Newbie at FDMB: Treating Diabetic Cat

Hi: I have a 15 year old male snowshoe Siamese cat named Shadow who was diagnosed with diabetes about 15 months ago. Three years ago my Mother could no longer care for him so I took him in so she could visit with him from time to time. Unfortunately my Mom fed him high carb dry food in unlimited quantities. I changed that to what I thought was better dry food (Iams Senior) in low quantities. He lost some weight but came down with diabetes anyway. I then changed his diet to low carb wet food only except for Purina DM dry food when I am away. I now use YoungAgain instead of the DM when I'm away. He has been getting one to two shots a day of Lantus (1.5 units twice a day recently as per vets advice).

The reason I joined this board is I test the cat's urine from time to time with Purina glocotest squares. Recently they showed zero ketones. I bought some Relion ketone test strips and checked again with the same results. I went online and realized he was showing signs of hypoglocemia so I stopped the Lantus 36 hours ago. The symptoms persisted so I fed him some high carb dry food with pure maple syrup on it (last night and again this morning). He seems better but a little lethargic which is inconclusive with an old guy. I decided I cannot be running to the vet all the time due to logistic and funds issues so I am going to start testing his blood glucose with a Relion Micro glucose monitor.

I'm fairly technical so I may figure it out but if I have questions I won't hesitate to post them here. I just tested his urine again and no ketones again. OK, here I go.

Question #1: I am concerned about feeding him more syrup. I bought some high carb wet food (32+%) , mid carb wet food ( about 15%), and low carb wet food (>10%) thinking I should gradually get him back to low carb food depending on his readings. Good thinking or out to lunch?

 

OK. Now I'm officially confused. I just tested Shadow twice with the new Relion glucometer and it read HI both times, which according to the booklet means his blood glucose level is above 600. And yet his urine showed ZERO ketones. I tested myself so I know the unit is working (101). It is 15 minutes to closing time at the Vet so I called her. She said if he is eating, which he is, to feed him and give him his normal dose of insulin and if he goes hypo to go back to the syrup. This seems reckless but I guess I should trust the glucometer and the vet. I did give him pure maple syrup on 35% carb dry food last night and again this morning. I gave him a small portion of 35% wet food about an hour ago. He seems to be resting comfortably right now without issue. Could he swing that far in 36 hours?

Symptoms 36 hours ago: restless then lethargic, urgent yowling (very unusual for him), hiding, a little disoriented.

I will wait a short time to hear from this board. I am leaning toward feeding him some low carb wet food (7% carbs) and 1.5 units of Lantus within an hour. Maybe I should do 1 unit. Wait an hour....test.... feed and another unit if warranted.

 

The Purina glocotest squares only test for glucose in the urine, not ketones.
You should measure Shadow's blood-glucose level to see what is happening.

 

I tested Shadow's urine with both the glucotest squares and a Relion ketone strip. Both gave negative results, as in zero glucose and ketones. This prompted me to buy a Relion glucometer and join this board. The glucometer says his blood glucose is above 600. I tested it twice with the same results. I tested myself to make sure its working properly which it is . I called the vet and she advised normal food and normal dose of Lantus. He showed hypo symptoms about 37 hours ago and again 20 hours ago. Today he has been fine but the blood test shows the opposite of what I may have expected. Up until the blood test I have been giving him higher carb food and no Lantus to raise his blood sugar. It looks like it's working too well. I'm going to feed him low carb food and then give him some his Lantus unless someone has a better ideas. He's heading for a coma otherwise. He was heading for a seizure yesterday. Whiplash.

 

A BG of 600 is not good. That can cause diabetic ketoacidosis. If y had the you would have ketones in the blood and urine. The sugar syrup might have cause the high BG you are seeing.

 

Thanks for the reply. It seems he was going too far one way and now too far the other way. I followed the advise on this website as far as the syrup goes. I see now I should have bought the glucometer this morning early. I am going to feed him now and give him some Lantus, then check his blood glucose in an hour.

 

first i want to say i don't know anything about the glucotest things so can't address them but wanted to ask if you have the relion ketone test sticks or ketodiastix test sticks? one tests for just ketones, and one tests for both glucose and ketones.

no ketones on a test stick does not mean blood sugar/glucose is fine, just that kitty doesn't have ketones.

the symptoms you describe do sound like his glucose levels may have been too low

nowwww, when kitty drops too low we react and so does their body so you may be seeing the HI due to the syrup and food plus the natural instinct of the body to protect itself, spitting out everything it's got to save itself.

how many test strips did you buy with the glucose meter? if you got enough to do some testing tonight you can yes, go ahead and give insulin and then do some testing tonight to make sure kitty's numbers don't plummet. the other option would be to wait til morning, give the system a little time to clear out the carbs and test/shoot in the morning. the problem with that is you do not want ketones to develop soooooooooooo if you are comfortable getting some tests in tonight about 4-6 hours after you give the insulin, and possibly beyond that, i'd lean towards giving the insulin myself. what do you think?

 

Welcome, you came to the right place to get this figured out. :smile:

The Relion Micro glucometer will be the primary indicator of what's going on with Shadow, high or low numbers. However do keep testing urine for ketones with the Relion ketone strips.

You want to give a single dose of Lantus every 12 hours and keep checking the blood glucose with the Relion Micro meter. It may stay high for a while longer because of the high carb dry food along with all the syrup and a reaction to possible low numbers.

Hard to know if those symptoms were hypo without knowing the actual blood glucose, but going forward you can know so you can take appropriate action.

Don't Panic! or How to Handle Low Numbers

If the cat is showing symptoms or acting funny, test the blood glucose.

 

I bought plenty of test strips and I will be testing the old guy's BG often until this blows over, and then probably daily after that. He is hanging out with his people like usual after some low carb food and a little insulin. I just tested his BG an hour or so after his injection and it is dropping, slowly. (516) Since you mentioned it takes four to six hours to see the real effect that the insulin has I will check him in five hours and again six hours later after which I will feed him and give him another shot. This mirrors my sleep habits anyway. It's seems obvious to me now that continuous BG and ketone testing has to be done to even be in the ballpark with insulin vs no insulin in the short term, when things are moving relatively fast and in the long run to avoid misdosage. I wish I had started BG monitoring when he was asymptomatic for a good baseline but better late than never.

 

Sounds like a good plan for now.

Thankfully you caught it in time. That was the correct move to assume hypo and treat as such until you could test blood glucose. Along with testing promptly for ketones.

Many of us ended up here in similar circumstances. Too many vets don't seem to understand Lantus is not set it and forget it. Now that you are testing BG you can get up to speed on proper Lantus dosing here on the forum.

 

Thanks for your encouragement. Can you recommend any threads or websites with regard to dialing in dosages of Lantus?

 

Hi Steven..and extra sweet Shadow!

