11/16 Chnoudi /Need help with dosing

Hello!! Im a new sugarcat mom, new to this forum and completely freak out with the disease!!
If i've done everything right, you ll be able to see my cat's spreadseet. I'll post it as a picture, anyway.
I use Lantus pen from 10/15 . I have switched the food from kibble to canned low carb. I hometest. Every dose changing until today, is according to my vet's instructions. However, I thing she's giving me wrong advice. I should use syringe instead of pen, right? I should do smaller increases to the dose, right? These are things I've learned from the fb page.
However, I need advice with the dose.... My cat's BG has many ups and downs, especially after food change... In the morning 400s and at night 100s... I need support, I'm really confused...
Thank you in advance! You are an oasis..

https://docs.google.com/spreadsheet...-oFAIC0vUwQF68i30Du3_hLZkY/edit#gid=361360320

 

Your dose changes are definitly too fast. The pen doesn't give you the flexibility that a syringe does. You can use a syringe in your pen. I've never used a pen so I'll let A lantus user help you with that.

I will say that we always advise people to increase by no more than 0.25-0.5 increments so that the ideal dose isn't Skipped, and I think that's what happened here.


On the top of the lantus forum there are yellow stickies that describes the dosing protocols the lantus users here use. One is TR(tight regulation) and one is SLGS (start low go slow) read through it and see which you are most comfortable with. https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

So i will leave the specific dosing advice to the lantus experts... I'm curious why you raised to 3 from 2 when you were already getting low pmps at the 2 dose? Was that on advice from your vet? Ideally you want two shootable numbers.
It was not safe advise. And raising in whole units is a huge jump. Do you have syringes at home? If not, run to Walmart or a pharmacy and pick up a box. You will want u100 syringes, 3/10 cc, with half unit markings.

You don't have many mid cycle numbers. Whenever possible, try to get at least one mid cycle reading in between shots. If you aren't home during the day that might mean getting a before bed reading and then testing more on weekends or days off.


I want to applaud you for staying home testing and for getting your cat on the proper food. I totally understand how scary all this is.... You are not alone. Be patient and we will get some lantus eyes on this. I'll tag a few people.

 

Trading for dosing help. @Olive & Paula . @tiffmaxee . @Lisa & Oberon
@Wendy&Neko @Christie & Maverick

 

Yep, that's the first problem! So many vets are unfamiliar with feline diabetes and give poor information.

As JanetNJ has already stated, for starters please get a box of syringes. I use the Relion's 15/64th from Walmart - the needle is short and easy to use so you don't have to worry about poking too deep.

You also need to settle on a consistent dose - perhaps start with 1 unit and STICK to it. As Janet said, read the dosing methods. The most important take-away is doses are determined by the lowest point reached during the day AND night! It's very important to get a BG reading AFTER giving the insulin. We don't know how low the doses have been taking your cat. So that's also a first step.

Please update your title to say this: DATE / CAT NAME / AMPS (first reading of the day)...then HELP with dosing...

You'll get more eyes on your post that way....as the day continues this forum gets loaded up with many condos and yours will be pushed down as that happens...it's helpful for all who are viewing today to see the date, etc. many like myself, work so I just jump on and scan quickly...those without date/cat name, amps often get overlooked...

Best of luck today! Let's get you started on the right foot to help take care of your kitty.

 

If you don’t hear From anyone else before shoot time, I would go back to no more than 2 units this morning. (1.5 is probably even better but I don’t think You can do half units with the pen, can you?) You want two shootable numbers a day.

 

I suggested 1 unit to start.

 

Welcome! I can't give dosing advice, but notice how once you changed to the low carb diet the PMPS numbers suddenly dropped? Diet change can make a huge difference, and can dramatically affect the amount of insulin needed. (When my cat was first diagnosed last December, I changed his diet and within two weeks he was in remission! Pretty extreme example, but it can happen.) So you may find that a much lower dose is all you need now. More testing besides the AMPS and PMPS tests will help you determine that.

