? Units and Shooting advice needed

Jocke was diagnosed exactly 2 months ago, with > 700 and we started on 2 units Lantus every 12 hrs. The first curve was done 12/22 at my vet with numbers in the 500s, units were increased to 3. I started home testing and my vet increased his dose about 2 weeks ago to 4 units. Today's readings were alarmingly low:
+3 71
+5 48/51 (tested twice)
+6 55
+8 62

https://docs.google.com/spreadsheets/d/1sGefDxCi5MV4EqJyD0uXNrxPA3licDsxiPXwPitBwQk/edit?usp=sharing

My cat acts normal and I gave him some fancy feast with gravy and a few pieces of temptations, when I saw his low BG numbers. I called my vet and he said to continue giving him his 4 units of Lantus tonight and also stop testing so much, only retest 6 days from now. My gut feeling is to not give him his 4 units tonight and I posted on facebook, where I received the advice to cross-post here.

Thanks so much in advance,
Astrid and Jocke

 

Good to see you over here from the FB group! Welcome to the FDMB!

As I said on the group, your vet has increased your dose by too much. We only recommend dose increases in .25 to .5 unit increments.

By dropping below 50 today on your Relion meter, he's earned a reduction. I think I'd reduce him to 3.5 and start always getting Pre-shot tests and at least 1 mid-cycle test on the AM cycle (5-7 hours after the AM shot) and at least 1 "before bed" test on the PM cycle. You don't have a lot of PM tests but they're just as important (if not more important) as the AM tests are. Most cats go lower at night so getting at least a "before bed" test lets you know if it's safe to go ahead and sleep throughout the night or if you should set an alarm to get more tests later.

 

Thank you Chris, I appreciate the advice! Are you still recommending to skip tonight's shot and then test in the AM pre-shot? Thank you!

 

No, I'd make sure he has no food after +10 today and then test at your usual PMPS time (or even better, test at +11.5 so you have some time before shot time to get some opinions)

He will most likely bounce high at some point from dropping so low today

 

Thanks, will do! I'm at +9 now, so will do that and then share the latest readings.

 

Hi Astrid! You can start posting daily too, helps the admins keep track of you and help in real time. I'm so glad you are here, getting expert advice from Chris, and have that spreadsheet! Whenever you have a question you can edit the title of your post to put a question mark from the drop down menu - gives it more attention!

 

That's good advice I will follow. Thank you! I'm now seriously considering switching my vet, they used to be really amazing but their advice has been confusing based on what I learned in the past weeks following the fb group on feline diabetes.

 

I think a lot of vets aren't really knowledgeable about feline diabetes - dogs are generally easier to deal with in terms of BG numbers so maybe they think cats should be too (and they are wrong about that). But this group is fabulous for help and support and keep you going in the right direction. I would trust this group for sure. You can check out my Pearl's SS (linked in my signature) and see how well she is doing - all with the support of this group and me listening to their directions.

My vet is great about diagnosing other things, so I am keeping her, but she can be antagonistic about the diabetes and not wanting me to test and to increase doses by big jumps. I don't know how to deal with this yet or whether this means she won't be a good fit long term. But a lot of vets are like that. The good news is, you hold the needle and YOU decide what you are doing. They just need to write the script!

 

Just took his reading at 11.5 at it is 223 mg/dl

 

Hi Chris, Hi Bhooma is it me or does Astrid's SS not look like it should for Lantus, I am talking about the color coding at the top.
There is no dark green and the neon green isn't correct
I didn't check the rest .
Thanks @Chris & China (GA)
@Bandit's Mom Thanks Bhooma

 

OK....take it again since it's PMPS time but if under 200, DON'T feed....otherwise, go ahead with the 3.5 dose tonight as long as you can test tonight and have plenty of supplies (high carb food, test strips, Karo/honey/syrup)

 

Thanks Chris. It's 266 now so I will give him 3.5 and I have supplies at hand to test and feed, thanks again for the support!

