Really Confused...

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HiTorq

HiTorq

Member Since 2014
Ok, well switched insulin yesterday to Lantus, dosing 1u BID. Didn't get PMPS due to forgetting and leaving the meter in my truck after the new vet appointment, but got a +3 once home and was 385 so felt good about the initial dose. This morning AMPS was 359 so again 1u and managed to get a +3 in and things again looking good at 262. I figured these numbers seemed good for first two doses of Lantus, and was planning on running a curve this weekend.

Wife gets home does the PMPS and it's 114 confused. Waits 30 and retests gets a 102 more confused. Went ahead and gave the evening meal before they all chewed her legs off and rested +1 and was 130 so at least it looks like it's going up as it should after feeding. Waiting on +3 and will go from there.

Obviously no shot tonight based on the current numbers and will continue to monitor through the evening.

Was just getting ready to move Felixs info over to the Lantus forums and this happens and of course nerves went through the roof again. Ideas? Did we jump start his pancreas? (I wish) or just getting really long numbers from Lantus? Obviously a curve this weekend will help tell the story. I now wonder just how low he was getting during the day since we just couldn't swing the +2, 4, 6 checks... At least he's still with us and kicking, and mad as all get out for having to wait an extra hour for his evening meal... :lol:
 
The dose may be too high for just beginning.

The initial starting dose is calculated as follow:
How much does your cat weigh?
How much should your cat weigh?
Convert to kilograms (pounds / 2.2)
Multiply by 0.25
Round down to the nearest 0.25 units.

We suggest not shooting below 200 mg/dL when starting out and gradually lowering that to 150 mg/dL as you get data showing it is safe.. And Lantus builds up its effect over the first 5 to 7 days of shooting, so if you're seeing this within a few shots, you might reduce the current dose 0.25 units.
 
As nerve-wracking as it is, it's a good sign that he's responded so well to Lantus. :-D

Was just getting ready to move Felixs info over to the Lantus forums
Click to expand...

You have the basics down - testing, food, a good insulin, so moving to one of the Lantus forums definitely isn't a bad idea, especially since you're already dealing with lower numbers.

One suggestion I would have is to insert a line in your spreadsheet (e.g., in between 10/8 and 10/9) to show when you made the switch to Lantus. I know you have it in the notes section, but people might overlook that. If you can find a way to make the switch stand out more (an extra line, highlighting, etc.), it might help ensure others don't accidentally overlook the date you made the switch.
 
Hello everyone. I am MizTorq. That would be HiTorq's wife. :-)

He's off fishing this weekend so I'm taking over the BG testing every 2 hours to get a good curve with the Lantus. (I had to practically kick him out the door to go fishing.)

I've been annotating Felix's spreadsheet, but I haven't figured out how to link it in my signature as of yet. I'll get HiTorq to help me with that when he comes home on Sunday.

So far things are looking pretty good, I think. We are a bit concerned about the fact that I just took the +4 reading and he's already down to 102. We did the calculations suggested above and it came out to .09 dose. He started at 518 this morning because of the low reading last night we didn't give him any insulin. So the 518 was 24 hours after his last dose. +2 was 231 and now at the current reading of 102 at +4.

I'm watching him carefully and I'm trying not to worry too much as of yet. We shall see how the day plays out.
 
Here you go:

Editing your profile

Go to the top left of the screen.
Click on User Control Panel.
Click on Profile
Click on Edit Signature
A test box displays.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name, cat's name,
city and state,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like food issues, allergies, IBD, etc.
 
Thank you BJM. I got most of that figured out, it's the part where the link to Felix's SS is that I'm having a problem with. It's too long to paste the URL, and I can't for the life of me figure out how he made it say "Felix's SS" and link to it instead of the long URL.

Pretty obvious who the html wizard is in this house. Not me. :o

At any rate, I'll get it figured out eventually. Just checked Felix's BG and it was down to 49. I will admit to being a little nervous now. I gave him a little food and will check it again here in about 15 more minutes.
 
Uh-oh. I see you're dealing with a low number. Great job catching it! First, take a deep breath. Feed just a couple of teaspoons of food and retest in about 20 minutes. (Don't wait longer than 30 minutes to test.)

Do you have high-carb food and honey, Karo, or maple syrup on hand?
 
Hi Shelly,

Yes, I have both high carb food and Karo syrup on hand and ready to go. I gave him a little high carb food and just checked him again (had been roughly 30 minutes) and he's at 105.
 
