Simmie - first time down to 125- need help

[LydetteSimmie (Iceman)]

Hi all,

I know you could help me better once I do the spreadsheet and I keep saying it will get done. I mean it today. So to make up for the lack of the spreadsheet I'll try to avoid my long emails and get to the facts :

- TODAY - tested at 8:30 am EDT Simmie came in at 125! I fed him but did NOT shoot
- he is transitioned 100% to low carb food. No runs anymore
- Very alert, happy, licking his ice

- tested last night at 8:30 pm at 293, fed and shot 4 units (his normal dose)

- before bed around 11:30 he had his evening snack of lo carb food, no longer gets his 1/8 or 1/4 cup of dry M/D

Two concerns:

- When should I dose him again? He's been on Lantus for a year (only recently started testing myself) I assume I should test again in a couple of hours?

- How much insulin should I give him?

question

- is it possible that while I was sleeping he became hypo? This scares the bejesus out of me.

Other

- he had a curve just a few days ago, two hours apart - (am shot) 347, 247, 247, 231, 226, 272

I guess this really illustrates why you need that spreadsheet - maybe other newbies like me can really see the importance too..

 

[BJM]

What is his normal pre-shot like?

Removing high carb may drop the glucose about 100 mg/dL and may reduce the insulin by 2 units. To get a number you can shoot twice a day, you may need to reduce the dose.

Was the curve at home? If at the vet, vet stress can raise the numbers from 100 to 180 mg/dL.

Lantus is an insulin you can shoot low to stay low IF you are testing in the +5 to +7 time frame to monitor how low he goes.

 

[LydetteSimmie (Iceman)]

Hi BJM,

His normal pre-shot for the last few days have run like this (there are 2 #s per day) - 237 and 270, 271 and 293, then this morning at 125.

I have been transitioning him to the low carb food over the past week or so, mixing in a little wet m/d once a day and giving him about an 1/8 cup of dry. Yesterday was the first full day that I did not give him any m/d, only low carb food.

Yes, I did the curve at home. Precisely for the reason you give. I do remember once the vet said a previous curve ran hi and low the last time they did it for me. Also, what you said about the danger point being between 5-7 hour post shot kind of jives with what my vet told me awhile ago when I asked when I should be nervous...she said between 6 and 8 hours post. But then, another vet said, when I asked about their shooting routine when I had to put Simmie there because of vacation, "It's ok if we give him insulin sooner than you normally do while you are away...we can dispense the insulin within a 9-12 hour window with Lantus".

I'm starting to confuse myself, sorry. How do you think I should proceed, given all this data? confused_cat Thank you so much for your help.

 

[Elizabeth and Bertie]

Hi Lydette,

His normal pre-shot for the last few days have run like this (there are 2 #s per day) - 237 and 270, 271 and 293, then this morning at 125.

I have been transitioning him to the low carb food over the past week or so
Yesterday was the first full day that I did not give him any m/d, only low carb food

.
The fact that Simmie had no high carb food yesterday could be suffcient reason for that low preshot number this am. (It's not the only possible reason for lower numbers, but looks to be a likely suspect.)

what you said about the danger point being between 5-7 hour post shot kind of jives with what my vet told me awhile ago when I asked when I should be nervous...she said between 6 and 8 hours post.

Have you identified when Simmie's typical 'nadir' is? (Nadir is the point in the insulin cycle when the blood glucose is at it's lowest (and the insulin having it's strongest effect). It could well be, as BJ says, 5-7 hours post shot. (And some cats have blood glucose dips later in the cycle also).

But then, another vet said, when I asked about their shooting routine..., "It's ok if we give him insulin sooner than you normally do while you are away...we can dispense the insulin within a 9-12 hour window with Lantus".

The experience of most Lantus users here is that it works best if given as close as possible to 12 hourly. Because of it's 'depot' properties a shot given early can act as a dose increase, and a shot given late can act as a dose decrease. (Note: I am NOT a Lantus user myself. I'm writing what I understand to be the case, and am sure someone will correct me if I'm wrong!)

How do you think I should proceed, given all this data? confused_cat .

It's possible that Simmie may need a dose reduction now that the high carb food is out of his diet. It could take a few days to see the full effect of that, so you may need to be cautious.
Hopefully, those experienced in Lantus use will chime in with some specific advice.

You're doing really well, Lydette!

Eliz

 

[BJM]

When I changed Spitzer to low carb food, his Lantus dropped from 3 units to 1 unit. That is an N of 1, so it may not generalize to your cat. You might try dropping 2 units and waiting out the 3-5 days it takes for the dose to settle.

Do test for ketones if/when you do this, so you can see if he is breaking down fat for energy. Urine testing tips are in my signature link Secondary Monitoring Tools.

 

[LydetteSimmie (Iceman)]

Thank you all.

I have completed the spreadsheet and will link it tomorrow. Everyone has been so good to me and Simmie. Thank you.

Hugs, Lydette and Simmie