Oscar is on Lantus worried he might be going to low

Hi All,
I have set up a spreadsheet of Oscar's readings ( I hope it works.). I have done as many tests as I have been able to over that period I received my monitor on the 3rd. He has just gone to Lantus but has dropped rapidly. He didn't look well after lunch (41.4bg) and I gave him some Snappy Tom (like Whiskas) with a 1/4 tspn of honey in it and he cheered up. The vet said she would ideally like to see him at about 90-180 range as she feels below that is a bit dangerous. I dropped back to 1.5u in this morning's dose and he is still dropping - looking for advice?
Cheers Joan

 

Your last test was 41 at +5.
you need to intervene. do you have any high carb canned food? ( something with gravy ? )

have you tested again?


ETA -- doesn't look like you have been getting preshot tests. Is there a problem with doing that ? Very very important to ALWAYS test before every shot. ok water under the bridge and want to focus on how he is now.
Just want to make sure that from now on you get those preshot tests, ok?
As far as future dosing. lets see what happens and where he ends up tonight/today for you ;-) and please post before giving next shot, k?

 

Hi Cheryl,
Yes I have just tested and he is 73.8 so the tinned and honey did help. I just don't know what amount of Lantus to give him in the pm dose? We are in Aus so it is 4 hours away. I do have some Whisakas in gravy type Single serve shall I give him that for tea(dinner) prior to dose?
Thanks for prompt answer.
Joan

 

joan-- here are some tools for you to check out about hypos.

how to treat hypos:

viewtopic.php?f=14&t=1122


what you need for your own hypo tool box:

viewtopic.php?f=14&t=2354

 

Sorry didn't see the last of your post. I didn't realize how important pre shot test was(with Caninsulin it didn't seem to matter as he was always high). I will test before giving shot tonight and post but if time isn't right to catch you guys what should I do, still give dose?
Thanks Joan

 

Thanks Cheryl I will check out suggested sights. Still really new at this - sorry.
Joan

 

the honey can give him a spike and then he could drop again. hopefully the food will keep him up.
great job !!!
nadir on lantus can vary ( peak insulin action time) *usually * around +6 you want to make sure you get two rising tests ( say 1/2 hour apart) past nadir before he is out of the woods. right now looks good. what is the "*" of that last test?

 

Took test at four pm so is 8 hours after dose. I thought I would need to wait for test as time would be needed to show diff. so I will do after 15 mins nexct time. I thought Lantus was the right thing to do so asked the vet to change I hope I haven't done the wrong thing!
Thanks for help - really!

 

we were all new once ! there is a learning curve. you did great to get him back up.
and now you know to always test before every shot.

can you give me some more information about oscar?
he's only been on lantus 3 days?
have you changed his food lately?

when was he dx'd with diabetes?

 

usually low numbers like that with lantus mean you treat ( feed high carb canned food) and then test after 15-20-30 minutes depending on how low and if cat is symptomatic. . i felt more comfortable testing Winnie every 15 when she went into the lowlands. It can take a bit for the food to get into the system. But if is low and dropping you need to do more frequent tests.

at +8 and with food in him he should be good .

have you read the stickies about using lantus? it is a very good insulin.
you are definitely going to need to drop the dose. lantus is actually dosed based on the nadir ( peak insulin action) obviously Oscar is going too low at that point. AND what is of particular concern is that he did that w/o having his shed aka insulin depot built up on a consistent dose for 3-5 days.
even though lantus is dosed on nadir. preshot important to know if you are starting out at a safe number.

to be continued. i type slow.

 

something else that would help is to put together a profile and post it in your sig line with your spreadsheet -- great job on that btw !
here is link w/ template for profile:

viewtopic.php?f=6&t=17766

it really helps to have that info to look at when board members are helping you w/ your kitty.
also keeps you from having to repeat that info !!

 

THat's ok (about typing). Oscar was diagnosed on August 20th he stayed at the vet for a week and started Caninsulin 2 days before returning home. I tested on the 1st of November as a friend came by with their BG monitor (he is diabetic). Then Marilyn in Melbourne who I met through this website purchased a monitor for me (as I live in the outback), once I recceived that I started testing when time permits - also husband and son carry on about me testing too much!!
I asked for Lantus thinking it was milder and easier to get him settled on and we started Thursday night (our time). The universtity of Queensland Aus has done lots of studies which indicate Lantus is the best option as well.
Not sure what you mean buy stickies but I did read Lantus entry on Insulin support page as it gave me a lot more info than the paper that came with the medication.

 

Great I will add to profile thanks for tip. Actually just been making casual posts and trying to find time to get spreadsheet up and going until today when panic set in. This website is truly great.
Thanks

 

You are doing great, both of you! I feel like a noob, since I havent shot insulin in years.

Stickies are at the top of the board and are "stuck" at the top, thats why they are called...stickies!

If he is not over 100 at shot time I wouldnt give any insulin, my own opinion. I dont think you have enough info yet about how Oscar responds to Lantus. If he goes significantly higher then you might be able to give a reduced dose IF you will be around to test more.

