To much insulin?

Hello all!

My cat has been stable to 1 - 1.5 units for a while now but today i don't know what it was but i think I gave her a unit over.. 2.5units.
I checked her level an hour later and shes still on the mid 100's.
Am i in the clear or can she dropped extremely because of it?

Im not sure if it was the right amount or 2.5 units....

Im a bit nervous .. Is it a small amount that she should be ok? or still watch her? nailbite_smile


Edited to remove 911 icon.
Carl

 

shes on lantas and her first reading was 114 .... her second an hour later was 145

 

When did you give the dose? Lantus works for twelve hours (sometimes 14) and doesn't really kick in until after the second hour so I would keep checking, especially mid way as you approach hours 6-8. How low does she normally go and when does she normally do it, do you know?

 

normally she gets her insulin at 8:30am and 8:30 - 9 pm .. im not sure how low she normally gets but by next morning shes still in the 100's...
she only got as low as 57 during xmas time and i skipped the dose and the next day she was in the 300's .. but usually she stays at 1 - 1.5 units..

 

So you gave the shot when? 90mins ago?

 

around 8:45- 9pm was her shot.. its been a half hour to 45 min

 

she was supposed to get 1.5 units today

 

Ok so you gave her 2.5 units less than an hour ago? So when were the 114 and 145 readings taken?

 

no, she got her first dosage in the morning at 8:30am - 1.5 units and her reading before the dosage was 103
then her second reading was at 8:45 which was 114 and she was supposed to get 1.5 again.. when i gave her the shot, it was about 8:55 - 9pm but i think i gave her 2.5 instead of 1.5.. a half hour after the dosage and dinner i tested her again and she was at 145 ..

 

Ok so her reading tonite after the shot was 145 right? As I said, lantus usually kicks in after two hours but why don't you check now to see where she is and let me know? Do you have syrup or a high carb food in the house just in case?

I would also check her at 11pm to see if she is starting to drop. Then I would do spot checks for the next 12 hours, and be ready to give syrup or high carb if she starts to go low. Lantus tends to take maximum action around hours 6-8 so I would set the alarm for 3am to check her then as one of your checks.

 

Yes i have honey in the house that i can rub on her lips.. yes i would put the alarm and check again.. I will also check at 11 and let you know her reading.. right now she seems fine.. laying next to me in bed like usual while watching the dog act silly hehe..

I hope my mind is so used to giving her 1.5 and i did it with out thinking and im just making myself crazy... i always make sure the dosage .. i dont know what was on my mind... :-|

 

Well let's hope so. She might be fine now but a hypo can hit fast. Let me know how she is at 11pm. If she is dropping fast you might need to do more tests than just 3am but let's see how she does.

 

Thank you! Should i check in 30 min aswell? it will make it an hour and a half

 

Just tested her now and shes 74 ----- 11pm

 

Ok I would stay up and measure her in another hour. I dont like how fast she is dropping. The problem is you dont know how low she normally drops, whether she levels out here or keeps dropping. Please change your icon on the first post to the 911 icon. I am going over to the other forum to get some advice and eyes on this.

 

ok .. i will test again in an hour and let you know.. thank you

 

Keep checking here, the others may want another test before then.

 

Hi everything okay? I'm sorry, I don't know your name...

When and what has your kitty eaten since you gave the shot?

Carl

 

What is your name, please?

Wendy posted in lantus so I popped over.

First, let's talk in terms of time since her shot because we are all on different time zones. So one hour after her shot is +1, two hours is +2, five hours is +5, etc.

Did you feed her after the 74? If so, what carb food and how much? I'd like you to test 30 mins from when she ate and then post it as the number of hours since her shot. So if her +2 was 74 and then you fed and tested 30 mins later, it would be +2.5.

Standing by.

 

Re: To much insulin

74 was PMPS+2 which was 11pm EST.

 

hypo protocol for reference

If you did a full unit over her regular dose, I would take her to an ER because I'm not sure you can feed your way out of this. My housemate overdosed Spitzer (misread new syringes) and we had to do that.

 

If I'm reading this right...

AMPS (1.5u) 103
PMPS (might have been 2.5u but not sure) 114
+.5 145
+2 74

 

Thanks, Carl and Wendy. That's what I came up with, too.