 

Yeah, looks like he's going to bounce. Bounces happen when 1. they drop too low, 2. they drop too quickly, 3. they drop into numbers their body isn't used to anymore (or any combination of all 3). The liver releases stored sugars and hormones to bring the blood glucose (BG) up quickly so don't be surprised if he continues to go higher despite the shot. It can take up to 6 cycles for those hormones to clear out of the bloodstream so you can get a true idea of what the dose is actually doing.

I'd get a +2 and let's see where he's at then and go from there.

Looks like getting rid of whatever dry you were feeding is making a big difference!

 

Hi Chris, Hi Bhooma is it me or does Astrid's SS not look like it should for Lantus, I am talking about the color coding at the top.
There is no dark green and the neon green isn't correct
I didn't check the rest .


@Chris & China (GA)

@Bandit's Mom

Thanks ladies

 

Getting the +2 for his evening shot and it's 356.

 

Yeah that's the bounce I figured would happen. Tomorrow morning, don't go back to 4U no matter how high he is. Stick with the 3.5 for now

 

You're absolutely correct. @Astrid Oechtering, send me a private message on Facebook tomorrow so we can figure out what's going on with your spreadsheet before it goes on too much longer.

 

will do, Chris! took his AMPS and it is at 190. Unsure if I should shoot at all now? He has been throwing up a little this morning (he usually doesn't, unless he ate something he shouldn't have).

 

Hi Astrid,

I see from the spreadsheet that you've given Jocke 3.5IU Lantus. Has he eaten anything yet? If yes, was it a reasonable amount?

Also, do you have a good supply of test strips for your meter in the house?


Mogs
.

 

Yes I read some more of the resources available here and went ahead, he ate some and I have about 140 test strips left to monitor him. Planning to test him every 3 hours given the numbers look ok.

 

Glad to hear that Jocke has eaten.

I see that he was down to 116 at +2. There's a fair way to go in the cycle. I'd suggest testing hourly to make sure he doesn't drop too low.


Mogs
.

 

Thank you @Chris & China (GA) for seeing the tag ♥

 

Yes, I just did that, thinking the same! his +3 is 58, but he now just ate a good portion - I was looking for some guidelines on when to shoot, when to wait and haven't found them yet, or maybe I did but didn't recognize them? I'm still figuring all of this out and am trying to understand when to do what how. Thanks for the support!

 

Glad you got Jocke to eat again. Not much of a safety margin at 58, Astrid, and it's still early in the cycle so please test again at +3.5.


Mogs
.

 

retested, and it's closer to +4, so added it in at 45 mg/dl. Gave him some treats he usually doesn't get (temptations).

 

For cats that don't yet have much data, initially a 'no shoot' threshold of 200 is recommended (human meter), so if the preshot is lower than that then, if possible, stalling is the next step:

* DON'T FEED YET!
* Don't give insulin yet.
* Wait 30 minutes and test again to see whether BG has come up high enough to give insulin.
* While waiting to test, post for help and advice on how to proceed.
* If BG comes back up high enough feed your kitty. If he's eating OK, give the insulin dose.
* If you have stalled then you need to wait for 12 hours from the time you gave the stalled dose before giving more insulin.

After you've gathered more data, here are the recommendations from the Lantus dosing methods sticky post (see Start Low, Go Slow [SLGS] method):

How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.
• Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
  • a.) give nothing
  • b.) give a token dose (10-25% of the usual dose)
  • c.) feed as usual, test in a couple of hours, and make a decision based on that value
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

​

We all start in that position, Astrid! It's good to be able to pay forward some of the help I've received from other members.


Mogs
.

 

Astrid please send @Chris & China (GA) a private message so she can fix the color coding on your spreadsheet when you get a chance

 

That's too low (obvs). Carbs definitely needed. Now you need to get numbers back up into a safer range. It will take a little time for the carbs from the Temptations to get into the bloodstream so please test again 20-30 minutes from the time Jocke ate the Temptations (no later). Jocke may need more food to get/keep numbers up.