 

also wanted to point out the stickies in Lantus ISG that can help you learn about the insulin, how it works , etc...

viewforum.php?f=9

the stickies are at the top of the forum with the stars next to them.

________
Questions for you --- will you be home to monitor him through his next shot cycle?

and from the time you had a last test on caninsulin and starting lantus -- did anything else change ??
his diet? other health issues?

____________
as far as tomorrow/next shot goes. depends on preshot.
He may spike up ( rebound) from going low -- but odd that he has not done that considering the last few days numbers. ... really want to know answers to questions above about diet changes, etc

In anycase, If it were my cat I would drop back to 1u (whether you are able to shoot or wait a cycle per below) and keep that dose ( unless. of course, that turns out to drop him too low) for 5-7 days. you can check out the protocol on the lantus stickie.

his numbers could still be less then comfortable to shoot w/o having any data to how he responds to lantus yet.
here are the guidelines on that please read :

IF YOU'RE A NEWBIE the FAQ section 4.4 applies:

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher. Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.


and please post back with numbers before next shot if you are able. someone should be around.
what time will that be? i can make a note to be back to check

eta: also please ask lots of questions !! :smile: we are happy to help you out.

 

Thanks - should have realized about stickies!
I will do preshot at 7.30pm and dose at 8pm if required 7.30pm is 2.13hours from now.
Maybe he may only need 1 shot of Lantus per day? Does that happen
Cheers Joan.

 

ok. i will check in then.... confused me with the time LOL -- thanks for the hours.

no lantus is not given 1x a day.
I know I gave you a lot of reading. but when you do you will read about the shed and see a *typical* curve and see why once a day does not work ( of course we have a saying on board -- in case you haven't heard it yet -- ECID -- Every Cat Is Different . there are very rare exceptions)

but Oscar might be a low dose kitty.

the reason I wanted to know about any food changes or other new health issues since starting lantus or in the time between your last testing with C. insulin is that perhaps his needs have changed.

you can see why, after tonight, testing is such an invaluable tool and saves lives !

I know the stickys are a lot of info and can be overwhelming -- we've all been there -- but so important to read.
this is a direct link to the "new to the group" sticky and has that typical curve example.
viewtopic.php?f=9&t=18139
you can see again how important it is to get preshots and to spot check/ do curves to gather data to understand how lantus works with Oscar.
it takes a little more work in the beginning, but the rewards are great.
and as said before -- please ask questions :smile:

 

When I brought him home on Caninsulin the vet suggested diabetic dry food .5 cup twice daily 1/2 hour before shot. I started (after a few days) feeding him raw meat and tuna as it sounded like a better choice after reading so i gave fresh and dry whilst on Caninsulin. When I changed to Lantus I strated by trying fresh meat and tinned tuna and found that I had to leave some dry overnight for him top graze on as he dropped so fast. I have attached a spreadsheet I have been keeping which tells food, water etc that may give you a better picture!
All sounds a jumble now but at the time made sense!

 

my mac does not like your attachment file so I can't read it

Changing food ( reducing carbs) can have a huge effect on insulin needs. I think that is what you are seeing. When starting a new insulin/ dose. is never a good idea to change food at the same time.
If you are shooting the right dose there shouldn't be a need to leave dry out at night to keep him up.
It means dose too high.

The tinnied tuna and fresh meat -- are you adding supplements -- like taurine to name just one ? so it is a complete diet? oh.. that's another thread altogether for those who make their own food to respond --- I never used a homemade diet.
there is some info on that at : http://www.catinfo.org/

ok back to Oscar's insulin needs. well lets still see what number he gives us at shot time. But he definitely needs less insulin.
( have you checked him again to see if he kept his numbers up? that would also help us see what direction he headed at ps)
But something else to consider is skipping any shot for a couple days --- need to let the effect of that 41 to clear-- and seeing how he does with food change alone( and no dry food) many cats can go w/o insulin on diet change alone. ( Important question--- has he ever had any problems w/ ketones? )

ok let's see what happens w/ his numbers. I'll be here.

 

God you are good! Thanks you for support. He has just tested 147.6 in your scale so I guess we are heading up before next dose - it is about 1.2 hours until next feed and about 1.7 until next dose. No I haven't supplemented raw meat (read the carnivore bit somewhere) so much to absorb about all this. I just thought it would be better to start raw meat, tinned tuna is his favourite so always a winner before dose and the vet loves diabetic dry food so covering all bases. I left him dry food last night as the day before without dry to nibble over night he started vomiting water and looked awful first morning after Lantus so I thought he obviously needs to eat o'night and he paces himself more with dry.
As you say I guess they are all different but it is hard gettting it right.
Thanks Joan

 

No ketone probs so far

 

good no ketones in the past.

i know you said you are out there in the boonies..... is there low carb canned cat food available?
It is really important that they get a complete diet with enough of the right nutrients-- otherwise he's going to end up w/ more health issues.
It really looks like your kitty *might* be able to be diet controlled.
but as I said you can't start this insulin and change the diet at first. if you're going to shoot you're going to have to keep out the dry. wondering if the vomiting overnight w/o the dry was cause he went too low.... or b/c of diet issues..... i'm betting on the low numbers.
and right now, unless you can feed him a balanced diet(eta-- in the near term), you need to keep in the dry.

