If you're new to the FDMB, please start on FELINE HEALTH: The Main Forum where you'll learn all about hometesting, the basics of feline nutrition, and feline diabetes.
*** IMPORTANT DOCUMENTS ***
Symptoms of & how to treat HYPOGLYCEMIA - what to do if your kitty experiences hypoglycemia
Jojo's Hypo Tool box - be prepared, what to have on hand in case of an emergency
Don't Panic! or How to Handle Low Numbers
Welcome to the Lantus, Levemir and Biosimilars Group!
We've put together information we think will be helpful. Most Stickys and Info posts have links (clickable, in blue font) to provide answers to many of your questions. Although, one of the first things you'll probably want to do is check out the Syringe & Insulin Info: Handling, Drawing, & Fine doses sticky to learn how to properly care for your insulin so it'll last as long as possible.
Confused about our jargon? Don't let it scare you off! You'll catch on in no time.
Until then, here's some help:
Creating a FDMB Profile
Blood Glucose Converter Calculator (1 mmol/L = 18 mg/dL)
Index: Health Links/FAQs
Food and feeding:
Why do spot checks or curves?
Example of a prolonged hypo: Baby begins Lantus (first day, first shot).
Meowzi surprised her caretakers one night! Luckily, they caught the low by doing a simple spot check.
PMPS 241; +4~132; +7~20; +7.25~31; +7.5~47; +8~89; +9~93
Reference numbers given are for blood glucose meters calibrated for humans, not pet-specific meters.
Blood Glucose Meter Ratings, Comparisons, & Recommendations
Pet-calibrated AlphaTRAK meters and AlphaTRAK test strips:
The pet-calibrated AlphaTrak (AT) (current version) is widely considered by vets to be the “gold standard” for testing blood glucose for cats because the results are closer to that of veterinary lab equipment. An AT meter must be purchased either from a vet clinic or online. Most vets don’t carry the test strips. They are much more expensive than human meter strips. Some additional info: Alpha Trak
Learn how YOUR kitty is responding to insulin:
Example of an ACTIVE, but NOT necessarily typical Lantus and glargine biosimilars cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar/Semglee cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir/Biosimilars: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
An active Levemir cycle will have an onset at approximately +4 and a nadir around +8 - +10. However, please keep in mind every cat is different (ECID). Data collection will offer you a better picture of YOUR cat's response to either of these insulins.
Initially, don't expect to see "active" cycles after every single shot whether you're using Lantus, Levemir or Biosimilars. Chances are, your kitty had diabetes for some time before diagnosis. It requires time for kitty's body to become used to dropping into lower numbers than their bodies have become accustomed. Don't expect immediate results! Regulation takes time and patience:
'What is Regulation?':
There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":
Approaches to Regulation:
Many here choose one of two methods to hopefully achieve regulation: Tight Regulation Protocol with Lantus or Levemir or a less intense method with fewer blood glucose tests required called Start Low, Go Slow (SLGS).
Note: Lantus, Basaglar, and Semglee are brand names for insulin glargine, also called Biosimilars.
Both approaches were created and developed by laypersons using human meters. Reference numbers given for blood glucose numbers are from blood glucose meters calibrated for human use.
As of this writing, the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats is the only published protocol we know of for use with glargine or detemir. This approach was created by laypersons from the German-Katzen Group and was eventually published several years later.
The TR protocol is the same, but presented in different formats here:
If the Tight Regulation Protocol isn't the right fit for you, the FDMB's Start Low, Go Slow Method (SLGS) offers an alternative method for regulation. SLGS offers caregivers a less intensive approach to managing their cat's glucose levels.
Guidelines listed for each of these approaches are not intended to portray the ONLY way you can use Lantus, Levemir, and Biosimilar insulins. The guidelines on this website suggest how to best use Lantus, Levemir, or Biosimilars when following one or the other of the protocols mentioned above. Be aware there are other feline diabetes message boards on the web using different dosing methods/protocols successfully.
Once you have learned the onset, peak/nadir, and duration of the insulin in your cat by collecting data from spot checks and curves you'll want to be sure to read Shooting & Handling Low Numbers if you're following the Tight Regulation Protocol.
Links to more information and discussion:
Hope this information helps ease your way through this journey...
WELCOME to the LANTUS, LEVEMIR, and Biosimilars
INSULIN SUPPORT GROUP!
*** IMPORTANT DOCUMENTS ***
Symptoms of & how to treat HYPOGLYCEMIA - what to do if your kitty experiences hypoglycemia
Jojo's Hypo Tool box - be prepared, what to have on hand in case of an emergency
Don't Panic! or How to Handle Low Numbers
Welcome to the Lantus, Levemir and Biosimilars Group!
We've put together information we think will be helpful. Most Stickys and Info posts have links (clickable, in blue font) to provide answers to many of your questions. Although, one of the first things you'll probably want to do is check out the Syringe & Insulin Info: Handling, Drawing, & Fine doses sticky to learn how to properly care for your insulin so it'll last as long as possible.
Confused about our jargon? Don't let it scare you off! You'll catch on in no time.
Until then, here's some help:
- The Official Lantus, Levemir & Biosimilars Slang Dictionary
- Created by lynn and bear (ga) with a little help from her friends, circa 2008; updated & edited numerous times over the years by members of the Lantus & Levemir ISG - FDMB Glossary - common abbreviations & definitions used throughout the Feline Diabetes Message Board
- Please use one thread for all your comments and questions you have that day since this forum is so busy. This will keep all pertaining to your cat together everyday.
- Start your thread with the date, kitty's name, and AMPS
- Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
- The 911 prefix in the subject line should only be used for emergencies such as symptomatic hypos, very low numbers (below 30 on a human meter), and/or very sick cats potentially needing ER care. Please remove the 911 as soon as someone has responded and you have received help.
- Making the Most of Your Lantus, Levemir, & Biosimilars ISG Experience
- Please set up a Google Spreadsheet as soon as possible. Always keep spreadsheets up-to-date! Valuable time may be lost looking for information when a spreadsheet is not up to the minute.
- If you have not been able to transition your kitty off of DRY food yet, please note it on your spreadsheet and in your signature. A dry food diet will often require higher doses of insulin to bring numbers down. Having this information plainly visible will help us help you.
Creating a FDMB Profile
Blood Glucose Converter Calculator (1 mmol/L = 18 mg/dL)
Index: Health Links/FAQs
Food and feeding:
- Feeding Your Cat: Know the Basics of Feline Nutrition - everything you need to know about proper nutrition and lots more from Lisa A. Pierson, DVM.
- WSAVA Body Condition Score Chart
- Food Charts
Why do spot checks or curves?
Example of a prolonged hypo: Baby begins Lantus (first day, first shot).
Meowzi surprised her caretakers one night! Luckily, they caught the low by doing a simple spot check.
PMPS 241; +4~132; +7~20; +7.25~31; +7.5~47; +8~89; +9~93
Reference numbers given are for blood glucose meters calibrated for humans, not pet-specific meters.
Blood Glucose Meter Ratings, Comparisons, & Recommendations
Pet-calibrated AlphaTRAK meters and AlphaTRAK test strips:
The pet-calibrated AlphaTrak (AT) (current version) is widely considered by vets to be the “gold standard” for testing blood glucose for cats because the results are closer to that of veterinary lab equipment. An AT meter must be purchased either from a vet clinic or online. Most vets don’t carry the test strips. They are much more expensive than human meter strips. Some additional info: Alpha Trak
Learn how YOUR kitty is responding to insulin:
- 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
Example of an ACTIVE, but NOT necessarily typical Lantus and glargine biosimilars cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar/Semglee cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir/Biosimilars: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
An active Levemir cycle will have an onset at approximately +4 and a nadir around +8 - +10. However, please keep in mind every cat is different (ECID). Data collection will offer you a better picture of YOUR cat's response to either of these insulins.
Initially, don't expect to see "active" cycles after every single shot whether you're using Lantus, Levemir or Biosimilars. Chances are, your kitty had diabetes for some time before diagnosis. It requires time for kitty's body to become used to dropping into lower numbers than their bodies have become accustomed. Don't expect immediate results! Regulation takes time and patience:
- "Fluctuations are very common in this phase before BGs start to stabilize under consistent dosing: a typical curve of cat over the first 1.5 months on Lantus can be seen here: Lantus Starting Graph". http://www.tillydiabetes.net/en_6_protocol2.htm
- Also worth noting: "Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations." http://www.tillydiabetes.net/en_6_protocol2.htm. Here in the Lantus, Levemir, and Biosimilars Insulin Support Group (ISG), we've affectionately dubbed this unexplained phenomenon "New Dose Wonkiness" (NDW).
- Carryover - insulin effects lasting past the insulin's official duration
- Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
- Insulin Depot - a "spare tank" of insulin, which has yet to be used by the body
- Lantus, Levemir, Biosimilars: What is the Insulin Depot?
- Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
'What is Regulation?':
There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":
- Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
- Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
- Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
- Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
- Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
- Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin
Approaches to Regulation:
Many here choose one of two methods to hopefully achieve regulation: Tight Regulation Protocol with Lantus or Levemir or a less intense method with fewer blood glucose tests required called Start Low, Go Slow (SLGS).
Note: Lantus, Basaglar, and Semglee are brand names for insulin glargine, also called Biosimilars.
Both approaches were created and developed by laypersons using human meters. Reference numbers given for blood glucose numbers are from blood glucose meters calibrated for human use.
As of this writing, the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats is the only published protocol we know of for use with glargine or detemir. This approach was created by laypersons from the German-Katzen Group and was eventually published several years later.
The TR protocol is the same, but presented in different formats here:
- Tight Regulation Protocol with Lantus or Levemir
- Management of Diabetic Cats with Long-acting Insulin.pdf
If the Tight Regulation Protocol isn't the right fit for you, the FDMB's Start Low, Go Slow Method (SLGS) offers an alternative method for regulation. SLGS offers caregivers a less intensive approach to managing their cat's glucose levels.
Guidelines listed for each of these approaches are not intended to portray the ONLY way you can use Lantus, Levemir, and Biosimilar insulins. The guidelines on this website suggest how to best use Lantus, Levemir, or Biosimilars when following one or the other of the protocols mentioned above. Be aware there are other feline diabetes message boards on the web using different dosing methods/protocols successfully.
Once you have learned the onset, peak/nadir, and duration of the insulin in your cat by collecting data from spot checks and curves you'll want to be sure to read Shooting & Handling Low Numbers if you're following the Tight Regulation Protocol.
Links to more information and discussion:
- Making the Most of Your Lantus, Basaglar, & Levemir ISG Experience
- Blood Glucose Converter Calculator (metric to US value)
- The Official Lantus, Levemir, & Biosimilar ISG Slang Dictionary - Created by lynn and bear (ga) with a little help from her friends, circa 2008; updated & edited numerous times over the years by members of the Lantus, Basaglar, & Levemir ISG.
- FDMB Glossary - common abbreviations & definitions used throughout the Feline Diabetes Message Board
- Suggestions for Advice Givers
- Buying insulin from Canada
- Sourcing Insulin More Economically
- Vet Interview/Screening Topics & Check List - ideas for what to ask when looking for a new vet
- American Association of Feline Practitioners - find Veterinarians & Practices in your area
- INDEX: Health Links / FAQs about Feline Diabetes - Bookmark this forum! Answers to questions, tips, and articles on feline diabetes. Check it out.
- How to "Shoot" Your Cat - Some basics on syringes and how to shoot.
- Hometesting Links and Shooting Tips - Tips, tricks, & videos from FDMB members. Find what works for you!
- Dosing with calipers (optional)
- Insulin ruler template for use with BD syringes: https://www.diabetes-katzen.net/insulinruler.pdf
- Preventing over doses - FDMB members share test-feed-shoot routines
- Getting back on a 12/12 shot schedule - suggestions for newer caregivers
- Calculating % Calories from Carbohydrates
- Using Food to Manipulate the Curve
- Feeding Low Carb vs Lower Carb Foods
- Carb sensitivity - thoughts
- Discussion: "Feed kitty as much as they want?"
- How much should I feed?
- How to Stimulate Kitty's Appetite
- Discussion: Thoughts/Ideas on how to extend duration
- Should I Increase the Dose?
- New Dose Wonkiness (NDW) and failed reductions
- Reminder: *earning* reductions and starting OTJ trials
- Reminder: Counting Cycles
- How Low is Too Low?
- Reductions and Why We Should Take Them
- Protocols: Myths Debunked
- Cat on a Pogo Stick Discussion: Increase, maintain or lower the dose to stop bouncing?
- Rebound hyperglycaemia in diabetic cats.pdf
- Ketones, Diabetic Ketoacidosis (DKA), and Blood/Ketone Meters
- Oldtimer Alex Update & Ketone Awareness thread
- American Veterinary Dental College
- Anesthesia Free Pet Dentistry: Know the Facts
- AVDC Veterinary Dentist Directory
- Medication Warnings - Certain veterinary medications for other conditions may seriously affect diabetic patients.
- Alternative Medication Warnings
- Metacam/Meloxicam discussions (Strength and Dosing for Cats):
- Metacam ! - Is it safe?
- Bronx's hypo & arthritis thread (begins around Post #80)
- Where Can I Find ________?
- Info: OTJ (Off the Juice) Party Videos - criteria from the folks who create OTJ and GA videos
- Who 'ya gonna call? Myth-busters!
Please be aware: There are not any "dose advisers" or "experts" on the FDMB. The FDMB is an open board subject to peer review where laypersons with varied degrees of knowledge and experience are free to share their own thoughts and opinions through explanation and by making suggestions.
We are not veterinarians. It is not our intention to take the place of your veterinarian. Please discuss dosing, methods, medications, and care for your cat with your veterinarian.
We are not veterinarians. It is not our intention to take the place of your veterinarian. Please discuss dosing, methods, medications, and care for your cat with your veterinarian.
Hope this information helps ease your way through this journey...
WELCOME to the LANTUS, LEVEMIR, and Biosimilars
INSULIN SUPPORT GROUP!
======================
This document was written by FDMB members Jill & Alex (GA) and jojo and bunny
with contributions from Libby and Lucy and wcf and meowzi.
=====================
This document was written by FDMB members Jill & Alex (GA) and jojo and bunny
with contributions from Libby and Lucy and wcf and meowzi.
=====================
Last edited by a moderator: