? Don't be mad at me for what I did

Okay everyone, I hope none of you get upset because I went against some protocols on here but I did it because it was what my gut finally told me to do and I wasn't satisfied until I did it. This morning I took his preshot and it was 450. I initially was going to give him 2 units but somehow I missed his skin because it shot into his fur. So I felt like I didn't get any into him so I went and drawed 1.5 units out and gave him a shot. At +4 hours later I checked his numbers and he actually went up to 455 so I decided to do what I wanted to do and that was to give him 5 units. That is on top of the 1.5 so in total in those 4 hours he got 6.5 units of insulin. As I noticed is that he has went down all day long and at the end of the day he ends up at 192. That is what happened the time before when he was getting 5 units. I am thinking that he needs a higher dose and 6 units may be what he needs right now. I did not give him any insulin tonight because he was under 200 and I won't be up +4 or more hours tonight so I didn't want to worry about giving him just 1 unit and he dropping too low. Or do you guys think he should get some sort of insulin tonight?

 

Personally, I think you're going to have to monitor tonight regardless of whether you give insulin or not. He might have got some of the initial 2 units, then you've given him another 6.5 on top of that...and he's still dropping. If he got 1 of the 2 units you think was a fur shot then he's had 7.5 - and the highest he'd had to date was 5 - that's a huge increase and there's no way of knowing what might happen with his numbers after that.

 

I will take his glucose again before I go to bed here in a hour or so. So that'll be +10.5 hours since the last shot and see if it went down or up.

 

No. Given your dosing method and the nature of the insulin, in the interest of safety I don't think he should get some sort of insulin tonight.

I agree.

 

For future reference, if you ever have a fur shot, wait until the next shot time to give insulin.
Better too high for a day, than too low for a moment.

 

Please post his number and wait for people to take a look at it before you sign off for the night. We can't possibly know whether a 10.5 test will be enough to make sure he's safe overnight until you know whether he's still dropping and if so how fast.

 

several of us have outlined your options, pros and cons, and what we would expect to see happen based on our experience. The final decisions are always up to you.

As Jill said, Lantus has a cumulative effect. Often when changes are made (like giving additional insulin) we see more effect from the change in either the next cycle or even the next day. Just keep that in mind as you are making your decisions over the next few days.

If he were my cat, I wouldn't go to bed until he was very clearly rising and staying up. Even then, I would leave food out. Probably even a high carb food to be safe. I can't imagine what it would be like to wake up and find that my cat had hypo'd overnight, so I wouldn't take the chance.

 

Ryan,
please set an alarm several times tonight and check on him. Don't just go to bed.
you have to check him and keep him safe.

 

Well I believe the 192 was the low point because he ate and it went up to 220.

 

that can just be food influence..... we call it a food spike and it's about the right amount.

We all want you to test again in another hour. and probably again after that.

 

He didn't drop anymore. I didn't give him anymore insulin. Will wait in morning to do his usual preshot and insulin

 

If the 220 is food influenced, then he might well still be dropping. The first couple of hours after food you often get a food spike in BG level. I wouldn't leave him for the night yet - I don't think he's necessarily safe at this point.

 

Ryan,
you were grateful for the help I gave before...
Please Trust me, that it is entirely possible that he could drop dangerously low in just a few hours.....

it's also possible he won't.
but better too high, than too low....
too low can mean dead.... or extremely outrageous vet bills.....

 

Okay I will test before I go to bed here shortly. He was at 220 from 192. You said that usually the NADIR for Lantus is 6 hours or so. Its been 11 hours since I gave him the last shot. If anything another hour it would be 12 hours since his last shot or the next time I'd give him another shot but I am not giving him anymore insulin tonight.

 

You're not understanding. Whether he got more insulin or not, he just ate and that is going to push his BG up TEMPORARILY. He might well still drop after the food spike wears off - and I think that 220 being food influenced means his 'real' number is still falling. That's not a safe place to leave him in overnight when he's just had a 50% dose increase - which, frankly is unheard of with Lantus.

 

How can he continue to drop alot more if the NADIR is usually 6 hours or so. Its been 11 hours since he got the shot. How would it still be going down if anything would be staying consistent to what it is now.

 

I will check his number here shortly and report

 

nadir's can happen at any time....

each cat is different.
we don't really know his pattern that well because of the dosing not being consistent.

there is also such thing as a double dip....

some cats drop low twice during a cycle, especially if they've been bouncing around.....
it can throw a normal cycle off.....

pooper just got more insulin than normal....
so who knows?

 

The nadir can, and does, vary. I've seen nadirs as early as +3 and as late as +13 or +14 and that's on a steady dose with a cat who's been medicated at steady doses for some time. We don't know what the sort of dose increase you gave him today might do - that's the problem we have with you leaving him overnight right now.

 

Okay his number is 237 now. It was 220 a little more than 30 mins ago. Its been atlest an hour since he ate a bit.

 

You need a test in another hour - cats can BG spike for up to 2 hours after food. You're also going to need to keep a very close eye on him tomorrow especially if you plan to keep shooting 6.5 units - as the depot from that builds, he could crash...hard...at any point.

 

1. We don't know when booper's nadir is, do we?
2. You gave multiple shots within hours. Each of those shots has it's own onset, nadir, and duration. They will interact with each other (add a little oomph to each dose) in ways that we cannot possibly predict.

