Rufus' inconsistent #s - Shoot?

Ooook, today Rufus tested 408 before breakfast, I didn't get a chance to test him afterward, but we gave his normal 2u of Lantus and his behavior was dandy.

Just before dinner, at about ten to six o'clock, he was at 78. We didn't shoot, and I tested him again at about ten after seven o'clock and he'd risen to 147. Being the wonderfully careless person I am, I didn't notice I was low on strips until I looked in the bottle this morning - I now have one strip left with fifty on the way. Should I try to test again soon (Mom [shot lady] just stepped out, so I'll wait until she comes back) and see about shooting then? I don't want to skip a dose - he missed one last Tuesday, but at the same time I can't have his time schedule swinging wildly since I'm not a shot-giver.

He's been so off (the numbers I'm getting, his skin) lately, but he's been acting fine. He bathes regularly, he watches the outdoors at the window seat, and he demands plenty of nernies and attention. I just don't get the 408 to 78 drop. Geesh, this certainly is an adventure, isn't it? :?

 

hi.
I just went back and read your previous posts. You were given some great tips.
Have you checked out the links on using lantus yet?

it would be fantastic if you could create a profile on google docs
instructions and form for profile creation are here: viewtopic.php?f=6&t=17766

information that you will supply there will include what kind of insulin, how much , when dx'd, what kind of food, etc....
you can then put your profile in your signature ( instructions for that also at the above link )
that way it makes it easier for those trying to get to know you and help you w/ your kitty to have all that in one place.
AND as others have suggested, starting a spreadsheet for Rufus's numbers is invaluable to you and your vet and the folks here. instructions on that are here: viewtopic.php?f=6&t=18207

I know it is all rather overwhelming at first. we've all been there !
the more information you can share via those tools the better we can answer your questions .
when you give us a number and a time that doesn't really tell us much unless we know how far away from the shot that number is. so instead of writing the time you would post a " + " sign and the number of hours past his shot. (so if that 550pm time was at six hours past his last shot it would be +6 78) a preshot number would be posted as either AMPS or PMPS.
so it would of been
AMPS 408
+6 78 <<<< of course I made up that 6, don't know how long that was after shot ;-)

on the ss -- it lays it all out in a nice form for you to do that and keep track.
But until you can get that ss up and running, please try and post your numbers that way so
we (including you ;-) )can understand how the insulin is working w/ Rufus.



now..... for the running out of test strips issue.....
Questions ---
how far from ps were the numbers you posted ? how long has he been on lantus?
the 78 is a lovely number, but if we don't know where it was.... well he could of dipped much lower.

If you only have one left and you don't know how low he has been getting , you might wish, instead of skipping a shot, slightly lowering the dose. (say to 1.75 or 1.5 ) what is your comfort level?
It's so very important to test before every shot.
That still only leaves you w/ one strip ( or none after your pmps) until ???
can a family member or friend run out and pick up a small amt of strips at an all night drugstore ( or first thing in the am) for your meter -- or buy another meter that has some strips in the box and is free after rebate. or pick up a relion meter at walmart ?? the strips for that are less expensive.
cause that one strip may give you a preshot for your night dose, but you don't have anything for the morning or to check him if need be inbetween. --- esp since you don't know how low he has actually been going.

post back and let us know about when in the cycle those numbers were and how Rufus is.
sounds like he is a lucky cat to have you and your mom care for him.

welcome to the board !

 

Thank you so much for doing all that work and replying. It is just a tad overwhelming, but I figure I can tackle a little at a time. The profile is done easily enough, although there are several things I can't remember. I've read about the spreadsheets, too, but I wanted to really get the hang of testing before I set one up. My meter uses software that creates them, so it will definitely be easy to input all that saved data manually - right now I have less than ten successful tests to report, but that's a start! (I just have to keep telling myself that Rufus is doing rather brilliantly well for squirmy worm of a cat - no yeowling, no biting, no hissing, no scratching).

Technically those numbers came from the AMPS (408), PMPS [+12] (78) and then what would have been +1 (147)... if that doesn't confuse anybody. We didn't wind up shooting anything but a sliver of Lantus from a u100 syringe at +4 hours - which I finally just up and did. I don't like the idea of being unable to administer insulin. It's unfair to both Rufus and Mom.

