Riley's #s are all over the place

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artrageous

Member Since 2010
Edited to add that right or wrong (okay, okay, probably wrong...sigh) I just gave him 1 unit because I tested again and his BGL was up to 315. Three hours ago it was 53!


I know it's important to be consistent with time and dosage when giving Lantus, but in the last few weeks (based on Riley's #s) I haven't been consistent with the dose, even though I'm able to give injections almost exactly 12 hrs apart.

In November I tested my meter against my vet's AlphaTrak (? is that what it's called?) and it seemed to be about 70 pts lower than hers. HOWEVER, when comparing it with my mom's meter (different brand) it was within 2 points. I also random-tested one of my non-diabetic cats and his BGL was 51 and when I've tested myself, it's also in a normal range. So when I see low #s I don't always assume he's headed into a hypo situation, BUT depending on HOW low, I sometimes don't give a shot. When I don't shoot, he's usually much higher in the morning.

I'm going to try to do a curve (every 3 hrs) this weekend. Riley's not easy to test and I usually use his left ear because I can't always hang on to him well enough to use the right ear. :sad:

I'm just not sure what's going on with the change in numbers. For the most part, his schedule is pretty consistent re: times he eats, what he eats (blended Fancy Feast Turkey & Giblets Classic), etc.

Last night my vet and I had decided that I'd just continue to give him 2 units, 2x a day and then do a curve this weekend. This afternoon, however, when I tested at +9.5 and it was low--and then it was even LOWER before I fed him "dinner"--I just wasn't comfortable giving him 2 units and so I didn't give him any insulin at all.

So with this background, do you think it would make ANY sense to just start over with 1 unit 2x a day? Regardless of what his # is in the morning (typically high with no pm shot) I'm very hesitant to give him as much as 2 units since I'll be gone all day and he won't have access to food.

We'd actually been increasing the dosage prior to his surgery (molars and premolars extracted due to caudal stomatitis) and I was very hopeful that he wouldn't need insulin after everything healed up. He apparently developed diabetes after being on prednisolone and then dexamethasone last summer in attempt to control his stomatitis.

Thanks for your help.
 
Hi Sharon.

I think your idea regarding starting over at 1.0u makes a lot of sense. You have a good handle on what's going on -- you shoot 2.0u in the AM, Riley's numbers come down and he's often too low to shoot at the PM shot so you skip and his numbers are high in the AM. We generally encourage people who have started on too high of a dose to drop the dose to a point where they can comfortably shoot twice a day. So, good instincts on your part. You may need to increase the dose from a starting point of 1.0u but you'll be increasing in increments of 0.25u so you will not miss what could be an ideal dose. Please read the sticky note on the Tight Regulation Protocol for more info.

One observation on Riley's SS. We also encourage you to get at minimum, one spot check per cycle. For example, on Sunday, you had a PMPS of 45. I would really like to have known where Riley's numbers were during the AM cycle. I'm not sure if your vet explained this or not, but Lantus dosing is based on the nadir, not the pre-shot numbers. It's quite possible that Riley dropped low during that Sunday morning cycle. If Riley is less than a year from his diagnosis, numbers below 50 earn a dose reduction. Getting spot checks during both the AM and PM cycle are critical.

The AlphaTrack and human meters do test differently. The AlphaTrack is usually higher than human meters. As I noted above, a BG of 50 earns a decrease on a human glucometer. For an AlphaTrack, the cut-point is 80 to earn a reduction.
 
Hi Sharon & Riley,
I've never visited your condo, so first of all I want to say Welcome.
There are lots of questions in your post and I'm not knowledgeable enough to reply to all of them, but I will give some of them a stab.
First: you will find the answer to all of your questions about low numbers at pre-shot time, skipping shots, etc. in Libby's excellent post here:
viewtopic.php?f=9&t=26571
This is a "must read".

Second: Your "human" meter is fine for our purposes. Almost everyone here uses a human meter and the protocol we use is adjusted for the human meter.

