BJ's Rough Start

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Mike and Bj, Jul 22, 2012.

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  1. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    My buddy BJ is 14 year old fuzzy creamsicle in Washington. I got all the supplies for him, ketostrips, glucometer, etc and gave him his first shot of lantus at noon.

    I tested him before the feeding (he was 485) and gave him the (2u) injection a few minutes after his lunch. I'm not entirely confident the needle went in all the way because he was struggling with me. That's stressing me out a bit. I tried to see if his scruff was wet but he was pissed and didn't let me be thourough. That said, I didn't feel anything wet.

    The doc said to feed him twice a day, 12 hours apart. For my schedule that's noon and midnight. I plan on checking his BG again around 6pm. He HATED getting his ear pricked. Of course, I botched getting the blood twice which didn't help. So I'm very excited to draw blood again. I did freehand this time but will try the lancing device next time. I practiced using it on myself to see how it worked but I can see how it might be difficult to aim it so precisely on a cat ear.

    Any general advice or words of wisdom appreciated.

    Thanks,
    Mike and BJ
     
  2. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Hi and welcome.

    We have all had concerns about giving fur shots, don't worry about it and certainly DO NOT give additional insulin. Just wait until the next shot time to give his shots.

    As for feeding times, honestly, you can feed him more than every 12 hours. Actually, feeding several small meals/snacks throughout the day is better for treating diabetes than two meals. It's the same for humans, it helps keeps the Bg's more consistent - there are other reasons why, which I'm sure others can elaborate about.

    What kind of food are you feeding? If you are using dry/kibbles at all, we strongly recommend removing this completely and feeding a low carb wet food diet only - wet food can be canned or raw.

    For more info on the reasons, please check out Dr. Lisa's site www.catinfo.org

    And by low carb, we mean less than 10% in carbs - so foods that have gravy, chunks, slices, grilled etc. tend to be high carb (and is good for the hypo kit). Low carb tends to be pates. Check out Janet & Binky's food chart for low carb options:

    http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=115

    Regarding testing - let's talk about your testing technique. Where are you aiming on the ear?

    http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

    Look at this link and the "sweet spot" picture to understand where you want to aim for.

    Warming the ear before poking is also a good idea, you can do this by massaging the ear and/or using a warming sock -

    To make a sock - take one sock, add 1/4 cup of rice, oatmeal, dry beans, knot the top - put in micro 15-30 seconds until warm to touch, then place and hold behind cat's ear until ear warms up. I also keep it there as a buffer when poking so I don't jab my finger.

    The insulin you are using is great - if you haven't already, please visit the lantus board and read up on the handling, storage and how to use the insulin.

    I am curious if 2 units is your starting dose. As we typically recommend a starting dose of 1 unit or even 0.5 unit. You can always increase the dose, but you can't remove it once injected.

    You mentioned you are in Washington is that state or DC? As we may have members close to you if you ever need in person help.
     
  3. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    The doc said to start him at 2u. I've read other people saying on here that he should start at 1u as well. I don't really know what to do... I'm scared to go against what the vet said. But it's making me nervous.

    Should I ignore what the vet said and drop him to 1u? He was really fantastic with BJ, I don't want to second guess him.

    My other main concern is that I'm not sure he got the first shot of insulin in him. Since his next injection is at midnight, I'm worried because if he has problems I'll be asleep. But that is the schedule I'm stuck with. I'm wondering if I should just start over again tomorrow at noon?

    We're in Washington State. Also, I did use the sock warmer and got him in the sweet spot. But after pricking him, he wouldn't sit still so it was hard to get the blood on the strip :(
     
  4. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    The next time, if he moves away, you can get the blood droplet on your fingernail and test from there. The other thing that really helped us at first was to have a large enough lancet - 25-28 gauge works well. The smaller 30-31 guage sold for humans are often too small for cats.

    We do have members in Washington State. if you continue to have troubles, post with your city and ask for testing help.
     
  5. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    Hi Mike! Make sure you associate the ear prick with a treat. That has been key for me. I give a treat whether I am successful in getting blood or not, and only try sticking the ear a couple of times before letting my cat go. That way, she is not overly traumatized by the whole process and now tolerates it pretty well. I was the worst BG tester on the board (took me WEEKS and I tried everything!). I have also had good success using the lancet pen WITHOUT THE CAP. I just insert the lancet, leave the cap off, cock the pen and aim for the sweet spot.

    As to the injections, I give them while my cat is eating or enjoying a snack and she doesn't even notice. I do not give them in the scruff as I read that the blood supply is not the best in that area. Make sure you pull up the skin into a triangle-shaped tent...and inject parallel to the cat's body (not straight down), and into the lower half of the "tent." If you inject too high up in the tent, you'll get a fur shot. If you get a fur shot, his fur will smell medicinal -- someone described it as smelling like "bandaids" ...LOL!! Also, make sure you hold the needle with the numbers facing up - so the bevel of the needle is facing the right way (if the bevel of the needle is not pointing the right way, the cat can feel the injection more).

    Until you feel confident in getting regular BG readings, I would echo what Hillary said, that a lower dose is typically recommended. My vet wanted to start at 2 units also, but because I was unable to get regular BG readings on my cat at first, we agreed that 1 unit twice a day was a safer number. Better to have too little at first than too much, in my opinion.

    Forgot to ask, what is BJ eating? Low carbohydrate, wet food only is recommended by pretty much everyone on this board. Some pets go into remission by a diet change alone (and do not need insulin at all). Even if BJ does not go into remission, his BG numbers will drop (often by 100 points or more) by removing dry food and other high carbohydrate treats. BJ will also need less insulin if he is on an all wet food, low carb diet.

    Good luck to you and BJ!!! Keep posting to let us know how things are going!

    Melanie
     
  6. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Hi, cat friends. Thank you all for the kind replies. My stress level is sky high right now as you can imagine.

    Bj's BG was down to approx. 275 at the 6hour mark. I say approx because by the time I got him to settle down the device already shut off before I could properly record it(!).

    I will take the advice and drop his second dose of glargine down to 1u at midnight tonight instead of 2u. I hope the vet doesn't yell at me. I have to take Bj back to see him in two weeks to do the curve thing. Or should I just save the money and do it myself? Sigh...

    As to what he's eating, well... I just started everything today. It took a week for me to do research and find supplies and get the insulin, etc etc. All I have is 3 prescription cans of diabetic food the vet sold me at $3/can and a similar bag of dry food which I come to find out is crap. So I have enough wet food to last til Tuesday when I will try to hunt down the Fancy Feast Classics at the store. In the future I will see what kind of things that we can cook for him at home. I have no idea what kind of things he could eat though. But I'm not feeding him the dry stuff anymore. He is pretty upset about that already. But I fed him a tablepoonful of wet food after his blood test instead of making him wait until midnight.

