12/21 Checkers pmps 158

Discussion in 'Lantus / Levemir / Biosimilars' started by Lukewithcats, Dec 21, 2015.

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  1. Lukewithcats

    Lukewithcats Member

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    checkers finally didnt have a high BG morning. I lowered his dose alittle bit to 1.75 from 2. I feel like 2 is good for bringing him down from high but when he isnt that high to start with I think it's a tad much. It could just be luck that he was down this morning but just incase I will stick with the slightly lower dose and see how he does. I also put alot of water in his food last night so if he pigged out he would be forced to drink lots of water as well which may have helped.

    Just curious what ranges should I be aiming for? I held off on a shot last night by 45 mins due to him being only at 140 which is low for him and i felt a full dose at that bg would be too much for him, i waited 45 mins and he raised to 180 which i liked the sound of better atleast for now.

    Only other problem is he may be getting to addicted to his treats, i will probably need to cut them into smaller bits or something. Not sure if the freeze dried chicken breast is as good as his regular food or not. I would think it would be actually healthy for him to eat lots of it but just not sure how balanced it would be.

    thanks for everyones help and advice, finally a good bg morning so i'm happy until the next time i have to poke my babies ears at least.

    Link from yesterday HERE
     
  2. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Morning, glad to see Checkers clearing a bounce.:cool::cool:

    FYI Lantus is best utilized at a consistent dose. It's counterintuitive, but it is much better at holding numbers flat than at dragging them down.

    If you can get a spot check or two in today it could be very helpful.

    Have a good day!
    :):)
     
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  3. Lukewithcats

    Lukewithcats Member

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    I can go back up if you think I should. The main reason i went down was because my vet put checkers on one unit of lantus for 4 days and then doubled it to 2 units because she likes the lantus pen and there are no half/quarter doses with it. After looking on here i realized i may have jumped past an optimal dose so thought now is the time to drop it if i'm going to since he still wasn't stable and i've begun using syringes that allow for precise dosing. I also figured as long as it was only a quarter unit that it wouldnt have that much effect on him but if i'm wrong then my bad and i will not do it again.
     
  4. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Quarter unit is a big difference at smaller dose, if you go from 1u to 1.25u that's a 25% difference. Nothing wrong with reducing a little bit but you want to try to shoot the same amount every time to avoid disrupting the depot too much. Read about the depot here

    Edited to add: The important thing here is the numbers you see today won't be from the reduced dose this morning. You won't see effects of the reduction until tonight or tomorrow because of the cumulative effect of Lantus.
     
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  5. Lukewithcats

    Lukewithcats Member

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    So do you think i should go back up or do readings today and just see how he does by pmps?

    sorry i'm still just getting the hang of this. Since 2 units of insulin takes him from 500 to 100-150 over 12 hours i've been concerned its too high of a dose to stabilize on. perhaps i'm being too mathematical in this and not understanding how insulin works exactly, i was just worried if his dose causes a 400 bg drop then how could i expect it to stabalize him. am i just crazy for thinking that?

    i wasnt totally aware of the depot, i thought it wore off in probably 16 hours or so and so there was just a small overlap, i didnt realize it was building up over along period so thats my bad. I could have swore i read every sticky but maybe i missed that one.
     
  6. Anne & Hyde (GA)

    Anne & Hyde (GA) Well-Known Member

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    Hi Luke & Checkers!!

    I would recommend waiting to make any dose decisions to later today. If you can get any additional readings today, that would provide more data to base any suggestions on. When we first started, people likened the spreadsheet to a jigsaw puzzle, the more areas that you can fill in, the better you can see the whole picture.

    What I have found is that when shooting a low pre-shot, the BG curve flattens out and the drop is reduced. You can only see the differences if you collect the data. :)
     
  7. Andy & Pimp

    Andy & Pimp Well-Known Member

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    That's the counter intuitive part, about "if this dose brought him down this far..."
    Lantus is actually much better at holding numbers flat than it is at bringing them down. You'll just have to gather data on Checkers to see how it works.
    I would stick with the 1.75 for a few days and see how he does. The blue presots are encouraging, but we really need some mid-cycle data to properly assess the dose. You can always take him back to 2u if 1.75 isn't working for him.
     
