1. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    Hi all. Just wondering with Lantus at what preshot BG value do you decide either not to shoot or to reduce dosage? Sketch is a relatively high dose cat with his dose being 8 1/2u but lately he seems to have been less insulin resistant and his numbers have been coming down. I have seen the lowest numbers in the year and a half I have been giving insulin to him. I randomly tested him because he had the lowest number I had seen at +8 (which seems to be his nadir) @106. He is typically 190 to 250 around then. With that low number I had decided to test just before bed and was shocked to see 66 at only +4 well before his nadir...which he is NEVER been that low ever. So I started some crash procedures although he didn't display any symptoms. I monitored all night just to be safe and everything turned out fine with the help of a few of the fine knowledgeable folks on here.
    So my question again is what preshot value do some of you lantus experts consider decreasing dose or not shooting? I don't want to put Sketch in danger of a crash and us another sleepless night of testing and feeding!
     
  2. Leah

    Leah Member

    Joined:
    Jul 9, 2018
    So, do you have another spreadsheet? The one linked in your signature appears to be a year old?

    Typically with the depot insulins, you're shooting what they show at nadir (peak), which is mid cycle. You need to record that and the pre-shot numbers so you can see how they're reacting which would then give you enough data to decide how low you're willing to shoot.
     
  3. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    Yes I have a spreadsheet that I will post. I think I mentioned that his nadir seems to occur about +8 and has usually been around 190 to 250. Usually preshot values have been in the 300s and sometime 400's however like I said that has had some rapid changes and dropping(for what reason I don't know..same food etc). The other night he was 160 preshot and I gave full dose and that is the night that he went low. So since I don't have a great recent accurate history given his what seems to be not being as insulin resistant (this has just started happening) any suggestions?
     
  4. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    Just a note/question regarding "nadir". My understanding is this is the lowest point of the cycle which probably for most cats comes at the +6 mark. For some reason with Sketch when I have done curves or random tests I typically see his lowest #s at the +8-9 mark pretty consistently.
     
  5. Leah

    Leah Member

    Joined:
    Jul 9, 2018
    Well, every cat is different ;) and actually they bran decide to switch things up whenever they want. Mine head a random late nadir the other day and it made shooting his normal dose a bit scary.

    As far as guidelines, in general, without data or following a specific protocol (you should totally pick one - they're at the top of this forum as sticky notes) you are going to have to pick a number that feels ok to you. Do you know about stalling and testing again to see if the number is rising? Read the stickies ;)
     
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  6. Rosie & Bailey

    Rosie & Bailey Well-Known Member

    Joined:
    Sep 4, 2018
    Looks like you and I are dealing with similar issues.

    Bailey would hit her nadir at PMPS, and board members suggested her insulin dose was too high. Vet agreed. I bungled the reduction so Bailey is still on a roller coaster, with her numbers tumbling then skyrocketing after eating if I don't shoot.

    I'm ordering a digital caliper to help me with dosing because I suspect that I'm not actually giving her what I think I am. I don't know if that is something that may apply to you, but I wanted to share in case it can help.
     
  7. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    At over six units dose, it's likely Sketch has a high dose condition. Have you ever had him tested for acromegaly (IGF-1 test) or insulin auto antibodies (IAA). One in four diabetic cats has acromegaly. Some cats have both like my Neko did. With both those conditions, insulin needs can change over time. If we could see your spreadsheet, we might be able to help you on dosing.

    As for personal experience, my girl was on Levemir and often nadired around shot time, the lowest I ever shot was 51. For people following Tight Regulation, we recommend not shooting below 50, for those following Start Low Go Slow, we suggest not shooting below 90. People here follow one of those two dosing methods, and they give guidelines as to when to decrease or increase the dose.

    The glycobalance is relatively high carb food, we would call it the upper end of medium carb. I would stick to low carb food if you can.
     
  8. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    Wow Wendy...50 seems very low to shoot but you probably know more than I for sure!!! I will post his sheet but the reality is since this has occurred in the last week there is really no actual valid history/pattern to go on. He's been pretty bouncy. And even though he hasn't been tested for acromegaly we have (the vets and I) thought and do believe that is quite likely he is a acromegaly cat.
    Tonight he was 190 (lower than usual as he is usually in the mid to high 200's then) at shot time so I reduced dose from 8 1/2 down to 7 1/4. and three hours in he seems to be going lower again. He ate 40 minutes ago (snack) and I just tested him for the heck of it and he is at 105. With eating 40 minutes I was thinking he'd be high! This is his third lowest number ever. Obviously 105 is not a danger but since he is well outside his normal nadir of +8 or9 and going into the night it does concern me a bit plus it is totally out of character for him to be low.
    I thought the same as far as glycobalance and carbs but its supposed to be formulated for diabetic cats to help maintain a more even BG. I've had three vets recommend it and none actually carry it so don't think they are just trying to sell me. One of them was supposedly involved in the development of the food. He has been on the Glyco and for over a year and I supplement with Fancy Feast pate's for variety. Didn't notice any diff (increase or decrease) in #'s but he likes it and it helps keep his weight normal.
     