    Can somebody recommend some cat treats for him that I can find at the grocery store? All I have now is Pounce, I gave him two after his ear prick. He's so mad at me!

    Bj says thank you. He wants you to know he has pretty white and orange fur like a creamsicle and that all cats are Royal.
     
  7. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    He sounds GORGEOUS! See if you can attach a picture (when you get a chance). Unfortunately, the grocery stores don't typically carry much in the form of low carb treats. But if you have a Petco or Petsmart in your town, you might want to try the PureBites freeze dried chicken or turkey treats. They are yummy (or so I've heard) -- two paws up! Also on the food, I think most people here recommend feeding smaller amounts 3 or 4 times a day (experts, please weigh in).

    I am very impressed that you have been able to get a blood glucose (BG) reading this soon. A reading of 275 is not bad, and as you start feeding BJ wet food exclusively you will see his numbers drop further. This is why it is good to start low on the Lantus because you really don't know what kind of additional drop in BG you're going to get, just from diet change alone. Many people on this board estimate 100 points lower or more, when you switch from dry to wet.

    On the curves: I think you would get a more accurate result if you are able to do the curve at home. Cats experience a lot of stress at the vet's office and this causes their BG readings to be high -- sometimes very high (it's called stress hyperglycemia). This can happen with any cat, not just a diabetic cat. It is stressful going to the vet and this is reflected in their BG readings; consequently, readings at the vet are not a reliable indicator on which to base insulin dose increases. My vet (the 2nd one...had to ditch the first) told me this and recommended I do the curves at home and just send her the info to evaluate.

    For example: say you do the curve at the vet, and BJ's low (nadir) readings are in the 400's (partly from stress and partly from diabetes) so the vet thinks he needs 2 units of Lantus based on these high readings; but, then let's say you test him the next day at home and come up with low numbers in the 200's (because he is not stressed). You see? Which is more reliable? So home testing is better (and more accurate) for BJ and a lot better for your wallet too! :)

    If your vet is not open to home testing (including curves) and helping you interpret the results by looking at your spreadsheet -- then you may want to look for another vet. That's what I had to do. One of the board members here recommended a great vet in my town who is an expert on Feline Diabetes, and I cannot tell you how happy I am that I switched!

    Here's a great reference article for you to read in your spare time (LOL!). For myself, I printed it out and use it as a textbook -- reading a few pages a day as I have time.

    There is an interesting passage in this material related to doing curves at home. It says that you don't have to do them all in one day. As long as you keep the cat's food and insulin dosage the same from day to day, you can collect data from multiple days and use this for plotting your curve. This may be especially helpful for beginners who are having difficulty getting several BG readings, all in one day. Here is the link to the article, and an excerpt from it below:
    ---------

    http://felinediabetes.com/dummies

    Diabetes in Cats for Beginners:
    Glucose curves don't have to be done all in one day. If the insulin and food are held constant, you can spread the testing over several days and wind up with just as accurate a picture -- possibly even more reliable than a day in which he got an ear stick every time he woke up. Also, you can start your curve at any time of day. For example, test at 7 pm and 9 pm Friday, 10 am and noon Saturday, and so on. When you have at least one test for every two-hour block, plot them all on one graph as if they were taken on a single day and in sequence.
    Keep in mind that you did not have to interpret blood glucose curves. If you want to do the tests, plot the curves, and take them to your vet for interpretation (some will let you fax the curves), that is just fine.

    -------------
     
  8. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    Hello Mike and BJ,

    I'm the one who said if you make a furr shot it smells like bandaids. really cheap plastic ones. :smile:

    I'll give you link for the purebites. They do have them at Petsmart.
    Here is the best price I've found online.
    http://www.entirelypets.com/purebitecats.html

    my cat prefers that i stick them in a tiny bit of water and re-hydrate them...
    I also use real shrimp. I just cut them up since she has no teeth.
    put the pounce away in your hypo kit. You want to gather the stuff you would need in advance and print the instructions of what to do.

    Last night was a good example. Could not log on the this website for over 12 hrs.
    I would also advise to keep a written notebook so that if you had to , you could re-create your spreadsheet.
    computer failure, power outage. Wouldn't we all be lost without our data?


    You do not have to get yourself stuck in a midnight/6 am schedule.
    Figure out what your optimal time is.
    Anytime you need to shift your shot times you need to plan in advance, ( once you get really going with the shots) because you can
    shift it in 15 minute increments.
    I started at 7 am /7 pm and then realized I'd prefer closer to 8 so I just started changing it by 5 minutes.
    Sometimes it takes me longer than that just to get a blood sample.

    As for your vet, go with your gut. If you feel more comfortable starting with 1 unit. Say so. You want to find out early if he' going
    to help you or hinder you with BJ's progress.
    We all walk away from the vets who think they are dictators and expect us to blindly follow their instructions.
    That's why we are all here together on this site, to learn and do what's best for our sugarbabies.

    But I do understand why some of them are that way.
    Unfortunately the majority of pet owners aren't willing to do what we are all doing here.
    And the vet sees those people and their pets too.

    If you are able to, it is best to feed several small meals a day. It does keep the glucose levels on a more steady keel.
    2 times a day creates a feast or famine for their bodies and the glucose levels rise and drop accordingly.
    And in the beginning, as you are switching foods, their bodies have been starving so it's okay to give a little extra.
    Appetites will normalize after the insulin is received on a regular basis and they adjust to their new diet.
    Have you see binky' lists for canned?
    http://www.felinediabetes.com/diet.htm
    see the binky charts. There are two, old and new.
    Most of us try to keep under 10% carbs, and some of us try even lower like 5%.
    It's a good idea to print the lists so you have it with you when you shop or what I did was highlight all the one's I wanted to find in
    yellow and then made myself a grocery list.

    Keep asking questions. It's the best way to learn.
    Read other people's posts. It helps to learn with the things that you haven't had to deal with.
    Welcome to a great community!
     
  9. Pumbaa

    Pumbaa Well-Known Member

    Joined:
    Apr 7, 2012
    Mike:

    Don't worry, we ALL had rough starts to this whole FD thing! It does get easier dealing with the testing and shots. And it sounds like you are doing great so far!