  8. Lukewithcats

    Lukewithcats Member

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    i just did a +3 reading of 85. i came home from work and am pushing him to eat by sprinking the small bits from the freeze dried chicken on his wet food which is working as hes pigging out. I'm worried about leaving him at that number though. Should i stay home another hour or should he be ok at 85 and having just ate?.

    as for the filling out my spreadsheet better its just so hard when he hates me taking blood so much. I'm hoping he will get used to it soon and I've been holding out on testing a lot due to me being bad at it and him hating it. it's taking me around 3-4 pokes each go because blood just won't come out and if i try to even massage any out he flips.
     
  9. Andy & Pimp

    Andy & Pimp Well-Known Member

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    It wouldn't be a bad idea to stick around (if you can) just to make sure he stays in safe numbers. Do you have any medium or high carb food, in case he needs help getting his sugar up?
     
  10. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Probably a good call to reduce the dose this morning, too. You have a wise gut :)
    The numbers you're seeing this morning are from the 2.0 dose. I'd hold at 1.75
     
  11. Lukewithcats

    Lukewithcats Member

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    I have just the regular dry food that he used to eat (whiskers with tuna). i have some gravy wetfoodwhich i would guess is medium carb while the dry food is high carb? he just ate aload of wetfood though so i doubt i'll get anything else into him other then treats.
     
  12. Andy & Pimp

    Andy & Pimp Well-Known Member

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    The gravy food is most likely high carb and and should be reserved for "emergency". There's a good chance his normal wet food will give him a bump and help him surf. Can you test again in a half hour?
     
  13. Lukewithcats

    Lukewithcats Member

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    absolutely i will make sure its on its way up before i leave.

    yes i agree i probably got lucky with that dose drop. sometimes you just have to do what you think is right i guess. i haven't liked his dose since finding this site. i've screwed up so much because of not being here, i switched him to wet food from a lifetime of dry food cold turkey and jumped from 1 unit to 2 units of lantus overnight also. i've felt bad for the sudden large changes i've forced on him and have been feeling like there may be a better dose between 1 and 2 for him. so far the numbers look good on this dose so if i'm lucky this is the one for him. fingers crossed. i'm certainly willing to go back up there if I feel this isnt working.
     
  14. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Sounds good. I have some obligations but I'll try to check in from my phone in a bit.
    You're probably not going to see numbers rising you just want to make sure they're not dropping too fast. He'll be ok if he goes a bit lower.
    If the regular food slows the drop and you have to leave, it might be a good idea to leave a bit more out for him to snack on while you're gone.

    Just for dosing purposes, how long since you cut the dry food from his diet, and what was the dose at that point? Sometimes cutting out the junk can drop BG's by 100-150 points.
     
  15. Andy & Pimp

    Andy & Pimp Well-Known Member

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    If you need help use the "thread tools" button at the top of the page and edit your title to include a "?" or in emergency "911" prefix from the drop down menu. You can also type your question or situation in the title to help more people see you faster.
    You're doing great with Checkers.:):)
     
  16. Lukewithcats

    Lukewithcats Member

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    he was only diagnosed about 2 weeks ago and i cut the dry food out immediately so he began right away on lantus 1unit and only wet food so i have no idea what effect the food switch had since i didnt know to change it slowly. he was on 1 unit for 4-5 days and then he was increased to 2 units and those numbers are on the spread sheet, prior to increasing to 2 units he was running 500 bg all day, it wasnt until it went up to 2units that he started fluctuating a bit.

    I just did a bloodtest although from a paw pad this time to try it out and it was 56 now so i just gave him some of his old dry food and he ate some so i hope that will keep him going lower. i will stay and do another test before i leave to ensure he doesnt drop below 50.

    thanks for telling me how to change the thread title, i couldn't find a way earlier.
     
