? Units and Shooting advice needed

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Astrid & Jocke

Astrid & Jocke

Member Since 2020
Jocke was diagnosed exactly 2 months ago, with > 700 and we started on 2 units Lantus every 12 hrs. The first curve was done 12/22 at my vet with numbers in the 500s, units were increased to 3. I started home testing and my vet increased his dose about 2 weeks ago to 4 units. Today's readings were alarmingly low:
+3 71
+5 48/51 (tested twice)
+6 55
+8 62

https://docs.google.com/spreadsheets/d/1sGefDxCi5MV4EqJyD0uXNrxPA3licDsxiPXwPitBwQk/edit?usp=sharing

My cat acts normal and I gave him some fancy feast with gravy and a few pieces of temptations, when I saw his low BG numbers. I called my vet and he said to continue giving him his 4 units of Lantus tonight and also stop testing so much, only retest 6 days from now. My gut feeling is to not give him his 4 units tonight and I posted on facebook, where I received the advice to cross-post here.

Thanks so much in advance,
Astrid and Jocke
 
Good to see you over here from the FB group! Welcome to the FDMB!

As I said on the group, your vet has increased your dose by too much. We only recommend dose increases in .25 to .5 unit increments.

By dropping below 50 today on your Relion meter, he's earned a reduction. I think I'd reduce him to 3.5 and start always getting Pre-shot tests and at least 1 mid-cycle test on the AM cycle (5-7 hours after the AM shot) and at least 1 "before bed" test on the PM cycle. You don't have a lot of PM tests but they're just as important (if not more important) as the AM tests are. Most cats go lower at night so getting at least a "before bed" test lets you know if it's safe to go ahead and sleep throughout the night or if you should set an alarm to get more tests later.
 
Thank you Chris, I appreciate the advice! Are you still recommending to skip tonight's shot and then test in the AM pre-shot? Thank you!
 
Astrid Oechtering said:
Are you still recommending to skip tonight's shot and then test in the AM pre-shot?
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No, I'd make sure he has no food after +10 today and then test at your usual PMPS time (or even better, test at +11.5 so you have some time before shot time to get some opinions)

He will most likely bounce high at some point from dropping so low today
 
Chris & China (GA) said:
No, I'd make sure he has no food after +10 today and then test at your usual PMPS time (or even better, test at +11.5 so you have some time before shot time to get some opinions)

He will most likely bounce high at some point from dropping so low today
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Thanks, will do! I'm at +9 now, so will do that and then share the latest readings.
 
Hi Astrid! You can start posting daily too, helps the admins keep track of you and help in real time. I'm so glad you are here, getting expert advice from Chris, and have that spreadsheet! Whenever you have a question you can edit the title of your post to put a question mark from the drop down menu - gives it more attention!
 
Margaret (and Pearl) said:
Hi Astrid! You can start posting daily too, helps the admins keep track of you and help in real time. I'm so glad you are here, getting expert advice from Chris, and have that spreadsheet! Whenever you have a question you can edit the title of your post to put a question mark from the drop down menu - gives it more attention!
Click to expand...


That's good advice I will follow. Thank you! I'm now seriously considering switching my vet, they used to be really amazing but their advice has been confusing based on what I learned in the past weeks following the fb group on feline diabetes.
 
Astrid Oechtering said:
That's good advice I will follow. Thank you! I'm now seriously considering switching my vet, they used to be really amazing but their advice has been confusing based on what I learned in the past weeks following the fb group on feline diabetes.
Click to expand...

I think a lot of vets aren't really knowledgeable about feline diabetes - dogs are generally easier to deal with in terms of BG numbers so maybe they think cats should be too (and they are wrong about that). But this group is fabulous for help and support and keep you going in the right direction. I would trust this group for sure. You can check out my Pearl's SS (linked in my signature) and see how well she is doing - all with the support of this group and me listening to their directions.

My vet is great about diagnosing other things, so I am keeping her, but she can be antagonistic about the diabetes and not wanting me to test and to increase doses by big jumps. I don't know how to deal with this yet or whether this means she won't be a good fit long term. But a lot of vets are like that. The good news is, you hold the needle and YOU decide what you are doing. They just need to write the script!
 
Chris & China (GA) said:
No, I'd make sure he has no food after +10 today and then test at your usual PMPS time (or even better, test at +11.5 so you have some time before shot time to get some opinions)

He will most likely bounce high at some point from dropping so low today
Click to expand...

Just took his reading at 11.5 at it is 223 mg/dl
 
Chris & China (GA) said:
Good to see you over here from the FB group! Welcome to the FDMB!

As I said on the group, your vet has increased your dose by too much. We only recommend dose increases in .25 to .5 unit increments.

