Newbie Lantus Questions - Expecting Travel and Turmoil With My Father's Passing Away

[Sweet Spot]

Hi Everyone -

If this should have been posted in the Lantus section, please let me know. It applies to Lantus but also just general "what to do?" in crisis questions, too.

My first post is THIS LINK if you aren't familiar with my story. My father is on hospice and is getting very close to the end now (body shutting down). Hospice believes he will pass in a few days. He has a very strong will and we expected him to begin his new journey by now. At the same time, my sweet guy "Spot" has been diagnosed with diabetes. Where the turmoil comes in is that when my father passes, we will be traveling by car from Seattle to Illinois for funeral/burial, then visiting my daughter for two weeks (who resides in Illinois). This means a lot of disruption to routine during such a crucial time when starting insulin. He does ok in the car but new motels can cause stress, etc. I think this paints the picture quite well of what lies ahead. It is the worst time to begin the insulin protocol, yet he has to have it as he began to lose weight, drink more, etc.

I did commit myself to making the spreadsheet last night, figuring this will be a lifeline between me and this forum if things should happen on the road. Yes, it lacks a lot of data, but I am at my father's bedside most of the day, suffering adrenal exhaustion and getting little sleep - it is the best I can do. I am going to try to test him hourly today when I am home, to at least have more data - but the 6 hour nadir isn't possible until my father passes.

Here are my questions, if you don't mind my grouping them into one forum post:

1. Spot's numbers aren't budging much (though I know we don't have nadir, which is the true measurement) but he is in the "depot" phase still, from what I am reading. That said, tight regulation protocol suggests .25u/kg of ideal body weight. He is 17 pounds but ideal is 13 - he is very, very long...like a cougar...would never be a small cat. When I do the math that means about 1.5 units...(13# = 5.89kg) but is that TOTAL FOR THE DAY or EACH CYCLE DOSE? My thought is, due to his size, should he have started on 1.5u/2xday instead of the 1u/2xday he is on?
   
2. Though the numbers don't seem to be moving much yet, he seems more animated, playful, better appetite. Can you see slight changes even if numbers stay put during "depot time?"
3. Expecting we will have 4 long days in the car when we leave, history shows he spends most of the time sleeping in the car and doesn't eat as much. Should I not even consider increasing the dose if the time to do so should fall while on the highway (eating less should lower his blood sugar, correct?).
4. Should I change nothing at all until the total 3 weeks or so of chaos are over? I just feel he will likely need a slight dosage increase at a minimum, but is the stress of travel, motels and the like too risky for such changes?
5. To the best of my knowledge, I am not doing fur shots. I have been doing the tent method to date, I've watched the videos, I feel the needle go in...I did take time to "learn" this important part. That said, I am going to try the rolling method tonight. He has long, thick fur but I actually can get a "part" like you would see on human hair, in an area close to the flank, where I could actually see the needle enter vs just feel it. I do hold it for 10 seconds, etc. so you know. He is ok with receiving shots.

He has been a "grazer" all his life, and does eat on his own at sunrise while we are sleeping. He will likely not change this pattern at almost 14 years of age - and now is not the time to try to implement a feeding schedule, as you can imagine. So his pre-shots certainly can be food influenced (higher). Just wanted to share that information.

Thanks so much for all of your help during this tremendously challenging time.......Robin

 

[Sarah Smith]

Sorry I cant give you any info on the lantus, but I know someone who can will be along soon, just wanted to emphasize you are doing a great job, spreadsheets up and running and youve got Spot started on his insulin and testing seems to be working well. Sending some hugs your way , give Spot some scritches from me

 

[manxcat419]

Robin, I haven't traveled with a cat on insulin so I don't have specific answers to your questions. However, I do live very near Seattle - if you feel that Spot might do better in a home environment while you have to travel, please let me know as I do have experience with Lantus and would be happy to help. I'm sorry to hear about your father - the combination of losing a close family member and having a newly diagnosed cat must be incredibly stressful for you so please don't hesitate to let me know if there's anything I can do to help.

 

[Wendy&Neko]

I'm so sorry things are so difficult for you right now.

I have taken Neko to Colorado State University twice for some radiation treatment. It is a three day drive each way, about 9 hours each day. Neko's dose was already at a good dose, but I don't think I would change the dose on the road. It's just one more thing to worry about. We were driving in the summer and we had two days of travel where we could not find a spot to pull over and do blood testing, but her numbers were running a little low. One day traffic was jammed due to a fire on the road median, the other time all the pullouts were closed. You never know what might happen. Make sure you have a small cooler with water, low carb and high carb food, dishes and spoon easily accessible. Save the dose increase for when you are settled.

