113 PMPS +3 73, +4 68...

Per my vets advice, I gave 3 units at PM shot time with a PMPS reading of 113 BG. But now am up testing every hour for fear of her going hypo. Why can't I just not worry??? Ugh, hate this. Guess I will sleep another 30 mins and test again at +5. Praying she miraculously already hit her nadir.

 

I'm afraid you have at least a couple hours to go. I'm glad you're testing, but I'm not sure why the vet recommended an increase when you are not able to test mid-cycle. For all you know, she could be going low and the PS numbers are bouncing. If you aren't already giving her some food, I recommend you do so.

 

Thank you so much for responding! Yes, fed her her own food at +3, then at +4 I gave her some of her sisters food, which is high in carbs (canned Royal Canin Renal Support D).

Ugh all week I was too scared to shoot at the PM shoot time because she is slowly going lower. But saw a specialist vet today and she reassured me it would be okay. That to get a cat in remission you have to continue to shoot. And said she would walk me through it. I felt so much better. But now am a nervous wreck.

 

Yes, you have to continue to shoot, but raising the dose without data is not a great idea. Don't mean to criticize your vet, but I don't understand what she based that increase on. If it is the preshot numbers, she doesn't understand how Lantus works.

That 68 earns you a reduction on an Alpha Trak, and since you're doing SLGS, the 70 already earned one. Feeding HC was a good idea. Let's see where she is with your next test.

 

Since week 2 (8/27) I was told by my vet and now by my specialist as well that I should have taken my cat to 3 units 2x daily but I was scared and didn't. So today she said to do it.

 

The little amount of data you have shows that increases could have been needed, but with SLGS we give each dose a week, then do a curve and decide if an increase is needed. By skipping the PM shots, you've partly drained the depot, so it's hard to know if the 2.75 is a good dose or not. I'm not criticizing you, just explaining. The best thing would be to find a dose you can safely shoot twice a day. Skipping shots makes the numbers go wonky. I know you have confidence in your vet, but I would not shoot 3.0 in the morning, especially if you can't monitor closely. I imagine if you tell her Indie dropped to 68, she would agree.

 

There's no nice way to say this, but if you keep listening to your vets, you may end up with a tragic ending

It's obvious neither of these vets understands how to use Lantus safely

The fact that Indie keeps dropping to a point where you're unsure about shooting says the dose is too high

 

That's better. Now you need to withhold food and test again in 30-60 minutes, because the HC can wear off and she can drop again. You want two consecutive rising tests without food influence before going to bed.

 

I am sorry I didn't respond again last night. Was too upset and too tired. I kept testing until she had the two consecutive readings on the rise with no food.

Now this morning her BG reading is 147. I am supposed to be gone all day at a conference. I emailed the vet but haven't heard back yet. I could call the ER vet but would prefer I make an executive decision. Am leaning towards giving her 1 or 1.5 units. Thoughts?

 

I never heard back from vet or anyone on here so ended up giving just 0.5 units. Praying she is fine as I am at a conference for the day!

 

It's better to be safe especially if you can't monitor. Please leave food out for Indie today while your away.

 

Thank you!

Yes left a good amount of food out and my sister will stop by mid day and give her some fresh food as well.

 

I saw on your SS Indie has runny poop. Are you giving Indie probiotics? If not a really good one is Renew Life Ultimate Flora 25 billion live cultures start out with a small amount from the capsule mixed in the food then gradually work up to one capsule a day.
My Fritz had really smelly black tar like poop for awhile when I started insulin. look at my SS. I don't know about the DM canned food. I feed Fritz homemade raw food.

 

Awe thanks for taking a peak at her SS. Yes, I just ordered a probiotic. Fortiflora?? Vet recommended that or Proviable. Ordered through Amazon (which sometimes scares me on items that are digestible).

She finally had solid stool yesterday but didn't last long.

 

Some here use Fortiflora I used it for awhile. Fritz does better on the Renew Life. Once you finish with the Fortiflora you might want to consider the Renew Life.
With Fritz his was like that for awhile. I even called the manufacture of Prozinc and Levemier. Rushed him to the vet after discussing it with the vet we decided to monitor. It did clear up.
Thats nice that your sister will check up on Indie while your away!
Have a nice day! Keep coming back there are alot of really nice knowledgeable people here!
Some times the site gets really busy if you find your not getting help type bump and or put in your subject line need help????? or dosing advice please or whatever you need.

 

Thank you for the tips!! ❤ Still a bit new to all of this!

I made a note to check out Renew Life once the Fortiflora runs out. Thank you!

 

Hi there,
sorry no one was there to help with the amps this morning, I think that, given the lack of data, and the way that you have arrived at this dose (ie in large steps, potentially missing out on the goldilocks dose), 0.5u was a sensible choice as you are going to be away this morning, another option would have been to skip altogether.

Can you leave some food out for Indie, even though you have shot a much reduced dose, she may still react to the insulin.

Another tip that will get folks attention, firstly we start a new thread every day, in the thread title we put pertinent info typically. And in the post we link the previous days thread which makes it easy to look back through the history, whenever anyone is helping you out.
Name date amps 123
so for example this morning something like
9/17 Indie amps 147 stalling Low Preshot have to leave/advice please
would probably have got more eyes on you. Often when folk see an old thread they don't go back to it.

 

Ahhh, thank you! Now I know for next time!!

Yes, left food out and my sister is going to put fresh food out mid day for me.

 

I think you made a good choice this morning. Better safe than sorry, and some insulin is usually better than none. Will you be home all day tomorrow? It might be a good idea to run a curve so we can see what Indie is doing.

