Nikko has been on insulin (lantus) for one week now - help with my spreadsheet?

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by AmandaJean, Mar 14, 2019.

  1. AmandaJean

    AmandaJean Member

    Joined:
    Mar 10, 2019
    Hi everyone, still very new to this and need to do a proper curve this weekend.

    Based on my current spreadsheet, does anyone have any observations for me? I feel like between the lantus and low carb wet food, Nikko's BG has really dropped from when the vet first tested him. Is this normal? I'm getting yellows and blues already. This makes me think he's doing really well on the new diet.

    With him under 200 before his PM shot tonight I'm definitely a little nervous. Been studying the rest of your spreadsheets and it looks like at a "high blue" I see some of you lowering the dose so that's what I'm going to do tonight to rest easy. Instead of 1.00 units he will be getting 0.5.

    Hope this is good - any insight appreciated - thank you so much!
     
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Hello and welcome over here. Yes, Nikko is seeing some nice response to the Lantus. Take a read of the yellow starred Sticky Notes. You will also want to review the dosing methods Sticky Note and see which of the two methods there would suit you best. We determine how to change doses based on how low the Lantus dose takes the cat. Those are typically somewhere in the middle of the cycle, so getting mid cycle tests when you can will really be helpful.
     
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  3. JoyBee&Ravan

    JoyBee&Ravan Well-Known Member

    Joined:
    Feb 17, 2018
    Hello Amanda :)
    I'm very glad you came to the Lantus Forum! And yes, Nikko is doing better because of his diet (no Dry Food) & the Lantus.
    It's OK you lowered the dose but it would be "BETTER" if you had posted early with a ? mark & asked for dosing advice. I do not give advice on dosing & I've been here a year.

    If you follow the advice of the Experienced people here on "how to dose the insulin" it's possible Nikko just might go into remission. It's always better to ask for advice before you change the dose.You don't have enough data to make correct decisions yet. I don't think you understand yet how the insulin works.

    It takes a lot of reading & testing before you can really know what to do with the dose. Insulin is a very powerful Hormone. Lowering the dose is safe and they might have told you to lower it! But it's better to get some advice before you make a decision on the dosing. OK? It's better to ask first,to be sure.

    You can look at the spreadsheets but you shouldn't do what someone else did . EVERY CAT is DIFFERENT! You are here on the Lantus Forum to get Expert advice. Please ask for help before you change Nikko's dose.

    Nikko's SS is better! We'll see in the next few days what his Bg does on the lower dose. I hope he continues to get good test results! Remember the insulin takes a few days to show us how he will react to the new dose.Lantus is a SLOW acting insulin.

    I'll check back later to see any new test results. :bighug:
     
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  4. AmandaJean

    AmandaJean Member

    Joined:
    Mar 10, 2019
    Oh, sorry I'm not officially changing his dosing! Just the other day you seemed concerned he had a blue number and that was hours after his shot - so I didn't want to give him too much insulin and send him into green. It was more like a precaution at this point as I took the reading right before shot time and didn't think I could get an answer here ASAP. Based on the SLGS method and Nikko being on insulin for 1 week now, I am feeling pretty confident about that decision

    If anyone can confirm on that? It is from the yellow stickies on this forum. I know I don't have a ton of readings yet - unfortunately I can't take time off work and still afford the insulin and supplies. I can take more readings on weekends and the occasional sick day.
     
    Last edited: Mar 15, 2019
  5. AmandaJean

    AmandaJean Member

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    Mar 10, 2019
    Thank you! used that as my bed time reading
     
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  6. JoyBee&Ravan

    JoyBee&Ravan Well-Known Member

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    Feb 17, 2018
    I just think in the beginning it's best to at least "try" to get advice before changing the dose.

    I was concerned seeing a blue # because that means she can drop even lower Possibly even to a dangerously LOW #! A lot of cats drop the lowest during the night. Because you hardly test at all at night & you wouldn't know if she was too low.