 

I havent checked again since 11pm. I am now waiting till 12am
Sorry didnt mention our names.. My name is Crystal and my baby is Luscious

she ate her fancy feast chicken since the shot at 9pm.

I havent feed her since the shot. Only given her a treat for letting me check her level... should i?

 

First, please test her now and post her number. And yes, you should always feed her at shot time at least. Lantus kicks in about +2 and she should have food on board before then.

So please let us know her number by testing now. Thank you Crystal.

 

Ok i will test her now..
sorry i wrote it wrong.. She did eat after her dosage.. I always give dosage during her eating time..

 

Well, test her now and see what you get.

When you see a decent drop this early in the cycle, feeding can slow things down.

Do you have anything besides the low carb stuff?

Nice to meet you Crystal and Luscious :smile:

Carl

 

Ok shes 45 now

 

i have her normal Fancy Feast and honey i can rub on her lips and i have her old hard junk food she used to eat

 

Do you have anything like fancy feast gravy lovers? If so, I'd like you to give her two good tsps of gravy and retest in 20 mins. If you don't have any food with gravy, do you have any high carb food? If so, give her a good tsp of that. If you only have low carb food, please add a drop of syrup or honey to the LC and retest in 20.

Please do not give any dry food. It takes too long to kick in. See you in 20.

 

Got any HC food, something with gravy? If so, give her a teaspoon, mostly the gravy. It will help slow the drop. Don't stuff her though. She might need a bit more in a little while.
And test again in another 20 minutes?

Carl

edit- just saw your response.....take a teaspoon of the normal FF and put a few drops of honey on it. I'd stay away from the dry food. It takes too long to digest and inflate the numbers.

 

ok im going to do the FF with honey now .. Half a can then?

 

That's fine.
This is okay, Crystal. You may not have had to deal with early low numbers, but we have, so we're here as long as you need us. ;-)

 

I'd be careful on the half a can....you don't want her to get too full. Lantus is a long acting insulin and a dose can affect numbers for many hours after. You might be feeding her for a while. So just a couple tsps and a couple drops of honey/syrup.

 

AMPS (1.5u) 103
PMPS (might have been 2.5u but not sure) 114
+.5 145
+2 74
+2.75 45

 

thanks guys!! :YMHUG:

im nervous now .. Oh boy....
ok so i just gave her the FF half a can and a few drops honey... Not alot to over power it but two good squeezes ... should i put more? or give more?

 

I would wait and test again in 15mins. And grab yourself a coffee. Looks like she wants to keep you up.her blood will probably hopefully rise now but she could come down again fast.

 

oh no! saw this to late... i gave her half but shes always happy to eat lol...
next time one ill do a a little less

 

With that 45 at 2.5 hours post-shot, I think you did give her an extra unit of insulin.

I'm concerned about this and think you should go to a vet. Call ahead if you decide to go.

A vet can put in an IV of dextrose to match the insulin faster than trying to feed her.

Can someone drive while you monitor and give honey if she starts to seizure? If not, I'd leave now.

 

Hold off on feeding more right now. Each test will determine whether she needs more food. You want to give this serving time to hit her system to see what it does.

You'll want to be testing about 20 minutes apart for the next hour.

Carl

 

Crystal,
Do you have tomorrow off? If so, the coffee Wendy suggested is a pretty good idea. Luscious may or may not be giving you low numbers for several hours. But we won't know that until later, lol.

Carl

 

No i dont work tmm... guess im sleeping in lol @-)

yes i have someone that can drive incase.. i'm hoping she can get her number up before we have to go to that step ... FIngers crossed

 

Crystal

It's ok...just breathe and be calm. We are very used to handling low numbers and I will not hesitate to send you to the ER if I think it's necessary. Carl and I tag team to help new members quite often so we are on the same page. Let's see where she is next test. We will stay with you until she is safely up.

By feeding her with some honey, we are having you abort the cycle. We often do this. Tomorrow, I will want you to decrease her dose to 1.25u, ok?

 

If you get the numbers up and keep them up, great.

I'm a big believer in contingency plans.

 

Sounds good I will decrease her .. everyone is always so helpful when im panicking on here lol ...
was the next test supposed to be in 15 min or 20min?

 

You are going to be testing soon, let's see how it goes. You might have a sleepless night though to keep on top of this. In between tests you should check to make sure your local vet is open. I think the next test is in 2 mins.. 12.15 right? 15 mins from the food you just gave.

