New to the forum- dosing question

Hello everyone,

I am brand new to the forum and am looking forward to learning more about diabetes from all of you.
My 9 year old cat Ella was diagnosed with acute pancreatitis in Decemeber. She was hospitalized for what seemed like the longest four days of my life. Since then she's become diabetic and we still haven't been able to get her regulated. She is currently on four units of Lantus twice a day and her numbers have been slowly decreasing over the last month. Before her injection last night, I noticed that there was a lump under her skin where I normally inject (scruff). I did not see redness and when I touched it, Ella didn't seem uncomfortable so it may just be scar tissue?!
We injected her 4 units to the left of the lump and I began to panic, thinking that perhaps the insulin has not been able to absorb properly because I have been injecting in the same place. This morning she was begging for food (more than ususal) and seemed agitated. I fed her, she ate well, and then checked her blood glucose level and she was at 3.3! This is the lowest that she has ever been! I didn't give her the insulin shot and offered some wet food which she also ate. She currently eats dry hills m/d and I have wet m/d for emrgencies if I have to syringe her when she is sick.
I tested her bg an hour later and she was at 8.5. She is sleeping comfortably right now but I'm not sure if I should have given her a decreased shot when she went up to 8.5.
I will continue to test her bg throughout the day but was seeking advice regarding doses from expereinced pet owners.

Not sure if this is helpful but here are some of her numbers from the curve we did last weekend. She was at 3 units at this point which perpetuated the increase to 4.
7:30am 16.2 (prior to meal)
8:00am insulin
10:30am 18.4
1:30pm14.9
3:30pm 13.2
3:45 (ate a bit of food)
6:30pm 16.7
7:45pm dinner
8:00pm insulin
9:30pm 16.4

Now with these numbers it important to know that her insulin might not have been absorbed properly this whole time.
My vet told me that I could use the scruff for up to a year without rotation. She had a fever a few days ago, with diahrea and has been lethargic. I took her to the vet on Friday and she gave me Fortiflora to help stop the diahrea. She had some yesterday but no poo in the litter box today so perhaps it is working. Temp went down too. Last night I tested her because of her lethragy and she was at 17.6 and her glucose strips showed high glucose in the evening which is why I was very surprised with this morning number of 3.3. I'm assuming the insulin hasn't been absorbed properly. I apologize for the long winded email but I guess my question is: should I have given her a decreased dose when she went up to 8.5? She is on a long acting insulin and it was an hour after her required dose so I just trust my intuition but am curious as to what others think.

Thank you so much for taking the time to read my posting Looking forward to your comments.

Tamara

 

Hey Tamara!

You must be in Canada too! I have been converting my Cdn numbers to american for the forum.

We are super new here too I will defer the expertise to more seasoned BEANS, however I will mention that we have had remarkable results switching to wet food only. We find that the hard food spikes Elie's sugars...even 10 pieces. I like to think of it as chocolate...or coffee...you go up, but then you crash down a bit. It would be interesting to see what happens if you make a full switch to wet.

I hope you guys have a good day!

Tanya

 

Please be careful when switching food from dry to wet. That dry food is likely why you are having to dose so high. Monitor closely when switching from dry to wet. Changing my Trouble from dry to wet brought his numbers down by 100 points or more.

Trouble has been gone a long time now, his death NOT related to diabetes, so I dont give dosing advice. But this is a bit of advice you MUST be aware of.

Welcome to the best site on the planet!

jeanne

edited to fix lame spelling :/

 

Agreed Jeanne

 

hi tamara!

sounds like you've had quite a time! i think we can help you.

it's ok to shoot in the scruff - but you do want to move around where you put the needle in. cats can form scar tissue and lumps from the injection.

is there any possibility you can make up a spreadsheet for us - we use american numbers here and i am not familiar enough with the mmol to be able to just "read" what you've got. our world ss template will let you enter numbers in mmol and it will convert them for the rest of us. here are the instructions for setting up the template:

http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0

if you can't get the ss to work, post back and one of us can set it up for you and then transfer ownership to you.

would you do the ss first and check back often for comments/questions from us? often it takes a little bit of unraveling and a lot of questions for us to get to the bottom of what's going on. people will respond fairly quickly to you, so check back often today.

some questions:
- is ella eating fairly normally today?
- do you know what her BG number was at diagnosis?
- does she seem sick, nauseous or in pain today at all? behaving normally?

thanks - we'll do our best to help you.

julie

 

Thanks for your advice of food. I just took her bg and she is at 20.4! I'm really worried about her numbers as I skipped the dose this morning. Her usual doses are 7:30am and 7:30pm. Please advise what I should do. She is on Lantus.

