? Rover - do I give an injection

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Red & Rover (GA)

Red & Rover (GA)

Member Since 2016
Hello - I posted his information earlier in the Health thread

http://www.felinediabetes.com/FDMB/threads/rover-numbers-all-over-the-place.158058/

In a nutshell, was on 4 units Lantus 2x daily for 3 1/2 years. Then the numbers went wonky - all over the place for the last while, ranging from 1.7 to HI. (Apologies for not being able to translate numbers from my human glucometre yet.)

Switched to 2 units 2x for about a week, then upped to 3 units 2x.

Tonight, his PMPS was 8.9, down from last night's reading of 24.2.

I honestly don't know how much, if any, insulin to give. Any advice welcomed.

https://docs.google.com/spreadsheets/d/1pOkrv-J40OdGHoJ8HdHWexlLkDPDDMFzQa036d8mMkI/pubhtml
 
:eek:Your cat is overdosed. The 1.7 pmps should have been a red flag. You need to drop to around 1.5 units, absolutely no more!
 
It could be some 'bouncing'
When the glucose drops suddenly, and/or drops to an unusual (for the cat) level, or drops to a hypoglycemic level, the body responds by releasing stored glucose (glycogen) which raises the glucose above what is needed, for up to 3 days.
 
You're entering the numbers in the wrong place, if you enter them in the world spreadsheet they will enter themselves into the US spreadsheet translated appropriately.

Are you shooting with a pen or a syringe? I ask because of the whole unit changes in dose, if you're using a pen you will need to get syringes for finer dosing. That 1.7 at 2 units should have earned a reduction to 1.75.

What is Rover eating? Is he on a fully low carb wet diet or is there dry food involved?

ETA - shooting that 1.7 was very unwise. Even the most experienced caregivers here won't shoot under 2.8
 
Thanks for pointing that out. I'm not used to spreadsheets. Checked notebook. Did not shoot when 1.7.

Shooting with a syringe. Too much hair to feel comfortable using a pen.

He eats low carb wet mostly. Currently, Natures Instinct dry available. Sometimes Wellness Core. He's a grazer. Gets roughly 10 pieces of K/D dry while receiving subq fluids. Keeps him still and occupied.

He must have eaten some Natures Instinct dry in the last two hours. 8:30pm reading - 8.9. Took another reading just after 10:30pm - 16.2.
 
Hi and welcome.

Don't worry about having problems with the spreadsheet. Lots of people do when they first join. We have plenty of people here that can help you sort it out if Serryn's hint doesn't do it.

I know you've been using Lantus for a long time, so you probably feel you know a lot about it, but there is always more to learn. When you can, please read the stickies at the top of the Lantus & Levemir page, especially New to the Group, which will bring you up to speed on how we do things here. It can be very confusing, cause there is a ton of info for you to absorb, and we kind of speak our own language, so ask lots of questions. The only dumb question is the one you don't ask! ;)

We're a nosy group, so there will be a lot of questions we'll be asking you - all the better to help you. I take it you go by Red and your cat is Rover? How old is Rover, and how much does he weigh? Also, it helps us to know what time zone you're in, so can you tell us what country/state/region (whatever you're comfortable with ) you live in, please?

I agree with the others that it looks like Rover is bouncing. It's kind of hard to be sure, as you are missing a lot of tests. We strongly recommend that you ALWAYS test before shooting (AMPS - morning preshot, and PMPS - evening preshot), to be sure it's safe to give insulin. Also, in order to determine the correct dose, we need to know how low the dose is taking the cat, so as many mid-cycle tests as you can manage really help. Think of the spreadsheet as a jigsaw puzzle. The more pieces you can fill in, the clearer the picture becomes. Again, I know you've been doing this a while and your system has been working, but it sounds like it might not be anymore, and you're wanting to find out if ours will, is that correct? We are more than happy to help!
 
Would you mind adding to your signature that Rover gets dry food - that way we know not to give you advice from the TR protocol.

the easiest way to fix the spreadsheet might be to delete the rows you have already entered (because the formatting will have been messed up) and then renter in the world side

If you haven't shot yet you could shoot 1.75 (NO MORE) now if your schedule allows you to get back on track half an hour per day. If it doesn't then just start fresh in the morning with 1.75 u or if you want to be more conservative 1.5 u as suggested by Andy.

