Started Blood Monitoring... what's next? | Feline Diabetes Message Board - FDMB

Started Blood Monitoring... what's next?

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Durielle

Durielle

Member since 2012
Hi all,

I just started blood monitoring. My kitty gets 1.5 units of Lantus with breakfast and dinner. I took a reading 1.5 hrs after dinner, and got a result of 232.
I am currently switching Duriel's food from Wellness to Fancy Feast.. and might still try a couple of other foods over the next couple of weeks. Is it too early to start changing her insulin dosage? My sense is that I should settle on a food choice first, and then begin to change dosages slightly.
What advice would you have for me at this point?
PS - A HUGE thanks to Diabetic Cats in Need for sending me the Kirby Kit blood monitor. I hope Kirby is purring in Kitty Heaven.. and I hope he runs into my amazing cat Gabriel who went up this last February.
 
OK, before you consider changing the dose, you'll need to gather more data. Congrats on being able to get blood successfully on your first day!

What you want to do with Lantus is get a minimum of 3 tests per day. One just before each shot, and one around 6 hours after one shot or the other. That's for starters.

You need to know what the BG is before the shots (with no food having been eaten for the prior two hours), and you need to know/find her "low point" or nadir, which "typically" happens about half way between shots. That's the most important number with Lantus, because dosing is based on the lowest number you see in a 12 hour cycle (and not on the numbers you get just before the shots).

It could be that her dose will need to be changed, but it's possible she'll need less insulin rather than more insulin. Your data will tell you which way to go, and people here will be more than happy to help you interpret the data.

The next thing you should consider is setting up a google spreadsheet like you'll see attached to most people's signatures. It's a powerful tool that will help you, and anyone that looks at it determine how the insulin is working.
Here is a link to "how to" create a spreadsheet and attach it to your signature. If you have any trouble with it, let people know and they can help you out with it.
http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

Carl
 
Okay, so I've been monitoring using a spreadsheet, testing before meals at 7am and 7pm, and dosing a steady 1.5 units in each shot. I'm told Duriel's values are too high, but also that they're too low for such a dose. I'm getting more confused as I go. Is there a chart somewhere that tells you how much to dose, based on the cat's weight and pre-meal glucose level? I've searched but haven't found one. Please help clear up the confusion. The cat looks fine, eats well, is recovering, has more energy, has not gone hypo, and does not show any negative symptoms. But apparently, there's some advice I'm still missing. What is it?
 
As you move forward, you want to start getting more data to learn your cat's patterns. ECID . Every cat is different.
Perhaps you can do a curve soon ( every 2 hrs) or a mini curve (every 3 hrs) .
You've got some blues suddenly showing up so it's a good time to be monitoring . . perhaps you'll even see a dip into green.
This info will help you later when you start seeing lower numbers.
 
tompytomp said:
Okay, so I've been monitoring using a spreadsheet, testing before meals at 7am and 7pm, and dosing a steady 1.5 units in each shot. I'm told Duriel's values are too high, but also that they're too low for such a dose. I'm getting more confused as I go. Is there a chart somewhere that tells you how much to dose, based on the cat's weight and pre-meal glucose level? I've searched but haven't found one. Please help clear up the confusion. The cat looks fine, eats well, is recovering, has more energy, has not gone hypo, and does not show any negative symptoms. But apparently, there's some advice I'm still missing. What is it?
Click to expand...

Lantus is not dosed based on weight and pre-shots, but rather the nadir (lowest number of the cycle). That means you need to get at least 3 tests a day to dose Lantus properly--once before each shot to make sure it's safe to shoot insulin, and one mid-cycle testsabout 6 hours after either shot that tells you how low he is going on the dose. Any additional tests you can get are also helpful, but these are the minimum you need to dose Lantus safely and effectively.

Most cats on a low carb, canned diet do not need much more than 1u of insulin. It's hard to tell for sure without mid-cycle tests, but my guess is 1.5u is too high a dose. Too much insulin can keep preshot tests just as high as too little insulin--that's why those mid-cycle tests are so important for proper dosing.

Here is a link to the Lantus Dosing Protocol: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf, and the more user friendly version here on the boards: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581.

