Been using Lantus, can't seem to regulate

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Emily'smom

Member Since 2017
Hi! I am somewhat new to the boards, been posting for a few months. As my questions got more specific on the main message boards, it was suggested I post to the Lantus board, so here I am! In a nutshell, here is my Lantus experience with our little 6.5 lb (normal weight) Emily:
Diagnosed in June, Emily's numbers were in the 400's. She was put on 1 unit of Lantus, 2x per day. At this time, I also changed her diet from regular over the counter Friskies wet and dry, to Purina DM dry (1/8 cup, 2x per day) and low-carb (under 10%) wet. She would not eat the wet "prescription" (eye roll) food, so I am using FF and other low-carb wet foods suggested on the chart on this site. Very quickly, my husband and I could tell the 1 unit, 2x per day dosage was too much for Emily, so on our own, we cut her down to .5 unit, 2x per day. She seemed to be doing well. After 2.5 weeks of diet change and insulin, we brought her back to the vet for her all day test. At the low point of the curve, her number dropped to 60. When we picked her up the vet suggested she go off the insulin as clearly even the .5 unit, 2x per day was too much for her, with the thought being that maybe the diabetes was being diet controlled. We were thrilled. Two weeks later we brought her back for just ONE mid-day check. Diet was still the same. Her numbers were in the mid 200's. The vet suggested that since .5 was too much and we couldn't measure less, we just keep her on the low carb diet and bring her back in a month for another re-test. That didn't sit well with us, so we ordered 1/2 unit needles so we could try and eye-up .25 units, which I do not feel is easy to do, or certainly not completely accurate. We also started to wean her off the PM dry altogether, which didn't initially go so well, (she is a dry-food girl) so it has taken some time. We ordered home-test supplies and learned to home test. During this time, I also got a new vet, who makes home visits, feeling blood tests would be more accurate if we did not have to bring Emily in the car to the vet. During the initial home visit, (a little over one week ago) it was discovered Emily had a bad tooth (which was partially removed) and also a UTI, which she was given an antibiotic shot for. We continued on the .25 unit 2x per day insulin regimen and continued to home test. Of course all of this is occurring as we are getting ready to leave for vacation for a week! Here are some of her numbers around this time: August 12: 1:30 p.m. 192, 7:06 p.m. 189 (at this point she was fed), 8:15 p.m 214, injection given at 8:30. At 11:35 p.m., 211. August 13: 8:00 a.m. 189 (no injection given, as we are fearful it will bring her too low), at 3:30 she is at 239, 8:00 pm she is at 220, and she is fed. Given an injection at 8:15 p.m. August 14: tested at 5:30 a.m. 233, fed at 7:30 a.m. and given a .25 injection, noticed she hardly eats all day, and appears somewhat "lazy". At 7:00 pm. she is tested and is at 112 ... FOURTEEN HOURS after her morning injection. No injection given. The next day we left for vacation with instructions for the sitter to hold off on all insulin. During the time we were away (we returned yesterday) the sitter informs us that Emily is eating well, has had NO DRY FOOD for the duration of the week, and does not appear to her, to be drinking heavily or peeing abnormally. Tonight, after being certain she had no food for at least 2 hours we home tested her for the first time since August 14. At 6:30 this evening, she was at 254. I have not yet emailed the new vet this number, but even without knowing this, her suggestion is to take Emily off the Lantus and put her on something called Glipizide. I am willing to try anything, as both my husband and I feel we can not accurately give Emily less Lantus than we had been, and even at that her numbers are dipping too low. We both work full time and home testing her is a two person job, so it is not feasible to watch her all day, and on a daily basis take numerous tests. Any thoughts on Emily and her seemingly erratic numbers with Lantus and how to proceed would be appreciated! Thank you, all! Mary (and Emily!)
 
Hi Mary, Glipizide isn't a good choice.
We all wish for those quick easy fixes but it really isn't one.
All glipizide will do is postpone the inevitable.

Believe it or not, there are doses that are even smaller than 0.25 u...

It sounds like Emily needs "some" insulin for at least a while ( only she knows how long) to help her pancreas heal and work as it should.
That's the good news, is cats pancreas's can heal with support.
So I want to encourage you to continue with the insulin.

With your travels and skipped shots, she hasn't had consistent help.

The lowest number I saw mentioned ( correct me if I'm wrong) was 60 back when she was on a higher dose.

