? Zoot! Day 7 -Dosing changes and understanding glucose measurements

[Cinnie Cole]

Zoot! is on Lantus 1U twice daily, and he seems to be doing okay- except I keep testing his glucose with keto diastix and they show consistently higher readings than our Verio OneTouch glucometer when we take blood from the ear. Does that make sense?

What we see is a cat that is more active, peeing less, and drinking less. He only once got into the blue range in the past 7 days, and there are a couple of reds that I attribute to improper dosing because of bubbles in the syringe; but I think I am getting the hang of the syringe now and that might be less of an issue (I hope).

Since he is mainly in yellow and red ranges our vet is going to increase his dose after looking at the chart tomorrow. She will probably increase to 2U twice daily. Would that seem reasonable?

 

[AmandaE]

Hey Cinnie!

I was wondering if you had a chance to decide if you wanted to follow Tight Regulation or Start Low Go Slow? Without knowing that, it will be hard for anyone to weigh in If you do know could you add either a "TR" or "SLGS" to your signature?

1u is a very large dose increase for a cat, typically we only change dose in 0.25u increments, increases or decreases are based on nadir so typically a full curve is executed so you can make an informed decision. The blood glucose level that you increase or decrease at depends on whether you follow TR or SLGS.

To me, It looks like Zoot would benefit from an increase... I personally would stick to a 0.25u based off of my experience with dose changes but ECID... also I am not at all a dosing expert. Would you be able to do a 12 hour curve in the near future to get the true nadir value that Zoot is experiencing on 1u?

In the meantime, hopefully someone will be along to help you out with more experience

 

[Cinnie Cole]

Honestly, I have not had time to compare go slow with tight regulation As humans in my house are going through surgeries right now so I’m trying to balance human and pet priorities on top of work. i’m going to see our vet on Friday; she only gave us one unit syringes; I can ask her for the half dose syringes. What I don’t understand is even if I get the half unit syringes, how my ever going to figure out quarter unit changes.

I guess I’ll just follow her guidance until we have time to figure this out. He seems to be doing well but his numbers are not going down much.

 

[Wendy&Neko]

You can get syringes with half unit markings at human pharmacies. I don’t know New Jersey regulations and whether or not you need a prescription from your vet for syringes there. Brands with half unit markings in the US are listed in the syringe info Sticky Note.

Since you did see some blue on this dose, I would only increase by 0.25 units. We base dosing decisions on how low the dose can take the cat. Safety first, especially with a lot going on in your house right now. A full unit increase is too much and might send him too low.

 

[Tomlin]

Honestly, I have not had time to compare go slow with tight regulation As humans in my house are going through surgeries right now so I’m trying to balance human and pet priorities on top of work. i’m going to see our vet on Friday; she only gave us one unit syringes; I can ask her for the half dose syringes. What I don’t understand is even if I get the half unit syringes, how my ever going to figure out quarter unit changes.

I guess I’ll just follow her guidance until we have time to figure this out. He seems to be doing well but his numbers are not going down much.

Hi Cinnie. I 'm on the same page as you....in more ways than the Lantus! Hang in there with taking care of Zoot & family members going through surgeries. I hope all is going well as far as recoveries & that you have compliant/easy "patients'.

This is the start of Day 6 for us on 1U of Lantus & the plan is for me to do a curve this Friday to try to find the lowest # & then based on that as well as clinical signs, change the dose. I'm definitely leaning toward an increase, but I'm thinking 0.5 vs 1U. Like you, I will consult with my team & determine what (&why) the new dose should be. The only pink I have in the last few days was when T was severely nauseated. He literally looked like someone who is seasick or who got off one of those spinning rides at the amusement park!

I purchased the BD Ultra-Fine Insulin Syringes with 1/2 unit markings from a local pharmacy. They ordered them for me but you are also able to order them online. This is a link to see the product:
https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes

And this is an image of the syringe with 1/2 unit markings:
https://images.app.goo.gl/iEAuupaZkqh1P3HNA

 

[Tomlin]

And this is the link to the Sticky (they are very helpful) from this site regarding using U-100 syringes, including pictures of what .25 vs .25 would look like using the 1/2 unit marked syringes (scroll almost to the bottom for pictures):

http://www.felinediabetes.com/FDMB/...info-proper-handling-drawing-fine-dosing.151/

 

[Cinnie Cole]

Thanks! I am going to take the info to my vet on Friday - we informed her that we want to test BG regularly (she was initially reluctant to have us do it and only wanted us to do keto diastix). We want to be certain that he is getting the correct dosage - he was in the yellow again today (morning was red) but he overall is doing well. And he is getting used to my testing him.

 

[Tomlin]

Thanks! I am going to take the info to my vet on Friday - we informed her that we want to test BG regularly (she was initially reluctant to have us do it and only wanted us to do keto diastix). We want to be certain that he is getting the correct dosage - he was in the yellow again today (morning was red) but he overall is doing well. And he is getting used to my testing him.

That is so great to hear Cinnie! It's great that he was in the yellow again yesterday & he is doing well.

I'll be curious what they do with dose. I'm doing a curve Friday. Today is Day 7 but given that my T has been in a pancreatitis flare since the weekend & then he had side effects from the appetite stimulant yesterday (looked like ), not sure what to expect as far as #s & hoping its all calmed down by Friday for his curve. Funny thing is despite not being able to sleep, eating like a crazy man (including the dry), we took his BG pre insulin last night worried about how hight it would be & he was at a 207! I was thrilled but also a bit perplexed.

 

[Cinnie Cole]

It is amazing how they manage and when I think it might be high it is in the yellow. Wish, of I wish, that it could be blue some times. I think I will take a fuew more days before I do the curve - maybe Sunday or Monday; I have been wanting to, but I am still getting comfortable with the testing. Today AMPS was 297, and I just tried to get his BG at +4 but he was not having any of it. Will try an another hour.

 

[Tomlin]

That makes sense ! If my boy is still in a funk, I'll also wait on my curve. I'm actually happy with the yellows for now. Would like to eventually see greens when its been a fair amount of time since eating, but will be happy with blues if he's eaten. I'm also reading everything I can get my hands on with respect to published studies, national & international recommendations & why they are what they are with regard to BGs as well as diet info just to make sure I have a solid grasp on the info & can continue to ask questions & discuss with my team. Hope your +4 is where you want it to be!!

 

[Tomlin]

It is amazing how they manage and when I think it might be high it is in the yellow. Wish, of I wish, that it could be blue some times. I think I will take a fuew more days before I do the curve - maybe Sunday or Monday; I have been wanting to, but I am still getting comfortable with the testing. Today AMPS was 297, and I just tried to get his BG at +4 but he was not having any of it. Will try an another hour.

Cinnie. Just got a +5 and it was 390. Not sure how much food factored in since he ate a few times before it was taken. Hope Zoot was cooperative for his +5!