??? Need advice regarding giving or not giving insulin

Good morning - these last two mornings, Tigger's insulin has been at 181. However yesterday when I got home, he ate, I waited two hours to test for PM dose and his sugar was at 463. I gave him his 2 units of Lantus. This morning, after he had his breakfast, I started getting ready for work, and before I left the house (about an hour after breakfast), I checked his # and it was at 181 again, so I'm sure it was much lower before he ate. Same as yesterday morning. I was contemplating giving him the insulin but I did not do it b/c I'm just afraid of him going hypo when no one is home. Is there a threshold where it's ok to give insulin if he's between 100-200? I've always read that if the number is under 200, do not give insulin. Am I making a mistake in skipping in the morning insulin these last two days?

 

Hi, yes you need to skip if it's under 200. You don't have enough data, especially in the mid-cycles, to see how low Tigger is going on this particular dose. Is there a way you do a curve - every 2 hours for 12 hours - on a day you are home this week? It will help so much to have more data throughout the cycle. Try to get various spot checks. Only then when you are armed with more data, you can feel more confident shooting a lower number. Are you posting in L&L as well?

 

Thank you for replying. I did a curve on him a few weeks ago, please see attached.

 

That was a great visual aid! That was on 8/12/17. Have you done another curve? With SLGS, they recommend you do a curve every week. If the curve is similar to the last one, then I think you are safe to start lowering the no-shoot number. For example, your cut-off number is 200. Maybe try 180 next time? Choose a number you are comfortable shooting.

I think you would be better posting this question in L&L because there are many experienced people using Lantus or have in the past.

 

Ok thank you so much for taking the time to respond back to me.

 

I'm pretty new to this so maybe I'm missing something but why are you waiting 2 hours to take a reading and give a shot? I take a reading, feed and shoot right away after making sure my Tigger has eaten...of course taking into consideration his PS number. I'm not surprised he is so high at 2 hours after eating with no insulin on board.

 

Someone on this forum recommended to me that I take a reading 2 hours after he eats, so that's what I started doing. Sometimes I will take a reading as soon as I wake up, then I feed him and based on how low/high the AMPS number was, I give or don't give insulin.

 

Are you giving insulin 12 hours apart? What you should be doing is making sure Tigger has not eaten for 2 hours before the scheduled AMPS, then you can go ahead and feed and shoot. Same for PMPS - no food in that +10 to +12.

 

Yes, I do give him insulin 12 hours apart. Sometimes I'm off by maybe 1/2 hour but for the most part, it is 12 hours apart. So what if I do the AMPS and get a reading that is anywhere below 200. Do I still give him the insulin right after he eats with a below 200 number? That's where I'm having a problem. If he's between let's say 85-100, I obviously will NOT give him insulin. But what about if he's in the 100-200 range? Do I give it to him?

 

This is part of the reason I thought it was good to shoot right after PS and eating...because the PS number unaffected by food is a true measure of BG (and how much insulin it's safe go give). If too much time goes between feeding and testing/shooting, BG is always going to be high.

 

As I suggested above, if you get more spot checks, then you will build confidence on what numbers you are comfortable shooting. Right now, your cut-off number is 200. Work down slowly. If you are really worried, start with 180.

I'm going to tag some pros for you.
@Wendy&Neko
@Bobbie And Bubba
@Marje and Gracie
@rhiannon and shadow (GA)
@tiffmaxee

 

Ok thank you so much @Mandy & Rex and @vbc2000. I have to buy some more strips today and will start spot checking more often.

 

Greetings,
There are several things we say with 2 hours.....
don't feed 2 hours before shot time if you can help it because you will have a food influenced number at preshot.
We like it when you can get a +2 ( that's 2 hours after shot time) because if it's a big drop from the preshot number, it can mean you will have an active
cycle where you want to monitor and test more frequently. Lower numbers ( not necessarily too low) are likely about to happen.

I would say let's make 180 for now....
But....
when you have a preshot number lower than 180, post on the lantus forum for help ( we'd like it if you can post daily, we will have lots of tips and input as you go)
You will be shooting lower numbers as you get a little more experienced and have the data in your spreadsheet where you are learning how he responds.
The first time you shoot below a 150, one of us will commit to staying with you telling you when to test next, or when it's time to pull out the high carb
gravy to bump up numbers.

You won't ever shoot a number below 50.... but down the road, you might be shooting a 90.


The dose of lantus is determined by how low they go during a cycle.....
It is not determined by the high numbers....

So when you shoot that 180, you are keeping the momentum going.....
and when you skip, you drain the depot and lose momentum....


keep asking questions....
Glad you found us.