Third: If you are not home during the day you have to find a way to make sure Riley has food available to him. Many people use automatic feeders. Others simply leave out enough food. I like the Cat Mate C 20, two-compartment feeder. The compartments have separate mechanical timers and if you are out all day you can give Riley his normal breakfast outside the feeder and then be able to feed twice more during the course of the day, setting the feeder for the desired times. The Cat Mate has a cold block that fits under the food trays, so it keeps wet food cool in the summer, too. The PetSafe 5-compartment rotary feeder is used by many people, but I personally have had problems with mechanical failure using this feeder. Many people freeze wet-food "pucks" and leave them to defrost in the cat's dish. This allows for the food to stay fresh longer. When you leave out wet food, it is always a good idea to mix in a little water. This is good for the cat and also helps to keep the food from drying out.

I will leave your question about Riley's dose for someone more knowledgeable to answer. But in general, it is wise to keep in mind that Lantus needs consistent dosing to work correctly. Frequent skipping of shots is not a great way to proceed!

Best of luck to you and Riley,

Ella & Rusty

p.s. In the time that it took me to write this, I see that Sienne has already given you some great advice!
 
Thanks so much for the responses. I updated my original post to add that (first time ever) I just gave him an injection a few hours after I'd decided NOT to give him an injection. What led to this was that I was able to test again and his BGL had jumped from 53 at 6 pm to 315 at 9 pm.

Riley was started on 1 unit of Lantus 2x a day in October. I didn't start home testing until November and I wasn't always successful. Generally I'm doing better (the warmed sock helps a lot) but he's not always cooperative. To my surprise, when I tested just a while ago, he actually was sitting there waiting for me to pick him up, didn't struggle and I was able to get blood on the first stick.

We'd been increasing his dosage and 2.5 units 2x a day was where we were at the time of his dental surgery on Dec. 28th. Since then it's been totally erratic.

As to the food situation, Riley is one of 7 cats, all indoors. I'd been free-feeding dry food with the bulk of their diet being canned, but then once Riley was diagnosed, things changed. I continued to offer kibble, but I switched to EVO, knowing it had the lowest carbs. The cats who still prefer dry get a little in the morning and then the bowls are put away until afternoon and then again at dinner time. I leave canned food out but I haven't seen Riley eat any of the food (canned or kibble) since before his surgery. Instead, I've been blending cat food and feeding him separately, usually 4x a day. I feed him at 6 am, again between 3:30 and 4 (when I get home), again around 6pm and then again between 9 and 10 pm.

This weekend I tried offering all of them some raw food (ground turkey) but they weren't too impressed. I've joined the raw feeding group on yahoo and it's something I'd like to consider but just getting all of them off of their old, high-carb kibble and eating mainly canned has been the first goal...

Riley is the bravest and most resilient kitty I've ever known. Goodness knows how many of his "9 lives" he's used up since he first got sick last May; there have been several times that I thought he'd reached the end of his run.... IF I had more $$, IF I had more time, maybe I could do things differently, but I'm honestly doing the best that I can for him.

For the most part, he seems to have a good quality of life now and seems to feel pretty well. He's one special boy...

Riley-Aja-011711-1.jpg

Riley and Aja, Jan. 17, 2011
 
Hi again, Sharon,

If you gave your evening shot 3 hours late (9 P.M.?) , you have to alter your morning schedule so that the morning shot is 12 hours after your evening shot (9 A.M.). You can gradually move your shot times back to your normal schedule by 1/2 hour per DAY (either 15 minutes at both A.M. and P.M., or 30 minutes once a day--either A.M. or P.M. until you get back to your usual time).
Sienne suggested that you begin again with a 1-unit dose every 12 hours. So tomorrow morning, (at 9 A.M.) you would shoot 1 unit.
Clear?

Have a good night. Your kitty is beautiful!

Ella & Rusty
 
The dental explains a lot! Any infection or inflammation will raise BG. The dose of insulin you were giving prior to the dental was probably fine given that Riley probably had some inflammation in his gums from tartar and/or gingivitis. Once his teeth were cleaned, the inflammation disappeared, and he probably needed less insulin. Instead, because you've been dosing based on pre-shot numbers, you increased Riley's dose.

What can happen with too much insulin is drops into lower numbers followed by bounces. Gabby at one point had 400s at AMPS and PMPS and was in the 40s at mid-cycle. The mid-cycle number earned her a dose reduction. If I hadn't been testing, in all likelihood, I would have increased her dose.

