looking for some advice

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Tals said:
Its says a world spreadsheet, but its not recording the numbers in my units of measure. I'll just use a converter and will convert the numbers myself. hopefully this will work.Doing it right now thank you ladies so much.
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I think I did it! Can you please take a look and let me know if it looks ok? @Vyktors Mum
 
I can access it yes, it will be more convenient for you to have it set up so you can just enter into the world sheet and have it convert itself though. Did you follow the instructions from the link I just posted or do it some other way?
 
Vyktors Mum said:
I can access it yes, it will be more convenient for you to have it set up so you can just enter into the world sheet and have it convert itself though. Did you follow the instructions from the link I just posted or do it some other way?
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I followed the link BJM instructed to use yesterday. I don't mind using a converter. I really don't. The numbers in black are scaring me. what does it mean?
 
The black is a high ugly number but don't panic about that, it's just one number. Lantus takes a little time to settle in, it's not a quick fix. Insulin is a hormone not a drug so it doesn't work like a dose of antibiotics or something like that.

be right back got to test
 
Vyktors Mum said:
Have you entered all the data that you have? Do you have any of the vet's data?
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no...that's all I have apart from the very first day on June 5th when I took Shimi to the vet and I already knew he has diabetes, because of his acetone breath
When I first brought him in, his BG was 612 they kept him for 30 hours and started him on 2.5 Units at first and increased to 3 Units right after while he was getting electrolytes via IV for the next 30 hours. When I took him home, they said his BG will drop to 216...I dont' remember when I checked but I did once between June 5 and 19 and it was 288, thats all the numbers I have.
 
@Tals I'm watching this post but I'm afraid even with the spreadsheet I lack the experience to make any dosing recommendations.

All I can think of is that too much insulin can sometimes cause high readings - Genghis' initial reading was almost as high and she was started on only 2 units (mind you, it was a different insulin and all cats are different, but 5 units seems like so much, even with my limited experience)

It is also possible that your meter (same brand as mine) gave you a wacky reading - do you think you can get another reading, just to be sure you're not reacting to a false number? Did you ever test yourself with your meter to ensure your strips are okay? Maybe something got on the tip and threw you that high number? Just thinking out loud. I know you hate blood and hate poking Shimmi, but I promise you his ears don't hurt.

Breathe!! You guys will get through this!!!
 
Welcome to FDMB.

You initially mentioned that the dosing suggestions from the vets seems to be random. The reality is that there is good, published research regarding the use of Lantus in cats. BJ gave you the link to the German websites where Lantus was first being used (and the moderator of the website was involved in the published research.) I'm linking the journal article where this research first appeared. The article may be something you want to share with your vet.

The initial dose of Lantus is based on a weight-related formula: initial dose = 0.25 x ideal weight in kilograms. Your cat would have to be very large to be started on 3u. Most cats' initial dose is in the neighborhood of 1.0u.

I would strongly discourage you from changing the dose. You typically want to hold the dose for at least 3 days in order for the insulin depot to stabilize after a dose change. If you change the dose too often, you end up with wonky BG numbers.

With regard to testing, as others mentioned, it's essential to get pre-shot tests. I tend to like data and test frequently. (I also have a cat who likes to dive early in the cycle so I test frequently during those early hours.) I would encourage you to get some additional tests during the cycle. The minimum number of tests that are recommended is four -- your pre-shot tests and at least one additional test each cycle (2 cycles -- AM and PM -- per day).

You may also want to read the sticky notes at the top of the Lantus board. There is a great deal of very helpful information in those notes.

@Shiloh & Rhonda - the link doesn't work.
 

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OK - I'm going to call along some others to confirm (or deny) but my view is you were started too high, you have insufficient data to be adjusting the dose and you should basically start all over from the appropriate starting dose for Shimi's weight.

This will sound counter intuitive to you because of the high number readings that you have but you really need to trust the experts here because I'm calling your vet out on knowing jack about lantus and how to use it - that doesn't mean he's a bad vet, vets can't be across all the treatments for all the ailments across all the species that they see.