Great job. Just remember that the high-carb food can wear off quickly. At this point, you want to withhold food and get two rising (or steady) numbers in a row before you back off on testing.

Felix also earned a dose reduction today by going under 50. The new dose will be .75 units, which you'll have to eyeball on the syringe. :YMSIGH: If you get a low pre-shot number this evening, post and ask for advice.
 
Thank you Shelly. I plan on testing him again in just over an hour. Our goal today is to get a good curve, testing every 2 hours, barring the unforseen low BG I just had. I'm going to continue to test every 2 hours for a 24 hour period so we can get a good curve to see where he is. Felix may very well hate me by the end of the day but I am determined to get his curve figured out.

HiTorq and I were just discussing the 1 unit maybe being TOO much. Is it normal for this quick a response to the Lantus? We honestly didn't expect for his numbers to be this low this soon, so naturally we're concerned. He did not receive an injection last night because he was below 200, so his number this morning was high (518).
 
HiTorq and I were just discussing the 1 unit maybe being TOO much. Is it normal for this quick a response to the Lantus?
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That's a really good question, and one I pondered, too. Usually, Lantus builds up slowly in the body over the first several days and then really starts to "kick in" and pull numbers down. For Felix to respond so quickly to 1 unit, especially after the skipped shot and before the depot may be fully established, makes me wonder about the best dose for him. The .75 units might still be too much. I just don't know.

I had mentioned this in an earlier post to HiTorq - it may be a really good idea to go ahead and post in one of the Lantus forums (today) - either Tight Regulation or Relaxed Lantus. There, you will find many experienced users who can help you decide what an ideal dose might be right now for Felix. I was a member of TR, and the people there helped me get Jersey into remission after just a couple of months. As such, I'm not the most experienced individual when it comes to advising on doses, except to recognize obvious situations like today where Felix earned a dose reduction by falling under 50. What do you think about posting in one of the forums?
 
I don't have a problem posting in the other forums, really. I was kind of waiting for HiTorq to get the ball rolling but I'm at the point now that I agree I should go ahead and post everything there to see what I can find out. We'll see where that takes us for now.

Thank you very much for your help today Shelly!
 
I did ask one of the more experienced users to come take a look at the numbers just in case you don't make it over to one of the insulin support groups. Hopefully she'll be able to stop by and offer some advice for you.

Since you did catch that low number and fed high-carb food, I wouldn't go more than an hour without testing again (since the 105). You're probably past nadir now, but it's better to play it safe! We just don't know Felix's patterns yet. And Felix will forgive you. I've found low-carb treats go a long way in the forgiveness department. ;-)
 
Shelly,

I have a lot of reading to do before I post on the ISBs. I don't want to be one of those people that asked a question that was already answered somewhere and have everyone miffed. So I will do some reading before I post there.
 
Shelly asked me to stop by. I'm a denizen of the Lantus Tight Regulation board.

I wouldn't worry about asking questions on the ISG boards. There's a huge amount to absorb and everyone is always learning something. There are starred sticky notes at the top of the board that will give you a solid foundation on how to use Lantus, the conventions of the board, shooting low, etc.

When a kitty's numbers drop below 50 with Lantus, a dose reduction is indicated. Like Shelly indicated, you will want to drop the dose this evening to 0.75u. I also wouldn't be surprised if Felix's numbers are high by PMPS but we'll need to see just what Felix has in mind.

FWIW, most of us don't do 24 hour curves. Testing every 2 - 3 hrs during one, 12-hour cycle is fine. You may want to plan on getting a test before bedtime every night so you will know if it's safe to go to sleep or if you need to set an alarm and get up to test (i.e., "sleep testing").
 
Thank you very much for stopping by. As you can see, we had a bit of a scare today. We're coming up on our +10 reading, so we will see what Mr. Mayhem (our nickname for Felix) has to tell us. Mr. Torq and I have come to the conclusion, as did everyone else here that has posted (thank you!) that 1u seems to be too much for him. Depending on what his PMPS reads, we are planning on lowering the dose to .75u tonight.

**Update** I just took his +10 at it's at 274, so he's back on the rise again.
 
I like the nickname - Mr. Mayhem. My name for Jersey is "the evil that is my cat." She's a little bit of a plotting kitty. :lol:

I have a lot of reading to do before I post on the ISBs. I don't want to be one of those people that asked a question that was already answered somewhere and have everyone miffed.
Click to expand...

