dosage advice

Hi,

i was wondering if people could please give me some advice on where to go with freds dosage. my understanding of glargine from the vet is that it is a long lasting insulin and his levels should drop and stay pretty low and level when on it on the correct dose. we have started at 1u and gone up to 4u then went back down to 2u as on 4u he was dropping to 11-12s and then bouncing back up to 25-27 in the afternoon and the vet thought we may have gone to high and missed his ideal dose. we are now on 3u and he is showing very little drop hes hanging around A 22-23 whenever we test him. we cant test him multiple times a day as we both work a lot but we test him whenever we can get him, from what the vet has told us testing once to twice a day with glargine should be enough to know how hes reacting to it due to it being long lasting insulin.

My problem is im a bit confused on where to go from the 3u and i think the vet may be a bit stumped to so i thought id ask people using it regularly. if we go to 5u and hes bouncing on 4u will it make the bouncing worse or should he eventually level out? from peoples experience do cats on glargine generally stay at a fairly constant level or is it normal for them to drop from 25 to 11 then back to 25? we cant get 1/2 unit syringes here in Australia, is it possible 3.5u is his ideal dose and we havent been able to go there and does anyone have a suggestion on how to do that without 1/2 unit syringes?

the vet says he seems to be showing signs of insulin resistance but we have had him tested for most obvious diseases outside of diabetes that could be causing that and he has been given the all clear so im guessing its just we cant find the right dosage.

any help is very much appreciated

 

Hi there
I’m live in Sydney and think I have spoken to you before.
Looking at your SS I can see you are not testing before every shot. Sometimes you test on the morning and then not again that day or maybe only a mid cycle test and one at night.
The only way we are going to be able to see what Fred is doing, is to consistently test before every shot night and morning and then get as many tests in between that you can even if it is a +2 or a +10 in the day cycle. Then at night you should be able to get more tests in and at the weekend. A +6 or around that time is a good one to get sometimes. I know you both work but if I were you I would try and work out how you can get some more tests in to help sort Fred out. I’d also try and post regularly on LL forum so people get to know you and can help get things in track.
Fred could be dropping low during the day or night then bouncing back up to reds at shot time. This happens a lot. The only way to find out is to test.
Dosing is based on how LOW the insulin takes him, not the Preshot.
I don’t agree with your vet about only two tests a day is enough, especially while you are trying to find the right dose.
We increase or decrease in 1/4 unit increments. It is far safer for the cat and you have a better chance of finding the right dose.
You are right, we can’t get 1/2 unit syringes here in Australia but I will send you a link when I get home where you can buy them online.
I dosed for several years with 1 unit syringes successfully by just eyeballing the amount with a magnifying glass.
I would not increase until you get some consistent testing done to see if he is bouncing and then if you do I would only go up to 3.25 units.
Lantus is supposed to have a fairly flat curve and some cats have them especially when their numbers are low. But the curves can be very bouncy too.
I’ll post the link to the syringes a bit later.
Good to see you again

 

Here is the link for the address in the U.K. to get the 1/2 unit syringes.
They arrive in about a week I was told by someone who gets them

https://www.hyperdrug.co.uk/BD-Micr...03ml-pack-of-100/Productinfo/BDMICROFINE03ML/

 

Hi there and welcome to L & L !

Bron gave you some really good advice as far as always testing before you shoot. Safety first. And about increasing in 1/4 units increments and that way you are least likely to go past the ideal dose. Also getting a curve to see just how this present dose is working for Fred.

I am glad she gave you a link to get 1/2 unit marked syringes as that will make it a lot easier for you to do 1/4 unit increases and decreases.

One other thing, I see on you SS that you feed twice a day. Diabetic kitties benefit from smaller more frequent feedings. Is it possible that you break up Fred's calories and spread them out more like every 4 -6 hours?

And as Bron suggested posting more here for dosing advice. We are glad to help you.

 

hi, we currently feed him about 4 times a day, once in the morning, once midday, once at night and once before bed i didn't realise i hadn't updated my signature sorry . we have just gone back to 4 units as i haven't got the 1/2 unit syringes yet (we are going to) and he was just a lot happier/normal and we were getting better numbers on the 4 units than 3, the aim is to go back down to 3.5 when we get the syringes. my question is we just tested him 5+ and got a 7 this is the lowest we have ever got from him and he is acting really normal and happy for the first time since this ordeal started but im a bit concerned on what to do if when we test him before shooting tonight and he is still low (below 11) do we skip a dose completely or just shoot a lower amount? last time we shot him with 4u when he was reasonably low (12.8) he bounced straight up to 26 and went all funny for the next few days. we are so used to shooting from 20s that i have no idea what to do if he is low and since this is the first time he has been in a single digit number i dont wont to stuff it all up or possibly over dose him?