Thanks,
Tamara

 

Conversions for our non mmol/l friends...

7:30am 16.2 (prior to meal) - 292
8:00am insulin
10:30am 18.4 - 331
1:30pm14.9 - 268
3:30pm 13.2 - 238
3:45 (ate a bit of food)
6:30pm 16.7 - 301
7:45pm dinner
8:00pm insulin
9:30pm 16.4 - 295


3.3- 59
8.5 - 153

 

Hi Julie,

Thanks for your reply. I will try and figure out the program and post to the group.
Do you want the numbers of her latest curve?

To answer a few of your questions:

Yes Ella ate normally today but because she was so low, the lowest she'd ever been, I sisn't give her the dose and now she's at 20.4. Eek!
I believe she was 22/23 at diagnosis. She has been lethargic for the past few days. Not purring and not wanting to be pet so much. I just did a glucose urine test and no keytones and high blood sugar which is a bit strange as I know it measures the last few hours.

Thanks!
Tamara

 

Thank you for converting Tanya

Tamara

 

when you say "no ketones and high blood sugar"

does that mean there WAS high blood sugar or was NOT high blood sugar on the urine test?

 

Tamara, how did you get to the 4unit dose? what dose did you start at and how were the increases made?

 

Hi Julie,

High blood sugar but negative keytones.

We have been increasing throught the advice of our vet. In December she began at 1 and then as we have been doing the curves she has been increasing gradually 1 unit at a time. We just started the 4 units last Monday.

 

ok - thanks for answering those questions so quickly. i've asked for some help from others as well.

re her high number today - when a cat hits a BG number lower than they are used to, the cat's liver will release stored sugars and counterregulatory hormones to save the cat's life. likely that 3.3 this morning caused that to happen. we call that a bounce and it is VERY common. i wouldn't worry too much about it. we don't focus on a single number, but on the overall picture.

if you have a chance, the sooner we can see the spreadsheet the better. we look at the numbers in context, depending on the time of day in relation to the shots and to the other numbers.

so she is eating all dry m/d except when you think there's an emergency, then you have wet m/d - is that right?

has she had ketones in the past?

 

Thanks for your reply.

Do you just want me to enter last week's curve and/or the numbers from today?

She is eating only m/d dry. I have wet for emergency and when I need to give her the fortiflora which I gave her this morning. In total she eats 5/8 of dry a day.

 

Ok so I'm ready to enter last week's curve on the spread sheet and am a bit confused as to how it works.
Are the numbers correlated with the time I gave insulin? For example: 1=7:30am and then I type the number in below? And what does PMPS mean?

Thanks!

 

put every date and every number that you have into the spreadsheet, including anything from the past and the vet's if you have them.

when you say she had a fever a few days ago, was that over by the time you took her back to the vet on friday or was she still running a fever? was there a diagnosis as to what was causing the fever?

is she on any antibiotics?

just saw your post:

the first column is the date, next column is the blood glucose test right before the insulin shot, third column is the volume of the dose of insulin. the +1, +2, etc. mean that many hours after the shot.

then it repeats again in the evening cycle. does that make sense?

 

amps = morning preshot number
pmps = evening preshot number

we always test before giving the shot, because as you have seen, you can get a number that is too low to safely give insulin.

people here are from all over the world, so rather than use times, we refer to how many hours after each shot when we talk about our tests.

 

Hi, Tamara and welcome to FDMB. Jeanne (JT) posted over on the Lantus forum and asked if a few of us could stop by.

One immediate thought is whether you had a bad test strip. That Ella was starving does suggest it was a low number but whenever I get a number that seems inconsistent, I re-test. Did your vet give Ella an antibiotic given the fever and diarrhea? Did the vet run any lab tests? Also, if you're giving FortiFlora, I usually give a full packet over the course of a day. Has her behavior improved since Friday?

It's great that you're home testing. FWIW, most of us feed low carb, canned food. The Hill's foods are truly poor quality food (lots of animal by-products) and more expensive than what you will spend for a premium quality cat food like Wellness or Evo. We consider low carb, less than 10% carb. The M/D canned and dry are around 14% carb (vs. several of the Wellness canned varieties which ar 4%). It's also hard to get BG numbers to come down when you are feeding a higher carb food. You might want to take a look at the website on feline nutrition that's written by a vet, Lisa Pierson.

With regard to dose, many of us follow a dosing protocol that was published in one of the leading veterinary journals. It gives parameters for when to increase and reduce a dose. One thing to be aware of is that with Lantus, doses are changed in increments of 0.25u. If I'm understanding, Ella's dose was increased by a full unit. It is possible that she is over what would have been an effective dose.