If you think you can get canned for long term use or will eventually get added nutrients for your HM, it would be ok to go a couple/few days on the fresh diet sans supplements. (w/o dry{ But only short term.
and then you could skip shots and see if he really needs insulin. what do you think? I don't know what you have access to or what your sced allows as far as learning to make a *complete* HM diet.

I have given you soooo many things to read tonight -- gee my own head is spinning :razz:
I hate to dump more on you about nutrition.... it is such an important part of treating this illness.

any way you can get the low carb canned food until you can figure out the homemade????

ok waiting for more numbers --- great job testing btw !!!

and I'll think on it some more......

ETA-- will you be around all day to test/check on him?

 

Pre dose reading is 133.2. Shall I dose or not? He isn't all that hungry and belly seems a little bloated?
Cheers Joan

 

I would not shoot that number.

 

It is going into night here so if I dose him I may not see early morn results - sorry I will sleep sometime. Yes I do live out in the boonies and can't get more tinned food until Tuesday. I do have a small packet of Whiskas, Advance dry food that he has always had and the new diabetic dry food from the vet. I have all kind of fresh meat plus some tinned Tuna in springwater. I have given him raw meat and tinned tuna for tea (saved the whiskas in case I need it later) I can make gravy to add? Ok Just got your message I will leave food as is and not give him Lantus tonight. He seems happy enough.
Cheers Joan

 

that's after a hypo and honey and food.......

If It were me. not only would I not shoot this number. But I would see about keeping away the dry and NOT give any insulin for a couple days and test and see what happens.

Hopefully you can figure out the supplements to his homemade food or get some low carb canned in the near future..

please keep us posted on how he does today.
he could still spike up from rebound. don't worry about that.

 

It would be really good if we end up on just diet as distance is always going to be a problem.

 

feeding him your homemade until tuesday with lots of fluid would be fine. I'd try to stay away from the dry and not shoot.....

but please post back and we'll check out his numbers ok?

have a good rest -- you're doing great !!

ps --- re the bloated -- everything moving through -- stool in litterbox?

 

Cheryl, Thank you for being there for me today. I will do as you suggest and leave Insulin for a couple of days and test.
Cheers Joan

 

you're welcome.

can't wait to see how his BG is w/o insulin --- keep track of when he eats compared to when you test, k?

night.

edit -- ack ! i'm tired. I said w/o test I meant w/o insulin. hope you got that !!!
we still want tests !! love tests :mrgreen:

 

Stools limited today I guess due to drop in BG but he did do some early morn. I will test him again before bed and first thing in morn and post then (11 hours) from now. Gee time diff is a bit hard.
THanks again Joan

 

stool can be decreased with raw diet. and some kitties can get a little constipated when switch made. just something to be aware of.

yes. has been a long night. is morning here !

see ya soon !!

 

SO sorry I kept you awake, but so grateful.

 

happy i could help. someday you will be a pro and be able to pay it forward.

I have insomnia and am up most nights anyways. so no problem there !

 

Hi Joan,

I have been watching for a post from you! What an introduction to Lantus! You and Cheryl did a great job - hope you are both able to get some rest. The good news is that the Lantus really seems to be working well for Oscar. It looks like it is going to take lots of tests and fine tuning on your part, but he is responding very well.

I would suggest that you start posting for dosage advice on the Lantus Support group site: viewforum.php?f=9 They all use your insulin and have experience with different responses. They can give you excellent advice on dosage.

Did want to be sure and say that you will probably get a high number for your next test. It is to be expected, with the higher carb food and sugars. It isn't a "real" number - it's a response to the glucose in his system. So just warning you not to think you need to give more insulin. I would suggest when you get a number, go over to Lantus, copy this thread and ask about dosage.

 

memberlist.php?mode=viewprofile&u=284

Hi Joan, I've posted the url for a moggy called Big Mac. I think you could learn a lot from having a look at Big Mac's spread sheet. It starts at the top (latest numbers now off insulin) and works down - reverse of how spread sheets normally read. The initial problems with Big Mac were a little like what you've had with Oscar. I understand that Carolyn ignored what the vet told her with regards insulin and dropped the amount considerably. The dose she persisted with looked low to me but Big Mac is now in remission. You could try privately messaging Carolyn for advice. She helped david put LB's photo up on the sight.

Waiting to hear how Oscar is this morning....

 

HI Sue, Marilyn and Cheryl (if I haven't completely worn her out),
Oscar has tested 331.2 this morning so bg has increased a lot. NOt sure what to do after the rocky road of yesterday, I have posted Lantus site but if I don't get an answer soon I will dose small amount I guess. I haven't talked to the vet as yet but will try ands get her today.
Chers JOan

 

Good. Looks like you are getting responses on the Lantus forum. They will have good advice for you.