? Dosing help -Coco at 60 mid cycle - new to testing

Discussion in 'Lantus / Levemir / Biosimilars' started by jeanene and chase, Jun 17, 2016.

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  1. jeanene and chase

    jeanene and chase Member

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    Posting for Anna123 and Coco. Disregard prior SS for my GA Chase. Coco originally was in the high 300's & was put on 2 units 2X a day, then the next week her number increased to the 400's. He changed it to 3 units, which brought it down to 260. He finally did an increase to the 4 units & it went to 181, so he kept that insulin amount for her & she's been on that for about 8-9 days. First successful home test today about seven hours post shot, and result was 60 on a Relion meter. Please provide feedback. Posting for Anna123. Thanks
     
    Last edited: Jun 17, 2016
    Reason for edit: Clarification
  2. MJ+Donovan

    MJ+Donovan Well-Known Member

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  3. MJ+Donovan

    MJ+Donovan Well-Known Member

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    that's the link to the thread on the Facebook group, hopefully...
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

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    We never increase by whole units here even with high dose kitties. I'm pretty sure she is getting too much. The dose is based on the nadir and not the preshot numbers. I'm a little confused though since the ss says Chase and you mention Coco. Are they the same cat? I don't see three weeks of tests on your ss either. Here we increase in .25 increments.

    I'd read the yellow stickies on TR and SLGS to see which approach you intend to follow and change your subject to dosing advice needed. Welcome to LL.
     
  5. MJ+Donovan

    MJ+Donovan Well-Known Member

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    Anna and Coco are new, and confused about posting here, so Jeanene started a thread for them.
    Thus far Coco has only been vet-tested, and just today Anna got her first successful home test. That's when she posted on Facebook that it was 60 after giving 4 units of Lantus about 7 hrs prior (no preshot number)
     
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  6. Anna123

    Anna123 Member

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    Jeanene actually posted on here on behalf of me because I'm very confused on how this whole site works (and she's a pro & is helping). She's speaking of my cat, Coco. My vet has her on Lantus 4 units 2X a day. I literally JUST got a successful home glucose read (after many unsuccessful) and about 7 hours post shot she's at a 60 on the Relion confirm meter. I have been told to test her again, which I will soon. I hope I'm successful again with that. I'm not sure what is "normal" & what is "alarming", so I'm kind of freaking out & need it layed out in very basic terms. Any help is appreciated! :)
     
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  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Below 50 is where we give high carb foods if you are using the Relion Confirm. So Coco is quite close to that, hence the request to test again soon. She's not in danger at 60 but we don't know if her numbers are going up or coming down.

    It's quite hard for us to give dose suggestions without an idea of what the blood sugar has looked like during the day. Most of us keep track of our blood sugar tests in a spreadsheet. Instructions are here. You might want to start by reading the New to the Group Sticky Note at the top of this forum. We'll probably use a lot of terminology you may be unfamiliar with. But feel free to ask questions, we love to help here.
     
    Last edited: Jun 17, 2016
  8. mucacopatarica

    mucacopatarica Well-Known Member

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    Hi Anna and Coco. I just wanna say wellcome ;). You are in good hands now. Everything it will be OK. :cat:
     
  9. mucacopatarica

    mucacopatarica Well-Known Member

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    Anna at first can you tell us few informations: When was Coco diagnosed? Does she have any other problems? How old is she? What kind of food are you giving her? are you familiar with % of carbohydrates in food?
    You can write some informations in your signature. If you look up in right corner you see your name. If you place cursor on it you will see some details about your profile page. Click on signature and write some informations for us please.
     
  10. Anna123

    Anna123 Member

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    Thanks everyone!! A little about Ms. Coco~ she's a newly 12 year old tuxedo girl & was diagnosed about 4 weeks ago. I have been on another forum which helped me with the food..she's eating ONLY Fancy Feast Classic pates now & we cut out dry food entirely (all in the last 3 weeks or so). I will update my profile ASAP :) I also just retested her glucose & she's now at 83. So at 2:15 she was at 60 & 4:05 pm 83. Now what?? lol . Her next insulin shot is due at about 8:00 pm (4 units). Do I give the full doe as usual? Also, what high carb food do you recommend, should she ever hit 5o on the glucometer (I was told you give syrup)..
     