There is a great deal of information on the Lantus board about dosing, using Lantus, etc.

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
• New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
• Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
• Lantus depot/shed: This is an important concept for understanding how Lantus works.
• Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

 

Hi Julie and Sienne,

Wow these quick responses are overwhelming. Thank you! I'm trying to work as quickly as I can here but am not too familiar with spread sheets.
Do I write food intake in the remarks section? Also, if I plug in the numbers in the world ss can you press a magic button to convert them so they make sense to you or do I need to convert to your measurement right away?

She had a fever on Thursday of 40.2 as well as diarrhea. I took her to the vet on Friday. The vet gave me fortiflora and told me to give metronizodale today if she still had diarrhea. So far no diarrhea. We had something similar happen a month ago minus the diarrhea. I took her into the vet with high fever and they did all of her blood work. While waiting for the results, the vet was procactive and gave her sub q fluids and prescribed her clavamox and metronizodale and treated her as an out patient. It turns out that and her pancreas levels were back to normal. The results showed she had a slight infection so she decided to put her on clavamox and metronizodale. Well it gave her bloody diarrhea and we stopped it, giving her fortiflora instead. It cleared up and she got better. When I brought her last Friday the vet said her symptoms sounded familiar to her episode a month ago but couldn't give me a reason why it was reoccuring. No more blood work at this time.

Ok pluggin in the number and then will try and figure out how to attach.

 

if you are using the world template, there is a tab that says US numbers that we can click on to see the conversion. you enter in mmol and we see in mg. it's really helpful - someone was brilliant to make it for the rest of us! make sure the template you're using has 2 tabs! i hope it does.

yes, you can enter the food in the remarks section, also any meds or supplements, any behavior things that seem significant.

 

I apologize for the long delay but my link has now been posted.
Ella is currently sleeping and I cringe at the thought of testing her again and getting a super high number. Have I compromised her health by skipping a dose?
Do you think I should resume at her 4 units tonight? Unfortunately, I won't be home to monitor tomorrow

 

no, i don't think you've compromised her health by skipping the shot.

i don't know about the dose. how many hours from now until you have to make a decision on the dose? let me look at her spreadsheet.

we try to get all diabetic cats onto a low-carb canned food diet. there is an excellent published protocol for treating diabetic cats that Sienne posted to you above. one of the prerequisites of following that protocol, however, is that the cats must be on all low-carb canned food.

as Elie's person, Tanya, said to you above - the switch to the all canned LC alone can drop a cat's BG significantly. Newly diagnosed cats who make that change and follow the protocol above have an excellent track record of going off of insulin and usually being able to maintain their BG by diet only.

i'm having to take care of my cat right now too, so be patient if answers aren't immediate. in the meantime, can you do a little reading from what sienne gave you? you don't have to remember it all - but it at least gives you basic info on what we do and why.

 

the link didn't work - can you edit the subject line of your first post in this thread and say "help needed with SS" so someone can give you a hand on that?

while you're waiting for that, would you just copy the URL of the ss and post it here? thanks!

 

I will definitely do some reading and totally understand and appreciate that you have your own fur babies to take care. Thank you so much for taking your time to help me out. I will check back later
Enjoy your day!

https://docs.google.com/spreadsheet/ccc ... 5YkE#gid=5

Tamara

As a side note: she started 4 units last Monday and we were told not to do a curve for two weeks. At this point my vet doesn't think it's necessary to do bg's before each shot. What I find confusing is that they say if she eats well I should give the shot but ravenous hunger can also be a sign of hypo!

 

argh, the ss is saying i don't have permission to enter the ss. there's a spot in there, and i'm not a ss guru, so i can't tell you exactly where, that asks who can see the google doc. you want "anyone with the link" as the option. it might be at the upper right corner, but i'm not sure.

we hear that about the vet's advice from others sometimes. i have no idea where it comes from. if it were your child, would you give insulin for 2 weeks without knowing what the blood sugar was doing? it's crazy. cat's ears get used to it. my cat will come when i call him - and you KNOW if it hurt that much they wouldn't do it for anything.

knowing what i know now, in a zillion years i wouldn't shoot punkin without testing first. i think that's dangerous and am VERY glad you are hometesting. that's your insurance to keep her safe.

 

Hi Julie,

I think all the links should work now. Until today, I have to say that I was totally relying on my vet for sound advice. I'm not too sure why they want me to wait two weeks before doing the curve. Perhaps because her numbers have been so high?
The whole experience has been so stressful. I constantly worry about her well being and also have three other kitties to tend to. I feel as though it is taking too long to regulate her. Is this normal?