    1) Low carb treats: When I started testing Pumbaa, I had him sit on my lap in front of the kitchen table, with his front paws resting on the table in front of us. I put smooshed up sardines (human grade, purchased at the grocery store, packed in water with no salt added) in front of him. While he snarfed these up, he ignored me during the testing. Other low carb treats that are easy to create/find include Stella & Chewy's Freeze Dried Raw food (I can't afford to feed my guys this all the time, but they LOVE it for treats), cheddar cheese, Parmesan cheese, baked chicken, cooked hamburger, etc. To me it's easier to always have human-grade high-quality treats on hand than it is finding/ordering overpriced low-carb cat treats.

    2) To avoid fur shots, I used a Wahl hair trimmer to buzz off Pumbaa's fur around his flanks and front shoulders, so that I could actually see what I was doing when I was injecting him. The fur grows back quickly, and 3 months later, I'm still buzzing him, because when I don't, it's still too easy to give a fur shot. You can get the Wahl hair trimmers at Sally's Beauty Supply as well as at WalMart, and many other places. It buzzes the fur off without any risk of harming the cat. I can't believe my Pumbaa sits still for this! :)

    3) Here's a link to injection site information for cats. The scruff of the neck isn't the best location for insulin.

    4) Oh yes! Do all of your blood glucose testing at home, regularly. I know others have already chimed in on the advantages of this. My vet is shocked that Pumbaa allows me to poke his ears as frequently as I do, considering how agitated he was in her office during our initial diagnostic visit.

    5) Feeding. Your vet is wrong. Sorry. When Pumbaa was diagnosed, he was eating like the Russian Army 24/7 because he wasn't absorbing any nutrients. Feeding small quantities over the course of the day, or, if BJ is now underweight, just free feeding him as much as he can eat, would be fine. I still free-feed my Pumbaa, but his eating has decreased as the insulin has been working. I now find myself encouraging him to eat when his numbers are dropping.

    6) Testing. I have always free-handed the lancet, as I think that gives me more control and doesn't subject Pumbaa to the anticipation of the popping sound. But ECID and some people free hand and some use the lancet device. :)

    7) 12-hour shooting times. They all depend on YOUR schedule and what is convenient for you, as well as testing after the shooting times, during critical points in the curve. Six hours after the shot is the common nadir for many cats, not all. At the minimum, I try to do an AM +3, AM +6, AM +9, PMPS, PM +3 and PM +6. But, I am self-employed and work at home, and my Pumbaa has been a diver, so I never know when he's going to appear to have normal numbers and then take a dive to much lower numbers.

    I wish you the best of luck dealing with BJ's FD! You sound very dedicated to your little guy! You were smart enough to find these boards, and the people here will help you out, a lot! Even when you just need a hug for all of the new things you are now dealing with! :YMHUG:

    Suze
     
  10. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Here is a link to a list of diabetic friendly treats:

    viewtopic.php?f=3&t=9172

    In addition, you can serve him baked chicken, turkey, etc. Even some deli meats and cheeses, but you want to make sure that they don't have flavorings and stuff added to them.

    Maui's favorite treat is being brushed. After testing we would have a 5-10 minute brushing session.

    If the times of 12/12 don't work for you, you can always change it to times that are more suitable to your schedule.

    There are a couple ways to change it -

    1) skip a shot and start over at the new time

    2) with 30 minute increments slowly over several days change to the new time.


    Honestly, considering that you just started this process, I'd opt for 1. IT's quick and easy.

    I get the concern about going against the vet. The thing to remember is that YOU are the customer and YOU are in charge of your cat's care. The vet is a consultant who recommends and works for you. Do not be afraid of the vet. (Yes, I went through something similar with my former vet so I know what you are talking about).

    Starting at 1 unit, is a safe way to go. And especially if you are going to sleep after shooting, you won't be up to monitor to know if giving 2 units is too much or not.
     
  11. Julia & Bandit (GA)

    Julia & Bandit (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    You are doing the right thing starting at 1u. Here's a link to the Lantus dosing protocol: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf, and the American Animal Hospital Association guidelines: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. I would print these out and bring them to your vet, especially if he tries to give you grief starting on the lower dose. The starting dose formula is .25u per kg of ideal weight, so unless your cat is a naturally very large cat (like a maine coon), then 2u is too high a starting dose. Most cats on a low carb canned diet do not need much more than 1u of insulin. Bandit is a 13lb cat, and the most insulin he ever needed was 1.25u.

    The vet who diagnosed Bandit was fantastic--she started him on a good insulin (Lantus), told me I had to home test, and handed me a list of low carb commercial canned foods in different price ranges. But...her dosing advice was off. She was having me shoot once a day and had me raise the dose in full unit increments (Lantus should be increased/decreased in .25u-.5u increments, depending on the numbers). So I counted my blessings that she got most everything else right and educated myself so that I could handle Bandit's dosing on my own. It seems like you're experiencing something similar with your vet--he probably is just not aware of the Lantus protocol for cats, which is why I would bring him that document.
     
  12. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Hi guys.

    Thanks for all the info - I haven't had time to go through all the links yet (but briefly) but I wanted to update and get some advice. I am not a stupid person by any means but I don't process things well under pressure/stress. Which is where I've been at in the last two days.

    I think I am messing up so you can smack me if you want.

    Instead of 2u at midnight last night I gave him only 1u. Before his noon feeding he was at (496). I panicked and gave him 2u. Then I gave him a very small meal about 4:30p and checked him again at 5:45 and the glucometer said HI which is (>600). So I'm a bit scared. I'm screwing things up!

    Based on the info you kind feline friends have provided, I have decided on 1.5u for now unless you guys think that's foolish. Bj was really overweight the past couple years and went through dramatic weight loss the last 3 months or so. At the vet he weighed in at 11 pounds so I'm guessing his normal is around 13. (He's in the big range, not the hugest however. Though I didn't factor his age, he's 14 now.) So 1.5u sounds right according to the chart and it's between what you guys and the vet thinks is right.

    I have to run but two more quick questions -
    A: What is Nadir
    B: Is there a chart around here I can download to record his BG? The one that came with the glucometer sucks.

    I said it before but thank you SO MUCH for helping us out
     
  13. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
  14. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    Hi Mike! I think the most helpful thing you could do now would be to set up the spreadsheet so everyone can see your numbers. Try not to panic on those preshot readings. They are typically the highest of the day and will dip lowest about 6 hours after you give the shot. You do not base dosage changes on pre-shot readings. You only base dosage changes on the nadir (the low point) which is about 6 hours after you give the shot (though in some cats it is 5 hours or 7 hours after). And you don't make dosage changes frequently based on one or two nadir numbers. Changes are made slowly over time and based on patterns, which the experts on this board will help you identify.

