New Member, question about skipping doses

Discussion in 'Feline Health - (Welcome & Main Forum)' started by SaMindy, May 12, 2020.

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  1. SaMindy

    SaMindy New Member

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    For 3 weeks my Sammie was getting his dose every 12 hours. He’s on Lantus, I’ve switched him gradually to an all wet diet. I’m using a pet meter, the Alpha Trak 2. He was first at 1 unit am/pm. Then 2 am/1 pm. Then 1.5 am/ 1 pm. Now he’s supposed to be at 1am/pm.

    Sunday he dipped very low, I had to give him some Karo syrup. Yesterday he was low but a good(?) low. Both Sunday and Monday I skipped his pm shot because of his still low numbers at 7:00 pm (we dose at 7:30).

    Monday morning he was at 352 at 7 am, after skipping the first pm dose. Today he was at 245 at 7 am, after skipping last night’s pm dose.

    Two nights now we’ve skipped the pm dose. I worry if I would’ve dosed him he might’ve gotten really low when I’m sleeping and can’t help him. But on the second skipped morning his number is lower. I’ve filled out the spreadsheet and added it to my signature (I think) if that helps.
     
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  2. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Welcome to FDMB We are glad you found us. this is the best place to get answers to your question. THANK YOU for creating a spread sheet that will help us help you help Sammie. ;)
    You are already ahead of the game doing so. I am not a dosing expert but there are plently of folks here that are. Hang on and someone will be with you when they get the chance! and again
    WELCOME to the best darn site on the planet to help you with the ins and outs of feline diabetes!:bighug:
    jeanne
     
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  3. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    Hi guys,

    @Bron and Sheba (GA) and @Diane Tyler's Mom were helping Sam through the lows yesterday, myself and Nan too.

    Sam can you copy the link of last nights post here so folks can use it as a reference?

    thanks!
     
  4. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    OOPS:oops: Thanks Ale...Not that my welcome doesnt stand :p:joyful::coffee:
     
  5. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    245 is actually a good number which means you definitely need a lower dose. Good thing you skipped again. Cairo may just need .5 moving forward. Let’s see what others say. Hang on :)
     
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  6. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    You’re welcome is always valued. Can I get another welcome too? :p
     
  7. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Of COURSE! :bighug::kiss::kiss::kiss:
     
  8. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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  9. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Oh lordy I did read that thread! My apologies. I get to reading and they all meld into one another. lol I will be more careful. :rolleyes:
     
  10. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Hey Ale, think there's some confusion here, Sam from last night (cat Cairo) posted on Lantus this morning: 2020.05.12 Cairo AMPS 111

    OK, back to today's Sammie!

    Very glad you are testing while transitioning to wet food-- it definitely seems to be making a difference in Sammie's numbers! You've actually "missed" several reductions, so I suspect that 0.75 may still be too high, but we'll see. The goal is shooting consistently morning and night, as you say, so we want to find that magic dose...
     
  11. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    I guess I’m the one who didn’t have her coffee yet!! So sorry :coffee::coffee::banghead::banghead::banghead:
     

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  12. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    I'm also glad that you chose to skip when you couldn't be sure you could test at night, but Sammie probably needed more than that last night. 59 is pretty low on an Alphatrak, so when you get a number like that (anything below 68, will show up as lime green on the spreadsheet) it's time for high carb food, Karo if needed, and testing until he comes up.

    Let's try the 0.75U today and see where he is tonight!
     
  13. SaMindy

    SaMindy New Member

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    May 12, 2020
    I do have syringes with half unit dose lines. I honestly don’t understand this mystic magic of knowing when to reduce/add. My vet gave me very basic info and demo of how to use the syringe and sent me out.
     
  14. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    We use a couple of dosing methods on the Lantus forum, the rules are described here: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

    They are designed for human meters rather than the AT, so the reduction point of TR is 68 rather than 50. Eventually, you'll want to choose one of the methods to guide dose adjustments, but my comments above were based on the fact that whichever method you choose, a dose that brings your kitty into a lime green number warrants a reduction. Sammie is definitely telling you he's feeling a bit better and doesn't need quite so much insulin!
     
