04/11 New to forum, unsure how to adjust dose

Hi Everyone,

We are new to the forum -- I have a 6 year old sphynx who was diagnosed as diabetic about 1 year ago. Lately I have been having some issues controlling her numbers. She eats Fancy Feast pate and we are currently using Lantus. Based on the numbers I have been getting I'm not sure if I should increase the dose again or maybe she is bouncing and it needs to be reduced further? I was also debating just stopping the insulin entirely for a few days as kind of a reset and then start again with a super low dose. If anyone has any ideas that would be great!

 

Hi Melissa and welcome to the forum. You will find this a wonderful place to get help and support for your kitty.
I would definitely NOT stop the insulin for a few days as you will run the risk of your kitty developing Ketones which can develop into DKA which is a dangerous illness.
Unfortunately I can't see your spreadsheet you posted. It just won't open. Can you try and repost it please or maybe it is just me who can't open it.
Can you tell us what type of meter you are using please? Is it is human meter or an Alphatrak meter?
Does she have any issues with her teeth or maybe has a UTI which could be raising the numbers.?
Another thing could be the insulin may need replacing.
Without seeing the spreadsheet we really can't help much......will wait and see if you can repost it.
Bron

 

I think I have found it....is this it?

 

Strange, does it work through this link for you? https://docs.google.com/spreadsheet...bYYbu4hlHr5EhSxG_osTgnqHpkI/edit?usp=drivesdk

We are using the OneTouch Verio Flex meter (human). We ruled out a UTI probably about 2 weeks ago and she had a bunch of teeth pulled in the fall so no more issues there-- she is hairless and almost toothless!

I had been wondering if it was the insulin cartridge I was using so I got a spare one from someone else that was still sealed and stored in the fridge, the date I made the change is on the spreadsheet if you are able to open it. Thanks for your response!

 

Just some observations about the SS above, which I think is yours. Not being critical at all....just wanting to help
Always try and get a 'before giving the insulin' test to check it is safe.
If you could get some other inbetween tests during the cycle it would tell us a lot more......the nadir ( lowestpoint in the cycle) is around +6 mostly but not always, so if you could get some random tests in either night or day around +5 to +8 it would show us how low Pinkie is going. Cats can be high at the beginning of the cycle, drop low and be back high by the next shot, and unless we are testing, we don't know.
It is possible she might be bouncing from the +3 of 8.8 on the 9th. Bounces can happen even when the cat doesn't drop into low numbers,but drops lower than she is used to lately, if the cat has been in high numbers for a while ..
I think I would try and get some extra inbetween tests in for a couple of days to see if she is dropping lower. If she doesn't in the next two days I would increase to 0.75 units. They are not terrible numbers but you do want to get them into blues and greens if possible

 

Yes that's our spreadsheet. The ones missing are usually because my husband had to check and wasn't able to-- he's still learning. I'm planning on doing a curve this weekend I'm just waiting on some more strips as I'm running low, they should be here tomorrow. I just got really confused when I saw that she went from 8.8 at +3 to 15.7 at +6 the one evening, I thought we were finally back on track with the dose but apparently not! I'll try and do a few more checks this weekend and go from there

 

You have done all the right things....getting her teeth attended to, ruling out a UTI, getting new insulin.....you obviously know what to look for which is great. Sometimes a cat just needs a bit more insulin. ....and then you might have to drop it back down in dose at a later date. It is great you are increasing and decreasing the dose in 0.25 increments. Perfect!
Going up quickly after a lower number as she did with the 8.8 can sometimes mean it is the beginning of a bounce.....or it just could mean she needs a bit more insulin.
Great your husband is learning to test........that is a real help!! Well done!
Please keep us posted with how Pinkie goes....we are always interested in how thinks work out and progress.
Ask all the questions you like ....we are more than happy to help
Bron

 

Great, thanks for your help! Unfortunately Pinkie is a bit of a train wreck so I have learned a few things after many, many trips to the vet. She also has IBD and currently takes a steroid for it which is probably why she is diabetic in the first place. Managing the diabetes is definitely a challenge though, seems like its endless experimenting at this point

 

Yes I totally get what you are saying. You are obviously a wonderful caregiver.
Yes the steroid probably did cause the diabetes but the IBD has to be treated. You just have to work around the steroid and adjust the insulin as needed. I had an IBD kitty until a few years ago and it is a challenge caring for them sometimes.
Have you ever thought of giving a raw or home made diet for the IBD?
Here on the forum we say the FD journey is a marathon not a sprint....I'm sure you understand that!!!