    Last edited: Dec 21, 2015
  17. Lukewithcats

    Lukewithcats Member

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    just did another test and its down to 45 at +5hours. he just went to go eat more high carb food, i guess i will have to take the day off to make sure it doesnt go down more. At what point should i take drastic action? Vet recommended rubbing syrup on gums if it gets too low, is that my best bet?
     
  18. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    What type of high-carb food did you feed?
     
  19. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    You will want to check the blood sugar level again no more than 30 minutes after your last test. Our goal is to get Checkers up above 50.
     
  20. Gill & George

    Gill & George Well-Known Member

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    How are you doing? Has checkers come up? Have you managed to get another Test in? I hope you are OK:bighug::bighug:
     
  21. Lukewithcats

    Lukewithcats Member

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    yes i did another test at the 30 minute mark and he came up to 48. i've just been trying to find out how many carbs are on my dry food but haven't had any luck yet. I have my eye on him and he will get another check in 5 mins or so.
     
  22. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    That's good that he's leveled out a bit, although we still want him up above 50. If you've been feeding dry food, that's probably going to take longer to kick in and bring the numbers up. If you have any canned gravy food, try giving him a just a little bit (e.g., a teaspoon or so) of the gravy from the can.
     
  23. Andy & Pimp

    Andy & Pimp Well-Known Member

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    hey Luke I'm back home. Sorry couldn't check in:(

    You're doing fine with him. How long ago was that last test?

    We usually wait until they are in the 30's for rubbing honey or syrup on gums, it works fast but won't sustain them for long. When they drop under 50 the high-carb wet food with gravy is appropriate.

    Were you able to take the day off to stay with him?
    Don't worry about the dry food carbs too much, we want to get that stuff completely out of the picture anyway.
     
  24. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    You're doing a great job, by the way. Nothing like dealing with low numbers right off the bat.

    I'm going to flag some of our most experienced users to see if they have thoughts about Checker's dose.

    @Wendy&Neko, @julie & punkin (ga), @Sienne and Gabby
     
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  25. Andy & Pimp

    Andy & Pimp Well-Known Member

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  26. Gill & George

    Gill & George Well-Known Member

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    Most dry food is high, unless it's Yousung Again, which some on here use. But it we till take a while to work, it's best not to resort to dry if you can help it as it can mess with kitties numbers for quite a while after as it takes a long time to clear the system, having said that, don't worry about that the important thing now is to get Checker over 50, he is still too low. If you have some wet food with gravy give that the gravy foods usually are high carb, give a couple of teaspoons. If he drops below 40 you need to get his BG up urgently this can be done by rubbing karo/honey/maple syrup on his gums. Not too much though as too much syrup can make kitty puke. If your food is not HC you could add a drop of syrup to his regular food and mix it up. Remember just a couple of teaspons at a time, you dont want to stuff him. tesst again in 20min
     
  27. Andy & Pimp

    Andy & Pimp Well-Known Member

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    I sent Julie a PM when I was on my way out the door I'm surprised she hasn't popped in.
     
  28. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    Just saw the 56 on the spreadsheet - great job getting that number up above 50. At this point, don't feed and try to get another test in about 30 minutes. We want to make sure that Checkers stays above 50. When you're dealing with high-carb (canned) food, the carbs can wear off quickly, and the numbers can come back down.
     
  29. Lukewithcats

    Lukewithcats Member

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    I just did another test and he shows at 55 so seems like the dry food is kicking in now. i was getting worried but other then taking most the day off work it wasnt too bad, luckily my job is somewhat flexible.
     
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  30. Lukewithcats

    Lukewithcats Member

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    I didn't give him high carb wetfood I only gave him his old dry food which i think is high in carbs. It didnt cross my mind to give him gravy until i had already gave him dryfood for an hour so i decided to wait and monitor and give the gravy if it went down anymore but it hasnt. I will keep testing him. I think i read somewhere that dry food raises glucose for longer is that correct?
     
  31. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Shelly is spot on no more food and test in 30. If he's still flat or rising, continue to hold food and test for the next hour. We need 2 hours of rising or flat numbers without food to consider him safe.

    Correct, but it also takes longer to have an effect. Gravy or syrup are fastest.
     
  32. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    Yep, dry food will last longer in the system.

