Upped the dose

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Sue484

Member Since 2015
Morning all. I have upped Frankie's dose back to 5 units today. His numbers have been gradually increasing since Sunday with no nadirs that I could see. He is also sleeping more and not as playful as he was on his good blue day on Sunday when he was on 5 units. His 3am check today (not on spreadsheet) was 28 (450) and his amps +30 mins (again not on spreadsheet) was 33 (594) so he is gradually creeping back into the blacks. I have a sitter coming in every day to give him half a pouch of food and test his blood so he can't go too low when (or if!!) his numbers start to go down again.
 
I have a sitter coming in every day to give him half a pouch of food and test his blood so he can't go too low when (or if!!) his numbers start to go down again.
(emphasis mine)

Hi Sue,
The numbers will go down again. What you are seeing may be some residual bounce plus the effect of the insulin depot having drained because of that reduced dose on 3rd May.

It's great news that you have a pet sitter who can test! Wowsy! :woot:

Chin up, sweetie. I know it can be discouraging to see high numbers return. But I feel sure you'll be seeing better numbers again soon. :bighug:

Eliz
 
That's why I thought I had better put him up. I will keep him at 5 and see how he goes when the sitter comes, as that should be roughly at nadir, although it will probably be a few days until things improve, knowing Frankie. My sitter could neither test nor inject before I found her, but she was very willing to learn and is very capable, and has since had several diabetic animals to look after. I had to have her in when I went away as my friend who moves into my house (it's her holiday from her husband she says!!) has a phobia of needles. She just about conquered it with Frankie, but after Rom's diagnosis too it just freaked her out too much.
 
Hi Sue,
It's good to see those numbers coming down again. :cat:

I will keep him at 5
Just noticed that you raised to 5 units from 4 units. :nailbiting:

I can see why you'd think that might be necessary (seeing that high AMPS today). But do be careful. Lantus isn't like Caninsulin. Lantus is dosed according to the lowest number of the cycle, and 5 units has previously shown itself to be too high a dose. And remember, any given Lantus dose/shot doesn't only affect that particular insulin cycle; it influences the ones that follow also...

Eliz
 
I did that bcause 5 units worked for him previously and lower didn't. 5 units put him into a normal range, and now with the sitter coming I can make sure he doesn't go too low while I'm at work.
 
Hi Sue!

I wanted to explain a little about what you've got going on with Frankie. He has "bounced" from the blues and greens on Sunday. A bounce can last up to 3 days or so, and in a cat that isn't used to being in normal numbers (those greens and blue numbers), it surely will take the entire 3 days.

What is important here is that these high numbers yesterday & today do not mean that he needed more insulin. The 5u that was working before was when he was eating dry food. There is a HUGE difference between how much insulin a cat needs when eating dry food compared to how much they need when they are eating low carb canned food. One of our kitties here in Lantus/Lev Land went from 5.5u to off of insulin when the dry food was removed. The little bit of dry food Scooter was sneaking caused him to need 5.5u of insulin per shot. That's a powerful carb-effect. You've changed the situation when you removed the dry food and it's important that the insulin also change.

There are 3 occasions when high numbers do not mean that a cat needs more insulin:
1. If a cat's dose is too high, they might have constant high blood sugar
2. If a cat's dose has just been increased, their body might respond with higher numbers for the following day or two after a dose increase.
3. If a cat's blood sugar either drops into a range it's not used to (which could be 200 if a cat is used to 400), or if the blood sugar drops too quickly (depending on the cat, might be 50 points an hour or more) then the body perceives it as a hypo and responds by releasing counter-regulatory hormones and stored sugars to raise the blood sugar. The result is high numbers.

Please read this explanation here so you understand this a bit better. It's counter-intuitive, but it is the way feline diabetes works.

If you count forward 3 days from Sunday, that means that he might still be high until tomorrow sometime.

I would encourage you to reduce his dose back to 3 or 4u in the morning and to keep it there. It's counter-intuitive, but truly, I think you will see sometime tomorrow he will clear this bounce out of his system and his blood sugar will drop back into blue/green numbers. You don't want him overdosed when this happens.

With Lantus & Lev, you don't increase the dose based upon high numbers in one cycle. We look at the previous 3 days' tests to determine what's going on. Until new members get the hang of things, we encourage people to ask for help evaluating blood sugar before raising the dose. It's for Frankie's safety.

Please ask if this doesn't make sense because it is pretty important to understand.
 
Thanks @julie & punkin (ga) . I will reduce his dose to 4 today and see what happens. As I'm ahead of you, did you mean the third day was today (Wednesday) or Thursday? If no decrease in numbers by Thursday at latest, I post to the Lantus board and see what they say or just go back to 5?
 