By dropping below 50 today on your Relion meter, he's earned a reduction. I think I'd reduce him to 3.5 and start always getting Pre-shot tests and at least 1 mid-cycle test on the AM cycle (5-7 hours after the AM shot) and at least 1 "before bed" test on the PM cycle. You don't have a lot of PM tests but they're just as important (if not more important) as the AM tests are. Most cats go lower at night so getting at least a "before bed" test lets you know if it's safe to go ahead and sleep throughout the night or if you should set an alarm to get more tests later.
Click to expand...
Hi Chris, Hi Bhooma is it me or does Astrid's SS not look like it should for Lantus, I am talking about the color coding at the top.
There is no dark green and the neon green isn't correct
I didn't check the rest .
Thanks @Chris & China (GA)
@Bandit's Mom Thanks Bhooma
 
Chris & China (GA) said:
OK....take it again since it's PMPS time but if under 200, DON'T feed....otherwise, go ahead with the 3.5 dose tonight as long as you can test tonight and have plenty of supplies (high carb food, test strips, Karo/honey/syrup)
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Thanks Chris. It's 266 now so I will give him 3.5 and I have supplies at hand to test and feed, thanks again for the support!
 
Astrid Oechtering said:
It's 266 now so I will give him 3.5 and I have supplies at hand to test and feed,
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Yeah, looks like he's going to bounce. Bounces happen when 1. they drop too low, 2. they drop too quickly, 3. they drop into numbers their body isn't used to anymore (or any combination of all 3). The liver releases stored sugars and hormones to bring the blood glucose (BG) up quickly so don't be surprised if he continues to go higher despite the shot. It can take up to 6 cycles for those hormones to clear out of the bloodstream so you can get a true idea of what the dose is actually doing.

I'd get a +2 and let's see where he's at then and go from there.

Looks like getting rid of whatever dry you were feeding is making a big difference!
 
Chris & China (GA) said:
You're absolutely correct. @Astrid Oechtering, send me a private message on Facebook tomorrow so we can figure out what's going on with your spreadsheet before it goes on too much longer.
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will do, Chris! took his AMPS and it is at 190. Unsure if I should shoot at all now? He has been throwing up a little this morning (he usually doesn't, unless he ate something he shouldn't have).
 
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Hi Astrid,

I see from the spreadsheet that you've given Jocke 3.5IU Lantus. Has he eaten anything yet? If yes, was it a reasonable amount?

Also, do you have a good supply of test strips for your meter in the house?


Mogs
.
 
Critter Mom said:
Hi Astrid,

I see from the spreadsheet that you've given Jocke 3.5IU Lantus. Has he eaten anything yet? If yes, was it a reasonable amount?

Also, do you have a good supply of test strips for your meter in the house?


Mogs
.
Click to expand...

Yes I read some more of the resources available here and went ahead, he ate some and I have about 140 test strips left to monitor him. Planning to test him every 3 hours given the numbers look ok.
 
Glad to hear that Jocke has eaten.

I see that he was down to 116 at +2. There's a fair way to go in the cycle. I'd suggest testing hourly to make sure he doesn't drop too low.


Mogs
.
 
Critter Mom said:
Glad to hear that Jocke has eaten.

I see that he was down to 116 at +2. There's a fair way to go in the cycle. I'd suggest testing hourly to make sure he doesn't drop too low.


Mogs
.
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Yes, I just did that, thinking the same! his +3 is 58, but he now just ate a good portion - I was looking for some guidelines on when to shoot, when to wait and haven't found them yet, or maybe I did but didn't recognize them? I'm still figuring all of this out and am trying to understand when to do what how. Thanks for the support!
 
Astrid Oechtering said:
I was looking for some guidelines on when to shoot, when to wait and haven't found them yet, or maybe I did but didn't recognize them?
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For cats that don't yet have much data, initially a 'no shoot' threshold of 200 is recommended (human meter), so if the preshot is lower than that then, if possible, stalling is the next step:

* DON'T FEED YET!
* Don't give insulin yet.
* Wait 30 minutes and test again to see whether BG has come up high enough to give insulin.
* While waiting to test, post for help and advice on how to proceed.
* If BG comes back up high enough feed your kitty. If he's eating OK, give the insulin dose.
* If you have stalled then you need to wait for 12 hours from the time you gave the stalled dose before giving more insulin.

After you've gathered more data, here are the recommendations from the Lantus dosing methods sticky post (see Start Low, Go Slow [SLGS] method):

How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Astrid Oechtering said:
I'm still figuring all of this out and am trying to understand when to do what how. Thanks for the support!
Click to expand...
We all start in that position, Astrid! It's good to be able to pay forward some of the help I've received from other members. :)


Mogs
.
 
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Astrid Oechtering said:
retested, and it's closer to +4, so added it in at 45 mg/dl. Gave him some treats he usually doesn't get (temptations).
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That's too low (obvs). Carbs definitely needed. Now you need to get numbers back up into a safer range. It will take a little time for the carbs from the Temptations to get into the bloodstream so please test again 20-30 minutes from the time Jocke ate the Temptations (no later). Jocke may need more food to get/keep numbers up.

