Question-how long should I hold dose?

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Deena and Malby

Deena and Malby

Member Since 2016
Hello,
My cat started Lantus on 3/20 (previously on a Vetsulin).
He has been staying in the mid 300's. and his nadir hasn't been below 307. The vet suggested I keep him on 1 Unit for another 2 weeks and then run a another fructosomine test.
Do you agree with this? Disagree? I feel like I could bump him up to 1.25 or even 1.5 at this point. Should I hold the 1 Unit for another 2 weeks? Haven't seen any improvement in his mood or energy at 1unit.

Thanks in advance!

Deena
 
We really need to see more tests

You should always test before shooting (the AMPS and PMPS) and then get a mid-cycle on the AM cycle and a "before bed" test on the PM cycle.....most cats go lower at night, so it's really important to get a test in before you sleep to make sure he's going to be OK overnight

If you can get more testing in, there's no reason in the world you need to have a fructosamine test done at the vet.

If you can test at least 3-4 times a day, it would help us to help you with when it's appropriate to increase. We do only increase in .25 unit increments so we don't accidentally bypass what could be a "perfect" dose
 
Hi Deena!

I haven't stopped by to say hi to you yet - welcome to the group! I looked back through a few of your posts to get a better idea for what's going on. You said earlier that you are shooting twice a day - would you add those pm doses to the spreadsheet please? That makes a huge difference in advice - no one wants to give you bad advice and we use the spreadsheet to help us. That's the first stop for anyone who's going to help you. We are a data-driven group.

Sounds like it was your vet that had you drop the dose to 1u when you switched to Lantus. Wendy mentioned earlier that we take into account the dose the cat was on previously, so we'd have suggested you start about 2.5-3u. Since you started lower, I wouldn't linger excessively long on a dose - provided that you can get enough tests in that you are confident there aren't any hidden low numbers there. You're doing great at getting a mid-cycle test during the day cycle. Can you add in a preshot test both am and pm, so that you are sure it's safe to shoot, and one test before bed? Once in a while a kitty will turn up at preshot in very low numbers, and you wouldn't want to shoot that! Those 4 tests each day will make a huge difference in filling out the picture of what's going on inside Malachai's body. It will tell you (and us) how to adjust his dose. He's a beautiful cat - we want to keep him safe!

When you are testing more, you'll see that blood sugar goes up and down, so one can't assume that just because the blood sugar was a particular number before that the cat's blood sugar will still be at that number later.

I see you're using an AlphaTrak glucometer. Many people arrive here using them, but the test strips are so expensive that most people can't afford to test multiple times a day. Switching to a human glucometer will mean that 4 tests a day will cost you about the same as 1 AT test per day. The strips are just a fraction of the cost for human meters compared to AT's. Even if you bought the AT from your vet (which is a common story here) you will recover the cost of switching in no time. Probably the least expensive glucometers that seem pretty accurate (for our purposes) are the Relions from Walmart. The same glucometer in a generic is called Arkray and you can get it and strips very inexpensively from www.AmericanDiabetesWholesale.com. I had a Relion Confirm and liked it quite a bit. Anyway, for many people the cost is a factor in how often they test, so I thought I'd pass all that along in case it's helpful to you.

Here is a link called "Where Can I Find?" that you may want to bookmark. It can help you find helpful information that we frequently use in this group.

Glad to have you here! Keep asking questions and it won't be long until Malachai is in better control. You'll get him there!
 
julie & punkin (ga) said:
Hi Deena!

I haven't stopped by to say hi to you yet - welcome to the group! I looked back through a few of your posts to get a better idea for what's going on. You said earlier that you are shooting twice a day - would you add those pm doses to the spreadsheet please? That makes a huge difference in advice - no one wants to give you bad advice and we use the spreadsheet to help us. That's the first stop for anyone who's going to help you. We are a data-driven group.

Sounds like it was your vet that had you drop the dose to 1u when you switched to Lantus. Wendy mentioned earlier that we take into account the dose the cat was on previously, so we'd have suggested you start about 2.5-3u. Since you started lower, I wouldn't linger excessively long on a dose - provided that you can get enough tests in that you are confident there aren't any hidden low numbers there. You're doing great at getting a mid-cycle test during the day cycle. Can you add in a preshot test both am and pm, so that you are sure it's safe to shoot, and one test before bed? Once in a while a kitty will turn up at preshot in very low numbers, and you wouldn't want to shoot that! Those 4 tests each day will make a huge difference in filling out the picture of what's going on inside Malachai's body. It will tell you (and us) how to adjust his dose. He's a beautiful cat - we want to keep him safe!

When you are testing more, you'll see that blood sugar goes up and down, so one can't assume that just because the blood sugar was a particular number before that the cat's blood sugar will still be at that number later.

