Lantus and dosing questions by Betty and Bear

Started Bear on Lantus last night and already had to skip her shot this morning because BG 185. I gave her .75u for first dose. Readings were 234 predose shot given at 7:00pm,+4-82,fed her her normal bedtime snack,+5-70,gave her some wet with gravy to get numbers up,+6-77, gave her some more wet with gravy, +12-185 which was this morning. I read AAHA guidelines that if BG goes below 150at any time during the day decrease insulin dose by .5U. I haven't tested her BG yet-but does that mean a .25u tonight?

Also, for those following my saga, I talked to my new vet today on phone and filled her in on what I was up to-basically not following anything she instructed me to do. Asked her about the 2 unit initial dose. Told her I used the .25IU/kg dose computation and came up with 1 unit not 2. Asked her if she based her computation on lean body weight and she asked me what Bear's lean body weight was. I said probably around 9-10 lbs and she said we can't really know for sure what her lean body weight is. I told her she went down to 70 on .75 dose and she said to give 1 unit 2x per day. I said I was concerned about hypo and the fact that Bear does not have free access to food all day. Basically got nowhere.

Well-got to run. Time to go test Bear. I'll check back shortly to see if anybody has some suggestions.

Thanks
Betty

 

Hi Betty,
Sorry this morning's thread got lost in the transfer to the new server.

I think .5u would be okay, assuming you see a number over 200.

Ummmm, yeah your vet? I think you've got her figured out

"What is Bear's lean body weigh?" Like she's challenging your knowledge.
9-10 is probably right, and average for adult cats.
"We don't know what her lean weight is" ???
You were right. She wasn't when she told you to start at two units. Pretty sure Bear's lean body weight isn't 20 lbs!

I'll be back after I get off work shortly.
Carl

 

.
At that point I would probably have smiled and nodded a lot, then said "okay, thanks!"
Carl

 

Just a quick update-Bear's preshot BG =225. We really had a hard time getting blood tonight. She got preety upset with us. Could that affect her numbers. Just not sure how fast stress causes BG to climb. If it went smoothly could her number have been closer to 200? Carl if your still there-what do you think?
Thanks\Betty

 

Yes, stress can raise bg numbers, short term. If you feel better about .25u instead of .5u, that's fine

 

Hi-Went ahead and gave Bear .5u. I was wondering if anybody has any ideas on how to do Bear's testing. From what I've read about Lantus I should always test her at +6 to +8 at a minimum. If I give her a shot around 7:00pm then I'm testing her around 1:00-3:00 in the early morning hours. I'm gone all day so can't test her during the day. We got about 4 hours sleep last night. Just not sure how I can keep this up. Besides Bear I have 12 other cats and a dog that need taken care of too.

Not sure how to handle my relationship with my vet. She wants me to run a curve on Sunday with a 1u dose 2x/day using her Alpha Trak meter.

Betty

 

You may need to do a kitty burrito to restrain her for testing.

You hold the needle; if your tests show good control with 0.5 units, she's not going to be able to argue with you because you'll have the data to show its appropriate.

You might want to give her this link for the University of Queensland Centre for Companion Animal Health so she can read the PDFs by Dr Rand. It specifically discusses reference ranges for using human glucometers.

 

Well, you can't keep running on four hours sleep a night. Obviously.
Let me get to a computer so I can copy/paste some stuff...
Carl

 

The mid-cycle testing is most important when you are starting a new dose. The mid-cycle testing helps ensure the new dose is safe and allows you to intervene if it is not. If you can't get those mid-day until the weekend, then that's when you get them. That means the best time to try a new dose is when you can do the mid-cycle testing.

If you can test before bedtime, that helps you know if Bear might go too low without intervention. For example, if he drops from 200 to 70 by +2, you'd want to stay up and monitor to prevent a hypo.

 

Betty
To your questions about when to test.

First let me include this, which shows a typical curve on Lantus:

Given your situation - you can't test during the day because you aren't home to do so. And you can't test for "nadir" around +6 or so at night without sleep -
What I would normally suggest is that you save the real curves for daytime, and on days when you can do that. Test every 2 hours from AMPS to PMPS. You have to able to find the balance that works for you and for your family (furry and otherwise), and for Bear.