The high readings that you have could be from too high a dose, bouncing (when the cat drops too fast or goes lower than it's used to and springs back up high again) or just because the lantus depot hasn't had a chance to settle yet - especially with all the dose changes.

Lets see if others agree @Sienne and Gabby @Wendy&Neko @Marje and Gracie as it happens Marje is also a spreadsheet expert so she may be able to help you get that right :)

ETA: I see that Sienne has just been - Sienne do you think she should hold the high dose or start again using the weight based formula and hold that dose for the appropriate time?
 
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I would also pick up some ketodiastix from the chemist so you can test his urine for ketones regularly until his numbers come down.
 
@Sienne and Gabby. Hi and thank you for joining this conversation. Shimmi was in a bad stage when I first took him to the vet. he is 12 lb now, so according to your formula his dose should be 3 at the very most. and that's exactly what it was since June 5 to June 23. But poor cat started to drink and pee like a human, his sugar was too high and I didn't know about this group...so what do I do now? step by step. I'm ready to do what it takes to make him better. Can I see one normal reading before dropping the dose? Look what happened when I lowered it to 4 units. My vet has 40 years of experience, but I'm not on his side here. I'm on Shimmi's side. You guidance is greatly appreciated and thank you in advance.
 
Vyktors Mum said:
I would also pick up some ketodiastix from the chemist so you can test his urine for ketones regularly until his numbers come down.
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What sticks? I dont' know a chemist, is it something I can buy at a pharmacy? Please guide me. I'll try it
 
Tee hee sorry in Australia they're chemists - same thing as a pharmacy :) they don't cost too much

If kitty is overweight the weight based formula is usually done on ideal weight

Hmmm I forgot he'd been on the 3 units for so long either, based on the spreadsheet I thought just a short time, that may change things a little but it's very hard to know without the data. I might lean towards 3.5 units with that info but lets see what the others say. I notice @julie & punkin (ga) is on the board too.

Edited to change errors - needed coffee and a shower!
 
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I honestly don't want to second guess the vet. It sounds like Shimi was in DKA if the vet was giving electrolytes. Lantus is typically not used to manage DKA in a newly diagnosed cat. (Usually, a faster acting insulin like Humulin N/Novolin/Normal insulin is used along with a rapid acting insulin like Humulin R to manage the numbers.) Once the crisis is over, the type of insulin can be switched to an insulin like Lantus which is much longer acting.

With many cats who have experienced DKA, you need enough insulin to keep the ketones in check. I would be very reticent to suggest dropping the dose in a cat that is recently out of the hospital. I don't necessarily disagree with Serryn it's just that I would not want Shimi to be back battling with ketones.

Tal -- are you still feeding W/D? If so, it may be contributing to the high numbers. Canned W/D is 25% carb. I have no doubt that the dry is even higher in carbs. (We consider a low carb good to be under 10%.) Is Shimi eating well? Food is also a critical factor in a cat that is post-DKA. This link to Lisa Pierson, DVM's site on feline nutrition is a wealth of information and there are charts listing the carb content of many varieties of canned food.

Did your vet happen to suggest that you test for ketones? You can get Ketostix at any pharmacy. You dip the stick into your cat's urine and it will give you a color coded reading on the paper end of the strip that tells you if ketones are present and if so, how much. I would test Shimi daily until you are sure the ketones are gone.. Also, once you smell acetone, it's a pretty good indicator of DKA. You want to catch the presence of ketones well before ketones turn into DKA.

 
Tals said:
he is 12 lb now, so according to your formula his dose should be 3 at the very most.
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Actually, the dose calculation should have been around 1.25 - 1.5u. You didn't convert from lbs to kilograms (initial dose = 0.25 x ideal weight in kilograms).
 
