Do i still give Insulin?!

I just started my cat Molson on insulin 0.5 units of lantus on Sunday, I have been having a hard time testing him sometimes i can get it sometimes i can't.

he is dropping pretty good, do i still continue to give him the insulin?

What if i can't test him or what if i can only test him right before his shot?

I am working 9-5 the next three days so i will only be able to test him before his shots in the morning and at night, IF i am able to, i was unsuccessful today unfortunately...

What do you think i should do if i can't test him.. do i still give him the 0.5 shots the next three days?

 

I worked full time. I also had a cat who was prone to dramatic drops in her numbers. My strategy was to shift my shot time so I was able to get a test or two before I left the house. Testing at 5:00 worked for my schedule. You might consider if shifting your shot time would help. (Without knowing how much time you spend commuting, etc., I'm just offering a thought.)

I would encourage you to do what you can to get a pre-shot test. So far, it doesn't look like Molson is dropping into low numbers. The difficulty with Lantus is that if you skip a shot or change the dose disrupts the depot. You have to do your best to be consistent.

 

okay so if he stays within the blue or green when i test him (whether thats mid cycle or before his shot) should i still give him 0.5 units? also can you explain to me what depot means?

i am worried he'll go hypo in the next three days since i am not going to be home to do any midcycle tests, i am going to do my best to get the preshot.. but it's hit or miss if i can get it and if i can't get it i don't know if i should give him his insulin still..

I am also going to try to change the time to a bit earlier following your advice.

 

Caterina:

There's a ton of information in the sticky notes at the top of the Lantus board. I would encourage you to start there to read about the depot, how Lantus works, etc. Take a look at the information and then we can help to answer your questions.

What you do at pre-shot differs from what you do at mid-cycle. What I would suggest is that you leave food out if you're not going to be home. If the numbers are making you nervous, leave out some higher carb food.

 

Wow, those are some sizable drops you’ve been getting for the last couple days! That’s great news since it means the insulin is working, but you definitely need to make sure you’re keeping away from dangerously low numbers.

Can you tell us a little more about your challenges with testing? It’s pretty normal to not have the testing down by this point, so lots of us have experience working through the early testing troubles.

 

I can't seem to get enough blood. i prick him 5-7 times and just can't get enough blood, and after pricking him so many times i feel terrible and feel like i'm torturing him so i feel like i need to stop. He's pretty good and lets me do it it's just making me feel SO bad that i'm failing and hurting him.. sometimes i can get it though but haven't fully figured out what i'm doing differently.

Sometimes when i see him taking a nap ill go sit with him, rub his ear and test him and am successful, but obviously he isn't always taking a nap during the times i need to test him.

i will be gone for 8+ hours the next three days and am worried that i will give him too much insulin or he'll go hypo since i know forsure i won't be able to do a mid cycle test. I am hoping i can do a successful test pre shot though, but it's never garanteed

 

Are you warming the ear first? Milking the ear towards the top?
What is the size of your lancets? For beginners size 26 or 28 is best, if you can get that size.
Always get a preshot BG so that you know it is save to give the dose.
And try and get a test in every pm cycle. cats often drop lower at night
Is Monson the only cat in the household? You can leave food out for him when you go to work. If you think he will eat it all at once, have a look at an automatic timed feeder that will dispense when you set the times

 

I was able to test him before giving him his shot tonight and he was 18.4. So at 1pm he was 7 and at 6:40pm he was 18.4. Why is he so high all of a sudden. Is that normal? I’m so confused.

I did rub his ear longer than I have and was successfull so maybe that’s my trick. I will have to try it tomorrow morning when I need to test him next. I did give him his normal dose of 0.5units since he was so high.

his numbers are so wonky though. Can you take a look at my spreadsheet and let me know what you think?

 

Hi Catrina,
Well done getting that test !
It is very normal for a newly diagnosed diabetic cat to have BGs all over the place. His body is still getting used to the insulin, which is a hormone and not a medication like an antibiotic that goes to work right away to fix the problem.
The dose of 0.5 U is taking him down nicely to a lovely nadir and for a newly diagnosed kitty it is great he is responding well to the dose. Some cats take a lot longer.
The reason he is up high again at the end of the cycle is because the dose has worn off.
The normal cycle of Lantus is...onset at around +2 and then gradually goes down to Nadir around +4 to +7 or 8 ( every cat is different). The the dose starts to wear off then and the BG starts rising again.
As you get closer to the best dose, the preshots will start to come down. This can take time.
You have only been giving the dose for 4 days and the depot will take up to 7 days to fill and the full effect to be felt.
Feline diabetes is a journey not a race and the main think I had to learn in my journey was patience.
Another reason the BG can go high is bouncing which is very normal in newly diagnosed cat. This is from The Basics on the Lantus page

• 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).