You'll notice in the above cycle, that the +2 number is typically about the same at the PS number you got at shot time? And that the +3 is a little lower, but not much lower. That's when Lantus typically starts to kick in (onset).
One good idea, that won't mess up your schedule on a typical night is to test at +2 and/or +3. IF you see a number at +2 that is a good bit lower than the PMPS number, it can be a sign that Bear's numbers are going to go lower than "normal" that cycle. If you see a number at +3 that is significantly lower than PMPS, then that indicates the same thing may happen. I'm guessing the +2 or +3 number would be before your normal bedtime? If she's at 250 at PMPS and at 230 by +3, then the odds are that you won't be in for any huge surprises overnight (OF course nothing is ever etched in stone here), and you could probably give her a snack before turning in and sleep okay.
But if she's 250 at PMPS, and you see a 150 by +2 or a 100 by +3, then you're likely to have to get some more tests later, and feed her to slow things down or stop the drop. Because that much drop in 2 or 3 hours is outside of "typical".

In general, what I think you will want to do is always err on the side of caution. So that means if it's a choice between 1u or .5, you'd go with the .5u dose. The thing about Lantus is that you want to be able to give Bear a dose that is the same both day and night. It just works better when the dose is consistent. So the dose has to make logical sense given the rest of your life (schedule). If the choice, because you are faced with a lower number at shot time (like right now, under 200), is to shoot or skip, then you skip. Especially the AM dose if you can't be around to monitor for 12 hours.

As time passes, as you collect data, it will become easier, and much of the guesswork will go away. You'll see how she reacts to a dose, and while unexpected things can always happen, you'll have a better feel, and a higher degree in confidence with all of this. It's just hard now because it always is at the beginning.
What you're trying to do at this point is figure out a good safe logical dose based on the numbers you're getting. And we always start low and work our way up rather than start too high and try to figure out how much to lower the dose. It's the safe way to do things.

Now, about the vet....
Telling you to run a curve on a 1u 2x per day, AFTER you've shown her the numbers from last night? Sorry, that's just crazy. What's it supposed to prove? That twice as much insulin works too well? And as far the AT meter goes.... again, sorry. The people on this board, some of them have been doing this for 6 years or more, using plain old "human" meters. Thousands of cats have gone into remission and never got anyplace close to an AT meter (except at the vet's office maybe). No matter what she thinks, human meters work perfectly fine for feline diabetes. Yes, human meters tend to run lower than pet meters, and the oft-mentioned magic number used most around here is "30 points". Big whoopty-doo! So your vet's meter will tell you that Bear is at 90 when your meter says 60. The thing is, you'd react the same exact way in either case. A 60 on a human meter is a wonderfully normal, safe, perfect BG reading. So is the 90 on the AT.

The protocols that we use here account for meter differences. The Tight Regulation protocol says that if you see a number under 50, that means your cat gets a reduced dose the next shot. It also says that if you're using an AT meter, you would reduce the dose when you saw a number under 80. There's no difference in what you do based on the number, because the protocol specifies increases or decreases that are specific to whether you are using a pet meter, or a human meter.

Yes, all meters can be "off" by as much as 20%, and still meet FDA approved standards. But her super-duper gold standard high priced meter can also be off by 20% and get FDA approval.

The really sad part of it is that she could have gone out years ago and bought a Relion meter from walmart, and over the years she would have saved thousands of dollars! Maybe if she'd done that, she wouldn't charge 30 bucks or more to do a BG test like most vets do. For a test that costs "us" about 20 cents to do at home. If you run a curve on Bear at home using a human meter, it's going to cost you a couple bucks in strips. Using her meter at home, the strips will cost twice that much. But ask her how much she charges for a curve run at her clinic.

A test takes 5 minutes, at most. A full curve is 7 tests. 35 minutes, tops, out of somebody's day. And maybe four bucks for 7 AT strips? I know a lady who works at a local vet clinic. She does BG curves. She makes $9 an hour. IF she ran a curve on Bob, her "cut" would be $5 whole dollars based on her hourly rate. The strips might cost $4. So $9 in parts and labor? Then why is a curve $150-$200 dollars??? I understand overheard and all that crap, and somebody has to pay for that nice Lexus parked out back. But it ain't gonna be me! Safe bet it won't be your vet who is poking your cat 7 times that day. It'll be some poor "helper" who does it. Sorry for the rant, but to me, this is obscene!

Tell your vet you'll be perfectly happy to run a curve on Bear using your meter. Tell her she can have all your numbers, and that they'll be about 30 points lower than her meter would come up with. She can do the math. And it'll save her $4 in test strips.

Carl

 

Hi Carl-Thanks for taking so much time to help me. I can't tell you enough how much I appreciate it.

