tight regulation question

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hml0228

Member Since 2014
I feel I have failed my kitty. With being a single and full time working mom I am basically maintaing katie at this point. She has been on lantus since feb with really no changes.

I want to do tight regulation and start all over to try and get her better but I am not finding clear cut instructions.

Basically I need to know at what time do I change her dosage.I know you are supposed to check glucose..but I dont know how to change her dose based on the levels I get? Ive been trying to find charts and documentation but I guess I am not looking in the right areas. Can someone please babystep me through the Process?
 
We never increase by full units and 2 units is going to build up too high!!!The glucometer reading should stay above 50 mg/dL on a human meter; above 68 mg/dL on a pet meter, or your cat risks hypoglycemia and death.

Whoops! just saw the spreadsheet is not be current data. Without current test numbers, we can't help you very much.

Always test before you shoot.

Do not shoot below 200 mg/dL until we've had a chance to see some numbers in the middle of the cycle.

The lowest it should ever go is 50 mg/dL on a human glucometer.

Dose adjustments are based on the nadir, the lowest glucose level after a shot. The nadir is around +5 to +7 hours after the shot in many cases; it can move around a bit.

All the instructions for the Tight Regulation protocol are in the Tight Regulation sub-forum. Read over the stickie posts here.

You need some revision of the spreadsheet to either add a column for time, if you want to keep those, or to enter the pre-shot values in AM or PM PS (pre-shot)

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Hi Heather,

I was a member of Tight Regulation, so I may be able to help answer some of your questions, although most of what I will say at this point is just reiterating the points BJ made.

I noticed the dates on your spreadsheet are February dates. Are those numbers actually from February or did you mean to write in October dates? If that information is from February, could you update your spreadsheet with the most recent numbers? Those numbers are going to be very important in terms of the advice we give you about dosing.

As for testing...it's really important to always get a test before each shot. The numbers you get will tell you if it's safe to give insulin. For Lantus, we base the dose on the "nadir" - which is the low point in the cycle. Usually, the nadir for Lantus is 5 to 7 hours after the shot. However, every cat is different. Some cats reach their lowest point earlier than that, and some of them reach the lowest point after that. It's going to be important to get tests in between each shot ("mid-cycle" tests) because that tells us how well the insulin is working. It also tells us if the insulin dose is too much.

How are you doing with home testing? Are you able to get tests before each shot and in between shots? Our first goal is to keep Katie safe, and the very best way to do that is to test. I know it's hard when you're working full-time and trying to take care of a family. Many people here do it, and we can give you tips on how to keep Katie safe while you're at work.

You're still using the ReliOn meter to test, right? If so, you do not want Katie to fall below 50. If she does, that's entering hypoglycemia territory, and that's when you want to take action and feed her high-carb food and/or Karo syrup. I'm sure you've seen the information about hypoglycemia. Just in case you haven't, here is a link to it: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887 If Katie does fall below 50 at any point, make sure you reduce the dose.

What questions do you have right now? We don't want to overwhelm you with too much information all at once, but we also don't want to leave you with unanswered questions, either.

Shelly
 
I see you have gotten great advice from others but wanted to pop by to offer support if you are awake right now. Let us know how things are going and could you start updating the ss?
 
So sorry for the wrong information on spreadsheet, I am accessing the board from my phone because my computer crashed and havent gotten it going yet.

Todays numbers
This is with the pet glucometer-
Am Pre shot-503
+3= 373
+5=270
+7=183
+9=157

Pre pm shot- 206 on human, 269 on pet (I am running out of pet testing sticks) I feel like I am poking her little ears off :( she doesnt seem to mind, but goodness!

How do yall handle tight regulation when you work ft? All advice is welcome. Basically I give her food at 530a (fancy feast.classic) then after her shot. I leave the house at 7am and not back til 5p. I feel like I am doing her more harm than good bc I am Not home. Also where do you purchasre your lantus? I pay 230 every 5 months...any other options? Thank you!!
 
Sounds like you are using a pen a month?
Refrigerated, kept on a stationary shelf, a pen can last until finished.