 

Do you have an autofeeder, or can you leave food out for your kitty when you are gone at work? Eventually you'll be shooting lower numbers, and leaving food out to eat is a tool you can use to help keep him safe.

 

Wow - thank you so much for replying. To give you a brief rundown - my Tigger was diagnosed in October 2016. He was 11 at the time, now 12. He's been on Lantus, started at 1.5U twice a day. He's now at 2U twice a day. I have an excel file with all of his curves, I will update that as soon as I find it so that you can see. His latest curve was on August 12th, here it that one. (see attached) His schedule right now is to eat when I wake up for work (normally ~7am; then again he eats when I get home at around ~6pm) These are his wet food servings. I feed him the Fancy Feast White Meat with Broth, which does not have many if any carbs. He then has Dr. Elsey's cleanprotein that I put out for him to graze on throughout the day. I know that the dry food is not great for them, but they do love it. I figure it's better for them to eat one of the "better" ones out there. He was on Young Again Zero Mature but that gave him bad diarrhea. (I have two other non-diabetic cats that also get the wet food and Dr. Elsey's) I will now start to test him as soon as I wake up before he eats; and then give him the insulin. That still gives me about an hour before I leave for work so I can re-test him again to see where he's at. It's been a bit of a challenge because I do work full time outside of the house so I can only test him while I'm home. Except on weekends when I have more time to do so. I will continue to update his SS.

 

I do not have an automatic feeder but I am going to look into getting one. I think that would put me more at ease. Do you have any recommendations?

 

A popular model is the Petsafe 5.

 

Great, thank you!

 

I liked the petsafe 2. it made no noise at all. just opened.... i often wanted to put a little bell on it so she would know it opened.....
she didn't hover over her feeder.

 

Franklin was at 203 this morning. He has not had insulin since Sunday night because he shot a 110 on Monday morning and then I was out of strips. Got them yesterday and he was at 167 last night. (He was at 250 +3 in the morning but I still decided not to shoot.) I don't think I'm going to give him insulin this morning, right? I went ahead and fed him. He was starving. He's about finished with one can of FF Turkey and Giblets.

We haven't done the curve on him yet because of my strip issue. When I talked to the vet on Monday, we were going to wait until later in the week on that. Thanks.

 

That is interesting that the numbers are coming down during the cycle without any insulin. Have you made any changes to his diet...such as removing dry or HC food? A diet change to LC wet food can sometimes make a big difference.

It seems that the 3 units is definitely too high a dose. He is still high but better than when he was on 3 units. A diet change can definitely drop insulin requirements.

I would continue doing some spot tests, especially about 3 hours after a meal to see if he is regulating the glucose on his own. Franklin may need a lower dose of insulin but some more data would help.


Hopefully some others will weigh in with their opinions.

 

Thanks! When he was first diagnosed, he was on a combo of wet and dry Science Diet W/D. ON 08/17 I mixed Fancy Feast with dry W/D and then just went Fancy Feast after that. No more W/D. I did start out with just a 1/2 can of FF for both him and his sister. He devoured his and then would finish off what she didn't eat. I also started splitting a can of FF with them in the middle of the day.

On Monday I stocked up on Sheba Beef Pate and Roasted Turkey pate because it was buy one get one free at the grocery store. But I found out he can't tolerate the beef Sheba or Fancy Feast for some reason. (His sister isn't having any issues.) So we had a loss of food yesterday but after a little while I gave him a can of FF Liver/Chicken Classic. He devoured that. He is getting one can of FF at every meal now. I also started the deli turkey treats for his shot...one small piece of deli turkey. Glucose man devours that but his sister doesn't seem to know what to do with deli turkey. If I put it on MY dinner plate, I bet she would figure it out. Monday night I split one tub of Sheba Roast turkey between them at night around 9:30. Last night around 9:30 or so, I gave them each one tub of Sheba Roast Turkey pate.

He is also getting one Lysine treat in the morning and one Lysine treat at night.

I will check him again in about 30 minutes or so and see where we are.

Thanks very much! Appreciate it.

 

It sounds like the diet change has definitely affected the insulin requirements. Getting some more tests in even without having given insulin will give some good data. The numbers on an AT2 meter are still higher than normal but are definitely much better than they were when he was getting 3 units of insulin.

There have been a number of kitties on FDMB that have managed to become diet controlled by changing to a proper wet LC diet. Since it has been less than a week since cutting out the dry you may continue to see the numbers improving. But continued testing will give a clearer picture of what is happening.