When should I reduce insulin?

I just switched to all wet food for my cat 3 days ago. Since then she's been pretty close to 200 (on an Alphatrak) at her AM shot times, so I've had to delay that shot for an hour each day. Yesterday she was also at 200 for her PM shot. Doing her shots later is also difficult because I need to be at work and any longer than +1 means I need to make a call to give her a lower dose or none at all for the whole day.

When does it make sense to tick her insulin down again? Or should I only reduce it if her nadir is too low?

 

Generally, we suggest an initial "no shot" number of 200 until you have enough data to shoot lower, and then gradually reducing it down. Some of us will shoot anything above 50, but that's only after a LOT of testing and knowing how our cats respond to both food and insulin.

A "no shot" number doesn't necessarily mean you don't shoot either. It means if you get a test below 200, you should "Stall", DON'T feed and post and ask for help (making sure the subject line says something like "Stalling, please help!")

If you can't do that, or the board is down, you can retest every 20 minutes or so (again, don't feed!) and when the number is climbing, you can be pretty sure that it's safe to go ahead and shoot because the insulin is wearing off.

All that being said, you could try shooting .75 every 12 hours and seeing what kind of numbers you get.

It's also important that you try to get some tests in during the PM cycle. Most cats go lower at night, so it's important to get some tests in at night. Most of us will try to get a "before bed" test in, so if it looks like our kitties are going to go lower, we can set an alarm to wake us up to check later in the cycle.

 

I need to leave for work, so I can't stall the morning shot more than an hour based on when I give them.

For the PM shots, do you actually wake up and test in the middle of the night? I give the shot only 2 hours before I go to sleep.

I have a newborn and a toddler, and work full-time, so I'm honestly finding all the work needed around this diagnosis pretty overwhelming in my already sleep- and time-deprived life. :sad:

 

I should also add that I am able generally to test throughout the day Friday - Sunday, so I suppose my main concern is what best practices for me should be on the days when I have to either give her a shot or not by +1 at the latest and then leave her all day (so can't test or treat until +9).

 

We totally understand sleep deprivation!!

We just celebrated the 1st birthday of one of our other members firstborn .....she had a baby and got the diagnosis almost the same time!

I absolutely hate mornings, so when we first started, I figured I'd just test/feed/shoot at 11am/11pm since I'm a night person...but soon realized that it meant a lot of testing at 4, 5 and 6am! So I now drag my rear out at 6am every morning, but it gives me the chance to get a +2 pretty much every day before I might have to leave for doctor appointments and taking care of my mom. That +2 is what I call my "crystal ball" test. If it's about the same as the Pre-shot, you can expect a pretty "normal" Lantus cycle...but if it's lower than the Pre-shot, it's a clue that they're going to keep going lower and if you can't be home to test, you should leave down some extra food so if they drop low, they can eat. Most cats will look for food if their blood glucose drops low.

Now I'm a testing fool too...if you look at our spreadsheet, you'll see how often I test, but I'm disabled, so other than dealing with my mom, and my own doctor appointments, I can be home to test most of the time. We do have people who work full time jobs though and make it work! The Tight Regulation protocol gives the best chance for your cat to be able to get off insulin completely, but it does require more testing. Do you have a friend or neighbor who might be able to help?

If not, it doesn't necessarily mean you can't do it. There's also a protocol called "Start low, go slow" where you don't have to test as often, but you do curves on weekends and days when you're off work. But even with that, it's still important to get 4 tests per day in (if at all possible)
The 2 Pre-shot tests (to make sure they're high enough to give insulin at all) and 1 test somewhere mid-cycle on both the AM and PM cycle. Lantus dosing is based on the nadir (how far down it takes them), not the pre-shot numbers, so it's important to try to find how low each dose is taking them, and find a dose you can safely give every 12 hours.

If you were to get up a little earlier (I know..it's really not easy, especially with a baby and a toddler!) could you maybe get a +2 and then another test as you walk in the door in the afternoon? If not, if you can even get a +1 and one at +9, that'll help us to help you figure out the best dose. (and then do more frequent testing on your days off)

 

Thank you for the really thoughtful and helpful responses!

Yes, my cat got the blood test that resulted in the FD diagnosis while I was in the hospital recovering from delivery of my second child! So, it's been a very crazy few months for us.

I could shift the morning shot earlier, but the reason for our current timing is actually the toddler's bedtime. There is absolutely no chance of disappearing for even the few minutes needed to do testing and an injection between dinner time and when she goes to sleep (6-8:30pm). So, I picked 8:30 for the shot time based on that.

For now I'll try to get a +1 and +9 each day, and see if that's helpful at all. I also may try .75 if she's still on the low side tonight at PMPS, just so that I'm completely comfortable giving the injections in the morning (vs. shooting when she's at a borderline level and then leaving).

 

I'm not familiar with lantus, but how often are you feeding and what? When Hidey started to get near the 200's I tried everyone's suggestions of mini meals. Hidey was on prozinc and when he was that close to 200 I was so nervous about giving him a shot and had to go to work so I couldn't try a lower dose without worrying he'd go into hypo while I was at work. When I started him on mini meals I guess it kicked his pancreas in gear a little more and since then he's been in remission. My fingers are crossed but it's been about 2 months, but he has to eat about every 4-5 hrs. I bought one of the auto feeders and it's been a great help. If you can't monitor closely with a lower dose, maybe mini meals would be an option to try good luck

 

I don't know how old your toddler is but you might try getting her involved in the process so you might be able to shoot in the evening.