I would recommend lowering the dose back down to 1u, and starting over on the dosing scale with the dosing protocol (and getting those daily mid-cycle checks). Also, I would highly recommend doing a curve (testing every 2 hours for a cycle) at least once a week. This gives you a better picture of how your cat is reacting to the dose throughout the entire cycle.
 
Thanks for all the suggestions and information. I did lower her dose to 1 unit 2 days ago, and unfortunately now I'm seeing high numbers again. However, I will keep it at 1 unit, and test at 6hrs post-shot when possible.
 
I haven't been able to test halfway between shots since I last posted. But I have noticed that her test scores have become higher pre-meals with only 1unit of insulin. When I would give 1.5, her scores were lower. Does this mean she was better off with 1.5?
 
It's really hard to tell how the insulin is working without those mid-cycle checks. What is preventing you from getting them? Perhaps we can give you some suggestions on altering your schedule so that they are possible. Remember, you can get them either cycle--the AM or the PM cycle. Also, doing a curve once a week (testing every 2 hours for a 12 hour cycle) is also recommended to get a good picture of what's going on. The pre-shot tests only tell you if it's safe to give that particular insulin shot. The mid-cycle check tells you how the insulin is working and what the dose should be.

When a cat drops too low (usually in the middle of the cycle), their livers release glucose into the blood stream. This causes number to raise back up. This often happens before the next shot. So you don't know if a dose is too high or low because low number and high number will BOTH keep preshot values high. Also, when a cat first starts insulin, even normal range numbers can trigger this kind of reaction. The only way to stop this reaction from happening is to find the correct dose and stick to it, and the way to find the correct dose (because it is impossible to guess from preshots) is by daily mid-cycle tests.

Also, Lantus is dosed in .25u-.5 unit increments in cats. .5u increases are only made when a cat's mid-cycle numbers are mostly over 300; most of the time dose adjustments are made in .25u increments. But again, you can't really tell how much the dose needs to be increased/decreased, or held without those numbers.

Without those mid-cycle checks, you're not exactly dosing blind, but more like dosing with your hands in front of your eyes. In order to get a complete picture of how the dose is working and adjust it correctly, you need daily mid-cycle checks. I was working two jobs and going to grad school when Bandit was on insulin, so what I did weekdays was test before each shot (7am, 7pm), test again before bed (10-11pm) and then set an alarm to test 6 hrs after the shot and went right back to bed (1am). On the weekends when I was home during the day, I did a curve. It seems like a lot of extra work to get that extra daily test, but trust me, it will make your life a thousand times easier getting the diabetes under control and your cat into remission. And it will allow you do it much more quickly. Once your cat is in remission, you only have to test once or twice a month. It is 100x worth the extra effort now, especially if you have a really busy life, like me.
 
Thanks for the advice, I am off school for Christmas break so I can test her mid-cycle over the next couple of weeks.
 
That's good, and nice to see you:-)
I love the note for today on Duriel's spreadsheet! Try to post as you collect the data over the next few days and we can help you make sense of the numbers.

Carl
 
Happy New Year everyone, and all the best to you (and your furry babies) in 2013!

I have been doing testing at +6 hrs. after each shot (when possible). In the last 2 weeks, she's had 4 'blue' test results, 13 'yellow', 20 'purple', and 7 'red'. To me, it seems she still has too much blood glucose. She had a couple of good mornings around Dec 20, but lately she's testing in the 3-400's before shots and at +6 hrs. Her health is good overall, but I continue to question whether I'm giving the correct amount of insulin. It would seem to me that she needs more, perhaps 1.25 units vs the current 1. I will start doing so tomorrow, and do +6 hrs testing to see if her scores come down.
 
I am wondering if the dose is still too high - you get intermmittent reds, and it seems like you're getting elevations rather than reductions from the Lantus at times. This could be the liver releasing compensating hormones and glycogen.

Since you are using Lantus, glucose testing, and have your spreadsheet up, you may get more thorough review of your data if you post in the Lantus forum.

How thoroughly have you read over the Lantus protocol? What questions do you have about it?
 
