K I just got off the phone and got the results from Emmy's fructose test. Vet said the low normal is 219 and the high normal is 347mmol and my fur girl is at 481mmol. So he wants me to up her dose to 2units in Am and 2units in PM. I'm a little scared to do it, I am a newbie and I'm petrified of hitting a low. I've only dosed her in the AM so far. How important is it to does on time? I'm dosing her right now at 8am because sometimes I leave at 9Am this gives me time to make sure her food stays down. With this new PM dosing I'd have to dose her at 8Pm but that doesn't work for me one night a week. Is it o.k. to be an hour early or late with her shot or can I skip a shot once a week?
raising Lantus dose
- Thread starter jennyb
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Amy & Papaya (GA)
Member Since 2012
I'm fairly new at this too, but it's getting easier! It's great that you're using Lantus. From what I understand, it's very important to give Lantus twice a day 12 hours apart, consistently. Your schedule sounds like mine at the beginning - 8 would have worked most of the time but there was one night I had to leave the house before that. What I've ended up doing is working backwards from the time I get home from work (about 4:30 in my case) and giving the shot at that time morning and night. Of course this means I set my alarm for 4:15, roll out of bed to test & shoot, then go back to bed for a few hours, but my cat is happy because she usually starts to be awake and prowling around at that time anyway so she likes not waiting until 7:30 for breakfast. Plus it gives me lots of hours to know how a dose is going to work before I leave the house.
I see from your spreadsheet that you're doing some home testing. That's good - it's really, really important so you know the lowest numbers. It's best to test at least before each shot and somewhere in the middle - you can test a few hours after the evening shot to give you an idea of what's happening if you're not home during the day. Even if it seems like a hassle to you right now, it will make you a lot less petrified because you won't be shooting blind. The more you test, the more you know, and soon you'll have a really good idea of what's happening with Emmy.
Others can give you more advice on dosing, but I think it would be really helpful get more home test numbers first. Frucosamine tests just tell you the average over the last few weeks, not how low her blood sugar is between shots, and that is what you need to use to adjust the dose.
There is a TON of information on this site that will help you learn what the numbers mean. Plus there are a lot of amazing people here that will walk you through everything step by step. You're in the right place! Best wishes for you and Emmy.
I see from your spreadsheet that you're doing some home testing. That's good - it's really, really important so you know the lowest numbers. It's best to test at least before each shot and somewhere in the middle - you can test a few hours after the evening shot to give you an idea of what's happening if you're not home during the day. Even if it seems like a hassle to you right now, it will make you a lot less petrified because you won't be shooting blind. The more you test, the more you know, and soon you'll have a really good idea of what's happening with Emmy.
Others can give you more advice on dosing, but I think it would be really helpful get more home test numbers first. Frucosamine tests just tell you the average over the last few weeks, not how low her blood sugar is between shots, and that is what you need to use to adjust the dose.
There is a TON of information on this site that will help you learn what the numbers mean. Plus there are a lot of amazing people here that will walk you through everything step by step. You're in the right place! Best wishes for you and Emmy.
Larry and Kitties
Member Since 2009
I would change to 1 unit AM and 1 PM. I say it is OK to give an your early or late if you have to vice skipping a shot. Just make sure you test before each shot, especially before an earlier shot and before the the next show after you shoot late.
C
Carl & Polly & Bob (GA)
Hi Jenni,
I'll let someone who understands fruct' test data answer that part of your question, because I don't think comparing those results to a single test is comparing apples to apples...
The other stuff...
I know you had difficulty at first with testing, and I think it's great that you've overcome that hurdle! Is Emmy getting to be okay with it?
The dose recommendation is a little concerning to me. The vet is telling you to double the daily intake of insulin, and I think that might be a bit extreme. I think it might make more sense to go with the twice a day shots, but instead of 2u, perhaps starting with 1u each shot makes more sense. At least until you can collect a few days of data to see what that dose does. While you've been shooting once a day, it means that the insulin isn't working around the clock. Lantus is long lasting, but it isn't intended to work 24 hours on a cat. With the insulin working 24 hours a day, with a shot every 12 hours, you could see some overall improvement in the numbers. After a few days, you'll see if it needs to be increased or not. If so, then you'd increase by only .25u at a time, try that for a few days, and reevaluate based on the test data.