You may also like to read THE BASICS from the lantus page.

Are you feeding snacks during both the cycles?
I would also try and get more tests in during the PM cycles as that gives valuable information. Always try and get a before bed test. If that test is below the preshot BG that is a bit of a heads up to you that the BG might drop lower, so I would se the alarm and get up and test a bit later.

 

I also work a 9-5 job every day, and some days I have to be out the door at 7:30 am and then I’m not back until 6:30 pm. So like Bron suggested I rely on an automatic feeder (the CatMate C500 is really good).

I know it’s hard to be chill about this stuff when it’s your cat and you’re doing all the things people are suggesting and it’s just still not quite clicking. But, you’ve got really great progress for week 1, especially since (if I recall correctly) you’re doing it all on your own right now. Just keep at it, and keep tweaking your testing technique until you and Molson work out a system.

I think having an automatic feeder so that Molson gets something to eat while you’re away will go a long way towards making it less stressful. The solution to a cat’s blood sugar dropping too low is to give them food, so some food left out ahead of time will help keep him safe, especially if you’re following the rest of the dosing guidelines.

Will you be able to do a full curve this weekend? You should be due for your first dose adjustment by Saturday or Sunday, and you’ll want to get a full curve with tests every 2-3 hours if possible before adjusting (except if you see a dangerously low BG number before you get a chance to do a curve; always adjust as soon as you see the BG below the reduction threshold).

 

Wow so much to learn! thanks for summing everything up i guess i do need to be a bit more patient, out of the 4 days, 2 he had a curve and 2 he was pretty flat staying the same number everytime i'd test him, not sure if that is good or not. the next few days i don't think i'll be able to test him mid cycle so i will keep his dose the same at 0.5u and on Sunday or Monday i will do a curve to see if i need to adjust it up to 0.75 or 1u.

i have been feeding him one can of fancy feast in the morning after his first shot, then i give him half of another can a few hours later, and then the rest of the can a few hours after that. if he is bugging me for more sometimes ill give more. then at night time after his pm shot i give him another can. I mix water with his food everytime i feed him as well. I also give treats everytime after i test.

 

I have someone who is going to stop in during the day to feed him while i am gone, and then in 4 weeks i'm having a baby so i will be home a lot and will be able to feed him easier throughout the day. So i am going to hold off on an automatic feeder until i am gone a lot, right now it's just a few days here and there.

I am going to try to do a curve either Sunday or Monday, likely Monday though, that's when ill have more help. I am undecided on which protocol i should follow:

TG: when your cat starts to see nadirs under 100 (5.6), hold the dose for at least 10 cycles (5 days) before increasing. Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200(11.2), but less than 300 (16.7). Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300 (16.7)

SLGS:If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose. If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

So far, day 1 on insulin he had a curve with a nadir at 12, day 2-3 he was flat at 16-17, day 4 he had a curve with a nadir of 7... Do i make my decision on what dose adjustment to do on the Monday when i do a curve and ignore all of the other numbers/nadirs and only look at the data from Monday?

 

To pick between TR and SLGS, you should go off your comfort level and ability to test often enough. SLGS keeps you in higher numbers, which might be less stressful if there are going to be stretches for the next few weeks where you can't easily get a test near the nadir every day. TR is more aggressive, but you need to be able to get in a test every day around the AM or PM nadir.

One approach could be to use SLGS until you have your baby, and then once you're back home, look at switching to TR.

Once you've picked a protocol, you still have to use some judgment. If he's been bouncing all over the place and curve day he just happens to be high, I would maybe wait until he settles into more of a pattern before making an adjustment. On the other hand, if he's been bouncing all over the place and you happen to get a number below your reduction threshold, you should take the reduction right away. Until you really get to know how your individual cat responds to the insulin, you want to err on the side of keeping them safe.

Soon enough you'll start to recognize his patterns and it'll become clearer what the data is telling you. You can always post for advice, of course.