Do you have any high carb wet food in the house (e.g. Fancy Feast Gravy Lovers)?

NB: Regardless of which dosing method you're following, you need to reduce the dose again immediately. Tagging Chris to ask her to suggest how much of a reduction is appropriate. (@Chris & China (GA) ). At minimum, you need to reduce it by 0.25IU.


Mogs
.
 
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Critter Mom said:
For cats that don't yet have much data, initially a 'no shoot' threshold of 200 is recommended (human meter), so if the preshot is lower then if possible stalling is the next step:

{...}

We all start in that position, Astrid! It's good to be able to pay forward some of the help I've received from other members. :)


Mogs
.
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Wow, this is what I was looking for, thank you!!!
I gave him FF Grilled with Gravy about an hour ago which he happily ate and more temptations (which he also loved) and put a tiny bit of syrup on his lips to lick off to bridge the time the carbs take to get into the system.
 
Astrid Oechtering said:
I gave him FF Grilled with Gravy
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Had a gander at Dr. Pierson's food list and I see that these are all in the 12-15% carb range. Is that the highest carb wet food you have in the house, Astrid? (Just getting an idea of what hypo toolkit supplies you have available, particularly because the Grilled in Gravy medium carb food didn't keep numbers up after the +3 feed.)


Mogs
.
 
he's now at 60. It is the highest carb one I have, but also have some "high calorie" nutritional paste for cats and dogs. just gave him a little of that.
 
Astrid Oechtering said:
he's now at 60. It is the highest carb one I have, but also have some "high calorie" nutritional paste for cats and dogs. just gave him a little of that.
Click to expand...
Not much of a rise from the Temptations and syrup (yet...).

Can you test again please, Astrid, and please post how far along you are in the cycle ('+???'). Need to make sure that Jocke doesn't drop back. If he's between 50 and 70 feed a couple of teaspoons of his regular low carb food. If he's above 70, please don't give him anything to eat for the time being.


Mogs
.
 
Astrid Oechtering said:
he's now at 60. It is the highest carb one I have, but also have some "high calorie" nutritional paste for cats and dogs. just gave him a little of that.
Click to expand...

Good deal....now that he's back above our "take action" line of 50 and has eaten, test again in 30 mins. (which I guess would be about now)

Definitely think getting the dry food out of his diet is making a huge difference in his need for insulin!
 
Better - and at half-way point in the cycle.

Don't give any food and please test again in 30 minutes to see if his numbers will hold without any food intervention.


Mogs
.
 
That's grand, Astrid.

I'm literally just about to sign off because I'm going to pass out any minute so I can't stay on with you (in the UK and have sleep meds on board). I'm tagging @Chris & China (GA) to ask her to pop in. I'm also going to tag Melissa to ask her to keep an eye out for the two of you this evening and also to find you support from an experienced Lantus user if you need it (@FrostD).

Chris has posted a dosing suggestion above. The PMPS isn't high so if you do decide to give insulin this evening there's a possibility you might need to test intensively for many hours if Jocke's numbers drop down again. I'd suggest starting to test at +1.5 and then +2 if you do give the dose.

I'd urge caution tonight. Jocke's numbers were a little slow to come up earlier on and now, even after the Temptations treats, he hasn't climbed very high.

If you need help quickly but the Feline Health board is quiet, please post on the Lantus board, indicate that you need urgent help in the thread title, and include the URL of this thread in your first post there so that members can easily check back here to see what happened earlier in the day.

Wishing you both a safe and uneventful night.


Mogs
.
 
Critter Mom said:
That's grand, Astrid.

I'm literally just about to sign off because I'm going to pass out any minute so I can't stay on with you (in the UK and have sleep meds on board). I'm tagging @Chris & China (GA) to ask her to pop in. I'm also going to tag Melissa to ask her to keep an eye out for the two of you this evening and also to find you support from an experienced Lantus user if you need it (@FrostD).

Chris has posted a dosing suggestion above. The PMPS isn't high so if you do decide to give insulin this evening there's a possibility you might need to test intensively for many hours if Jocke's numbers drop down again. I'd suggest starting to test at +1.5 and then +2 if you do give the dose.

I'd urge caution tonight. Jocke's numbers were a little slow to come up earlier on and now, even after the Temptations treats, he hasn't climbed very high.

If you need help quickly but the Feline Health board is quiet, please post on the Lantus board, indicate that you need urgent help in the thread title, and include the URL of this thread in your first post there so that members can easily check back here to see what happened earlier in the day.

Wishing you both a safe and uneventful night.


Mogs
.
Click to expand...

Thanks so much Mogs, have a good night!

Just took his latest reading at +13 (or more +13.5/ +1.5) and it's 287 mg/dl
 
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