Shooting on a 12 hour schedule is definitely advised. But you said one night a week, that won't be possible. Can you tell us more? How far off of 12 hours would it need to be. You can make adjustments (or skip) if there's no way around it, but if you tell us more, maybe we can get creative. ;-)
You definitely want to test before every shot. Not sure if you've got more data that isn't in your spreadsheet yet, but the one I looked at stopped on 12/3.
Carl
I'll let someone who understands fruct' test data answer that part of your question, because I don't think comparing those results to a single test is comparing apples to apples...
The other stuff...
I know you had difficulty at first with testing, and I think it's great that you've overcome that hurdle! Is Emmy getting to be okay with it?
The dose recommendation is a little concerning to me. The vet is telling you to double the daily intake of insulin, and I think that might be a bit extreme. I think it might make more sense to go with the twice a day shots, but instead of 2u, perhaps starting with 1u each shot makes more sense. At least until you can collect a few days of data to see what that dose does. While you've been shooting once a day, it means that the insulin isn't working around the clock. Lantus is long lasting, but it isn't intended to work 24 hours on a cat. With the insulin working 24 hours a day, with a shot every 12 hours, you could see some overall improvement in the numbers. After a few days, you'll see if it needs to be increased or not. If so, then you'd increase by only .25u at a time, try that for a few days, and reevaluate based on the test data.
Shooting on a 12 hour schedule is definitely advised. But you said one night a week, that won't be possible. Can you tell us more? How far off of 12 hours would it need to be. You can make adjustments (or skip) if there's no way around it, but if you tell us more, maybe we can get creative. ;-)
You definitely want to test before every shot. Not sure if you've got more data that isn't in your spreadsheet yet, but the one I looked at stopped on 12/3.
Carl
BJM
Member Since 2010
Can you find someone else to shoot the time you aren't available? Perhaps hire a vet tech or see if there's a high school student interested in veterinay science willing to learn about feline diabetes.
Also, please take a look at my signature link Secondary Monitoring Tools to see how to test for urine ketones. While you are working to get her regulated, when the insulin dose doesn't match the glucose level, fat may be broken down for energy, resulting in ketones. This can be a warning sign of diabetic ketoacidosis, which is very expensive to treat.
Also, please take a look at my signature link Secondary Monitoring Tools to see how to test for urine ketones. While you are working to get her regulated, when the insulin dose doesn't match the glucose level, fat may be broken down for energy, resulting in ketones. This can be a warning sign of diabetic ketoacidosis, which is very expensive to treat.
Carl & Bob said:
Yes, Emmy is becoming use to it now, which is a really big relief, we should really emphasize to newbies that it may be really hard at first but, they will get the hang of it.
I was concerned about what the vet said too. One night a week I might be 1 hour off, and I was actually thinking of adjusting it so I get up 1 hour earlier so I can make both shots. But it still would be good to know in case something comes up, how much time off can a person reasonably be(just ball park)
The spreadsheet, I've been using mmol and that side is up to date, but when I added more rows to it I guess it didn't convert them on the other side, I'm open to suggestions to fix it, anyone have any ideas?
Increasing the dose...rats I already gave her 2 this morning. I was planning on giving her one unit tonight, do you think that would still be too much?
BJM said:
That would be a nice thought, except we don't even have a vet in the town we live in, there is a moble that comes once a week and the nearest vet is a 6 hour round trip. And my cat doesn't like anyone I have ever had to cat sit before she was diabetic. She loves me lol but hates everyone else. It was alright before they would just come and check the box and feed and water her, make sure she was alive, and she would hiss at them and run and hide to show her disdain lol.
Thanks for the other info tho on the pee thing
C
Carl & Polly & Bob (GA)
Jenny,
You can stall if you see a number that is too low to shoot, but if/when you do that, you want to do it without feeding. You want to see the number come up without food making it happen.
With Lantus, you want to be able to keep the dose constant, so you wouldn't for instance shoot a lower dose if you see a lower number (or higher if the number is higher). It is the low point of the day, which typically happens around +6 hours after the shot that is the important thing. That's the number that the dose is dependent upon.