I used Feliway spray in her carrier and when first arriving in a new hotel room. Since you are going to be in one spot for a while, you might want to get a Feliway plug in that you put in each hotel on the road, and also in the room at your daughter's. I also got some Rescue Remedy for pets and put a couple drops on her breakfast each morning before we travelled. I originally was dreading the travel as Neko used to hate going 10 minutes to the vet. Now she's a champ traveller. We bonded even more during the trips.

Thank you for creating the spreadsheet. As you can't get mid day tests at the moment, you could try getting a before bed test which would tell us what he's doing in the night cycle. A test 2 or 3 hours after the shot can still give us a hint what is happening. Cats often go lower at night. As to your other questions:

Spot's numbers aren't budging much (though I know we don't have nadir, which is the true measurement) but he is in the "depot" phase still, from what I am reading. That said, tight regulation protocol suggests .25u/kg of ideal body weight. He is 17 pounds but ideal is 13 - he is very, very long...like a cougar...would never be a small cat. When I do the math that means about 1.5 units...(13# = 5.89kg) but is that TOTAL FOR THE DAY or EACH CYCLE DOSE? My thought is, due to his size, should he have started on 1.5u/2xday instead of the 1u/2xday he is on?

That would be 1.5 units per cycle - there are two cycles a day. And yes, you are building the Lantus depot which means holding the initial dose 5-7 days. With all the pink I'm seeing, he probably needs a dose increase to 1.5U, but unless it's going to be over 3 days until you travel, I'd hold the dose for now.

Though the numbers don't seem to be moving much yet, he seems more animated, playful, better appetite. Can you see slight changes even if numbers stay put during "depot time?"

You will see improvements because he is getting some insulin. Cats are more than their numbers. If they are playing, preening, purring, pooing and peeing normally, those are good signs. We call those the 5 Ps.

Expecting we will have 4 long days in the car when we leave, history shows he spends most of the time sleeping in the car and doesn't eat as much. Should I not even consider increasing the dose if the time to do so should fall while on the highway (eating less should lower his blood sugar, correct?).

I answered most of this above. I tried to make sure Neko had a good breakfast in her before getting on the road. Some cats can eat less during travel. I hope Spot isn't one of those that throws up on the road. You may want to mention your travel to the vet and see if you can get some Cerenia just in case.

• Should I change nothing at all until the total 3 weeks or so of chaos are over? I just feel he will likely need a slight dosage increase at a minimum, but is the stress of travel, motels and the like too risky for such changes?

If you can get some testing in, that is before each preshot and at least one other somewhere in the middle of each cycle, then you should be OK to increase once you are established at a location. But only if you can monitor. If you are going to be away 12 hours, I wouldn't recommend it.

To the best of my knowledge, I am not doing fur shots. I have been doing the tent method to date, I've watched the videos, I feel the needle go in...I did take time to "learn" this important part. That said, I am going to try the rolling method tonight. He has long, thick fur but I actually can get a "part" like you would see on human hair, in an area close to the flank, where I could actually see the needle enter vs just feel it. I do hold it for 10 seconds, etc. so you know. He is ok with receiving shots.

I still excel at fur shots. I have a long haired girl who occasionally likes to move in the middle of the shot. You don't need to hold the needle in for 10 seconds, just give it a good push at the end. I find it helpful to smell the injection site afterwards. The smell of Lantus is hard to miss. Squirt a bit out on some paper towel and sniff it - you'll see what I mean.

 

[Sweet Spot]

Sarah and Manx -
Thank you so much for your sweet words.....and Manx, I am speechless as to your offering to take Spot in. We appreciate that offer so much. Spot, however, has been attached to my hip for nearly 14 years and his stress is high if I am gone for an evening...let alone 3 weeks! Having to choose the lesser of two evils (not that your offer was evil, but choosing to LEAVE him for weeks) I have to trust my gut and feel he will do better next to me through this turmoil. He is a good traveler overall - Feliway in the motel is a good idea (I think it is the scent of other animals who have been there before that makes him more anxious and unsettled).

Wendy -
I am going to read your posts a few times but thanks so much for putting so much time and thought into all of my questions. Such great information there...and I think I better make a run to the pet store and get some of these extras ready in my travel kit. I am so frustrated because I can't find those small 12v coolers that used to be sold in auto sections of places like Walmart, Target, etc....the SMALLER ones. Would have been so nice to keep insulin chilled on the road. Anyway, if I have questions as to your post I will reply again....otherwise please just know I am so grateful for all of the information

Robin

 

[manxcat419]

You are so very welcome Robin and I completely understand that Spot will be happier with you - my Rosa's twin, Regan is exactly the same. I just put the suggestion out there in case you needed to consider other options for him for such a difficult time as I would have been only too happy to take care of him for you. I'm glad he travels well - that definitely helps. This board is a place where many of us will offer to do whatever we can when we can - it's like having an extended family right here on the internet! Even if you find you have a day or two where you just can't make it home from sitting with your father to do Spot's shot, let me know and I can work something out to cover that for you. I'm about on here on and off every day, so just shout out if there's anything at all I can do to help you through this. My girl is off insulin at the moment, so my schedule is flexible. I'm so glad you were able to get some tips for traveling with Spot and his insulin too - it makes it much easier when there are people who have already done that and worked out how to get the traveling done and keep a diabetic cat safe at the same time.