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  11. Anna123

    Anna123 Member

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    Oh, also Coco has no other health problems
     
  12. mucacopatarica

    mucacopatarica Well-Known Member

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    how much time is left until PM shot. We always test before insulin shot. That way we know what to expect. I am relatively new here so I will not tell you about dose (I have problems with dosing too) but I think Coco is having too big dose for the beginning. Can i ask you to put ? in your topic. That way others will see you have a question(s)
     
  13. Anna123

    Anna123 Member

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    3.5 hours before next shot. I'm looking to see where to put the "?" and I'm just not sure!
     
  14. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Syrup will work, but it can be easier to give a high carb cat food. should you need it - you don't now. The Fancy Feast Gravy Lovers is one example. If you look at the food chart on catinfo.org, check out options that are 15% carbs and above for high carb (HC) food.

    For the ?, go to your first post. On the top left is a Thread Tools drop down, you can edit the title prefix in there.

    How long after the shot time was the 60 recorded? Since everyone here is on different time zones (and countries), we talk in number of hours after the shot. So for example, 7 hours after the shot is +7. Since it's now 3.5 hours until the shot, it's now +8.5.
     
  15. Anna123

    Anna123 Member

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  16. mucacopatarica

    mucacopatarica Well-Known Member

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    Thank you Wendy. I need much more time because of my bad english to write the instructions
     
  17. Anna123

    Anna123 Member

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    the 60 was recorded about 6 hours post shot. I had many problems obtaining blood, so I was just trying to get anything at anytime & this was my first success with the glucometer.
     
  18. MJ+Donovan

    MJ+Donovan Well-Known Member

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    My main concern is that she has only really been tested at the vet, which can lead to artificially inflated numbers. You made a diet change before you were home testing. Diet change typically helps to decrease sugar levels, but no way to know that since the first home test was today.

    Personally I'm too chicken to shoot when BG is near 100, even though I have years of experience. My first sugarcat's BGs were never normally in the low range anyway; he typically hung out around 100. My current sugarcat is a different beast altogether and I won't even attempt to describe how I dose her :p

    So, as of now we know this about Coco:
    no AMPS number; gave 4U Lantus
    AMPS +7 = 60
    AMPS +9 = 83
     
  19. Anna123

    Anna123 Member

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    I still don't see the Thread Tools drop down! uggh!
     
  20. Anna123

    Anna123 Member

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  21. Anna123

    Anna123 Member

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    I will test her again right before dosing & post it on here for further advice. She eats dinner in 15 minutes & her next dose is in 3 hours 15 minutes
     
  22. MJ+Donovan

    MJ+Donovan Well-Known Member

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    I think maybe you can't do it since you didn't write the first post.
    Ask Jeanene to try.
     
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  23. mucacopatarica

    mucacopatarica Well-Known Member

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    Just please dont give her food two hours before insulin shot.
     
  24. Anna123

    Anna123 Member

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    I always give a snack before the shot :)
     
  25. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Right...the only one who can go back and edit the original post is the person who posted it
     
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  26. Gill & George

    Gill & George Well-Known Member

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    Just to reiterate @mucacopatarica no food in the two hours prior to insulin shot, when you test just before her insulin shot you want to be sure that the number you are shooting is not influenced by food.
    once you have tested and are giving her her insulin she can have her fuds:)
     
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  27. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    Around here we do what we call t/f/s for Test/Feed/Shoot. We withhold food for two hours before shot time, then we test. We give kitty some food and when we're sure he/she is eating, we give the insulin (assuming the number isn't too low to shoot). All this should happen within 5-10 minutes. It takes about 20 minutes for food to affect the BG, so you want to test before that time frame.

    Welcome, Anna! You're in the best place to get help for your kitty.
     
  28. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    Anna, how much does Coco weigh? Initial dose is figured based on weight.
     
  29. Anna123

    Anna123 Member

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    she wi
    She weighs a little over 9 lbs.
     
  30. Anna123

    Anna123 Member

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    thanks~ very helpful!
     
  31. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    One way to calculate a starting dose of Lantus is to base the dose on weight. Initial dose = 0.25 x ideal weight in kilograms. If Coco was started on 1.0u, that was a good starting dose. We typically increase doses in 0.25u increments. Given the relatively recent change in food and you're still getting testing under your belt, what would you think about reducing Coco's dose? With the drop into double digits today, I think having a little greater margin of safety would make sense. I'm thinking about a drop to 2.0u but let's see what others think.

     
  32. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    I think what Sienne suggests is very reasonable. Once you have some more data, we can re-evaluate the dose, but for now we need to make sure Coco is safe from a hypo event.
     
  33. Gill & George

    Gill & George Well-Known Member

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    I too think that Siennes suggestion is a sensible approach given your particular set of circumstances.
     