I see you're using an AlphaTrak glucometer. Many people arrive here using them, but the test strips are so expensive that most people can't afford to test multiple times a day. Switching to a human glucometer will mean that 4 tests a day will cost you about the same as 1 AT test per day. The strips are just a fraction of the cost for human meters compared to AT's. Even if you bought the AT from your vet (which is a common story here) you will recover the cost of switching in no time. Probably the least expensive glucometers that seem pretty accurate (for our purposes) are the Relions from Walmart. The same glucometer in a generic is called Arkray and you can get it and strips very inexpensively from www.AmericanDiabetesWholesale.com. I had a Relion Confirm and liked it quite a bit. Anyway, for many people the cost is a factor in how often they test, so I thought I'd pass all that along in case it's helpful to you.

Here is a link called "Where Can I Find?" that you may want to bookmark. It can help you find helpful information that we frequently use in this group.

Glad to have you here! Keep asking questions and it won't be long until Malachai is in better control. You'll get him there!
Click to expand...

Hello!
Thank you for this information....you have been very helpful :) I will add the 2nd dose to my chart right away. He's actually had lower numbers the past few days during his nadir on the 1.25...I haven't had him in the yellow much. The vet suggested I keep him on each dose for roughly 3 weeks although I think I'll go up to 1.5 shortly.
I know I should be testing before I inject him. I just haven't "gotten" there yet as I can barely get him below 300's when he peaks and every time I have ever tested him before a shot, he's in the 500-600's. I think when I start seeing some lower numbers I will start pre-testing. I know safety is everyone's number one concern here as is mine, but I literally have zero concern RIGHT NOW that his numbers would be too low in the early AM or PM. I'll test tonight (and post) just to do a spot check but he is always in the black.
I wanted to ask about the Relion meter...what strips do you use with that? I didn't see "Relion Test Strips" on the ADW site unless I missed it? I am currently using Freestyle Lite test strips w/my AT2 meter which are made by the same manufacturer. I get 50 test strips for $29.99. Are the Relion test strips similar in price?
Thanks again for all of your help!
Deena and Malachai
 
Deena Traina said:
Hello!
Thank you for this information....you have been very helpful :) I will add the 2nd dose to my chart right away. He's actually had lower numbers the past few days during his nadir on the 1.25...I haven't had him in the yellow much. The vet suggested I keep him on each dose for roughly 3 weeks although I think I'll go up to 1.5 shortly.
I know I should be testing before I inject him. I just haven't "gotten" there yet as I can barely get him below 300's when he peaks and every time I have ever tested him before a shot, he's in the 500-600's. I think when I start seeing some lower numbers I will start pre-testing. I know safety is everyone's number one concern here as is mine, but I literally have zero concern RIGHT NOW that his numbers would be too low in the early AM or PM. I'll test tonight (and post) just to do a spot check but he is always in the black.
I wanted to ask about the Relion meter...what strips do you use with that? I didn't see "Relion Test Strips" on the ADW site unless I missed it? I am currently using Freestyle Lite test strips w/my AT2 meter which are made by the same manufacturer. I get 50 test strips for $29.99. Are the Relion test strips similar in price?
Thanks again for all of your help!
Deena and Malachai
Click to expand...
I think that Relion test strips are only available through Walmart. I pay roughly $35 for 100 Relion test strips.
 
Deena Traina said:
I wanted to ask about the Relion meter...what strips do you use with that? I didn't see "Relion Test Strips" on the ADW site unless I missed it?
Click to expand...
I used Arkray test strips from ADW - they are the generic for the Relion Confirm glucometers. However, Punkin passed away several years ago and I'm not up to date with the latest on test strip information. I do think you could try this Arkray glucometer and test strip deal - 200 strips + free glucometer for $72.56. https://www.adwdiabetes.com/product/arkray-glucocard-01-blood-glucose-monitoring-kit_4045_123.htm

If you're paying $30 for 50 test strips, that's $120 for 200 strips - so you can see there is a significant savings.

Of course it's up to you, but many people do switch - it's safe to do so, our dosing guidelines for both the Tight Regulation Protocol and Start Low Go Slow use human glucometer numbers, and it's so much more affordable than the AT glucometers.

If you'd like more input on it, put something like "need advice on meters" in your subject line to catch the eye of people who can comment on that.

I would be remiss if I didn't mention to you that we see cats that can go from 400 to 40 in 3 hours and zoom back up to 400 in another few hours. As cats are on insulin, if their bodies are getting into normal numbers, the possibility exists for the cat's pancreas to heal and begin putting out insulin again. This is one of the reasons that many people are fans of the Tight Regulation Protocol - that study showed that some cats whose blood sugar is brought back into normal range as soon as possible after diagnosis can often become diet-controlled and go off of insulin. That doesn't happen to every cat - some, like mine, are diabetic because of other conditions, which don't go away just because their blood sugar is brought into normal range. There are many causes of diabetes in cats. I'm mentioning this because it's possible that Malachai's insulin needs will decrease.

You just can't assume that because he's been high, he will therefore continue to be high.
 
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