You want her numbers to ideally be between 50 and 12o ( on a human glucometer) ....

under 200 is regulated.
But always in the ideal range would be remission. Bear in mind that remission is usually temporary as infections or tooth issues or other cropping health issues will bump them back out of remission.

Without continuing her insulin, her numbers will likely increase over time and she will get "sicker" plus the longer she goes without treatment,
she could even develop ketones which would be costly and life threatening.
ketones come with not enough insulin + infection +dehydration

with FD, her body will slowly stop being able to absorb nutrients from her food and she will drink more and more, pee more and more, stop grooming herself, and dandruff/fur will be unhealthy looking.

I would like to encourage you to set up a spreadsheet
and if you need help setting it up, there are some here who can do it for you

I would also like to encourage you to post daily ....
and we will all give you tips on how to do this....
I know it feels overwhelming..... We all have been where you are.....
It's a lot to learn in the beginning but over time it becomes routine and manageable.

A good post is is tight regulation possible with a full time job

click on the blue links to see what some have done.

It may be that you need to start at less than a 1/4 unit....
we have pictures of what that looks like on the syringe....

I'm going to let others chime in.... and check back on you tomorrow.
I hope you will join us daily.....
 
Glipizide makes the pancreas work harder. If your goal is remission at all, don't go there. Here is the section on it in the FDMB FAQ.
If you enter your data in a spreadsheet, we might be able to help you with dosing. The normal progression of doses as people wean off Lantus is 0.5 units to 0.25 units to 0.1 units, and sometimes to a drop after that. The longer you can safely give insulin, the better for pancreatic healing. Sounds like Emily still needs a little insulin support.
 
Rhiannon and Wendy, thank you for your detailed and thoughtful replies! Really, it means a lot. As I have no experience with diabetes in the human OR animal form, this has been a very costly, sometimes frustrating, often worrisome journey. I'm sure I am not telling you something you don't know! I am trying to educate myself so I can first and foremost make the best decisions for Emily, but also not drive ourselves crazy in the process. I do realize it may get a little "hairy" until we get a pattern down or hopefully eventually Emily will be well enough to be off the insulin altogether. I will read up on Glipizide, since I don't even know what is is. Thank you for the link. I was able to dig up Emily's numbers on the all-day test at the vet ... this test was done on June 28, when Emily was receiving .5 units 2x per day Lantus, and was still eating 1/8 cup dry Purina DM 2x per day, as well as low carb wet. At this time we were not home testing. Emily was fed in the morning, (around 7:00 am) and given her .5 unit shot. She arrived at the vet at 8:45 a.m. At 9:00 a.m. she tested at 253. At 11:00 am. she tested at 104, at 1:00 p.m. she tested at 60, at 3:15 pm she tested at 85 and at 5:00 p.m. when we picked her up, she was at 124. At this time, we were told "60" was too low, so to take her off the insulin as the vet didn't feel we could measure less than .5 unit (which I know is not true). I had been unhappy with this vet for a various of reasons, so that is why most recently, I am seeking the advice of a new vet, that makes home visits. I will seriously take into consideration setting up a spreadsheet...just that task seems a bit overwhelming right now...I am not very computer literate (notice there is no photo of Emily. LOL!) and I work two part time jobs AND my husband and I run our own business. I will take a look at how to do that either tonight or tomorrow. I will also read up on the Tight Regulation with a Full Time Job. Again, thank you for the link. I can honestly say, testing Emily mid-day during the week on most days will be virtually impossible because of our jobs and how far away we work. But, I will read the article and will hopefully find some sort of system that will work for us and our schedule, even if it is not "perfect". Finally, once last thing I should mention, as I do not know if it has any bearing on anything. When the vet came to the house on August 11th, she ran all kinds of blood tests as this was the first time she was seeing Emily and wanted a full health assessment. Her T4 thyroid levels came back low (.8). The vet did say this is very unusual. Since the thyroid is part of the endocrine system, could this have any bearing on how Emily is responding to insulin, how much her body may or may not require, the type of insulin she is receiving, etc? I appreciate your thoughts. Mary
 
Hi Mary, and welcome to Lantus & Levemir Land, the nicest place you never wanted to be.

Thanks for adding info to your signature, as that keeps us from all asking you the same questions over and over! One more thing that would be helpful to know is: what meter are you using? It makes a difference in the recommendations we would give you if you are using a pet meter vs a human meter.