Here's some reading from our Lantus forum...the "sticky's" have lots of information about Lantus, dosing and the Tight Regulation Protocol which is the only published protocol that was shown to get up to 84% of cats OTJ (off the juice) http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Cats with super high glucose readings can also act like they're pretty sickly, as they can when they're too low. That's why it's important to learn to home test and start keeping track of the numbers so you can learn how Shadow reacts to both insulin and food. Here's our How to get a Spreadsheet and Link in your signature

Keeping that spreadsheet up to date and the link in your signature will help us help you to know what to do going forward.

We recommend starting at no more than 1 unit twice/day at first. Lantus is a "depot insulin"... It takes time to "fill the depot". I'd strongly suggest you drop Shadow back..especially if it's POSSIBLE she went too low already!

If you're home testing, it's safe to continue to get Shadow off of all the higher carb foods and on to only those that are less than 10%. Here's a list of pretty much every food you can buy and the carb percentage http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

 

That's the protocol you will want to use for dosing Lantus. We can help you get that figured out one step at a time. And you'll likely want to record the blood glucose readings in a spreadsheet which we can also help with.

What dose of Lantus did you shoot? I would keep testing the blood glucose before each shot (every 12 hours) and again about 6 hours later. Let's see what that looks like.

If he is acting unusual or any other time you are curious, test the blood glucose.

Any more questions just fire away. Post the readings here and we can go from there.

 

After showing multiple signs of hypoglocemia on Monday evening I gave shadow syrup with high carb dry food. As soon as I could I got a glucometer and tested him. His initial BG was HI, over 600. His ketones and glucose were zero (0) and he was behaving normally. I switched his food to low carb wet food and gave Shadow 1.5 units of Lantus last night at about 6:30pm. I tested his BG at about 8:30pm and it was 516. At midnight I got up but he was having none of it. After some time I gave up and went back to bed. At 8am I tried to get his BG again and kept getting E-6 error codes (three of these). I had to go to work so at 8:30 am, 14 hours after his last shot, so I decided to give him 1.5 units of Lantus again... which was not a good guess apparently. I came home early at 1:15pm and took his BG level again. I got three E-6 error codes again but I took some strips from the other side of the dispencer and did two tests at 1:30pm I got two readings, both alarming. The first one was 34. Because of the error codes I did another one right after this one and got a reading of 51. Both of these are way low. He seems fine and is not displaying any of the hypoglycemic signs that set off my antennae to begin with. I just fed him some high carb wet food, but I am hesitant to give him syrup because of the apparent big swing yesterday. Help me here if you can. I am going to read the stuff suggested in the previous posts right now and am thinking vet, despite the hassle. I am concerned about the integrity of the test strips so to be safe I am going to buy some new ones as soon as I can. I may have mishandled some of the strips, but not the last four for sure. Two showed E-6 and the last two showed the low readings.

 

you are doing just as you should. good going on the instant retest! that's what we advise anyone that gets a real low number.

do you have to go back to work? that will play a big roll in what we advise you to do now so i'll wait to see what your reply is

 

I did not read last nights late replies at midnight or this morning, and gave shadow 1.5 units this morning instead of the suggested 1.0 unit. As detailed in my previous post this was not wise and it appears giving him any at all without a good BG test at the time of injection is not wise. He seems to be just fine although he is drinking a lot of water, which he always has since he was young. He drank even more (double) for awhile when his initial signs of diabetes showed up 18 months ago. I am not going back to work.

 

then you are fine with the food and no syrup for now. test again about half hour after the last test just to make sure kitty is still going up instead of down. post your number if down and we will help you

 

OK. The lowest point for the insulin is going to be somewhere around +5 to +7 hours after the shot; this is called the nadir.

Just be prepared with the moderate to high carb foods, snag a test to see how he's doing, and if necessary, you can give 1-2 teaspoons of higher carb to steer the numbers.

 

OK. I tested him five (5) full hours after I gave him his insulin this morning, close to the nadir probably. Because of the low readings and my paranoia, 15 minutes after the test I fed him some high carb wet food according to Dr. Lisa's tables, which I am familiar with. After discovering this board I bought the glucometer and the foods, etc. I needed for an emergency hypoglycemic kit. I gave him a little pure maple syrup yesterday on the first hypo go-around instead of Karo's since I had it. This may not be good and I did not do so today. He is resting comfortably in one of his resting spots right now. No issues.

 

As you know now, you should always get a test before you shoot any insulin. These are Pre-shot tests, and you should pick up all food at least 2 hours before Pre-shot tests so those aren't influenced by food.

The other two that are really important are a mid-cycle test during the AM cycle (like between +5 and +7) to try to figure out where the nadir is...BUT, nadirs can and do change, even from one cycle to the next, so just because it's at +6 one cycle, doesn't mean it will be at +6 the next cycle. That's where lots of tests at all different point during the cycles can be really valuable. The "forgotten" tests, like +1, +10 and +11 can also teach you a lot, so every once in awhile, just get tests at other times

The other mid-cycle to get is during the PM cycle...if you're up until +5 through +7, that's great, but you should always get a "before bed" test...whenever that is for you. Most cats go lower at night, so it's good to know where they are in case you might need to set an alarm to get up during the night and test again.

Testing/shooting/feeding should all be done at the same time...within about 15 minutes. Some of us like to test/feed/shoot...making sure our cats are eating well before giving the insulin since it's important that they eat enough too. Personally, I shoot China in the middle of her meals since I know she's eaten at least half, and she's also "occupied" and doesn't care if I'm shooting her....lol

It'll help us (and you) a lot to get that spreadsheet program going so you can start to learn to see the "patterns" your cat shows. It also lets us keep track of how it's going and advise you if you might need to increase, decrease or hold the dose awhile longer.

You can also feed throughout the day...Just take it up 2 hours before pre-shot tests. It's actually better for a healing pancreas to have several small meals per day instead of 2 big ones

 

OK. I just tested shadow and his BG level is now 117. So far so good. This test was done at 3:20pm, about 100 minutes after his low tests and 85 minutes after I gave him some high carb wet food. (about one large tablespoon). Shall I give him some more HC food, dial it back to mid or low carb food, or none at all for now?

I usually feed him about 15 minutes before he gets his insulin and two times in between shots if I'm here. Don't get me wrong here, I'm not stuffing him. This is one 5.5 oz can per day. His serving sizes are according to what I think I can do, 2, 3, or 4 servings per day. I was intending to give him insulin at about 8:00pm tonight. Right now that is not going to happen.

He can be a pain to test if he's cranked off for some reason. Because of this, my newbie status, and maybe some of the strips were not good, Shadow's ears are getting the pin cushion treatment. Any suggestions for other areas to stick him?