    In any case, I think most people here will tell you that you have to maintain consistent dosing for a period of time (like 5 to 7 days) -- particularly in the beginning, before changing it. Lantus creates a "shed" (like a reservoir under the skin) when you first start using it...so initially you are filling up the shed and typically the cat's BG numbers remain high as a result -- because much of the insulin is going into the shed and not into the cat, per se. Within a few days, the shed is filled and you'll see BJ's numbers start to come down as more of the insulin is being used by BJ -- particularly if you have switched to an all wet, low carbohydrate food.

    At this point, you should just pick a number (for your dosage) and stick with it (LOL!!), until the experts on the board advise you otherwise. I myself am not an expert, but have ultimate trust and respect in the folks here who are. If you can get your spreadsheet set up soon, that will help them to guide you - step by step. If you need help getting your spreadsheet set up (and you live in the US), just send me a PM and I will set it up for you.

    I know it is hard to see high numbers in the beginning and not panic, but that's the way this stuff works. You have to start low and go slow - which is pretty much the opposite of how most guys like to do things (I am reminded of the old tv show "Tool Time"... and Tim's motto of "MORE POWER." LOL!! In this case, more power (insulin) is not the way to go. :)

    You're doing great! Try not to stress out. BJ will get through this and so will you. The first month is the hardest..and then everything settles into place. Promise.

    Melanie
     
  15. Pumbaa

    Pumbaa Well-Known Member

    Joined:
    Apr 7, 2012
    *LMAO* I so understand! Some people here think I am an idiot (not all, but many) because there is so much to process under the gun! And because I have made decisions I would have made in the business world that don't correlate to an FD cat.

    I've been thanking people for hitting me in the head with a 2 x 4 because I needed it. :)

    FD is a lot to handle, and it doesn't relate to anything you've learned in work/life about analyzing data and making decisions based on that data. From my perspective, every time I find a pattern in my Pumbaa's data, he changes the pattern. Hope that doesn't happen to you and BJ!

    Do set up the spreadsheet so that everyone can see BG test results as well as the shooting times and doses.

    Good luck to you and BJ!
    Suze
     
  16. Julia & Bandit (GA)

    Julia & Bandit (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    As Melanie mentioned, you do not base dosing decisions off the preshots, but rather the lowest number of the cycle (usually somewhere in the middle of the cycle). For example, Bandit's nadir was usually about 6 hrs after the shot, which is pretty common. The preshots are going to be high, especially in the beginning while your cat's body adjusts to the insulin. We call this "bouncing"--his body is so used to high blood sugar, that when you get a normal-ish number mid cycle, his liver will dump glucose into his bloodstream to counteract the "low" blood sugar. Eventually his body will get used to lower blood sugar and stop doing this, and that's usually when cats regulate well. It's very important not to change the dose up an down frequently during this process.

    That's why it's important to get at least one daily mid-cycle number along with the preshots. This is how you decide whether to raise/lower/hold your dose.

    Lantus must build up a "shed" under the skin before it starts to work on BG. That means it can take up to 3 days to see any action from the Lantus at first, and subsequent dose changes usually don't show up in your numbers for about 24 hours after the change. So you need to be patient with the dose before changing it. Getting to right dose is a marathon, not a sprint. Moving up the dosing scale prematurely will set you back more than taking your time, not to mention it can create a dangerous hypoglycemic situation for your cat. It's better that your cat be too high for a little while, than drop too low for a second. Just make sure you're testing for ketones when he's in these high numbers.

    I would continue with the 1u and stick with it for at least three days. If you don't see any mid-cycle numbers below 200, then you would raise the dose by .25-.5u depending on how high his blood sugar is. Here's a post that explains dose adjustments a bit more simply than the document I provided earlier: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. This dosing protocol has an 84% remission rate in newly diagnosed cats, with better odds of remission the sooner you start it.

    If you are confused and unsure what to do with the dose, you can always post here or in the Lantus forums for advice! There's a ton of people that have a lot of experience with this insulin.

    And there's always information overload in the beginning with treatment...don't let it get you down! It takes a little while to process everything, especially when it contradicts what your vet is telling you.
     
  17. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Alrighty.

    Re: Spreadsheet-

    I'll get to that as soon as I can get some damn blood out of him. 45 minutes later and 4 pricking attempts and no dice. So I need to review the articles on that. Maybe I'm not keeping the rice sock on long enough. I can't get the lancet to work, with or without the cap, abandoned that and went back to freehand where I am sticking the thing all the way through his ear. I managed to get blood yesterday without the sock but neither that or the sock worked today. So no BG and now it's feed time.

    Aaaagh!
     
  18. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Are you using the larger size lancets - 25 to 28? Do you have something behind the ear to poke against? Push the lancet firmly against the ear and whatever is behind it.

    If you want, let us know where you live and we might have a member nearby. It is so much easier to watch someone do it the first time.
     
  19. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    They are 26g Thin.
     
  20. carolynandlatte

    carolynandlatte Well-Known Member

    Joined:
    Dec 28, 2009
    Awwww Mike! You are doing great! Sometimes it takes a while for the ear to "learn" to bleed. Until that happens, you just do your best. I know there were some lancet devices that worked well for us, others did not. I always struggled to get blood when using a generic or the relion devices. I loved the one's which came with the contour. Most of those devices have a spot to adjust the depth the lancet will go. I had to start with it on high in the beginning. In time, I had it set to the lowest.

    After using the sock, have you tried rubbing his ear to get the blood flowing?

    Maybe you can try again in a little bit, if you have time.

    And yes...post the city you are in and we can put a shout out to those in your area to come help you. That is how I learned.

    It's going to be ok! :mrgreen:
     
  21. Pumbaa

    Pumbaa Well-Known Member

    Joined:
    Apr 7, 2012
    The higher the gauge number, the thinner they are, so 26 gauge should be fine.

    Instead of holding the rice sock on his ear, try massaging the outer ear with the rice sock. And do try both ears, as Pumbaa's left ear bleeds easier than his right ear, for some reason. Hold the lancet on an angle so you don't poke through the ear. Aim for the outer edge of the ear, between the vein and the edge. You might have to massage the outer ear gently, around where you poked, to get the blood drop to well up. Also, I read that some people do two pokes, right next to each other, to make sure they get blood initially.

    Good luck!
     
  22. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
  23. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Also, don't poke to pierce, rather hold the lancet (freehand) at an upward 45 degreeish angle - then poke, you just want to insert a little into the skin. I found this upward angle seems to help -

    here is a pick to show you what I mean:

    [​IMG]

    And are you aiming for the sweet spot?