We have a member here that is a wiz at setting up spreadsheets, @Marje and Gracie. If you would like her to, she can set yours up when she has time and then we can tell you how to use it if you need guidance. We have people here all over the spectrum on computer literacy, so no worries about asking for help!
 
Hi Tricia, thank you for your thoughts! I am using a human meter. As recommended on these boards, I purchased the ReLion meter from Walmart, along with all of the necessary supplies. It was the most cost effective of anything else I had looked at, so as always, great information from these boards. I do not know what type of meter the vet was using when I was given those numbers from the all day test. I can easily find out (if that helps) because my current pet sitter works at that veterinarian. :) Let me take a look at the spread sheet instructions to see if I can figure it out...if not, I will for sure contact @Marje and Gracie. How sweet that she would offer her time and help! xoxo
 
How sweet that she would offer her time and help!
That's what we do here! :)

Yes, please do ask about the meter the vet used. It likely is a pet meter, which measures slightly differently from a human one. 60 would be low on a pet meter, but perfectly acceptable on a human one.

As far as measuring the tiny doses, you might see about picking up a set of calipers. Many people here use them and it really helps shoot consistently at very small doses.

 
That's what we do here! :)

Yes, please do ask about the meter the vet used. It likely is a pet meter, which measures slightly differently from a human one. 60 would be low on a pet meter, but perfectly acceptable on a human one.

As far as measuring the tiny doses, you might see about picking up a set of calipers. Many people here use them and it really helps shoot consistently at very small doses.
Tricia, can you elaborate on what the calipers are and where I can find them? This seems like it may be something helpful to us, as Emily was getting such a small dose. Thank you!
 
Tricia, can you elaborate on what the calipers are and where I can find them? This seems like it may be something helpful to us, as Emily was getting such a small dose. Thank you!

Some people buy them at Harbor Freight, if you have one near you. You can also get them on Amazon, as well as Home Depot. Here is a post that Marje did on using the calipers. When you get to those tiny doses, accuracy each time is not as important as consistency. Figure out where your dose is and shoot that same amount each time. You've probably already seen the sticky on low doses, but I'll link it here, anyway.
 
Thank you! We have a Harbor Freight close to us, and a Home Depot within walking distance. I will drop by today and pick a pair up.
 
I'd be happy to set up your spreadsheet too...just need a little information from you first and then it takes about 30 seconds

Marje isn't online as much as she used to be since her kitty passed but she's still here offering her help and guidance when she can!
Thank you so much!! You know what, I am going to take you up on your offer, so I can get the ball rolling and hopefully can get Emily on track sooner rather than later. Please let me know what you need from me. I am heading to work shortly and will have limited email access at work, so I may not be able to respond until I get home this evening. THANK YOU, THANK YOU, THANK YOU!!
 
Hi Mary and Emily,
Welcome to L&L Land.

The calipers are a really useful tool for the microdosing, I never used them myself, but I would say that I was able to consistently dose as little as a drop of insulin for a couple of weeks as George approached remission.

This link for the sticky on the small doses is really useful too, gives you an idea of what is possible, if you can't find the calipers
http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

Also FWIW I tried the oral meds (before I joined the board), my vet suggested them at first, when George was first diagnosed his BG was in the low 300's at the vet, by the time I got my human meter and started home testing (after a 10 days) on the tablets he was testing 450-510 at home. I felt like I had wasted time with the tablets, and was happy when he had his bloodwork done and his liver values came back normal.

Look forward to seeing the ss with the numbers you have so far for Emily.
 
Please let me know what you need from me

When you can, send me a Private message....just click on my name and choose "Start Conversation" to send a PM and we'll get you set up!

I'll need an email address that's registered with a Google account (it doesn't need to be a Gmail account, just an email associated with a Google account), the type of meter you're using (human or pet), and if you live in the US or somewhere else
 
Hi Mary & Emily,

Welcome

Micro dosing is very doable and that is what I do with Jones. Look at his spreadsheet! I don't use the calipers as it drove me crazy with my old eyes, but I think my approach is consistent and I think his numbers for the most part say I can get the right dose in.

For Jones - the difference is in the # drops he gets - so I know most vets look at you like you just dropped off the turnip truck when you tell them the dose, but it does work.
 
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