 

Steven, we use a different system here because we're all over the world. Each cycle is 12 hours long, so if you test/feed/shoot at (for example) 8am, and your first test is at 10am, that would be +2...it's always +"however many hours" since the last shot

There's an AM cycle and a PM one and each one is 12 hours, so if you say that you got a 184 at AMPS (AM Pre-shot) and a 115 at +6, we'd all know that it had been 6 hours since his insulin

Again, once you get the spreadsheet, this will help a lot since it's already broken down into AMPS, PMPS and +1 through +11

We don't want you to feed him for 2 hours before his PM shot..you say that's at 8:00pm but "that's not going to happen"....when did you give his AM shot? What time is it there for you now?

There's no real reason you need to feed anymore right now...117 is a safe number but you might want to test again in 30-60 mins

 

I downloaded the spreadsheet and will try to link it ASAP. For now I will post the list below with the most recent events at the
top for quick reference with each post. The last reading showed a drop to 75 for some reason (no food or insulin since 117 two hours earilier). I will feed him some 15% carb food and retest at PMPS time in 2.5 hours. The vet called back finally, before the last test though. I
leveled with her. She thinks he may be non-diabetic now as she thinks his root issue is pancreatitus, which he had issues with
earlier this year. She says these cats can get off the insulin sometimes if their pancreas normalizes. She says lower carb food and no insulin until the numbers warrant it, especially since his urine has been testing negative for glucose too. But he must be monitored and eat low carb food which I am taking care of now. Everything I've read says no insulin if BG is less than 200 which I will follow.

10.23.13 /AM+9.....BG level is 75. Normal behavior. MC wet food.
10.23.13 /AM+7.....BG level is 117. Normal behavior. No food.
10.23.13 /AM+5.....BG level is 51 (retest). Normal behavior. Fed him HC wet food.
10.23.13 /AM+5.....BG level is 34. Normal behavior.
10.23.13 /AMPS.....BG test strips failed (3). 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC wet food.
10.22.13 /PM+6.....Cat was agitated and hid so no BG test. Normal behavior for him sometimes.
10.22.13 /PM+2.....BG level is 517. Normal behavior. LC food
10.22.13 /PMPS.....BG level is >600. 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC food.
10.22.13 /AMPS.....No insulin. Normal behavior. No ketones or glucose in urine. Fed HC food with small teaspoon of syrup.
10.21.13 /PMPS.....No insulin . Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him HC dry food with small
tablespoon of syrup.
10.21.13 /AM+3.....Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him MC wet food.
10.21.13 /AMPS.....1.5 units of insulin. LC food.

 

Thanks for the summary. I agree for now post for guidance or don't shoot below 200.

As soon as you get a chance to catch your breath here, get the spreadsheet going. If you need any help with that let us know.

For the record Shadow will always be considered diabetic. But if he no longer needs insulin that's considered remission or diet controlled. He will always need to be on low carb food, and will need regular monitoring of blood glucose. But we are getting a little ahead of ourselves here. :smile:

To have the best chance of remission you will likely want to keep supporting the pancreas with insulin and keep him in healing (normal) blood glucose numbers. So take that one day at a time for now as you try to find a dose you can shoot every 12 hours without going below 50.

If he does go over 200, then I would just shoot 1U and keep testing blood glucose and observing closely.

 

1.5 units is too much when you wind up skipping doses and having near hypo events. If you get above 200 mg/dL, try shooting only 0.5 or 1.0 units.

The initial starting dose for Lantus is calculated as
The lower of current or ideal weight
If kilograms (pounds divided by 2.2)
Multiplied by 0.25
Rounded down to the nearest 0.25 units for safety.

 

Hi Steven-

Welcome to FDMB!

I have only just glanced at your thread so need to look back more closely, but confused about a couple of these entries:

Can you clarify:
1)What was the BG number before AMPS today?
2) how close together were the 34 and 51BG taken today?

you do NOT want kitty in the 30's. Definitely want to rely on testing him....as opposed to 'how he looks'

it looks like this evening he got a bump from the food but is now going back down so it's wearing off. Keep an eye on him. I suspect his dose is too high also.
You test before shots to be sure it is safe to shoot..but w/ Lantus, dosing is adjusted by nadir. You monitor to see how low the dose is taking them and adjust accordingly (using the protocol) 200 is a good no shoot number to begin with, but you will work your way down as you collect data and know how your kitty responds and will get more comfortable shooting lower numbers.
For testing, are you using something to warm the ears first?....helps them bleed more easily. I also rub his ears between my fingers to get the blood flowing. And it helps to hold a tissue or cotton pad behind the ear to poke against. Then you can fold the tissue over and apply pressure at the poke site between your fingers for a minute or so to help avoid bruising. A little dot of Neosporin w/ pain relief also helps.

So glad you are helping Shadow. There is so much to learn but you will feel so much more in control when you do. It really is very manageable. Ask lots of questions. there are no bad questions.

BTW, with food you can leave out catsicles if you will be gone awhile. You mix low carb canned food w/ water and freeze it in portions which kitty can munch on as it thaws. It is much easier on their pancreas to eat frequent small meals throughout the day. Shadow may need more food that he is getting if still unregulated. Does he seem hungry?
You are doing great!

 

Thanks to all for your input. I'm amazed this board exists and certainly thankful it does. As to your questions I've made rookie mistakes in each of the last two days, but Shadow is a gamer and he's thriving despite my miscues. Things are looking positive right now. OK, one more test tonight and then the rack. Good night and thanks again for your help .

P.S. The 51 was an immediate retest of the 34.

 

10.23.13 /PM+2.....BG level is 132. Normal behavior. No food.
10.23.13 /PMPS.....BG level is 121. No insulin given. Normal behavior. No glucose or ketones in urine. No food.
10.23.13 /AM+9.....BG level is 75. Normal behavior. MC wet food.
10.23.13 /AM+7.....BG level is 117. Normal behavior. No food.
10.23.13 /AM+5.....BG level is 51 (retest). Normal behavior. Fed him HC wet food.
10.23.13 /AM+5.....BG level is 34. Normal behavior.
10.23.13 /AMPS.....BG test strips failed (3). 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC wet food.
10.22.13 /PM+6.....Cat was agitated and hid so no BG test. Normal behavior for him sometimes.
10.22.13 /PM+2.....BG level is 517. Normal behavior. LC food
10.22.13 /PMPS.....BG level is >600. 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC food.
10.22.13 /AMPS.....No insulin. Normal behavior. No ketones or glucose in urine. Fed HC food with small teaspoon of syrup.
10.21.13 /PMPS.....No insulin . Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him HC dry food with small tablespoon of syrup.
10.21.13 /AM+3.....Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him MC wet food.
10.21.13 /AMPS.....1.5 units of insulin. LC food.

 

Steven...we all have been where you've been...either having our vets tell us to give outrageous amounts of insulin that we're darn lucky didn't kill our cats, or making our own mistakes and being thankful our kitties both survived and forgave us.

Someone reached out to each of us when we were new and afraid...we just pay it forward!