 

20 mins from when she ate. And let me clarify on the dose. She needs a reduction by .25u so if you have been consistently shooting 1.5u then the new dose is 1.25u. If you've been shooting 1.25u, then it will be 1u.

 

I agree with Marje.
She and I have done this sort of thing a few times in the last year or so. She's a great tutor!

Tomorrow, we'll also start to work on you setting up a spreadsheet for Luscious' numbers, and making sure you have a well stocked "hypo kit" that includes medium and high carb canned food.

I'm a fan of every 20 minutes, because I think it takes that long for the food boost in the BG numbers to show up.

 

Ok i got to get it at 18 min - just saw the 20 min one now..
She went up to 54

 

I agree, BJ, contingency plans are great to have. You should always have an emergency vet contact number on the fridge or next to the phone, just in case.

Carl

 

AMPS (1.5u) 103
PMPS (might have been 2.5u but not sure) 114
+.5 145
+2 74
+2.75 45
+3.3 54

 

Nice...I'm glad she's coming up.

Crystal...it's still early in the cycle and onset could be when she dropped or she could be one that onsets at +3. Also, the honey will wear off so I would like you to go ahead and give her more LC food...about one tbsp with another drop of honey. Again, I want to abort the cycle because she has earned a reduction and I would like her a little higher.

After she eats, please retest in 30 minutes and post. We will be waiting. You are doing really great.

Luscious doing ok?

 

yeah sorry im not used to the hour number stuff ...

Ok i will give her a little more food with honey again and test in 30min..
Luscious is doing good.. watching me because her can is open lol... she sure does love to eat lol

 

OK, Crystal.

That would make your next test right at the stroke of 1AM, which should be her +4. We'll keep an eye out for it.

Carl

 

Crystal

While we are waiting, can you please give us an idea of your dosing? Have you consistently been giving 1.5u and for how long (how many cycles if there are two 12-hour cycles in a day)?

Any information you can give us as to your dosing strategy and the kinds of numbers you've been getting will help us. Thank you.

 

She gets two 12 hour cycles..
Shes only been on insulin since 11/11/2012
i usually test her and go by a chart my vet gave me .. you have to follow from your last dosage ..
+216 - increase .5 units
100-216 no change
80-99 decrease .5
60-79 decrease 1
-60 skip dose

since 12/8/2012 shes been maintaining on 1 unit .. or 1.5

 

Oh gosh...no disrespect to your vet but that is not the way to dose this insulin. We don't use sliding scales, we don't dose on the preshot....is that the number he's asking you to dose on in that scale?

After this next test, I have some other questions for you if that's ok. See you in a few.

 

ok
+4 is 88

so its
AMPS (1.5u) 103
PMPS (might have been 2.5u but not sure) 114
+.5 145
+2 74
+2.75 45
+3.3 54
+4 88

 

88 is great!

Rather than ask some of the same questions Marje is likely to ask, I'll hold off on that for now. ;-)

Carl

 

yeah he says to test before i give dosage.. they started me on .5
and depending the numbers i will up it or lower it ..

example: if she was on 1 unit and goes to 280 i will up it .5 so she will get 1.5
and next 12hrs if shes 218 up again .5 so it will be 2.00 units
and then the next 12hrs if she drops to 85 then she drops .5 and gets 1 unit
and the next 12 hrs if she drops to 50 i skip dose and the next 12 hrs i start again at .5

sure you can ask me anything

 

Great! How is she doing.....is she still hungry?

You are at +4 and that is still early in the cycle. The 88 is from the honey/syrup. My guess is she will come back down as she gets to her nadir but without data, we don't know if her nadir is early or later.

If she's still hungry, it would be good to give her another tsp or so of food only to see if we can get her to just hold her numbers. Then test in another 30 minutes.

Is she doing ok with the tests?

 

YAY!! :RAHCAT
so should i hold on the next honey?

 

See my above post. Sometimes we cross post so it's always good to scroll back to your last post and make sure you've read everything.

 

Shes doing good.. Sleeping right now .. shes doing good with the shots since shes getting all these treats lol

ok so give her some more now? and test at 30? or wait before i feed her honey again since shes not asking?

 

Feed another tsp of LC and test in 30. I want you to stay on the tests right now. And the food is important o try and keep her from coming back down it we want to be careful so she does not get sick.

Is she a vomited or does she do well with food, etc. any health issues we should know about?