Do you know to remove food two hours prior to shooting? We do this so the PS BG reading isn't artificially inflated by food.

Glad to hear you didn't shoot that 1.7 :cat:
 
I'm stymied because he was stable for so long. It was so simple. Is this remission or something else? Is remission gradual? or an up-and-down experience? Being at such a high dose for so long, I haven't done my homework. Rover is almost 16 (July 1st). He currently weighs 10.6 pounds, down from a pre-CKD weight of 12 pounds. He's a big boned cat.
I'm in Ontario, Canada. EST.

No, I didn't know about removing food. That is going to be a loud experience, and hard to do first thing in the morning. Have already instructed spouse not to give morning shot at the usual time. He can't stand blood and cannot do an a.m. BG. I cannot because of medical problems that affect my mornings and sleep cycle badly. I have to wait until my own drugs kick in. Hoping to do fuller testing over the weekend, but morning numbers are difficult. Also, work takes me in and out at odd hours

I'll redo the chart over the weekend. Thought I was using the world chart. Apologies.

Will be giving 1.5 units at midnight. And will check as soon as I can in the a.m., looking to shot around 11:30.

Thank you all, once again.
 
I think you've had some good advice here already, so just want to say hi and welcome.

When you say he was stable on the 4u for the past couple of years, what do you mean? Were you hometesting? Or do you mean you didn't see any evidence of problems?

If you don't understand the directions about your spreadsheet, Marje @Marje and Gracie would be happy to get it fixed so you're started on the right track.
 
It's not remission at this point - those high numbers tell us that. Insulin needs change, in my experience it is pretty unusual for a cat to stay on the same dose for so long. Try not to stress, it won't happen overnight but we will work him out and get him stable again :cat:

An easy way to remove the food two hours prior to his shot would be to use a timed feeder and set it to turn to an empty slot at the appropriate time.
 
His fructosamine tests were consistently "good" until 12/2015 when they up to "fair." So good that I only did random testing. Always similar numbers. Since 12/2015 have been mostly focussed on dealing with and slowing down his kidney disease while staying on a low carb regime. Hard to figure out sometimes if what I see on bad days is kidney or diabetes related, or consequences of, or both.

If there is no food available, he will eat anything small enough to fit in his mouth, edible or not. Crumbs, bits of carpet. Always has.

Good night all, and many thanks.
 
There are many people here whose diabetic cats also have CKD, so you are in good company, and maybe we can help you with that juggling act!

I like Serryn's suggestion of a timed feeder. They come in very handy. Here is the one many of us use: Petsafe 5 Meal Feeder. Is Rover an only cat, so you don't have to worry about other critters getting his food and vice versa?
 
Just deleting the numbers on the US SS and then adding them on the World SS will cause you many hours of woe. The reason is because if you delete numbers on the US SS, you will also delete all the formatting that converts the BG on the World SS to US numbers.

I'll send you a message ...I can fix it for you quickly as long as you don't delete anything on the US SS. If you already have an have entered it on the World SS, I can just reformat the US SS for you.

Look in the upper right corner and click on inbox for a message from me.
 
Rover's PMPS is "HI." I managed to get a few more BG readings today and have posted on the spreadsheet (thanks to Marje!).

I don't understand what is going on with him. I know in the last 5 hours he ate a bit of tuna and 1/3 can wet NI turkey ltd. No dry.
 
First thing to remember is Lantus craves consistency, so you want to give the same dose both AM and PM and then you have to hold that same dose for at least 3 days to see how low it's going to take Rover

Lantus dosing is always based on how LOW it takes them....you just have to "grin and bear it" when you see the higher Pre-shot numbers!!