Do you have any high carb wet food in the house (e.g. Fancy Feast Gravy Lovers)?

NB: Regardless of which dosing method you're following, you need to reduce the dose again immediately. Tagging Chris to ask her to suggest how much of a reduction is appropriate. (@Chris & China (GA) ). At minimum, you need to reduce it by 0.25IU.


Mogs
.

 

Diane, any chance you could keep reminders like this till later, please? Right now Astrid needs to focus on getting Jocke back into safe numbers.


Mogs
.

 

Wow, this is what I was looking for, thank you!!!
I gave him FF Grilled with Gravy about an hour ago which he happily ate and more temptations (which he also loved) and put a tiny bit of syrup on his lips to lick off to bridge the time the carbs take to get into the system.

 

Reached out via FB this morning, thank you!

 

You ate absolutely right, I'm sorry about that

 

Had a gander at Dr. Pierson's food list and I see that these are all in the 12-15% carb range. Is that the highest carb wet food you have in the house, Astrid? (Just getting an idea of what hypo toolkit supplies you have available, particularly because the Grilled in Gravy medium carb food didn't keep numbers up after the +3 feed.)


Mogs
.

 

he's now at 60. It is the highest carb one I have, but also have some "high calorie" nutritional paste for cats and dogs. just gave him a little of that.

 

updated the spreadsheet to the right one https://docs.google.com/spreadsheets/d/1rJCnDNSzSOM984THuPu-P7ukRKnZrEnaVQ2jLf96m1o/edit?usp=sharing

 

Not much of a rise from the Temptations and syrup (yet...).

Can you test again please, Astrid, and please post how far along you are in the cycle ('+???'). Need to make sure that Jocke doesn't drop back. If he's between 50 and 70 feed a couple of teaspoons of his regular low carb food. If he's above 70, please don't give him anything to eat for the time being.


Mogs
.

 

Good deal....now that he's back above our "take action" line of 50 and has eaten, test again in 30 mins. (which I guess would be about now)

Definitely think getting the dry food out of his diet is making a huge difference in his need for insulin!

 

@Chris & China (GA) -

Hi Chris,

I note that you recommended a reduction of 0.5IU yesterday (very good call!). Please can you give Astrid a bit of a steer on how much to reduce the dose tonight?


Mogs
.

 

yeah I was just waiting to see how the next few hours played out

 

That's great, Chris. Thank you!


Mogs
.

 

+6 is 86 now

 

Better - and at half-way point in the cycle.

Don't give any food and please test again in 30 minutes to see if his numbers will hold without any food intervention.


Mogs
.

 

Hi Astrid,

How's Jocke's BG doing?


Mogs
.

 

just tested at 102 mg/dl at +6.75 (no food given between the tests)

 

Great! I think you can relax now

Get a +11.5 but I'm thinking of suggesting we drop him back down again....maybe 3U

 

Yes that sounds like a good idea. I'll do that an post the readings. Thanks so much for the support!!

 

Glad to see Jocke's staying up now. Good job today, Astrid.


Mogs
.

 

Thank you for your support!!!

He was hiding and I wasn't able to get his +11.5 numbers, so now his +12 reading is 194 mg/dl

 

That's grand, Astrid.

I'm literally just about to sign off because I'm going to pass out any minute so I can't stay on with you (in the UK and have sleep meds on board). I'm tagging @Chris & China (GA) to ask her to pop in. I'm also going to tag Melissa to ask her to keep an eye out for the two of you this evening and also to find you support from an experienced Lantus user if you need it (@FrostD).

Chris has posted a dosing suggestion above. The PMPS isn't high so if you do decide to give insulin this evening there's a possibility you might need to test intensively for many hours if Jocke's numbers drop down again. I'd suggest starting to test at +1.5 and then +2 if you do give the dose.

I'd urge caution tonight. Jocke's numbers were a little slow to come up earlier on and now, even after the Temptations treats, he hasn't climbed very high.