    [​IMG]

    You may find that if you poke from the back of the ear to the front, it may draw more blood than poking from the inside (front) of ear to back.
     
  24. Julia & Bandit (GA)

    Julia & Bandit (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Are you backing the ear with a tissue or cottonball when you're poking with the lancet? If you're not backing it firmly, the Lancet device will just glance off the ear and not draw blood. That was my biggest problem when I learned! Also, I found bandit's left ear bleeds quite easily, while I'm lucky if I can get blood within 4 or 5 pokes on his right ear.
     
  25. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    I just bought a lancet device that is turning out to work pretty well.
    I , too, was having to try several times because I had one that was too fine a gauge.

    I can recommend the Accu-chek Softclix plus.
    http://www.diabetessupplies4less.com/acsopllade10.html
    You push it once to cock it, and then push it again to lance. I'm on setting 4/12 pressurewise.
    I cant freehand at all and my cat got very upset when I tried. I think she prefers the click cause she knows when it's coming.
    And it's fast and done. I kinda lean on her so she doesn't leave before I get the sample and i find if I put both hands on each side
    of the blood droplet, I can swish back and forth and get it to be a little bigger. Or even stroke the ear under the poked area
    and that increases the flow too.

    I also noticed someone said shooting on the inside of the ear.
    I've been on the ouside and I find the closer I get to the edge ( around the sweet spot area), the better luck I have.
    The neosporin ointment ( not cream) helps the blood bead up in a little ball so it's easy for my meter to sip it ( like a straw).

    and yes, make sure you are using something on the backside to give resistance when you poke. I was poking my finger on the other side.
     
  26. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Been having family drama but I finally got the spreadsheet done and linked to my signature. He is banned from dry food and only getting Fancy Feast Classics and PureBites snacks. Bj LOVES the PureBites treats. That has helped during blood test time. Plus, I use them to lure him when he's not in the mood. Works great.

    I've gotten this far but now I realize I don't know what to do with the numbers. Bj is at his lowest (124) pre-shot today. I really didn't expect this to drop so fast and am clueless what to do. I have to go feed him and give him his insulin now...

    If I can only manage to get blood one to two times a day, what times would be the best? I've been getting it about an hour before his first shot so far. Be back later.
     
  27. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    The more experienced members will be by shortly to advise you on dose, but I believe 124 could be a non-diabetic number. We are advised not to shoot insulin below 200 (for inexperienced folks) or below 150 (for the more experienced); so I would recommend you wait for guidance from the experienced members before shooting. :)
     
  28. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Too late, I better keep an eye on him :(
     
  29. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    You're fine, I'd recommend giving the shot, so don't fret. Remember, we don't base doses on just one pre-shot test. So, continue what you are doing and I suggest getting readings at +4, +5, +6, +8 -- as you can only get one test in, in addition to the pre-shot - today start with +4, tomorrow test at +5 and so on.

    This will help to see where his low point in the cycle may be.

    Also, I see you don't have any tests in at night - are you able to get any additional tests in then? Maybe one before you go to sleep?

    And yes, a lower number like 124 is great to see. It's the high normal range, which means he still needs insulin help, but his pancreas is trying to work. With the food change and insulin, he has a good chance of going into remission (OTJ).

    But one step at a time. And just a suggestion - you may want to add the insulin name to your spreadsheet - put it with the name is fine. This will make it easier for anyone who looks at it.
     
  30. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    My bad. If Hillary says your fine, then you are fine. She is very experienced! I was worried because you didn't have any mid-cycle readings to show how low the 1.5 has been taking BJ this last week, so to my untrained eye I thought this could be a problem -- but if Hillary says you're good, then go with her guidance. :)
     
  31. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Thank you ladies so much.

    I will do as suggested and I will try to get him after his midnight shot as well. Updated database name. He is sleeping right now.

    Well enough about Bj already. Please tell us about YOUR beautiful cats!
     
  32. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Just to confirm, you are home to watch him right? While maybe not test, you can keep an eye on him?

    Melanie, no "my bad" - you are correct in your thinking, as we typically tell people who don't have data or haven't been doing this very long to not shoot under 200 or even 150.

    But given some of BJ's higher numbers and the fact that Mike is home with him, I don't think it's wrong to give the insulin - as we all know, it will be the only way to get him off insulin in the long run.

    Of course, when you get your first double digits and below 50 reading - that's when the adreline really flows! And 50 or below, qualifies for a dose reduction!
     
  33. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    Mike: To answer your question, my kitty Ninja is a domestic short hair black female; though she thinks she is an alpha male cat -- so...shhh... don't tell her. She's about 8 years old (adopted her from the Humane Society so I'm not really sure). Her most endearing talent is waking me each morning, precisely 1 hour before the alarm goes off, by slapping me in the face (exactly like the "Simon's Cat" video http://www.simonscat.com/Films/Cat-Man-Do/ -- except that Ninja has never resorted to the use of a baseball bat -- yet).

    Show us a picture of your kitty. You can add his pic as an avatar if you'd like, under the User Control Panel at the top of this page. Would be nice to see what he looks like :)
     
  34. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Ninja looks so cute. That's such an awesome name too. I have a pic of Bj on disk somewhere... have to search.

    Well, I tested him at +4 and he's at (48)BG. I fed him a small meal after. I've been keeping a close eye on him between errands/chores all day. And I'll be home all evening.

    Advice?
     
  35. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    As you can see Maui is also a black DSH. When I adopted her from the shelter, she was very sick with an URI - the shelter told me that they gave her something for it. But when I got her home, I didn't believe them. I took her to my vet and was told that if I hadn't brought her in she would have been dead in a matter of days.

    The stupid shelter named her Raven, and I knew that was just a dumb numb and not worthy of this beauty. I waited for her to tell me her name - and she did - she walked into the bathroom and let out the loudest Meow I ever heard. And I asked her if her name was Maui and she said yes.

    Maui has had many medical issues, some I now think were possible misdiagnosis from the former vet. But anyway - she was treated for hyperthyroidism, where I almost lost her - as the vet prescribed a too high dose of tapazole. It took several weeks to get her white blood count from near 0 back to normal - the vet wanted to put her down. I nursed her back, with baby food and syringe feeding. Then she got the I131 treatment.

    She always had skin issues - itchy, scratchy, burning - and again, the vet treated symptoms only - shampoos, steroids, etc. NEVER did the vet ask what are you feeding. Of course this vet had no idea about the correlation of food and cats, especially dry food.

    It wasn't until Maui was diagnosed with FD that I learned about food and that she had a simple food allergy to something in the dry food (no clue what it is), but of course, it was too late, the damage was done - she got diabetes, IBS and while she is in remission, she still has bathroom problems. And yes, the vet told me that we would just have to live with it and I would just have clean her bottom.