    I recommend having some high-carb canned food on hand. We used Fancy Feast gravy lover's varieties with Jersey. When Jersey dropped into the 40s, we would give her a couple of teaspoons of the gravy out of the can and retest in about 20-30 minutes. We kept repeating that process until she got up above 50.
     
  33. Andy & Pimp

    Andy & Pimp Well-Known Member

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  34. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    I know you're dealing with a lot right now, but I wanted to mention paw testing. I'm not sure if you tested on the paw just once or if you've done that for the past several tests. Anyway, if you are paw testing, here's what worked for me: I heated the rice sock and held it on Jersey's paw pad for a few seconds. I then put a little Neosporin with pain relief on the paw, got the blood sample, held a cotton ball to the test site for a few seconds, and then put a little more Neosporin on the site. We typically alternated paws and used back paws only. My vet said the back paws were better for testing than the front (i.e., less likely to get contaminated/infected). I don't know if that's true, but that's what we stuck with. Hope that helps!
     
  35. Gill & George

    Gill & George Well-Known Member

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    Glad Checkers is above 50, come on Checkers, up a little more and then nice and steady. Keeping paws crossed he comes up for you
     
  36. Lukewithcats

    Lukewithcats Member

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    yes i've been paw testing he much prefers it. i tried an ear but after a few pricks he was not happy and i didnt want to upset him too much with the BG being where it was. I will put cream on them and I have a vet appointment tomorrow so maybe someone there can help me perfect my ear testing. thanks for the info on the paw testing, i have a lancet device and it just works so well on the paws that he doesnt feel it at all, i wish i could use the lancet device on his ears but i tried to start with and it seems unusable as anything but a handle for the lancet.
     
  37. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    I was in tears trying to ear test. We just couldn't do it, and Jersey threw an absolute fit. In desperation, I moved to the paw, and it worked much better for us. I don't think it's ideal, but it's what ended up working for us.

    A lot of people just use the needle free-handed when ear testing instead of using the actual device. We tried that, too, without success. :rolleyes:
     
  38. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Most of us here just hold the lancet freehand when ear testing.
    I see Shelly just noted that as well.

    On your spreadsheet, you can stack readings in the appropriate hour blocks. There's a good example on P's SS a couple of days ago.
    Just type (reading)SPACE@SPACE(time).
    If you shot at 8 am and the 45 was at 12:30, it would read
    45 @ 4.5

    You may have to select "text wrapping" in the format menu.
     
  39. Gill & George

    Gill & George Well-Known Member

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    You may have done this already, but try doing a U tube search for testing a diabetic cat, different people use slightly different techniques, I was having trouble at first, but after watching a few different people test I finally figured out what worked best for me. Try treats when you test as well, George now comes up for his test when I rattle his treats, and often purrs right through the procedure (he will do anything for a tasty treat:)) I use the lancet device, as I found it easier, but whatever works for you.
     
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  40. Lukewithcats

    Lukewithcats Member

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    when you prick the ear are you aiming to pierce the vein running up the ear or aiming for th
    i have the treat part down, turns out he loves freeze dried chicken breast and they are pure meat so no carbs and he doesnt mind me heating his ears but poking and after that squeezing/folding or massaging just annoys him royaly. I never get a bead come up when i try just nothing, even the vet was surprised how hard it was for her to get blood from his ear. I even tried hitting the vein and using needle tips but still no luck. a few times i've got a good bead by itself but other then that its constant poking and squezzing/rubbing. His paws he doesnt care much about, i can lance and then squeeze and always get a drop so it wil lbe hard to justify using his ears over his paws unless i can get better with his ears. I will look up some tips on what to do with cats whose ears dont want to bleed.

    just did another reading his +7 is 83 so he seems to be coming back up now pretty steadily.
     