If you need help quickly but the Feline Health board is quiet, please post on the Lantus board, indicate that you need urgent help in the thread title, and include the URL of this thread in your first post there so that members can easily check back here to see what happened earlier in the day.

Wishing you both a safe and uneventful night.


Mogs
.

 

Thanks so much Mogs, have a good night!

Just took his latest reading at +13 (or more +13.5/ +1.5) and it's 287 mg/dl

 

Did you decide skip the shot?

 

since the PMPS number was so low I waited and now it's 287 - haven't given him the shot yet, would you think it's best to administer the lesser dose as advised by Chris earlier now with these numbers and test +1.5 and +2?

 

I know you haven't chosen a Lantus dosing method, but by either method he earned another 0.25-0.5U reduction today...Chris has much more Lantus experience than I do, so I'd go with her recommendation.

I think you would have been ok to shoot, and still are but you'll have to "walk back" your schedule over time (so the next shot would have to be 12 hrs from now, give or take 15 minutes).

When has he eaten over the past 3 hours, what did he eat, and how much? It would be helpful to see in the Remarks column if you get a chance. I'm just wondering if the 287 is maybe inflated by some high carb food, or perhaps a bounce.

Edit: if it's potentially inflated by high carb food the situation is slightly different. I say still ok to shoot, but testing will be different

 

he ate some fancy feast paté within the last hour (after the PMPS reading) because I forgot to take the food away my other cat was eating, nothing high carb for about 8hrs, so not caused by that. I will then go ahead and shoot the recommended 3U, 0.5U less than this morning. Will restest +1.5 and +2. Thank you!!

 

@FrostD - Thank you, Melissa.


Mogs
.

 

No problem!

I'm also off to bed. If you run into trouble go ahead and post on Lantus board with a link to this thread. There's usually a few people around at night, your best bet is to look at the recent threads and who's been active/ replying. tiffmaxee, Bandit's Mom, Bron and Sheba, and the moderators are often around.

It's most helpful for them if your thread title follows this format: "2/10 Jocke - AMPS 190, +4 46, PMPS 287, <whatever test is most recent and concerning> New to this Please Help" It's the format they use to quickly scan the board and "triage" who needs help first.

In the meantime you'll want to do exactly what you did today. If he starts to go below 70, a little bit of LC wet (want to keep him hungry in case he continues to drop). If he drops below 50, give the higher carb stuff. Continue to test every 20-30 mins, want numbers back above 70 and ideally holding steady or rising without food. Keep in mind dry food takes longer to kick in, and the syrup wears off quickly.

 

I'm also around and she knows who I am on Facebook too in case I'm not in 2 places at the same time.

Good shooting!! Now be a good kitty Jocke....mama had enough drama for one day!

 

Thanks for the great advice and strong support all around, I'll see what the night brings and will stock up on some even higher carb wet food tomorrow in case he drops again. THANK YOU!

 

+1.5 reading is at 224. I'll do another one at +2 and if that looks good call it a day and leave my boy's ears alone until tomorrow

 

I'll be watching for the +2

Don't forget that since you shot 1 1/2 hours late tonight, tomorrow you have to shoot late too. You can work your way back to your chosen shot time by shooting 15 minutes early on each cycle or 30 minutes once per day.

 

Thanks Chris. Just took the +2 and it's at 167. I feel like I should set an alarm to test at night too. Maybe at +4, since he dropped so low at +4 for his morning shot.

 

You're learning fast. If you haven't already done it, I'd give him a couple of teaspoons of his regular low carb food now to see if it helps slow him down a little

 

@Diane Tyler's Mom Just checking this thread. Don't know how I didn't get both tags!

@Chris & China (GA) I will be around for the +4.

 

Hi Astrid, how long till +4?

 

@Hi and welcome to the FDMB. I hope to see you posting on the Lantus forum soon.

 

I can see 89 in the SS @+4
I would feed some low carb food (around 8% carbs if you have any) and test again in30 mins

 

@Astrid Oechtering have you tested again for the 4.5 yet?