  9. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I had a lot of data, so it was easier for me to shoot low. When you shoot low, often the cycle is a lot flatter. Without seeing your spreadsheet, I wouldn't recommend you shoot that low. Neko didn't have a "normal nadir". It often was from +9 to +12, but could be as early as +5 or as late as +15.

    if Sketch does have acromegaly, it's possible the tumour is waning a bit and his dose needs may be dropping. We've got one cat here whose dose has gone from the 20's to 0.1 unit.
     
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  10. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    Ya Wendy I'm not even comfortable shooting him a full dose below 200. I know cats seem to go lower at night but I haven't experienced that with him till now. Holy cow...from the 20's down to .1 That is incredible.
    Sketch's nadir is pretty consistent but I have seen him lowest at shot time on occasion. They are definitely a puzzle. I love this old guy and just am trying not to screw things up and keep his quality of life enjoyable for as long as possible. Thanks for your input!
     
  11. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    It would definitely be helpful if you could link your current spreadsheet in your signature instead of the old one.

    Wendy is our most knowledgeable and experienced member when it comes to high dose conditions, and she really does know what she's talking about. She does more research than most vets and stays current on the latest studies.

    Looking at the SS you have linked, I see you weren't testing before shooting, which to me is really scary. Am I correct in thinking that you are now doing so regularly? Especially with the changes you're seeing lately, it really is important to know it's safe to shoot before giving insulin. Clearly you love your cat, so I know you only want to do what is best for him.

    Sketch seems to be ready to take you for a ride. Buckle your seatbelt!
     
  12. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    Hi Tricia, I am trying to copy and paste Sketch's recent SS from my other computer...but may have to just renter #s in the current format sheet when time allows. In the mean time I have started entering his numbers on the SS posted here (scroll down to red lines and new section) since 9/25 when he went his lowest since he started on insulin well over a year ago. Actually I was/am pre shot / pre meal testing...his numbers were always so high at 400 to 500's that I was always shooting full dose as it increased to 8.5u . As I said now something has seemed to change since he has dropped pretty significantly the last few days which is why I have been adjusting his dosage.
    And of course now that I have fed him some Gravy Lovers food as a precaution to keep him from going too low at night he now wants nothing to do with his regular food!!! He can be a challenge! Thanks for your input!
     
  13. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    Hi Wendy I have a bit more data on Sketchs sheet from when he initially went low. Today he has been in the low 100's and 90's from his AMPS test of 120. Now just a few minutes to shot time and he is only 102 (and he had a snack about an hour ago so probably is somewhat food influenced reading). His appetite today has been off his normal but his numbers are running lower for an extended time and he is eating...just not ravenously!
    Wondering if you might review his sheet for the last couple weeks and give me your informed opinion on dose or whether to shoot when he is that low going into the night since he seems to go even lower at night.
    Thanks in advance for your valued input!
     
  14. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Perfect example of shoot low to stay low (and relatively flat) today. :D:cool:

    How well can you monitor tonight? Can you stay up later if the numbers tell you that you need to? Do you have plenty of high carb wet food or syrup/honey? How many test strips do you have on hand?

    FYI - in order to get more eyes on you, it's best to start a new post every day. And change the subject line to reflect the current question.
     
  15. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    Hi Wendy just retested at +12.5 and he is at 134 but ate a bit at 6. I hadn't seen you post yet so I went ahead and shot him and reduced his dose to 5.0 for tonight. So I am kind of thinking that despite vets advice I should try to drop his dose slightly in AM after test so I can even out morning and evening dosage....any suggestions?? I do have plenty of test strips plus crash kit stocked with FF gravy lovers, Treats and syrup.
     
  16. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    People here use one of two dosing methods, Tight Regulation (TR) protocol or the Start Low Go Slow (SLGS) methods. Using one of those dosing methods guides you when deciding what to do with the dose. TR requires feeding only low carb wet or raw food. Take a read of those two methods, and see which one would suit you. Note that neither of those methods would have you reduce the dose with nadirs above 90, but they would have you shoot the same dose in the AM and PM. Because of the depot, reducing the dose in the PM doesn't really get you much. How about trying 7.5 units both AM and PM for a while and see what it does.
     

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