 

[Wendy&Neko]

One more thing, one of our members put together a document on travelling with diabetic kitties with suggestiosn from others. She had to travel every week with her little guy to work in a different city - he did not travel well. Here's the document.

I didn't have a plug in cooler for the insulin. I kept it wrapped in a facecloth, inside a tupperware (so it wouldn't be jarred), and put that inside an insulated container that had gelpacks. The tupperware also kept the insulin from direct contact with the gel pack. Opened cans of cat food, and cool water also went in there. I also made sure the pet friendly hotel I was stopping at had a freezer for refreezing the gel pack each night. Another option to consider is the Frio wallet, which I used when I took Neko on the plane.

 

[Sweet Spot]

Thank you all for the travel tips - great ideas!

If you don't mind (especially Wendy) as a follow up to answering all of my questions, would you please give one more glance to my spreadsheet? Took more readings yesterday, plus one evening reading before bed, and again this morning. We have been inching him up earlier by 15 minutes so that we could snag one nadir today before leaving to be with my father - so that will be up around noon Pacific Time. Just curious how you feel about the new data I have posted.

My favor is this: looking at the number of cycles he has had to date, with all numbers in the purple still - what would you be telling me to do now if my life was "normal" and I didn't have travel and crisis, etc.? I will take all of the safety issues into concern - not saying I would increase now - but would like to know what your input would be based on his rock steady numbers to date and number of cycles and lower starting dose than the tight regulation protocol would recommend. Would you say it is still depot time so keep monitoring OR you started on too low a dose for his weight OR?? I recognize the big piece missing is we need more of that 6-9 hour range.

Thanks again,
Robin

 

[Chris & China (GA)]

If your life were "normal" and you weren't having to go through all this, then we'd probably suggest going up to 1.5 soon since his nadirs seem to be >300

But since you're about to have some major changes, I'd suggest you hold it where it's at until you get where you're going to be staying for several days (at least). Most cats do respond to stress like traveling by going higher, but we've had several who've actually gone lower when under stress (and having to pull over on the side of the road to poke your cat is NOT a fun thing to do!!)

You've been doing fine with getting tests on the AM cycle, but so far only one test on the PM cycle....If at all possible (I realize you're under crazy conditions), it's really important to get at least a quick "before bed" test on the PM cycle. Most cats go lower at night, so it's important for his safety

 

[Wendy&Neko]

According to TR, initial doses are held 5-7 days (10-14 cycles), unless there are other circumstances like ketones at play. My advice, if you were staying at home, would be to hold for another day (24 hours or two cycles), try to get some more spot checks, and if you still see nothing but purple, to increase by 0.5 unit. His numbers aren't moving much on 1.0 unit and with no numbers under 300, the increase amount is 0.5 unit. Typical Lantus curves look more like a smile with some more downward movement in the middle. For testing, you don't need to test every hour. Some advice I got from the vet who pointed me here, test every two hours if doing a curve, unless you spot a number under 100, then move to once an hour testing.

You'll see the saying ECID (each cat is different). Some cats will dive steeply around 2-3 hours in, when the Lantus onsets (begins to work), some don't. But after that, you don't usually see steep dives from pink to anything where you have to step up the testing. At this point, it's helpful to get random tests throughout the cycle. We like to look at the spreadsheet as a jigsaw puzzle, and you are filling in places that don't have s test now. For example, testing at +1 helps you figure out how much his preshot meal raises his numbers. That can be useful information down the road. And try to always get at least one test in the PM cycle after preshot.

If you want more advice again, my suggestion would be to post in the Lantus/Levemir forum. Lots of experience in tight regulation there.

 

[Suzi_S]

I travel with my kitty quite a bit. Usually just an hour and a half away where I leave her at my mom's house until we sell it. But I have taken her on a few four hour car trips. I make sure she has all her needs right in the car and we plan our driving around her shot. One trip was a camping trip and she just stayed in our pop-up trailer. The most recent one was to a hotel. I gave her rescue remedy and a place to hide. She chose a chair with her blanket spread over her. I have to say Snickers adapts pretty well when we travel.