Would your sister be willing to learn to test? It would come in handy for days like today when you have to be gone all day. If she could just grab a mid-day test, it would help fill in some blanks on your SS. We look at the SS like a jigsaw puzzle. If only the edges are filled in, it's hard to determine what the picture is, but as more and more middle pieces are put in place, it becomes clearer. We know not everyone can test a lot, but most people can usually grab a test here and there, and the more data the better. We want to find you a dose you can comfortably shoot twice a day without having to worry if Indie will be safe.

Forti Flora was the go-to probiotic for a long time, but rumor has it they have changed the formula and it isn't as good as it once was. I've used it successfully for several years. It may be just what Indie needs, but if it isn't, I also recommend the Renew Ultra.

I don't know if anyone has given you this link yet, but we have a dictionary of our terms that can help newcomers to understand some of the strange things we say. When you have a moment (ha ha), give it a look:

http://www.felinediabetes.com/FDMB/threads/l-l-land-slang-dictionary.162551/#post-1744648

 

I typically always do a curve on Saturdays but today is unique. And meant to do one yesterday but didn't get a chance. Tomorrow am booked as well from 8am-2pm. But I will definitely get some random tests in tonight and tomorrow.

As for my sister, she is sort of scared of Indie at this point. Indie hisses and bites now when others go by her (not always but often). Which is weird because Indie is big on head butting and rubbing herself on people. Especially on my sister. Indie will meow and meow for attention. Will rub on my sister. My sister will lean down to pet or will actually get a pet or two in and Indie will snap. I told my sister she is sensitive and when u notice her skin twitch it means she has had enough. Or if her tail goes back and forth quickly. I tell my sister that is her sign again, that she has had enough and to back away, haha. So my sister now knows the signals but is still difficult and scary as sometimes the signals come too close in time to her biting. So there isn't exactly a signal!

Anyways, her demeanor has changed greatly since being diagnosed. So at this point I don't think its wise for my sister to even try. Just petting her is scary. And I don't feel it would be fair to my sister or Indie. Hopefully some day though!

Thank you for sharing the dictionary. I did actually have the opportunity to check it out.

 

I agree that it's not time to teach your sister to test if Indie isn't cooperative. Perhaps Indie is behaving this way because she doesn't feel 100%, and this is her way of showing it. Hopefully, once you get her regulated, her sweet personality will re-emerge full time.

Just get the tests you can. I've asked some other veterans to take a look at your SS and give you some thoughts about your dose. Will you be able to monitor some tonight? You must be very tired after last night.

 

I'm one of the ones Tricia tagged to look at the SS and give you some thoughts.

First, if it were me, I'd see if I could return the Fortiflora. They call it a probiotic but it has very, very few strains of beneficial bacteria. I also use Renew Life Ultimate Flora but I use the Adult 15b CFU 1/2 twice a day. The Fortiflora could be contributing to her soft stools. It looks like she still has runny poo so you might want to read this info on probiotics which also discusses how to emergency stop diarrhea. I have used the S. Boulardii for soft poo and it works like a charm. If it doesn't stop the diarrhea, she might have an allergy to yeast. The info linked is great regardless of whether the cat has IBD or not. My cats always get the RL Ultimate Flora probiotics...including my 14 week old kitten.

As Tricia said, under SLGS Indie earned a reduction last night to 2.75u. She wasn't on 2.75u long enough to see what the dose might do. She was showing some small progress on 2.5u and the curve you did showed her nadir to be close to 150 and that was on an AT. Under SLGS, you would have held the dose another week and then done another curve.

While 2.75u might be a better dose for her, if you are concerned about keeping her safe and being able to shoot every 12 hours, you might consider 2.5u. I'm going to leave that decision up to you.

I know you work during the day but I think getting more tests at night might help everyone figure out what is going on. In fact, any more data you can get would help.

Just a few suggestions for you to consider:

• Are you able to move her shot time earlier so you can get a +2 test? If not, I would at least try to get an "out the door test".
• I would also suggest a test as soon as you get home even if it's +11
• Every single night, I would get a +2 and a before bed test
• If you can't move the shot time but you are up early, I'd also use the opportunity to grab a test.

I'm not suggesting that you skimp on sleep or get up to test unless she's running low. But any opportunitymyounhave to grab a test will help.

 

Hi again,
I'm someone else that Tricia has been chatting to regarding Indie's dose.
Looking at the ss, as Marje mentioned that nadir with the 2.5u was awful close to seeing you hold the 2.5u for another week. The other cycle that has me asking questions about how low that 2.5u might be getting Indie is the am cycle on the 6th September which gave you an pmps of 163, two hours later she was back in yellow following a skipped shot, it makes me think that at pmps her numbers were probably rising and makes me wonder how low she might have gone in that am cycle.

Additionally the 2.75u has been giving you pmps values that you are not comfortable with leading to skipped shots, which is not ideal, kitties do better with Lantus dosing BID. Some of those numbers you skipped, may well have been shootable, but with not enough data, if availability to test is limited and the way the dose has been arrived at makes it difficult to say with confidence that it would be safe to do so at this point.

So summing up I think that 2.5u or 2.75 could be the way to go, the 2.75 will likely see her run lower, so you'll need to weigh up your availability to monitor, keep her safe and your ability to shoot BID if monitoring is limited. The 2.5u might not be enough but it may buy you some time to collect some data over the next week which will hopefully give you a better idea of what exactly this dose does for Indie, giving you more confidence taking her up if you need to.

As Marje and Tricia both mentioned getting some midcycle tests in (ie anything from +1 to +11) will be extremely helpful at this stage.
I would always test George just before I headed out the door, and depending on what I saw I would feed or not (and decide if I needed to carb him or not to keep him safe when I did have to go out), the other test I always did was just before heading to bed.
Have a read of this sticky about doing TR on a full time job, a lot of the tips for grabbing that extra data still apply to SLGS