I have read extensively on Lantus over the approximate two years he's been taking it, but I hadn't really found the resources I needed until I started paying attention to the FDMB. What I really needed was other Lantus users (who would know better than a Lantus Mom or Dad how to keep a Lantus Boy or Girl on the steady?), and they popped up quite readily when I asked my first round of questions.

When Mom stepped out, she was going to pick up a prescription and a few things at the grocery store, so she also picked up a small bottle of strips for me (with much sighing lol). I feel much better about life in general with those babies where they ought to be.

Rufus was fine last night, thankfully. but this morning - possibly +1-2 hours past shot (Mom woke up earlier than I did - she hasn't tried testing on her own yet, and she's not as concerned about his numbers as I am, so she doesn't pay too much attention to the time, etc.. In other words, I don't know the exact time of his injection.) he was 367. Either he hadn't hit the onset when I tested, or it was a furshot, I figure. I'm going to try to test again very shortly. I'm wondering if I should inject if he's still climbing.

I know those numbers looked awesome last night - possibly even like he's lowering his dependency on insulin - but the morning numbers concern me. I probably should have stayed up/woken up last night to check him.

No wonder Rufus has been unregulated for so long - Diabetes isn't "easy", plain and simple. All the vets here seem to give off that impression, though. I wish my grandfather (retired veterinarian) weren't old and senile - he always gave the best advice. ohmygod_smile

... I'm sure there's something in there that I've forgotten to articulate on, but I suppose I'll figure it out in a little while.

 

Hi Bee

good job getting your spreadsheet and profile going.
I just wanted to let you know, you are more than welcomed to start a thread in the Lantus forum as well if you need extra eyes.

Lots of info in the information stickies too about how Lantus works.

I'm adding an example of a curve chart here to help you with testing and if you'd like to do a curve when you have some time.
You can find in the Lantus forum stickie New To The Group
I've included all the links for Onset, Peak, Duration etc highlighted in bold blue:

Learn how YOUR kitty is responding to insulin:
Onset ---> the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir ---> the lowest point in the cycle
Duration ---> the length of time insulin continues to lower blood glucose

How to do a Curve: you don't have to test every hour. Typically curves are every 2 hours in a 12/12 cycle. Or a mini-curve, about every 3 hours.
Depending on where the numbers are, you may have to re-test frequently and offer food to help steer numbers.

Example of a typical curve:
+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 (may dip around +10 or +11).
+12 - PreShot number.

Carryover ---> insulin effects lasting past the insulin's official duration
Overlap---> the period of time when the effect of one insulin shot is diminishing & the next insulin shot is taking effect
Insulin Depot ---> (aka "storage shed" in Lantus Land) "spare tank" of insulin, which has yet to be used by the body
More on the Shed ---> Lantus & Levemir Insulin Depot AKA Storage Shed

In the meantime, keep posting your updates. And welcome to the FDMB!

Have a good day!

 

hi bee, sorry i didn't get back to you yesterday. I am fighting off a cold :sad:
I'm glad ronnie was around to give you some great info.

Fantastic job on Rufus' ss and profile. thanks for doing that !

I did want to quickly comment on one thing you wrote :

I'm glad ronnie posted a *typical* curve for you . ( we do have a saying on board ECID --Every Cat is Different)
It will give you a good idea what to expect and look for .

If you have already shot -- even if you *think* it was a fur shot --- you never know how much got in or not and best to error on side of caution w/ a fur shot . It is not good to shoot again until the next sced. time.
once you get on a reg 12/12 sced. try to stick with it and then test away and get a curve or mini curve so we can see what's going on and you can do some tweaking.

of course, since you had a low ps number , you were wise in delaying shot until you have more data. ( or cutting dose per my other post)
in fact there is a sticky in lantus isg( hey there are stickies for everything ! ) about getting data ready to shoot lower numbers.

Can't wait to see more numbers for your pal --
You are doing a great job !!
please keep asking any questions you have. that's what we are here for.

ok it's btb for me .