One consideration when you can't shoot on a 12 hour schedule on occasion, whether due to your schedule, or numbers that aren't high enough to give a shot at... Moving forward from that point, you want to stay on a 12 hour routine. So, if you had to shoot late because you couldn't be home at shot time, you can do that. But the next day, you're going to want to keep the shots 12 hours apart. Make sense?
What you can do is adjust the shot time by 30 minutes a day. Or 15 minutes per 12 hour cycle. What it really comes down to, however, is that we can only due what is possible to do. The world doesn't stop turning because our cats get diabetes, and if you have to give one shot a week an hour late, then that's what you do. In the big picture, it's not going to make too much of a difference.
Carl
You can stall if you see a number that is too low to shoot, but if/when you do that, you want to do it without feeding. You want to see the number come up without food making it happen.
With Lantus, you want to be able to keep the dose constant, so you wouldn't for instance shoot a lower dose if you see a lower number (or higher if the number is higher). It is the low point of the day, which typically happens around +6 hours after the shot that is the important thing. That's the number that the dose is dependent upon.
One consideration when you can't shoot on a 12 hour schedule on occasion, whether due to your schedule, or numbers that aren't high enough to give a shot at... Moving forward from that point, you want to stay on a 12 hour routine. So, if you had to shoot late because you couldn't be home at shot time, you can do that. But the next day, you're going to want to keep the shots 12 hours apart. Make sense?
What you can do is adjust the shot time by 30 minutes a day. Or 15 minutes per 12 hour cycle. What it really comes down to, however, is that we can only due what is possible to do. The world doesn't stop turning because our cats get diabetes, and if you have to give one shot a week an hour late, then that's what you do. In the big picture, it's not going to make too much of a difference.
Carl
MommaOfMuse
Member Since 2010
If you can if below 200 you stallfor 30 minutes WITHOUT feeding and retest to see if she is headed up, if on the second retest she is above 200 then shoot the full dose but your 12 hours to the next shot starts with when you finally give that shot.
Mel, Maxwell, Autumn & The Fur Gang
Mel, Maxwell, Autumn & The Fur Gang
C
Carl & Polly & Bob (GA)
When will that decision need to be made? Let's see what sort of numbers you get first.
Carl
Carl & Bob said:
I read the don't go too fast on insulin thing, I tested her at 12 hrs. she was 13.4mmol or 241.2 so I fed her and gave her 1/2 a unit. Tommorrow I will consult with the other vet to see what he suggests, cause I don't really put much faith in the one that told me to go ahead and give her 2 in the am and 2 pm.....he wants to see her BG between 4-12, and I agree that is too low especially since I live 3 hours from nearest vet.
Thank you for walking me thru all this stuff, I really appreciate it.
C
Carl & Polly & Bob (GA)
You're very welcome!
If your new vet says "1u twice a day", that would seem logical to me. I think you're fine with the 1/2 unit tonight too.
Most kitties, according to the AAHA dosing guidelines, would start out between .5u and 1.0u, twice a day.
http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf
Carl
edit to add: If your vet (either one) is wondering, you can tell him that we advocate safety above all else, so if we sound "conservative" on dosing, our theory is that once the insulin is in, you can't get it back out. So for safety's sake, a low dose makes more sense. Another thing you'll read around here is "better high BG for a day than BG that is too low for even a few minutes". Safety is also why we recommend testing before every shot, and a couple other times during the day or night, and why we strongly recommend home testing. There's a high level of comfort knowing that you can see where the BG level is at any time day or night. A human can tell, or tell someone else, when their blood sugar seems high or low. Cats can't communicate that.
If your new vet says "1u twice a day", that would seem logical to me. I think you're fine with the 1/2 unit tonight too.
Most kitties, according to the AAHA dosing guidelines, would start out between .5u and 1.0u, twice a day.
http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf
Carl
edit to add: If your vet (either one) is wondering, you can tell him that we advocate safety above all else, so if we sound "conservative" on dosing, our theory is that once the insulin is in, you can't get it back out. So for safety's sake, a low dose makes more sense. Another thing you'll read around here is "better high BG for a day than BG that is too low for even a few minutes". Safety is also why we recommend testing before every shot, and a couple other times during the day or night, and why we strongly recommend home testing. There's a high level of comfort knowing that you can see where the BG level is at any time day or night. A human can tell, or tell someone else, when their blood sugar seems high or low. Cats can't communicate that.
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