    It's important to get as much data as you can. We all set our clocks & get up during the night to test. It only takes several minutes.
    Good Luck to you & Nikko. ;)
     
    Last edited: Mar 16, 2019
  7. AmandaJean

    AmandaJean Member

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    Mar 10, 2019
    I didn't mean to sound like that at all. I mentioned in my intro post but unfortunately this has happened at a pretty bad time in my life and I have been hospitalized twice, myself in the past 2 weeks. I'm trying to learn how to test within minutes, and trying to read and follow the pages of stickies I find here. I don't think I'm cut out for this.
     
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  8. Erin & Scott

    Erin & Scott Member

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    Jan 11, 2019
    I'm not sure that any of us felt that we were cut out for this at first - but this is what life has given us so we learn to roll with the punches. It is a lot of information to take in all at once, and it's understandable that you might have a hard time sorting it all out. Hang in there, eventually it will all start to make sense.

    For now, when you get a chance, could you please go to your Google docs and share your spreadsheet? When I click on the link it's telling me that it's not published.
     
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  9. JoyBee&Ravan

    JoyBee&Ravan Well-Known Member

    Joined:
    Feb 17, 2018
    I'm sorry you're having problems.
    Nikko is just starting to get some good #'s. It's possible she could go into remission.I hope you don't give up on Nikko. She needs you now.
     
    Last edited: Mar 16, 2019
  10. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Amanda

    First, welcome to FDMB. Second, I’m so very sorry for your health issues and that now, when you should be concentrating on yourself, you get the diabetes diagnosis. I’m also sorry there has not been more empathy here for your situation. It doesn’t really matter what others are going through at this time because what we aren’t doing is walking in your shoes. FD can be a challenge to deal with when you are healthy but if you are not well, it becomes even more stressful. There is a steep learning curve so pat yourself on the back that you’ve done what you have so far:
    • started testing
    • feeding LC wet food
    • determining SLGS is the best for Nikko
    In a month, you’ll look back and see all that you have been able to learn and do for Nikko. Sometimes it’s just baby steps and that’s enough.

    I also cannot see the SS but I can fix that for you since I developed this latest rendition that we’ve been using for several years. I’ll send you a private message as I’ll need to have you allow me editing rights. Check your inbox in the upper right corner and when you see a number, click on it and there will be a message from me.

    Once I can see his SS, I’ll be happy to help you with some suggestions on dosing.
     
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  11. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Welcome Amanda.
    First let me say good job!
    You are an amazing person to take the initiative to join FDMB and search for the knowledge to help your sweet Kitty get better.
    Remember to take a moment for yourself and just take some deep breathes.
    Things are going to improve.

    You have come to the right place there are some very kind, compassionate, experienced people on this forum who are more than willing to give you guidance.
    I am so glad Marje noticed that you asked for help with your Spreadsheet plus bonus Marje is the one that developed the Spreadsheet we use on FDMB.
    Wendy & Neko have been invaluable to Bear and I too.

    If you ever need some encouragement or possibly just to vent some of your anxiety you are welcome to PM me.

    Oh yeah, not to beat a dead horse but remember (Take some deep breathes). :D
     
  12. AmandaJean

    AmandaJean Member

    Joined:
    Mar 10, 2019
    You are very sweet - thank you, both! Yes definitely overwhelming but my little guy is putting some weight on! He's put on 4oz (he was already trim kitty but went significantly underweight with the diabetes). No more flooding the litter box, no more waking me up at 3am for food.

    I've fixed the link if you want to look at his SS and help me with dosing. As you can see, he's been low enough where I have skipped some shots lately (at my vet's suggestion) but your input is very valuable to me!
     
  13. Erin & Scott

    Erin & Scott Member

    Joined:
    Jan 11, 2019
    Hi Amanda - it looks like Nikko is making some progress! A couple of thoughts about what I'm seeing on your spreadsheet -

    First, I see several times that you didn't get a pre-shot test. It is very important that you test before every shot, just to ensure that he's not too low for you to shoot.