If you have trouble figuring out how to use our spreadsheet, let us know. We have people who can help you with that too!

 

Hmmmm. Yesterday during my phone call from the vet said that the urine glucose may actually be the thing to look at as Shadow's stress when he is getting stuck can cause inaccurate BG readings on the high side. Whatever, I'm doing both. He does not like the BG test process, that's for sure. This morning I set up an "operating room" in the master bathroom where the light is great and gave him zero carb treats from YoungAgain, which he loves, during and after his BG test; and his normal food after the test as well. Hopefully he will associate the "operating room" with getting treats/food and settle down. I hope to get some time to work on the spreadsheet today.

10.24.13 /AMPS.....BG level is 189. No insulin given. Normal behavior. Glucose/ketones negative in urine. LC Food.
10.23.13 /PM+2.....BG level is 132. Normal behavior. No food.
10.23.13 /PMPS.....BG level is 121. No insulin given. Normal behavior. No glucose or ketones in urine. No food.
10.23.13 /AM+9.....BG level is 75. Normal behavior. MC wet food.
10.23.13 /AM+7.....BG level is 117. Normal behavior. No food.
10.23.13 /AM+5.....BG level is 51 (retest). Normal behavior. Fed him HC wet food.
10.23.13 /AM+5.....BG level is 34. Normal behavior.
10.23.13 /AMPS.....BG test strips failed (3). 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC wet food.
10.22.13 /PM+6.....Cat was agitated and hid so no BG test. Normal behavior for him sometimes.
10.22.13 /PM+2.....BG level is 517. Normal behavior. LC food
10.22.13 /PMPS.....BG level is >600. 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC food.
10.22.13 /AMPS.....No insulin. Normal behavior. No ketones or glucose in urine. Fed HC food with small teaspoon of syrup.
10.21.13 /PMPS.....No insulin . Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him HC dry food with small tablespoon of syrup.
10.21.13 /AM+3.....Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him MC wet food.
10.21.13 /AMPS.....1.5 units of insulin. LC food.

 

Hmmmm. Yesterday during my phone call from the vet said that the urine glucose may actually be the thing to look at as Shadow's stress when he is getting stuck can cause inaccurate BG readings on the high side. Whatever, I'm doing both. He does not like the BG test process, that's for sure. This morning I set up an "operating room" in the master bathroom where the light is great and gave him zero carb treats from YoungAgain, which he loves, during and after his BG test; and his normal food after the test as well. Hopefully he will associate the "operating room" with getting treats/food and settle down. I hope to get some time to work on the spreadsheet today.

10.24.13 /AMPS.....BG level is 189. No insulin given. Normal behavior. Glucose/ketones negative in urine. LC Food.
10.23.13 /PM+2.....BG level is 132. Normal behavior. No food.
10.23.13 /PMPS.....BG level is 121. No insulin given. Normal behavior. No glucose or ketones in urine. No food.
10.23.13 /AM+9.....BG level is 75. Normal behavior. MC wet food.
10.23.13 /AM+7.....BG level is 117. Normal behavior. No food.
10.23.13 /AM+5.....BG level is 51 (retest). Normal behavior. Fed him HC wet food.
10.23.13 /AM+5.....BG level is 34. Normal behavior.
10.23.13 /AMPS.....BG test strips failed (3). 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC wet food.
10.22.13 /PM+6.....Cat was agitated and hid so no BG test. Normal behavior for him sometimes.
10.22.13 /PM+2.....BG level is 517. Normal behavior. LC food
10.22.13 /PMPS.....BG level is >600. 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC food.
10.22.13 /AMPS.....No insulin. Normal behavior. No ketones or glucose in urine. Fed HC food with small teaspoon of syrup.
10.21.13 /PMPS.....No insulin . Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him HC dry food with small tablespoon of syrup.
10.21.13 /AM+3.....Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him MC wet food.
10.21.13 /AMPS.....1.5 units of insulin. LC food.

 

Great idea on the bedroom "operating room" Steven! One of our "tips" on home testing is to decide on one place where you're testing/shooting, and several times a day, take the cat there and just rub it's ears, give it a couple of good scritches, get used to seeing the "supplies" around, and getting lots of yummy (low carb) treats. They usually quickly learn to associate that place as "the place I have to put up with a little fooling around, but I get yummy yummy treats there"!

Most cats, once used to the "routine", will actually start to remind their caretaker it's time to test/shoot by going to the "test spot"...or like China, she comes from wherever she is in the house when I call out "China, test time!"...she doesn't care that I poke on her..she just wants her munchies...lol

Now in reply to the vet's assertion that urine glucose is the better thing to look at. I don't agree and I doubt if many here will.
For one thing, the urine glucose will only show a positive sign if there's enough sugar spilling over the renal threshold (at about a 240 Blood glucose level) If Shadow's renal threshold is (for example) 240, but his blood glucose is 229 (thus no sugar is "spilling over"), does that mean he's not diabetic? No, it does not. Damage to his organs is still happening at that 229..anything above about 130 is doing damage, slowly but surely.

"Normal" blood glucose ranges for a well controlled diabetic cat is 50-120...too much higher than that and it's causing damage..even if it's not over his renal threshold and showing a positive sign for sugar in the urine.

The next thing is that the urine glucose readings have to be done with a fresh sample (within 15-30 minutes of voiding) to be accurate. Without chasing Shadow around to catch him "in the act", that can cause some inaccurate readings.

Next, you were getting a HI reading on your meter (and when you tested yourself, it was correct). Because you say he went down into the 30's before that, he was most likely "bouncing". Bouncing happens when the blood glucose goes lower than the cat's liver is used to, so it "panics" and sends out hormones and glucogen(sugar) to bring it back up quickly to the level's it's more used to.(and many times even higher) Bounces can take up to 72 hours to clear.

Last but not least, there's a good chance that the dose you started on was just way too much, so caused some of those crazy numbers. It's also possible that Shadow may not need a lot of insulin to get him under control, but still might need "some" to give his pancreas a good chance at healing itself and putting him into remission (diet controlled only). Cats are lucky in that they're one of the few animals that have a pancreas that can do this magic thing!

The only way to know anything for sure, is to continue blood glucose testing at home...then you'll know for sure if he needs a little help in the way of insulin, or just the diet change to low carb wet has been enough for him to be diet controlled, OTJ (off the juice)

Just one more thing...If you could be home today to test, it might have been the best idea to "stall" when you got that 189, didn't feed him, and come and ask for advice here. We tell new people not to shoot below 200 WITHOUT HELP...not "never"...eventually you will want to shoot even when they're in much lower numbers (we call this "shooting low to stay low) but that's a little ways off yet.

I know it seems complicated and crazy at times, but we're always here to help you in any way we can!

Hope you're having a wonderful Fursday too!!

 

I just came home for the day at noon and gave him about 1/4 of his daily LC food before I read your message so I'll do a BG test on him again in two hours at AM+6 and post the number.

