Different AM/PM doses?

Hi everyone!

Just wondering what the prevailing wisdom is about giving different amounts of insulin in the morning and the evening. Splunk's numbers have been coming down, and in the evening he's been hovering around 8-9 (150-180) for the past few days. I haven't been giving him an evening shot, because his normal dose is already only 0.5.

We saw my vet for another reason today, and she wants me to give him 0.5u in the evening, even when his sugar is around 8. Well, he typically drops about 7 points by the nadir, so I told her I was very uncomfortable with this. She thinks I'm crazy, but... too bad. Gotta look out for my little guy. Anyway, after I pushed back, she suggested giving 0.5 in the morning, and 0.25 in the evening. I was under the impression that the doses should be the same at both ends of the day. Should I maybe be trying to give 0.35 (or some other weird number less than 0.5) in the morning and in the evening?

(Note that he's still on Baytril for two more days, and his levels might change when he comes off it.)

I gave him 0.25 tonight, and will check him throughout the night to make sure he's ok.

Overall, though, I'm happy his numbers are looking a bit more reasonable, and he's even gained a tiny bit of weight. Woo hoo!

Thanks for any thoughts,

Jenn

 

I'm inclined to agree with your vet. I'd do 0.5 when over 200 and 0.25 when 150-200. You wanna push those numbers under 150... I always aimed for 85-100.

 

Ok great. That's what I was hoping to hear -- it's easier than trying to figure out some weird in-between number.

 

When you get into these low numbers you really have to dose as it comes. Look at my ss and you will see at the end how I was adjusting for those lower numbers.

 

Jennifer, I might suggest lowering dose to 0.25U for both cycles, if he gives you another similar AMPS. Might level out the PMPS. *Usually* when you get the lower PMPS, obviously at higher numbers the difference is greater, it can indicate the AM, or opposite, dose can be too high. You hold the syringe though

 

The same thing happens with Smoky. He is too low for either am or pm shot. I was advised to give a lower dose on whichever one was the higher number. As Janet says it levels out the BG numbers.
I use a sliding scale type of dosing with Smoky and he seems to do well with it.

 

Awesome, thanks everyone. He's 5.4 (97) at +6 now, so yes, he might not need the 0.5 in the morning! My vet said she felt foolish even suggesting a dose as low as 0.25, but it's obviously having some effect. Thanks for your help!

 

Perfect number

 

If it was me, I'd be more inclined to lower both doses to see if that got you a gentler curve during the day cycle that got you a bit of a higher PMPS...in hopes of getting them both to even out. That's just me, though.

I would be careful about that PM cycle. I think you do want to give a shot if you can, but just make sure you can monitor. Get a +3 if you can, and that can help you determine if he's going to drop quickly or not and whether you'll need to get more tests in.

On a side note, are you using u100 needles or u40?

 

Hi Rachel, thanks for your input. I will definitely be careful about the PM cycle, and I'm grateful to hear it's not just me who is worried about this. I'm happy I stood my ground with the vet about not giving him 0.5 at night... I think we'd have a problem with that dose. I checked on him every 1.5 hours last night, and will probably continue to do that until I'm relatively certain things are ok.

He was at 10.2 (184) this morning, so I gave him just 0.25. I'll see how he does throughout the day. Maybe 0.25 AM & PM will even him out. The only problem is that my syringes are marked in whole units, so I'm eyeballing it, and, as comfortable as I am with that, it won't be completely consistent. I need to get some new syringes; I've been looking online, but haven't found a reliable source yet. Oh, and I'm using U-40.

Thank you!

 

Looking good! One syringe option that allows small fractions to be drawn up is to use U100 syringes with half unit marks for the ProZinc along with a conversion chart. You can read as small as 0.2 u directly and eyeball 0.1 u quite easily. Maybe you can buy them from your vet because their kitties who are on Lantus use them.
http://www.felinediabetes.com/insulin-conversions.htm
You might find U100s with half units marks at a human pharmacy if you call around.

 

Awesome, thanks Kris. I'll look into that.

 

Be prepared: if your vet practice does sell U100s to Lantus users, they might be reluctant to sell them to a U40 insulin user because they think you'l mess up the conversion and overdose your kitty. You could print out the conversion chart to show them.

 

Here are some links to syringes:

Syringes:

https://www.adwdiabetes.com/product/2552/monoject-ultra-comfort-insulin-syringes
https://www.adwdiabetes.com/product/16367/carepoint-vet-u-100-pet-syringe-31g-half-unit
https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes

And I agree about lowering both doses. If it was me, that's what I would try first. Sometimes a different AM/PM dose is necessary, but I tend toward the more consistent option first.

 

Jennifer is in Canada so I'm not sure about the issue of shipping across the border.

 

I use the u40 syringes with half markings on them. I use carepoint brand and I also have some u100 syringes from BD that I keep in a separate place from the u40's .
I use the u100's for those times when I need a smaller dose.

 

Great, thanks everyone. Yeah, I try to avoid shipping across the border, if possible -- it can be a bit of a nightmare. I just found the U-40 Carepoint syringes with half-unit markings at lifesupply.ca, so I've ordered them. (And I found lactated ringers cheaper than I'm getting it at my vet, so... bonus!) If it looks like Splunk will need smaller doses, I'll get some of the U-100 ones and do the conversion. I like the idea of having both around. Thank you!