 

no shes not vomiting .. shes sleeping right now... should i add the honey to the FF? or just the FF no honey?

 

Crystal

It's important to read through the instructions carefully...no honey right now. Just food. I don't want to make her sick and want to see if she can hold with just food. If you wait too long to feed her, she could come back down.

Have you fed her the FF?

 

ok got it... Just gave her the rest of her ff .. was about a table spoon left .. is that good enough?

 

Crystal,
How's your supply of test strips?

Carl

 

Time for another test by my watch...

Carl

 

You have more food at home, right? And as Carl asked....how many test strips ?

Waiting for next test now.

 

I fed her at 1:30 . I have about 20 min left to test
im running a little low on test strips but ill have to buy tmm

i have food, yes

Shes doing well.. Ate and went back to sleep ... Lucky her lol

 

Crystal,
You may have misunderstood given all the excitement... but you want to test every 30 minutes whether you've fed more or not. I think the last test you did was at 1am, so you could have tested at 1:30 as well, then again at 2am

carl

 

How low on test strips? Can you send someone out for more? If you don't have about 50 strips on hand or can get them tonight, then you should consider a trip to the ER with her.

Lantus overdoses can last up to 16 hours. She might go up, come down, go up, etc. we will have you testing alot until she is safely way up. If you don't have strips, you need to go to the ER.

 

oh ok...
i thought it was every time she ate
Ok i tested her now and shes 113

AMPS (1.5u) 103
PMPS (might have been 2.5u but not sure) 114
+.5 145
+2 74
+2.75 45
+3.3 54
+4 88
+4.3 113 (did i add the hour right?)

 

Did you see this?

we want to test every 30 mins whether you feed or not. Could you please let me know when the last time you fed her?

 

AMPS (1.5u) 103
PMPS (might have been 2.5u but not sure) 114
+.5 145
+2 74
+2.75 45
+3.3 54
+4 88
+4.75 113 (it's been 45 minutes since the 1am +4)

Carl

 

i feed her at 1:30am last

 

i have someone that can go get me some strips when i run out

 

You want to send them before you run out for sure.
They should also pick up a couple of cans of high carb gravy-style food.

Carl

 

Crystal

I'd like to lay this out for you now that she is up a bit.

1. Lantus overdoses can last a very, very long time
2. We don't have any data on what you've been shooting, what kinds of numbers she's been having mid cycle, etc
3. You don't have many test strips
4. It's possible if she comes back down and we are feeding and giving honey, that she will vomit. Then we have a problem.
5. Hypos are very serious and can be life threatening. She can come back down on us at any time and quickly. Sometimes they do not respond so quickly to honey as she did earlier.

She is at a safe number now and you can safely transport her to the ER. My recommendation is that you take her now.

 

I think I have to agree with Marje. If this were just a "normal" low number early in the cycle case, I'd feel confident that things would continue to go just the way we'd like them too.

But with no hard data to know what/how she's reacted to low numbers before tonight, and not positive exactly what the dose you gave tonight was, it's impossible to say if this is a short or long term fight you have on your hands in keeping her numbers up safely. You'd have to stay up all night to be safe.

Carl

 

yeah im going to test her again and she wear she is .... then decide what to do...
Oh boy am i never going to do this again!

Thank you guys for helping me so much!

 

shes at 194 now
tested her at 2:23

 

OK, after all the dust has settled, and you can get back to "normal", there are three things I'd like you to try to do.

1 - buy a couple cans of medium and high carb food for your "hypo kit"
2 - try to set up a google spreadsheet so you can record all the numbers. That is a huge help to you and to anyone who looks at it. It makes this soooo much easier and less stressful for you.
3 - let's try to help you figure out a better dose plan than the one you're using, where there's dose consistency based on the mid-cycle and nadir numbers and not on the pre-shot numbers.

Those 3 things will really, really help you out. :smile:

Carl

 

AMPS (1.5u) 103
PMPS (might have been 2.5u but not sure) 114
+.5 145
+2 74
+2.75 45
+3.3 54
+4 88
+4.75 113
+5.4 194

And the last time you fed her, it was at 1:30 which would have been at +4.5, correct?

Carl

 

yes ... i fed her at 1.30 (4.5)
Thats good right? a hour after feeding and shes going up

 

Yes, it is good!