The example of the typical Lantus curve helped. It just seems like Bear goes so low right off the bat. She did with the N and now with Lantus. If she is going from 234 to 82 in 4 hours, I wonder what she would have been at +6 if I hadn't intervened with the food. Doesn't it seem like she has a lot of ups and downs. It's hard because her numbers aren't that awful to start with. I hated not giving her a shot this morning. I just feel like my schedule is really going to hurt Bear's chances of going into remission.

I don't have to work weekends for now. I will later on in May and again in August so I could do some curves on Saturdays and Sundays. Am I understanding right that the spot checks of BG are just to make sure she wont't get into a hypo situation and the curve is used to adjust dose?
Another part I don't understand is how stress doesn't play into this. The other night with the N curve, Bear was very stressed. Tonight we had to chase her down just to get a pre shot #. Can't imagine what state she'll be in if test every 2 hours all day. I'm sure maybe down the road it won't be so bad as she gets used to it, but right now when it is critical to get good numbers she is stressed a lot.

My vet was lending me her meter because I told her I couln't afford a $200.00 meter right now. She said she lends hers out. She never mentioned how much she is charging me for test strips. I don't know why she is set on such a high dose. She said she would be fine home alone as long as she eats. But even if I lock Bear in the bathroom of the cottage, its not like I can tell Bear this plate is your 10:00 snack, save this one for lunchtime, ect..


Im going to go test Bear shortly for +3. Didn't do a +2. She was 225 at preshot. I could be wrong because gave her a lower dose this time ,but I won't be surprised if she is below 100 again.

Thanks again!
Betty

 

Hi Carl- BG at around +3 1/2 =118. I just fed her regular bedtime snack of low carb Fancy Feast. Probably should give her some gravy wet to bring numbers up a little. Do you think it is safe to go to bed? It seems like she sure drops fast.
Betty
Carl-just reread your post and you said a 100 at +3 would mean further testing necessry. Does she need to be on a .25 dose? Just don't understand why she is dropping so fast.

 

Right spot checks are to make sure she doesn't go into a hypo situation, and a curve is used to adjust dose. Those of us that can get lots of mid-cycle tests can adjust the dose off our spot checks, but if you can't get those, then you can't get those so then you just pick a day that you have the time and run the curve. What I use to do on a saturday or sunday was set the alarms on my cell phone to go off every 2 hours then go about my day cleaning house, working in the yard in the summer, taking care of the other 13 cats and the dog etc. (Yes I have 14 cats and a large dog too). When the alarm would go off I would stop go test Musette, then go right back to whatever I was doing. On the other days when I was working I would test before her morning shot which I would set the alarm to go off early enough that by the time I left for work it was her +2 or +3 then I would test right before I went out the door to work, then again when I would first walk in the door from work and that would usually depending on traffic her +9 and then again right before her evening shot, and then the last one of the day would be right before I went to bed at night again about her +2 to +3.

In the beginning yes there is a lot of testing until you figure out Bear's unique pattern. But you also need to take care of yourself, if you aren't getting enough sleep and stressing out then you can't take care of Bear either. So you need to find what balance works for you and your schedule to get in enough tests to make sure she is safe, but not so many that it drives you nuts. For some that is getting in what tests you can and when you can and save the major curves and dose adjustments for a day off, and for others that is having a friend, neighbor, or pet sitter that they can train to test and shoot that they pay to come over and do it when they can't.

Bear may not be as stressed out as you think, confused yes, afterall mom and dad are acting weird all of a sudden changing her food, chasing her around to poke her in the ear, worrying over her all the time, plus she hasn't been feeling good...but at least they are still mom and dad and not a strange vetty bean type person. She is still where she feels safe at home, not in a place that smells of sickness and fear, with all kinds of strange animal noises and smells. Her feline brothers and sisters are there with her etc. But cats are also really really smart, it won't take her too long to figure out those annoying little pokes to her ear nets her a yummy treat that no one else gets. And those tiny pricks of the needle make her feel better.

I don't know if this will help or not but since all 3 of my diabetics have been adopted after they were already diabetic I didn't have an established trust bond with them when I started testing. But I never chased any of mine...I bribed. I would get everything ready where I wanted them to come to, to be tested. Then I would go find them, with a few treats in my pocket or hand. I would talk softly to them telling them everything I was going to do and why. I would love on them, brush or pet, play anything to get them interacting with me, then pick them up, take them to their testing spot and give the first treat, while telling them what beautiful kitties they were, praising them so being so brave etc. Push the strip in the meter to turn it on, slip the rice sock into place, give treat, poke and test give treat, then give more lovings and let them go about their day. Since there is no race normally to get a test, it doesn't have to be right at the hour mark, if its 10 to 15 minutes later oh well just mark it on the spreadsheet and neither of you have to be stressed out.