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  41. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Sounds good. The dry food should help sustain higher numbers but you'll want to test again in 30-60 minutes to be sure.
    Good thing you came home today;) Someone is watching out for our sugar kitties, you're the second one here in the last 4 days that has just "Happened to stop at home". :)
    You want to hit a little bit outside the vein. If you hit the vein directly and they shake their head, you can get a mess.
    Warming the ear first makes a HUGE difference when you're starting out. You should be getting it almost hot to the touch.
    Also some support behind the ear helps. Another member here turned me on to the cotton rounds you can find in the cosmetics isle, they work great to back it up while you're poking and then fold over to hold pressure for a few seconds.
     
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  42. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Bigger lancets help at first too, you want the ones marked "for alternate site testing". 24-26 gauge usually. Bigger needle=more blood.
    As you test ears more, they will grow new capillaries to heal the old pokes, makes them bleed much easier. Their ears "learn to bleed":)
     
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  43. Gill & George

    Gill & George Well-Known Member

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    83 is better, hopefully he will sustain that, ditto to @Andy & Pimp advice, they do bleed better after a while, george was hard at first, he didn't fight me but not much blood to test with. Remember to check BG again in an hour to be sure.. Well handled by the way. Not sure but as new myself but I think Checkers has earned a reduction, as he has dropped below 50 and is newly diagnosed. (if it was my George I would be looking at a .25 reduction, we are following Tight Regulation Protocol) Are you following Tight Regulation Protocol(TR)? Can't see it any where on your spreadsheet? If you are wondering what TR is follow these two links it explains the two different ways that the folk here on FDMB try to regulate there kitties see which one is a better fit for you. Tight Regulation (TR) and Start Low Go Slow (SLGS) I have tagged a couple of experienced members for dosing advice for next shot.@Wendy&Neko @VyktorsMum
    Also on my signature there is a food nutrition calculator you can use that to determine the Carb content of any wet food you have using the food analysis figures, there are also some food lists out there, I don't have links to those, as I am in Europe I don't use the US ones, cat food options are different here. Take a read of Dr Piersons site (if you haven't already) very informative and will answer loads of questions on FD and feline nutrition;)
    Well done, bet you are glad you popped home!:):)
     
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  44. Lukewithcats

    Lukewithcats Member

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    I just got back from an hour at work, fixing to do another test. Curious what people think about his dose. I'm still concerned it could be too high. He's only been on insulin for 10 days and my vet really likes the lantus pen and sees no point in partial doses but i am scared of that. he was on 1 unit for 4 days and then 2 units for 5 days and now i've lowered it to 1.75 for 1 day. my vet didn't encourage me at all to do home testing and felt just getting him tested every 4-5 days at the vet with their glucose monitor would be sufficent. I'm really questioning the vets recommendations at this point. Should i be worried its too high or should I have more faith in the vet?
     
  45. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    We definitely know that 2 units is too much, and the 1.75 units may very well be too much insulin, as well. Going up in full units certainly isn't recommended. In fact, most people here only increase by .25 (a quarter of a unit) at a time.

    You still have about 3 hours to go before shot time, right? We've flagged several of the most experienced users here, and I'm hoping some of them will be on before your shot time tonight to share their thoughts on Checker's dose.
     
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  46. Gill & George

    Gill & George Well-Known Member

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    Taking him up or down by one unit is a lot. I use a lantus pen too, but I buy insulin syringes with 0.5 units marked which makes it easier to do the .25 u, then I draw the units from the pen, I think that is what everyone is doing here.

    As to home testing, ask your vet if he was diabetic would he shoot insulin blind without knowing what his BG were?? I think not.

    Take a look at my spread sheet and see what a difference a .5 unit or even a .25 unit can make. Take a look at numerous SS you will see from them that when you reach a dose that is 'working' for your cat .25 can make all the difference.

    You do right to question your vets recommendation, are there any vets locally that have experience or special interest in FD, it really helps if you can get your vet to support you, many have found it necessary to change, and others have found that they have been able to 'win their vet over'.