What dose are you giving?
 
Not cheaper per se, but you can use the entire contents before the insulin potency starts waning if you keep it in the refrigerator on a stationary shelf. No shaking nor rolling needed for Lantus or Levemir.

Some places will sell one pen at a time.
300 ml, 100 units per mL, so 300 units. At 4 units per day, you'd get 75 days out of 1 pen.
 
Hi Heather,

One of the members on TR, Chris (& China), has been purchasing the Lantus pens from a Canadian pharmacy. Here's a link to one of her posts about it: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=121078.

Thanks for letting us know that you're using the pet meter (the AlphaTrak, I'm assuming). May I ask why you chose to go with it? If you start using the human meter for all of your home testing, you'll save quite a bit of money on the test strips. That's up to you, though. Just make sure you remind us often that you're using a pet meter. Most of us on here use the human meters, so we have a tendency to read the numbers with those values in mind.

How familiar are you with the TR protocol? With Lantus, dosing decisions are based on nadir, which most often happens 5 to 7 hours after each shot. However, some cats have a much earlier nadir, and other cats have a much later nadir. With TR, we re-evaluate the dose every 3 days to see if it needs to be raised. Because the dose is re-evaluated so often, it's important to get tests before each AM and PM shot and at least once in each cycle (in between shots). Ideally, you want those tests to be around nadir (whenever that might be), but real life gets in the way of that all too often, and we have to find ways to work around it.

Here's just one possible example of something that might work for you:

Test, feed, and then give Katie insulin at 5:30 a.m. Grab a test before you walk out the door, which would be 1.5. We actually recommend on the TR board grabbing a test at +2 whenever you can because it can be a good indicator of how the rest of the cycle will go.

When you get home from work, you'll be testing, feeding, and giving insulin at 5:30 p.m. Then you can test in the evening and, if Katie's numbers indicate the need for more testing, you can set an alarm to get up in the night. (It's no fun, I know.)

On weekends, assuming you're off on weekends, you can get some extra testing in. One member of TR, Deborah (& Shasta) works full-time and doesn't have anyone to help her with testing. Here's Shasta's ss. As you can see, she gets the AMPS test and one before she walks out the door. Then she tests more during the evenings and on weekends when she is home.

A few other thoughts I have:
  • - Is there anyone else who can help you? One member here works throughout the day, but her mom is able to test for her.
    - Can you run home for lunch occasionally to grab a test? I'm a college teacher, so I was very fortunate that I could get home from work most days by +7. On days when I thought Jersey might go to low, I was able to run home (which was actually about a 30-mile drive round-trip) in between my classes to get an earlier check.
    - A timed feeder is well worth the investment. The feeder that was most often recommended to me was the PetSafe 5. I set it to open several times throughout the morning while I was at work. If Jersey's out-the-door check indicated that her numbers might headed down too low, I would put higher-carb food in it. I think you can find timed feeders in pet stores, but I had to buy mine online since my (one and only) local pet store didn't carry any.

I hope this helps!
Shelly
 
My vet was not supportive of me doing testing at home
..she wanted me to bring katie in every week. Once I told her I was using the human glucometer she told me the values were too different amd told me to get the pet version....expensive!! I have my last pet strip coming up at 1 today. Im not intending on getting morr at this point. 50$+ is expensive!

Pre shot this am was
236 human and 302 pet
+4 103 HUMAN

I have other cats so I cant keep her food down because they will eat it on her and I work too far away for my 30min lunch break, but I understand testing when you can.

Her lowest numbers are in the 100s the past 2days at 2u twice a day. If this continues what is the course of action looking like from here?
 
Definitely feed her ASAP, preferably with a little higher carb food. Monitor her very closely and test again in 20 minutes and post the result back. 51 on a human meter is low and you'll need to steer her BG with food. Have you got some Karo syrup / honey / glucose on standby?
 
51 is getting right down to the bottom, but still in our desired range. At +7, she should be starting to head back up on her own and you shouldn't need to do anything. Can you test again in a little bit to confirm she is moving back up? If you feed her now, I would only give a small amount of her regular low carb food just to see if you can flatten her out in good numbers, but not fill her up too much in case she is still dropping and you need to intervene with food later on.

