? Sept 11 - Charlie - dosing increase?

Previous thread: https://www.felinediabetes.com/FDMB...-5-230-6-211-8-182-9-211.234880/#post-2632241

Charlie has been between 350 and 450 the last few days. I just started giving him 2 units consistency in the AM and PM 3 days ago.

Is it too early in increase his dose?

 

Glucose toxicity makes it hard to get their bg down and you need to keep increasing the dose.

 

Read this thread.

https://www.felinediabetes.com/FDMB/threads/new-member-up-to-5u-how-to-reduce.234587/#post-2626345

 

I’m not sure if I got out of that thread what I should. If I’m not doing TR (I’m doing the Lowe and slow method), I should give it another couple days to get a week’s data?

Assuming he stays in the reds and pinks, a dose increase is needed, but to 2.25 or 2.5?

 

I wanted you to read about glucose toxicity.

 

oh ok. I read the whole thing haha.

Yea I def don't want him getting "used" to the higher numbers and then having a harder time bringing it down

 

That's where I've been stuck with Oberon. Just can't seem to get him out of the 300s, except for occasional brief dips. The sooner you can get him out of that range the better!

 

Yea I def want to see him lower. I just don’t know when (and by how much) I should adjust his dose

 

If you're following SLGS, I think you're supposed to stick with a dose for 7 days before increasing. I was frustrated by that pace since it was clear Oberon needed more, and eventually managed to get him (and the rest of the cats) off of dry food so I could switch to TR, which increases the dose more frequently.

 

Yea i think I’m going to give it another couple days.
And I need to work on slowly getting him over to Dr Elsey’s since he hates wet food. That’s gonna take a lot more time

 

Good luck with it! Oberon loves wet food; it was the other cats that were stuck on dry. I thought I had one holdout, but she's my scaredy-cat and it turned out that she was just being kept away from the good stuff by the other cats, so she could only get to the dry. Once I started feeding her in another room, it was smooth sailing.

 

The vet called this morning and we’ll be increasing Charlie to 3 units starting this evening.

 

If you’ve only been on 2 units consistently for 3 days, then going to 3 units tonight is a 50% increase. Does your cat have a history of DKA? If not, and if you’re doing SLGS as your signature says, I believe you might be moving too aggressively too quickly. Sometimes we need to “sit on our hands” and be patient.

Keep in mind that it’s not at all like “my car is a quart low on oil so I’ll just add more.” The cats body needs time to adapt. Plus, it appears you recently moved from a high-carb food (c/d) to lower carb, which can also affect insulin needs. Please be careful.

Anyone else have thoughts?

 

He’s been on 2 units for 5 days now, hovering around 370-425 the last 3 days.
If I don’t hear otherwise, I’m going to go with the vets advise and increase to 3 units in the morning

 

It can take up to 5 days for the Lantus depot to build.
Going from 2 units to 3 units is a whopping 33% increase.
It is recommended that increases be no more than 0.25 units so that you don't skip right past the best dose for the cat.

 

I did ask the vet about this. I specifically asked if I should try 2.5 instead of 3. He said that because his numbers are still so high he thinks that we should go to 3. I might try 2.5 but I don’t have a syringe that would measure by 0.25 increments, so idk how I could do 2.25.

 

You eyeball it.
Practice with a used syringe and some coloured water. When you get it as good as it's going to get, put that syringe aside and use it as a guide to be consistent.
A pair of dollar store magnifying glasses and good lighting help.
Some people use calipers.

 

I have a caliber but even with it locked in place, the same measurement seems to be different for different syringes. One was dead on 2 units and in another it was between 1 and 1.5

I might try 2.5 for a few days and see how it goes

 

Feline diabetes is a marathon, not a sprint. Charlie is just starting the race.

 

The lines can differ from syringe to syringe. Was the 0 line in the same place on both syringes?

 

They looked the same.

 

If you go up that fast you might miss a good dose. We see vets saying this so often and then they end up having to go back down. Vets don’t realize we can shoot .25 increments. I had to teach my Boarded Vet Internist that it’s possible and he became a believer. You hold the syringe but I sure hope you don’t try to rush this.

 

So if I’m not going to 3, what should I do? I get that people are telling me that 3 is the wrong number but I don’t know what the “right number” is then. 2.25 or 2.5?

the inaccuracy of the 0.25 units makes me nervous in how consistent my eyeballing will be

 

That is why it is good to have a coloured water syringe as a guide.

Do you have syringes with half unit markings?

 

I would shoot 2.25 and maybe 2.5 tops. You can increase if needed every 3 days. If my cat I would choose 2.25.

 

I just picked some up. I have 90 syringes with unit markings and 10 with 1/2 unit markings

 

I will try that in the morning

 

Giving a 0.25 unit increase, even if it is approximate, is safer at this early stage than giving a 1.0 unit increase.

 

2.25 it is (or my best approximate of it)

 

Kinda of related questions. When measuring... the top ring of the plunger is used for measuring, but do you line that up with the top of the “line” on the syringe or the bottom? (Maybe my syringes just have thick lines). Or just be consistent?

and the syringes I have with 1/2 units are only 5/16” long. The syringes I got from the vet have a 1/2” needle. Is a needle that is 5/16” long enough?