peteys' lantus #'s

#'s were high yesterday, bg= 302 @ 6 AM, bg= 464 @ 7:30 AM , 2.5 units given , last night= 359 @ 7:30 pm , bg= 342 @ 8:45 Pm....I gave him 4 units of lantus @ 7:20 Pm..This morning @ 6 AM bg= 195, should I stick with 4 units or go lower ?

Hi Heidi, and Welcome to you and Petey to the Tight Regulation Forum. For other people reading here, here is their background post from Health:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=125291
Petey did have ketones earlier this year.

I'm glad you stuck to the 4U this morning. Lantus likes consistency so it's recommended to keep giving the same dose unless that dose takes Petey below 50. Is there any chance of getting any mid cycle tests today, say at lunch time?

I did a test when I came home @5, 213, I will def stick with the 4 units as you say

Welcome to Lantus Land!!

I tried to skim your initial postings on the Health board. It's a long thread!! I'm glad you switched to a lower carb food. No doubt that has helped.

There are a few things that jump out at me from Petey's SS. First, he's bouncing. When his numbers drop into a range he's not used to spending time in, his liver and pancreas go into panic mode. When this happens, a stored form of glucose and counterregulatory hormones are released and the numbers skyrocket. This is a normal phenomenon -- it's annoying but normal. The more time Petey spends in a normal BG range, the less this is likely to happen. For example, I wouldn't be surprised if Petey was in high numbers by PMPS. There's a pretty good chance he dropped into numbers lower than his AMPS last night. Since he's not spent much time in "blue" numbers, there's a good chance his numbers will bounce.

Especially evenings when you see that your +2 test is considerably lower than your pre-shot number, you may want to try to get some additional tests. It may not be critical now, but it will be. The +2 test is helpful in that the number should be close to your pre-shot number if it's a typical Lantus cycle. If the +2 is a lot lower, then there's a good chance that numbers will continue to drop and some additional tests will help to insure that Petey is in good, safe numbers.

If I'm reading your comments correctly, yesterday it sounds like you tested at 6:00 AM and fed Petey and then shot at 7:30. In general, you don't want to feed that close to shot time. We encourage you to not feed 2 hours prior to when you're shooting. Food that close to your shot may artificially elevate BG levels and you won't know whether your seeing a food spike or an actual rise in numbers. This means you won't be completely sure if it's safe to shoot.

It looks like on 10/13, you shot later than usual. I'm not sure if anyone pointed out that if you do need to alter your shot time, your next shot is due 12 hours from whatever time you shot. Because Lantus is a depot-type of insulin, an early shot acts like a dose increase whereas a late shot acts like a dose reduction. There are certainly times when you an use this to your advantage. But, if you were unaware of this being one of those quirky things about Lantus, the resulting numbers can be a surprise. The bottom line is that barring life happening, Lantus likes consistency both in terms of a consistent shot time and a consistent dose.

Please let us know if you have questions or how we can help. The people here are very generous with their time and their knowledge.

I don't know if I am understanding, isn't he supposed to eat an than get his shot right after???

We usually test, feed and shoot all within fifteen minutes. If kitties head is in the bowl, that makes giving the shot easier.

I don't know if I am understanding, isn't he supposed to eat an than get his shot right after???

Click to expand...

That's correct.

I may be misunderstanding the comment on your spreadsheet. You wrote:

BG= 6 AM----fed fancy feast @ 6 am. will feed a little @ 7:30to give shot @ 7:30

Click to expand...

What I took this to mean is that you tested at 6:00 AM and fed some Fancy Feast. You fed again at 7:30 and then shot around the same time. So, it looks to me like you fed at 6:00 and then fed and shot at 7:30. The 6:00 food could inflate your pre-shot numbers. If your usual shot time is at 7:30, then you don't want to feed after 5:00.

In general, it's helpful to not feed after nadir. There are times when this isn't the case but for most newly diagnosed cats, if you feed after nadir, there's less insulin available to help offset the effects of the food.

Hi Heidi! Just want to add my welcome to Lantus Land! I'm glad you're here - we'll help you learn how it works so you can help Petey!



Keep asking questions! None of us mind - and there are no dumb questions here.

Hi Heidi and welcome to LL. Julie suggested one food chart and I want to suggest another that has more recent numbers although a work in progress. It can be found at :
http://www.felinecrf.org/canned_food_usa.htm

Yes, I always test, feed and shoot...The other morning was an exception, his #'s were very low, so I had to give him something to eat, tested him again in a few hours, and they were starting to rise, so i fed him and gave him a shot. i did not want to be at work all day worrying about his #'s going too high.

Petey was so feisty this morning, could barely check his blood. Ate his breakfast like crazy, could barely wait. His BG was 282, I am happy with that number. I am still giving him 4 units. His numbers yesterday were somewhat elevated. Please check his chart. Thank you.

I think it looks like he needs more insulin, heidi. looks like he was getting better numbers on the 5.0u. I'm not sure why you reduced his dose. If I were you, I'd go back to the 5.0u. If you're not comfortable doing that, I'd at least increase him some. If you hadn't already been at 5.0u and seeing better numbers, I'd have suggested increasing by 0.25u.

Tight Regulation Protocol

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Click to expand...

Depends on what your goal is, but even if it's not remission, most people at least want to keep their cat's blood sugar under renal threshold, meaning low enough that the kidneys are able to process it. That's generally accepted to be somewhere around 200-250 in most cats. If you can get him under there all of the time, it will protect his organs from the damage of high blood sugar.