Hmm, unless I don't understand it, the protocols say that if nadir tests are between 200-300 (which is the case with Duriel) the dose should be increased by .25u. Duriel initially weighed 5 pounds when diagnosed in late Sep 2012, and was initiated and held at 1unit per shot from Oct-Dec. She now weighs 8.5 pounds (almost 4 kilos). The dosage according to the protocol ought to be 2 units per shot now (.5u X 4 Kg). And she doesn't test below 50mg/dL at nadir, which would be reason to reduce the dosage further. What makes you think she is being given too much insulin? Is there a counter-intutive effect I'm not aware of, whereby giving insulin makes test scores higher for some reason? Thanks for the advice.
 
I think you're looking at a dated version of the protocol and mis-read the weight related information. Weight, your cat's ideal weight, is only used to formulate the initial dose. The more current formula is: initial dose = 0.25 x ideal weight in kilograms. This would calculate out to 1.0u as a starting dose.

As far as testing, more tests are better than fewer tests. It's also very helpful to not test just at +6. Not all cats have their nadir in the middle of the cycle. For example, my cat's nadir is usually at around +3 or +4. Further, the nadir can shift around on a daily basis. It's very helpful if, in addition to your pre-shot tests, you can get random tests: before you leave the house, when you return, always before your go to bed, etc. In this way, you begin to fill in the empty spaces on your spreadsheet and it allows you to begin to see patterns.

It may also help to to a curve (testing every 2 hours) or a mini-curve (testing every 3 hours) on occasion. This approach allows you to see when Lantus onset begins and where the nadir falls. It also gives you an idea of what kind of duration you're getting from a shot. If you take a look at Julia/Bandit's SS, it will give you an idea of how Julia was testing when Bandit first came here. I'd encourage you to take advantage of getting as much data as you can before you go back to school.

Looking at the data on your SS, I tend to agree with you. I think you need to increase Duriel's dose to 1.25u. Do you have syringes that are in half unit increments? That's the smallest they come and the half unit syringes will help you with small unit dosing that's used with Lantus. If you haven't done so already, please take a look at the starred, sticky notes at the top of the Lantus board:
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
 
Okay, I'll keep her at current dose and do as much testing as possible at 3 hour intervals. Thanks again.
 
tompytomp said:
...What makes you think she is being given too much insulin? ...
Click to expand...

If the dose is too high or the drop from the insulin is fast enough, or sometimes if the insulin just takes the cat to a level that hasn't been experienced in a while, the liver reacts to prevent a hypo. It releases counter-regulatory hormones and glycogen. This results in an increased glucose level (the glycogen gets broken down into glucose). Its called a bounce and it can take several days to clear (ECID - each cat is different). I was wondering that because sometimes your +3 were going up, not down, and in many cats, the glucose is going down by then.

You started recording data with a dose of 1.5. If that was the initial dose, it might have been too high, missing the optimal dose. Did the vet base it on the cat's ideal weight, current weight, or something else?

You also had a couple of times you skipped because the preshot test was low; if that happens routinely, its a clue to reduce the dose.


I noticed comments on your spreadsheet about black stools. Did you every figure out what that was? Sometimes black or coffee-ground colored feces indicate an upper digestive tract bleed (not always).
 
The stools have become quite normal. I am doing interval testing today, and she does go up and down. I will keep doing as much testing as possible until Jan 6, and make sure her dose is .75 to understand more clearly what's going on. Thanks for the info!
 
I've been giving .75 units while interval testing. Duriel spiked before dinner, and then went hypo 4 hours after evening shot. She recovered with a pinch of sugar dissolved in water, given with an oral syringe. To avoid spikes and dips I will reduce dose to .5 starting next shot Jan 4. Thanks for the advice everyone, and if anyone has further pointers or opinions please let me know.
 
tompytomp said:
I've been giving .75 units while interval testing. Duriel spiked before dinner, and then went hypo 4 hours after evening shot. She recovered with a pinch of sugar dissolved in water, given with an oral syringe. To avoid spikes and dips I will reduce dose to .5 starting next shot Jan 4. Thanks for the advice everyone, and if anyone has further pointers or opinions please let me know.
Click to expand...

Scary! Glad she was able to recover. How is she doing now?

I agree with BJ that the reason there didn't seem to be much improvement is because she was bouncing from lower numbers that you weren't seeing...and I think Duriel's hypo tells you she wants a lower dose, too. :smile: How about tomorrow, you come on over and join us in Lantus Land? I promise we won't bite. :-D
 
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