thoughts on split dosing

[Just-As-Appy]

Twix's vet suggested that I give her 1 u in the am and .5 u at night. Her fructosamine apparently shows that she is too low over night which could be as she doesn't eat at night (very limited mobility). I do recall this discussion from many years ago but wondering what current thinking is. Fructosamine # was 393 and on the IDEXX scale below 400 is good control.


https://docs.google.com/spreadsheets/d/1HNSwDK37Uh4X-Zj4eIijYqjyqFFaOKphOTJaPTStehY/edit?usp=sharing

 

[Ale & Bobo & Minnie (GA)]

Since you’re following SLGS and she went under 90 today, the new dose tonight should be .75. I’m not sure how the fructosamime test would show that she’s going low overnight since it’s a 3-week average but tagging a few others who may be able to understand what your vet means. I’d suggest the same dose am and pm though @Sienne and Gabby (GA) @tiffmaxee

any chance you can start getting a +2 every night? That should help you gauge where she’s headed overnight. It would also be helpful to us if you could fill in your signature with more info. See mine as an example. Thanks!

 

[Sienne and Gabby (GA)]

There is no way a fructosamine test can provide the information that your vet suggested. It's an average for blood glucose levels over a period of 2 - 3 weeks. If you've ever had your blood checked for diabetes, the test is called a hemoglobin A1c. It gives you a single number that is similarly an average of blood glucose over 3 months. It doesn't tell you what time of day your blood glucose is either high or low.

The best way to know if there are variations in Twix's blood glucose is home testing. Like Ale suggested, I think it would be helpful to get some tests during the PM cycle. I'd be very curious if Twix's numbers are dropping at night and you've missed some dose reduction-worthy numbers. Looking at the difference between your AMPS and PMPS suggests that numbers may be dropping at night.

Giving differing amounts of Lantus at each shot time creates problems. Lantus is a depot type of insulin. This is a link to information on the insulin depot. Ideally, with Lantus, you want to keep a steady level of insulin in "storage." When you give an injection, Lantus forms microcrystals that are deposited in the fat tissue. Much of the insulin dissolves over the 12-hour cycle. However, some is left and overlaps the next cycle. This is what gives Lantus a gentle, "flat" curve. In order to get those results, you want to give the same amount of insulin at AM and PM shot times (unless the dose needs to be changed). If you change the dose at each shot time, the depot never reaches a steady state. As a result, you get wonky numbers.

 

[tiffmaxee]

Do you work nights? Is that why all testing has been during the day?

 

[Wendy&Neko]

If the fructosamine was done by Idexx, they changed their references ranges a few years ago. Good control is now 360-410 if Idexx was the lab that did the test. On top of that, fructosamine for hyperthyroid cats may read lower than it should. I believe you mentioned she is hyperT. From this article:

For these reasons, the serum fructosamine concentration should not be considered a reliable monitoring tool in hyperthyroid cats with concurrent diabetes mellitus. Additionally, serum fructosamine concentrations should not be considered reliable for differentiating between diabetes mellitus and stress-related hyperglycemia in hyperthyroid cats

She has definitely earned a reduction down to 0.75 units today.

With the dosing methods we use here, we find it best for Lantus and Levemir if we shoot the same dose AM and PM.

 

[Just-As-Appy]

Since you’re following SLGS and she went under 90 today, the new dose tonight should be .75. I’m not sure how the fructosamime test would show that she’s going low overnight since it’s a 3-week average but tagging a few others who may be able to understand what your vet means. I’d suggest the same dose am and pm though @Sienne and Gabby (GA) @tiffmaxee

any chance you can start getting a +2 every night? That should help you gauge where she’s headed overnight. It would also be helpful to us if you could fill in your signature with more info. See mine as an example. Thanks!

I'll drop to .75 and see if it holds. Thanks
I'd be happy to fill in my signature if I knew how.

 

[Just-As-Appy]

If the fructosamine was done by Idexx, they changed their references ranges a few years ago. Good control is now 360-410 if Idexx was the lab that did the test. On top of that, fructosamine for hyperthyroid cats may read lower than it should. I believe you mentioned she is hyperT. From this article:


She has definitely earned a reduction down to 0.75 units today.

With the dosing methods we use here, we find it best for Lantus and Levemir if we shoot the same dose AM and PM.

Interesting about the hyperthyroid and fructosamine test. Thanks for that and the other info

 

[Just-As-Appy]

There is no way a fructosamine test can provide the information that your vet suggested. It's an average for blood glucose levels over a period of 2 - 3 weeks. If you've ever had your blood checked for diabetes, the test is called a hemoglobin A1c. It gives you a single number that is similarly an average of blood glucose over 3 months. It doesn't tell you what time of day your blood glucose is either high or low.

The best way to know if there are variations in Twix's blood glucose is home testing. Like Ale suggested, I think it would be helpful to get some tests during the PM cycle. I'd be very curious if Twix's numbers are dropping at night and you've missed some dose reduction-worthy numbers. Looking at the difference between your AMPS and PMPS suggests that numbers may be dropping at night.

Giving differing amounts of Lantus at each shot time creates problems. Lantus is a depot type of insulin. This is a link to information on the insulin depot. Ideally, with Lantus, you want to keep a steady level of insulin in "storage." When you give an injection, Lantus forms microcrystals that are deposited in the fat tissue. Much of the insulin dissolves over the 12-hour cycle. However, some is left and overlaps the next cycle. This is what gives Lantus a gentle, "flat" curve. In order to get those results, you want to give the same amount of insulin at AM and PM shot times (unless the dose needs to be changed). If you change the dose at each shot time, the depot never reaches a steady state. As a result, you get wonky numbers.

Thanks. I didn't think different doses would be a good idea. Glad to have confirmation

 

[Just-As-Appy]

Do you work nights? Is that why all testing has been during the day?

I have to work her dosing and testing around horse and other barn chores and hope to get a few hours sleep to fend off the migraines.