Dosing question (I don't have a spreadsheet yet)

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migoto and mom

migoto and mom

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Hi...I was referred here from the main board. I have a Lantus question and I'm sorry if I'm not formatting my post correctly. I am new and confused and I did read through the FAQ and the "New to this section" section - but I'm still confused.

My kitty was diagnosed last week and had a blood glucose level of 400 on Wednesday the 6th. I was told to give her 1u of Lantus twice a day, 12 hours apart, after meals. I did this, and she had her blood glucose tested at the vet's again today. It was 370. My vet (who is really great) wants me to increase the dose to 2u of Lantus, but I am nervous about such a large increase. Has this been recommended to anyone else and was it okay?

I just bought a home glucose test kit for Migoto this afternoon (with my vet's approval), but I'm nervous about using it. I think I need to get over that, but this is all very new and there's a lot to take in at once.

Does 1u sound like a rather large increase or is this reasonable given her numbers?

Thanks...
 
Hi there,
You're very right, it's a huge increase for Lantus. We can't really tell you if it's safe at all to increase because we don't have any numbers, though we'd love to be able to help you with that. Don't worry about being behind on getting numbers, if you can start getting them now, we can help you. I don't know if they told you on the Health board, but that glucose reading (unless it was fructosamine) is not likely to be even remotely accurate due to vet stress. If it was a fructosamine, that number is not applicable to what you need to know. So go ahead and talk yourself into testing, because you'll be a lot more informed about what's safe for your kitty! :smile:
 
Hi Kathy

welcome to Lantus Land. Take your time, it will all get easier.
First thing to know - this thread you began is your thread for the day.
As people reply and when u have questions, just hit reply to the last post in this thread, when that happens, this thread will "bump" itself to the top.

It's also known as your "condo", every cat here has their own condo (thread) a new one each day, this is something very easy to get use to and soon enough you will get the hang of it!

Just wanted to say hello, while you wait, just poke around and read and look at Spreadsheets.

We're glad you're here with Migoto (beautiful name by the way - Japanese you had said in Health - really nice name!)
cat_pet_icon
 
Hi Kathy and welcome to you and Migoto. Sorry you need to be here but this is a great place to find information, support, and help for managing Migoto's diabetes. For the moment, don't worry about the details of getting a spreadsheet set up. It's more important that you get started home testing -- then you'll have data to put on the spreadsheet (SS). The main Health board probably has the greatest number of people passing through. I would suggest putting a note there, as well as here, indicating the city in Indiana where you are located. Hopefully, there is a member nearby who can walk you through and show you the steps involved in testing. You will need to edit the subject line in your first post here to include where you live if you choose to do that.

What you may find helpful is to look over and try to digest the dosing protocol that we use here. You may want to print this out and share it with your vet, as well. Many vets, despite prescribing Lantus, are not thoroughly familiar with this protocol and will use Lantus like other, shorter acting insulins. There is solid research that supports the use of this protocol. If you look at the section on increasing dose, most cats receive an increase between 0.25 and 0.5 units. This is to insure that you don't miss your cat's optimal dose of insulin. So, that's the long answer to saying yes, according to one of the established dosing protocols, a 1.0 unit increase is a very big jump in dose.
 
Hi. Welcome to LL. So glad that you got a meter and will start testing soon. If it were my cat, I would definitely stay on 1 unit BID (2 times a day) until you are able to gather some data from spot checking his glucose. Better to be safe ya know?

We will help you through this. Do you have any questions we can help you with?
 
Linda and Fluffy said:
Hi. Welcome to LL. So glad that you got a meter and will start testing soon. If it were my cat, I would definitely stay on 1 unit BID (2 times a day) until you are able to gather some data from spot checking his glucose.
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i agree with linda. once you begin testing, we'll have a better idea about dose.
 
Thank you all for the warm welcome!

I just got the glucose meter set up and tested her (though I feel bad - I got way more blood than I needed from her ear, poor baby - I stanched it with cotton but she is pointedly cleaning off Mommy's Mistake right now). Her BG is 402. That's awfully high. :(
 
She gets fed and then injected at 6:30am & 6:30 pm. It's now 5:57pm, so she will get fed in about another half-hour. She did get a little snack of extra food this afternoon (I think around 3pm) because she's still unregulated and gets hungry. Could that be what made it so high?
 
migoto and mom said:
Thank you all for the warm welcome!

