Would like some dosing opionions/advise

Discussion in 'Feline Health - (The Main Forum)' started by Bumpsy & Shady, Dec 15, 2017.

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  1. Bumpsy & Shady

    Bumpsy & Shady Member

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    We are still unregulated, and just getting the hang of testing...sorta.

    We dosed 2u at 9:30 this morning. We just had successful test and he's at 183 now. I feel like I shouldn't give another 2u at 183, but don't know what I should give. 1u?

    What do you think?
     
  2. nmveasey

    nmveasey Member

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    I’m not comfortable giving dosing advice, but I know people will need more information.

    Do you have a spreadsheet?
    When was the cat diagnosed?
    What kind if insulin are you using?
    How long on the insulin?
    What kind of meter?
    What are you feeding?

    I’m sure someone else can help with dosing soon.
     
  3. nmveasey

    nmveasey Member

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    Also, if you change the headline to dosing advice, that may get some more attention.
     
  4. Bumpsy & Shady

    Bumpsy & Shady Member

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    I do have a spreadsheet, but not sure how to link it yet, and it's not completely filled out as we don't always have a successful test (but we are getting better).

    Diagnosed in February, but didn't start insulin until October because he was borderline.

    He's on Lantus.

    The meter is Relyon (I think).

    We are feeding Friskies Pate's.

    Also, while I was waiting around to see if anyone had any advise I was reading some other threads etc. I think I'm doing something wrong. The vet said to feed him before his shot, so I have been giving him his food and then testing the blood, and then giving the shot. Am I supposed to test before he eats? He ate about 1/2 hour before I got the 183 reading.
     
  5. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    How many hours since you shoot the 2u? Since a lot of people are on different time lines it would help to know
    Has he had any food in the previous 2 hours?
     
  6. Bumpsy & Shady

    Bumpsy & Shady Member

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    Not sure how to change the headline, but will try to figure it out.
     
  7. Bumpsy & Shady

    Bumpsy & Shady Member

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    It had been ~10.5 hours since the 2u, and he ate about 1/2 hour before I got the 183 reading.
     
  8. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    You should withdraw food for 2 hours before shooting time so that the result you get when you test is not food influenced, then shoot and give food.

    Are you following any of the protocols for Lantus ? Tight regulation or SLGS?

    You are still 1 1/2 hour before his shooting time then, you should withdraw food now and test before his shooting time and see if his BG is raising or not.
     
  9. nmveasey

    nmveasey Member

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    the Order is test-feed-shoot. It’s ok if your spreadsheet isn’t completely filled out. Any data that’s in there is helpful. Let me look for the post about how to add your signature and link the spreadsheet.
     
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  10. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    To change the title go to the upper part of the thread and you'll find a link that says 'Thread tools' give it a click and it will show you an option that says 'Edit Title'
     
  11. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Lantus works better if you keep the same dose AM and PM, having said that when you test before his shooting time today and since I'm guessing you are new to testing and shooting this are the general guidelines

    "In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
    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."
    In any case you may want to test and post your result here and ask for advice
     
  12. Bumpsy & Shady

    Bumpsy & Shady Member

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    protocols for Lantus? SLGS? - I don't even know what that means. As I said earlier, at this point we are unregulated.

    Well, now i'm at 1/2 hour before shooting time, but I gotta be out of the house by 6:30 am, so I was trying to back it up a little bit so I would be able to dose in the morning too. (pharmacist told me a 1 hour swing either way wouldn't make to much of a difference.) My work schedule fluctuates, so sometimes I try to take advantage of that 1 hour swing to try to keep things on track as best as I am able.

    Honestly, I'm lucky I got one reading today, I can't say that I'll be able to get another. (His poor ears are so bruised up from all this learning.) Sometimes all I still get is E7 for days. The other day I must have poked his ear 12 times and still got nothing.
     
  13. nmveasey

    nmveasey Member

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  14. nmveasey

    nmveasey Member

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    Try not to get frustrated here. It will come in time. @JanetNJ has a great video in her signature on testing. Have you tried to warm the ear first?