    Second, you've been changing up the dosing a LOT. Lantus works best when dosed consistently, i.e., you find the appropriate dose and stick with it for a minimum of 6 cycles, except in case of numbers dropping below the threshold for reducing. He had a reading of 49 on the 19th, which would have earned a reduction. However, since you'd been shooting anywhere between 0.25 and 1.0, it's hard to say what his appropriate dose should be.

    Since he did drop below 50 after a 1.0u dose, he earned a dose reduction, so you should not continue giving the 1.0u. You need to pick a dose that keeps him in safe numbers - and from what I'm seeing, that's probably 0.5u. Stay at that dose for 6 cycles (3 days) and record before every shot and at least once more at around +3 (morning or evening, just so you get one in-between reading).

    If his AMPS is low enough that you don't feel comfortable shooting, delay for half an hour without feeding to see if his BG will rise on its own. If you see that he's on an upswing, then you can go ahead and feed & shoot, knowing that by the time the insulin starts working, his food will start to hit his bloodstream and he'll be fine.

    If his numbers are not coming up after stalling, you may decide to skip the shot (if, for example, you're not home to monitor). In that case, you should reduce the dose and stick with that reduced dose for 6 cycles. If his nadirs start to go above 200, then you can gradually increase the dose by 1/4 units. Remember that Lantus dosing is based on how low it takes him, and not what his BG is at pre-shot.

    Lantus is a depot insulin, meaning that when it is injected under the skin, it forms a deposit that the body then draws from over the next several hours. By shooting 1.0u one time, then skipping the next shot, you're draining the depot, so it's impossible to tell how the previous dose is actually affecting him.

    It looks like he really WANTS to give you some good numbers - so you've got to help him out by giving insulin in the way he can best make use of it. Once you get his depot stabilized, you'll get a better picture of what dose is working the best for him.

    It's a journey, and a very steep learning curve - but you're off to a good start. Just a bit more tweaking and you should be seeing some consistently good numbers!
     
  14. AmandaJean

    AmandaJean Member

    Joined:
    Mar 10, 2019
    Ahhh thank you thank you thank you! This is all super helpful, and I will immediately reduce (consistently) to 0.50 units and monitor him carefully on that.

    Now.... weird question. How do you approach with your vet that you've decided to change your cat's dosing? It's so awkward, but obviously, I want the best for him. They told me keep him on 1 unit 2x/day after seeing his last curve and then do another curve in 10-14 days time but as you can see, 1 unit is probably too much for him right now.
     
  15. Erin & Scott

    Erin & Scott Member

    Joined:
    Jan 11, 2019
    Well . . . that can be a sticky question! Sometimes you just need to be selective in how much you want to share with your vet. Most vets have good knowledge of lots of different canine and feline illnesses - but not necessarily a deep knowledge about feline diabetes. The older insulins often were dosed based on pre-shot numbers, so if the vet is used to dosing with those, they may not be completely on board with how Lantus works.

    I'm actually quite concerned that they told you to hold the dose even after seeing that 49 - that's a dangerous practice. Maybe next time you send a curve, tell them that you were skipping so many shots that it just made sense to you to cut it in half so that you were dosing consistently every 12 hours. None of us want to antagonize our vets when we depend on them for our cats' care, but sometimes a little discretion, and a bit of smiling and nodding, are the best tools when communicating with them. When Nikko goes into remission following your dosing (and seeing his numbers, I think there's a good chance he can), then you can give the vet all the praise and credit. ;)
     
  16. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    I’d like to address some things which are not exactly correct. A lot of members read but don’t post and they should have the correct information.

