Please review his spreadsheet and let me know what I should do. Any advise would be helpful, hes on Lantus. Seems to have become unregulated and possibly bouncing, but I'm no expert. https://docs.google.com/spreadsheets/d/1ydCtZUdidVYrTvB9dQyAAFTEBsHN_hoksRv5jit1aIM/edit?usp=sharing
Hi and welcome. Looking at your spreadsheet, I have several questions. First, why are there no tests in the nighttime cycle? We are only seeing half the picture here. It's impossible to know what is going on without tests in both cycles. Can you tell us why you raised the dose on the evening of 12/10 after he dropped to 43 that day? Not trying to criticize, just trying to understand your logic. You seem to be jumping around in dose alot, and that makes the depot unstable and can result in very wonky numbers. Remember that Lantus dosing is based on the nadir, and it works best with consistent dosing. You should hold a dose at least six cycles, unless a reduction is earned. Are you following either Tight Regulation or Start Low Go Slow? This info will help us give dosing recommendations. That 39 today for sure earns him a reduction. I would drop him back to 1.0 and try to get some tests in at night. A "before bed" test is fine, assuming it's at least 2 hours after you shoot. If that's too late at night for you, can you adjust your shot time an hour or two earlier? These are just some initial thoughts. It would help to have some more info about Dunkin. How much does he weigh? Do you know what might have caused his FD (ie, steroids, etc)? Is he on any other meds? What are you feeding him? Please keep coming back and asking questions and sharing info on your sweet Dunkin. We love to help. (BTW, none of us here are experts. Some are more experienced than others, but we all have more to learn! )
I agree with Tricia....it's really important to get tests on the PM cycle too because most cats go lower at night. Grabbing a "before bed" test will not only help figure out what's going on, but help to keep him safe overnight. If the "before bed" test shows he's dropping quickly, you should plan on getting at least another test in. We sure don't want you to wake up to a tragedy! Lantus dosing is based on how LOW it takes them, not the Pre-shot number. The Pre-shot just tells us if it's safe to give insulin at all. It looks like Dunkin is dropping too low and then bouncing high. Bounces are caused by 1. dropping too low, 2. dropping too fast, 3. dropping into numbers their body isn't used to anymore (or any combination of all three) The liver reacts to a low (or what it perceives as too low) by releasing stored sugars and hormones to bring them back up quickly. With Lantus, you need to hold each dose for at least 6 cycles unless they drop too low (below 50 on a human meter) to let the depot stabilize. Think of it like this....Lantus is like steering an ocean liner...you can jerk the wheel,(change the dose) but it takes time to get the ship turned around. I would drop him back down to 1U and hold that dose for at least 6 cycles (unless he drops below 50 again) and then see how he's doing (as well as getting some PM tests) Keep posting and we'll help you figure out what's best for Dunkin as well as keeping him safe!
Dunkin is a handsome boy! I agree with both Tricia and Chris. Looking through the SS I can see a few times where Dunkin has dropped below 50 and you haven't reduced the dose. Testing more inbetween the shots will give us lots of information as well as keep Dunkin safe. Keep asking lots of questions. This is a very knowledgeable and supportive group who will able to help you.
Aloha all! Thank you for all the feedback and advice. Heres more info: Hes 17 years old, currently eats FF pate and primal raw freeze dried nuggets. Ive been working directly with someone I met online from this board for the last four years, and am posting now because this SS just needs more eyes on it after we've been trying to tweak the dosing lately. I didn't reduce the dosage because I was told not to. I will be trying to get in more PM spots to round out this picture, in the meantime I'll decrease to a steady 1.0 dosage and continue to follow advice from this board. Unless anyone thinks I should take him down to 0.5 for six cycles? That 39 was really alarming. Hes never had any symptoms of being hypo. He ate alot of food right after I took that spot check. Got a PM spot last night and his numbers were pretty even until AM testing and shot. Started decreased dosage last night. Again, thank you all for your time and assistance in getting this under control. We appreciate you immensely and send our aloha to you all \m/ ^_^\m/
"Newly diagnosed CKD" in the signature line...stabilizing Dunkin's BGs will help with that. Glad you reached out. Stick here. Ask questions and you will get the answers.