Good job keeping an eye for those low numbers!

eta: I guess my reaction to a 51 at +7 is different than Critters, do what you feel most comfortable doing.
 
Hi,

Please follow Melanie's recommendations on food. She is much more experienced than me. I spook very easily and maybe err a little heavier on the side of caution.
 
She is acting fine and running around but I gave her the food, half a can..Ill post in 15. Im alaed because yesterday her lowest was at 9 hours and wasnin the 100s....I have to work tomorrow and no one will be home to test....her usual dose is 2u...should I drop this if she is already so low?
 
Glad she is acting normal. That is the most important thing to watch for. I am a tight regulation person, so my advice will sometimes be a little more walk-the-lines than some people may be comfortable doing. You always want to feel comfortable in your treatment.

Since you have fed now, the numbers following could show some food influence so you won't know for sure if she is rising on her own, or if she was dropping yet but you are seeing food affecting her numbers. You will want to see a couple rising numbers. If she is up on the 15min, maybe check again after 30min.
 
Ok just checked and its up to 74...per yesterdays course she probably would have dropped further. What does the mean for future doses?
 
As far as dose: without seeing data, its hard for me to advise on a dose. Tight regulation says under 50 is a dose reduction, so a 51 would not be. You wouldn't think 2 points would make a difference, but sometimes it does. I lowered ChrisFarley on a 51 and ended up taking his dose back up there for a bit until he did go under 50 to see progress. But from the discussions, it sounds like your dose might have been increased a little to quickly so it might not be a bad idea to reduce your dose and work back up safely if you need to.
 
Melanie, are you OK to stay with Heather on this? You have so much more experience than I have and will be able to give Heather the best advice and guidance.
 
esterdays numbers 
This is with the pet glucometer
-Am Pre shot-503
+3= 373
+5=270
+7=183
+9=157
Pre pm shot- 206 on human, 269 on pet (I am running out of pet testing sticks)

Today same dose..2u

Pre shot this am was 236 human and 302 Pet
+4 103 HUMAN
+7 51 human 76 pet
Gave food after 15 min she is 74
 
That might be the food influence that Melanie mentioned.

How long after the insulin dose was the 154 reading? And was that reading on a human or pet meter?
 
Critter Mom said:
...I spook very easily and maybe err a little heavier on the side of caution.
Click to expand...
Aine, I've been around here a good few years and I still "err a little heavier on the side of caution." ;-)
As the old FDMB quote says; "Better too high for a day than too low for a minute".

Unless I'm familiar with a particular poster I always tend to make the initial assumption that I may be trying to help someone who a)doesn't have a lot of experience treating their cat's diabetes; or b)who doesn't have a lot of hometesting data history; or c) may be seeing numbers lower than they are accustomed to; or d) may be trying a new insulin; or e) whose cat may have other health issues ; or f) whose cat hasn't 'read the rule book about how to be a diabetic!....
I'm probably more cautious than many folks here, but experience has taught me that caution is no bad thing.

Eliz
 
Thanks for that, Eliz. I'm painfullly aware of how little experience I have, especially with a depot insulin like Lantus. I know enough to spot a low number and know that a feeding intervention needs to be made but I would not feel confident advising someone how to steer their cat's numbers with just low carb food. nailbite_smile I know that you shouldn't feed too much too fast in case further feeding is needed later in the cycle.

The other thing that makes me very nervous is not knowing when a cat on a depot insulin is safely out of the potential hypo woods.
 
How are things going, Heather? I need to see to my little one right now, but I will check back as soon as I can.

If you get stuck in the meantime, have a look at the following forum sticky:

How to Handle Low Test Readings

Towards the end of the post you will find instructions for testing and feeding when numbers are in the lower ranges.
 
That's probably a combination of food, natural curve, and bounce.

Critter Mom wrote:
...I spook very easily and maybe err a little heavier on the side of caution
Click to expand...
.