    It's much better on the wet food diet, but she does get the occasional diarrea that we deal with.
    Maui was a dry food addict and in no way wanted anything to do with wet food. I had to teach her to eat it and what a mess that was. I spoon fed her for a couple weeks, until she decided to take that first lick of the spoon. Here is a pic of what she used to look like after a feeding session.

    [​IMG]

    Maui's latest medical issue is that she has degenerative retina myopathy - and is 100% blind. I noticed she was having vision issues, bumping into walls, walking against the walls, etc. And took her to eye specialist. He said, there is and was nothing I could do to prevent or slow it down. It is genetic and happens to some cats.

    It took me awhile to adjust to this, but as she may have been blind for almost a year, she already is adjusted. There are some things she doesn't do anymore, but that could be an age thing as well.
    (She is 14).
     
  36. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009

    OK - wow! Test him again in 15-20 minutes. Get out your higher carb food - if you have anything with gravy in it, get that out - give him 2 teaspoons of the gravy alone. As you may have to repeat this process several times tonight, we want that 48 to go up and not down, and if you can do it with gravy and food the better.

    As we want to avoid a hypo situation.

    But guess what, you need to reduce his dose! He just earned a reduction.

    So whatever plans you had tonight, can you put them aside as you need to watch BJ and for the next 8 hours, or at least until you get two tests that are rising and not going down.

    Does this make sense?

    HEre is something to read that will help.

    viewtopic.php?f=14&t=1122

    This is what we want to avoid - so let's not panic, but let's get prepared.

    I'll get more eyes to come here and help out as well.
     
  37. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    Hi Mike,
    Since you don't have a lot to compare to, you don't know where the lantus peaks on BJ and you are at +4.
    You will want to watch carefully for any signs of a hypo.

    His bg could go lower between now and +6 which is often the lowest number in the 12 hour cycle.


    Some cats don't hypo at numbers hovering in the 40's/ 50's and some do. You don't know with yours.
    I hope you have syrup, honey available. And a higher carb food available.

    Test again, 15 minutes or 20.
    and you don't want to stop testing until you have at least 2 consecutive rises in bg number.
     
  38. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    OK - I just asked for help on the Lantus board - and may I recommend that from here on out, you post over there, as they will be able to guide you with doses going forward.

    has it been 15-20 minutes yet?
     
  39. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I'm also going to PM you with my phone number so that if you would like to speak live, I'm here and can talk with you tonight and help you through this.

    look in the upper left corner for the message.
     
  40. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Awww, poor Maui :(

    Wow, she is so fortunate to have you in her life! I'm sure it's been super hard for you. Give Maui a scritch for us, please?

    The dry food thing has certainly been a wake up call. I heard it wasn't good for cats but I had NO idea how bad. I can't understand how they can sell this stuff.

    (Ok, wow I missed a lot of posts I'll go test him again now).
     
  41. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    Keep us updated.
     
  42. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Good please test - we need to keep on top of this, to ensure that he doesn't hypo!

    And don't feel bad for Maui - she is fine and beautiful and doing well.
     
  43. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
  44. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Hi Mike...I popped over from the Lantus TR ISG.

    Here is some information about Handling Low Numbers

    We have a saying "lather, rinse, repeat". So that is test, feed, and do it all again depending on numbers. So test, if his number is in the high 40s-60 range, feed a tsp of HC gravy, wait 30 mins and test to see where he is.

    Can you give us an update please?

    Good job on the SS.

    It's probably best to keep this on the board and not over the phone. This is a peer review board and off board advising, even for low numbers, is against the rules.
     
  45. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Mike

    Saw on the SS that you got a 46; please feed a tsp of HC gravy and retest in 30 minutes....and post. OK? Don't wait an hour to test. We need to get BJ's BG up.
     
  46. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    He's at (46) and I just let him pork out. He doesn't have any wierd symptoms, seems fine. Will test again in a bit.
     
  47. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Mike

    The problem with letting him pork out is that you could be dealing with very low numbers for hours and hours. You don't want him to get too full because then you will have to resort to syringing him karo.

    I'm concerned because you have very little data on BJ including consistent preshot tests. You should never shoot insulin into a cat that you don't know what the PS is. We also would have had you stall earlier today to see if his +12 number was coming up; we recommend new members do not shoot this low of a number without having a lot of data and knowing what their cat's onset, nadir, and duration is.

    Do you know that the %carb of the food is that he ate alot of? Please retest in 30 and post.
     
  48. Hi Mike,
    What did you feed him? Don't let him eat too much. You may have to do this for a while, and you need to leave some room in his belly.

    Carl
     
  49. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    hey Mike,
    The saying is "Feed the 40s".... when you get a BG in the 40s, it's a good idea to feed a wee bit of high carb food. The small bit, maybe a teaspoonful, should be enough to bring up the BG number in around 20min or so.... but even if the BG does rise, high carb food wears off in an hour or thereabouts, so it's a good idea to test in another 30min and see if BJ is rising, staying put in the 40s, or starts dropping again.

    If BJ is not rising, you may want to feed another teaspoonful .... keep in mind that if his numbers don't come up, you don't want to fill up his stomach, OK? The quickest way to bring up numbers would be to just give some of the gravy from the high carb food, but it does not last long in the system, so you have to keep watching his BG.... look for 3 rising numbers, and heading out of the 40s.

    Give mostly the gravies, and it will bring up the numbers but not fill him up.
     
  50. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Ok,

    After getting the 48 reading I gave him his regularly timed small meal afterwards. Then I let him eat a little of his 'old' dry food, it's Whiskas or Friskies. Then a while later he got some more of the dry food. Sorry, I misread and/or didn't see some of the posts in time before letting him pork out. I panicked. Going to test again shortly.
     
  51. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    do you have high carb canned food?

    you want to use this rather than dry. if you don't have high carb canned is there someone who can go to the store and pick up several cans? the best to buy is fancy feast gravy lovers - its perfect for this situation.

    and has it been 30 minutes - can you get another test in.
     
  52. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Mike

    Dry food doesn't work for low numbers. It takes forever to get the numbers to come up with dry food and then it stays around in the system like a bad hangover.

    Please take just a second to read through the posts. You have alot of experienced people asking you to give him HC gravy. We know this works :D :D :D

    Just breathe. We've all been at these numbers with our cats. You have alot of eyes here.
     
  53. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    @6:20pm (about +6) his BG is (100).
     