It can take a few days for dry to work it's way totally out of their bloodstream too, so if today was the first time you didn't let him have any, it may take a little longer before you'll see what the low carb only diet will do

Since you gave 2.5 today, it's important that you get at least a mid-cycle test in on this cycle (if at all possible)...if you can get more tests in, that's great too! I'd just hold that dose unless we see that it takes him below 50 (2.8)

It's even more important to get a "before bed" test in since most cats go lower at night. Getting that last test in at night can help not only fill in what might be going on, but can also keep him safe while you sleep.

With Lantus, we've found that the +2 or +3 is a lot like a crystal ball with a lot of cats....If the +2 is about the same as the Pre-shot, it's usually going to be a pretty normal cycle...where the blood glucose slowly drops to nadir and then slowly goes up again before the next shot

If the +2 is higher than the PS, that can signal the beginning of a bounce....those are the cycle when it's usually OK to not test quite as often

If the +2 is lower than the PS, that's your "early warning" that Rover might be continuing to drop in a big way and you'll want to make sure to get more tests in until you know he's gone as low as he's going to.

Hang in there....we'll help you!!
 
Thanks for the explanation. Working from home tonight, so I should be able to get a reading or two before bed.

Not totally taking him off dry. It's always available. But from now on, it will be a small amount in the bowl and a small amount given during subq.
 
Just wondering if you skipped last night's shot? There is no PMPS or units

Rover was coming down last night so it would have been a good idea to grab at least a +2 and before bed test :)
 
Red said:
Not totally taking him off dry. It's always available. But from now on, it will be a small amount in the bowl and a small amount given during subq.
Click to expand...

OK...if dry is going to stay in the picture, then if he drops below 90(5 for you), he gets a .25 unit reduction in dose (instead of dropping below 50(2.8)

The simple way to convert from World to US numbers is to multiply your number by 18 or divide the US numbers by 18 (in case you wondered)
 
No, sorry. Put the info in the wrong box. Urgh.

+2 reading is 471. Will try for one more reading but just gave him 1/2 small can wet Wellness grain-free.
 
Red said:
+2 reading is 471. Will try for one more reading but just gave him 1/2 small can wet Wellness grain-free.
Click to expand...

That's a pretty significant drop....HI means they're over 600 so that's a drop of at least 130 point in 2 hours

I'd try to get a +4 and then see how he's doing...especially since you increased his dose tonight
 
Chris & China said:
That's a pretty significant drop....HI means they're over 600 so that's a drop of at least 130 point in 2 hours

I'd try to get a +4 and then see how he's doing...especially since you increased his dose tonight
Click to expand...
+3 442
Need to get some sleep. Thank you for all your help tonight.
 
Today's high numbers were caused by the blue numbers yesterday.

I'm going to disagree about staying at 2.5u for his dose right now. The 2.0u got him to 31 a few days ago on May 15, which was why yesterday Vyktors Mum (Serryn) suggested that you decrease the dose to 1.75u. I definitely agree with her about it. That 31 gets to rule the dose decision-making for now, so I would go back to 1.75 in the morning and then hold it. The 30's are not numbers to fool around with.

This link has a couple of explanations about high numbers - the first post is about New Dose Wonkiness and the second is about Bouncing.

You asked earlier why Rover's dose needs could be changing. Things in Rover's body may be changing, and that could result in the dose needs changing as well. It's typical here to change the dose regularly. We use testing to guide us on what to do with the dose.
 
Are you going to be home and able to monitor? Do you have plenty of strips and high carb supplies? If so, you probably could go ahead with the 1.75u.


Another option is to stall (wait) without feeding Rover and recheck blood sugar in 15 minutes or so.
 
Was just checking out Rovers spreadsheet - good work on the testing :) not so good on the dosing. Lantus doses are not adjusted based on the PS BG levels they are adjusted based on the nadir (low points). You need to dose consistently to try and get consistent cycles - it just takes a little time and patience. I see you went with 1.5 last night which is not an unreasonable dose for Rover so please, unless he drops under 90, stick with a 1.5 dose for at least three days (6 cycles) so we can see what it does. Changing the dose around like you have been will just result in wonky numbers this is because lantus is a depot insulin not a straight in and out insulin so that each cycle is affected not just by the dose given that cycle but by the doses given in around the previous 6 cycles.
 
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