 

I agree with Sue at starting back with 1 unit AM and PM. With the food change alone could drop the glucose significantly. You need to keep that dose so the lantus depot is re-established . Unless he/she drops to low. At least 3 days. I see you already gave 2 units. You will need to test mid cycle and keep an eye on the glucoses until you know if the 2 units is to much.

Using the pen needle isn't recommended, 1. The cold from being in the fridge messes with the mechanism, 2. You can only give whole unit doses. Smaller increases and decreases work best so you don't pass the optimum dose and you don't overdose creating a crisis.

You will get there. Stay calm and breathe. We have seen all kinds of advice from vets. People who swear they can't give shots, afraid of hurting kitty, kitty can't be tested. Before they know it, they are doing it flawlessly.

Your here now, we help you help kitty. Kitty feels better, and that's the goal.

 

It is hard to say whether 3u is too much, although you increased a bit too quickly, so you may have gone past a good dose. Whenever I see lower preshots I always wonder what the kitty was doing before that number. Was there a lower number before that, and the kitty is now coming back up? You have skipped some shots, which subsequently led to higher numbers the next morning. In the beginning, we don't recommend giving insulin if the preshot number is less than 150. What we suggest when you get a lower preshot number, you can stall (not feed) and test again in 20 minutes to see if the number is rising, and post for help. Sometimes the kitty comes up on his own, to a number where you will be comfortable to give insulin. Just something to keep in mind for next time.

In looking at your SS, there technically hasn't been a reduction earned yet, and I believe the impact from changing from dry food to canned food should be over now.

Based on your current data, and since you have had to skip a few times, I would be inclined to say if you can get midcycle tests in, you may want to go back down to 2.5u, if you now have syringes with half unit markings, and see how that works.

With Lantus, mid-cycle tests are very important when trying to decide if the dose is working, as the preshot numbers don't always give an accurate picture alone of how the cycles are playing out. We dose based on how low the dose is taking the kitty, with only some consideration given to preshot numbers.

You need to get a feel for how your kitty responds to insulin and what influence the carbs in the food is having on the cycle.
Here are some of the basic concepts:

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose
• How to do a Curve - a simple explanation

By getting additional tests in each cycle, you'll be able to determine how the dose is working.

Here is a good info page for new people:

New: How you can help us help you

 

Thank you so much!!! It's very important for me to feel that so many people help me. I have tried 1U for a week, 2 U for 10 days, but nothing worked... So you suggest that I buy syringes and try 2.5 U??? I m sure that at night BG will be very low again, and tomorrow morning will be very high...
And why there is no reduction with canned low carb food? Does it mean something?

 

Again, remember without the midcycle tests, you really can't say what is working or not working. When Maverick was on Lantus he would often give me numbers in the mid200s or 300s, then drop down to 50s then go back up again to 300s or higher. Without getting midcycle tests in, I would have thought the insulin wasn't having any effect.

It would be best to get the syringes, so you can make dose adjustments in smaller increments than 1u at a time. We have found here based on experience that this works better than increasing or decreasing in whole units.

 

Thank you!!! So I will start mid cycle testsand come back here with new data! +3,+6,+9 hours is OK for the tests?

 

I like those tests, a good place to start. One other thing to note, the nadirs (lowest point in the cycle) can and do move around. They are not always at +6 each and every cycle, which is also why spot checks at different times over the course of a few days will help to get a better picture.

 

Welcome. I agree with Christie. I suggest you get a +2 test. If it’s lower than the preshot it will usually be an active cycle requiring close watching. It’s often a good indicator as onset is then for most cats, when Lantus kicks in.

 

Christie has given a very good explanation and I agree with her recommendation. Dropping back to 1u is way too much. We want to err on the side of safety, considering the food change and the 94, but we don’t want to leave kitty at such a low dose that glucose toxicity builds.

The answer, in a case like this, is to just slightly lower the dose and test more to find how low the dose is taking her. Then it’s easier to tweak up or down.