 

They will bounce if they go into lower numbers than they are used to.
There is no AMPS number for today. Did you do one?
It is really important to test before EVERY insulin shot to see it is safe to do so.
With the 7 (126) at + 5 we don't know if he has gone down this cycle or has been low all this cycle.
If you shoot a lower number tonight will you be able to stay up and test him...........it might possibly mean you have to say up for hours if he drops down low. Do you have plenty of test strips and high carb food and honey.?
There is no doubt that shooting lower numbers will get you better numbers overall, but you need to get a lot more data than you have at the moment to know it is safe to do so.
Can you get up at night and take a test? Or at least get a before bed test so we can see how he is going?
As Lantus is dosed on the nadir...lowest point.. it is hard to see with Fred as you don't really have many inbetween tests.

If you post the PMPS tonight we can decide what to do.
What time is you PMPS?
Bron

 

No we didn’t get an amps test we still can’t successfully test everytime and after a few tests we tend to let him go as it really stresses him out it certainly hasn’t got easier the more we’ve done it if anything it’s got harder as he knows what’s going on and there’s probably not much skin left on my wife’s fore arms, we will try and get a pmps test at 8 and see where he is at. We don’t have any carb food at all or honey we got rid of the high carb food so we weren’t tempted to feed it to him I will have to buy some more. We were really hoping just to be shooting under 16 so he’d start to gain some weight and were shocked by a 7 as he’s never gone close to that before.

 

In regards to the high carb food and honey, you really need to have some in the house because if he drops low, you don't want to be in the position of having nothing there to bring his BSL up. And the same for honey. I think you should go out NOW and buy some honey and a few cans of higher carb food.....especially with the lower numbers appearing...... mark it as higher carb and put somewhere safe where you both know where it is because I can promise you there will come a time when you will need either honey or high carb food and you will need to be able to just grab it from a cupboard......

I am sorry you are having trouble still with testing. I'll ask a few questions to see if we can make it easier for you all.
What are the size of the lancets you are using?
Are you using the lancet device when you jab the ear?
Are you warming the ear with a sock with some warm rice in the end of it?
Are you holding a cotton ball behind the ear to support it when you test?
Are you 'milking'the ear up towards the jab after you jab it?
When I tested Sheba, I did not hold her as such ....cats often fight if held.....I used to kneel behind her and place my knees either side of her body and lean over her body from the back towards her ears to test.....does that make sense.
I used to give her a small low carb treat or some chicken broth ( no onion or salt...nothing added at all) while I was testing and she didn't notice I was doing it. Maybe you could try that.
Do you give him a treat every time you test whether successful or not?
Try singing or humming as you test...sounds crazy but it will relax both the tester and Fred.

To your wife. Scratches are no fun.

 

We are using the lancet device and all of the above but he really is difficult especially the better he feels the more he hates it. We just got his pmps he is back to 25.9

 

The 25.9(466) is a bounce from the 7(126) he got at +5. He could also have gone lower later in the cycle. Bounces can last for up to 6 cycles and there is nothing you can do about them.
I would stick with the 4 units and try and get some more inbetween tests if you can during the next few days. Try offering more treats to Fred when testing.
Getting that 7 was great and tells us he is responding to the insulin and bouncing from the low number because he is no longer used to being in low numbers. The high numbers in his SS could well be bouncing from lower numbers during the cycles which up til now you have not been able to get.
You can see how misleading just getting preshot numbers can be and then changing the dose on the Preshots.
By dosing on the lowest point, we are adjusting the insulin on how low the insulin takes the blood sugars.
I know how difficult it is for you getting the BSL but try and persevere if you can.....Fred is the one who will benefit.

 

His pmps tonight was 11.5 so we skipped his dose as I’m away and I didn’t want to risk him going to low while away. Do you think 4 is to much?

 

11.5 (207) is a safe number to shoot, but I can understand your concern if you were not there afterwards.
Keep trying to get the midcycle tests as they are the ones that will tell us if the 4 units is too much/not enough/or just right.

 

Sorry you are having such trouble. It has helped me to not use the lancet device and just use the lancet in my hand.