@Sienne and Gabby, Oh my...he is getting too much insulin and seems like I took him to the vet too late...
He is a tall cat so to speak. He was always a bit large? but then he lost weight along with the rest of the symptoms. On June 5, he was 11.6lb and now he gained a bit of weight and looks more or less normal again. he is now at 12.2lb he is always hungry. So I guess its the insulin that makes him hungry. I don't know what to do...keep 4 units? 4.5?
I'l start checking his BG 4 times a day as much as I hate that, he jerks when I poke him and I think its causing him pain. then I stare at the poked ears for a while and hate myself for hurting him. But that's not whats important.
Whats the plan for the next few days? Should I keep him at 4.5? and try to get a normal reading?
As with food, why would they write on the can that its a special food for diabetic cats if the carb content is so high? I still have 24 cans of that glorious stuff. What should I do?
 
12 / 2.2 *0.25 = 1.36, rounded down to nearest quarter unit is 1.25 units.

Return the food and say he won't eat it.
 
Not going to address the dosing issue, but as to why they would put on the label that is a special food for a diabetic cat? $$$$ That is the only answer I have. Most vets, if you tell them they won't eat it will take it back and give you a refund.
 
@BJM :) HI!! Thanks for checking in on me. yes, it seems everyone is saying the same thing. I"m afraid to drop the dose from 4.5 to 1.25 right away though...not with todays readings. that is the goal for sure. I'd like his insulin dose to go down as well as his sugar.
 
It's the diabetes (lack of insulin) that causes weight loss.

Are you giving low carb treats after each test? Most kitties adjust very well and end up focussing on the treat rather than the test ;)

I have to go now but I'm sure some of the others that I tagged will be along to give advice and we can find some sort of consensus before Shimi's next shot is due..

I also recommend that you start posting Shimi's numbers regularly (daily is good) in the lantus/levemir insulin support group forum at least until you know what you're doing - and no mucking with his dose without advice :)
 
The nadir for Lantus is often between +5 to +7, although it can and does vary day to day. Aim to get tests during that period in case his ability to compensate fails and his glucose dives. Make sure you have the hypo instructions printed out and Karo syrup in case you need it.
 
wow, you've had a rough time. You're getting a lot of conflicting information and your kitty isn't doing well.

I've skimmed through this long thread, trying to get just your posts so i can get the story. Can you clarify, is Shimmi still eating any dry food? Eating dry food can really increase the amount of insulin needed.

We need to sort out if you have a high dose kitty, one that has a condition like acromegaly, which my punkin had, or if Simmi's high numbers are caused by too-high of a dose, or from eating dry food.
 
I want to give you a couple of things to read:

Bouncing - second post in this thread
When a cat is overdosed, his body will put out counter-regulatory hormones to keep the cat alive - the result can be constant high numbers. If the dose is reduced, it can take maybe 3 days for those hormones to clear out and the blood sugar to drop.

3/8/11 Punkin
When we arrived at FDMB, our vet had switched us from Prozinc, a U-40 insulin requiring u-40 syringes, to Lantus, a U-100 insulin requiring U-100 syringes. Only he hadn't switched our syringes - so the dose was actually 2.5x as large as we thought it was. Libby laid out some things for us to consider as we moved ahead. Your situation isn't exactly the same, but the choice is the same - should you drop the dose to see if he's overdosed, or should you hold this dose and move ahead.

Take a look at these and answer the question about dry food in the previous post, and let's see if we can help you figure out how to proceed.
 
I also don't like lowering a dose when the kitty has had DKA until we see if that's what they actually need. Since you reduced to 4.5u, I'd suggest you just leave him there for now and let it settle so we can see where the numbers are.

I've never heard of an aggressive form of diabetes. I suppose he could be talking about acromegaly that Julie discusses. But that's not our first thought....we need to just get a consistent dose and see where he is.

If you need help with your SS, I'm more than happy to fix it. Click on "Marje and Gracie" on the left and select "start conversation" and it will send me a message so I can get some info from you.

Lastly....take a deep breath. :) We've all been scared to death, too. We've seen our kitties become starving, lethargic, lose weight, high numbers, etc. so we totally understand your distress. But we've helped a lot of kitties and caregivers here and we will do our best for you and Shimi. There have been cats on this board that have lived with diabetes for more than 14 years.
 