    There are other FD sites where they shoot sliding scales of Lantus and the cats seem to be doing fairly well. It’s just that the methods we use here, TR and SLGS, call for consistent dosing. This mantra around here that “Lantus loves consistency” isn’t true, There are other ways to use it; again, it’s just not how we use it here because we’ve found the methods we do use to be effective.

    If she’s reducing the dose, there is no need to hold it for six cycles. I know you might think it’s not really a reduction because she’s not shot 1u every cycle but why stay at a dose that might not work for her when it’s less than what she was shooting?

    When stalling, we test every 20, not 30, minutes to catch the rise.

    Theoretically, the food should hit the BG within 30-60 minutes and before onset. However, if numbers are still lower and she has to leave, she will have to decide whether she’s comfortable shooting or not. Example: PS is 60; she stalls 30 minutes without feeding and it comes up to 70. She shoots and feeds and at +1, it’s 80. At +2, he onsets and drops to 50. Yes....I’ve seen it happen a lot. So to tell her the food will hit the bloodstream and he will be fine when she’s not there to test and be sure....maybe, maybe not.

    If she skips a shot for BG above 50 that she’s not comfortable shooting because she has to leave, why would she reduce the dose? She wouldn’t unless she was doing SLGS. If she was doing SLGS and didn’t feel comfortable shooting a 95 and leaving so she skips, she wouldn’t reduce the dose. Again, if she did get a number she couldn’t shoot because it was below 50 for TR or 90 for SLGS and she did have to reduce the dose, she wouldn’t hold it six cycles. For TR, if in three cycles, it was clear it’s a failed reduction, she would go back to the last good dose. If it’s SLGS, she’d wait seven days and do a curve and then adjust the dose, if necessary.

    Amanda...if you read the stickys at the top of the forum, you’ll see we direct new members to the two methods to regulation we use here....Tight Regulation Protocol and Start Low Go Slow. Although it’s very possible to do TR and work, it does require a bit more testing than you are able to do, it appears.

    No judgement here at all but we base dosing on the lowest number of the cycle and if you aren’t getting any tests at night, we have no idea how low a dose might be taking him. Cats often go lower at night. I usually suggest that members always, always get a preshot test both cycles. Always. For working members, in the morning after you’ve given insulin and fed, if you can grab an out the door test and then an in the door test, that helps. Then the PMPS, a +2, and a before bed test. That gives us plenty of data to have a better idea what’s going on.

    Where to go from here? Normally, I’d tell a member that with this SS, they should reduce to 0.75u and try to get in more tests long enough for us to see how low the dose is taking him. However, what is more important right now is to get you shooting twice a day as much as we safely can. Therefore, I agree that dropping the dose to 0.5u and trying to collect more data will help us figure out where he needs to be.

    Again, please read the stickys and let us know which method you want to follow by posting it in your signature. If you are doing TR, we dont shoot below 50. If you are doing SLGS, you’d skip if the BG is less than 90 at shot time and you can’t stall without feeding to see if it comes up.
     
    Last edited: Mar 26, 2019
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  17. AmandaJean

    AmandaJean Member

    Joined:
    Mar 10, 2019
    @Marje and Gracie unfortunately I had to skip the shot again this morning as Nikko was sitting at a 77. I won't be home until after work so no option to delay. Nikko is consisitently low in the mornings which is making it hard to shoot. I set my alarm and did some testing throughout the night last night. He's never going bright green but is pretty consistently green. I hate how often I'm still skipping his shot and I'm not sure what to do :(
     
  18. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Good morning Amanda. :)
    Nikko is having some beautiful numbers.
    The answer to this wonderful issue is in protocol.
    After looking at Nikko's SS and seeing that your work schedule is limiting you on the amount of testing required for Tight Regulation Protocol (TR) I am assuming Nikko is following Start Low Go Slow Protocol (SLGS).

    This is a copy from (SLGS) protocol:
    • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
    • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
    • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit


    • Following SLGS Nikko earned a reducttion last night with his +6 (85BG) on his current dose of .50, which would make his new dose (.25).
     