    As to the dose I really think that you should be looking to reducing at least to 1.5, but please understand that I am new here, it may be that he needs more of a reduction, I haven't got the experience to be able to advise with any confidence, but I do think the 1.75 is too much.
    Lantus is a slow acting insulin lasting about 12 hours and having (usually) peak incidence around +5 or +6 this is when we will usually expect to see the Nadir.(there are exceptions to this at times eg when your cat is clearing abounce early on in the cycle, my cat George has been doing this the last couple of nights, and tonight)

    Today with the low numbers you have seen you can expect to see a bounce in the PM cycle (though not every ccat does this) we call this bounce and it is believed that it is the liver that is responsible for the high BG that follow a low like Checkers has had today. His liver perceives these low numbers as abnormal, 'panics' and dumps glucose into kitties blood stream, this is because our cats body doesn't recognize the low numbers as healthy and normal. The bounces can last up to three cycles and they usually get shorter and less pronounced as our cats get used to more normal blood glucose levels.

    I hope that explains some points without being to confusing, I am sure someone more experienced will post up, there is less traffic than usual due to the approaching Holidays.

    If you are worried about the dose better a lower dose than one that is going to take your cat dangerously low, especially if you can't be around to monitor if they decide to slide into those low numbers.

    See what Checkers is doing @ +11 and post with his numbers he seems to have a surf on.

    If he is in green at PMPS you have an option to skip, stall or give a token dose.

    Gill
     
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  47. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

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    One more tip - you can always edit your subject line and put the "?" icon up. That helps others know you need help with something. :)

    ETA: I don't think the earlier tag for @Vyktors Mum worked right.
     
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  48. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Six cycles, three days.
     
  49. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Luke, you can always start back at one unit, and work your way back up, if necessary. 1/2 to 1 unit is standard starting dose depending on weight.

    How much does Checkers weigh? Do you know what his ideal weight is?
     
  50. Gill & George

    Gill & George Well-Known Member

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    oopsy :oops::oops::oops::oops: thank goodness you are on the ball what with my amps confusion earlier, I put it down to sleep deprivation. Take it I didn't say anything else that was crazy:confused::confused:
     
  51. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Nope the rest was good :)
     
  52. Gill & George

    Gill & George Well-Known Member

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    Having trouble with connection over here had to post that several times, thanks.
     
  53. Lukewithcats

    Lukewithcats Member

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    he used to weigh 16 pounds i think, hes pretty bony now at 10.5 i think his last weighin put him there. Sometimes over the last couple years he lost the 6 pounds or so, probably in the last 6months, slow enough to fly by my radar for too long maybe but I would imagine his current weight isnt that bad for him, he could do with another pound maybe but he used to be pretty chunky, he doesnt have a big frame like my other cat who is around 20 pounds but mostly muscle somehow.

    he was at 1 unit for 4 days and it had no real effect but i think his body was really fighting the insulin up until today when it just seemed to finally calm down. i think he should be ok with 1.5 so will probably go to there assuming his bg raises to his normal pm level.

    I have a vet appointment tomorrow to just get his BG done but they will just use their handheld BG meter so i'm not sure what the point is in me going in now that i'm home testing. I think i will have to see if i can find a vet specializing in feline diabetes.
     
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  54. Andy & Pimp

    Andy & Pimp Well-Known Member

    Joined:
    Oct 18, 2015
    My vet wanted me to bring Pimp in every other day for a BG when we first started, at $23 a pop. I bought a meter pretty darn quick.

    1.5 units should be ok but you'll still need to monitor him closely for a few days. The 2u depot will still be in play for a bit.
    Depending what his PMPS is you might want to skip tonight.
    I would wait for some other users to chime in here before making any decisions.
    Change your title to "? - dosing advice? new and low numbers today"
     
  55. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Hi just looking at your ss, I note that you delayed the pm shot on 12/20 by 45 minutes, that's not a problem,
    but have a question for you, this mornings shot, was it at it's usual time? or did you put it back by 45 min? it isn't clear what you did.

    Gill
     
  56. Lukewithcats

    Lukewithcats Member

    Joined:
    Dec 19, 2015
    it was at normal time. since it was higher then the normal pm shots i assumed he would be ok. i nearly put his dose back up to 2 infact but i realized that today was going to be a weird day since its the first morning he wasn't super high. I aim for 8:45-9am/pm. I have been working based on his norms which was high mornings and low evenings but i've been having a feeling that the high morning may be either due to too high a dose or just a bounce from recently starting insulin and that it would wear off eventually and i would have to start fresh with new norms when the bounce ends which may be taking place now.
     