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@Tals Have a look at my spreadsheet. After a failed year on Caninsulin, my specialist vet put my Frankie onto Lantus and started him on 3 units, then upped it to 4, then again to 5 and I was seeing much higher numbers than you. After finding this site, I realised he was on far too much and started taking control of him myself. I changed his food against the vets wishes and I get dosing advice from here. He has been slowly reduced and is now on 2.75 units twice a day. Admittedly, the last decrease failed and I will be going back up to 3 units tonight, but my spreadsheet did look very much like yours (or what there is of it) at the start. Trust the advice you are given here, they really do know much more than the vets!! Plus it is a slow process, you won't get results from a few shots. It can take 3-4 days to see what a consistent dose will do for Shimi.
 
If you're worried about testing and how Shimi will adjust, take a look at Gabby's' spreadsheet and Marje & Gracie's. We're testaholics! You kitty will catch on that this is the golden road to treats (lots of us use freeze dried chicken) and that what you're doing helps him to feel better.
 
@Sue484 @Marje and Gracie @julie & punkin (ga) @Sienne and Gabby Good morning guys. Thank you for joining this thread and for your advice. Shimmi is off the dry food. I stopped it, only wet cans and this morning I gave him a mainly protein can, not a W/D can, but a Signature can I had from before he got sick. his AMPS was super high though. 498.6 and a 4.5 unit shot followed. Sue, Frankie's story sounds very similar to mine. I looked at your chart. Poor Frankie :( his sugar is all over the place. Are you not afraid to drop the dose form 5 to 2 in a day in some cases? I saw that on your chart.
Julie, I Googled acromegaly and I don't think Shimi has that. There might be another explanation for the super high numbers....a tumor....but I don't want to think about it right now. I just want to see his sugar drop at least once.
As for treats :) Do you freeze cooked chicken pieces? My cat doesn't eat anything raw...never had, but he loooooves roasted chicken!
A million thanks, people. I was telling my friend last night about how I stumbled upon this forum and how amazing the people in here are. I truly appreciate the time you take out of your day to care for Shimi.
Tals,
 
@Tals I only halved his dose when he had a particularly low pre shot number. That was also the day after I changed him to an all wet low carb diet. I would rather he had too little insulin than too much. At least that way I know he was safe. I am doing things the hard way, starting high and reducing, I was a bit like you at first. I had advice to start afresh as he was overdosed, but couldn't quite get my head around it. It is better for them to have high sugars for a little while than be too low for a moment
 
Tals

Keep in mind that Sue also uses a pet meter and so the numbers will appear higher than you would see with a human meter.

One thing we say here and believe firmly is "every cat is different" or ECID. If you'd like some hope on how much things can improve, check out Cooper's Spreadsheet.
 
You can use roast chicken as a treat. Freeze dried chicken (and other proteins) are in the treat aisle at any pet food store. Many of us buy the "dog" version since it's cheaper than the cat version even though they are exactly the same. This is a link to one brand, PureBites, that's available.

I'm also giving you a link to the food chart that most of us use. If you look through the multitude of food available, you want to select food that's less than 10% carbohydrate. That's what we consider low carb (LC). I feed my guys Wellness Chicken or Turkey (it's around 4% carb so it's well below the 10% limit.
 
Hi Tals - and hello from another Canadian, but from the hot west coast. I see you are using the World version of the spreadsheet but entering data on the US side. If you look at the tabs on the bottom of the spreadsheet when you are editting it, you'll see the second one is World mmol/L. If you grab that tab and move it to the left, it'll end up being the top tab when you open the spreadsheet. You can then enter all the data in mmol/L as you see from your meter, and it will automatically do the conversions for the US tab.

Tals said:
Julie, I Googled acromegaly and I don't think Shimi has that. There might be another explanation for the super high numbers....a tumor....
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My Neko was also a high dose kitty and has acromegaly. Over 50% of acromegalic cats cannot be identified by looking at them. Neko's main symptom was being crazy hungry, including for inappropriate foods like banana bread. But otherwise didn't really have any visible symptoms. Later on I found out her eye tearing was also a symptom. Four years after that first symptom, she still here and fairly happy. Acromegaly is a benign tumor on the pituitary. I'm not saying Shimi has that, just that it's a little trickier to say one way or the other.
 