  54. Okay, good. But you still want to test to make sure he doesn't drop again. Hold off on feeding more for now.
    Carl
     
  55. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    ok this is good, test again in 30 minutes to be sure it stays and doesn't go low again.
     
  56. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    I'm on panic attack mode, I'm sorry guys. Besides the dry food all I have for gravy is from his old Friskies. I will use that next time unless not advised.
     
  57. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    yes you can use the gravy from the old canned friskies- that is exactly the right thing to use
     
  58. MIke,
    Nothing to be sorry for. We understand "panic attack mode". It's one of the reasons people hop in to try to help. Low numbers, at first, freak you out. They freak out the kitty too in some cases. But, you and BJ will get used to them, and you'll know exactly what to do.

    The Friskees gravy food would be fine too. If it's got gravy, it's most likely high carb. The trick is giving the most carbs in the smallest portion size, which is why we suggest gravy as a first step. It raises BG pretty quick, but it also goes away quick, and it takes up very little room in the stomach. The dry just takes a longer time to digest and then hangs around longer.
    You're doing great!

    Carl
     
  59. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Ok, it's a few minutes before 7pm (approx +7) his BG is (151).
     
  60. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    ok one more test in 30 minutes to be sure he doesn't drop again.

    please read through the posts and recommended links tonights/tomorrow.

    but you did well and glad that +4 reading.

    now when you do the next shot - drop the dose as he earned it - what i'm not sure is whether you should drop to 1 unit or 3/4th unit -

    and tomorrow you may want to post your amps on the lantus board BEFORE shooting just to be sure what dose to use

    make sense?
     
  61. Agree with Hillary.

    Tomorrow, test and post before dosing, and at most, it would be 1u. Best place to post is on TR for dose questions that need a quick answer.

    Do not be surprised by high numbers in the morning. He'll most likely "bounce" from today's lows, and it may take a day or longer for that to clear out of his system.

    Great job, Mike (and BJ)

    Carl
     
  62. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    just to clarify - TR means tight regulation lantus board -
     
  63. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    To be clear, he gets his shots at NOON and MIDNIGHT.

    Should I NOT give him anything for his MIDNIGHT dose?

    Going to warm the ear sock now, bbiab.
     
  64. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    You are Pacific time zone right... so 7:36 pm right now? The more experienced folks should be along shortly to guide you.
     
  65. Hillary & Maui (GA)

    Hillary & Maui (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    before we advise whether to dose or not, where are you? how many hours until midnight for you - I'm on east coast so it's almost 11 pm for me.

    this will help, also can you get another test in now, so we know where he is at.

    and it maybe ok to dose but definitely a reduced dose no more than 1 unit and maybe less. lets get some more opinions and will you be up to test? or could you wake up and test? just to be sure you don't have another huge drop.
     
  66. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    7:49pm Pacific.

    So, he twisted his head while lancing him and tore him up a bit and got a huge drop (of blood) and crazy readings.

    BG (253), (433), (379). This is three times from the same blood drop, one after another.
     
  67. Anne & Zener GA

    Anne & Zener GA Well-Known Member

    Joined:
    May 26, 2011
    Mike, you are getting great advice. Great job!! Low numbers are freaky and you handled everything very well. The good news is BJ is responding to Lantus. :D
    Liz
     
  68. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    I sure hope so! Yeah, the bad news is I'm screwing everything up *sigh*. I felt a lot better seeing the BG100 and 151 but the new numbers are nuts.

    If I only started him at 1u like I was instructed, we would be better off now. At least I lowered to 1.5u instead of the 2u the vet wanted me to do!
     
  69. OK, Mike, you can probably go with the first number you got. But, all 3 are probably suspect if there was a large amount of blood because sometimes you can get a messed up reading if the sample is too large. That happened a few times with me when I would hit the vein directly and it was a bloodbath.

    Given that his numbers have been climbing and continued to climb past what the food should have done to boost them, you're possibly looking at "bounce" numbers going into tonight's shot. Yes, I think you'll be able to dose him at midnight. And I'll probably still be awake (3am here) as will others, so you'll be able to get help if needed before shot time.

    I'd give his ears a break until 1130 or so your time, then just post the number and we can go from there. Sound good?

    Carl
     
  70. You did right by cutting back from the 2u the vet wanted you to do. The 1u vs. 1.5u question? Forget it, buddy. Put it in the rearview. After today, it's a whole new world going forward. Don't worry about "woulda coulda shoulda".

    Carl
     
  71. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    Maybe those new crazy high numbers are the result of the dry food you gave and will wear off over time. The experienced members will advise if they think this is the case. You did great tonight. It is not always this hectic. The key is starting low and going slow. :) If things get too crazy and you are ever unsure of what to do, just step back and ask for help. :)
     
  72. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Okay. I am going to take a break. Bj seems okay and is napping (he is pissed I interrupted nap time 5 times) so I am going to get off the puter for a bit and try to unwind a couple hours. I'll get his BG again before midnight and see if anybody thinks I should skip his next dose or not.

    I'm west coast (pacific). I suppose I could stay up til 3am and check then. Well, whatever is advised - I'll do whatever I have to do. I'm pretty terrified of having him drop in the wee hours though. Late at night is not a great time if I have some emergency.

    Sorry I'm late and if I missed any other replies I apologise.

    Thank you all SO MUCH.
     
  73. Hi again, Mike,

    I wanted to get this out there so you would see it before shot time. After thinking about it, and discussing it with a couple of other people who are much more familiar with Lantus that I am, here's what I'm thinking...
    The Tight Regulation protocol, if that is what you're trying to follow, would indicate a reduction of .25u, so tonight it would call for a dose of 1.25
    One important thing to keep in mind no matter what you shoot is how Lantus works. It is called a "depot" type insulin and it has a cumulative nature, where each dose builds upon the previous dose and forms what we refer to as the "shed". Because of that, when you reduce the dose, the depot is still there, so you might not see the results of a reduction immediately. It might take a day or longer for BJ to adjust to the lower dose. I guess what I'm trying to say is that even if you shoot less tonight, you could see the same thing you saw today happen again tonight. What that means is that you need to be prepared for that, so if it does happen, you see it coming early.

    To some extent whether or not or how much you can monitor his numbers overnight will play a part in how much you want to shoot. But no matter how much you give tonight, you should monitor. That doesn't mean you need to stay up all night. If you test him at +2 and +3, if he's going to drop quick or far, you should be able to tell by 3 hours after the shot. Do you have gravy/higher carb canned food, test strips, and can you stay up or set an alarm to check his BG a few times in the first 2-3 hours of the cycle?