 

I got 89 at +4,
and then +6 was 115
and just now the +9 which is 131. @Bron and Sheba (GA)

After the 89 at +4 I gave him a bowl of food (Fancy Feast grilled with gravy) which he completely finished. I thought that would give his body some little energy to get back above 100 which it did. Will test at +11.5 unless advised otherwise.

 

Hi Astrid, that's hardly any bump after eating a bowl of HC! How much longer for AMPS? 2 hours?

 

Yes, we're at +10 now.

 

+11.5 is at 169

 

Ok. Headed higher. When did he last eat?

 

he last ate after the +9, had FF paté and a few treats (pure freeze-dried chicken breast)

 

Have added the rows with the missing dates to your SS so that it has all dates from 01/01/2021. DO you remember when you started with the 4U?

 

Jocke also didn't get much of a bump from the Temptations and syrup he got on yesterday's AM cycle.

BTW, like the new pic of Bandit.


Mogs
.

 

thank you @Bandit's Mom ! we started the 4U on 1/28,

@Critter Mom
Just took his AMPS it is at 176, no food there so I will retest in 30mins, but don't want to get into the same issues I had the past 2 days, with him dropping so low after +4

 

You could shoot a token dose or skip the shot. That would drain the previous depot.

 

I think I might skip this shot and monitor throughout the day at the normal times (+6, PMPS etc). His BG is now at 218 at +12.5

 

He looks like he is going to bounce, so it might be safe to shoot. The other option is to shoot a token dose of say 1.5U. Just to get some insulin in and reduce the bouncing.
Does he have a history of ketones?

 

how would you feel about just giving 1.5U? His numbers are rising pretty quickly and I'd hate to see him back in pink or red by PMPS

 

Thanks for the input! Never tested ketones on him, but I do have a ketone meter at home (for blood testing). I can test ketones throughout the day. Ok, will retest and go ahead and shoot a 1.5U

 

You don't have to test for ketones throughout the day. Once a week or so should be fine.

 

oh ok, thank you!

 

it's 226 at +13.5 and I gave him 1.5U

 

The previous depot will still affect this cycle so continue to test. You could start with a +2. You are now feeding only LC wet, right?

Your AM shot is 1.5 hours late this AM? You can make up the lost time by 15 minutes every cycle. So you shoot tonight 11:45 hours later and tomorrow AM after 11:45 hours. Do I make sense? See this sticky:
https://www.felinediabetes.com/FDMB/threads/getting-back-on-a-12-12-shot-schedule.101059/

 

What time did you actually shoot last night? (because you were already 1.5 hours behind due to stalling)

What time did you actually shoot this morning?

 

last night I shot at 10.15 pm, and today 11.45 am

 

Yes, makes sense!!

I will continue to test today, especially since he'd been hitting the lowest around +4 the past days. He only gets LC wet food now, I eliminated Dr.Elsie's LC kibble a few days ago and as @Chris & China (GA) pointed out, this must have had some effect on his BG.

 

I'd also urge you to go ahead and move over to the Lantus forum today. This thread is getting too long so you need to start a new one soon anyway. Might as well move over to the right insulin support group!

There, we post a little differently. Our subject lines are usually done in a certain format:

Date, Cat's name, AMPS ### ......then as the day goes on, as you get new tests, you edit the subject line and add the new results like "2/11, Jocke, AMPS 226, +2 ###, +5 ###, etc.. etc.

That makes it easy for people who are scanning the boards to quickly see how everybody is doing and if they see something that concerns them, they start with those posts first.

In the body of your post you can ask any questions you have, tell us how things are going generally, give the Whole Cat Report (how Jocke is doing basically...is he doing the 5 P's? Peeing, pooping, preening, playing, purring?)

 

Thanks @Chris & China (GA) I'll do that

 

created a new thread here: https://www.felinediabetes.com/FDMB/threads/2-11-jocke-amps-226.242951/