  19. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    @Wendy&Neko @Marje and Gracie

    I am so happy for you and Nikko!
    Please read and refresh your knowledge on SLGS Protocol and add SLGS to Nikko's signature.
    Also I would advise you to leave some watered down wet food out for Nikko when you are away from home and at night.
    Nikko's numbers are going lower at this point and (most) cats will naturally search for food if their BG is low because they become hungry.

    Under SLGS Nikko needs to have a curve test weekly to evaluate his current insulin needs.

    Edited to add: It is also very important especially since Nikko is in lower #'s to get one test before you go to bed.
     
    Last edited: Mar 28, 2019
  20. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    I just have a minute and will be back later for further comment but Lora is correct that you should shoot 0.25u tonight and as your new dose.

    Good luck with the reduction!
     
  21. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Looks like Nikko is doing really well. Good luck with the new 0.25 unit dose.
     
  22. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Amanda

    I’m really hoping that by reducing to 0.25u, you will be able to shoot twice a day.

    Under SLGS, especially when you are new and don’t have much data, the guidance is to skip the shot for numbers under 150. As a member gets more experienced, he/she can shoot to 90 but the suggestion in the guidance is that if you get a BG under 90, you skip the shot. If possible, you can also stall a bit without feeding to see if the numbers come up on their own but for SLGS, you don’t want to shoot a number below 90 so you did good today!!!

    Also, if you get a number too low to shoot (below 90), we usually recommend lowering the dose. His AMPS combined with his lower numbers last night made reducing the dose tonight a good decision
     
  23. AmandaJean

    AmandaJean Member

    Joined:
    Mar 10, 2019
    @Wendy&Neko @Marje and Gracie @Bear & Lora thank you so much!

    I will do a weekly curve on Nikko on Sundays. Yes - really want to get back to shooting twice a day, so thank you, all for taking a look at my spreadsheet and giving me dosing suggestions.

    Great news is testing has become a breeze now. What a difference from a few weeks ago. I'll be continuing with lots of testing and 0.25 units twice a day.
     
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  24. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Love the new avatar! Especially the hat. :)
     
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  25. AmandaJean

    AmandaJean Member

    Joined:
    Mar 10, 2019
    @Bear & Lora @Wendy&Neko @Marje and Gracie

    I can't shoot this morning... AGAIN! Went down to 0.25 for his shot last night, tested a bit throughout the night and now again this morning and his readings are almost identical to the previous day. Should I reduce again tonight?

    I am also going to take a half day off at work.. go in for a meeting this morning and then come home to get some more readings after lunch
     
    Last edited: Mar 29, 2019
  26. Bear & Lora

    Bear & Lora Well-Known Member

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    Sep 24, 2018
    Wow Amanda! This situation is definitely out of my experience or knowledge.
    I will say from what little I have read that when a cat is this close to diet controlled remission the goal is to keep the cat on the smallest amount (drops) to increase the chances for a strong remission with continued support for the pancreas.
    Normally the Depot still effects the the preceding cycles but with the amount of skipped shots again I am not sure how much that is in play for Nikko.
    Wendy and Marje are the best people to help you and Nikko. :D
    :bighug::bighug:
     
  27. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    There is a picture of the 0.1 unit dose in the Sticky Note on fine dosing. See if you can try that one.

    A suggestion to get more eyes on you (more than Marje and I could have replied), you might want to start a new post with a link to this one. There are enough people here that we suggest creating one new post per day. People here tend to not look at the older posts.
     
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  28. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Welcome to the group!!

    Like Wendy was suggesting, if you are repeatedly unable to shoot due to a low pre-shot number, lowering the dose so that you can shoot twice a day may be the answer. Here's the photo of the 0.1u dose:
    [​IMG]
     
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  29. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Great avatar!

    Agreed with Wendy and Sienne; try to drop back to 0.1u but please do start a new thread. Thank you.
     

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