    I found a link here on testing: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
     
    Last edited: Dec 15, 2017
    Reason for edit: Because I have the attention span of a squirrel
  15. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    This is the link to some information about lantus so that you can start getting familiar with it

    http://www.felinediabetes.com/FDMB/...the-basics-new-to-the-group-start-here.18139/

    For Lantus here we use two protocols that give you guidelines on dosing and what to do, one is Tight Regulation (TR) (link ) and the other is Start Low Go Slow (SLGS)(link), I suggest you take a look at each one and decide which one suits you best

    Also is important to try and keep the schedule as regular as possible , when we need to change schedule we usually do by no more than 1/2 an hour a day or 15 minutes from one cycle to another

    Testing is hard at first but it does get easier with time so hang in there
     
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  16. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Considering that he was 183 having eaten and the fact that you will have to shoot tomorrow before 6:30 that would be almost 3 hours earlier than today if I'm understanding correctly, you may consider skipping the shoot altogether and shoot 6:30AM and 6:30 PM tomorow.

    Skipping would also be the safest option if you think you can not test him later on to be sure he is not going too low
     
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  17. Bumpsy & Shady

    Bumpsy & Shady Member

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    Thank You! Actually we are really getting better at it. I've been trying since October, and in the beginning the failure rate was over 98%. This month, I've already got 8 good readings, so our failure rate is closer to 75% now. Progress!

    And yes, we do try to warm the ear first, but I haven't owned a microwave in ~15 years, so I'm using a pill bottle with hot water instead of the rice thingy.
     
  18. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Good for you that your are getting better, to help his ears you may want to put some Neosporin on them, I don't use the rice thingy either, I warm a wet cloth that I put in a plastic bag
     
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  19. Bumpsy & Shady

    Bumpsy & Shady Member

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    Unfortunately, this is just not possible for me. If I am lucky, I can be that consistent for three or four days at a time, and when I am able, I do try to keep it as steady as possible, but there are times when I get home at 10:30 pm and have to be back at work by 9:30 am. This happens a weekly bases, so I'll never be able to be that consistent. :(
     
  20. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    I don't know your situation but I certainly can relate to having a full time job with crazy schedule I work full time plus I live in a city with an insane traffic, I had to find someone that could shoot when I wasn't going to be able to get back home on time in my case has been the vet or a vet tec but you could see if someone from your family can help or a pet sitter

    I had to skip a shoot sometimes too

    Thing is maybe for people is OK to change 1 hour or more with no problem (I really don't know since I don't know anyone who actually uses lantus on themselves) but the cat's metabolism is different in people lantus is used once a day in cats it has to be twice. Shooting too early can have the effect of raising the dose and that can be dangerous and shooting too late can act as lowering the dose
     
  21. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    I tried to see your SS but got this message Screenshot_20171215-222050.png
     
  22. Bumpsy & Shady

    Bumpsy & Shady Member

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    Hmmm... is it working now?

    Tonight, he's ate, it's been over 12 hours since his last shot, and he's going down. How can that be?
     
  23. Critter Mom

    Critter Mom Well-Known Member

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    • How long a fast between meal and PS test?
    • PS BG value?
    • How long after food (+??) did his BG go down and what was the test result?


    Mogs
    .
     
  24. Bumpsy & Shady

    Bumpsy & Shady Member

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    I feed him about 20 minutes before I did the pre-shot test. (I know, I'm doing it wrong).

    His BG value 20 minutes after eating was 117.

    ~2 hours later I tested him again (because he had a pathetic sickly meow) he was at 101.

    I just gave him 1/3 of a can of prescription (C & D) food now, because he was meowing like he was dying, and I was worried about the lower reading.

    Apparently I have no idea what I'm doing here.

    Can you see our SS now?
     
  25. Critter Mom

    Critter Mom Well-Known Member

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    Spreadsheet is asking me to create a Microsoft account.

    Please confirm that you did not give any insulin after the preshot test.