Mel, Maxwell, Autumn & The Fur Gang

 

Thanks Mel for the words of encouragement. I'll just have to figure out a schedule that works for all of us. It's just frustrating because it's 11:30pm and Bear dropped 100 points between +3 and +4. I was up until 1:30 last night. Don't mean to whine. I can come up with a manageable test schedule, its just all the hypo scares that are a killer.
Thanks
Betty

 

PMBG - 224
+3.5 - 118

Down 107 points in 3.5 hours

That's a drop of about 30 points per hour. It may or may not slow down and level out.
How much longer were you planning to stay up?

And it is possible that the 0.25 level may be better for her. You just won't know without monitoring.

 

BJM- I'm sitting here right now discussing wtih my husband what to do. We can't keep on getting 4 hours sleep a night because we have to get up at 5:30 and have a 1 hour commute to work.But I love Bear and wouldn't be able to sleep becausing I would just lay there and worry.
She has two more hours until it reaches its peak. I'll retest and feed high carb wet and stay with her until I feel she is safe. How do you even
measure .25u. Are cats on that low of a dose actually diabetic? Her numbers have never been terribly high. Is that why we have these crazy drops?
Thanks
Betty

 

I'm sorry Betty. I missed your post in between mine and Mel's !

Her numbers are not so low as to be "unsafe", Betty. They're actually very good numbers. The PMPS tonight was really nice, as she didn't have a shot this morning.

Her numbers are dropping so fast because she's in a lot better shape than she was in just a couple of weeks ago. It's also likely that the AB shot she got is helping the URI/UTI go away. Infection (or pain from one) can raise BG numbers. Once the infections is gone, she wouldn't need as much juice since her numbers would be lower overall.

Yes, I think .25u is a pretty good idea. We don't want to necessarily let the numbers go higher, but it would be worth a try, I think, for you to go with a lower dose and see if she stays in decent numbers. That will give you some peace of mind during the day, and might make the nights less exciting. ;-)

Carl

 

Betty, please pass this along to your husband. It won't always be this exciting or this chaotic. Bear is doing extremely well, numbers-wise, and you two are doing an amazing job keeping her safe. It can be pretty insane the first few days. One of two things will happen, I believe. Either this could be a short term "dance" for you and Bear, and she'll just keep improving. Or, this will settle into a much more orderly routine for all of you.

Here is a picture of what .25u would look like in a syringe.



Carl

 

Before long you will figure out her pattern, some cats drop hard and fast then level off and do what we call "surf" where they just hang on a certain level. Some you have to steer a little by giving them small meals early on, and some give you just about a perfect Lantus curve. You will hear this so much here you will want to scream but ECID (every cat is different) but so in every caregiver.

Honestly she really isn't dropping that fast tonight just a little over 28 pts per hour. Its just she didn't start out very high to begin with. The ultimate goal is to find a dose that holds her in normal numbers as much of the day as possible. Just right now we aren't sure if she is going to surf or keep dropping. Its not always going to be like this, like any new thing it takes awhile to get it all figured out so you know when you need to react and when you can relax. Kind a live and learn thing. :roll: If she still has you worried and keeps you up again tonight by dropping to low again then simply reduce her dose tomorrow. To be very honest in the beginning I have reduced a dose on a pm shot because I knew I was too sick to monitor and let Autumn run a little higher so I could sleep and not worry. Then when I felt better again I would bring it right back up again.

Mel, Maxwell, Autumn & The Fur Gang

 

And yes cats on the low of dose are still diabetic, in fact there are cats that aren't on any insulin that are still diabetic, because once a diabetic always a diabetic they are just diet controlled diabetics. I have one now that has been insulin free for over 2 years but he is still diabetic he can never go back to eating dry food or canned with gravy etc.

Mel, Maxwell, Autumn & The Fur Gang

 

Thanks everybody-Just did another BG and holding steady at 118. Gave her some gravy wet to help her to stop dropping so fast. I'll probably singn off for tonight. Going to watch Bear alittle longer and give her some more wet in an half hour.
Thanks again!
Betty

 

Good plan, Betty.
Sleep well,
Carl

 

Just a quick update-BG=196-didn't give her a shot. Will start .25u dose tonight.
Betty

 

I'll be looking for you then.

I have a sleep disorder, so when I needed to follow Spitzer into the wee hours, it was pretty tough due to how groggy I was.

 

Hi everybody-Just wanted to check in and let you know Bear's preshot BG was 245. A little higher than last night at this time. Gave her the.25u at 7:00. It seems like she is literally getting drops of insulin. Hopefully she will do OK tonight. Can't really adjust the dose much lower can I? I don't like the fact that I am skipping Bear's morning shot so often. She always just a little under 200 and so I don't feel comfortable giving her the shot and leaving for work. I read that it is not recommended to give only one shot per day.Do you think it is ok to wait until +4 to test Bear again? That was my plan.
Thanks
Betty

 

Checking at +4 is prudent, given her past drops.

Here's hoping for a normal bedtime & no need to stay up steering!

It is possible to microdose. You take an empty syringe, fill with water, and practice squeezing out consistent sized drops until you can get the same number of the same size each time. Then you determine how many drops you are going to give.

 

Yes, the +4 sounds good. Hoping that this small of a dose allows you to shoot twice a day. You're right, it is just "drops". Once you see what a couple of cycles on this dose will do, you may feel confident enough to give her a shot in the AM and not be worried during the day.
Carl

 

Hi-Just tested Bear +4=170. What do you think? She still dropped 70 points in 4 hours. Do you think she'll be OK or should I still keep an eye on her until 1:00am. Does this tell me anything about tomorrow mornings shot? I know its not even close to running a curve, but I won't do that until this weekend.
Thanks
Betty

 

Betty,
I think this number falls within the "typical lantus curve" outlines. The insulin "should" start to work around +3, and by +4 it should be a little lower.

I would give her a snack, and get some sleep. 170 at this point is great to see. If you want to stay up and test in a hour, that's a choice, and I'd be here to take a look at it. But I don't think it's a "must do" tonight.

In the morning, can you check at +11 and again at shot time? You might/should see her number rising by that time. If she's over 200, then giving .25u should be okay. If you want to raise that bar a little, and make it 225 or whatever, that's your call of course.

Carl

Edit to add - if you see a high number in the AM, like 300 or more, still go with the .25u dose. The dose shouldn't be adjusted higher based on the AMPS number.

 

Hi Carl- I was hoping you would say that. Could really use some sleep. I gave her her regular snack of low carb wet. Is that OK. Doesn't make sense to mess with her natural curve at this point does it by giving her the gravy stuff?
Thanks Betty

 

Just a suggestion--when Bandit was on insulin, I worked 10 hr day (with an hr commute there and back) so I couldn't run home to get the +6 during my lunch break. So I what I did was test at shot time (7am) then test when I got home at shot # 2 (7pm) and then again before bed (9-11pm,+2- +4) and I set an alarm to get his nadir at +6 (1am) and then went right back to bed. It takes a week or two for your body to adjust to getting up and going right back to bed, but after you do it's really no big deal. Thank goodness the meter saves the number, because I don't know what I would have done had I had to record it when I was about 80% asleep at the 1 am test. :smile:

 

No, you don't want to mess with her curve unless the numbers go low and force the issue. For the most part, you follow her standard feeding routine, and only use higher carbs when you are intervening in a cycle that is "active" as opposed to "typical".

Everybody likes a bedtime snack, and I'm sure Bear won't complain!

Get some sleep on the nights that you can, is my mantra.

Carl

 

Thanks Julia- It's nice to know someone with a crazy schedule like mine could make all this work.
Betty

 

Great suggestion from Julia! Lots of people have been in your shoes, Betty, and have to find creative ways to test when the rest of your life defines your schedule.

Someday somebody will invent a 24 hour BG monitor that can be used on cats, and an insulin pump to go with it. TIll then, we do what we can. ;-)

Carl

 

Thanks Carl and good night!!! I'll give an update again in the morning. Hopefully, I'll be able to give her another dose.
Betty

 

70 / 4 =17.5 pts drop per hour. Reasonable drop.

Go Bear!