  57. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Based on Checker's current weight, the initial dose would have been been between 1.0 and 1.25u (it calculated out to 1.19u). Given that he's been on insulin for 11 days, if you want to re-start the dose at 1.25u or 1.5u, I think that would be fine. What you're seeing today is some carry over from the 2.0u dose. It takes a while for the depot to adjust to a dose reduction.

    The bottom line is that it's up to you. It looks like 1.0u was too little and 2.0u was too much. You can stick with the 1.75u or drop the dose back. You can make an argument for either strategy.
     
  58. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    I had a feeling that you may have shot at regular time. It is fine to stall a dose, but the advice is that if you stall by an hour then you have to put back the next shot time by an hour.

    So this morning you should have aimed at 9.30 to 9.45 am, this is because of the overlap between the two doses. By not putting it back it may have acted as a slight dose increase and may have been, in part, responsible for those low numbers.

    So when you stall you have to always ask yourself, can I put back the next shot? You can make up the time, 15 per cycle or 30min in a day.

    At 45 min it may well have been a minor influence in your numbers this morning, but just thought it was worth mentioning for future reference.

    I'm off to get some sleep now, past midnight here, hope Checkers surfs safely.:)
     
    Last edited: Dec 21, 2015
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  59. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Joined:
    Oct 11, 2015
    Hi---I finally got the "sweet spot" with testing --my guy has been very patient with me.. This weekend I looked at a few videos (again) and although I was close as possible to the edge of the ear I found the 45 degree angle gentle poke instead of straight down made a huge difference… he hardly knows he was "poked" --also for my guy he doesn't mind his left ear but HATES when I go for the right ear so we stopped that--the things this boy is teaching me!!!
     
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  60. Lukewithcats

    Lukewithcats Member

    Joined:
    Dec 19, 2015
    thanks for chiming in. I will probably go with either 1.5 or 1.25, we will see what his pmps is and maybe make a choice from there. Its tempting to go low just in case and so i can sleep a little better tonight but i could see 1.5 being around ideal and would like to start getting him stabilized asap but i'm leaning towards 1.25 and going from there, it seems easier to add then take away and cats seem like they can handle highs better then they can handle lows.
     
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  61. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Joined:
    Oct 11, 2015
    I am new as well--I am sure others will "stop by" my guy was on 1.5 and we increased to 1.75-he was doing great for a few days and then the depot kicked in and he dropped too low-I skipped a shot and he dropped again too low-I skipped 3 shots and started up with 1 unit and we are "starting over" --every cat is different and will retain that depot for different lengths of time…. Drevon is doing well on 1 unit and has even hit greens yesterday. His amps was lower than normal today and we had a vet house call so I stalled a bit and lowered to .75--- I plan on 1 unit BID but if I cannot monitor and is a low pre shot I make the best decision I can that is safe for him as mentioned by @GTS
    it is often said better too high for a day than too low for a minute ;)
     
  62. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    It's hard on the nerves and even harder on sleep when the dose is too high. There's something to be said for starting a little lower than may be ideal and working the dose up systematically.
     
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  63. Andy & Pimp

    Andy & Pimp Well-Known Member

    Joined:
    Oct 18, 2015
    @Lukewithcats Sienne knows her stuff, Luke.
    Gill's right about shot times, too....you want to stay within 15 minutes of the 12 hour mark as much as possible. Again due to the cumulative effect of the insulin.
    In your last post you mentioned basing your shots on the preshot number, that is how other insulins are used, but Lantus and Levimer dosing are based on the lowest number through the cycle.
    It's your call if you want to drop back to 1.5 or even more with 1.25. There are two important points to make here:
    1. You don't need to fret about getting the dose exactly right. What is important is that you can reproduce whatever you call 1.5 or 1.25 consistently. Some people will use calipers or a piece of card cut to a certain size.
    2.Whatever dose you choose, make sure you stick with it for 6-8 cycles (unless Check goes under 50 again, then reduce by another .25u). This gives the depot a chance to stabilize and we can see what the dose is really doing. Changing the dose more often usually results in wonky numbers.