Maybe give her the job of passing out the pokey treat, or "talking" to kitty while you're busy. Young kids seem to really want to help mom with new babies (bringing diapers and such)...finding some way she can help with the "furkid" might give you the chance to move the shooting schedule

 

I'm feeding Mona a half can of low-carb (8% carb) wet food after her daily shots, though there in practice there's always some wet food available to her. She was free-fed on dry food her whole life and she only takes small bites of food at a time and then comes back later. Now she's free-feeding on wet food though we time when we put it down. We tried taking the food away after she wandered off, but she was literally only getting a couple bites of food a day that way since she couldn't get used to "binge eating" twice a day vs. small amounts throughout the day. Frankly that seems healthier to me overall anyway, so we're not trying to retrain her eating habits, just switched out the food to low-carb from high-fiber dry food.

As for having the toddler help with the PM shot - she is MORE than willing to help do anything, but is overly eager with her efforts at this point (she's just 2.5 years old). And the bigger issue is that I can't rely on her being in a mood where she can be 1) helpful to me if she's with me or 2) not harmful to herself if left alone for a few minutes. And obviously inconsistent ability to shoot at the time when insulin is needed is a bad thing. It seems like having it be later is the lesser evil to me, but if you all think otherwise, let me know and I'd be willing to try!

 

Is there another type of food that she'll eat thats lower in carbs? That might put you more in the safe zone with numbers. I found out through trial and error that Hidey does best with VERY low carbs. I can only feed him up to about 4% carbs. I know thats scary when your on that borderline because you don't want to neglect the shot, but you dont want hypo either.

 

I could certainly try a different food. The one she's on is the only low-carb one we've tried so far, though it's also the only one sold at my regular grocery store (Trader Joe's), which is why it's easiest for me if it ends up working. But, these numbers are hard to deal with.

Hopefully the more complete testing I can do this next weekend will give me a better picture (with more mid-cycle tests) so that I have a good sense of what the nadirs are each day.

 

Hi again!

Have you seen the Wet foods under 10% list? It's the shorter version of the Nutritional analysis chart by Dr. Lisa Pierson DVM

It's a handy thing to print out when you're shopping for foods. Make sure you also have some high carb food in the house too, just in case you need to bring her numbers up some time (and there will be those times when she drops below 50 and you'll need it). We usually use the Fancy Feast Gravy Lovers because the gravy part is where the carbs are and can bring them up safely without filling them up with lots of food in case we need to keep them eating for awhile.

Most of us also feed several small meals a day. There's no need to change how you're feeding and force her only 2 meals per day. You might want to watch your numbers after about +6 though since the insulin is starting to wear off then, so you might not want to feed much after that. Each cat responds differently though, so it's all trial and error until you find what works best for her!

I understand your problem with the toddler! Can you get at least a test in after you get her in bed at night? It's really important to know where Mona is going at night since most cats go lower at night. If you get a low number before you go to bed, it's a good idea to set an alarm to get another test in later...just to keep Mona safe!

Mona's doing very well so soon and is responding great to the lower carb foods! That's hopeful that she may be able to be diet controlled only at some point!

It's important that you give the same dose every 12 hours though. This morning, it looks like you only gave .75. We don't usually reduce the dose unless they drop below 50 during the cycle. Lantus is dosed based on the nadir (the lowest point in the cycle)

The morning of 6/21 and 6/23 she was a little higher than she was this morning and you can see how well she did. It dropped her into the blue numbers (which is great!) but the "best dose" will bring them down into normal numbers of 50-120 so their pancreas has a chance to heal and start producing it's own insulin again.

I think if she's above 200 again at Pre-shot, I'd probably go back to the 1 unit until she earns that reduction, but you can try the .75 for a few cycles if you want. We can always go back up if it's not enough. As you get more tests in, and if you move to one of the insulin support groups, your "no shot" number will drop to 150...and eventually, you'll learn to shoot numbers lower and lower! Those of us with a lot of data will shoot anything above 50

I'd like to invite you over to the Lantus Tight Regulation Forum too. Everyone there uses Lantus and you'll get the most experienced eyes watching over you and Mona.

You do not have to do the Tight Regulation protocol to post there either! The "Relaxed" board is the other option, but there are a lot more of us on the TR board. Sometimes the Relaxed board can take awhile to get attention.

If you can get 4 tests a day in, you can do the TR protocol too! It just depends on what you're most comfortable with

Good luck with Mona..and the new baby!

Edited to add....I see you have posted over on the Relaxed board. Of course that's fine, but again, if you want to post on the TR board, you are more than welcome and you'll see there are a lot more of us over there. It can be really helpful to read other people's condo's, look at other people's spreadsheets and it'll help you learn even faster how to deal with Mona's diabetes

 

Chris, thank you so much for this post! I think I'll jump into the TR group. Since I could only possibly follow that half the week, I assumed I wouldn't be welcome, so it's so helpful for you to let me know that I would be!

I'm very confused about how to dose based on the limited info I'm getting. AND she was hypo today when my husband was able to test her at +6 (71 on an Alphatrak, so equivalent of something in the 40s according to the chart) even with the .75, which just freaks me out.

I'll definitely post all of this in the TR board tomorrow with my specific questions about her situation and try to get my own head around this!