 

I'm messing with the spreadsheet now. I have a question if someone has an answer.

The spreadsheet that I downloaded assumes testing every two hours which I cannot do. I believe there is a way to enter no data and it doesn't register as zero, but rather is ignored. I remember this from a management accounting class I took a million years ago. Otherwise I will just eliminate the data I did not get. The other alternative is to enter fake numbers on the line but this is not what I want to do.

I will probably rework the spreadsheet to show more data over time, but I'll go with it for now.

 

I noticed that most people are using a spreadsheet to simply post data without the graph and color coding the data to show different levels graphically with color. Did I download the wrong spreadsheet?

 

Sounds like it Steve..ours colors the cells automatically in response to the numbers you enter and there isn't a graph program with it

Here's the important parts (I think...I'm not too computer literate myself...LOL)

SET UP (everyone should follow these directions)
1) You will need a google account.

In order to get a google account, click the link here: New Google Account

You do not need to have a gmail (email hosted by google) account. You can use your current email address and link it to the google account so you can have access to google docs.

Now we're ready to begin!!

A. Getting and Using the Template

Option #1: Direct from Google Docs:
1) Sign into your google account
2) Go to THIS TEMPLATE if you live in the USA. Go to THIS TEMPLATE for a WORLD spreadsheet if you live anywhere else.
3) Click on "use this template" button. (photo below)


Let us know if you still have problems!

 

I just tested Shadow at AM+6.....273. He hasn't eaten in over two hours. I'll hang for awhile to hear from you. I'd kind of like to wait about 3 or 4 hours to inject him and start a new PMPS at 6pm. If I had to inject him in the next 30 minutes without input, I'm thinking 0.5 units as I'm a little gun shy right now. Yesterday 1.5 units, his most recent normal? dosage, at AMPS put him at 50 or possibly less at AM+5, 25 hours ago. Unfortunately some bad strips (tossed and replaced) didn't get me an AMPS reading yesterday but given that he was coming down from a syrup induced 600 12 hours earlier eating low carb food with insulin it may have been less than 200.

10.24.13 /AM+6.....BG level is 273. Normal behavior. No food.
10.24.13 /AMPS.....BG level is 189. No insulin given. Normal behavior. Glucose/ketones negative in urine. LC Food.
10.23.13 /PM+2.....BG level is 132. Normal behavior. No food.
10.23.13 /PMPS.....BG level is 121. No insulin given. Normal behavior. No glucose or ketones in urine. No food.
10.23.13 /AM+9.....BG level is 75. Normal behavior. MC wet food.
10.23.13 /AM+7.....BG level is 117. Normal behavior. No food.
10.23.13 /AM+5.....BG level is 51 (immediate retest). Normal behavior. Fed him HC wet food.
10.23.13 /AM+5.....BG level is 34. Normal behavior.
10.23.13 /AMPS.....BG test strips failed (3). 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC wet food.
10.22.13 /PM+6.....Cat was agitated and hid so no BG test. Normal behavior for him sometimes.
10.22.13 /PM+2.....BG level is 517. Normal behavior. LC food
10.22.13 /PMPS.....BG level is >600. 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC food.
10.22.13 /AMPS.....No insulin. Normal behavior. No ketones or glucose in urine. Fed HC food with small teaspoon of syrup.
10.21.13 /PMPS.....No insulin . Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him HC dry food with small tablespoon of syrup.
10.21.13 /AM+3.....Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him MC wet food.
10.21.13 /AMPS.....1.5 units of insulin. LC food.

 

If you want to adjust the time, and shooting late will do it, a one time late shot won't hurt too much at this point. However, in the future, a late shot=a dose decrease...an early shot=a dose increase.

The most important thing is finding a dose you can give EVERY 12 hours without sending him below 50

I think you'd be good at 1 unit..or .75...but if you're most comfortable going with .5, that's what you should do. You hold the syringe and IF he did go too low, you'd be the one staying up testing all night.

But if you decide to go with .5, you need to HOLD that dose for at least 3-5 days (6-10 cycles)

IF you do happen to see a low number that worries you, as long as it's over 50, don't panic..and don't rush to stuff Shadow full of gravy or syrup. At most, if he's getting CLOSE to 50, give him a teaspoon of the "gravy" part of a "gravy" type food, or 1 drop of Karo/syrup along with a teaspoon of low carb food and retest in 30 minutes. (and post and ask for help to get you through it....add something like "HELP PLEASE..low number" to the first post here (edit the subject line) and add the ? icon

IF he goes below 50, give a couple teaspoons of gravy (or a couple teaspoons of low carb with 2-3 drops of Karo/syrup) and POST FOR HELP...Edit that first line and add the 911 icon...That icon is there to alert everyone here that you're having a medical emergency and need someone to help you.

Make sure you always have the How to handle hypos..They can Kill printed out or handy so if you don't get help quickly, you can have something to guide you with.

 

I will retest in two hours, which will be my new PMPS as it fits my routine much better. If his BG level is higher, and it most likely will be, I'll go with one unit. I'm going to feed him some LC food now. I'll wait 15 minutes. If you think I shouldn't feed him please post it. thanks.

 

You can feed low carb food anytime you want to EXCEPT the 2 hours prior to pre-shot tests. You need to know what that number is (without the influence of food) before you give any insulin

 

Ok. I just finished his latest test, about two hours after I fed him about one ounce of LC wet food. Up again but much less...299. What do you think? I'm thinking of splitting the baby in half and going with 0.75 units. You mentioned staying with whatever dose I go with for three to five days before a change. Let's say his numbers drop as they will but then start to rise at a slower rate even with 0.75 units. I guess as long as the numbers aren't rocketing toward the moon he'll be fine. I'm going to give him some more food right now and then give him some insulin after some input.

10.24.13 /PMPS.....BG level is 299. Given ?.?? units of insulin. Normal behavior. Fed at AM +10.
10.24.13 /AM+6.....BG level is 273. Normal behavior. No food.
10.24.13 /AMPS.....BG level is 189. No insulin given. Normal behavior. Glucose/ketones negative in urine. LC Food.
10.23.13 /PM+2.....BG level is 132. Normal behavior. No food.
10.23.13 /PMPS.....BG level is 121. No insulin given. Normal behavior. No glucose or ketones in urine. No food.
10.23.13 /AM+9.....BG level is 75. Normal behavior. MC wet food.
10.23.13 /AM+7.....BG level is 117. Normal behavior. No food.
10.23.13 /AM+5.....BG level is 51 (immediate retest). Normal behavior. Fed him HC wet food.
10.23.13 /AM+5.....BG level is 34. Normal behavior.
10.23.13 /AMPS.....BG test strips failed (3). 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC wet food.
10.22.13 /PM+6.....Cat was agitated and hid so no BG test. Normal behavior for him sometimes.
10.22.13 /PM+2.....BG level is 517. Normal behavior. LC food
10.22.13 /PMPS.....BG level is >600. 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC food.
10.22.13 /AMPS.....No insulin. Normal behavior. No ketones or glucose in urine. Fed HC food with small teaspoon of syrup.
10.21.13 /PMPS.....No insulin . Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him HC dry food with small tablespoon of syrup.
10.21.13 /AM+3.....Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him MC wet food.
10.21.13 /AMPS.....1.5 units of insulin. LC food.