I just got the glucose meter set up and tested her (though I feel bad - I got way more blood than I needed from her ear, poor baby - I stanched it with cotton but she is pointedly cleaning off Mommy's Mistake right now). Her BG is 402. That's awfully high. :(
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congratulations on getting the test!!!

we would write that +11.5 402.
yes, the number is high, but we don't want to make adjustments based on one number. for all we know, kitty may have bounced from a low number. i would suggest testing again before you go to bed tonight. every bit of data you collect will provide pieces to the puzzle.
test again in the morning before you shoot. please set up a spreadsheet as soon as you can. there's a link to the spreadsheet template in the "New to the Group?" announcement at the top of the forum.
 
Jill & Alex said:
congratulations on getting the test!!!

we would write that +11.5 402.
yes, the number is high, but we don't want to make adjustments based on one number. for all we know, kitty may have bounced from a low number. i would suggest testing again before you go to bed tonight. every bit of data you collect will provide pieces to the puzzle.
test again in the morning before you shoot. please set up a spreadsheet as soon as you can. there's a link to the spreadsheet template in the "New to the Group?" announcement at the top of the forum.
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Thanks! I set up a blank sheet for her in Google Docs, and I'm looking at the instructions now. Thank you for the information about how to write the number.

I'm really waffling about whether to double the dose or not. On the one hand, the vet knows my cat and is usually really good. On the other hand, the last thing I want to do is to make her hypoglycemic.
 
I know it is probably hard to trust us since we are strangers to you.

Also, dont go by just pre-shot numbers, which the +11.5 practically is. Migoto may have gone into the 200's earlier in the cycle and you just didnt know since you just started testing.

The snack this afternoon is totally fine. Most of use here use timed feeders and give mini meals throughout the day.

Like Jill mentioned, can you test again before you go to bed? And then post whether it was +4, +6, etc.
 
migoto and mom said:
I'm really waffling about whether to double the dose or not. On the one hand, the vet knows my cat and is usually really good. On the other hand, the last thing I want to do is to make her hypoglycemic.
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i understand. you're seeing a high number. your vet told you to increase the dose... which seems to make sense because the number is so high (and the vet is the professional).

however, "what if" you're seeing such a high number because kitty went lower than you know and now is bouncing from that low number? if the dose is increased (not to mention doubled)... we could be asking for trouble. obviously, this is your decision. i know it's difficult trusting a bunch of unknown internet crazies instead of your vet. it just seems to make a fair amount of sense in collecting some data before making dose adjustments...
 
Hi and welcome,

I love my vet. He's a great guy and has been totally supportive of everything we want to do as far as getting Basil healthy. He cares about animals, is accessible and--well, what more could you want? He's terrific! BUT, he doesn't have the data at his fingertips that this group of people does. How could he? Take a look at my Basil's spreadsheet. You will see what the kind of micromanaging you can accomplish here can do. I began here on Dec 21.

A week of high blood sugar is not great for your kitty, but it is not an immediate threat. Why not give this a try, hold off on doubling that dose, and see what happens?

Best of luck with all of this. You are in a great place.
 
migoto and mom said:
I'm really waffling about whether to double the dose or not. On the one hand, the vet knows my cat and is usually really good. On the other hand, the last thing I want to do is to make her hypoglycemic.
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Hello, Kathy! I'm glad you found LL. Let me first say that I cannot offer any dosing advice, nor will I, because this is my first day on Lantus (although not first day on insulin; we switched from PZI). I just wanted to tell you something in regards to your sentiment that I quoted above.

When Buzz was first diagnosed, the vet told me to give her 3u of insulin SID (once a day). I had already been to the board, I knew that the recommended starting dose (absent of any other issues that would cause you to need higher doses, like acromegaly) was 1u BID. I was more or less convinced that the board was right. So many people, so much collective experience and knowledge, after all. I had decided that I would ask her about BID dosing if she suggested SID, and also discuss the starting dose if she recommended anything but 1u.

And I did ask her about those things, and she said that we could do BID dosing if we wanted to, but that the manufacturer says that PZI can last up to 24 hours. She also felt very strongly that we should start at 3u. And just like that, all of my resolve was gone. Because, you see, here was a woman in a white coat, whom I like and respect, telling me that she knew best (not in those terms, though). And then on the other hand, I had some people on a board who I didn't know and who I had just discovered a few days ago. And I caved. Not because I had less respect for the board or the people here. Just because it's really hard to sit in a doctor's office and not take their advice, especially when you are scared and worried and you're talking about decisions that could possibly end the life of your precious baby. At least it was for me.

So we gave Buzz 3u at the vet's office and brought her home. Luckily for her (and me), I had already sort of learned to do hometesting and knew that it was something that was totally necessary both for my peace of mind and her health. And so 4 hours after the shot, I tested her BG. It was 39. If I had not hometested, Buzz would be dead right now. She showed absolutely NO symptoms of hypoglycemia.