 

I'm on board with Christie's recommendations, as well.

Also, please remember that it's not only important to get some spot checks during the AM cycle, you want to do your best to get some tests during the PM cycle, as well. Many cats like to drop into lower numbers at night. At the minimum, we suggest a "before bed" test so you can go to sleep and not be worried about Chnoudi's numbers not being in a safe range.

 

OK I see...!! I ll get to it, I ve already done 1 midcycle test, an hour ago.. Thank you!

 

And something else, cause I shouldn't make mistakes. Can I feed her one more time during the day? For example 6hours after the morning dose,in the middle of the cycle??
Or I should feed only twice, before the shooting??

 

Most of us feed several small meals each cycle trying to feed all the food in the first half as the insulin can wear off toward the end. How late to feed in the cycle depends on the individual cat. Some nadir late and need to be fed later. We just need to pick up the food 2 hours before insulin to make sure the preshot is not food influenced. As you gather more data it will be easier to find the best times to feed. Feeding just twice a day is not necessary with Lantus like it is with fast acting insulins. Lantus doesn’t usually onset until +2.

 

I've ordered 1/2 unit syringes, I ll have them tomorrow. But from yesterday, I saw a change!!!! I've risked a lot in the morning with the 3unit dose, But everything was fine in the end. No insulin at night, today 208!!!!!! I changed the canned food, I gave her Bozita than Pro plan, I dont know if that made a difference...
So, What am I shooting now??? 2U or 1U?? Until tomorrow that I ll have the syringes...https://docs.google.com/spreadsheet...-oFAIC0vUwQF68i30Du3_hLZkY/edit#gid=361360320

 

Wow on that 37 and great job testing! Let me look at your spreadsheet. Be right back.

 

I’m going to err on the side of caution and suggest you shoot 1.0 until your syringes arrive.

 

Thank you! Yes!! This is what I m going to do. I died yesterday night with that 37..! And it seems that there is not a great increase until now

 

I’m sure you did! Did you give her high carb food when you saw that 37? She came right up nicely probably because it was the end of the cycle. The food change is helping too I bet.

 

Νο, I gave her the low carb food and her food supplement for the liver, but I was standing by with the jar of honey . She was very cheerful so I relaxed a bit. I wanted to let it evolve and her good condition allowed me to do this

 

That’s good info and very smart of you as it was the end of the cycle. Many panic and go straight to the hc.

 

Hello!!! As I ' ve mentioned in a previous post, I was waiting to receive the 1/2 unit syringes. They are here!!
Should I increase to .25 or .5 unit from tomorrow morning?? Or still wait to 1 u?

 

Are you going to follow TR or SLGS?

 

Hmm..I'm in a dilemma...Do you have any suggestions? I've read all the reviews here...I Think I lean to TR.

 

It depends on your comfort level in regards to shooting low and ability to test. TR gives tge best chance at remission but requires more testing. You don’t need to be a testaholic like I was though. With TR once you have enough data you can shoot any bg 50 or over. With SLGS you reduce if your cat falls under 90.

 

Except the fact that her ears are really wounded, I have no problem testing! I already test a lot (I think )
But her nadirs are not stabilised... They are between 100 and almost 300! So how do I come to a conclusion?

 

With SLGS you hold a week. With TR when you see some blue you hold 8-10 cycles if nadirs less than 200. Then increase by .25. You did see greens but the dose was reduced. I think you are safe to increase by .25 So if TR, I think you have room to increase.

 

Οκ I see.!! What's more, do you think it's wise to wait a couple of cycles with 1u BUT with syringe?? I think I saw a liiiiittle difference in the dose when I tested 1u with pen and 1u with syringe...
... I don't know, maybe I imagined it....

 

It’s fine to give it a few more doses. You have seen some blue and green. It could be the depot from 2 and 3 units but no way to know.

 

The depot from 2 and 3?? Oh God, I didn't know that it can happen.
I've changed my opinion. I'll increase to .25 . Thank you so much!!!