 

Hi-BG=185 this morning. Didn't give a shot. I"ll check in tonight about whether OK to give shot tomorrow morning if she is that low as long as I'm home to watch her. Need to get on 2 shots per day.
Thanks
Betty

 

Hi-Had to work overtime tonight so didn't get Bear's shot done on time. Her preshot BG=268. One of her highest yet. I didn't give her a shot this morning because she was below 200. I don't feel like I am managing this very well. She is only getting one shot a day which makes her low inthe morning and high at night. I don't think this roller coaster she is on is doing her any good. I gave the shot to her around 7:45 rather than 7:00. What time can I give her the shot tommorow morning since I was late tonight? Could I give it around 7:15 or a little later to get back on schedule? What do I do tomorrow morning if she is below 200. I have to start regulaing her better don't I? Also my husband checked with water in the syringe to check exactly how much Lantus she was getting at .25u and it was barely 2 drops. Sorry for all the questions but I am getting frustrated again. I stressed the whole way home in the car because I knew we would be late.
Thanks
Betty

 

When you know how low she goes on the 0.25 units, you may be able to lower your 'no shot' level from 200 by small increments as your data show it is safe.

If you can set an alarm and get a +6 tonight, you'll get a number that may show adjusting your limit down to 180 would be OK for the morning shot (ex nadir above 150).

Note that shooting early is like a dose increase and shooting late is like a dose decrease. Doing each back to back may muddle the glucose levels for a bit. To get back on schedule, adjust the time by
A) 15 minutes per shot
OR
B) 30 minutes 1 time per day.

I always went with option A because I thought it made for a smoother change.

 

PS

It is safer to be too high for a day, than too low for a moment.
You have more time to deal with former than you do with the latter.

 

Hi everyone -Total confused. Last night Bear was 249 and went down to 170 in 4 hours. This morning she was 185 so no shot. Tonight I was 45 minutes late in giving shot. Preshot BG was 268. Now at +4 she id 122. Last night she went down 80 points in 4 hours and tonight she went down 140 points in 4 hours. Is this ok? I'm only giving her 2 drops of Lantus. Why such fluctuations in how much she drops? Can anybody explain what is going on?
Thanks
Betty

 

BGM-Bear is already at 122 and 2 hours to go before nadir. I'll check her at + 6 or maybe I should even earlier? You said 150 is safe nadir?
Betty

 

Hi Betty,

Just a simple answer to your questions. All of the numbers you got yesterday and today are perfectly fine numbers.

I'll be back in a few minutes, but if you want you could test at +5. Has she eaten since shot time? If not, a spoon of her regular low carb food would be fine to give her.

Carl

 

Actually, she can go as low as 50 and be safe. Its just that unless you know she'll stop above 50, you have to monitor & y'all need some sleep!

With the large drops on tiny doses, there are 2 options you might consider that may help manage it more easily (not better, just less stressful)
1) switching to a less concentrated, non-depot insulin such as Prozinc. This would let you microdose more easily as it has 40 units per mL, not 100 per mL like Lantus, plus there is minimal carryover shot to shot.
OR
2) slightly increasing the carb level (stay at or under 10% calories from carbs) so you'd have a high enough level to shoot consistently.

 

Hi-I just signed back on .Missed the +5, because I was planning on a+6 at 1:45. I gave her a snack after we tested at +4. Low carb Fancy Feast. I was just thinking also I won't know how low she can go during the day unless I do a +4 and +6 with no snacks because she won't have access to food while I am at work. I may consider getting a timed feeder and lock her in the bathroom while I'm a work. Will test in about 15 minutes.
Thanks
Betty

 

Try your best not to get frustrated. In reality, I think it's because you don't quite understand how well Bear (and you) are doing so far. ;-)

OK, some "positives" for you to consider -
Bear is having low BGs in the morning, and even after no shot for 24 hours, is not really high at all tonight or last night. Numbers under 300 are not "high", really. They're above normal, but some people here who have been doing this for months would be perfectly thrilled to trade places with you. ;-)

Bear is getting amazing response from what you've noted is just a couple of drops of insulin. While that might make you nervous, it's actually a great sign.

You haven't seen any radical drops in BG like you saw with the Novolin a couple weeks back. Remember the day you gave her .5u of N and she dropped from 338 to the 60s in just 3 hours?

Other things to keep in mind...
You asked why yesterday she dropped 80 points in 4 hours, but tonight it was 140 points in 4 hours? You're going to hate this answer but it is "just because". Because there is more at work inside her body than just the food and insulin that you are putting into it. You will be very hard pressed to look at anyone's spreadsheet and see duplicate curves on two consecutive days. One thing is that her pancreas seems to be working at least partially. Her body may be digesting the food at a different rate than it did yesterday. She might have been more or less active while you weren't home.
But the bottom line is that today, it looks like the insulin worked a little bit better than it did yesterday. Which is a good thing.