    • What's the carb % on the C&D food?
    • Are you in a position to test him +2 hours after the meal he has just eaten (and ideally at +3 hours after the feed if at all possible)?

    Mogs
    .
     
  26. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Still can't see your SS

    Could you post today's tests results ?
     
  27. Bumpsy & Shady

    Bumpsy & Shady Member

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    Thanks for your response!

    I did NOT give insulin tonight. His last shot was 1u at 8 am.

    unsure of the carb content on the C&D food, but I believe it is "low" carb. (whatever that means.)

    I am not in a position to test him again until morning. I have to be at work by 7:30 am tomorrow. heading off to bed soon. I may set an alarm so I can at least check on him in 3 hours to see how he's doing.
     
  28. Bumpsy & Shady

    Bumpsy & Shady Member

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    No test this morning. 117 BG at ~8pm tonight, no insulin given at that time. 101 @ ~10 pm after eating
     
  29. Critter Mom

    Critter Mom Well-Known Member

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    It would be great if you could snag that overnight test result. Looking to see whether the pancreas is doing a bit of work.


    Mogs
    .
     
  30. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    How many hours after his AM shoot was the 117?

    Do you mean Hill's c/d?

    117 and 101 are not terribly low values actually they are ok , but we would need some more information to try and figure out what to do there's a possibility he may need a small reduction on his dose but is hard to say
     
  31. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    If I am understanding correctly today's values would be

    AM preshoot- no test
    PM preshoot - 117
    PM + 2 - 101

    You shoot 1 unit AM And he did not got any insulin at PM

    What dose did you gave him yesterday?
     
  32. Bumpsy & Shady

    Bumpsy & Shady Member

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    The 117 was probably
    Yes! you understood correctly. Yesterday he go 2u at 11 am and 2 u at 10 pm. and then another 1 u at 8:30 this morning.
     
  33. Bumpsy & Shady

    Bumpsy & Shady Member

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    Yes, I believe that's correct, hill's c/d. His regular diet is Friskies pate's, but since he seemed to be going down, I gave him what I had on hand to try to even thing out a bit. He was diagnosed as borderline, and thats what I feel like I'm still dealing with. Doesn't make things easy.

    Thanks, I appreciate the response!
     
  34. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Both values were ok, our usual take action number is 50, there's not much information to be sure what's going on but since Lantus is a depot insulin you may be seeing effects of the 2 units that you gave him yesterday. Why did you gave a 1 unit decrease?

    What do you mean by borderline what were his values before you started him on insulin?

    Hill's c/d is what we would consider medium carb food not low carb since it's about 13% , low carb would be 10% or less
     
  35. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    I do suggest you read the protocols and decide which one you're going to follow, but which ever you decide there are two test that are really important, the preshoot test In my opinion no one should give insulin with out knowing the value he's on, specially since you are just starting and you do not know how he reacts it could be really dangerous
     
  36. PussCatPrince - GA

    PussCatPrince - GA Well-Known Member

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    Hey. I'm new to all this too. It is tough and confusing & quite hard at the very first , especially if vet thinks one thing but cat shows us something else and then we find this wonderful forum and learn a while new set of ways that will really help our cats & it is still hard.

    I couldn't see your spreadsheet either. I think it may help if you follow the instructions given above to start and link the spreadsheet.

    I know it is tough to get ear tests. Ty is a whole other cat with this so I hear you on the pin cushion ears and the failed E-7's/E-3's.

    Diet is also hard but best thing is get your cat off the dry food and onto the wet low carb. Then that is one hurdle.

    It is definitely Test - Food - Injection. In that order.

    The ear test thing is a fasting blood test so NO FOOD for a good two hours before the test.

    Whatever , don't mess with the injection dose unless you check here.

    He may have been borderline for a while, but he isn't now. He's diabetic on Lanctus insulin. For what it is worth, I believe my Tyler was borderline for quite a while but nothing was said until the testing results went over a certain limit. That robbed me of the chance to try and regulate with diet alone.

