Not an emergency, but need dosing advice.

I'm hoping for some help with Jazz's dosing. My 5 cats eat mostly at night and don't eat much during the day. I'm very hesitant to go higher than 2 units. I understand I hold the dose longer than I should but I get low numbers here and there so am afraid to go higher. I do believe my spreadsheet is accessible. Thank you!

 

Here’s your previous post for continuity.
https://felinediabetes.com/FDMB/threads/please-help-with-dosing.257332/#post-2895422

You need to get sone later night tests to catch the nadir as it will explain the higher numbers. With the info you gave he needs an increase. The next time you see a lower +2 at night get a later test and see if it’s green. If not it means you need an increase.

 

Thank you. I did that on 6/7 and 6/14

I also don't understand having days that are low and in the green.

 

Thank you. I appreciate what you're saying. I got a green number +2 and a 103 +4 on the 14th of this month. I don't understand with the hundreds of tests I've taken and the sheer amount of numbers in the first 14 hours every day since last September that when I reach out for help I'm always told to get more night numbers. I'm extremely disabled and physically am doing all that I can do. Previously when she was on 2 units we had two hypo incidents. She barely weighs 5 lbs. So you're saying based on what you see I should up her dose to 2.25?

 

When did you have hypo incidents? I don’t see any hypo numbers on your spreadsheet. Normal BG for a cat is 50-100 on a human meter. With SLGS you want the nadirs 90-150. Your cat is spending too much time over renal threshold. With nadirs like yours an increase is earned following SLGS. A cat needs however much insulin it needs and other than their weight when starting insulin weight does not determine the dose. It’s based upon nadir. Please reread the SLGS method sticky directions. It explains all this.
The reason more night tests are suggested if a cat stays in high numbers it generally will need more and more insulin. Cats often go lower at night and dosing is based upon how low a dose takes your cat. If a cat drops lower then used to she can bounce and be higher in the morning and look like she needs more insulin when she doesn’t. If not seeing blue at night she needs more insulin.

 

11/30/21, 12/15/21, and then not actual hypo but close, 1/3/22, 1/4/22, 3/24/22, 5/4/22, 5/26/22, 6/15 (96 so not a hypo) are don't some examples. Thank you so much for helping. I have read all that you mentioned. I just mentioned her weight. I didn't mean it had anything to do with dosing. It's just that's she's so small!

 

Was she ever symptomatic? What happened in 2021 is way too long ago to use to determine dosing. Numbers over 50 are not hypo. My cat hit the 30’s and 40’s but never had a symptomatic hypo. Cats that are not diabetic often have bg 40-60. Cats on TR on insulin don’t even earn reductions unless under 40. Green numbers are not hypo.

 

Yes thank you, I realize green doesn't mean hypo. But the one where it was 50 was scary. She wouldn't eat a treat, laid limp, and was not doing well. Of course I'd love seeing greens and blues! So please be clear, should I up the dose by .25? Thank you.

 

What dose should I up her to? 2.25?

 

That’s what I would do but you do need to get a test before bed until you know how low she goes.

 

The best I can do is +2 after her PM shot. Her numbers seem to be all over the place. I'm disabled. I will try to get more late night readings if possible. She doesn't eat much. Thank you, I'll start her at 2.25 tonight. My meter keeps 7, 14, 28 day averages so that's always handy too! I haven't found a new vet and her current one will only see her if I take her for a fructosamine test. The vet only allows caninisulin, feed only once every 12 hours, the exact same food, and doesn't support me testing her at home. You guys are all I have. I very much appreciate your time.

 

I’m so sorry to hear that about the vet situation. Often with Lantus if the +2 is not lower than the preshot it won’t be an active cycle. you. Start getting a +2 and posting and we can be of more help. If the preshot is lower than comfortable. Stall, don’t feed and test again in 20-30 minutes and post asking for help. Are you picking up food 2 hours before preshot? That way it won’t be food influenced.