Also I have the treat bag open so kitty can smell the treats and is nosing around the bag as I'm doing the test.

Hope something here helps.

 

Thanks very much for the advice. I’ve just got back after 5 days away and tested Fred and his pmps was 6.6. This is the lowest pmps we have ever got i imagine its part of his bouncing. We have skipped his dose tonight but wondering what most people do with a pmps this low?

 

The 6.6 (119) is a great number. It is really good you are getting all the preshots now. Are you able to get some tests in, in the evening after the PMPS?

The 6.6 is probably after a bounce but it is hard to tell because there are no tests in the PM cycle to see if he drops lower at night, which many cats do.
A lot of us would give insulin with a 6.6 (119) preshot. We will give insulin down to about 3 but we test more during the cycles and we have worked our way down to that number over a period of time and we know how our cat will react when given insulin with a low preshot. I would not recommmend you shoot low numbers unless you are testing more often than you are.
If you find you have a lower than normal preshot, you can stall, not feed, and post for help and retest after 20 minutes to see if the BSL is rising. If you gave insulin with a lower than normal Preshot, you would have to be prepared to test several times during that cycle to see how the blood sugar is going, to ensure Fred was in safe numbers.

 

bumping above spam

 

We have started the 3.5u and it seems to be the most effective dose we have tried yet his numbers are plummeting down but almost to much and not coming back up for 24hrs (his pmps tonight was 4.3) we are a bit scared to shoot to lower numbers as we aren’t able to get enough tests to know what’s happening. I did dial the dose back and give him a 3u from a 9.8 and he shot down to a 3.7 +2 and possibly lower afterwards and only back to a 7.1 which we were to scared to shoot at as we weren’t going to be around to watch him. Everytime we skip a dose he goes back up to 20s but I was wondering does anyone only dose once a day? It’s only early but The 3.5 seems to almost do a 24hr curve with him. What are people’s thoughts?

 

Just a few things from looking at Fred's SS....
On 31/7 you didn't get a PMPS test and at +2 you got a 67. It is important to always test before every preshot to ensure the number is not too low to shoot.. If you get a low number like 67 it is really important you get some follow up tests. A +2 is really early in the cycle and the insulin is just starting it's onset so it is most likely he would drop lower..
If you get a BSL in the region of 67 anywhere in a cycle, always test again in 1/2 to 1 hours time to ensure he is not dropping into very low numbers.
I know you have trouble getting tests during the cycle but do try and get a few more as it is really hard to know exactly what is happening. The high preshots are probably bounces but we can't tell because there are no inbetween tests.
Did you order the 1/2 unit syringes?

Glargine is meant to be given twice a day twelve hours apart. Dosing once a day means the cat is having the insulin for the first 12 hours, then has no insulin for the next twelve hours, resulting in the cat going back up into higher numbers.
You need to find a dose that allows you to shoot each twelve hours.
You have had 3 skipped doses in the last 7 cycles and he was still only 77 tonight at PMPS.
I think I would try him on 3 units and see if the numbers allow you to shoot both cycles and not skip. Skipping messes up the insulin depot......it is best to try and stay at the one dose for at least 6 cycles........unless you drop too low to shoot or you earn a reduction.
Have you looked at the two protocols we follow....the Start Low Go Slow and the Tight Regulation Protocols.
You are not doing enough testing to do the TR protocol. I will send you the link to the SLGS protocol for you to read. It has a lot of guidelines for you to follow. It has guidelines for when to reduce the dose and what to do if the preshot is much lower than normal. You will find the section on when to give insulin when the number is lower than normal very helpful.
If you choose to follow this protocol, could you put it in your signature please so we can see it when we help you. If you were following the SLGS protocol, you would have earned a reduction with the 67 and the 77.
http://www.felinediabetes.com/FDMB/threads/start-low-go-slow-method-slgs.129446/

@Bobbie And Bubba what are your thoughts in dropping the dose to 3 units? Any other suggestions?

We usually start a new thread each day on the L and L forum. Next time you ask a question would you mind starting a new thread please? Thanks

 

Hi there! I agree with Bron, I would take the dose back to 3 units and get as much testing in as you can so we can see what is the best dose. Without getting some mid cycle test it is hard to know what is going on. Also, always get a before you go to bed test as cats tend to run lower at night time.

Lantus needs to be dosed twice a day, so we need to find the dose that will allow that and keep him safe.