  15. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Despite my best efforts my second sugar cat never did achieve regulation, what we call a fairly predictable pattern of highs and lows. There were many nights Noah never got a PM shot but this is NOT something I can officially recommend. This depends on how low you mean by "low". Some members get up at 3:00AM every night to check their cats, I never did. In his case I was more comfortable with him being high in the morning rather than really low, high was an inconvenience for us, too low is an emergency.
    I'm Eastern time zone, starting on my second pot of coffee. :coffee: :coffee: :coffee:
     
  16. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    Hi Mindy,

    I’m really sorry again for my confusion. I get where you’re coming from. Most vets do that and I was completely lost when I came here. The talk about reductions confused me too and i felt like I didnt know what I was doing until I started following the guidelines from the link Nan posted. As you start to follow it, it all make more sense and it kinda becomes second nature. In the meantime, you can ask as many questions as you need to, God knows o did. Nan can tell you that ha! :)
     
  17. SaMindy

    SaMindy New Member

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    May 12, 2020
    I’ve read through that link several times already, I found it awhile ago. But I just don’t understand what all the numbers mean. Especially since I’m using a pet meter. Plus holding the dose in cycles for X amount of time unless this magical thing happens, but I don’t know what that magic thing is.

    Also, I’ve never gotten a test done with the ear. I prick it and nothing happens. I’ve been using his back paws. But I worry about testing him to much cause then he’s got all those pricks and he still has to walk around and get into his litter box with them.

    Would I do a reduction if we get 68 or lower (bright green) or the 68-99 section? I don’t like being in the bright green, Sammie has scary reactions to being there. And then I get no sleep.
     
  18. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Absolutely, yes, you would reduce by 0.25U if you see a bright green number, especially if Sammie is symptomatic. Under the SLGS method, you would reduce any time the number is less than 90, regardless of the type of meter you are using, so even more cautious.

    We can help guide you through dose changes, especially if you post over on the Lantus / Basaglar (glargine) and Levemir (detemir)-- there are many people over there who have a lot of experience with lantus and the two dosing methods.

    The worry about infection doing the paw pricks comes up a lot, I don't know that I've ever heard of anyone actually having a problem, though, so that's good. Maybe you could try occasionally dabbing a little antibiotic ointment (Neosporin/polysporin) on the pad and wiping it off. That will get a little messy as he walks around on a sticky foot, which is why I say occasionally-- maybe just when he seems settled in for a long nap, lol.
     
  19. SaMindy

    SaMindy New Member

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    okay. Good to know nobody has had issues with the paw pricks. I’ll try the occasional neosporin when he’s napping. Also good to know that green numbers mean a reduction. I reduced to .75 this morning. If he’s still green midday or evening should I reduce to .5 tomorrow?
     
  20. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    I would, but let's see where he is!
     
  21. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Using the paws is not unheard of, the rest is just common sense about keeping them clean. Wait until a cat gets "cement paws", wet gooey litter stuck between the toes. You'll know it when you see it. :oops: Oh please stop eating that! :(
     
  22. SaMindy

    SaMindy New Member

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    I have found that since I switched to pine litter we’ve had way less goop on the paws. But I’ll let you know what’s happened after his next tests. I’ll test him at 1 right before lunch, and again at 7 right before dinner.

    I notice on a lot of threads that leaving wet out (or frozen chunks) is recommended. However due to the chonky always hungry Bogart food can’t be left out. So Sammie is on strict meals and no free feeding.
     
  23. SaMindy

    SaMindy New Member

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    Just did the pre lunch check. He’s at 92, which turned regular green in my spreadsheet. I really love how it automatically colors itself. If he’s still low ish I’ll reduce to .5, if it goes high ish I’ll stay at .75.
     
  24. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    Have you thought of a microchip timer feeder? Only the cat with the microchip can open it. Just a thought. I have 2 cats too so I know it’s tricky!
     
  25. SaMindy

    SaMindy New Member

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    I have a pair of timed feeders, but I have to be careful. Sammie doesn’t always realize they’ve opened, Bogart always knows. He’ll gobble up the food in both feeders. I can’t afford the microchip ones though. Just keeping stocked up in wet food, lancets, insulin and test strips is hard.
     
