New member, first home curve, help figuring out dose.

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Grayboy, Mar 4, 2018.

  1. Grayboy

    Grayboy New Member

    Joined:
    Mar 4, 2018
    Hi All,

    Looking for reassurance before I talk to the vet again tomorrow morning.

    History: Grayboy was at 480bg fasting when I took him to the vet for his first curve on 2/16. They gave him 2 units of Lantus that morning and when I came to pick him up that night he was at 108. Per the vet, I didn’t give him a shot that night and only did 1 unit 2x/day until his next curve visit on 2/22. He gets wildly stressed at the vet so he started at 236 that morning and ended around 360, so the vet increased it back up to 2 units.

    I just did my first home curve today after 9 days on 2 units 2x/day (AT2) and, aside from not liking the ear pricks, he was considerably less stressed.

    It was as follows:
    (couldn’t get a pre-shot ear prick...first time)
    Right after food & shot: 104
    +2: 79
    +5: 92
    +9: 124
    +12: 103
    Right after food (no shot): 107

    I called the emergency vet to verify what to do and they said with numbers this low they would not give a shot at all tonight. Thinking that when I talk to the vet again tomorrow we need to go back down to 1 unit, especially since Grayboy’s bg was probably artificially high at past office visits.

    Thoughts? I know it’s new but I feel like 2units is too high.

    Thnx!

    L
     
  2. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

    Joined:
    Jan 11, 2010
    I would agree not to give a shot tonight, especially since you are using the AT2 meter. It's always preferable to start with a low dose and follow the protocol when increasing the dose (see the "stickies"--informational posts--at the top of the forum: particularly "new to the group", "Start Low go Slow" protocol, "Tight Regulation' protocol.) You will have to decide which protocol you want to follow (tips are in the posts cited above). In any event, it looks like 1 Unit is enough to start on tomorrow unless Grayboy is a particularly large cat. If you could change the title of this post you will get more eyes on your situation. Change it to something like "new member needs help determining dose"

    There is so much to learn at first. The people here are all ready to help you. It would help us if you could set up a spreadsheet (see the instructions in the Tech Forum for setting up a Google spreadsheet and linking it to your signature). Also, when you set up your signature make sure to add the fact that you are using the AT2 meter. (The cut-off numbers for skipping a dose are different for the AT2 than for the human meters.) If you need help with the spreadsheet or the signature, just ask. Someone will be along to help you.

    Welcome to L&LL Forum!
     
  3. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Welcome. First off, it will help us help you if you start a spreadsheet. Here are the directions.

    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    What are you feeding your cat? We have two protocols here, SLGS and TR. Both start we you increasing and decreasing I’m .25 increments. If feeding any dry food you can only follow SLGS and we would decrease because there was a test under 90. With a pretext of 107 it was good to skip the insulin tonight. If he were mine I would go back to 1 unit.

    He’s going to test more accurately at home. The only curve Max had with my vet was after his first shot. There’s no reason to take him for a curve again since you test at home.
     
  4. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Hi and welcome to Lantus & Levemir Land - the nicest place you never wanted to be.

    As Ella and Elise have mentioned, it helps us (and you) a lot if you can set up a spreadsheet to keep track of Grayboy's numbers. We are very data driven here and have a hard time giving guidance without as much info as possible.

    It definitely sounds like 2 units was too much. Many vets tend to do increases and decreases in 1 unit increments, because they don't think the caregiver can handle doing smaller dose changes. Here we advocate dose changes of .25 units (except in cases of high dose cats or cats with very, very high BGs) because for a small creature like a cat, that is actually a lot of insulin and can have a big impact. There are no syringes with .25 unit markings, but if you get syringes with .5 unit markings, it's not that difficult to figure out where .25 is. We can help.


    Here is a post with some tips that you might find helpful as you and Grayboy get accustomed to home testing. My favorite tip is to always give a treat, even if you aren't successful in getting blood. You want him to associate testing with something good. Diabetic-friendly treats include freeze-dried meats (available at most pet stores) or plain, cooked chicken cut up into bite-sized pieces. Warming the ear first is usually helpful, and getting some Neosporin gel with pain relief to rub into the ear at night before bed helps desensitize the ear.

    Here is a post we put together for new members, to help you get comfortable with this forum - kind of like an FAQ. Read everything you can on this site, and ask lots of questions. We've all been where you are, and we love to help.
     
  5. Grayboy

    Grayboy New Member

    Joined:
    Mar 4, 2018
    Thank you everyone! I really appreciate the feedback. He was at 117 about 45 mins ago and I’m waiting for the doc to get into the office soon to see if I need to give an AM shot. To answer Ella & Rusty & Stu, he is big at 26lbs.
     
  6. Grayboy

    Grayboy New Member

    Joined:
    Mar 4, 2018
    I didn't give him any this morning either per the doc's order and just re-tested him and he's still at 117. Waiting on another call-back from the vet and i know it's early, but maybe the change to DM food will end up being enough to regulate him?
     
  7. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Sometimes, a change to low carb food makes all the difference. A good way to tell if the pancreas is working is to test him before feeding (preferably when he hasn't eaten in two hours or so), and then test again about 2.5-3 hours after he eats. If the second test is lower than the first, the pancreas is working!
     
  8. Grayboy

    Grayboy New Member

    Joined:
    Mar 4, 2018
    Thanks for the tip! I tested him this morning about 10mins after he ate a bit of his breakfast and he was at 91 - I'll do it again before feeding him tonight and again before I hit the sack to see if there is a difference.
     
  9. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    Also: how was the diabetes diagnosed? Was it on a single blood glucose reading, or did they run a fructosamine test? I've seen a bunch of cats recently "wrongly" diagnosed with diabetes based on just one high blood glucose test, without the fructosamine done. The fructosamine test gives a picture of what the blood glucose was like over the past 2-3 weeks.
     
  10. Grayboy

    Grayboy New Member

    Joined:
    Mar 4, 2018
    When I brought him in for worrying symptoms (a ton of urine, lots of water consumption, sleeping on his water bowl, lethargy, groaning) they did xrays, urinalysis, and a senior feline blood profile and whittled it down to diabetes. I'm not sure if fructosamine was included in the senior profile, but when I took him in for the first curve he was at 480bg and we changed his food at the same time as starting insulin.
     
    Stephanie & Quintus likes this.
  11. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    I agree with you that the 2 units may be too high. Especially since you've changed his food....
    I look forward to the spreadsheet ....
     
  12. Grayboy

    Grayboy New Member

    Joined:
    Mar 4, 2018
    Hi All,

    Just a quick update - I spoke w/the vet again yesterday and we suspect Grayboy's going into remission due to the diet change (no insulin since Sunday). He told me to test him again once today (2hrs after eating he was at 107!) and if the number was good, to just spot check every week & keep an eye on behavior. He is acting much more like his old self the last few days (sleeping on the bed, not hiding, walking around more, interest in toys). I'm going to move on over to the OTJ board if I need to post again, but wanted to thank everyone for the links and tips and support :)
     
  13. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Wonderful news of no insulin since Sunday.:cat: I think I would continue to test every day for a bit to make sure he continues in good numbers. How about if you post here to keep us informed and if you have any issues peeps can help you.
     
    Grayboy likes this.
  14. Grayboy

    Grayboy New Member

    Joined:
    Mar 4, 2018
    Will do - I'd rather be safe than caught off-guard with a spike!
     
  15. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    That is GREAT news!!!
     
    Grayboy likes this.

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