Thinking about raising Bet's dose, again

Kathleen Einwich

Kathleen Einwich

Member Since 2018
I am doing a half-assed version of the Start Low, Go Slow method, and if you look at Bet's sheet, you will see his levels are still all over the place but never seem to go down and stay down into the good zone. I am really unsure what to do. I tried lowering his dose of Lantus to .5 twice a day and I'm not sure what difference that made. Maybe there's something I am not seeing. I am considering lowering it again, to .25, or raising it to .75, to see if that will bring him into the good zone. He eats as much as he wants of FF classic pate but has not been himself except for a short time in the early days of the treatment (running and playing). He's never had any problem with ketones.

I am tired of testing him every three hours (plus the strips are expensive) and so is he, though he appreciates the treats. What I am asking you folks is, what do I need to do to bring him to "normal" levels? I've looked at some other folks' sheets and I suspect it may never happen. His will be in the 200s for a day or two and then shoot up into the 300s, and every once in a while drop to "normal" levels for a few hours. I don't know what is causing this. I'd like some advice. Up or down on the Lantus dose? Any other thoughts?

I'd appreciate any advice you much more experienced folks could offer.
Kathy
 
Kathy, I'm glad to see you again. It's been awhile, and I hope you have been well. Please don't get discouraged with Bet's numbers, he is more than a collection of numbers. I know the Lantus experts will have some input for you. I see you look at other's spreadsheets, but Bet is Bet and every cat is different.
I'm not sure that you have to test every 3 hours, every day. Perhaps, and they will correct me if I'm wrong, maybe test 1 or 2 times a day at different times, on different days? That will save you strips and frustration. Plus, when you can, get some additional PM tests, a before bed test or if you happen to be watching a late movie, get one before you go to sleep?
It's the holidays, and people are traveling, being with family etc. and many not as active on the board, so please be patient and you will get responses. :cat::bighug:
 
Thank you. I decided to test only at the 6 hour point today, since that can most often be his nadir (ha, it took me a while to understand what that meant!). I'll try to test overnight if I manage to stay up or wake up in the middle of the night. Thanks for the suggestion. I hope you have/had a good holiday season. It's good to hear from you too.
Kathy
 
It took me a long time before I understood the terminology, and the abbreviations. I still see one now and then that I just don't know what that means! LOL
We are hanging in there, it's cold and snowing today, internet is being fussy so I am making messes in the kitchen for now. Idjit takes the snow and cold as a personal affront, and he has been getting his grumpy face on. DH just got a CPAP machine and you should have seen Idjit's reaction to that! LOL
 
Here is your last post for continuity, and for others to catch up on some history...

http://www.felinediabetes.com/FDMB/...sting-dose-need-opinions.207755/#post-2302977

In what way are you doing modified SLGS? It just helps to understand so others can advise. I looked at your SS, and have a few suggestions and thoughts. I see on Dec 15th, you had an AM preshot of 28, maybe a wonky strip, I would have tested again to double check. I hope that was a skipped shot, although your SS shows 0.5u...even the most experienced members here who follow TR do not shoot under 50, and folks following SLGS do not shoot under 90. That evening you went ahead with 0.75u, which should have been 0.5u (regardless of whether you are following SLGS or TR).

As a general comment, with SLGS, you would reduce if you get any numbers under 90, which you had on the am cycles of December 20th (preshot) and again mid cycle December 25th. I think if I had seen a 72 at +3, I would have taken another test at +4, to see he had flattened out or was dropping still. That is likely why you are seeing higher numbers the last few cycles.

What I would suggest is not to bother with am +9 tests, those aren't really doing anything for you. What I would do is get at least one test every night, before bed, most kitties like to go lower at night, and right now you are missing some key data. Even at +2 or +3, because if you see a significant drop from preshot (more than 20%), it may indicate Bet is going to go lower, and you might want to test again depending on how sharp the drop is, or perhaps offer some higher carb food to flatten out the potential drop, if you need to get to bed and can't test again. Also something to watch for, if you see a flat yellow cycle like you had yesteday, that sometimes means you will have an active following cycle, last night would have been interesting to see a test... It may be that he cleared a bounce, and is now starting another one today.

On a personal note, I have a bouncy kitty, and I've been doing this dance for 1 1/2 years. All I can say is don't get too fussed in seeing nice flat cycles other kitties have, while it helps to see other people's SS, please don't feel that you aren't doing things right. Some kitties just like to bounce, and those *usually* clear in 6 cycles.