 

I think 0.75U sounds good.

Do keep testing blood glucose, if he goes below 50 again you will need to reduce the dose further.

 

As long as he doesn't drop below 50, you want to keep the same dose for 3-5 days.

IF he drops below 50, you drop it back .25, so if you're shooting .75 tonight, and any time in the next 6-10 cycles he drops below 50, you're "next" dose would be .5...and the 3-5 day clock would start over

A normal Lantus cycle looks kind of like the bottom part of a smile...it starts high, then curves down, and the starts to climb again.

"Usually", somewhere around +5 to +7, you'll reach Shadow's "nadir"...this is the bottom part of the "smile"...then the numbers start to climb again until the next pre-shot time.

 

I gave him 0.75 units, I think, at PMPS. 0.25 units increments are tough, even with the right needles. I will check his BG before I hit the rack. I did the Google thing and filled out the spreadsheet. I am unclear as to whether I can save it somehow. I'm assuming it is automatic but I haven't closed it just in case. I am also unclear on how to share it with this board. Cliff Notes please.

 

Yes, the spreadsheet saves the entries automatically.

To share it with us, go to the top right where it says "Share" on the spreadsheet and click...It will open a new little window and you can choose the Privacy for it. You choose "anyone with the link" and save

Go to the top left side of the page and find "User Control Panel"
When you're in the User Control Panel, choose the "Profile" tab
If you want, you can fill out any of that information...most of us at least have where we live there.
Then go to "Edit Signature"
In that box, put your name, your cats name, age, sex. In the next lines, you can put your diagnosis date, the type of insulin you're using, the type of meter you're using, what you're feeding, any other health problems Shadow has, etc...anything you feel would help us to know.

You'd copy and paste the spreadsheet link there too

After you "submit", all that information will automatically be added to your posts so anyone who's helping you can glance at it and get all that information without asking you the same questions over and over.

If you look below here, you'll see the information I have in my signature block...there's no "right order" to put things in, as long as the most important things are there

 

Thanks for the link info I'll try to get it done tomorrow. The 0.75 units of Lantus did its job. 'til morning.

10.24.13 /PM+5.....BG level is 118. No food since PMPS.
10.24.13 /PMPS.....BG level is 299. 0.75 units of insulin given. Normal behavior. Fed at AM +10 and again immediately after PMPS, 15 minutes before insulin injection.
10.24.13 /AM+6.....BG level is 273. Normal behavior. No food.
10.24.13 /AMPS.....BG level is 189. No insulin given. Normal behavior. Glucose/ketones negative in urine. LC Food.
10.23.13 /PM+2.....BG level is 132. Normal behavior. No food.
10.23.13 /PMPS.....BG level is 121. No insulin given. Normal behavior. No glucose or ketones in urine. No food.
10.23.13 /AM+9.....BG level is 75. Normal behavior. MC wet food.
10.23.13 /AM+7.....BG level is 117. Normal behavior. No food.
10.23.13 /AM+5.....BG level is 51 (immediate retest). Normal behavior. Fed him HC wet food.
10.23.13 /AM+5.....BG level is 34. Normal behavior.
10.23.13 /AMPS.....BG test strips failed (3). 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC wet food.
10.22.13 /PM+6.....Cat was agitated and hid so no BG test. Normal behavior for him sometimes.
10.22.13 /PM+2.....BG level is 517. Normal behavior. LC food
10.22.13 /PMPS.....BG level is >600. 1.5 units of insulin. Normal behavior. No ketones or glucose in urine. LC food.
10.22.13 /AMPS.....No insulin. Normal behavior. No ketones or glucose in urine. Fed HC food with small teaspoon of syrup.
10.21.13 /PMPS.....No insulin . Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him HC dry food with small tablespoon of syrup.
10.21.13 /AM+3.....Multiple signs of hypoglycemia. No ketones or glucose in urine. Fed him MC wet food.
10.21.13 /AMPS.....1.5 units of insulin. LC food.

 

Twelve hours ago, 0.75 units dropped Shadow's BGL from 299 at PMPS to 117 at PM+5 and its holding there at 115 this morning at AMPS . Hypo symptoms brought me to this board 5 days ago so I'm concerned about giving him the same dose right now. Waiting for input. He was on 1.0 units once a day as per vet four months ago but after an annual cbc she bumped him up.

 

In this case, you should probably "stall"...don't feed, and retest 30 minutes later. We want to know for sure that he's climbing (without being fed) before deciding when (or if) to shoot.

When you have a question, go to your original post and "Edit" the Subject line...Put something like "Stalling--dose advice please"..or ''New..need help with dose"..whatever, and then add the ? icon like you did on this last post. The only way those icons show up as members are just "scanning" the message board are if they're in the original post

 

I fed him about 1.5 oz. of LC wet food an hour ago. I will wait an hour and retest. I'm not working today so I can hang with the little guy.

 

I'm glad you have a flexible schedule, but remember, we NEED to find a dose you can give safely every 12 hours.

Lantus needs to be given at a consistent dose, every 12 hours to work it's best, so IF you have a pre-shot number you're not comfortable shooting, stall, don't feed, and ask for help.

it looks like now you're going to be at least 90 minutes late with your shot..not anything that will hurt Shadow, but still not the best thing to do since Lantus needs that consistency

 

Shadows BGL at AM+3 is 171 so it's climbing again. It's close to AM+4 now so I'm inclined to test at AM + 6 or 7 and go with 0.5 units at PMPS and stick with that dose for three to five days.

P.S. I did the profile, info, spreadsheet link thing. This message will test whether it took.

 

Spreadsheet's working fine :smile:

 

You did great Steven! Now you won't have to constantly answer the same questions over and over, and once you get more used to using the spreadsheet, you'll start to learn a lot more about how Shadow reacts to Lantus and food

If starting at .5 is your comfort level, start at .5...I think you'd probably be fine at .75 too, but you hold the syringe...it's always your choice. Very tiny differences can make a big difference in the numbers. IF .75 is too much, you'd need to be able and willing to stay up testing/feeding (at least until he was up into safe numbers and staying there without feeding.) IF .5 isn't enough, he'll just run higher numbers for the 3-5 days and you'd end up increasing to .75...there's just NO way to know this early in the dance to know how Shadow is going to react.

The most important part at this point is finding an amount that can be given every 12 hours, and keeps him safe, and is comfortable for you to shoot.