    Me and Tyler. We're not really regulated either. Join our club.
    Slow steps and we will get there.

    Hugs.
     
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  37. Bumpsy & Shady

    Bumpsy & Shady Member

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    I really not sure what I'm doing here. We don't even know what dose he really should be on yet. Looking back on my notes, I gave him a 1u decrease because I didn't get home until late the night before, and had to be out of the house early. I didn't want him running high, but didn't want to overdose him either (obviously). I was going to be out of the house for 10+ hours), so I thought maybe if I gave him just a little we could reach a middle ground. Looking back that might not have been the right decision, but it's what I did.

    By borderline, I mean when I first brought him to the vet back in February, his BG was 450'ish, but I immediately switched his diet to low carb (from a dry food), and within 3 days he was a different cat (using litter box, less lethargic etc). When I brought him back to the vet 3 weeks later he tested at 102. A month or so after that, he again tested at 105. They ran a AC1 (is that what it's called?) and even then they could see him fluctuating from very normal levels to high levels. Finally in October after months of back and forth, we decided to start the insulin. Of course we all know how hard it is to get the testing part of it down so I am/was really running blind. When I do get a test I still don't know what the numbers really mean. I mean I know what's high and what's low, but I don't yet know how to translate that into proper dosing levels.

    We are getting better at the testing though, and hopefully I can start to really get this all under control. This morning at 7:30 he was at 200 and I did not give him any insulin. Again, probably not a good decision, but it's what I did. Tonight when I got home we tested and he was at 290 BG. I gave him a little less than 1.5u at 6:30 pm.

    What does depot insulin mean?
     
  38. Kris & Teasel

    Kris & Teasel Well-Known Member

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    This is from the list of yellow info stickies at the top of the Lantus forum page:
    http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/
     
  39. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    I wish we could see your spreadsheet ( you could try and set it up as the rest of us do this are the instructions http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/) and try to see a little bit more information, is hard to give anything but general suggestions with out information.

    But for what you have told us what I understand is that because of your schedule you have been changing shooting times and doses a lot, and unfortunately that is not how Lantus works, Lantus requires consistency for it to work properly, that is keep the same dose for a week unless he goes under 90 ( this is following the SLGS protocol ) and the 12 hour shooting schedule as close as possible.

    I strongly suggest you take a look at the information on Lantus (http://www.felinediabetes.com/FDMB/...the-basics-new-to-the-group-start-here.18139/ ) and specially on the Start Low Gow Slow Protocol (this is the link http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/) and maybe go with a very conservative approach in order to keep him safe and try and start as if he hadn't had any insulin with the 0.5 units starting dose that the protocol suggests, try and keep it for a week ( you can ask for help anytime during that period ) and do a curve by the end of the week ( you could ask for help on this one too before doing it) and then post here for a suggestion on how to adjust his dose.

    Still you do need to test before shooting ( this could really save his life )and withdraw food 2 hours before his preshoot test to get a test that is not food influenced.

    As I said before I do know that following the protocol with a full time job is complicated but it can be done and all the effort and complications are worthed once you see him ok and regulated.

    Keep asking as much as you need we will try to help you as much as possible
     
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  40. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Also I think that with other insulin types you can have a little bit more flexibility, I really do not know much about them but you could post an specific question on a new thread asking for suggestions on what insulin to use given your schedule
     
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  41. Bumpsy & Shady

    Bumpsy & Shady Member

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    I tried to update the spreadsheet again. Is it still not working? I don't know what I'm doing wrong.


    Yes, I have been changing shooting times and doses, because I thought that was what testing was all about, but after reading through the protocols again, I think you are absolutely right that I need to re-start with the .5 units , especially now that we are getting better with testing. That's what I'll do tomorrow AM. This line especially struck me from the protocols- "Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose." This is exactly what I think I was trying to do. (I just want him to feel better. )

    Thanks very much for your (and all the) response. I very much appreciate any help I can get with this.
     
  42. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Keep asking as much as you need we will try to help you and your kitty always trying to keep him safe
     
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