I think I would hold off on more food, and test again 30 minutes after this latest test (so about 2:50am)? Let's see what Marje thinks first though...

Carl

 

Yes but I'm still concerned about the lack of strips.

 

Crystal,

What kind of meter are you using? How many do you have left? And is the store you buy them at open 24 hours?

 

Crystal

Some info for you about using lantus.

Lantus is a depot insulin and it works best for your kitty with consistent dosing. We typically hold doses for six cycles and then reevaluate to determine if dose needs to go up or not. Specific numbers warrant reductions. We usually only increase and decrease by .25u (unless BG is really high) so we don't miss the fitting dose.

We dose primarily on the nadir with some consideration of the preshot. I've seen cats be 300 at the AM preshot, 40 at mid cycle, and 300 at PM preshot. If we dosed on the preshot, the cat might possibly drop even lower than 40.

On this board, we live feline diabetes 24/7. Vets do not and they do not typically stay on top of the treatment for FD. We follow a protocol based on scientific research which was published in a veterinary journal. Most vets are happy for you to keep the cat above 200. But for some cats, above that number is above Renal threshold where they dump sugar in their urine putting them at increased risk of urinary tract infections. Those of us using tight regulation, aim for our cats to be in the 50-120 range.

Luscious has the potential to go into remission and tight regulation is the best way to get there and w can help her and you. I hope you will at least understand that dosing on a sliding scale is not how this insulin works and it is important to get preshot and mid cycle tests. For those who work, we can help with other test times.

Please let us know what you wish to do tonight.

Edited to add: I'm signing off now...I've been sick and am just starting to recuperate. Carl is going to stay. You are in awesome hands. Good luck.

 

Still here, Crystal. Hoping everything is ok?
Carl

 

Crystal
I'm thinking you either brought Luscious to the ER, or gave in to exhaustion..

Please let us know how you're both doing when you see this.

Hope you're fine,
Carl

 

Just saw this thread. Hope everything is OK..?

 

Oh geez i had fell asleep on the sofa ... she was by me the whole time. Woke this morning to test her and she was at 410 - she just had her breakfast
Thank you all so much for helping me!! Im so happy she got back up and i didnt have to rush her to the Vet.. She gets extremely stressed at the vets.

i believe she should be fine now .. had me so scared! thank you again!! without you guys i would have been lost

 

so i will determine the dosage by nadir? how will i know how much to up her or lower her?

and thank you also for all your help! you guys have made me calmer then i would have been by myself at this

 

Just saw this thread this morning....Boy what a wild ride you had last night but you did great!!!!

Now to answer your last question...With Lantus you hold a dose for several days usually 3 to 5 days and then run a curve (testing every 2 hours between shots) it is that nadir that you base whether you go up or down. Now that things are calmer I highly recommend that you move over to the Lantus TR group and read all the stickies over they will tell you exactly how to raise or lower a dose based on the results of your curves. With Lantus preshots are only use to decide if they are high enough to give insulin to in the first place. Dose raises or decreases are based on the nadir (lowest point in the cycle).

When first starting out and not having a lot of data we recommend you don't give insulin if they are under 200 at preshot. Many of us do shoot under that 200 mark but we have months and months of data from testing them at home.

And always when in doubt you can post here and just like last night someone will help you out.

Mel, Maxwell, Autumn & The Fur Gang

 

Just a few corrections to what Mel said. We don't necessarily have you run a curve after 3-5 days at a dose. Spot checks work just fine for us to see what is going on. Starting out, we would have you do a preshot, +3, +6, +9 and then we would have you spot check a few other times the next cycle.

Also, for tight regulation, we advise our new members to post if they get a 150 or below and let us walk them through it.

We urge you to start a Spreadsheet as soon as you can and fill in as many numbers as you have so we can help you figure out a dose.

If you have not shot yet this morning, I'd go ahead and shoot the 1.5u because she is so darned high. That will help a little with that bounce.

And could you please take off the 911 for us? All is good and it will continue to draw more people who could be helping someone else since the emergency is over.

Thank you so much, Crystal, and I hope we see you in the TR forum.

 

Wow what a night you guys had. A what a great job Marge and Carl did!

 

Your vet had you giving Lantus on a sliding scale and that is incorrect.

The ideal dose of Lantus can be given every 12 hours and doesn't take the glucose too low. The Tight Regulation protocol for finding that dose is explained here.