Please don't let this stop you from moving to an ISG. I asked the same questions about bouncing repeatedly when I was posting on TR. People were always extremely kind and patient with me. We all know how hard it is when you are first starting out and how much there is to learn. Don't be afraid to "jump" in to one of the Lantus boards. We'll help you each step of the way.

I'm glad Sienne was able to stop by and offer her thoughts on the dose. She's just one of the many people who helped me with Jersey....and answered my repeated questions about bouncing. ;-)
 
We will move over there. I'm just a tad stressed after today and need to get my thoughts in order before I start posting willy-nilly in another place I'm unfamiliar with. I don't know exactly what protocol we're on, whether we're on the Tight Regulation or Relaxed. I do know we're struggling with all this and trying to read everything we possibly can. There is just so much to absorb and I'm honestly just overwhelmed trying to understand what's going on with my little furball. The new vet heard a heart murmur when she saw him and we're worried about that as well. Just so much to think about and absorb. :shock:
 
PMPS was 419, and I gave him the 0.75. I will check him at +2, and again at +6 so I can see how low he goes at nadir.
 
Wow! Quite the response to Lantus.

You got a 49 mg/dL, so already earned a reduction to 0.75 units per dose. I have a feeling you're going to need to take it down to 0.5 units pretty soon! And maybe, just maybe, get off insulin totally! Fingers crossed for you.

Just an FYI - the nadir can move around a bit between +5 to +7.

Unless too low to shoot or the nadir goes below 50 mg/d: again, keep the 0.75 units dose every 12 hours.
 
Omigod this is killing me. I just checked him at +2 and he's still going up. I hope someone is still out there reading this. Looking at his sheet, he should be in the 200s by now (historically). But that was for a 1u shot, and I did give him a .75u shot this evening. Could that be the reason for a higher reading at +2 or did I get a fur shot?
 
He's bouncing off that 49.

Anytime the glucose drops very rapidly AND/OR to a level that is unusual for the cat (49 was very unusual for your cat), compensatory hormones are triggered which release stored glucose (glycogen). This may elevate the glucose for up to 3 full days.

You just have to grit your teeth and wait it out.

Better too high for a day than too low for a moment. The first causes problems more slowly than the latter. The latter, hypoglycemia, can kill quickly!

Check the urine for ketones (see my signature link Secondary Monitoring Tools for tips)
 
Hi BJM and thank you for posting that. I guess maybe I'm a little frazzled after today. After you mentioned it I do remember reading something about that earlier today. HiTorq even asked me if it was bounce and I was like....what is bounce?

I will check his Ketone as soon as I can. We actually have some strips here at the house. My HiTorq is one prepared man, I have to say. We have high carb food, Karo syrup, and even quite a few varieties of low carb treats here and ready to go.

I've everything here I need except the knowledge. And we're working on that. Thank you all for being here for us!
 
Check the ketone strips expiration date.
Once the container has been opened, the strips age out quickly, too, with air exposure.
 
The date on the container is 31 Dec 2015, and we just opened it maybe two weeks ago.

His +6 reading was 500. I think it's safe to say I probably got a fur shot this evening when I thought I gave him his injection. Will try again in the morning.
 
Good morning! ~O)

I'm just checking in on you and Felix this morning. I know yesterday was overwhelming for you. You did a great job handling it all, though!

I also agree with BJ that Felix is bouncing. Felix's body is used to being in the 300s and 400s. That's what his body sees as "normal." When his body sees lower, truly normal numbers, his liver panics and releases extra sugars to bring the numbers back up. That's why you see those high, flat cycles. From looking at his ss, I'm guessing that it was also a bounce on the AM cycle of 10/6.

Shelly
 
Hi Shelly,

Thank you for checking in. He's still very high, I just did a +5.5 check at he's still up at 344. I would be more worried than I am, but you and BJ explained about the bouncing, so I'm watching him and not testing as often today. I think we both need a rest from all the needles today. angry(2)_cat

He is doing okay. Snoozing like he always does this time of day. At least he isn't running the other way when he sees me coming. Yet. :lol:
 
Just a quick thanks to everyone that helped the Miss's get through Sat. Being out of town and in spotty cell reception it was really appreciated. /salute
 
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