I relay this story not to terrify you into accepting these wonderful folks' advice, but so you know that we do understand where you are coming from. It's scary to take a leap of faith and trust people here, even when you know that they know what they are talking about. We have it drilled into us that people in white coats are more powerful than we are, they are more knowledgeable than we are, and that they are the ultimate authority on all things medical. And they ARE more knowledgeable than we are in many, many ways. They went to med school; I did not. However, that doesn't mean that you have to accept as fact everything they say. Most vets don't specialize in endocrinology, or oncology, or other specialties. They aren't exposed to FD on a daily basis, and for that I don't believe we can fault them. That's why we have to educate ourselves to be our kitties' best advocate. And sometimes that means trusting some weirdos on the internet. ;)

I know it's not an easy decision to make, but I hope you come to a decision you feel comfortable with, whatever that may be.

Sorry for the long-winded post; it got away from me.
 
Thank you all for the support and feedback - it's not that I don't trust you, at all! You all REALLY know what you are talking about. But it's so hard to choose to go against vet's orders (for me).

Sarah, I wish I had read your post before dosing Migoto this evening. I went ahead and gave her the 2u. She seems fine and I am watching her like a hawk, but the no-symptoms hypoglycemia is really worrying. I am so sorry that you and Buzz went through that!

It's been a little over an hour since Migoto had her dinner and insulin and I will test her BG in three more hours.

I have Karo syrup and emergency number handy just in case, but oh gosh I hope I don't have to use it.
 
Welcome to Lantus Kathy
I have only been here since Nov and I totally understand the "vet" vs "the board here"

Go through a lot of the "condos". Get familiar with the people here, the support, opinions and just the hugs.

It is an amazing place to be and everything is based on the protcocols and experience. Everyone here loves their sugar kitties and spend a lot of time helping others in need.

Take deep breaths, a lot of reading in the stickies and you will see everything will be okay.
Of course, you need to feel comfortable in how you handle Migoto.
Best of luck.
 
migoto and mom said:
But it's so hard to choose to go against vet's orders (for me).

I went ahead and gave her the 2u. She seems fine and I am watching her like a hawk, but the no-symptoms hypoglycemia is really worrying.

It's been a little over an hour since Migoto had her dinner and insulin and I will test her BG in three more hours.

I have Karo syrup and emergency number handy just in case, but oh gosh I hope I don't have to use it.
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Personally, I would not wait that long to test Migoto since you doubled the dose. Why don't you test now? Just to see if and how fast she's dropping? Peace of mind is a good thing....
 
Yes, +2 is correct.

+11.5 ~ 402
PMPS ~ ?
+2 ~ 316

So far, so good. That is an 86 point drop in two hours. Not a scary drop, but again, I'd watch carefully since this is first time on this larger dose.

Test again in an hour, okay?
 
Hi Kathy: Welcome to LL. Its great that you are setting up your spreadsheet. That contains valuable information for your kitty. Second, it is hard to make a decision regarding dosing here and dosing on a vet's advice. As so many others can say, Tuffy would be dead if I followed the advice I was givien. She was on 10 units. Started out on 3. When I came to the board she was on 7. She will be diabetic 2 years in March. She is now getting 1u of Lantus, has great numbers and it is all thanks to this community. They have "all been there, done that". This is a place of experience, knowledge and passing it forward.

Read some of the posts, (condos they are called) check out some of the spreadsheets. The more you read the more SS's you look at it will all begin to take shape.

Good luck. You will do well here.
 
So far you guys are doing fine. This was 55 points lower than last hour.
No panic here, just continue to be observant. I think you can give test in 1 hour.

Total points from +11.5 hours is 141 points lower. :smile:
 
You will be fine because you are hometesting. As long as you are getting tests in, no-hypo-symptoms don't, in theory, matter; you will have numbers rather than a set of behaviors to watch for. Obviously the symptoms are good because they can be your first clue, but you will be fine with testing. :)

I know Migoto's aggravated and sore, but you will both get through this just fine. If you have Neosporin (with or without pain reliever), you can put that on her ears after you test. I ended up getting the kind with the pain reliever in it, and it really did seem to help, but it's not something you need tonight by any means.

Your numbers look okay so far. Just remember that dry food, when given as a hypo aid, will take longer to hit the system than wet food will. Also be prepared if you have to use these methods that Migoto's BG will probably be much higher than normal tomorrow (not guaranteed, but likely). Don't panic and raise the dose due to the higher #s.

Remember to breathe deeply and have confidence that you can do this, because you can. So far nothing is awful and you are doing wonderfully. Even if you are faced with a hypo situation, you are prepared and although it will be scary at the time, you and Migoto will come through it a-okay. :)

(((Kathy))) (((Migoto))) :)
 
+4 233 !