I agree on the decrease to. 1.0 unit dose. Plus more testing in the PM. Many, if not most, cats go, lower at night. And next time you see a low number like the 39, it’s important to test more frequently to make sure he is coming up instead of going lower. No matter which of our dosing methods people use here, even longer time diabetics get a reduction if there is an under 40. It wasn’t safe to keep on that dose. Glad you reduced.
There's still the higher dose being released from the depot, so we don't usually do back to back reductions. Give him a teaspoon or two of food and test again in 30 minutes and let's see if he comes up a little. It will help if you'll edit your subject line and put your numbers in as you get them. The people here watch those subject lines to quickly see how kitties are doing and then check on any that have any red flags. If you look at other posts in this forum, you'll see how we usually post.
Just a couple of thoughts... How are you feeding Dunkin? Does your kitty get meals only at shot time or are you spreading out the food over the time before nadir? Given some of the drops by mid-cycle, you may want to divide up your cat's meals into smaller portions and provide food over the first few hours of the cycle. Likewise, routinely getting a +2 test may allow you to intervene with food to prop up the numbers. If your +2 is considerably lower than your pre-shot test, it may signal that numbers are dropping and you would want to monitor to see where the numbers are heading. Using food to steer the numbers can help to level out the cycle and, hopefully, prevent some of the bouncing. With the newly diagnosed CKD, you may want to look for foods that are low in both carbs and phosphorus. Weruva is one of those brands but there are others that are on Dr. Lisa's food chart.
A low carb/low phosphorus food my guys all enjoy is Whole Earth Duck pate .....carbs 4 and phos 130... their Chicken pate is also low phos but bit higher in carbs (10) . My 19 year old boy likes these as well as Holistic Select Chicken or Turkey pate... both a bit higher in phos( 221/243) that I keep on hand for picky days
His numbers seem to be getting better. A little lower and less of the dramatic drops and swings. Hes on 0.5 lantus twice a day.
I agree. The lower consistent dose is helping to level him out. Max was a grazer too. I was able to get him to eat small amounts hourly if he was dropping too quickly though. The lower bg seemed to make him hungry. CKD definitely complicates things. Some use a Petsafe feeder set to open hour,y or however you want. I thought about getting one but Max was a scaredy cat and also lost his hearing the last year. Here’s one. https://shop.bestreviews.com/produc...AHeEp1cvTWGV83s4qWPaPOyQpDqK8gcAaAjQcEALw_wcB
Is that the feeder that opens with some kind of sensor on a collar? Dunkin won't wear one, but that would be an awesome idea to control my other boy Diesel who is 20 lbs. He vacuums up the leftovers that Dunkin the grazer leaves behind.
Looks like you reduced to .5. And it’s not enough insulin. We go up and down in dose usually in .25 increments. You can guide cycles with food. Both Primal and ff pate are low carb. As mentioned before you can feed a little higher carb food to help keep safe numbers.
so funny you mentioned that! thats the FIRST thing our new vet noticed...the heart outline on his nose lol. he's now seeing a specialist/internist who feels that the low numbers may be causing the high numbers so hes not ready for an insulin increase for the highs... any input from here is appreciated.
First of all, you will get more eyes on you if you start a new post, rather than adding to one that is over a month old. Second, a couple observations from the spreadsheet. You are skipping the shot sometimes when he is still in safe numbers, not sure why. If there is a reason, it’s good to document it in the spreadsheet remarks so we can understand what went on. I also see some “*” for the units, but don’t know what that means, Next, a lot of mid cycle data is missing. It’s hard to tell with the data I see how he’s doing on this, by which I mean, how low is he going. Can you get more tests in the PM cycle? I realize you shoot late, but even drinking a large glass of water before bed will help you get to test. Even a +2 will give us a clue what is happening. And finally, yes it is possible Dunkin is seeing lower numbers than he is used to, which in turn are causing high numbers. It doesn’t mean those “low to Dunkin” numbers are necessarily unsafe hypo numbers. What data I can see doesn’t support that. Have you read over the two dosing methods we use here and decided which you’d like to follow? That information will help us help you better.
sorry, I thought I was previously instructed to update the title rather than start a new post. updated the chart.
The suggestion was to update the title if you have a new question for the day. Otherwise start a new post for a new day.
When you start the new post, include a link to the last one, so people can go back easily to see what has already been discussed. This helps prevent repeat questions. If you're not sure how to do it, ask for help.
ok please advise how that is done. i was just thinking that starting a new post wouldnt have the previous history, then your message came in. thanks.
