10/23 Lulu - Still having a challenge with insulin dose

M

Maya_

Member
Hello,

Back in the beginning of September, my cat Lulu was on 1 unit twice a day but we increased it to 1.25 due to her BG level still being high but on Sept. 9th the AM preshot level was 88 so we went back to 1 unit instead. Since then she's been on 1 unit, the vet wanted to do a fructosamine test so I held the dose at 1 unit. The results came out to 515, which I believe may have contributed from skipping insulin certain days because my cat would panic. So I kept going with 1 unit and some days the bg level at preshot would be 145-275 or 300+. Also, I did a curve on Oct. 16th where it seems like the insulin hits at +7 resulting in the next preshot to be a bit lower than usual. The vet recommended on giving insulin once a day but Im worried that will cause spikes in her BG level. Today I was going to give 1.25 units and do a curve to see how she responds to the dose but the AM preshot was 161 so I waited another 30-40 mins and it went down to 149, I ended up skipping the dose and fed her morning meal. Then +4 hours her BG level spiked to 554 so I fed her half her usual meal and gave her 1 unit.

I keep struggling with knowing what dose to give my cat when the preshot is lower than usual since I dont want to risk hypo but also the insulin seems to work later than usual. When I skip insulin at a lower BG level, it ends up spiking up. I don't know what to do and am trying to get her BG levels stabilized. What would have been the best approach to react to today's case? And what should I do going forward?

Thank you for any help or advice, really appreciate it
 
Here's the link to your previous post here, for continuity: https://felinediabetes.com/FDMB/threads/9-4-lulu-amps-88-help.293705/

The curve you did on the 17th looks like it might have been a type of cycle where Lulu was breaking a bounce. Starting high, ending lower, and with a later nadir are what that type of cycle can look like. Meaning, the nadir times might not be representative of when she generally nadirs. Nadir times can and do change.
Maya_ said:
When I skip insulin at a lower BG level, it ends up spiking up. I don't know what to do and am trying to get her BG levels stabilized. What would have been the best approach to react to today's case? And what should I do going forward?
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Start with delaying. That means not feeding, and testing 30-60 minutes later to see if she's come up to a level you feel comfortable shooting. As you saw today, she was zooming up and would have been shootable probably 1/2 hour later. That would have allowed you to keep on schedule. As is, the next shot is due 12 hours after you gave it, or 12:45 AM. You can move shot time back 15 minutes per cycle, or 1/2 hour once a day.

Going forward, it'd be great if you had a better idea of how Lulu is using the Lantus, which would give you confidence in shooting lower numbers. People with lots of data, and following SLGS, can shoot as low as 90. However, you aren't there yet as you don't have the data to do so. People typically pick a "do not shoot" or "shoot lower dose" number first, and gradually lower that number as they gather data about what happens when they shoot lower numbers than they have before.

To get better data, you need to do a few things. First, every single shot, get a test before hand. I see there have been a few that have been missed, and as today told you, sometimes the preshot can be lower than expected. Second thing, you need to get more test data from somewhere in the middle of the cycle, including at night time. If you can get a +2 or +3 after the PM shot, it'll help us figure out what she's doing at night. Many cats go lower at night. Today's whopper of a bounce tells me she probably was lower than 149 overnight. Since we figure out how to change the dose based on how low the dose is taking the cat, that night time data is very important. BTW, your first post says 161 for first AMPS test, but the spreadsheet says 149. I open the SS first thing and go by it.

I'd also like to see more frequent curves. With SLGS, they should be done once every 7 days.
 
Wendy&Neko said:
Here's the link to your previous post here, for continuity: https://felinediabetes.com/FDMB/threads/9-4-lulu-amps-88-help.293705/

The curve you did on the 17th looks like it might have been a type of cycle where Lulu was breaking a bounce. Starting high, ending lower, and with a later nadir are what that type of cycle can look like. Meaning, the nadir times might not be representative of when she generally nadirs. Nadir times can and do change.

Start with delaying. That means not feeding, and testing 30-60 minutes later to see if she's come up to a level you feel comfortable shooting. As you saw today, she was zooming up and would have been shootable probably 1/2 hour later. That would have allowed you to keep on schedule. As is, the next shot is due 12 hours after you gave it, or 12:45 AM. You can move shot time back 15 minutes per cycle, or 1/2 hour once a day.

Going forward, it'd be great if you had a better idea of how Lulu is using the Lantus, which would give you confidence in shooting lower numbers. People with lots of data, and following SLGS, can shoot as low as 90. However, you aren't there yet as you don't have the data to do so. People typically pick a "do not shoot" or "shoot lower dose" number first, and gradually lower that number as they gather data about what happens when they shoot lower numbers than they have before.

To get better data, you need to do a few things. First, every single shot, get a test before hand. I see there have been a few that have been missed, and as today told you, sometimes the preshot can be lower than expected. Second thing, you need to get more test data from somewhere in the middle of the cycle, including at night time. If you can get a +2 or +3 after the PM shot, it'll help us figure out what she's doing at night. Many cats go lower at night. Today's whopper of a bounce tells me she probably was lower than 149 overnight. Since we figure out how to change the dose based on how low the dose is taking the cat, that night time data is very important. BTW, your first post says 161 for first AMPS test, but the spreadsheet says 149. I open the SS first thing and go by it.

I'd also like to see more frequent curves. With SLGS, they should be done once every 7 days.
Click to expand...



Apologies, when I first tested the AM preshot it was at 161 then I waited another 40 mins and tested again with the BG level reducing to 149. That's why I skipped the dose thinking the BG level would stay low then fed her but then tested after and saw it spiked up. I had a case before on Oct. 13th where the BG level was 187 and I gave 0.5 units instead but the PM preshot was 422. Seems like the 0.5 unit wasn't enough that time and I should've just given her the usual dose. I'll be testing more, I'm finally able to get Lulu's blood samples quickly whereas before it would take me a long time. In this case, would it be best to stay on 1 unit twice a day instead of increasing it to 1.25?
 
I would see if 1 unit allows you to shoot every cycle. Sometimes when stalling the bg goes up enough to shoot but sometimes due to not eating it falls. Try retesting sooner, say in 20 minutes. Tge two tests were within meter variance which can be 20%.
 
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