 

I haven't tried raw yet. The IBD has been pretty much completely under control for the past 3 years and about 2 weeks ago I cut back the steroid dose some more (from 2.5 mg pred every 3 days to 1.25 every 3 days) and so far so good....I may try and take her off it and see what happens since it us such a small amount already. I tried in the past and she would start to throw up after about a week but I caught it early and just started the steroid again and she was fine

 

It’s a hard juggling act. 1.25 every three days is a small dose but it is obviously working. You can only judge what is best as you know Pinkie.

 

Is it common for the cats to just keep bouncing? Last night was high, pre shot this morning looked pretty good, but then she shot up to 18 which is the highest iv ever home tested her at
https://docs.google.com/spreadsheet...bYYbu4hlHr5EhSxG_osTgnqHpkI/edit?usp=drivesdk

 

Yes some cats can keep bouncing all the way to remission and some cats only bounce for a while.
I think you probably need to increase the dose to 0.75 unit if Pinkie doesn’t drop down this cycle. It can take up to 6 cycles once you increase for the depot to fill so keep testing at random times to keep Pinkie safe.

 

Hi Bron, hope you are doing well. We are on day 2 of the 0.75 dose and it's not looking too good so far, unfortunately. I'll keep it going for another day or 2 but it looks like we may need to increase again.

One thing I am a little confused about is it seems that the +3 reading is almost always higher than the preshot reading, and quite often by a significant amount. My understanding is that the numbers should be decreasing over the first 6 (on average) hours.

Are there different types of insulin that are recommended based on how the cat's BG respond? My mom is a nurse and was mentioning maybe she needs a more short term acting insulin than lantus but the majority of what I have heard says that lantus is the best type.

 

Hi Melissa
Nice to hear from you again.
Do you think you would be able to set up your signature please? We use it all the time when we help people and it saves asking questions all the time. If you go to the top right of this page and click onto your username and choose signature. Then tell us yours and Pinkie's name, dateof diagnosis, type of meter and insulin, any other illness and medications, type of food used and country you live in........then save .......great! If you could put your SS in the signature as well that would make things easier.
I would not use a short acting insulin. Cats have a fast metabolism and those insulins do not work well with cats. Sometimes cats come here on a short acting insulin but they mostly swap to another insulin..They can drop them very fast and the duration is not long..The only other time we use them is when the cat has something like acromegaly and is on a large dose of insulin and the numbers are still high. Occasionally then, a fast acting insulin is used in conjunction with Lantus or levemir but only when one of a few people here who are experienced with doing this can help. It is risky so has to be handled carefully. Pinkie doesn't fall into that category..The insulin you are using is considered one of the best........the other insulin you could think about is levemir which is very similar to Lantus. Some cats who do not do well on Lantus, do well on Levemir. Have you been using Lantus for over a year?
I would continue for another day on this dose and see if the BSLs come down a bit as the depot fills. If you could get a couple more tests in during the cycle both night and day that's would be helpful.. it would be good to see what she does in the early hours of the morning.
Post again after the 6 cycles and tag me and we can see if she needs another increase of 0.25 units.

 

@Bron and Sheba

Hi Bron,

I think I have my signature set up, I just cant figure out how to get the link to me spreadsheet in it as there are too many characters....how do I get it formatted like yours?

Here is the updated spreadsheet. She was looking pretty good this morning, gave her the 0.75 and now it looks like she is bouncing again.....time to reduce back to 0.50 maybe? Or should I keep at the 0.75 for a few more days and see if she stabilizes?