Tamara

 

Tamara,
Bring up the ssheet and click on the blue button on the right that says 'Share'. Select 'Anyone with the link' (or something like that) then click 'Done'. That should allow others to see it....paws crossed....

HUG!

EDIT TO ADD: Oops Tamara - we cross posted. I can see yours....THANK YOU for getting it set up!

 

I did that Is the link still not working?

oh yes: thanks for your reply and hug

 

Hi Julie,

I realized I didn't answer your question. I have 4 more hours until dosing time. Do you think that I should still do her bg's today knowing that she is so high? I only have 9 strips left so I have to be a bit conservative until the new ones arrive this week.

 

yay lyresa, thank you!!

i'm thinking that the 3.3 (59) that was this morning was when you didn't shoot. would you erase the 4.0 in the dose section, only so that no one thinks you shot 4.0 with the 59.

vets have to know so much about many animals and all of their conditions - the bottom line is that most don't have that much experience with feline diabetes and especially with lantus. it's a newer insulin and it is a longer-acting one. think timed-release, or cumulative to get the idea of how it works.

what that means is that when a dose is changed, it can take a while for the amount in the body to change to catch up. vets are more experienced with the older insulins that were given and then gone out of the body in the next few hours.

however, you've found feline diabetes mecca! at least that's what i thought when i found this site and the people here. everyone here does feline diabetes 24/7 - it takes a while to learn how lantus works in each cat's body. i've been doing it more than a year and i'm still learning some areas. there are people here with years of experience who can really advise accurately.

so - now that you're here - wahoo! let me ask where you want to go from here. tomorrow you won't be around the middle of the day, right? most of us work away from home and there are things we do to cope with living our kitters.

let me ask first - are you open to changing ella's food to all canned? if so, you want to switch slowly over the course of about 5 days while you are continuing to test. an insulin dose based upon the high carbs of dry food will be too great of a dose with low carbs.

 

um, yikes. that's not very many strips. i think i'd drop back to the 3units from last week and not make the switch to low carb canned food until you've got more strips. if you can buy some locally and are able to afford it, i would. you'll go through a lot of strips, so you want to find a cheap way to get them.

most of us buy diabetic supplies online, i think. people order from Hocks.com, AmericanDiabetesWholesale.com, ebay (verify sender and expiration date) to get good buys. the strips are the most expensive part of all of this. a lot of people use a Relion Confirm meter from Walmart and then buy the generic strips (Arkray) from ADW that go with this meter. i think that's the very cheapest accurate way. what glucosemeter are you using?

if you're thinking about increasing the dose tonight based upon today's numbers - i would absolutely NOT increase the dose. you are very likely seeing a bounce which can take up to 3 days to resolve.

punkin was 479 this morning at 7am and he was 45 at 11:30am. that's why i don't want you to increase the dose.

with lantus we are VERY interested in the lowest number that a particular dose has taken a cat down to. safety is our first concern. lantus dosing is based upon the lowest number, not the highest numbers.

with a fairly accurate dose and an all-canned food diet, a "typical" lantus curve will have the highest numbers 12 hrs apart right before the shot, then the BG will go down until about the middle of the cycle, around 4-7 hours after the shot, then increase back up again until the next shot time.

everything in that curve is thrown out the window when eating dry food, so it's hard to make a comparison, but when we see a 59 (3.3) 12 hours after the last shot, we would ordinarily wonder how low the cat was 6 hours prior to that. we don't know where ella went last night - with the dry food she might not have had her low point in the middle of the cycle. it might've been the 59. no way to know.

but what it does say is that the combination of the high carbs from the dry food along with the lantus dose of 4.0, her blood sugar got at least as low as 59. at this stage of the game, you do not want her lower than that, so you would NOT increase the dose.

 

Hi Julie,

Unfortunately I am away from home 9 hours a day and am worried to change her dose and food when I can't be here to monitor her during the day. Another set back is that Ella does not eat canned food. With TONS of coaxing she will eat some out of a syringe but never on her own.
So I'm not really sure where I should go from here. I also don't know what I can safely give her tonight and what I should give her if I get low numbers tomorrow before I leave for work.
I really appreciate everyone's concern but given my situation I'm not too sure where to start.

Tamara

 

I was thinking of going back to 3 units just to be safe as well. I was def not going to increase the dose as I got a good scare from the 4 units this morning.
From the advice of my vet, I purchased the ALphatrak meter. The strips are ridiculously expensive but what is done is done. I may try and sell it and buy a new one since the only way to keep Ella safe is by doing daily test which will cost me a fortune!
I'm going to have a conversation with my vet because I feel they have kept me in the dark with lack of info they have given me regarding the Lantus. Your information has been helpful and I'm slowly wrapping my head around the info Sienna posted.
Do you have to keep strict feeding times when they are on Lantus? I was told it's ok to feed her the allotted amount over three periods a day.
In the meantime I will keep reading and will keep you posted...if that's ok?!

Tamara

 

tamara, i have to go for awhile. i know carl is around and will help if you have questions - i'm sure others are too.

so, just to be succinct - because i am not! :lol:

if i were you, this is what i would do:

drop back the dose immediately to 3.0u
continue testing, put the data into the ss as you test
get more strips asap if you can afford it
when you have more strips, begin to transition gradually away from dry food to a low carb canned food (see the links sienne gave you for lists of carb values)

i'd also invite you to post on the Lantus TR Forum - there is a lot of traffic there and people experienced with lantus will be happy to help you. as i said, a requisite for following the Tight Reg protocol is being on all low-carb canned food, but if you don't want to make that transition for some reason, a second option is the Start Low Go Slow protocol. you will still want help figuring out dosing and we'll be glad to give you a hand.

the details for both of those protocols are in the link "Tight Regulation Protocol" that sienne gave you. it explains both protocols so you can decide what you would like to do.

if you see a number that scares you - we all understand - just post and someone will help you figure out what to do next. it's unnerving at the beginning but before long you learn enough to not worry all the time. when punkin was diagnosed i wondered every morning if he was going to be alive. but here he is 15 months later, quite alive and very happy.

i haven't addressed the fever/illness aspect for you at all. i'm not experienced in that, but it could definitely have an impact on ella's BG. behavior is a huge indicator in a cat - if she remains lethargic i would be concerned and probably call the vet for advice. many of our cats do seem kinda lethargic with blood sugar changes, but i don't think you're describing that. especially not when you're talking about fevers and diarrhea.

just saw your last post. as long as you're having to give her dry food, let's start you on the Start Low Go Slow protocol. would you read about that as i described above? and if you are gone, that's especially important for her to be getting insulin on the conservative side.

for tomorrow, as long as you leave food available she will likely feed herself if her numbers get low. many cats will and i think you said earlier that she was extra hungry, right? it would be best to leave food out for her while you're at work.

 

ok - well that is very important information. an alpha track is calibrated for felines - and they read 30points mg less than the human glucometers. so what i thought was a 59, was a 29. that is scary low. we absolutely don't want that to happen again.

don't be too hard on your vet. we hear your story all the time, and i had the same experience. many of us did. so many people put their cats to sleep when they get a diabetes diagnosis - i just don't think they have that much experience. my 3 vet practice had 2 diabetic cats between the 3 vets. lantus is really just now spreading across the veterinary world - and it is complicated to understand how it works in the body.

what most of us do is take our cats to the vet for everything except insulin dosing. we get that here.

some cats graze while on lantus, some cats eat by meals. since you are gone mid-day i would definitely leave food out so she can feed herself. even if she's eating too much, this is one way you can protect her.

several people on the Lantus TR forum use the AT, but it is expensive. some people keep it as a back-up meter. the cost of switching to a new meter with cheaper strips will be more than offset over a very short time. just don't buy a meter with TRUE in the name - consumer reports has rated those as less accurate than many. stick to a name brand. also don't buy the freestyle lite (which i had) - something has changed in the strips and they are less accurate. as i said, the cheapest accurate name brand is the Walmart Relion Confirm.

btw, on one of those links sienne gave you is info on transitioning a dry food addict to canned food - it's catinfo.org. well worth reading and trying.

of course! yes, keep posting. i'll be back later to check - i've just been on the computer here for like 5 hours straight and have got to eat lunch and do other things for a while! see you in awhile.

 

Hi Tamara,
Let me preface this by saying that I have no experience personally with Lantus. My cat, Bob, was a PZI user. I do understand the lantus protocol, and how doses are based on the nadir rather than the preshot numbers, I've just never used the insulin or had to manage the treatment.

There are a couple things that stick out to me, and Julie has already addressed most of what I was thinking. Sienne mentioned earlier that it may have been a bad test strip when you saw that 59. I agree, but given that the next test was only a 153, I'm inclined to think the 59 was most likely "real". In any case, since you didn't retest right then, I don't think we have an option other than to take it at face value.

As Julie mentioned, that low number, at this point in Ella's treatment, would be considered "odd" and would get everyone's attention. Usually you'd see the lower numbers between shots rather than just before a scheduled shot. Later on, you'd expect to see low numbers for preshots, but not until Ella is more regulated.

I agree with Julie on the dose going forward. Given that you are low on test strips, and that you have to save one for every "preshot" test at least, you don't want to give her a dose that sends her really low and find out you have no strips left. Julie said to go back to the 3u, and don't even consider increasing at this point. Ella is better off high for a few cycles than too low for minutes. You can increase, if needed, later. When you have enough home-testing data to evaluate her patterns. But once the insulin is in, you can't get it back out, and if there's a crisis, you need a good supply of test strips on hand.

My advice would be that you check her tonight, before her shot, and post the number here for dose advice. No telling what sort of number you'd get, but I would expect a high number since she didn't have a shot this morning. Don't let the high number freak you out, because it's "expected". Reacting to the high number by shooting a high dose isn't going to fix it. That isn't how Lantus works. Lantus is dependent on a steady dose for a few days, with tests at preshot as well as during the cycle. I understand you can't be there to test during the day, but perhaps you can get a test or two during the night? But you need to see where her numbers are in the +4 to +8 range if at all possible so that you can evaluate how the given dose is working. The other key is that when the dose is adjusted up or down, it needs to be in small increments like .25u at a time. That little bit of adjustment can make a huge difference in most cats. Jumping a unit at a time can cause you to miss the "right dose".

So tonight, test her, then let us know what you get. Tomorrow morning, same thing. People are on the board 24 hours a day. It might be a good idea to post a question you need a quick answer to on the Lantus TR forum, just in case there are not people on Health at 6am or whenever. Lantus TR is the busiest forum on the board, and someone is always on it. I am not sure what the right dose for tonight is, but it is somewhere at the 3 units or less level....

Carl

 

Thanks Julie and Carl,

Thanks again for your support
Will def post pre shots tonight and tomorrow. I live in Toronto so we are on Eastern time. I give insulin at 7:30am and pm.
Ella is used to eating 3 times a day. She is hungry now but I'm reluctant to give her a snack before dinner as I'm worried she'll spike even higher. Any advice?
Why do cats want to eat when they are hyperglycemic anyways? You think they would want to stay away from anything that makes them feel bad!

Tamara

 

We usually advise to not let kitty eat during the two hours leading up to the preshot test so that food isn't giving you a wonky number. With Lantus, I have read threads where it is suggested that the majority of the food is given during the first six hours of the cycle, and try not to feed in the two hours prior to the next preshot test.
LOL, there is no answer to any question that starts off with "Why do cats.....?"
Carl

 

Haha, you're right about the 'Why do cats" questions!

I hear what you're saying about getting wonky numbers but if I hold off giving her food until just before her shot then she will pig out and get a really big spike. Wouldn't feeding her in smaller increments lessen those spikes?

I really don't know...just a thought.
Tamara

 

Hi Tamara!

Kit and I wanted to welcome you to FDMB!!! You've received some awesome advice, so I'm not going to repeat any of it But I did want to say hello and assure you that things do get a lot better. At the beginning it feels like everything is whizzing past you at crazy speeds and all the info is overwhelming. Then magically, one day, it all makes sense. I'm from Mississauga so if you ever need anything please just let me know!!! I sent you a PM as well

 

In answer to the question, you are right. The thing is, you don't want any of those spikes to influence the test number. It would cause you to think that he would need a higher dose than he really does. You can feed in smaller portions, but you space those portions out in the two or three hours after you give him the shot. Some people using Lantus will feed that meal in three parts, like at shot time, then one hour and two hours after the shot. What that does is level out the boost from eating, and it also makes the onset of the insulin and the drop in BG that follows more gentle and slower. I will try to contact Marjorie, who is someone I have contacted on many occasions on issues regarding food and meal timing, and I'll ask if she can take a look at your thread here. She can explain it much better than I can!

Carl

 

ok so the pre shot is 486...yikes...it's the highest she's ever been! Is it advisable to give 3 units instead of the 4?


Thanks,
Tamara

 

Hi Tamara!!

Carl asked me to pop in and talk to you about feeding. My pal, Julie, has already discussed that we are huge proponents of a LC, canned or raw diet. We've seen alot of cats go off insulin once switched from dry to canned food and I've yet to see anyone not be able to do it so paws crossed you can get there. In the meantime, I agree with dropping back the dose and monitor as much as you are able to with your schedule.....and follow the Start Low Go Slow protocol. It will give you good guidance, with our assistance, as to when you should increase/decrease, etc. And we do it in small increments, as Carl said.

So the idea behind feeding the curve is to help manage the insulin. Here's what a typical lantus curve looks like:

As Carl said, you want to get food in the kitty between PS and when kitty nadirs so as to help the insulin work as it should. By feeding several small portions from Preshot to +4 or so (depending on when Ella nadirs which right now actually looks around +8...but can change), you can help steer the BG numbers. If you are feeding after the nadir (or peak of the insulin), then you risk slowing the insulin action down and decreasing the duration.