Also we make dose decisions based on how low the dose is taking kitty, so while those stinky pinkies are no fun to see, I definitely wouldn't increase...I'd get a few of those evening tests consistently, and go from there. Kitties can feel a bit off at higher numbers, but as long as you have your 5Ps...peeing, purring, preening, playing and pooping, try not to focus too much on the bounces, especially since Bet seems to be clearing them pretty quickly.

Lastly, just keep in mind that if you follow SLGS you should actually have reduced after the first low 70s to 0.25u. I'm just emphasizing this for other possible newbies who may be lurking on the forum ;)
 
Christie & Maverick said:
keep in mind that if you follow SLGS you should actually have reduced after the first low 70s to 0.25u.
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Christie nailed it. If you are following SLGS, you lower the dose when he goes below 90. Also about testing at night, before bed is a great test to get. I rather suspect he is going lower at night and bouncing during the day. Look at how many times lately he's gone up during the day cycle above his AMPS numbers. Sure sign of a bounce reacting to however low he went at night.

I also didn't test as much as you during the day, in spite of having a kitty who took over a year to stop bouncing as high as red. Going to pink was progress for me. :banghead: Though it take me learning my kitty to when to test strategically and you are still relatively new at this. Anyway, if you see his numbers start rising during the cycle, no need to test any more until the next preshot. Also, if he is lower at preshot time, I'd grab a +2 test instead of a +1. With a green preshot, even a +1 is recommended so you can intervene with carbs if he's going lower. Many cats don't nadir precisely at +6 (not sure Neko ever did), it's just a good starting point to test. Mix up the times as you learn what works for Bet. On days like the 25th when you saw a 70's, I would have tested an hour later (if possible), again to see if he was going low and needed intervention with food.
 
Wow to both of you. Like I said, a half-assed SLGS, not really being able to follow it because Bet almost never has levels below 200, among other things, and no-symptom low levels that go away quickly. I am still a newbie and it's hard at my age to follow all of this, I must confess. There are times I want to throw the meter against the wall. I will retest sometimes, as per y'all's instructions. But there are times, at least once per day, when Bet bleeds so much no matter how careful I am. Profuse bleeding, all over both of us. I go for the edge of the ear. Bet won't let me use the left ear. He has something weird about his ears overall, since he was a kitten. They are very clean, but he acts like they itch, deep inside. He likes me to massage them.

I am confused more when his levels went up after the shots. I was trying to follow instructions to test every 2-3 hours and settled on every 3 hours sometime back, with no idea why. I will try to do a test overnight...setting my alarm for 750am every day has my sisters amazed that I get up that early. It's not my habit, at all - but for Bet, I'll do anything. I appreciate the advice about not bothering to test at +9 and such.

I thought Lantus took 3 hours to take effect, and 50-120 is a "normal" reading? I know now not to shoot at all if his levels are below normal...but what if his level is in a normal range at AMPS? .5 or .25?

Your information overall is very helpful. I may write it down and try to memorize it at best, or re-read it frequently to keep it in mind as time goes on. I guess I'll leave Bet's dose where it is, for now, unless he has a low morning test that proves true. Thank you both so much.
Kathy
 
Let me see if I can help to reduce your confusion.

I'm assuming you test, feed, and shoot all within a very brief time. This being the case, for the first hour or two after you give a shot, Bet is also experiencing a food spike due to your having fed your kitty. So, you would expect numbers to rise the first few hours after a shot. Depending on your cat's metabolism, Lantus onset is at around +2 or +3. That's when you would expect to see numbers starting to decline due to the influence of insulin. Numbers should continue to drop through nadir and then they come back up during the latter part of the cycle. It helps to keep in mind that not only are numbers rising by shot time, feeding your kitty also is causing numbers to rise.

It sounds like when Bet is bleeding, you're hitting the vein than runs close to the edge of the ear. If you have a flashlight and shine it on the underside of her ear, you should be able to see the vein. It may give you a better sense of where to poke. I always tested on only one of Gabby's ears. If Bet is fussy about her ears, you can try poking on a paw pad. My cat wouldn't tolerate it but some cats don't mind.

Please let us know if you have a question or are confused. We'll do our best to reply and answer your questions.
 
Sienne and Gabby (GA) said:
Let me see if I can help to reduce your confusion.