I have also started giving her an extra can of fancy feast around lunch time because she is always starving so she gets 2 cans at 6 AM, 1 at 12 PM, and 2 at 6 PM.

https://docs.google.com/spreadsheet...bYYbu4hlHr5EhSxG_osTgnqHpkI/edit?usp=drivesdk

 

The signature looks great!
I would not reduce the dose. She probably needs an increase to 1 unit. But first can you get a couple of mid cycle tests overnight so we can see what she’s doing at night? She could be dropping low at night and that is why she is bouncing now.
I’m going to tag @Marje and Gracie as she is a whizz at sorting out SS issues.

 

You are probably going to need to shorten your signature. They don't allow us very many characters

I suggest this:

Melissa & Pinkie,6yrs,F, Dx 3/18,Lantus, human meter, Fancy Feast, IBD dx 2015 - recently weaned off prednisolone and have started CBD oil, Alberta, Canada
Spreadsheet link

 

If you want your spreadsheet link to look like mine and Bron's, this is how you do it.

Have your spreadsheet open in another tab.

Copy the link from your spreadsheet​

Open your signature box and type in "Pinkie's spreadsheet"

You "highlight" those words (like you were going to copy/paste them)

Click on the icon along the top that looks like a paper clip (or a link in a chain)….a new box will open and you "paste" the spreadsheet link into it and hit "insert"

 

@Chris & China (GA) what do you think about an increase to 1 unit?

 

@Chris & China (GA)
Didn’t realise you were a whizz too with the SS. I am hopeless with them.

 

I totally agree.....time to go up

 

So sorry but that’s not the correct SS. If you came from FB, they are giving out the wrong SS for us. The link itself is not correct but we use a World/US SS here and you just have a World one. Ours converts the World numbers to US.

If you send me a PM, I can fix all of that for you. Just click on “Marje and Gracie” to the left and then “ start a conversation”. I’ll be happy to get it all sorted out for you.

 

Ok I will set a couple alarms and try and get some reads in overnight - it'll be like reliving the newborn baby days!

Were also moving into a new house over the next couple days so I'm not sure if this will have some sort of impact on Pinkie's numbers as well. We will be moving her and our other 2 cats on Saturday.

 

@Bron and Sheba @Chris & China (GA)

Let me know if I should be starting new threads or just adding to this one and not tagging you guys, not too sure how everyone uses the forum yet.

I upped to 1u so she has had AM and PM shot today at that dose. Just checked her at PM +7 and she is at an 8. She normally gets her AM shot at 6 -- at what level should I still give 1u and at what level should I decrease just in case? I'm only going to be home until about 10 AM. Right now its 2 AM so hopefully one of you sees this before shot time!

Thanks!

 

I’m glad you tested at +7. You can see how useful these mid cycle tests are. I’d give her a small snack of low carb food now and retest in an hour if you can to see if she drops lower. We need to see what she is at AMPS before deciding. She will probably go back up. You will have 4 hours after the dose to monitor which is better than nothing.
I would get a +11 and post it and we can see.....are you then out for the rest of the cycle?

ETA yes it’s fine to tag us.
We usually start a new thread each day on the Lantus forum. Maybe start a new one tomorrow

 

I fell back asleep and didn't get this in time to check an hr later but she was 6.4 pre shot so I skipped since I wont be home to keep and eye on her later....hopefully that was the right thing to do, I haven't tested her that low in a very long time so I haven't really experimented with giving her insulin at that level before.

I'll check her when I can today and then start a new thread with my next post!

 

It was probably the safest thing to do if you are not going to be home to test.
Going forward I think if you can test more DURING the cycles you might find she is dropping lower than you think and bouncing up higher at Preshot.
Do you work or are you normally home most of the time?

 

I'm on maternity leave right now until July 2 but after that I go back to work full time and wouldn't be home to check during the day so trying to get her stabilized before then!

 

Good luck with your move Melissa! And welcome!