    You can shoot 1u if you choose to. Actually, keep in mind that it is always your decision because as we always say "you hold the needle". We advise, you decide, to paraphrase Fox News! It all comes down to your level of comfort when it comes to dosing. You can shoot 1.25, 1u, .75, .5 or even skip the shot (although I wouldn't recommend skipping on any number over 200).

    If you test him about half an hour before midnight, and then again at midnight, you'll have a better idea what to do. If his number is rising, it would be okay to give him some insulin, but you will need to get spot checks overnight. Maybe at +2 and +3. If you don't see a big drop by then, maybe set the alarm for +6?

    If you decide to skip the shot altogether tonight, you can do that. Without more insulin, and assuming his numbers are up in the 200-300 range at shot time, he won't drop low overnight.

    Tomorrow, it might be a good idea to start posting in the Lantus Tight Regulation forum. Most of the people who have been helping out today spend most of their time there. Lots of other people there can also give you great advice. It's the busiest forum on the board, and somebody is usually there 24/7. It's the best place to post if you need a quick reply.

    Carl
     
  74. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I think Carl has done a good summary.

    The take home is you need to get a PS and see where he is. If he's over 150 and rising quickly, I'd shoot 1.25u and get a +2. If his +2 is much higher than PS, you should be ok to go to bed. If its the same SS or similar, you can expect a typcial cycle. If the +2 is much lower than PS, you can expect an active cycle.

    I also want to add that if you can't start getting some nighttime tests, Mike, I'd take his dose down more.m you are missing half of his data by not getting a +2 and before bed test.
     
  75. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    +11.5 BG Hi (>600)

    :?
     
  76. Wow, I was expecting a bounce, but not that high. If you test in 30, you'll know whether that was accurate, or (hopefully) a bad test strip?

    Carl
     
  77. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    PS @ Hi (>600)
     
  78. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Hi Mike, I was just alerted that you may need some eyes, so I thought I'd stop in. Trying to catch up on your thread and SS, back in a few, k?
    Jane
    P.S. Your SS begins on PM cycles (on the left), is that intentional? Still trying to work out where you are, timezone-wise! :smile: No BGs listed in AM cycles?
     
  79. OK then...

    Did you read what I posted an hour or so back about tonight's dose? And what Marje said? What do you think?

    Carl

    Edit- Hi Jane! Nice to see you. :D
     
  80. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Hi Carl. I'd say go with a 1.25, I think Marje suggested thatalso, earlier? Still playing catch up! Carl, thoughts on 1.25u?

    Mike, are you comfortable shooting 1.25u? Got strips? Food? HC? BOS? :mrgreen:
    Jane
     
  81. I think the 1.25 is good, provided Mike can get a test by +3 just in case BJ decides to drop early and fast.

    Carl
     
  82. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Carl: Yes, I did. I just fed him and have a syringe loaded with 1.24u. Doing last minute thinking before shot.

    I have supplies.

    Jane: It's confusing because the first shot of the day is at 12 NOON. I might start at 11AM but not now.

    I haven't been getting enough readings til now, unfortunately.
     
  83. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    No worries, Mike. You're getting tests from now on, so we'll soon have good data to be able to advise you even better. I'd say go ahead and shoot and strap on those BOS.
    What's your local time at exactly shot-time, please?
    Jane
     
  84. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    12AM Pacific Time.

    Disaster. He has been freaking out the last few shots and this time he jerked and I wasn't able to get it in him. I read NOT to give him any more. I'm pretty confident that little to none went in. What to do now?
     
  85. Mike, you shoot what you think is best. It's just one dose, one 12 hour segment in the big picture. Marje said it well in another thread tonight to someone not quite sure what to shoot on a low number:

    The depot that has been built up so far is going to determine what happens tonight more than the dose you give him right now.

    Carl
     
  86. Oh poop.

    OK, so maybe part of it went in? But some missed?
    Carl
     
  87. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Man, I don't think any went in. The fatigue is setting in on me is what it is. FUBAR.
     
  88. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Mike, did you check his fur? Wetness? Lantus smell?
     
  89. Mike, no worries. Fur shots happen even with people who have been doing this for years. This is actually an okay thing. It makes it less likely you'll have a long night.
    Carl
     
  90. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Freaking nightmare. He's escaped out the cat door and fled the country for at least a half hour.

    He's gotten wise to shot time. Very wise. I'm going to have to have mom hold him for me. It's reverse of what it was, he used to take the shot well and hate the ear pricks. ohmygod_smile

    Let it ride til his next shot time? Or...
     
  91. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Breathe, Mike. This happens. Again: Did you smell his fur and check for wetness? (To see if it really was a furshot.)
     
  92. Yes, you definitely let it ride, and never shoot again if you miss the first time. If it was a furshot, that's all you can do because you have no way of knowing how much, if any, made it in. You can't risk shooting more based on a "maybe".

    Carl
     
  93. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    No, because I missed your post somehow and he escaped out the cat door.
     
  94. That okay too, Mike. Now we put it in the rearview and look ahead.

    Can you test at +2 and/or +3, even if you need to set the alarm to do it?

    If any of the insulin made it under the fur, you might see some movement down by then. If you don't see a drop by then, then you can probably get some uninterrupted sleep afterwards because he most likely won't drop to the greens you saw today.

    Carl
     
  95. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Ok. Can't be helped. Many of us have given furshots - try not to dwell on it, alright?
    Carl is right: Never do follow-up insulin shots. There's no way of being certain here what went in, if any

    Are you ok testing a follow-up BG, at (+2)/(+3)?
    Jane

    ETA Carl we're cross-posting again :D
     
  96. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Alright then. I'll resume insulin tomorrow. So frustrated right now, grrr...

    My focus is just shot, there was family uproar going on the last two days and dealing with The J-Man I am brain dead. It's making me sloppy, obviously.

    Anyway, I'll test him again at +2 / +3 as advised.
     
  97. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Don't be so hard on yourself, Mike! You are doing fine. Thinsg will keep getting easier, I promise. Get some rest. I'll be around for your update, though Carl will problee be sleepus. You won't be alone. Keep breathing!

    Jane
     
  98. Awesome!

    I'm turning in for the night (almost 4am here) but Jane will be around until the rest of the coffee club shows up in a couple of hours. You did great today Mike. Don't get too frustrated. I found it helped me to take life in 12 hour chunks when Bob was on the juice. You and he will be fine, and this gets a lot easier the more you do it.

    Carl
     
  99. Mike and Bj

    Mike and Bj Member

    Joined:
    Jul 19, 2012
    Right on, thanks Carl. We want to go to bed too lol.
     
  100. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    See you in 2 hours or so then, Mike.
    Jane
     
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