    so true
     
    Last edited: Dec 21, 2015
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  64. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Joined:
    Oct 11, 2015
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  65. Shelly & Jersey (GA)

    Shelly & Jersey (GA) Well-Known Member

    Joined:
    Feb 1, 2014
    Hi Luke,

    Is your name Luke, by the way? I’m assuming it is. Please correct me if I’m wrong. I know you have been bombarded with information over the past few days. You really are doing a great job handling it all! We’ve been throwing out tons of tidbits at you, and I thought it might be helpful to try to pull some of it together.

    With Lantus, dosing is largely based on how low it takes a kitty, although the pre-shot numbers are very important too. They tell us if it's safe to give insulin. For most cats, they reach their low point (the “nadir”) about mid-cycle. Every cat is different, though. Some cats have an earlier nadir; some have a later nadir. And the nadir can change, too!

    Lantus is also a depot insulin. I think of kitty as having a little insulin “tank” in his body. When you give a shot, some of the Lantus goes right to work. Some of the Lantus goes into the “tank,” where it will be used later. With each shot, the tank gets fuller and fuller....and then spills over for kitty to use. When you make adjustments to the dose, it may take a while for the levels in the tank to adjust. For instance, even though you might decrease the dose from 2 units to 1.75 units, the tank still has the 2 units in it for several more cycles. It’s not the greatest analogy, but it’s the best way I can wrap my mind around how Lantus works.

    You are doing a great job getting the pre—shot tests in. You also did a fantastic job catching that low number today. Well done! If you can try to get at least one test in between every shot, that will help us figure out the best dose for Checkers. For instance, if Checkers drops below 50, like he did today, we know that the dose needs to be reduced. You don’t have to test constantly. Just try to grab some tests in between shots to help fill in some of the blank spaces on the SS. As you go, you’ll learn when you need to grab another test (like today when Checkers was dropping pretty quickly) and when you don’t need to test more (like when Checkers is bouncing).

    Speaking of bouncing, I know it’s been discussed before, but I’ll mention it again. Checkers’ body has gotten used to high numbers. When his blood sugar drops into normal numbers now (or even if his numbers drop to numbers that aren’t normal but are simply lower than what he’s used to….or even if the numbers have just dropped quickly), his little liver panics and basically releases a whole bunch of sugar. That drives the numbers right back up….sometimes even higher than they were before you gave the shot. For example, on March 25th, Jersey’s AMPS reading was 355. She went down to 77 during that cycle and was up to 465 by PMPS. That’s the beginning of the bounce. It’s also a great example of why getting a test in between shots can be so helpful. If I wouldn’t have caught that green number, I might have thought she needed a larger dose. Really, she didn’t need a larger dose. She just needed time for her body to adjust.

    Anyway, I hope some of this information helps. As I said, you’re doing a great job handling all of this. We all know how stressful, confusing, and frightening it is in the beginning. :bighug:

    Shelly
     
    Last edited: Dec 21, 2015
  66. Lukewithcats

    Lukewithcats Member

    Joined:
    Dec 19, 2015
    i did 2 pmps's and they were quite different then eachother at 158 and 176. i got the 176 first (the blood drop formed super fast) and it seemed high to me for some reason so i retested and got 158. Should i be calibrating my glucose meter or something? Anyway i gave a pm shot at about 1.4. he just pigged out on wet food so i'm thinking he will be ok but we'll see. testing his paws is just too easy, i hope its as accurate as ears because its a dream come true really.
     
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  67. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Joined:
    Oct 11, 2015
    they can have a 20% variance--I wish they were more accurate but the same drop can test within 20%--sounds like you have it covered with food ;)
     
  68. Andy & Pimp

    Andy & Pimp Well-Known Member

    Joined:
    Oct 18, 2015
    What Jayla said. The same drop can test on the same meter as much as 20% different.
    If the paws work for you, stick with 'em (no pun intended :cat:)
    Try to stick with that 1.4 for 6 cycles now.
     
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