After 1 month...just starting home testing

I know I should have done this earlier, but after a few failed, frustrating attempts I put it aside. As background - late in September we adopted my sister in law's almost 17 year old Cat George, who had been diagnosed with diabetes in July but not treated. He was wasting away, so we took him. My vet waited several weeks to start him on insulin because she wanted to see what a diet change would do. Though he was putting on weight and looked better, his BG was still hovering around 400. George doesn't have any other health issues.

She suggested 2 units of Lantus twice daily. I started him at 1 for a couple of weeks. He continued to put on weight and was drinking and going a little less but not dramatically so, so I bumped him up to 1.5 units 2x per day. The drinking/urinating improved quite a bit so we've been settled there for about 2 weeks.

I decided to give it another go at testing today, and just had a successful test (after a bunch of tries and nearing tears). We are at +10 from his morning shot and his BG was 100. I've been home all day and he's been acting normal. I'm going to attempt to test him again in 2 hours. I have a Relion Confirm meter.

Should I reduce him back to 1 unit or keep him at 1.5? I have to work tomorrow so I will not be home to monitor him during the day.

 

Wow, it's really hard to advise with only one day of testing data, but if he's at 100 at +10, and doesn't come up much by +12, I'd suggest going back down to 1u or possibly skipping the shot.

But the thing is, the way that Lantus works, if you reduce or skip, the results won't be instantaneous. How long has he been on 1.5u? I don't know if you're familiar with the "depot" concept? The level of insulin in his body is sort of "set" to a certain level based on how high the dose is, and how long he's been at that dose. Reducing or skipping doesn't just "reset" that level, and it can take a day to two for it to adjust down.

If you had lots of data showing what the 1.5u dose was doing, it would be easier to look at it and determine if it's too much. It's actually the nadir BG number that is the number that indicates what the dose should be, and whether it needs to be increased or decreased. Long-time Lantus users will routinely give a shot on a preshot number like 100, but only because their data shows it is safe to do so. New members are usually encouraged to not give a shot if the preshot test shows under 200.

But you're not a "new member" in the sense that you've been giving insulin for a few months. On the other hand, you don't have the data yet to determine if shooting a number that low would be safe. Please wait for more feedback?

Carl

PS - congrats on being able to get blood! This whole experience will get easier now that you are armed with the data.

 

Unless the preshot number (+12) is significantly higher I would reduce to 1 unit based on your limited data.

 

Thank you both. Carl - it's been at least 2 weeks and probably 3 since he's been on 1.5. I just tested him (at +12, or the PMPS if I'm getting the terminology correct) and he's at 151. He's eating now and I need to decide in the next 15 minutes whether or not to inject or skip. I'm going to try for a +5 or +6 test to see where he is, but he's ticked off at me at the moment so it will be hard.

 

So yo are says:
- For the last two weeks he was at 1/2 units Lantus twice daily with no testing
- Gave 1 1/2 units Lantus this morning with no testing.
+10 100
PMPS 151

If I could do a +4, +6 and maybe +8 I would continue to give 1 1/2 units.

 

I think reducing to 1u like Larry suggested is okay.. And the +6 will be a good number to know.
I'll include this so that you know what to expect, typically:

Carl

 

Thank you Carl. That is great information to have. I ended up giving him the 1.5 a few minutes ago and I will get a +6.

I really appreciate your help.

 

You're welcome Jennifer,

That info came from one of the sticky threads in the Lantus forum...
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

Carl

 

Hi, Jennifer. Carl put a note on the Lantus board asking some of us to stop by.

I would suggest trying to get a test at +2 or +3. Getting an earlier test will give you some advance notice if George's numbers are falling from your pre-shot test. This will give you a bit more control over the cycle.

I'd encourage you to take a look at the starred, sticky notes at the top of the Lantus board. There's a wealth of information in the notes and the links within the notes. (It's actually a bit overwhelming but it's a great way to familiarize yourself with how Lantus works.) Below is an overview of what's in the stickies.

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
• New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
• Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
• Lantus depot: This is an important concept for understanding how Lantus works.
• Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

 

Thank you, Sienne. I've been lurking and reading but I can't say that all of this information isn't overwhelming. I've been trying to take my cues from George. Poor guy had to get used to a new home and medical treatment all at once. +3 is in about an hour and I'll see if he's receptive to me.

 

Good job on recovering from the hypo.. must have been pretty scary.. even if he wasnt showing symptoms. Its a shame you didnt get a +2 as you might have been able to prevent it. Sounds like he is a feisty one regarding testing though - do you treat him afterward (low carb treats only!)

He should definately get a dose decrease immediately. The protocol recommends 1/4 unit decrease at a time ie to 1.25. but you should keep a close eye on him because they can be more sensitive to insulin for a few days after a hypo. If you wont be home you might want to take it down further ...

 

You are getting some great advice, so I just wanted to chime in about something everyone forgot to say, as they were concentrating on the important issues.

Bless you for adopting a geriatric diabetic kitty. I'm sure everyone involved is trying to adjust. Obviously, you have a heart of gold, and before long, George will let you know how much you are appreciated.

Hang in there.

DZ and Sarah

 

Welcome to the vampire club! You're doing great! George is a lucky kitty to have such a wonderful bean looking after him. George, you be a good boy and learn to take your ear pokes like a brave kitty - it's for your own good!

 

Thanks all. I'm a sucker for a furry face with a sob story.

We lost a kitten (actually, just barely 1 year old) to FIP and I swore I'd never get a kitten again. It was heartbreaking. Who knew I'd go to the opposite extreme? George deserves a good end of life and we will do our best to give him one.