Could this become a non-event or a situation that requires intervention on your part? I don't know and personally, I wouldn't want to find out by waking up to a hypo'ing kitty... or worse.

It's too soon for a food spike to dissipate and 220 and 237 are virtually the same. If I were in your shoes I would not let my guard down yet.

 

The FDA allows glucometers to read +/- 20% from what a lab would read.
When 2 shots have been given at slightly different times, the overlap period is the most risky for ALL those hours of overlap, plus a higher than needed amount of insulin can keep going down, down, down.

I've done the all night test, feed, wait 30 minutes, rinse and repeat process. Yes, it is grueling. And my cat was alive the next morning.

 

and my own cat takes 2 hours 15 minutes or 2 1/2 hours before food influences disappear.
that's knowing my cat.....


we all just want Pooper to be okay.

 

I'm counting 3 shots. We still count fur shots, right?

Amps 2u (fur shot) + right after that 1.5u + 4 hours later 5u

 

Alex took longer. 3 - 4 hours. She was very carb sensitive.
ECID.

 

270 now

 

rbrumbaugh82:

Thank you. Not much of a change, but at least it's not going lower.
How many hours is that reading from the last shot?

 

going close to 2 hours since he ate a little bit of dry food. The 193 was 3 hours ago and he has been going up since.

 

Missed one, Jill. Crap vision.

 

How many hours has it been since the last shot?

 

If you zoom out on your spreadsheet, ie make it very small, you can see the color shift to more to purple, red, and black as you increased the dose above 1.0 units.

 

I am going to go to bed because I'm sorry but I just can't visualize him suddenly just dropping over 200 points through the overnight hours when he has been rising up since the 193 3 hours ago. Despite a little bit of food I don't think he ate enough to warrant a big BG spike.

 

about an hour since last shot

 

Are you serious? You gave him more insulin after we'd already told you the amount you gave him might have been too much?

 

I'd leave a plentiful supply of food out for Poopers before you go to bed and test if you get up for any reason.
You can't visualize a drop through the night only because you haven't seen/experienced it first-hand. Will he drop? I don't know, but I can tell you it wouldn't be unusual for him to drop as the cycle goes on... trust me.

Whaaaaaaaaaat? Is that a typo?

 

NO! I did not give him anymore insulin since 12:30pm so its been roughly 12 hour since he has had insulin

 

Thank god.

 

I thought you meant shot in as to last time I checked his glucose. It was about an hour since last I checked his glucose as it went up from 237 to 270

 

Gotcha.

 

OK, good I agree with Jill though - if you have to sleep you really need to leave him a lot of food out. I've seen the weirdest fast drops at odd times even without a dose increase. We just want him to be safe - that's the only reason for the amount of concern you're seeing from everyone tonight.

 

If you nap in multiples of 45 minute increments, the length of the average sleep cycle, you can wake up more easily and check on him periodically without losing too much sleep. Ex 45 minutes, 1.5 hours, 3 hours 4.5 hours, etc.

 

There is hard food out. He is fine. If he drops over 200 points from now to morning I would totally be in amaze because he usually goes up at night. And i know he didn't eat much at all this evening as he was sleeping at the time his number was 193. So I'd imagine it would have dropped further due to not eating.

 

We'll hope he doesn't vomit.

 

he may toot

 

I'm serious. I had a diabetic cat with probable IBD. It was very difficult to control his glucose because some days he could eat OK and other days he'd have diarrhea and/or vomiting, so the glucose could plummet. I tried everything I could for him.

 

If you're interested...
It's apparent you need help learning about not only the nuances of Lantus, but how to use it safely. You can find that kind of help in the Lantus & Levemir Insulin Support Group. IMHO, it would be in Pooper's best interest if you posted there for dosing help in the morning... before you administer insulin. There are plenty of people who can help you.

If you're not interested, please disregard this post.
It's past my bedtime... so, goodnight and good luck.
Also, a big "thank you" going out to everyone who has spent their own time contributing to all of rbrumbaugh82's recent threads for no other reason than they cared!


ETA: BJM is serious. It happens. Again, it's something that's not unusual. We've seen it happen a lot more than once.

 

I have nothing to add except this.
I watched a cat die from hypoglycemia. It took a long time and he suffered immensely. It was the most horrifying animal death I have ever witnessed. (And I've watched a beached whale take twelve hours to bleed to death on an oyster bank from ten feet away). Hypos can and do kill.
I think all that people have tried to impress upon you is that when a cat crashes, it can happen quickly, and unexpectedly. People here know the warning signs, and will - without fail - err on the side of caution. Just because you can't fathom that poopers can drop 200 points while you are sleeping, given the amount of insulin and the timing of his doses in the last 24 hours, it is a possibility.
Please follow Jill's advice. Post on the L & L forum and ask for help before sticking another syringe in your cat. For Poopers sake.

You may not have wanted to read my blunt advice. Sorry, but I don't really care about that. Poopers life is more important to me than your feelings.

Carl

 

I am not mad at you since I have done the same.
You are the one who knows best about Poopers and you are the one responsible for him.
All I really recommend is to test sufficiently so that you can take appropriate action to prevent him from going too low.