4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE?

Hello,
(we are Canadian so I have been multiplying my numbers by 18 for you)
My cat Noxin is newly diabetic and has been on 2.5 units of lantus ONCE a day for almost two weeks. I did a curve about four days ago and found out his nadir is at around +12.

Yesterday, saturday, he read at 109.8 before his food, so we skipped his shot.

This morning his pre-food number was at 297 so I gave him his 2.5 units. When I checked him at +4 he was at 61.2. Since his nadir isn't usually until +12 I was concerned (and he was active and asking for more food) So I put out some fresh fancy feast and he had some of that, then I gave him about 10 of the Temptation treats he likes. A half hour later he is up to 73.8, and is now back down to 57.6.

Since his diagnosis we have been feeding him a can of wet DM in the morning (though his sister ends up eating about half), and he has been grazing on dry DM until the next morning. A few days ago I started giving them both wet fancy feast throughout the day, and neither of them has really touched the dry food.

On friday, after giving her Noxins Curve numbers, I spoke with my vet and I told her that I wanted to feed him exclusively all wet high protein food and that I wanted to go to twice a day shots as we had previously discussed. I mentioned that I would be more comfortable going on a more conservative dose of maybe 1 unit twice a day, instead of 2 untis twice a day as she originally recommended, since I was doing the food change which would result in a drastic carbohydrate reduction in his diet. She said that lantus 'didn't work that way' and that IF we did put him on twice a day his dose would have to be 2units each shot. But she said that since his Nadir was twelve hours after his shot, that she wanted to keep him on his current dose, and do another curve in two weeks.

What should I be doing guys?

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

Lantus is a once a day insulin in HUMANS, but cats metabolize it much faster and it is nearly always given twice a day. There are exceptions of course, but they are rare cases. A lot of vets are just learning to use Lantus and have to unlearn a lot that they did w/ other insulins.

if you are changing diets it is very important to closely monitor his BG. It can cause a big drop in numbers almost immediately. I'm glad you are getting rid of the dry and sorry but the Temptations treats qualify as high carb dry. Many of us use freeze dried chicken or salmon treats. They are 0 carb and cats a re nuts about them. The problem w/ dry is that it actually takes a long time to raise BG, but it lasts a long time in the system too so BGs stay raised. if you are trying to bring Noxin up from numbers that are too low, gravy type foods (FF Gravy lovers or the grilled varieties) work more quickly and clear the system faster. Or try a drop of syrup!

I'm sure others will be along soon, with more advice.

ED: opps that was supposed to be (FF Gravy lovers or the grilled varieties)

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

I'm giving the temptations to raise his BG because his NAdir isn't going to be for another 6 hours. Managed to get him back up to 73.8 again right now...I think I will go out and grab some wet food with gravy.

I'll be testing him every half hour.

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

Hi and welcome to Lantus Land.

I'll let more knowledgeable people help you on the dose issues, but I want to strenuously support what Ann said, and what your instinct was:

LANTUS IS A TWICE DAILY INSULIN IN CATS. Our first vet put us on a once daily regimen, and it was a horrible story of misdosing. Happy ending: We found FDMB, started our dosing over at a twice daily dose, and Kitty is now in remission. Your twice daily/one unit per shot makes a lot of sense to me.

For the meantime, though, keep testing and posting your numbers!

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

welcome to Lantus Land!

With faster acting insulins, an overdose usually shows itself as low numbers. With long-acting insulins like Lantus and Levemir, instead of low numbers the overdose *might* look like extended duration. There's a good possibility that 2.5 units is too much insulin for Noxin, and that could be what is pushing his nadir so late. His AMPS numbers are high because he has run out of insulin by then. If you switch to a lower dose shot twice a day, you will probably see his whole curve flatten out and you might see his nadir move earlier too.

My recommendation would be to just cut the 2.5 units in half and shoot 1.25 units twice a day for a few days or a week. If you're changing diet too, then reducing to 1 unit twice a day makes good sense. Keep testing as much as you are, that is great! That might or might not be enough insulin, but by shooting consistently every 12 hours we'll see what he does with that dose and can make an informed recommendation about dose then.

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

Hi and Welcome,
It is likely that the once-a-day dosing has affected Noxin's nadir and that when he is dosed in the usual manner (twice a day) his nadir will also be more "normal". Since you have been at this for such a short time and have been dosing once a day, it is not really possible to determine what his nadir is. Also, nadirs can and do change. Once you begin following the protocol we use here and have more data to base your dose on, a clearer picture will begin to emerge. Please wait for some of our more experienced people to help you. Someone should be along soon.
Have you read the information "Stickies" at the top of the Lantus forum? They are full of good advice. Start with "New to the Group". Also, I believe that there is a version of the Google spreadsheet that automatically converts World/Canadian numbers to US numbers. Sienne knows which one it is. You might also be able to find this information in the Tech Forum.

1 unit twice a day is the normal starting dose. By starting low and following the protocol with regard to increases in dose (when to take them and how often), you will always keep your kitty safe. As you have discovered, the proper food is really important for a diabetic. Janet and Binky's lists (see New to the Group; most of the Fancy Feast foods are in the "Old" list) give the carb content of many brands. We try to feed low carb on a normal basis (10% carbs and lower; most of us aim for 4 or 5% and lower). Dry food, even "low carb" dry food, like EVO dry, tends to stay in the system too long and skews the numbers. When you go shopping for food, be sure to get some high carb canned food, too. The gravy varieties are all high carb. You will need this if Noxin goes too low and you have to feed to "bring him up". (But finding the proper dose will help to insure that he stays in safe numbers.)
Good luck. And WELCOME. You've come to the right place.