I think the 118 at +5 last night, and the fact that he's only at 171 at +3 today says that he did NOT go too low overnight on the .75. If he had, we'd expect to see a "bounce" number..maybe up to the 300-500 range, but I understand your reluctance to shoot a 115 this morning. Again, there's just no way to know for sure where Shadow went overnight. ECID (every cat is different) and until you've got more results, we just want to keep him safe while we're taking these first steps.

In the future, if you get a Pre-shot number you're not comfortable shooting, stall, don't feed, and retest in 30 minutes...use that 30 minutes to ask for help....and make sure you edit your first post and put something like "Stalling Dose Help Please!" (and add the ? icon) so people can easily see that you're waiting for help

You're doing well Steven, and the fact you're already home testing is just awesome.

 

I once saw a friend's cat convulse due to hypoglycemia. The reason I searched for answers, and found this board, is that Shadow looked to be heading in that direction. The drop from 0.75U at 299 at PMPS last night to 118 at PM+5 gave me pause about another 0.75U at 115 at AMPS. It seems prudent and safer to be a little high than risk hypoglycemic numbers. Although my schedule is flexible this morning, this is not normally the case. Thanks for your encouragement and understanding.

 

I see your spreadsheet link but not your profile link.

No rush, but You may want to soon start posting in Lantus for dosing advice, etc..

 

I totally understand. Hypos are really scary! Nobody wants Shadow to go too low! As I said earlier, eventually you'll learn to shoot those lower numbers, but if you get a number under 200, stall, don't feed, and ask for help. That's how you'll start learning the more advanced steps in this dance.

Just one thing...a drop from 299 to 115 isn't out of the ordinary..especially when you're first starting. China had a lot of those kinds of cycles..she'd start at high numbers too, drop into double digits or low 100's at +5 or +6 and then climb back into the 300-400's by the next shot time. On 7/14 you can see where she started at 314, at +4 was 100, +5 69, and +7 92

What we want is for them to spend as much time possible at numbers between 50-130...Those are "pancreas healing" numbers. Cats are one of the animals that has a pancreas that CAN heal and start working to produce insulin again, but to do that, it needs rest and time. Keeping their BG too high makes it try to work. This is one of the big reasons why we don't recommend the Glipizide pills. They force the pancreas to try harder to produce insulin...we want it to rest and heal.

This is a "typical" 12 hour cycle on Lantus looks like.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

If you go with the .5, that's fine too!! We want you to be comfortable with what you choose to do, as well as keeping Shadow safe. We can always add more insulin after we see how it's going after at least 6 cycles

 

Hi and welcome Steve and Shadow! :YMHUG:

We have a saying around here, "better high for a day than low for a moment." ;-)

 

Hi Steven and Shadow,
I've been reading your thread and see that you have gotten lots of good advice. It seems to me that the most important task you have to do is to determine what dose you can safely shoot every 12 hours. Skipping shots will certainly keep Shadow from getting hypos, but Lantus is a type of insulin that needs to be shot consistently. It is what we call a "depot" insulin. In other words, it builds a reserve "shed" or "depot" in the cat's body. When used properly this "shed" will help keep the cat in more stable numbers: ideally, he will not be diving and bouncing all over the place when the correct dose can be established. Some insulins are "in and out"--they leave no residue. When they are "out," the cat's numbers can soar. The "shed" Lantus builds helps to prevent this type of yo-yo effect.

Lantus dosing is based on the nadir--the lowest number in the cycle (usually appears somewhere around mid-cycle, but can move around). Pre-shot blood-glucose readings are important to determine whether or not it is safe to give the shot, but they only marginally figure into determining what the dose should be. At present you have had to skip so many shots that it is not really possible to figure out what dose you should be giving. Also--and this is important--when you begin using Lantus it takes 3 or 4 cycles of shooting a particular dose for the "shed" to build. While this building is taking place, some of the insulin is going into controlling the blood glucose, but the rest is going into forming the "shed" and therefore is not available to work on the blood glucose.

My suggestion would be for you to settle on a dose that looks to be safe. Perhaps 0.5 unit. This may be too little, but that can be determined and corrected later, if necessary. Try to shoot this dose consistently (every 12 hours). Keep track on your spreadsheet. You will see a picture begin to emerge. Give the dose a few cycles to "settle in" (the shed needs to be built--every time you change your dose, the shed will need to adjust itself and that always takes a few cycles). Go to the Lantus Forum and check out the "Sticky" that explains the TR Protocol to get an idea of how to go about adjusting the dose. You may not yet be ready to join the Lantus TR Forum, but you can learn a lot from reading the "Stickies" at the top of the index.

I have one question: Are you using the correct strips for your meter? It is unusual to have so many strip errors. The strips for the Relion micro/ Relion Confirm (both meters use the same strips) are not the same as for the other Relion meters. If you know that you have the correct strips, check the date on the plastic box.

You have come a long way in the last few days. Keep up the good work. Try to be consistent and try to be patient. Try not to panic. If you think you are in trouble, post a question in the subject line of your FIRST post of the day.

Ella & Rusty

 

I sent a reply 10 minutes ago but I guess it didn't work. I bought some new Relion strips for the Micro and it has been working without a hitch since. I won't use the first batch again and intend to call Relion for replacements. Both batches were for the Micro glucometer.

I just tested Shadow at AM+7 and got another unexpected result...131, down from 171 at AM+3 after rising from 115 at AMPS and 118 at PM+5. I erred on the side of caution and did not give him insulin this morning. I have to do some errands now and will retest at PMPS and feed him for the last time today after that. I was intending to start him at 0.5 units at PMPS but if the BCL is still down I am not sure that is prudent. If I have time I will read the TR stuff.

P.S. How do I rename the spreadsheet to something like Shadow's spreadsheet?

 

It could mean a couple of things: the insulin dose from the night before is still at work in his system or maybe his pancreas is working some or a little bit of both. Depending on what his PMPS is tonight, if it's over 200, I suggest going with the .5u dose for the evening. If it's under 200, post here first and ask for help. I'd say Shadow is definitely trying to go otj_icon with numbers like those even after a skipped shot this morning. :thumbup

P.S. You should be able to double-click on the name and another window will pop up allowing you to change it.

 

OK. This thread is getting kind of long now but earlier I mentioned a belated phone call from my vet two days ago. I leveled with her about what I was doing, why I was doing it, and that I intend to keep doing it. She was cool with it; and after going over the events and what I was seeing, she felt the same as you; that he was trying to get off the juice. I've gotta run, but I'll be giving him his PMPS test in 3.5 hours. Thanks for your support.

 

Hi Steve...You're right, this thread is getting a little long, so why do we get you to come over to the Lantus Tight Regulation Board. This board is for us Lantus users and you'll get lots of experienced eyes to help you there.