I'm assuming you test, feed, and shoot all within a very brief time. This being the case, for the first hour or two after you give a shot, Bet is also experiencing a food spike due to your having fed your kitty. So, you would expect numbers to rise the first few hours after a shot. Depending on your cat's metabolism, Lantus onset is at around +2 or +3. That's when you would expect to see numbers starting to decline due to the influence of insulin. Numbers should continue to drop through nadir and then they come back up during the latter part of the cycle. It helps to keep in mind that not only are numbers rising by shot time, feeding your kitty also is causing numbers to rise.

It sounds like when Bet is bleeding, you're hitting the vein than runs close to the edge of the ear. If you have a flashlight and shine it on the underside of her ear, you should be able to see the vein. It may give you a better sense of where to poke. I always tested on only one of Gabby's ears. If Bet is fussy about her ears, you can try poking on a paw pad. My cat wouldn't tolerate it but some cats don't mind.

Please let us know if you have a question or are confused. We'll do our best to reply and answer your questions.
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All of that is really helpful. It makes sense, with Bet's numbers rising after the shot and then falling! I feel like saying, duh... I feed him (them, really, him and his sister) after the morning shot and 6 hours later, then after the PM shot. Nothing until morning unless they wake me up, which they used to do in the early days. Bet has put a good portion of his former weight back on, which is great.

Sometimes when I poke Bet's ear nothing comes out. I must admit I've never looked at it backlighted with a flashlight but have looked at the illustration. He dutifully mostly puts up with the pokes, but sometimes gets impatient and pulls away at the critical moment, so I have to rush. I need better closeup glasses, I guess, which I have been promising myself to get at Walgreen's. That would help too, I'm sure. I turn on all the lights so I can see better.

Bet's eyes are dilated pretty much all the time. Not sure what that means, but I don't see him staring at the wall as much as I used to, at least.

I will test him late tonight to see how his levels are. Thanks so much for your help, it was good.
Kathy
 
I used to have to turn on multiple lights too. The best money I spent was on a headlamp from Amazon, maybe around $15.00. It keeps both my hands free, and has really great focused light I can direct right where I'm poking. I used to think I wasn't getting any blood, and would poke again, and often wasted strips. Then I realized I just wasn't seeing it :rolleyes:. Sometimes you have to squeeze the ear, press lightly upward from the centre toward the edge, just a little to get the blood drop to appear. With my fancy headlamp, I can see the smallest blood drop now, and luckily those FSL meters need only a small amount ;)
 
Krystina & Nelli said:
@Kathleen Einwich ... What an excellent pic of Bet! His pose and statleley posture :cat: is very handsome :)
How old is Bet?
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Bet is 14, having been born in Hot Springs, Arkansas, on August 4, 2004. He is a polydactyl (Hemingway cat), and I got him and his sister (also polydactyl) at the same time. His mom was from Key West, where his owner was stationed. I happened to be in Hot Springs at a spiritual gathering and came home with two baby kittens.... My best friend takes most of his photos, he loves her better than me! She could put him over her head and say "Kitty airplane!" and twirl him around and he would love it, even as an adult. Thanks for the compliments. Off to test...
 
majandra said:
You can get headlamps from dollar stores too. I have one in my vet kit- doesn't matter if it breaks cause it was so cheap.
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The electric out here in the country goes out fairly often, so my sisters sent me a three-light "headlight", taking pity on me. I was thankful. I can never find the darned flashlight(s) and I can never lay hands the ones I had left over from the last hurricane when it's dark. A friend gave me an "electric candle"...ha. I hang the "headlight" next to the bed but it's going downstairs where I do Bet's tests. It will help a lot. Never thought of that. Thanks so much.
 
Krystina & Nelli said:
Bet should come out of bounce after today ;) :)
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Bet's reading was 274 at +4 after an AMPS of 284, with a full can of FF put down in the meanwhile. I think he ate most of it. He's not so hungry very recently except in the morning, and maybe at +6 or at 6pm, the time I used to feed them for all of their lives. I'm just grateful that he likes the FF. He was always very fussy.
 
Dyana said:
Sometimes a flat yellow cycle is followed by an active cycle. Maybe he will come out of his bounce tonight.
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I managed to give Bet a furshot at PMPS tonight. What a mess, I could really smell the Lantus in his fur. His +3 level (after food at PMPS time) was 297. Well, there's always tomorrow.

His skin is really tight to his body and he has very little fat. I tried the roll method, which I don't usually do, and missed the mark entirely. I need to watch the injection videos again. I normally just find a clear spot in his fur in the appropriate areas and inject at an angle so I don't hit muscle. He doesn't object.
 
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