I feel that his numbers were better at 5, do you think this is why he has been so vocal and sooo feisty? I am also soon need a fresh btl of lantus . I am probably going to order from canada. It is 100. Cheaper. What do you think?

Oh and the reason I dropped down was because one morning his bg was really low

I guessed that's why you dropped him. What we often see is when the insulin dose finally gets high enough to provide some action and a cat's blood sugar gets into better numbers, people drop the dose. Then the lower dose puts them back into high numbers. It's what's happened to you and petey.

If you want to work towards regulation and/or getting him off of insulin, your goal range is 50-120. If you can't monitor, then ya gotta do what you gotta do to keep him safe, but if you drop a dose because you've got a lower preshot and you have to leave him/go to work, typically you go back to the normal dose at the next shot. Lantus works best on lower numbers - if you start with a preshot in the 90's, you may see him spend the next 12 hours between 50 and 90.

I'm not saying to shoot the full dose into green numbers when you have to leave the first time. You have to be able to monitor.

However, you want to gather data on him so you can work up to that. Definitely you need to be able to monitor when you shoot low, until you have confidence (based upon data from doing it when you could monitor) on how he will react to the shot. Here's a post I wrote recently explaining a little more about shootling low. There is a section on the "Shooting and Handling Low Numbers" sticky (with a yellow star at the top of this forum) that explains how to become "Data Ready" to shoot your full dose into normal numbers: 50-120. That's the path for getting a cat tightly regulated (kept in normal numbers) to protect their body from the ravages of high blood sugar, or ideally, to go off of insulin and become diet-controlled.

There are a lot of people who order from Canada - I'm not experienced at that but Chris/China has info about a pharmacy that she uses.

As far as his behavior, it's not unusual for a cat that's gotten used to high numbers to look like they feel crappy when their blood sugar gets back into normal ranges. The cat's body has developed Glucose Toxicity. They've accepted the high numbers as normal and then the lower numbers feel like a hypo to the body. As a cat spends more time in normal numbers they'll get re-accustomed to the normal numbers. I think of it like a person who is used to several cups of coffee every day will feel gross when they skip their coffee, although coffee-less is their natural state. Eventually you get used to it though, and then often people say they feel even better.

Not sure why he's feisty - when you say that do you mean he's starving? High blood sugar literally starves a cat. The energy from the food they eat (glucose) is circulating in their blood and not able to get into their cells.

Yes , He is absolutely starving all of the time ! It seems as though his hunger is never satisfied. I know this is the case with a diabetic cat. His #'s were not terrible today , this morning 282 & 1 pm 200.. i will keep him at 4 units depending on his bg level before his shot.

Just tested petey , 221, @ 5;15 seems to have stayed in the 200's all day. I am going to stick with the 4 units ???? confused_cat :?:

With nadirs in the 200's, you can still go ahead and increase by 0.25u. If i were you, I would go to 4.25u and then hold for 6 cycles unless he goes below 50.

ok will do, #"s were in the 400's tonight at 11 PM!!! after being so good all day ! :!:

a little more insulin will help him.

hang in there heidi - it gets easier! :YMHUG:

I am hanging in there, Thank you for your encouragement :smile:

peteys #'s are 95 this morning, I would like to drop his dose, not sure. He is currently at 4.25? confused_cat

Before I make any suggestions, I have a few questions:

• Is this your pre-shot number?
• Do you have high carb food on hand and plenty of strips?
• Will you be home to monitor?

this was my pre-shot #, and I will be leaving for work at 8:30 AM . I did give him 3 units of lantus, now I am nervous bout that. I was not comfortable not giving him a shot, since his #'s tend to shoot up. last nite at 7 :45 he was 136. I will test him again at 7 am nailbite_smile nailbite_smile

I also have fancy feast chicken, wellness, chicken and 9 lives, chicken. I have some dry food as well.

I feel like I need to stop testing his blood ! Now his #'s are in the 300's ! Next weekend I will also be away, and my daughter will be here, but she does not know how to test him, so she will just be giving him his shot. I will see how it goes later. his poor little ears must be so sore from being poked !

he's bounced, heidi. Whenever a cat jumps high like you had this morning - the amps 95 and then one hour later 326, that tells us that he's not used to normal numbers (the 95) and his liver reacted to it. There's an explanation of bouncing in the second post in this link here.

Your testing is what is keeping him safe and what is telling us that he needs as far as the dose. Probably last night after the blue 136 he continued going lower and the 95 you had at amps this morning he was on his way up.

I would go back to the 4.25 and hold it there and try to catch him if he goes below 50. You're using a human glucometer, aren't you? not an AlphaTrak? If it's an AT, then the number is 68. Those are the boundaries that if the cat goes below, you want to reduce the dose by 0.25u.

It was fine to reduce the dose this morning since you were going to be gone. Just go back to your regular dose tonight.

If you're using neosporin with pain relief every night, his ears will tolerate it. I poked punkin at least 5-6 times every day, sometimes much more than that, for 2.5 years. they can take it and it's what keeps them safe while they are getting insulin.

Can you add what kind of glucometer you're using in the top of the comments line on the spreadsheet - nice and big so it's obvious?

Hope you're having a great day.

We usually open a new thread (condo) every day for each cat. Can you start a new one the next time you post? It's really helpful.

Thanks for your encouragement ! How do I open a new thread ??

To start a new thread, go to the start of the forum here. Click the NEWTOPIC button and you can then start a new thread. In the subject line, put in the date, Petey's name and numbers. For tomorrow, it would be something like "10/21 Petey AMPS xxx"