 

Just keep them (U-40s and U-100s) in two separate places away from each other . Beautiful nadir last night

 

I definitely will, and Splunk says gracias!

He was 10.2 this morning and 10.1 this evening, with a +7 of 6.7. Not quite as low as I'd like it at +7, but I'm liking the evening out at the ends of the curve. So I guess we'll do this for a few days and see if it's consistent.

The great news is that he's definitely feeling better... he's getting back to his old bossypants ways.

 

Really nice numbers on a very low dose! Excellent progress!

 

Thanks! But he's 7.7 this morning, so I guess no shot... I'll have to read up on stalling.

 

Yes, no shot. I won't say where he's headed but it's good!

 

All our paws are crossed!

He does seem subdued this morning, though, and he's not eating quite as much as usual, so there's some chance he's just not feeling great. Today is his last day on Baytril, so we'll see what the next few days bring. Thanks for confirming no shot!

 

Wow! Splunk is looking great! Cats do eat less as they get into normal ranges, so fingers crossed it's just from that, and not anything else!

 

Thanks! Yeah, I hope it's nothing. He's definitely up and down in his eating and behaviour, and he's very flat this morning. I have to wonder if we're missing something in terms of a diagnosis (and he still has this intermittent shakiness we haven't figured out). But I'm happy about his sugar levels right now, so our paws are crossed that things sort themselves out.

 

That's a pretty good number two hours after a meal and with NS! Remind me about the shakiness? Is it just a little neuropathy? If so, it should clear up after a bit of time in these lower numbers.

 

Wow, Splunk is so grateful to you for taking the time to check his spreadsheet! Thank you! I wondered about neuropathy, but I'm not sure that's what it is; if it is, it's certainly atypical. The shakiness affects all his limbs intermittently (sometimes front, sometimes back, sometimes both), and sometimes he's a bit shaky even when he's lying down.

He's also got "snory" respirations a lot of the time, and sometimes stops breathing briefly, then follows up with big breaths to make up for it -- like sleep apnea, but it happens even when he's awake. This has been going on for a couple of years, and I used to think it was because he had a big tomcat chin, but now he's lost his big chin (he lost 2.5kg), and it's continuing. My vet hasn't really had any suggestions, and doesn't seem too worried, but it's really alarming to me. I wonder if he has polyps in his throat or something... or maybe it's neurological, too. It's a weird conglomeration of symptoms.

Anyway, yeah, I'm hoping the shakiness will clear up as he spends some time in the lower numbers. That would be amazing!! Hugs to your fur-kids!

 

I think a lot of us here check each other's SS every day or maybe I'm a weirdo lol, or both! Just for the "snory" thing, Maury does this too but he does have a heart murmur but in order to find out what type of cardiomyopathy he has, the test (I think EKG) is $500+ which I cannot afford right now. His respiratory rate is normal and heart rate on the higher side (these are done at resting state). Did your Vet mention Splunk having anything?

 

LOL, well, weird or not, we really appreciate the SS checks!

Maury does the snoring thing too?? While he's awake? Wow. No one else has ever heard of this... even my vet looks at me strangely when I mention it. I've never heard of snoring -- least of all while awake and with periods of apnea -- as a result of hypertrophic cardiomyopathy. (Gurgling, or wet cough, yes, but this is usually a dry, upper airway noise).

Splunk does have a heart murmur (grade 2-3-ish), but he gets yearly echocardiograms (i.e. cardiac ultrasound, last one was a few weeks ago), and this shows no significant HCM... it's mild at worst. When we went to the emerg vet the other night, she did a quick ultrasound and saw no fluid accumulation.

And yeah, I totally understand about the echo being expensive... Splunk's is a "deal" at about $370 because (a) I get him done regularly, and (b) I get him done at the same time as one of my other cats (who has more advanced HCM). Ugh.

HCM keeps coming up on the list of differential diagnoses, so I'm going to keep a close eye on this.

Thanks, and we hope Maury is doing well today!

 

Not snoring too often, unless his allergies were acting up and his nose is stuffy. But I've seen him like hold his breath while sleeping and then the next will be a big deep breath to make up for the skipped one.

Thanks for well wishes, you and Splunk as well

 

Hmm... interesting. If I get an answer from my vet about that, I'll definitely let you know what she says!

 

Sam snores too. Mostly when he's asleep, but sometimes when he's awake and relaxed. He also gets a nose whistle. My vet said it's probably just narrow nasal passages, or something harmless like that since he doesn't seem to have allergies, and his heart is fine.

 

Elektra (one of my civvies) snores sometimes too! As for the SS checks...yeah I think we all have gotten to the point where we LIKE seeing SS's so we can analyze data and just see how everything is going!

 

Oh really? That's good news, thanks.

We were at 9.5 tonight with no shot this morning. I gave him a skinny 0.25u, so I'll be checking on him all night again, and we'll see what the morning brings!

 

Not bad

 

6.6 this morning with only the tiniest of shots last night!