 

Yes I pick up the food two hours before. Then I feed but most of the time she doesn't eat right away. She grazes as her 4 other siblings do. I stopped the +2 for awhile but you'll notice more recently started again. I have a lot of numbers during the day and none of them make sense to me either. I'm dealing with her, get sister's CKD, another sister's thyroid and still need to take in the last two. They are all 17 years old. I hadn't anticipated everyone was going to fall apart on me at once!

 

Help! I upped her dose and her PMPS is 204 and I don't know if I should give her the full 2.25. What should I do? Thank you

 

If over 200 yes give a full dose provided you can monitor and have supplies. With slgs 200 and over warrants a full dose.

 

Your spreadsheet ends in May. We need it updated to help.

 

Chris updated it. Try pulling it again. It's completely up to date. I asked for advice 2 days ago and it was fine then. Maybe a glitch?
I can only monitor until +2.

 

Let me try again. Be right back. Would you get another test to see if on the way up?

 

It cuts off at 5/27. No June numbers.

 

I don't know. You were able to pull it up a few days ago. I was also able to get more night time numbers as you requested.
Since it was updated, sometimes I'll open it and it stops at May. I back out and pull it back up and that usually fixes it.

 

It’s not working for me. Try it yourself from your signature.

 

I screenshot it but can't figure out how to attach. It's very small though!

 

Have you shot 200 before?

 

Yes I've been shooting at 2 units until 3 days ago when I posted here and was told to go to 2.25. I did not shoot 2.25 this time. Her shot was 2. I retested +1 and we're down to 156 from 204. That's with a small (couple of pieces) of temptations

 

I've been shooting 2 units since May 26th when I upped it from 1.75.

 

Hi! I can see her numbers here is the link https://docs.google.com/spreadsheet...KHhQ6BIL00z0UuHD0LDGSF9bs/edit#gid=2084730325

 

But have you shot a bg of 200? Can you get another test please?

 

Usually with SLGS it’s shoot a full dose if over 200 regardless of the dose.

 

Thank you!

 

That link works for me.
Did your shoot? It looks like just 2.0.

 

The reduced dose will effect later cycles but not the first half or more of this one.

 

Yes, it was 2. I can give her an additional .25 if that's what I need to do. She's not eating at the moment. Which is not rare for her. Just some Temptations. (A few)

 

No. Don’t add any more. You never want to add to what you already have done as that will give you a wacky nadir. How late was the shot?

 

You were looking at the 2021 tab, not the 2022 tab....it ends 5/27

 

Ok. Thanks Chris. Juggling a few things and missed it I guess.

 

Would you recommend that @Terri Ridgway take another BG reading at +2 or +3?

 

Feed some now and definitely get a +2. You might need a +3 as well.

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After that if you need to go to bed and getting much lower just feed higher carbs and leave out the same.

 

8:30 pm EST. I tested and shot 2 units with 204. I realize now I probably should've just dosed at 2.25. I apologize, I didn't see the post to give the full dose. I tested (a little less time - 45 minutes) at +1 it was 156. I can only go to +2. I'm not available for a few hours after that. I usually am but not tonight. Figures, right?

 

Totally understand! In the group I'm usually trying to keep my eyes on multiple people and sometimes forget who I'm talking about. The FD world can get kind of nuts sometimes.

 

Thank you, I'll do my best to follow exactly. I free feed, so there's always food with the exception of 2 hours before shot time. She hasn't shown any interest in any food, which is not rare for her. I have 5 different foods out right now, all mostly low carb.

 

That is a HUGE drop for only +1....Can you get her to eat some more? You may need to leave some high carb food down if you have to leave after +2

How long will you be gone?

 

And that drop was with a few Temptations treats! I left food out (I free feed anyway) and there was her normal food left out. No one noticed her eating much as per her usual. Now we're at +6 and she's at 575! This is what I don't understand. Her spreadsheet shows this a lot. Many black numbers at the pre shot time. I am so used to seeing it that's why I was so surprised at the 204 this evening. I'll stay with the 2.25 units as advised but not sure what else I can do. Thanks for your help! Anything else you think I can do for her would be greatly appreciated.

 

And at +8 we're back to HI. I wish I knew what to do.