  34. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Given the change from dry to wet, I think that reduced dose is the way to go. The switch to low carb wet can make a big difference in the amount of insulin needed. I agree that 2.0 units is a good start.
     
  35. Anna123

    Anna123 Member

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    May 22, 2016
    But I switched completely about 3 weeks ago..so, she was diagnosed 4 weeks ago & I changed her diet 1 week after. She's only eaten FF pate/no dry for about 3 weeks
     
  36. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    But today is the first time you toted to see what the results were of the change. Previous tests were at the vet office and stress can inflate the numbers, which means blood tests at the vet are not the best for making dosing decisions. My non diabetic cat once tested over 200 at the vet, at 53 at home the next day.
     
  37. Anna123

    Anna123 Member

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    wow! I'm testing again in about 20 minutes. I will post results after!
     
  38. Anna123

    Anna123 Member

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    ok this seems impossible. I jut retested Coco & she's at 508!! How is that possible? Her last reading was about 4 hours earlier & she was at 83! Let me tell you though , she was highly stressed. I tried about 6 times to get blood & I couldn't get any. I finally had to completely immobalize her & she was visibly stressed during the testing, which I know elevates number..please help!!
     
  39. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    It's OK. Coco is doing what we call bouncing. She will come down. Her body isn't used to the low numbers like 60. Here is the description of bouncing from the New to the Group Sticky Note:

    Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
     
  40. Anna123

    Anna123 Member

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  41. Anna123

    Anna123 Member

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    ok, thanks for explaining that...but I am totally confused as to how to dose her now...she was a 60 at 2:16 pm, 83 at 4:05 pm, and now 508 at 8:28 pm~ this is the time I should be giving her a dose of insulin..4 units 2X a day is what the dr. ordered, but everyone's thinking that's too high..
     
  42. jeanene and chase

    jeanene and chase Member

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    Thanks for the great explanation of bouncing. If it was my cat, I'd reduce to 2 units and keep up the testing to see what happens. As long as you have your number, you can reward your poor little girl for being so brave today. As long as she's food motivated. Dinner is fine too. Just needed the "fasting" number.
     
  43. Anna123

    Anna123 Member

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    ok thanks Jeanene..so i'll give her something to eat & then reduce to 2 units of insulin? should I stick to that amount for tomorrow too?
     
  44. jeanene and chase

    jeanene and chase Member

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    Yes, I'd go with 2u again tomorrow morning.
     
  45. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    Anna, it will help you make her more relaxed at test time if you always give her a treat, even when you don't get the blood. Freeze dried meat treats, which you can buy at any pet store, are FD friendly treats most cats love, or little bits of plain, cooked chicken work, too. If you always give her at treat, she'll associate the pokes with the treat and will soon be calmer and more patient with it. Here are some tips to help with testing: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/.

    Yes. Depending on which method you decide you want to follow, TR or SLGS, you should hold the dose for 3-7 days before making any adjustments (unless she earns a reduction) to give the depot time to fill and let you see what the dose is actually doing.
     
  46. Anna123

    Anna123 Member

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    I also w
    what is TR or SLGS?
     
  47. Anna123

    Anna123 Member

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    Regarding the treats, I do have freeze dried chicken. I was giving them to her, but she got so excited, she wouldn't sit down for the shot. lol
     
  48. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    From the first sticky at the top of the Lantus & Levemir page:

     
  49. Anna123

    Anna123 Member

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    pk I would be more apt to do the SLGS
     
  50. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    TR gives the best chance at remission because you can change the dose as often as every 3 days if the current dose isn't getting them where we want them. With SLGS you hold the same dose for at least 7 days and although that's OK, the longer they stay in higher numbers, the more likely it is that you'll have to keep increasing the dose due to glucose toxicity (basically the body getting more and more used to living in those high numbers and thinking they're normal)

    If you can get at least the PS tests in before each shot, and at least 1 test either mid-cycle on the AM cycle (like 5-7 hours after the morning shot) or at least a "before bed" test on the PM cycle, that's the bare minimum required to do TR

    Of course it's even better (and safer) if you can test more than those minimum 3 times a day but that's all that's required to do TR.

    Do you work outside the home? Is there any reason (other than Coco getting used to the idea) that you can't test at least 4 times a day? The 2 PS tests and a mid-cycle on the AM and a "before bed" on the PM?

    It's always your choice of course...and some people just don't have the makeup to test that often or feel comfortable letting them drop lower, so it's fine no matter what you decide. You can always change your mind too!
     
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