like Casey has a late nadir so looking at her lowest point in her cycle I would only raise her by .5u which is still a 50% increase. Go slow doesn't only stand for how fast we raise a dose over here but also how much we raise, we raise slowly by small amounts to make sure we don't skip over the ideal dose. And even by raising by only a .25u or .5u we can still miss the ideal and have to go back and fine tune it once we get in the ball park by adding or subtracting amounts as little as a drop at a time.

Mel, Maxwell, Musette & The Fur Gang.
 
Thanks, everybody! I tried 1.5u this morning (although I had to eyeball it, since my syringe doesn't have 1/2u measurements), so we'll see what happens.

ETA So far so good! She's down to 267 from 336 at +2.
 
Hi, Sarah ~

Glad you're going to give the 1.50U dose a try for Casey. You'll need to hold that dose for a week or so to let it settle in, fill the Lantus depot/shed, and then you'll be able to see how it's working for Casey, Sarah.

Oh, and one thing I forgot to mention earlier, Sarah: If you want to run a curve to see how well a new dose is working, you should let that dose settle in first. For example, after you have Casey on the 1.50U dose for 5 days or so, then running a curve can tell you more about how that dose is working.
"Since I can be home tomorrow to do a curve, I'm going to try 2 units tomorrow and see what happens."

Eva
 
[quote="Eva & Butters & 5 Others] "Oh, and one thing I forgot to mention earlier, Sarah: If you want to run a curve to see how well a new dose is working, you should let that dose settle in first. For example, after you have Casey on the 1.50U dose for 5 days or so, then running a curve can tell you more about how that dose is working.[/quote]

So are you saying to not do a curve on Casey today? The next day I can do a curve is this coming Saturday, since I work full time during the week.

Of course Casey would be happy if I didn't poke her ear today! And it'll save me some BG strips. I can do either (although I'll be out of the house this Saturday night, so won't be able to do PM curves). I bow to the wisdom of this board. :-D
 
Hi, Sarah ~

You could do the full curve today testing every two hours or a mini-curve testing every three hours if you want to. What I meant is that a curve today isn't going to show the full effect of the dose increase to 1.50U, Sarah. I think what I'd do is run a mini-curve today to get more bg data on Casey and then a full curve after she's been on the 1.50U dose longer...next Saturday maybe.

Let's see what others suggest, too.

Eva
 
OK, I'll do a mini-curve today and do a full curve on Saturday.

As an aside: I'll be leaving the apartment at about 5 p.m. on Saturday, and won't be home until probably about 10. What should I do about Casey's shot? She usually gets it around 7 a.m. and 7 p.m.
 
Hi Sarah!

Not sure if I've already posted a hello --- so HELLO! I've been following your thread with Casey - you're doing a fantastic job! I agree with Eva that you should wait til next week for the full curve, especially since you just raised the dose today. You may notice a change in numbers today, but it wont give you an accurate picture of how the dose is working as it takes a couple of days for the dose to settle. That being said, definitely do a couple of checks to see where things are going - always good to know that.

I'm super interested to see what the answer is to your question about Casey's shot next weekend. I have a wedding coming up and will be leaving around 5-ish (Kit's shot is at 7pm)...and not sure what to do either.

Hope you enjoy your Sunday!
 
Hi, Sarah and LIL ~

You've asked an interesting question about needing to shoot 2 hours early. I've had to shoot late, but never early. I do know that shooting early is like a dose increase, and shooting late is like a dose decrease.

One of you might want to start a new topic with "Need to shoot Lantus 2 hours early" or something similar so that your question doesn't get lost in this thread. I'd like to hear what other members have to say about this, too. Maybe Mel could answer this for you both.

LIL, I think you're going to need to be particularly careful since Kitten has late nadirs, something you might want to mention in the new discussion.

Hope you're both having a good Sunday afternoon.

Eva
 
There are two ways that I know of for moving shot times earlier, moving them later is so much easier than earlier..lol

But to move it 2 hours earlier and you will have to plan this one out, is to either give each shot 15 minutes early until you get them backed up to where you want them, or giving 1 shot per day 30 minutes early.

So if you need it to be two hours early on Saturday you would have to start moving it back to that time on Wednesday. So Wednesday instead of shooting 9a/9p you would shoot 8:30a/8:30p, then on Thursday it would be 8a/8p, then Friday at 7:30a/7:30p which would get you to 7a/7p on Saturday. Or you could move each shot only 15 minutes at a time but both methods get you where you need to get, I just find it easier to remember to move the time once each day by 30 minutes at a time.

Mel, Maxwell, Musette & The Fur Gang
 
Thanks, MoM! I appreciate the info! :-D

Just took Casey's BG at approx. +11 (before I gave her anything to eat, after being at work all day) and was shocked to see it was 460. Can't imagine how her BG got so high! Maybe I missed with the shot this morning? I didn't think so, but yikes. She was also acting like she was STARVING hungry, meowing desperately as soon as I walked into the kitchen like she hadn't eaten in weeks. I went ahead and fed her, but it's odd - she hasn't acted that hungry in a long time.

Oh well! Guess I'll just keep on the 1.5u course and see what her BG is tomorrow morning.
 
Hi, Sarah ~

If your morning shot yesterday wasn't a fur shot (which we've all done, by the way), then it's possible that Casey had a lower number during the day causing her to bounce into that higher 460 at AM +11 and 500 at PMPS. Just stay the course with that 1.50 dose, Sarah, allowing the bounce (if it is bounce) to clear and waiting for a breakthrough in Casey's numbers. I know seeing those higher numbers for our sweet kitties can be hard to take, Sarah, but with a new dose, we need to wait it out and give that dose a chance to work.

You're still checking Casey for ketones, aren't you, Sarah?

Hope you and Casey have a pleasant day.

Eva
 
Eva & Butters & 5 Others said:
Hi, Sarah ~

If your morning shot yesterday wasn't a fur shot (which we've all done, by the way), then it's possible that Casey had a lower number during the day causing her to bounce into that higher 460 at AM +11 and 500 at PMPS. Just stay the course with that 1.50 dose, Sarah, allowing the bounce (if it is bounce) to clear and waiting for a breakthrough in Casey's numbers. I know seeing those higher numbers for our sweet kitties can be hard to take, Sarah, but with a new dose, we need to wait it out and give that dose a chance to work.

You're still checking Casey for ketones, aren't you, Sarah?

Hope you and Casey have a pleasant day.

Eva
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Hi Eva, Butters, et al! :-)

Thanks for the encouragement - Her numbers were lower this morning, we'll see what they are this afternoon! And yes, I am testing her for ketones, once a day after I get home from work, nothing so far! I'll keep y'all updated.
 
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