I never discourage caution! I hope my post did not come off as indicating my advice was in anyway better or more correct that Critter Mom's, just different. When typing fast things can get flat. I am an accountant so following procedure comes naturally to me, but the caregiver always has to be comfortable, so if that contradicts TR protocol, you go with what the caregiver finds most comfortable and safest. Different advice shows the caregiver alternatives to how to treat and since every cat is different, its good to have options!

I've had to remove Smokey's spread to make room in my sig for the foster boys' stuff, but towards the end when she developed a mass on her pancreas she became higher dose and we often shot 10U b.i.d into 80s so my spook level is in a different place than most. :lol: I won't ever give advice that I think will put someone's cat in danger I will always look at the data and what protocol says to do.
 
Melanie and Smokey said:
I hope my post did not come off as indicating my advice was in anyway better or more correct that Critter Mom's, just different.
Click to expand...
Not at all, Melanie! :smile: I just recognise that I'm very new at the sugar dance and that I've got an awful lot to learn. I've been very grateful to the members who have held my hand when Saoirse's numbers have gone low and with their experienced guidance I was able to get Saoirse back into safer numbers with low or medium carb food. The problem I would have with suggesting another caregiver do similar is I would not know what warning signs to look out for while employing the low-carb approach to steering, or how to judge when their cat should be out of danger. I thought that Heather would be in much safer hands with you.
 
So it looks like the 154 was probably around +7.5ish? My guess is she's likely hit her bottom for the cycle, but I'd get at least 1 more test between the 154 and +9 since that is where her bottom was yesterday. Even if she turns down from 154, she hopefully won't get back down to the 50s.

As far as dose. I'd see what your PMPS brings tonight. You may want to shoot the current dose through tonight if you have a huge bounce off the low number. If you are not comfortable with 2U and not being able to test tomorrow, then take a dose reduction. We usually reduce by 1/4U so your new dose would be 1.75U. You always have the option, if faced with a low preshot number that you are not comfortable with shooting a full dose, to shoot a reduced dose and then go back to your normal dose on the next cycle.

If you can get onto a computer at all and get your SS up-to-date, they really do help seeing the big picture and what is going on. Sometimes patterns emerge that aren't seen on paper.
 
I hope that everything is OK with Katie. If you're not sure, or if you need any further help, please post again.
 
After she was out of the woods I had to run errands and go get more testing sticks because I ran out. Katie is doing fine! Her pre pm shot was 429...I am guessing the higher number iis due to the eating half a can from the low number today. Im going to try and get a new spreadsheet running tonight to try and get those numbers posted
.Hopefully my computer works for me. Thank you for all the help earlier today...I still feel as overwhelmedd with everything as the day she was first diagnosed!
 
Hope Katie comes out of that bounce quickly! How was your AM number?

Don't be surprised if she hangs high or is a bit bouncy today, it can take 72 hours to clear a bounce off of a new low number.

You are doing great! It was a great catch of the low number yesterday and you managed it well.
 
So numbers for today

Pre am meal 348
Pre shot 497
+1 422

Got home and tested before meal +11- 150

Pre pm shot-297

I dropped to1.75 last night, this am, and this dose due to the low drop the other day and I wouldnt be home.
 
Could you add a few more details to your signature to help remind us if some important details?

Go to the top left of the screen.
Click on User Control Panel.
Click on Profile
Click on Edit Signature
A text box displays.
This is where you paste the link for your spreadsheet.
Add any other text, such as
your name, cat's name,
city and state,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like food issues, allergies, IBD, etc.
 
I think I got it working. ...but can only update at night. Her before meal this am was 157....before shot was 187 so i waited 15 min and it went to 247 and I gave 1.75 at work all day so I cannot check until later tonight
 
I'm a bit confused about the method you're using at pre-shot.

The sequence is test first. If number is not at a safe level, stall without feeding then test again to see if the numbers are rising to a safe level to give the injection. Any rise seen after food is not going to give you a clear picture because subsequent readings may be influenced by the food eaten. (I hope I've explained this OK. :-| - There's a better explanation in the Tight Regulation protocol document available in one of the forum stickies on the TR board.)
 
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