I think she's going to be okay. :)

((((HUGS BACK!)))) to Sarah and Buzz and (((HUGS))) to all of you. I can't tell you how much you have all helped.

I think I'll be getting Miglet some Neosporin in the morning...what a great idea.
 
As Libby said, leave out food so Migoto can continue to surf. Most kitties will eat on their own if they feel a little low, they know what to do.
 
migoto and mom said:
Thank you all for the warm welcome!

I just got the glucose meter set up and tested her (though I feel bad - I got way more blood than I needed from her ear, poor baby - I stanched it with cotton but she is pointedly cleaning off Mommy's Mistake right now). Her BG is 402. That's awfully high. :(
Click to expand...

Don't worry so much about poking your Kitty. I too was worried too, but my cat has been very accepting of all the poking. And many time she is purring through the process. The only time she has gotten a little restless during the process is when I was poking her every 2 hours for a few days, but I can't see having to do that very often.

Also, I have learned in the past few days, that it is important not to freak out over the number. Give it some time and collect data, the people on this board are so helpful. I have gotten more information from this board then I got from my vet and most of the information the vet gave me wasn't correct. Stick around and your kitty will be feeling better soon.
 
Thanks, Tina. :)

Migoto seems to really hate the ear pokes, but she doesn't mind the insulin shots at all - she'll eat and then go lie down in her "shot spot" for her injection!

But the ear thing seems to really hurt her - she struggles a little and meows and I feel so awful. I hope when I get less clumsy she won't mind so much. I pet her a LOT afterwards and tell her how good she is.

I've been reading a lot of you guys's condos and looking at spreadsheets but I haven't commented elsewhere yet because I still don't know what I am doing. :oops:
 
migoto and mom said:
Thanks, Tina. :)

Migoto seems to really hate the ear pokes, but she doesn't mind the insulin shots at all - she'll eat and then go lie down in her "shot spot" for her injection!

But the ear thing seems to really hurt her - she struggles a little and meows and I feel so awful. I hope when I get less clumsy she won't mind so much. I pet her a LOT afterwards and tell her how good she is.

I've been reading a lot of you guys's condos and looking at spreadsheets but I haven't commented elsewhere yet because I still don't know what I am doing. :oops:
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Are you using the lancet pen or trying to poke without it. At first I tried without the automatic pen, but I wasn't have much luck and it was bothering Sami. Now I use the automatic pen and have it set to a low setting (not very deep) and it seems to work much better and I almost always get blood with the first poke. Before switching to the pen it might take 3-7 pokes before I found a good spot. Also I have found warming up the ear with a warm washcloth before poking helps too.

It will get easier as you feel more comfortable doing it. After testing for over two months, I can usually get the test done in less than a minute, including getting the lancet and strips ready. Sometimes it takes a little longer if her ears are really cold before I get started because I hold the washcloth on it a little longer.
 
Hi I'm coming to the party a little late, but I wanted to offer some suggestions that you may find useful.

If you have any neosporin, you can put that on kitty's ears after poking. I used to make it part of Maui's routine. she loves to be brushed, so I would poke, brush her and then massage the neosporin onto her ears. Any topical type ointment will do. And if you need to shop - you can pick it up in the first aide section of the store.

Also, I totally understand the feeling of how do I go against what the vet said and what these strangers on the internet recommend. It's hard to not do what an authority figure tells you.

But it's now been two days and look at the numbers you're getting. Imagine if you did follow the vets instructions and gave 2 units, instead of the 1. Migoto could have gotten in serious distress and you could have ended up in an ER with him.

I don't know if anyone mentioned it, but the motto of this board is to start low and go slow.

Meaning, start at a low amount of insulin like 1 unit or even less in some instances and let that work it's way into the cat's system and build up and see what happens over the course of several days (the go slow part) before making any major changes.

Even though it's only been a few days, don't you feel more empowered now that you are home testing and can see how the insulin is working in Migoto.

You're doing great and we're all here to help.

I also see from your profile that you are currently feeding dry food. Well as I'm sure you have heard and if not, you will now :cool: that dry food isn't good for a cat, diabetic or not.

The sooner you can transition Migoto to canned or even raw food the better for both of you. And yes, you can still free feed canned food, I do it for 3 cats.

Please note this caveat - BEFORE removing these foods, please make sure of your insulin dose as it will most likely need to be reduced, so as to avoid a possible hypoglycemic situation due to the removal of the dry/high carb foods that will lower the BG’s and reduce the amount of insulin required.

Thanks for trusting and listening to us. The people here really DO know what they are talking about.

They helped Maui and I have a healthy cat as a result.
 
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