 

Thanks for the welcomes everyone, and sorry to hear about that cold! (Had one myself not long ago. I think the nose is still healing).

Thanks for all the information, I know it's all right there to look at to begin with, but it kinda helps to keep having it nudged in your direction when you hit a stumbling block.

On a feeling-guilty-for-sounding-so-nasty note: I correct myself. Mom cares just as much about Rufus' numbers, she just hasn't quite absorbed the concepts yet. That, and I think she's just a bit reluctant not to follow the vet's instructions - loose as they are. I think it comes from being a vet's daughter. (We're workin' on her.)

I didn't shoot, thankfully. The Furshot rule occurred to me once my head cleared. I got the much nicer number a few hours after I first checked and I attributed the high to being pre-onset. His PMPS last night was a nice safe-shooting 210, so I gave him 2 units. This morning his AMPS (which I had to fight tooth, nail, and bonito flakes for) was 235 - another 2u. I know I could have bumped it up a little, and his vet actually wants to see another unit in him in the AM, but I was reluctant to go higher without a solid dose of "yes, you should". I don't want to start pumping in insulin like his little (*snort*) body has never seen before.

One problem I'm encountering is sore ears, I think. I have difficulty getting blood from his left ear, so his right ear has been poked more than a pin cushion. He won't keep still afterward, either, so forget about me preventing bruising. :-| I probably need to warm up his ear better. Fingers clearly aren't working well enough. Doing a curve with those poor little pointy ears like that just sounds mean.

 

You're picking up knowledge and getting good practice -- you're getting good advice -- keep reading and learning.

One comment I'd like to make ....

if you don't give a shot at +12 (normal shot time)... the timer keeps ticking, so your next +1 test is really a +13 test (hours from last shot)

so in the spreadsheet, you might note +13 for the PMPS time or put in comments - shot given an hour late

Since I was giving insulin TID for a while, I made a spreadsheet that had 24 hours and I made a new row for every shot

So... one shot was +8, one shot might be +10, the next might be +7 (using PZI insulin -- shouldn't shoot TID with Lantus or Levemir)
and every other day or third day, Norton would be too low to shoot --- so we'd get up to +15 or so.

Anyway -- you can start with the "standard" template and customize it as you like.

 

It does get kind of confusing once you miss that shot, lol. I'm ordering a 24 hour appointment book to keep track of Rufus' schedule in hard copy, so maybe that will help me orient myself better in the spreadsheet.

That being said - I'm not quite sure if you're making a hypothetical situation there, or I somehow messed up my spreadsheet. Rufus hasn't had any shots an hour late - but he has had one 4 hours late. I updated just now and sort of translated the data in the comments section of that day's grid, just to make sure that the dosage was noted. It reads: .5u given at +16 ("PMPS +4"), 10:45pm. I hope that's correct. To be honest, my forte is language, I have to concentrate really hard on the spreadsheets, lol. I know the goal of posting the spreadsheets in the signature is so that people can help each other, though, so I really need it as accurate as possible. Oy.

Head + wall = conk! ohmygod_smile

 

you did the right thing. lantus is dosed on the nadir NOT the preshot. see that number you had that you felt too uncomfortable to shoot? and those other numbers on your ss that were in the double digits ???
there is absolutely no need to raise his insulin right now and in fact it would be dangerous to do so until you have more data. when you get to reading ( i know you have been reading a lot already and is hard to take it all in) the protocol for using lantus you will see that taking a big jump up 1u is seldom done. and certainly never w/ a cat who's +6 the other day was 102. both shots are usually the same dose in order for lantus to work correctly. ( see the info on the shed/insulin depot on the lantus stickies)

I know you switched from another insulin? am i remembering correctly? when did Rufus first start using lantus? how long has he been on it? Important to know . Thanks.

as for his ears. don't worry. I poked my Winnie's ears for ears multiple times a day. didn't hurt her a bit and she was just fine with it. if he is not holding still for you to apply pressure after -- can you distract him w/ a treat( low carb of course ! )

I think it 's great you mom is helping out. It's good to have support and back up for each other .

best,

 

Rufus began using Lantus (after using PZI Vet)... I want to say a year and a half ago. I'd really need to get a hold of his veterinary records to know for sure. Actually, I'd really like to get a hold of those records, period. (My medicine makes me have Swiss cheese for memory).