Ella & Rusty

p.s. I see that Libby has given you excellent advice while I was struggling to write this!!

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

Thanks guys.

With regards to switching to two shots a day at a lower dose, my vet said that lantus 'does not work this way', and is currently not willing to do so. Obviously I will not be giving him 2.5 units tomorrow, but I would like to talk to my vet about this too. She seems to think that we should stick to once a day because of the late nadir. I also mentioned that she seems to be looking at some sort of dosing chart based on the nadir I got (and probably his size, he's 21 lbs), and said that IF we did go to two times a day, his dose would HAVE to be 2units.

I realize that 2.5 is probably too much for him, and might be why he has such a late nadir; Especially now that he won't touch his dry food that is left out.

What info should I look at to discuss with her about this? Do you know what the actual lantus company recommended dosing is that the vets (or my vet) might be going by? I would like to be well informed for when I see her next.

I have read over most of the stickies, i think. I look through them again.

Also, I do have his numbers graphed on the spread sheet, but it doesn't seem to be converting or adding my Canadian values onto the US chart. NOXINS NUMBERS are linked at the bottom.

Thank you all for your help, it is appreciated.

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

Perhaps you'd like to share this journal article with your vet:

The article contains the formal version of the dosing protocol that we use here and it is from a top tier veterinary journal. Fundamentally, your instincts are right on target and I don't know where your vet is getting her information. (Sorry, I didn't mean for that to sound as harsh as it does.) Maybe, having the article in hand will allow you to continue a discussion with your vet.

Due to a cat's faster metabolism, Lantus needs to be dosed twice a day. When dosing once a day, there will be wide swings in the numbers due to the insulin wearing off after +12. You will never achieve duration because there isn't sufficient insulin available to form a depot or shed -- it's being completely metabolized within the 24 hour period.

I think Libby's suggestion makes a great deal of sense. Not that I want to create a difficult situation between you and your vet, I do want to point out that you're the one with the syringe. You can give Noxin insulin twice a day if you choose to. My vet suggested that I go to once a day dosing. I did that for one day then called her up and told her Gabby's numbers were awful and I was going back to twice a day.

I'm not sure why your SS isn't translating the World #s to the US. I'll see if someone can come by to help.

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

Hi and welcome felllow Candian to FDMB.
Where in Canada are you, city/province??
We have quiet a few memebers her, I am in Montreal.

This is an amazing place to be to get help for your Noxin.
My vet(s) did not believe or agree with anything that I was doing and with a lot
of hard work and fantastic advice from this board I got Max off insulin within 5 months
(yes we were lucky) and it has been a year of good health and no insulin.

I created a world spreadhsheet in the tech section and provided the link here.
If you are using a Canadian meter than enter you numbers in the tab that says world and
everything will be converted to the US numbers.

Be patient with the loading. It might be a bit slow. Let me know if you have a problem, you can send me a PM (private message) and I can give you other instrusctions.

viewtopic.php?f=6&t=18207

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

You're getting such good input here.

I just want to give you my personal experience. I saw what Sienne explained:

You will never achieve duration because there isn't sufficient insulin available to form a depot or shed -- it's being completely metabolized within the 24 hour period.

Click to expand...

We were also told that Kitty had a "late nadir." But he had a "late nadir" because he was getting only one shot per day. The vet continually raised Kitty's dose, without regulating him at all. Constant roller coaster, until finally he was on one shot, 10 units daily, and I almost lost him. When we moved to two shots per day (after I found a different vet and FDMB), voila, his nadir was more normal. You can look at our spreadsheet and see how normal his nadir was. So I take "late nadir" with a grain of salt, when it's based on one shot per day.

I hope your vet reads the article Sienne suggested, and agrees to try something different. But you may also want to consider getting a second opinion from another vet -- either locally, or via phone consult. Many of us have used phone consults to good advantage and can offer vets to talk with.

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

My computer just ate my last reply, so here goes again. Thank you everyone for your help.

Sienne.
Thank you for the .PDF. I have saved it and will be reading through it. It will be nice be armed with something like this when I next talk to my vet.

Randi.
I am in Coquitlam/Burnaby, BC. I sent you a PM about Noxin's Spreadsheet not converting from world numbers to US numbers. Thank you for your help!

Thank you Kathy,
It's great to hear other people have gone through this with their cats and have come out the other end. 10 units a day sounds frightening!

There seem to be three vets at the clinic that I take Noxin to that all consult with each other about dosing... I might give his old vet a call to see if they are experienced with FD and maybe follow a similar protocol to the one you all follow here.

This gives me a lot to think about, read, and do; plus I have to poke Noxin again and make dinner for my husband (speaking of my two favorite men, here is my favorite picture of the both of them: http://members.shaw.ca/junebugg/boys.jpg )

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

Well, now you have to figure out how to put that cute kitty's photo up as your avatar!

Re: 4/10 Noxin AMPS 297, +4 61.2, Nadir usually @+12, ADVICE

That is one cute picture! They play so nicely together. :lol:

Let us know how it goes at the vet!