And please don't fall into the trap of "if I gave her .25u today, and she went from 270 down to 120 in just four hours, then what do I do if she's at 200? Will it make her drop to 50 or lower? It might, but don't assume it will. There's a "concept" used in the Lantus protocol for tight regulation that says "shoot low to stay low".
NOT SAYING that this is what you should do. Just letting you know that it can be done. What seems to happen is that when Lantus is working really well, and the doses are down to really small ones, the "curves" tend to get flatter and flatter. You might see a cat who starts the day at 100, gets .25u on that number, and the cat stays is the 50-75 range all day long. No big drops, no big climbs, just steady good "normal range" numbers all day long.
If you think about it, a non-diabetic cat's blood glucose is that way. They eat, their system produces insulin, their bodies absorb glucose out of their blood, use it for energy, and the BG comes up a tad from food and right back down again because that's the way their system is supposed to work. As a diabetic cat improves, and their insulin dose continues to decrease, it's because their body is almost functioning "correctly" on its own. You're just adding a touch of insulin to keep things from getting out of control.

The other unknown in this equation is when exactly Bear's nadir is. Just because you haven't been doing this long, it's really impossible to know if it's +4, +6, or +8. It isn't even known if it happens at or around the same time every day. It likely doesn't, and just because it happens at +6 one day, it can be earlier or later another day. But that's okay. It isn't necessary to pinpoint exactly when it happens. You just get a general idea from testing, and you pretty much know when to "expect it to happen". What's important is to try to test before the "typical" +6 nadir, to see how low the BG might be, and how fast it went low. When we see it happen "early in the cycle" like in the first three hours, we assume that we're still a few hours away from "nadir", so we intervene.
Look at it this way. If you had seen the 120 at +2 or +3, you'd react more aggressively than you would if you saw it at +4 or +5. Make sense?

Carl

 

Hi-Bear was 160. I did give her a snack at +4, so is that why its is higher than at +6. I thought +6 is typically the lowest number of the cycle.
Carl-I'll have to reread your post in the morning when I've had a little more sleep so it sinks in better, but I generally understand what your saying. When I test tomorrow, should I avoid snacks. The snack I gave her was more than a spoonful.
Thanks
Betty

 

Hi Betty,
When you test tomorrow, your routine should be your normal routine as far as feeding goes. If she normally gets a snack at a given time, keep things that way. Just make notes on what you fed and when, and post those along with your numbers.

If you're planning on a "full curve", you should test her every two hours after her shot.
You can list it like this:

AMPS (BG number and dose)
+ 2 BG#
+4 BG# (add any comments like "Fed 1 tsp of LC fancy feast)
+6 BG#
etc...

Carl

 

And the 160 was a great number!

Carl

 

Thanks Carl-Was planning on doing my curve on Sunday. Heading to bed.
Betty

 

I just realized I gave you a dumb answer to your question about feeding snacks. If your trying to simulate a normal day, when you wouldn't be at home to feed her snacks (duh), then I guess you should only give her extra food if the numbers she gives you warrant the food to try to level off or raise her numbers.
What you see might convince you whether or not it makes sense to look at a timed feeder?
Carl

 

Betty - you and Bear are doing so good!
Carl has been giving great advice and support - you all deserve a great big:
drinking24

Good luck on the curve - its not as bad as you think

 

Hi-Probably nobody on this early, but Bear's preshot BG =159. I assume that is too low to give shot, so won't. I wanted to be able to test her am +4 and +6 to see if OK while I'm at work-but I guess that is not happening. She'll be high again tonight, so was hoping to give shot to get pm preshot lower. Am I doing the right thing?
Betty

 

Good Morning1
Yes - that 160 was lovely! I seldom got that with Spitzer.

 

Carl/BMJ-Need some advise. Will I ever be able to give a morning shot? I'm suppose to do my curve tomorrow morning for my vet. What am I going to do if she is low again? Could you let me know what a curve would look like on a well regulated cat? What would its am BG be? Iguess I don't know what we are trying to achieve. I reread your post from last night and you said shoot low to stay low and you may start out at 100 preshot and still give .25. When do you get to the point where it's ok to shoot at 100. Will Bear's pm drops start being less dramatic? I know I sound like a broken record but when will I know it is ok to give her a shot in the morning?
Thanks
Betty

 

Betty,
Even though you didn't give insulin this morning, go ahead a get a +4. Let's see if Bear's pancreas is trying to keep her numbers down.