Each day, we start a new posts (we call them condo's). The Subject line includes the date, cats name and your AMPS reading. As the day progresses, you add your test numbers until PMPS, and then you can either erase all the numbers from AM or just add PMPS and continue (until you run out of room)

Yours for today would be:
10/25 Shadow AMBG 115,+3 171,7 131 (In this case, since you didn't shoot this morning, it's AMBG (AM blood glucose) instead of AMPS (AM Pre-shot)

Then in the body of the condo, you give the WCR (Whole Cat Report)..how Shadow is feeling, acting, eating..anything you think might be helpful. We're interested in the 5 "P's" too...Purring, Playing, Preening, Peeing and Pooping. Anything unusual happen? Shadow not eating well? You have visitor in the house and Shadow won't come out from under the bed? ....whatever might help us know Shadow better as well as help you if there's a problem you're not sure how to deal with.

As for the link to your spreadsheet, do you just mean how do you make it work when you click on "Shadow's Spreadsheet" instead of the way it is now? It's not necessary to do that, but we can show you how if you want to learn.

Hope to see you in Lantus Land soon! You're not required to go to the Lantus board..if you want, you can continue posting here in Health but you'll find that in Lantus Land you'll learn a lot from just reading other people's condo's and seeing how and what they do when they deal with the same issues you'll be dealing with. (and I'll be watching for your PMPS number in about 3 hours too)

 

If I'm right in assuming you want to "name" your spreadsheet, here's how

If you would like a "word" link, such as Shadow's SS, use the following code: text. replace "link" with your spreadsheet URL, and replace 'text' with the name of your spreadsheet.

So you'd go to your Signature box, and click on the URL tab.

Immediately after the first [url put an = sign in ......then "paste" the link into it. At the end of the link, add the ]

Directly after you add the ] type "Shadow's SS"

That's all.

What I usually do is just put my cursor after the first and backspace once. Add the = and ...pic.php?f=6&t=50130]viewtopic.php?f=6&t=50130

Down where it says "B. Publishing your SS, aka Attaching to signature (directions by Squeem3)".... Look for line 7B
There's a picture there too

 

Shadow's PMPS is 183. Input please.

Ok. Shadow's PMPS test climbed to 183. Less than the 200 cutoff. Waiting for input before I do anything, including feed him. He hasn't eaten in awhile except for two tiny low carb treats. If I don't hear from anyone in by PM+2, I'm going to retest and let it ride if no change, 0.5U if >200...and feed him.

 

Wait 30 minutes and re-test. If rising glucose values, shoot.

Also, the FDA allows meters to read within 20% of what a lab would get.
80% of 200 is 160, so its likely safe to shoot, although helpful if you can be around to observe.

 

Wait 30 minutes and test again. If the number is "rising," I say it's safe to shoot the full dose. 200 is the cut-off number on the main board for people who are just getting started. If/when you move over to the Lantus forum, that cut-off drops to 150. If you feel up for it, you could even give the shot now without waiting. Just make sure you can get a +2 to see if he's already dropping because you might be in for a late night of testing if this is the first time you've shot lower than 200.

 

By the time I retested it was +1, but no matter. It dropped to 175 even though he was a little more stressed than usual this time. I'm letting it ride for now.

 

Have you fed him yet? If so, he'll probably be higher at his +14 (food-influenced).

 

175 is really the same number as 180...the variance in the meter means it's going to be "within" certain limits....For now, if you didn't feed, you could go ahead and feed, shoot

 

Yep, it's a +/-20% variance if you feel like doing the math (although I could have sworn BJM had a crib sheet with the math already done; I just can't seem to find it now).

Just remember, Lantus works best on consistent dosing with only ~30 minute variances a day so if you don't give a shot till +14, tomorrow's shot will have to be given at least an hour and a half later than Shadow's regular shot time. Then Sunday, you only have to wait an hour later and by Tuesday, you should be back on track.

 

Re: Newbie at FDMB: 188 this morning. Input appreciated.

I did not give Shadow insulin last night as I counldn't follow up for 4 or more hours and his numbers were not climbing. At any rate he is cruisin' along right now just under 200 without juice. He tested at 188 a few minutes ago, ate his breakfast, and I'm leaning toward giving him 0.5 units soon. If I shoot him, I will test him early and maybe often to make sure he doesn't nosedive. I was advised to decrease in the morning but I've got to get him dialed in some time. I'll wait a little while for input.

Also, I am having trouble getting blood out of one ear now for some reason. I've tried to rotate ears and locations but last night and this morning I've had to stay with one ear. Any help here is appreciated.

 

I injected Shadow with 0.5U at AM+1 and will follow up with tests to monitor for potential hypo. I think I'll move this thread to Lantus forum as suggested. I don't think I will be able to consistently do the tight regulation so I will post in the relaxed Lantus forum.

 

Morning Steven,
I just have to come say hello to someone with a Shadow.

One ear does generally bleed better than the other.
I find it helps to get just a little higher than the sweet spot, closer to the edge.


If you are using a lancet, it sometimes helps to do a quick double poke in the same spot.

 

I ran out of room in my signature! I'm going to have to make a page of links to the stuff I've pulled tgether!

You might find it helpful to review this table of Test Value Ranges It shows the FDA allowed +/- 20% around a test value which indicates the range in which the test likely falls.

The variability is kind of like ring toss - so long as the big ring is on the stake, it counts. With several rings, the area of overlap starts to narrow in on the stake ... at least, it is supposed to, based on measurement theory!

Glucose Value Ranges Graph

 

Good morning Steven!

What concerns you about doing the Tight Regulation protocol? I understand that you won't always be able to be home to test every 2 hours, but that doesn't mean you can't follow the TR protocol. If you can get 4 tests per day (If possible) and maybe curves on weekends, that's enough

If you do decide to go with the Start Low, Go Slow approach, that's fine too...just add SLGS to your signature...that'll tell use which one you're going to use. The only difference I can see between the 2 protocols is maybe how often you increase doses. You're still going to want to get those 4 tests in (If at all possible)

You always need the pre-shot tests. Then one somewhere around +5 and +8 during the AM cycle, and one "before bed" test at night.

No matter which you decide, it's fine to post on the TR board..it's much more active than the SLGS board is, and the main thing you'll need the boards for is advice..and all of us use Lantus

Glad to see you shot the .5 this morning! Let the dance begin! :mrgreen:

 

Hi Steven and extra sweet Shadow! Welcome from me and 'Da Sugarboyz', KT and Dakota.

Moving to Lantus group...not everyone that posts in Lantus Tight Regulation actually follows the TR protocol, some of us do 'SLGS' - Start low, go slow.... We still get lots of help and support even tho' I can't do tight regulation. Lantus TR is much more active than the Relaxed forum. There are still some very wonderful, helpful, caring people on Relaxed, just not nearly as often. Whichever you choose to post in is fine, just wanted to share the 'difference'.

You're learning this sugardance quite well!!!