Tals, I think the thing that would be most helpful in helping us figure out how to help you move ahead, is for you to hold this dose for the next few cycles, and get at least one preshot and one mid-cycle test in both morning and evening. Sometimes there are hidden low numbers in there and a cat will bounce (I linked you some info on it above) and then remain high for the next 3 days. The most helpful pm cycle test is probably just before you go to bed. During the day, I think anytime between 3 and 8 hours after the morning shot would be good. Because we have people here from all over the world, we measure time in + hours counting from the last test - so if you shoot at 6am, then +3 is 9am and +8 is 2pm.

If you can get 4 tests a day for 3 consecutive days while you hold the dose constant, we ought to be able to tell from those tests if you need to increase or decrease the dose.

Is that something you might be able to do?

While he is high it's also important to test him frequently for ketones. Here is a good information post on them. Since he had DKA at diagnosis, the risk is present for him to develop ketones again and that's a dangerous situation we want to avoid. If you see a trace of ketones, please post immediately and ask for help. Trace ketones can be dealt with at home - more than small requires a vet and can become a crisis in a matter of hours.

I'd also encourage you to post on the Lantus/Levemir Insulin Support Group. That's going to keep your sweet Shimi on the radar of those who all use Lantus and Levemir, and many people there can help you. Don't worry about the lingo or the subject lines - for now I'd just encourage you to post there so we can keep an eye on how Shimi is doing.
 
Hi Tals,

I'm still going through all the notes on this thread to catch up (late to the party!:rolleyes:), but wanted to let you know that I am another Canuck and quite possibly a neighbour. I too live in Toronto. I am in the west end near 427 and Rathburn. Where are you?

I have been at this battle a smidge longer than you and can appreciate your frustrations although mine are for totally different reasons. ECID is sooooo true. I have a zebra who is not following the rules and refuses to read the manual.:cat::banghead: I will continue to follow your posts to see how you are managing. Cheers!
 
Hi Everyone.

Shimi's sugar dropped from he highest cliff! at 3.6 (or 64.8 US) @+7
I gave him a tea spoon of sugar and some high caloric food. now what?? what am I waiting for? when do I check him next?
Whats happening to him?
 
@MrWorfMen's Mom Hi Linda, I'm in Distillery and currently totally scared...my hands are shaking as I'm typing. I've never seen his numbers that low.
Is 1 tea spoon of sugar water is enough?
 
If you are using an AlphaTrak or other pet meter, he is borderline. Give 1-2 teaspoons of high carb food or several drops of syrup/honey/sugar water.
 
Hi BJM, trying to breathe.... it is a human meter yes. should I give him more sugar? food?
 
Nope. He's right around his nadir (or even possibly past it) and that is a beautiful number!
Wait 30 minutes and re-test.
 
Saw you were posting in Lantus, too, so answered there.

I need to pop out for a bit to help a friend, so keep posting on this post in Lantus, ok?
 
Oh Tals,

I'm so sorry I didn't see your message until now but I see BJM got to you pretty quickly and others have since chimed in. That's the beauty of this board.....there's usually someone around to help. I checked the message in the Lantus section and see that Shimmi's numbers have started rising . You are getting a great nadir number but I understand how scary that must have been. You must have been going nuts when you got that low number. I'm shaking just thinking about how you must have felt. Sending you a big HUG! :bighug: You should go do something nice for yourself now. You earned it!

In the Distillery district.....so you are in the heart of Downtown. That's one of the few places the old buildings with their remarkable architecture have been preserved in this city. I love going for a stroll through the area although I haven't done it for years. I need to put another stroll down there on my ever growing ToDo list.

I will keep an eye out for any more unwanted "excitement" but hope that's over for you today.
 
Linda, thank you for the hug...much needed. If you do end up strolling down here, let me know. Would love to have a coffee with you.
Thanks again for your support.
 
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