Happy Cat said:
Jerry has been on Lantus since August 9th and has had multiple dose changes. Although it hasn't been a terribly long time I'm getting a bit frustrated over not seeming to get him just right where he needs to be. He likes to hang out in those high numbers - he seems responsive to changes at first then starts to climb again. I don't know if anyone else has had this issue or if it really just takes months to get them where they need to be. Being patient but feeling discouraged.
i understand your frustration, but hang in there! what you're seeing on his spreadsheet is pretty typical. it can take months to get to the point we think we should have kitty at in weeks.
Happy Cat said:
Part of it may be that though I don't yet have a scale for him due to my own health issues I can tell he's put on weight. Not a huge amount just in the beginning his spine had been bonier than ever and it's not like that anymore, he's re-cushioned so to say. He has had general health improvements besides not being so boney. His water consumption has dropped drastically from 6 bowls to a day later there's still some left of 1 bowl not completely dry as it had been with multiples. Urination isn't as frequent and I'm not having mold issues anymore in his litter box. Even his fur is brighter, he previously had been looking like a solid dull orange cat and now the base orange looks healthier as well as his orange stripes reappearing noticeably.
wonderful! now this is very typical of kitties after being on lantus for a relatively short period of time! these improvements are awesome! treating any diabetic kitty is not just about numbers. your observations are what we call part of the "whole cat report". the 5 Ps... pooping, peeing, preening, playing, and purring are every bit as important as blood glucose numbers.
Happy Cat said:
However I don't know how to interpret these readings or what they're trying to tell me so I'd appreciate any feedback on his spreadsheet in general or especially those with Lantus experience.
imho, he's responding well and you're doing a great job collecting data!
the action of lantus is cumulative, meaning one dose can affect up to what you see over the next three days. in other words, it could take up to 3 full days to see what effect the adjustment will make on kitty's numbers... whether you're increasing or decreasing the dose. when attempting to interpret a lantus kitty's spreadsheet you want to look for what i call "waves of action". i don't look at single cycles. i look at what happened over at least the 3 days prior to explain what ever i'm trying to figure out... especially when kitty is relatively new to insulin therapy.
for example:
on 8/22 and 8/23 there were two injections at 1.5 units before the dose was dropped back to 1.25 units. remember, the action of lantus is cumulative. if you count three days from the last injection of 1.5 units you come to the AM cycle on 8/26 where he dropped to 77. you can see how those two injections of 1.5 units influenced the AM cycle on 8/26 even though the dose had been dropped back to 1.25 units on 8/23 (PM cycle).
BJM mentioned "bouncing" in her post above. after beginning insulin therapy, *most* kitties will react to numbers their bodies are not used to after a drop. some kitties bounce harder than others. jerry appears to bounce hard. don't worry. it's normal. as frustrating as it is to see higher numbers caused by a bounce, his body is reacting the way it's supposed to react.
if i were in your shoes, given the time already spent at 1.25 units, and giving ample consideration to the amount of testing you're doing... i would take the dose back up to 1.5 units
if your goal is to bring Jerry back to greens. however,
bringing kitty into green numbers requires some preparation on your part. please take the time to read through the "stickies" (posts marked with stars) at the top of the "Topics" section in the
LANTUS (GLARGINE) - Tight Regulation group. there's a ton of information contained in those stickies... much too much to absorb all at once, but pay special attention to how to handle low numbers and putting together a hypo kit. you can post in that group whether you wish to follow a Tight Regulation Protocol or not. ask any questions you may have. the sheer size of the group can be intimidating, but they're a friendly lot! But... if you're not ready yet to take that step... it's ok. :mrgreen:
Wendy&Tiggy said:
Basically you look back at the last 3-5 days and kind of take an average of the nadirs.
i feel obligated to comment on and clarify wendy's comment about averaging nadirs to help determine whether a dose increase is warranted because the statement scares me. in fairness to wendy (she went on to post guidelines for making dose adjustments) , i think her explanation was simply a poor choice of words, but because the explanation could cause harm if her post was not interpreted correctly... the post begs for clarification.
we don't "average" or consider "percentages" of
anything when it comes to making dose adjustments. not ever.
let me give you an example:
day 1 nadir: 265
day 2 nadir: 35
day 3 nadir: 365
average of the three days = 261
using an "averaging" system/method, one might increase the dose by 0.25 (rather than decrease the dose) because the average of the nadirs is greater than 200, but less than 300. this could put kitty in danger real fast.
NancyJac said:
I'm a little surprised that he started on insulin the day after he was diagnosed. Most vets will recommend trying to manage with a change in diet first. If you changed his diet and started insulin concurrently, that makes it more difficult to interpret the BG numbers since you don't know how much is attributable to food and how much to insulin. I would try holding the same dose for a week (unless his readings become extremely low) and also keep track of how much and how recently he ate before each BG reading.
many kitties are started on insulin immediately after being diagnosed for various reasons. kitty's vet usually makes that call based on other issues we may not be aware of.
just my thoughts...
And sent just in time!