I remember him doing really well on the Lantus for about a week, and then just going splat. His coat flattened out, the dry skin started coming back, and he became anxious and unsociable - something I've come to attribute to his levels being off. I'm really hoping that the hometesting will show us either the right way to treat him - or that we need another way to treat him, even if I have to throw a tantrum to get it. :lol:

And thanks for the back-up on those ears. In all likelihood he's just being a baby about the whole thing. I had trouble getting blood from him one night and it sort of shook my confidence - he's been a little booger about it ever since.

(You know, there's a problem with those treats! I keep them near me and he makes grabby hands at them while I'm trying to get a good spot on his ear. He's full of beans, really.)

I agree about Mom. She has never-ending patience and a whole arsenal of other great stuff to offer up in times of need. :mrgreen:

 

thanks for the info. I wanted to make sure that he has been on a while and this is not shed building time.
I am of the mind that it is always good to have a copy of one's cat's medical records.

since you have had numbers you have not felt comfortable shooting. you might think about sticking with the 1.5 dose for a few days --then doing a curve and see how Rufus is responding . We know he is getting some pretty numbers, but with the late shots,skipped shots and reduced shots it kinda muddies the waters .
lantus is best used on a consistent dose and 12/12 time. It's too hard to really tell what those numbers you have so far mean b/c of the adjustments you have made ( and I think they were certainly good decisions at the time). We just don't have enough data yet and don't know how low he really has been going.
Then depending on his curve ( he needs to be on the same dose for 6-10 cycles or 3-5 days then do the curve) , you can see where his nadir is, and tweak his insulin if need be. what do you think?
of course your ps numbers and spot checks are important to continue to get in the mean time.
(is late/early so I hope this makes sense -- remember to ask any questions you have !)

was wondering if have you given any thought to posting over in lantus isg now that you are getting good a testing?
over there it is a group of lantus users -- who support each other in the use of that insulin and help each other evaluate the numbers. you can at least take a look see how things work over there and see if you would be comfortable doing that.
and If you do post over there -- I'll find you !

Hope you and Rufus have a great day and I'll check back in later in the day and see how you guys are doing.
I like his picture. He looks like a real sweetie.

ps. also wanted to make sure that you put together a hypo tool box. ( yes there is a sticky :mrgreen: lol )
esp important for lantus users to have some high carb canned food ( think grilled fancy feast flavors in gravy kinda thing . It's a fantastic tool to help you control the numbers .

you're doing great !!

 

Ah! Thanks so much for the backup. I already posted this morning's debacle without reading this post - Whoops! You addressed most of my concerns here. I know I need to go over to the Lantus board, but when I see the numbers in those subject lines I get dizzy. :?

I'll see about hanging in there with the 1.5. I'm completely blown away by the nadir-dosing. To be honest, after this long, I really think Lantus is not the insulin for either Rufus or myself!

 

you're welcome. that's what we are here for. some day you will pay it forward !

Yes lantus land can be a little overwhelming -- I hear you.But you will be fine.

There is a lot of info to take in and it can be scary when you first start to dose via nadir . When you hang out in LL you will be able to see other members "condos" and their numbers and know you are not alone.

And I disagree with you -- I think lantus is working quite nicely w/ Rufus and it will turn out to be a good insulin for him. It takes time, not just to get his numbers where you want them to be, but also for you to have a comfort level w/ using insulin. Even though you are not new to using insulin , including lantus, seeing the numbers is -- esp ones that are lower than you thought he was getting. That's a good thing. Remember, you and your mom have been giving Rufus this insulin for a year and 1/2 --- you were still getting those numbers ( at least recently-- they probably changed over time) you just didn't see them before. Maybe if you think of it that way it will feel better? Especially b/c I hope you feel more in control of his care w/ the numbers. before you were shooting blind. I offer my congratulations to you for stepping up to the plate !

I think the lower dose and keeping it regular per prev post will show you numbers that will make you more comfy and let you see how lantus can work w/ Rufus. Keep on !