Question about Consistant Dosing of Insulin

[oreosmom]

Hello,

I am new to this section and just learning, so please bear with my ignorance on this subject. Our vet doesn't believe in frequent testing and we feel it is the only way we can manage this disease responsibily. That being said, our cat Oreo is having lower numbers recently. Our vet said to keep him at 2. units of Landus consistantly. We saw his numbers start falling to the low 100's and 80's so we felt it was important to drop the dose a little. One night his BG was around 80 so I really couldn't give him two units and feel safe. Our vet's belief is that when you feed the cat, it will make up for the drop in BG. How can I know how much the food will bring the BG up? Basicly the vet is saying just hang around and keep the Karo syrup at hand. I have another life too and don't want to be in the house 24-7 , nor do I want to risk hypo. Have I been doing harm dropping the dose by 1/4 - 1/2 unit? I would love to get your input. ( by the way, Oreo is on Prednisilone for GI Lymphoma)

By the way, I am amazed at how much you all know about Feline diabetes. I am reading as much as I can and taking your crash course by reading your posts!

Warm Wishes,

Carol, Oreo's Mom

 

[Wendy&Tiggy(GA)]

Hello and welcome to LL!

Your vet doesnt believe in frequent testing?? You are right, that is irresponsible .... but its good that you have your head on straight! My vet said the same about the dose "feed and he'll be fine". I have had both cats have a hypo through that logic. It might make sense if you are free feeding high carb ( which i hope you aren't? please confirm food!!) but otherwise its dangerous to just shoot and not test and wait to see what happens. And who has the time to sit and wait for a hypo to happen.. you have a life too. Its safe and recommended to always measure preshot.

Anyway my rant over.. Are you going to follow our protocol? please read the sticky on our protocol, and shooting at low numbers. It advises on how and when to change the dose and what to do when you see a low number.

However I think the 2units right now look good on him so your vet is right about that at least. Your kitty isnt dropping that low to merit a decrease ( and not low for a hypo as far as I can tell)... we don't usually change dose unless he drops under 50 as his lowest number of the day (nadir) and I dont see that in your sheet. So if I were you I'd keep the 2 units for a few more days and try and get some more measurements in at times you havent done before - to fill in some blanks especially around +4 to +6. But always measure preshot. Also try and use just the one meter, many meters is confusing. And see how it goes. And keep posting and we will advise as to how to proceed further!

 

[Sienne and Gabby (GA)]

My name is Sienne and I'm a testaholic!

I suspect that you know you're preaching to the choir when it comes to testing. I suspect at some point, your vet may have suggested to people that they test and he met with resistance. At least that's what my vet told me when I asked her why she didn't take a hard line about getting people to test. Of course, you don't need to tell your vet how much you are testing.

I also suspect that your vet is used to his clients feeding dry food -- especially the prescription diabetic diet dry food which is very high in carbs. In all likelihood, the carbs in that food will offset the dose. However, even with lower carb foods, you get a food spike at +1. The problem with this approach is that is may be more accurate with the shorter acting types of insulin. With an insulin that has an early nadir, food may offset the drop in numbers. Lantus, on the other hand, is a long-acting insulin. It begins to work typically at around +2. So, by the time you hit what is the ideal nadir, it's +6 and unless you're continuing to feed throughout the cycle, you could be giving too much insulin. In addition, Lantus dosing is based on nadir. I suspect your vet is thinking that dose is based on the pre-shot numbers. The pre-shot numbers are more of a factor in dosing with the shorter acting types of insulin.

We try to work the dose up in a systematic manner. The initial dose of Lantus can be based on a formula: initial dose = 0.25 x ideal weight in kilograms. This usually calculates out to around 1.0u, give or take. By raising the dose in small increments, you are less likely to miss what can be a good dose for your cat.

There's really no way to know how much food will bring numbers up. There are a number of variables that are involved -- how fast numbers are dropping, where in the cycle the drop is occurring, how carb sensitive your cat is, what the carb count is in what you're feeding, etc. I also agree with you; you can't be chained to the house terrified that Oreo is going to have a hypoglycemic crisis.

If you're not comfortable with the 2.0u dose and/or if your skipping shots because you're not comfortable with shooting numbers in the 150 range, then lower the dose. You could easily lower your dose to 1.5u so you can shoot twice a day. Lantus does like consistency! If you are changing the dose regularly, it has an effect on the insulin depot and the depot never adequately stabilizes. It's best to have a dose that you're comfortable shooting twice a day.

 

[Blue]

One thing I noticed on your ss is that you are using diff meters.... the AlphaTrak animal meter has numbers around 30pts higher than your Relion and other human meters. If you have the Relion, I would say to stick to that one because it's easier to get strips when you run out than trying to the the pet meter ones, as noted on your ss last week. In your comparison, you can see the AT was always higher, so if you want to follow the protocol mentioned by many here, you will need to think of the diff in measuring and adjust..... when the protocol talks about ranges, and when most people here are talking numbers, they are usually referring to numbers obtained from human meters unless noted otherwise... look in people's signatures to see if they say which meter they are using.

If you feel that the dose is too high and your vet is pushing you, or you won't be around to monitor and act to bring up the numbers, then always side with safety. Always. It's easier to deal with numbers on the high side than ones on the low side and having to rush to ER with a hypo'd cat. You were OK to give less insulin.

 

[MelanieAndRacci]

Hi Carol,

Welcome! Oreo has beautiful numbers. He's doing very well on the 2u dose. His numbers are not too low unless he doesn't eat. Right now they are traveling down, without going very low, which is what you want them to do.

A lot of vets do not want us testing or changing doses, etc. With some of them it's because they don't trust us to do it properly and with others it's because they want to be in control. I just ignored the vets who were like that & used them for the other things I needed and the prescriptions but handled the diabetes myself until I found vets that agreed to work with me on this protocol. I handle Racci's dose changes, etc, myself according to the tight protocol with the help of the more learned ones on this board. I keep my vet informed and she runs a fructosamin of her own when Racci goes in for a 6 month check up.

The stickies at the top of the first page have a lot of important information. You might want to print it out and study it. It's important to find out what Oreo's nadir is also. Usually it's about +3-4 or +5-6. The only way you'll figure that out is by testing on several days. There's a lot to learn so don't get overwhelmed. Just ask when you have a question and take it slowly.

Melanie & Racci