So, now here's the issue with your having shot at 9:00 PM. Your AM shot needs to be 12 hours from when you gave Riley his shot this evening -- in other words, at 9:00 AM. DO NOT shoot 3 hours early tomorrow. An early shot acts like a dose increase. The post that Ella linked outlines the options for what to do when you have a low pre-shot number. The most that you can migrate your shot time is by 30 min. per day. There are some exceptions but they don't involve shooting 3 hours early.
 
Hi there, just have to tell you that my Tessie Lou thinks Riley is one handsome guy and just her type!
Good luck with the dose change. We'll be watching and sending good thoughts!
 
boy, I could just bury my face in that big ole tummy. I love it when they turn that tummy top-side. hard to resist, isn't it?

I've never visited your condo, either. Riley is one handsome dude. Hopefully, now that the dental is behind him, things will settle down a bit with him.

So, tomorrow's shot needs to be given at 9 a.m.

was just peeking at Riley's SS - you guys need to find a dose that you can shoot consistently twice a day and not have to skip his shot at night. I can't give you advice on that part, but I can stress how much better he'll do when you find a dose that works for him and you and then give it consistently every 12 hours.

I saw the recommendation that you shoot 1 unit at 9 a.m. what's your feelings about that?
 
Due to my work schedule I simply couldn't shoot at 9 am today. It was 6 am or not at all, so I gave 1 unit at 6 am and then 1 unit tonight at 6 pm. I've talked with my vet who understands why I was worried about continuing to give 2 units since he's been all over the place.

We'll keep him on 1 unit for at least one week (pretty much regardless of #s) to see if things stabilize, even if he's in the 300s. The surgery, antibiotic, pain meds, etc.--and then healing, finishing antibiotics, etc.--just seemed to wreak havoc with any sort of dosing consistency and I guess we're dealing with the aftermath.

The vet wants me to wait until the 29th to do the curve (to try to let things regulate to some degree, if possible) then we'll adjust the dosage as needed. I'll try to do some mid-cycle checks when I can until we do the curve.

I sincerely appreciate those of you who took the time to reach out and offer your advice and encouragement; means a lot! Thank you!

And please get your fingers crossed for us to get it right (or at least right-er) as we start this process again! cat_pet_icon

(And a note to pretty Miss Tessie Lou--sorry, sweetie, Riley's taken. The little girl he's curled up with in the pic I posted is his lady. They've been a bonded pair for years. They're SO cute together!)
 
Sharon --

For the future, if you get into a situation like yesterday where the choices are to delay or skip, given your schedule, it's often better to skip or to shoot on time but to shoot a reduced dose. My hunch is that if you'd tested in 30 min., Riley's numbers would have been rising and it would have been OK to shoot. Right now, there were hopefully no ill effects from a shot that was 3 hours early. As Riley's numbers stabilize and he's in better ranges, this could be a serious concern and a risk for hypoglycemia.

FWIW, I've had one curve at the vet's office. Since I'm home testing, there's no point for the vet to do a curve. You can do a curve on a day when you don't have to work. In addition to saving you $$, your numbers are likely to be more reliable. Most kitties experience vet stress and their numbers are elevated when at the vet's office making the results of the curve skewed. Doing a curve with Riley at home, means that he's in familiar surroundings and the numbers will be far more typical.
 
Sienne and Gabby said:
Sharon --

My hunch is that if you'd tested in 30 min., Riley's numbers would have been rising and it would have been OK to shoot.
Click to expand...

I absolutely did not think of doing that--thank you so much for giving me another strategy! Testing again and possibly shooting 1/2 hour late would have been SO much better than giving it as late as I did.... ohmygod_smile

Yes, I'll do the curve at home. Fortunately, my vet has been really good to work with and understands my financial situation as well as all of the other things that are going on in my life that make caring for a sick kitty even more of a challenge. I gave her the url to Riley's spreadsheet and she checks that and emails every couple of days and also responds quickly to emails that I send to her. ALL of the vets in the practice know and have treated Riley over the last 8+ months, but this one, in particular, has really gone out of her way to help.
 
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