I'm going to ask a couple of lantus users who've had to deal with this type of situation before if they can offer some of their wisdom.

Carl

 

You might have missed this yesterday

With the large drops on tiny doses, there are 2 options you might consider that may help manage it more easily (not better, just less stressful)

1) switching to a less concentrated, non-depot insulin such as Prozinc. This would let you microdose more easily as it has 40 units per mL, not 100 per mL like Lantus, plus there is minimal carryover shot to shot.
OR
2) slightly increasing the carb level (stay at or under 10% calories from carbs) so you'd have a high enough glucose level to shoot consistently.

Other than those options, go to a 'fat' 0 tonight or about 1 drop. Bear is looking very much like a cat who wants to go off the juice (OTJ), you lucky soul!

 

Carl-Sorry I just read your post so I missed the +4 reading. I actually slept most of the day and didn't figure I had to do anything testing wise until this evening.

BMJ-What food would you sugget? Why would I purposely try to raise her numbers with food? Do you feel it is important to give the two shots ?


BMJ gave me three options. I need some help deciding what is the best route to take. Can you imagine me telling my vet Monday I did my curve using 1 drop of insulin rather than 1 unit?

Thanks
Betty

 

Just another thought. I sometimes wonder if something else isn't up with Bear that is causing the higher BG. She still seems to have some URI issues. She has been fighting it off and on since June. I remember someone suggesting some outside lab work for that. Her URI isn't bad. You can just hear her nose is a little stuffy sometimes when she breathes. But I don't think a URI would cause a 3lb weight loss though.
Betty

 

hello betty. carl asked a few of us to take a look at what's going on with bear.

have you been keeping a written log of some sort? the reason i'm asking is it has now become more important than ever to share all your test results by putting them into a spreadsheet or giving them to us in the format we used before spreadsheets.

an example taken from my cat's spreadsheet yesterday (this is how it looks if you don't use a spreadsheet):

2/15/13

(+12.25) AMPS 115 (2.4u) - fed LC meal
+4 121
+5 75
+6.5 48 - fed LC meal
+8.75 65
(+11.25) PMPS 65 (2.4u) - fed LC meal
+3.25 115
+4.75 85
+6 69
+7 51 - fed LC meal
+9 89

bear is responding very, very well to lantus! at this point and after reading through your threads, i think BJM's suggestions may be a tad premature. if you can present us with the data we need to offer suggestions... we can help. until then, it's almost impossible for any of us to offer dosing advice responsibly. we certainly don't want to cause bear any harm. do you think you can work on putting the information/data together so we can take a look?
it'll go a long way towards helping us help you...

 

Betty

I'm another that Carl asked to hop in and offer help. What I can do for you is set up the Spreadsheet. I've done it for many, many new members who feel overwhelmed with everything else going on. It will take me just a few minutes.

If you would like to take me up on my offer, please just PM me so we don't clog up your condo further, ok?

 

If you were feeding 4-5% and only able to shoot once a day, feeding 7-8% might let you shoot consistently twice a day. It might help moderate the sudden drops, too. Since many cats go lower at night, feeding a very slightly higher carb dinner might help prevent him from going too low when you're trying to sleep.

Lantus, according to the manufacturer should not be diluted, so it is difficult to measure precise doses under 0.5 units. ProZinc is already at a lower concentration (U-40, or 40 units per mL), so micro-dosing can be done as low as 0.2 units when using a conversion table with U-100 syringes.

A chronic URI may impair the ability to smell, which may make food less appetising. This could reduce appetite and thus cause weight loss. If it is feline herpes, adding the amino acid lysine may help supress it. If it is some other respiratory infection, IDEXX offers several respiratory panels on bloodwork. That was how I discovered Spitzer had a form of bartonella and got him on the proper treatment. He was always mildly stuffy, not severly ill.

If there is an ongoing source of infection, that could be what is elevating the glucose. Treatin that could eliminate the need for insulin, given how low Bear is already.

 

Hi everyone-not real good with computers so couldn't post new type of spread sheet but I started a new topic-Bear's numbers please help which hopefully gives the info needed to give some advise.
Thanks
Betty

 

Hi-I thought I would use my other post for Bear's numbers only. I did note on it though that her PMPS # keeps getting higher every night with no insulin in the AM.
Thanks
Betty

 

Betty,
You're doing a great job--keep up the good work! :RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT