11/29 Tommy 300-500 - advice on R booster shots?

Hi,

We recently re-started at 1.5u Lantus, and are up to 3.5. BG's have stayed very high, and dose increases do not yet seem to affect BG. Also, BG does not seem to follow a 12-hour Lantus curve.

We are very concerned that BG has been so high so long (neuropathy appears to be worsening), and feel that Tommy needs more insulin. However, if we increase too quickly, we may miss the appropriate dose.

It has been suggested that we consider using short-acting insulin booster shots as a quicker way to arrive at an appropriate Lantus dose, basically following this protocol: http://www.felinediabetes.com/phorum5/r ... ?15,471430 .

So...are there folks who've had experience with this approach, and would be willing to do some coaching??

Any other suggestions?

Thanks.

will let the experts advise you...
bumping your post...good luck

hello and welcome to the group!

i've never seen anyone practice this particular approach in the lantus support group in the 4+ years i've been here. steve posted that method before following a tight regulation protocol was common practice in this group. you might want to send steve a PM. he would probably be the best person to go to if this is what you want to do. do notice that he cautions this is not an approach for beginners.

in recent years, it's been more common to use small amounts of R as a booster as needed with levemir or lantus while following the tight regulation protocol. there are several who could help with this approach...

Hi there,
I am glad to see that you started over; that first starting dose of 4u BID is just so wrong.

I tried to clik on the link but it took me to an older protocol. Anyways, the protocol link I have is this one:
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed

I have used R in the past, but don't use it much now. You can take a look at the ss I have for my two cats - they are both high dose kitties, which is something you may keep in mind if your dosing keeps rising and Tommy's BG remains steady and high.

I think the most important thing you should be doing with such high numbers is to test for ketones daily. I have no experience with this area.

For using R, it's very important to start extremely low because even a small amount like .1u could be enough to realize a huge BG drop.

I can relate to the starting over I did the same thing with Oliver when I adopted him. He had arrived at the 4uBID dose, but I started over, and worked back up following the above protocol for Lantus/Lev. I did use R but I had a fair amount of data and I received alot of help from a few people when I first started.

I did not start using any R until Shadoe was up to 9u BID, but I started much earlier with Oliver as I had prior experience and his numbers were much higher.

Have you received any advice on treating the neuropathy? I have no experience in that area but I believe that many use B12 and have great results.

I am sure others will be along who can give you more info on the safe use of R.

Thanks folks for the input.

We've been in touch with Steve who provided really good info and links, but were wondering if anyone who is active now has had experience with this, and would be around in case of questions.

Tommy is taking xobaline 3 mg/day for the neuropathy.

Thanks again.

Learning how to use R (thanks to Jojo) saved Fiona's life because we couldn't raise the lantus doses fast enough safely to make a difference. She's very ketone prone. Occasionally, we still have to use it. Here's what we did/do:

1) Shoot 0.1u R along with Lantus at regular shot time. Test every hour watching BG's go down and keep testing hourly until BG's start going back up. It's a pain, but you gotta know how Tommy uses the R.

2) Depending on 0.1u R curve, keep it at 0.1u R or take it up to 0.25u R and repeat curve. When you shoot this depends on the end of the curve. Might be +6 or +12. Also depends on when you can be awake to do a lot of testing.

3) Depending on the 0.25u R curve, keep it at 0.25u R or take it up to 0.50u R and repeat curve.

4) Increase by 0.25 increments until you see the results you want.

You may get a really good feel for when Tommy's R nadir is on any of these trials. When you do, you can reduce the amount of testing from every hour to every 2-3 hours, depending on how Tommy uses the R. This is a super conservative approach but knowledge is power. Fiona's R nadir was much later than most kitties.

Once you get a feel for how much oompf Tommy gets from whatever dose of R you can create a scale to figure out doses. 300-350 = .25u
350-400 = .50u
400-450 = .75u
etc...

NOTE: Shooting R more than every 6 hours is not a good idea until you get lots of data on how Tommy uses the R.

If you look at our ss, we have a separate row for R (or notes) in olive and I list the + hours under the time in two different rows (one for lantus and one for R (note that the R row starts over at +6))
https://spreadsheets.google.com/ccc?key=0AspCGYp5HCuNcFNjb2pMWnRva1E3dm9QSllsS2llQXc&hl=en

Here's our ss from 2008 when we first started using R in Aug. Not sure it will help, but it might.
https://spreadsheets.google.com/ccc?key=0AspCGYp5HCuNcFNjb2pMWnRva1E3dm9QSllsS2llQXc&hl=en

Keep in mind, Fiona has IAA and therefore needed huge amounts of R to make a diff.

Ditto checking the ketones. We use the Precision Xtra Glucometer. You can test ketones in the blood. Much easier than waiting for Tommy to pee. Here's a recent post with good info http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=30086&p

I wish I could offer to be around to coach, but I'm so freakin' busy these days I don't get on the computer much so I'm not reliable. Start low and test often until you are comfortable. Good luck!

Thanks Sharyn, that is really helpful.

I just wanted to add that you need to be very cautious with your increases; be ready in case Tommy goes too low as well.
I have found that R is pretty much gone as far as affecting my cats' numbers. I do not use any R unless BG is above 400 because Shadoe is VERY sensitive and will drop like a stone sometimes. She reacts within the first 2 hrs, so you should test hourly for the first 4 hours and you will get a feel for how Tommy is reacting to the R. After the R fizzles out, your Lantus should have kicked in and will (or should) be able to keep him surfing at the lower number.
There are a few people around that could help you - if you put something like "need R help now" in your subject line, it may catch the attention of a person with R experience