? DOSING ADVICE NEEDED PMPS213

My cat was diagnosed about 3 months ago. Started on Prozinc switched to Lantus. I have a thread going on another post. I'm new to this so don't know where to post. Her BG was 398 on the 8th.She was on 8 units once a day. He raised her to 8 and 8!! Took her Tuesday and BG was 346. I just bought a kit myself and tested her at 3:00 pm. She had 8 units at 7:00 am with food. Her BG was 231. Just tested again at 6:00. Got 213. What dose should I give her? I'm seeing a new vet Saturday.

 

Hi Rebecca,
here is the link from your post on the welcome to the group forum
http://www.felinediabetes.com/FDMB/threads/too-much-insulin.154334/#post-1626959

 

Rebecca, nice. You caught on quick. I'm also getting ready to do Smokey so I'm back and forth now.

 

Rebecca, since nobody has jumped in yet and shot time is coming, would you consider going down to 1 unit twice per day and starting over?

 

in a couple minutes see if you can get another test. You might be asked.

 

Yea she is ready to eat big time. I've given her no dry food only a couple small freeze dried salmon pieces before each test

 

I'm not comfortable going that low since she's been on such a high dose.

 

Rebecca...just posted your condo in the FB group so they can hop over and help But like I said, I would personally start with one unit and hold that for a week till her shed drains from the higher dose. And keep testing at different times mid-cycle so you can find her "nadir" b/c dosing decisions with Lantus and Levemir are based on nadir numbers, not pre-shot numbers. And read all the stuff I sent on "Start Low, Go slow" method. That will tell you when/if to increase doses, etc. That's the info I sent on the FB messsage

 

At a starting dose of 8-10 units you most likely overshot her "good" dose. Giving too much insulin can often have the same effect as not enough, which is too high numbers. This is coming from YEARS AND YEARS of many lay people's experience. You could potentially be creating either glucose toxicity or a future hypoglycemic episode. How much Prozinc was she on before you switched her?

 

I too would start all over personally. A few days or even weeks of higher numbers are much less dangerous than 1 12 cycle of too low a number.

 

She was on 5 units twice a day

 

There is always the option to continue to stall and test Rebecca, and you can wait until someone more experienced turns up I am going to tag some of our most experienced members see if someone is about that can help.
The problem with dropping all the way down to 1u if you are going to do SLGS is that it might take a long time to get to a good dose for her, if you were doing TR then you can fast track up the dosing scale more easily.
I certainly haven't got the experience to advise you on dose, but I would just stall and see if we get a response.
Another option is to do two 18hour cycles to buy you some time while we figure this out.
@Marje and Gracie
@Wendy&Neko
@Sienne and Gabby (GA)
@Vyktors Mum
@Jill & Alex (GA)
Ladies would you please see if you can help Rebecca, no ss set up she has only just started testing and vet has made some questionable decisions on dosing, the original post is linked and is on the welcome to the group forum. thank you , I hope someone is about to help.

 

Okay I"m tagging like crazy over on the FB page to have some of the more experienced members back me up on this but I really strongly believe you should "start over" and go with Start Low Go Slow method. It's your cat and do what you feel in your heart but I'm just talking from my own 2 1/2 yrs experience and also seeing other cats who had started out on high doses and the numbers were high as a result of that. Are you Eastern time?

 

I agree. If it were my kitty, I would start at the recommended starting dose of 1 - 1.5 units twice a day and go from there.

 

She just started testing today and have no idea what her schedule is like that she can do TR, which is why I suggested Start Low Go Slow. Anything's safer than what this vet has her doing now!

 

I just want to do what's right. What happens if I don't give her enough? Is not enough better than too much? And she usually eats at 7:00. Do I feed her now? I'm in Florida

 

Congrats on learning to home test....so quickly!!! Kudos to you.

As for dose, if you have cut out all the dry food, I'd start at 1 unit twice a day, then you can increase in 3 days if you are still seeing high numbers. I have a feeling that the highs were caused by the dry food which was around 30% carbs. If you change to low carb food, then you won't need as much insulin.

 

I so agree 1u or 1.5u. Lantus builds a depot, so she does have some in reserve. What would you be comfortable with?

 

It is definitely better to have high numbers for a few days, then too low for even a minute. Test, feed, shoot is the order I did Zoe in......and hello from Ft. Myers!!

 

Not enough is better. If given to much she could have a severe hypo episode that could be fatal. That is why I asked if you have syrup in house.

 

We also have the concern here that she was using U40 syringes to shoot U100 insulin so actually was probably not shooting 8 units, I think a starting dose of one unit would be good but certainly no more than two.

 

As long as your kitty has never had DKA diabetic ketoacidosis I would agree with starting at the lower unit

 

She said she had some u100.

 

I missed that, where did you get she was using U40 syringes?

 

I don't even know the answer to that question. I am so unfamiliar with this drug and it's very confusing. I will go with what you guys are saying I guess. I don't know.

 

Oh duh, the other thread! Got it.

 

I have the u100's

 

Please do, the peeps on this forum have so much more knowledge about Feline Diabetes that most vets do. I am not trying to slam your vet but sadly it's true.

 

Oh good, you need to use the U100 for Lantus. Keep posting and asking questions as we can help you.

 

Well that's exactly why I'm going somewhere else on Saturday. I just wanna do what's right until then

 

Good call!

 

Well now she doesn't want to eat the wet food. I've tried every brand there is!

 

Ok now she's eating. So much for the ff. All she likes is BFF. I'm ready to scream!

 

We all just want Mercedes safe. Using the u100 syringe give her the dose and let us know how much you gave. Kudos for the paw test. I just tried it on Smokey and didn't get one drop.

Her readings could be high for a few days. It will be normal.

Now in your title edit so after the word needed, put PMPS 213. If you can get a test @+2 (9pm) and +3 (10pm). Theses two tests will show if she is going up or going down.

 

Cats will be cats.

 

You are a good kitty bean!

 

How do I edit? I'm so confused. Sorry

 

In this Lantus and Levemir forum there are stickies that will help you. Here is one for you to read when you get a chance that will help you understand Lantus a bit better.
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

 

She's being a cat....lol

 

In the upper right hand corner of your thread, is Thread Tool, click on that and you will see options for editing.

 

So do I give her some dry food? I just gave her 2 units. Which looks like nothing in that syringe. I thought that the Origen 6 fish was low carb

 

Go to the title. On the right is a tiny little box that has edit. Click that. Title box will open. Make sure your cursor is at the end and type in the info.

Your just about info overload now. So not to much more tonight. Just know you were great and Mercedes will love you more for making her feel better.

 

What is her normal feeding schedule?

 

I usually give her a little dry low carb food after the wet food. And 7 and 7. She didn't eat much wet food. She never does

 

Do you know what the carb count for the dry food is. We recommend wet food under 10 % carbs. Dry is usually to high except EVO and Young Again dry.

 

Just so you know Rebecca although orijen is lower carb than some other kibble, I think it's approx 18% carb, ideally for a diabetic cat you want to be looking at below 10%, but if you are going to change the diet be aware that if you remove it suddenly it can have a dramatic effect on her BG so it might be best to do that slowly should you decide to remove the dry food.
If she is on dry food then look at the SLGS sticky they give you the guidlines for dosing that we would use when there is kibble in the picture. If you want to attempt to follow Tight Regulation Protocol then you need to get the dry food out of the picture.

 

It says 18.5 but I don't allow her to free feed anymore. I'll probably give her a carb free food after seeing the new vet Saturday. But I didn't want to take it away cold turkey especially with not knowing how much insulin to give her

 

I think that is a good idea, now that you are home testing you will be better able to keep her safe and that new vet visit can't come too soon.

How much testing will your Schedule allow?

 

Thanks for weighing in with the carb count Gill.

 

I would NOT drop her down to 1 unit and start over, but if you're going to reduce the carbs by getting rid of the dry and start testing, I'd suggest dropping down to maybe 5U and see how she does while you gather data

While it's totally possible she's getting way too much insulin, by dropping back that quickly without proof that she doesn't need that much will probably just lead to glucose toxicity setting in and her ending up needing an even higher dose than she might otherwise.

What's important right now is getting her onto a low carb canned diet, and getting some testing in so we can see how she's really doing. If she needs less, she'll tell us!

It's very important that you start keeping your test results on our spreadsheet too. It's a very valuable tool and will help us to help you going forward. Here are Instructions on setting up the FDMB spreadsheet...if you have any trouble, let us know...we can help!

 

BTW, she is a beautiful cat!

 

I work from 8:30- 6:30. But I feed her in the morning before I go. I just started testing today and honestly I feel like my head is gonna explode! I am gonna test her again at 9:00 as suggested by people here. I guess again in the morning?

 

Most diabetic kitties do better on frequent smaller meals than twice a day. As long as it's not dry food you could leave some out. You can even freeze small foodsicles, so when she is ready it will be ready for her.

 

Try to get one right before you go to bed. It will be a good indicator from the 9pm test.

 

Just to back track, she was using U 40 syringes, so it is possible that she wasn't actually getting 8 units in a U100 syringe. Just want to make sure we are all on the same page.

 

You want to ALWAYS test before shooting to make sure they're high enough to give insulin at all

Then if at all possible, test somewhere mid-cycle on the AM dose (5 to 7 hours after the shot...what we call +5 to +7) and then at least a "before bed" test on the PM cycle to make sure she'll be safe overnight

Most cats go lower at night, so it's important to always get that "before bed" test in.

If you absolutely can't get mid-cycles on the AM cycle due to work/school, you'll want to try to get a +2....that can give you an "early warning" if she's going to drop too low.....that may mean getting up earlier in the morning to shoot (depends on your schedule of course)

If you can't do that either, it's even more important to get tests on the PM cycle and then do more testing on days off

 

OK...good to know....trying to catch up but there's a LOT of information here!

 

I don't even know. I threw the bag away. The syringes are very small tho. I'm not using them anymore.

 

Here is the original thread that Gill linked to this one. @Chris & China
http://www.felinediabetes.com/FDMB/threads/too-much-insulin.154334/#post-1626959

 

What color were they? Red or orange?

 

Orange caps if that helps

 

If they had orange caps, they were U100

U40 syringes have red caps

 

Okay, you were using U 100's which is the correct syringe to use with Lantus. I will defer to @Chris & China as she has so much more experience with lantus than I.

 

Thank god! I'm completely overwhelmed right now

 

Totally understandable!! The sugardance is hard enough when you start out here....you've got a lot of different opinions as well as LOTS of facts being thrown at you really quickly!!

When is your next shot time? (amount of time until next shot, not the actual time since we're from all over the world here)...2 hours? 10 minutes? How long?

 

Just gave her one an hour ago. Gave her 2 units. Next shot is 11 hours from now

 

OK.....she may surprise us and do well...until we get some tests in, it's all a big unknown!!

At least you can relax a little tonight...if she's been tolerating 8+ units this long and you only shot 2, you should be able to spend some time reading the stickies at the top of the forum and seeing how much you can absorb from the mountain of information there!

And it's a good time to get your spreadsheet set up, as well as putting some information into your signature. If you look below most of our comments, you'll see we have info like

our name/cats name, age, date of diagnosis, type of insulin, type of meter, type of food, any other health issues?, and maybe a general area where you live, and then when you have the link to your spreadsheet, it goes there too

That way we don't have to keep asking the same questions over and over again.

To do your signature, go to the top right of the page and click on your sign on name...you'll see "signature"...click there and a new little box will come up for you to put the information into....then click "save" and you're done!

 

You can buy syringes at Wal-Mart without prescription. They also have the 1/2u mark syringes. Just make sure you check the box before you pay. The pharmacist sometimes doesn't know what they have.

 

Here's the link for setting up a spreadsheet. This will allow you to keep track of Mercedes numbers and once you attach it to your signature, we will be able to view it, as well.

Every state has different laws with regard to whether you need a prescription to buy syringes. I'm not sure what the regulations are in Florida.

For the moment, take a deep breath. Here are some basic to keep in mind:

• Stick with the 2.0u dose for now. The dry food you were given Mercedes is probably what was preventing her BG from crashing on the dose you were told to give her. Since you are working at eliminating the dry food, it is high likely her insulin needs will be less. They may, in fact, decrease dramatically.
• If you are shooting at 7:00, then it sounds like you have time to get a test or two before you leave in the morning. That's helpful.
• You will want to buy some high carb, gravy based food. For example, Fancy Feast Gravy Lovers is around 15% carb. We use a higher carb food to help steer numbers, should they drop. You can also use Karo or other corn syrup, honey, maple syrup, etc.
• In addition to having a supply of high carb food, you want to make sure you have a supply of strips. You can order on line from American Diabetes Warehouse. Others can direct you to the steps that work with your meter since I used a different meter I'm no help with this.
• You want to ALWAYS test before you give a shot. Most of us test, feed, and shoot all within a few minutes. (I used to give Gabby her shot when her head was in her bowl.)
• You want to work toward getting data that lets you know when Lantus onset and nadir fall and how much duration you're getting. See the information in the New to the Group sticky about this.
• The other important thing to keep in mind is that dose increases and reductions are based on the lowest number in the cycle, not on the pre-shot values.

I know this is overwhelming. The front end of this learning curve is huge. However, it really does get easier and it will soon become second nature.

Please let us know how we can help. Ask questions! There's usually someone on this Board pretty close to 24/7.

 

You've really had a hard time! When you arrive on here and everyone is giving you advice, sometimes the best thing to do is to just hold on while you gather information.

Yes, too much insulin can look like too little insulin - it can cause high numbers.

Not all high numbers mean that a cat needs more insulin. Low numbers can also cause high numbers.

Dry food can cause a need for more insulin as well.

The spreadsheet will help us help you immensely! Start there with making a spreadsheet, and if you can, gather any old data you have from your vet's office. I called and asked for blood sugar tests, and dose changes. I could look at the calendar for when those appointments were, ie, how many hours after I'd giving punkin his shot the test was. Then I recreated things as well as I could.

As Sienne said, take a deep breath. Let's gather some information and we can help you untangle your puzzle and figure out what needs to be done with his dose. I also arrived here using u-40 syringes and Lanuts, not knowing better because the vet didn't tell me to change. Oops. The u-40 syringes mean that the dose is about 2.5 times as high as you think it is if you are using Lantus.

It would help me if you gave a quick summary in the top of the spreadsheet or in your signature line. Diagnosis date, any other medical issues, what kind of glucometer you are using (if it's a human meter or a pet meter.) Don't put dose in there because that's going to change. Just the permanent info.

And hang in there - you've hit the jackpot in terms of help for how to use Lantus with a diabetic cat. Just keep posting and we'll give you a hand.