Look at the recent low point - mid-day on May 3rd, and count forward 3 days til mid-day on May 6th. I'd expect him to clear the bounce around then. Some cats will even go a little longer, and since his dose went down and then up today that may change the pattern, but in general, most cats will clear the bounce right on schedule 3 days after the low numbers event.

Even if he's still high tomorrow, I would stick with that lowered dose.
 
I just read your hyperlink @julie & punkin (ga) and it made me laugh. I had read that in the case of a failed reduction go back to the last dose where you saw good numbers so that is what I did. It even says that in your attachment. However I understand it a bit more now, didn't realise he was bouncing. Let me know which day I should see the decrease and we'll keep our paws crossed!!
 
I will give it until Saturday then and increase from the evening dose if no joy. Does that sound reasonable?
 
I think we must've posted at the same time. Scan up a bit in this thread and see if I answered your question already.

That linked post - too funny - i see why you would think that. The explanation of bouncing is in the second post. Look there and see if that helps make things clearer.
 
Looks like we did post the same time! So that's midday today he should clear. I had never seen the bit about bouncing before, only the failed reduction, so that is why I upped his dose. I gave him 4 units this morning and we'll see where we are later. If my 5 units have messed up the schedule, when should I leave it until I go back to 5?
 
You can thank Elizabeth for the help - I rarely look on Main Health - there is more than enough to do on the Lantus/Lev board helping people who just use those insulins! Elizabeth saw your post and sent me a note asking me to help you figure out how to move ahead with the dose. She's your angel and is looking out for you!

I'd give the 4u a few cycles (maybe 4 days total of consecutive 4.0u shots) and re-evaluate on what the dose is doing. If you're following Tight Reg, your goal is to get to green, but you don't want to increase before we see what it does.
 
@Elizabeth and Bertie I believe I have you to thank for putting me right. I know you dropped me a line yesterday but I need a swift boot sometimes. Still not sure what is going on with Frankie. At least he is lower at this minute. I will keep at 4 for a few days then and see what happens. I can try TR apparantly, so I am going to see how that pans out.
 
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Sue, the choice is yours whether you want to follow Tight Regulation. Between your tests and the petsitter (a great catch!) you testing enough.
 
Morning, Sue,
Has Frankie's food been consistent over the past few days (just wondering about possible 'variables') ?
And is he OK in himself? No other health issues at the moment? (I know he is prone to pancreatitis).
.
 
@Elizabeth and Bertie What do you mean by consistent? Timings for food? Or the same food? His timings are the same during the day up to pmps but after that he gets his next meal (only half a pouch) whenever I wake up in the middle of the night. Should I set an alarm about midnight so that I can feed him then and give him time to get the food spike out of the way? I am alternating his food so that he has a bit of variety, but it is all low carb. Frankie is fine (touch wood) at the moment. No health issues and he is even starting to play a bit now (or as much as his legs will allow) That's the only reason I am freaking a bit about his doses is because of his legs that are progressively gettimg worse in spite of Zobaline. Now I have decided to try TR, I should be able to post for advice on Sunday to see whether to increase and what to. What are your thoughts on his spreadsheet? Is he doing ok on the 4 unit dose? Still bouncing or getting worse?
 
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What do you mean by consistent? Timings for food? Or the same food?
Was thinking about Frankie still hanging in high numbers. It may be that he's still being affected by the bounce; but I was just wondering whether something else might be contributing to the current high. Hence my asking about the food. In particular I was wondering whether the food over the past couple of days had a higher carb content; or whether (despite being low carb) it contains any ingredients that Frankie might be intolerant to...

Regarding the leg weakness, has Frankie's potassium level been checked recently? (Sorry if I've already asked this....)
.
 
Yes Frankie's potassium was checked just over a week ago and was fine. He's mainly eating the Felix meaty loaf but he was brought up on Felix and had really missed it. That's what he was eating on the 3rd when he had his good blue day so I doubt it's that.
 
Eek!! Green scares me. Can I aim for blue instead?
Sure, you can aim wherever you want. But the funny thing is that it's hard to get a cat tightly controlled in higher numbers. It's simply easier to hold a cat flat when they are running in normal numbers - in a tightly controlled cat the blood sugar might only move 10 points in the entire day. When the blood sugar doesn't move much you don't have to worry about that zig-zag pattern in blood sugar numbers.

Lower blues on an AT is probably equivalent to green on a human glucometer. We don't have conversions for AT meters, unfortunately. We know they run 30-40% higher than human glucometers. On page 4 of this document you'll see the dosing chart that has AT numbers in it. This is the original study that resulted in the Tight Regulation Protocol.

Just a reminder - if you want people who use Lantus and Levemir to be seeing your posts, you're going to want to post in that support group. It's fine for you to post here, but you're going to find a larger population of people who can help you evaluate the spreadsheet and the dosing if you post on there.

For right now, I'd give 2 more days (total of 6 consecutive cycles) at the 4.0u and then re-evaluate and decide if he needs more insulin.
 
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