  26. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    Yeap I know what you mean o_O
     
  27. SaMindy

    SaMindy New Member

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    Just managed to get the vet on the phone for a quick chat. Emailed her Sammie’s chart. She thinks his body is trying to regulate itself, maybe go into remission. She said to do no insulin for a week. Also no home testing for the week (I’m going to ignore that and test him at pre lunch anyway. Good to keep him in the routine, and good for my sanity). She said we’d talk in a week and see where he’s at.

    but she said he if suddenly starts acting funny, walking regresses (he’s still recovering from neuropathy) or drinking a ton, then test and call back, back on insulin.
     
  28. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    I think you have a good plan... Since you are up and running with the testing already, it's no problem to keep track of how he does without insulin.

    When we do a formal OTJ (off the juice, remission) trial, we do exactly this for 14 days, usually just testing at the AMPS and PMPS times. If a cat can maintain normal blood glucose for those 14 days, we call it remission! If not, no big deal, just re-start the insulin again. Sometimes they need a little more support of a tiny dose of insulin for a little while, but fingers crossed for Sammie that he's really done with the stuff!
     
  29. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    I agree with you, I’d still test him at least once a day. Let’s hope this is the road to recovery!! :bighug:

    is he on zobaline or b12 methyl for the neuropathy?
     
  30. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    Actually I agree with you more PS am and pm was my first instinct ha! ;)
     
  31. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I’m not sure Sammie is ready for no insulin yet. You want to make sure that the remission is strong. There are a few lower doses you can go to below 0.75 units such as 0.5 units, 0.1 units, a drop.
    However if you want to try for a few days with no insulin, I would definitely test before each main feed and again 3 hours after food for one cycle a day to see if the food brings down the BG which indicates that the pancreas is starting to work.
    Also if you are going to give no insulin I would test daily for ketones in the urine. You just need a bottle of Ketostix from a pharmacy or Walmart. Collect a urine sample and dip the test strip into the urine and read exactly 15 seconds later against the colours on the side of the bottle. Anything above a trace needs vet attention and would indicate that the insulin most likely needs restarting.
    Good luck
     
  32. SaMindy

    SaMindy New Member

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    Okay, I’ll keep doing the meal time testing. I have the stuff to test the urine, but so far the only thing I’ve managed to catch him doing is poop. He’s sneaky when it comes to the litter box. If his numbers are above 200 for PS am/pm I’m going to give a tiny dose (.25-.5). Under 200 and I’ll let it be to see how long it lasts. He’s been on insulin for 3 weeks.

    BTW, he also gets 1/4 of a Zyrtec right before bed due to massive allergies and itchiness. Don’t know if that info is useful.

    Also, a friend of mine keeps urging me to get a fructosamine test done. I’m considering it if I can scrap enough cash together for it.
     
  33. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Can you put in the signature that he had Zyrtec daily please.

    There is no need to get a fructosamine test done because you are home testing and we can see exactly what his BG is doing. A fructosamine test measures an average of the last 2 or 3 weeks BGs and gives one number. It does not give any highs or lows. It is useful to diagnose a diabetic cat in the beginning but home testing has superseded the fructosamine test. Don’t waste your money. Keep it for something else.
     
  34. SaMindy

    SaMindy New Member

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    Okay. I’ll skip the test for now. Rather use the cash to buy more testing strips anyway. I did update my signature.

    Just did the pre-dinner test and he’s at 64, so I’m skipping the pm insulin again. If he’s above 200 in the morning I’ll reduce to .5 dose.
     
  35. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Yes, skip, and test him again after dinner. A few extra carbs with dinner would be good, too. 64 is too low on an Alphatrak, so we want to make sure he comes back up!
     
  36. SaMindy

    SaMindy New Member

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    May 12, 2020
    I gave him some wet with gravy, and shredded up some chicken I keep in the fridge. Plus in a bit he’ll be getting a few treats with his Zyrtec. Right now we’re enjoying the nice evening and went for a bit of a stroll.
     

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  37. Ale & Bobo & Minnie (GA)

    Ale & Bobo & Minnie (GA) Well-Known Member

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    I love when their tongues stick out! :kiss:
     

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