When should you adjust/give less insulin?

Over the weekend, most of Bojangles tests gave readings in the high 100s or low 200s - she did go as low as 116 on a +8 reading. Should I still be giving a full unit? Is there a chart that helps us to determine what dose to give? I know it may be individualized to the cat and their reactions to the insulin. I should note my syringes only have full units, so giving less than a full unit is just by "eyeballing it". I did go slightly less than the full unit this weekend as I'm not online to receive advice from the board and my vet was closed by the time I measured the lower readings. Are there guidelines I can follow that will help determine the dose to be given dependent on the reading? She's only at most been given 1 unit 2x per day, but unsure of when 1 unit might be too much.

UPDATE: This is what my vet responded: Saturday's curve is actually exactly what we want to see. What the internists recommend is the following: continue current insulin dose if pre-insulin BG is 240-360 and/or the lowest reading is 90-180 (this is where she is right now). The dose is to be decreased to 1/2 unit if her pre-insulin BG is less than 180 (we're teetering on this) or discontinued altogether if the lowest reading is less than 54.

Would you agree with what the vet indicates?

 

You do not have a link for the BG spreadsheet.

 

I think I fixed the link.

 

Until someone more experienced comes alone- I would recommend that you check out the START LOW, GO SLOW METHOD (SLGS) Sticky on the Lantus forum- link-

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

I try to follow this method of dosage adjustment (the best I can)... hope this helps

 

You need to start getting mid-cycle tests every day in addition to the AMPS and PMPS tests so as to work out the dosage because you need to know the nadir (applies for either Start Low, Go Slow or Tight Regulation protocols).

Is it possible for you to get additional tests during the day and, say, just before bed on the PM cycles?
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This is just my gut talking, but has he only been on insulin for a little over two weeks? Or have you only been monitoring for the last two weeks? You have just started getting consistent blues, and then reduced the dose, even though it was only by a little. Basically what your vet is wanting to do (based on the information that he is giving you) is to get Bojangles "regulated." Following the SLSG, he doesn't earn a reduction, even by a bit, until he dips below 90, which he hasn't. If you are following TR, no reduction earned until he dips below 50. Alternatively, if he has normal number (50-120) for a week, you can try a reduction. Just my two cents, but I would stick with the 1.0 unit.

 

Hope I didn't offend.

 

Thanks all for your thoughts. I'm at work and away from the house most days from 6:30am - 5pm, so no mid-day tests other than on the weekends. Can do a test just before bed though. Bobo has only been on insulin for 2 weeks. I just am not familiar with the number ranges for cats as far as this range is good no shot, this range is getting there but still need .5 unit, this range still needs full unit, etc. Thanks BJM for showing me the notes/reference values.

 

No offense taken, just need all the help advice I can get while I try to learn what numbers are good. I don't want to risk having her drop too low when I'm away from the house at work for so long.

 

Hi, Bojangles' mom, (I don't have your name ... )

When you start getting 'before bed' tests it will help a lot to get an idea of how Bojangles is doing on the evening cycles.

I've just had a look at Bojangles' spreadsheet. He's responding really well to the Lantus. For example, the curve you ran on 15 August is a lovely, classic Lantus 'smile' shape and no nasty bouncing, by the look of things. His numbers are getting steadily better, even without a dose increase. That's really positive. I hope this reassures you a little.

All going well, as you refine Bojangle's dose you'll be able to gradually lower that lovely 'smile' curve into even better numbers. If you post on the Lantus and Levemir insulin support group, they will be able to guide you on dosing. There are two protocols: Start Low, Go Slow (SLGS) is not as aggressive as Tight Regulation (TR). It may suit you and Bojangles better, given that you can't snag daytime tests during the work week. The L&L group will be able to advise you on the target BG ranges for each protocol as there are slight differences between the two. For example, TR dose reductions are earned when a cat's BG drops below 50/2.8 on a human glucometer (68/3.8 Alphatrak) whereas under SLGS dose reductions are earned when a cat's BG goes below 90/5.0 on a human meter (not sure of the FDMB reference value for Alphatraks on SLGS).


Mogs
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Thanks Mogs for the tip, I'll look at the SLGS and the Lantus support group - I'm Marcy by the way, but also happy to be known as Bojangles' mom since she's my focus.

 

Hi Marcy! (Much better. )

EDITED TO ADD:

I owe Bojangles an apology for the accidental gender reassignment in my earlier post. (I'm such a numpty ... ).

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