We also do not feed between +10 and +12 because you do not want to shoot a food spike. As an example, let's say Ella was at 3.9 mmo/L (70 mg/dl) on a human meter or 100 mg/dl on an AT at +11 and was acting hungry. If you feed her, especially dry food, then an hour later when you do the PS test, she will most likely be much higher than that. Let's say she had increased to 7.2 mmo/L (130 mg/dl) and you gave her insulin. But then she wouldn't eat again. As the carbs from the food wear off, numbers could start to drop and as the insulin onsets, they can drop really fast. So we never feed in those two hours before a shot so that we KNOW we are not shooting a food spike number that could come plummeting down on us.

Now...let's say you did not feed her between +10 and +12, you did your PS test, gave insulin, and then fed her. Perfect. If you look at the chart above, normally onset does not start until +2 to +3 depending on the kitty. But alot of kitties, when they do onset, they onset fast and come down fast. Food is our friend!! Many of us take the portion the kitty is allotted for each 12 hour cycle and we divide it up into four feedings: PS, +1, +2, and +3. How you divide it up depends on when your kitty onsets. For kitties that onset early, it's good to give a sizable portion at PS and +1 to try and keep them from diving down. If kitty onsets later, the portions might be larger at +1 and +2. The food helps manage the insulin curve just as in a human diabetic. We also use foods that are different in the % of calories from carbs to manage BG numbers. It's quite a science AND it differs from cat to cat. Some cats are very carb sensitive and never need anything more than foods that are 3-4% calories from carbs. Others need more.

We all have to take the data from the spreadsheet and determine what feeding schedule is best for our kitty. There are some that free feed all day until about +8 or so without affecting the insulin action after nadir. But by and large, you want to get the food in kitty prior to nadir so the duration of the insulin can extend to +10 or so.

So for Ella, yes...hold off and don't feed her between +10 and +12 but then to keep her from getting an enormous spike up front when you might need some of it later, feed her a few smaller helpings spaced out. Of course, I say all of this with my knowledge based on canned food. I don't know how the dry food affects it because what I have seen of dry food is it might take a bit to spike up the BG and then keep it there a long time. Obviously, Ella has been getting too much insulin if she can get to low numbers on dry food.

Please let me know if you have questions and hope we see you in Lantus Land!

eta: yes...just give 3u. We dose on the nadir not the preshot. And I think she's bouncing as Julie explained. Please do not give 4u. Trust us

 

Tamara

Sorry I couldn't explain more...I had to take care of my kitty.

Ella got really low today....29 is a very low number and if you were following either protocol, that would easily have earned a reduction in dose. Lantus is an insulin with a depot which forms as a precipitate in the fat tissue. While the term is not the best, we refer to it as a shed. At 4u, Ella has a pretty large shed and because of the cumulative nature of lantus where one dose builds upon another, when you get a shed this big, it will affect several subsequent cycles. So we want you to take her down and let that shed drain a bit and let her clear the bounce ( high numbers in response to that really low one) . It can take up to six cycles to clear the bounce so don't panic if her numbers stay high...do not take the dose back up...it's dangerous. Ok?

 

THANK YOU Marjorie, Julie, Carl and everyone else for your advice.

Marjorie, your post regarding food intake is fabulous and much appreciated. Thank you Carl for facilitating this conversation
I did not intend to confuse anyone by posting in the Lantus section. It was suggested to do when I did the pre-shot in the instance that the others weren't around to "walk" me through the latest reading
It's been an overwhelming day and I feel so grateful that you are all here helping me from a far. I know more now then I ever have and will continue to develop my knowledge through the info you posted as well as the forum.

Many thanks!!!
Tamara from Toronto

 

Tamara...you are very welcome. I didn't see your post in lantus ISG....I saw two posts here in Health because I was waiting for you. Perhaps you thought the last post was in Lantus

At any rate....because we have so many more eyes there that are used to lantus...that is the best place to post. We'll just need to link up your threads. I came to Health from cuz Carl tracked me down ;-)

Eta: could you please take the 911 off the other Health post? I think we have you covered and that old 911 gets the adrenalin going. Thank you! Let us know how we can help.

 

I thought I did post in the Lantus section! I guess I need to spend some more time figuring this forum out
Out of curiosity....if your cat had gone down to 59 this morning would you have given a dose?
I'm already thinking about what will happen tomorrow morning if I get a low number.

Thanks!
Tamara

 

I promise I won't take the dose back up but what happens if I do get a low number tomorrow? Should I still dose her at 3 u?

 

Tamara,
The easy answer, (and probably not the one you're looking for?), is that it totally depends on the number you see in the morning. If it's around the same as it was tonight, then 3u would make sense. But it depends on different things..... like whether or not someone can be there to watch and test throughout the day, or how much data you have collected. What ends up happening is that over time, you will see definite patterns with her numbers on the spreadsheet. As she gets used to the insulin, the results will become somewhat predictable. You'll know what to expect when you see a certain number at test time. BUT, there's no such thing as "knowing for sure". Just when you think you know what is going to happen, kitty will throw you a curveball. That is the primary reason why we are so big on home testing. It gives you an instant "snapshot" of the blood glucose number. So there are fewer surprises. At some point in the not too distant future, you won't need to ask, you'll know what to do. In fact, it will be you answering the questions of the new person who just joined the board. Everyone of us was right in the same place you are today. Amazing "oldbies" were here to answer our questions, and not too many of us believed what I am saying right now when "they" told us the same thing!

The reason many of us are here is to do "this". Some of us, like me, don't currently have a diabetic cat on insulin. But we come online every day to pay back or forward, the gift that was given to us when we were the "newbie".

If you get a lower number in the morning, then it might be that you will need to give less insulin. If you had joined here on the day she was diagnosed, we would have also recommended the low 1 unit twice a day that your vet advised. The big difference is that had you joined then, the universal advice would have been to "go slow" with the increases if Ella had needed an increase. There's a chance that the right way to go is even lower than 3u or 2u. But the answer will be evident based on the test numbers you get from this point forward. You'll be able to get lots of opinions from people who have mucho experience with Lantus. They might not all agree with one another, but that's what this place is all about....peer review.... If I tell you something that isn't quite right, there's hundreds of other people here who can say "hey wait, that ain't right....". Much, much better than having only one opinion (like from a vet) which might not quite be right, but there's no other voices that can say "hey wait....".

Posting on the TR forum is easy. You just go to the main index page, find the link to "Lantus-Tight Regulatin", click on it, and hit the "new topic" button. You just weren't in the right place when you hit the button this last time. :smile:
Carl

 

Tamara...to answer your question about whether I would have shot a 59 on an Alpha Trak........absolutely not. For safety none of us in the lantus ISG ever shoot under 80 on an AT which is roughly 50 on a human meter.

I'd start a thread in lantus ISG tonight so our early morning folks will be looking for you.

 

On an AT meter, I think "normal" is 80-150, so no way would I have dosed Bob on a 59. Or an 80 for that matter.

Carl

 

Hi Marjorie,

I'm just reading over your food regulation post and its suggested that we don't feed at +10 and 12. Well I always feed at 12 as I was told by my vet that Ella needs to eat before her insulin shot so we know she has some glucose in her to accomodate the dose. It sounds like she should be eating at +1 and higher but I'm not home to accomodate that in the morning unless I get her all started by 5:00am!

Tamara

 

Tamara

Actually what I said was between +10 and +12. And then I said feed AT preshot. So that means do not feed up to two hours prior to shot; then you test, feed, and shoot all within about ten minutes. I'm sorry that wasn't clear. In reality, since lantus doesn't typically onset for two hours, you don't have to feed exactly at preshot. Most vets are used to the faster onset insulins where you must feed when you shoot. However, because most kitties are hungry by then AND we want to start managing the curve, I don't know of anyone in the lantus isg who doesn't feed when they test and shoot.

 

Thanks for the clarification Marjorie. And yes, you did say between...my bad

Do you think it woul be helpful to post my original post on the Lantus page or just cut to the chase and explain the readings?

Tamara

 

Tamara:

Usually what we have you do is start a "New Topic" in Lantus TR ISG and then link to the Health Thread. To do that, when you have this Health Thread open, copy the browser address. Then go to Lantus TR ISG, click on "New Topic", put your cursor in the text box, click on the "URL" button above the text box and then paste the browser address in between so it looks like this:

PASTE LINK HERE

Then go ahead an do a brief intro; be sure you put something in the subject line like "3/18 Ella New to Lantus" or something like that.

I wanted to demonstrate to you why we are careful and do not change doses based on the Preshot but on the nadir. I've added a link below to Mannie's SS; click on it and at the top are several buttons for the years. Click on "2011". Scroll down
to 1/13/11 and notice in the a.m. cycle, he started at 422 and by +12 of that cycle, he was too low for Michelle to shoot his pm shot. Also, look at 2/2/2011. In the a.m. he started at 436 and he was in the 60s by +5. In both cases, he was clearing a bounce that started high.

Mannie's SS

Michelle has been working diligently on food management and has made great progress with him; he rarely dives down like this any more.

See you in Lantus Land.