I had a few questions I wanted to ask you

[Teresa & KitKat]

I am currently giving my cat Buddy between 10u to 11u twice a day, the problem I am having and I think I am going to have this problem again tonight, is at time to shoot he does not come up high enough that I am not afraid to give him a Shot. I have already earlier today gave him at least 1/2 can of FF, MC, 13 carbs(what he eats all the time) because I had to leave for a couple hours and I was afraid he would go to low. I had asked Kris & Teasel earlier and she told me to post here, that several of you had experience with Lantus.

 

[Kris & Teasel]

Hi Teresa,

There's a saying for Lantus: "shoot low to stay low". Strangely enough, when you shoot full doses on low PSs (even dark greens) they don't tend to drop as much. The curve stays flatter. Of course, it's scary the first few times but you'll never find out how Buddy responds to this technique without trying it out on a day when you know you can monitor. It's even more daunting when a cat is at a high dose. @StephG has experience with this.

I see a bit of dose fluctuation between 10 and 11 u in response to different PSs (and none are lower than blue). When you do this it messes with the Lantus depot and destabilizes it. That can create a bit of BG wonkiness. You've had some cycles (eg. Dec. 08) with lovely runs of dark green and that's your goal. The guidelines for SLGS (and your vet endocrinologist's) say to hold a dose for a week at least. SLGS also says to reduce the dose any time you get a BG under 90. The reduction can be 0.5 u at the dose level you're at but no more than that. For example, on Dec. 03, your AM dose was 11 u, you had a BG of 70 in the afternoon and you knocked the dose down by 1.5 u to 9.5 u in the evening. SLGS says a dose reduction of 0.5 u was the way to go, so down to 10.5 u.

You can also give a full dose on lower PSs as I said above. For example, on Dec. 05 PM the PS was 108 and you decided on a no shot. You have lots of data on Buddy so you could have shot the same 10.5 u dose as the AM and he might have continued on in nice numbers overnight and into the next morning.

These are just a few examples of things to try. Feel free to ask here - it's extremely busy on the L&L forum. Does this help a bit?

@Yong
@Djamila

 

[Rachel]

Hi Teresa! I have no Lantus experience but just wanted to say it's great to see you! You could definitely post here when you need help...I know the L forum is a bit busy.

 

[Teresa & KitKat]

Hi Teresa,

There's a saying for Lantus: "shoot low to stay low". Strangely enough, when you shoot full doses on low PSs (even dark greens) they don't tend to drop as much. The curve stays flatter. Of course, it's scary the first few times but you'll never find out how Buddy responds to this technique without trying it out on a day when you know you can monitor. It's even more daunting when a cat is at a high dose. @StephG has experience with this.

I see a bit of dose fluctuation between 10 and 11 u in response to different PSs (and none are lower than blue). When you do this it messes with the Lantus depot and destabilizes it. That can create a bit of BG wonkiness. You've had some cycles (eg. Dec. 08) with lovely runs of dark green and that's your goal. The guidelines for SLGS (and your vet endocrinologist's) say to hold a dose for a week at least. SLGS also says to reduce the dose any time you get a BG under 90. The reduction can be 0.5 u at the dose level you're at but no more than that. For example, on Dec. 03, your AM dose was 11 u, you had a BG of 70 in the afternoon and you knocked the dose down by 1.5 u to 9.5 u in the evening. SLGS says a dose reduction of 0.5 u was the way to go, so down to 10.5 u.

You can also give a full dose on lower PSs as I said above. For example, on Dec. 05 PM the PS was 108 and you decided on a no shot. You have lots of data on Buddy so you could have shot the same 10.5 u dose as the AM and he might have continued on in nice numbers overnight and into the next morning.

These are just a few examples of things to try. Feel free to ask here - it's extremely busy on the L&L forum. Does this help a bit?

@Yong
@Djamila

know the saying "shoot low to stay low" but I do not know if I could do that. How low do you think the number should be before you would either shoot a lower number or no shoot. I am going to try to shoot a lower number the next time, which it will not take long to get. If you shoot a lower number dose the BG rise at all or does it get lower. I know that Steph G is at a high dose, but I think between 10u to 11u is a high dose. Yes, this does help. Do you get up at night to check Teasel's BG, when he has been low and you shoot low.

 

[Teresa & KitKat]

Hi Teresa! I have no Lantus experience but just wanted to say it's great to see you! You could definitely post here when you need help...I know the L forum is a bit busy.

Hi Rachel, how are you doing, how are your fur babies.

 

[Jill & Alex (GA)]

Hello ladies! I'm sure everyone has pure and the very best intentions or they wouldn't be here. That said, encouraging any member to post in a forum that is not set up to handle the insulin used ends up being a disservice to the member. Please understand posting in the appropriate insulin support group will be of much more help to our members long term... especially since Buddy has a high dose condition.

The Lantus & Levemir Forum has those who are experienced with Lantus. Many members there have intimate knowledge in treating kitties with high dose conditions. Those using Lantus will be in the best of hands in that forum! The same can be said for those using the P insulins. This is the best insulin specific forum on the FDMB for P users to land in!

Teresa, for your benefit and that of Buddy's please post in the L & L Forum. I know it's busy and can be daunting or intimidating, but no one will bite. I think you'll find the help and level of understanding and expertise invaluable.

If you're not getting the help you need, feel free to PM @Wendy&Neko . She is extremely knowledgeable with kitties with high dose conditions. Ask her to look at your thread to offer advice or suggestions. I'm sure she will help or get help to you.


Everyone, please take this post in the spirit intended. All our members deserve to be pointed in the right direction. It's "why" we have insulin specific support groups set up on the FDMB. Let's all work at helping members become comfortable within those groups.

Thank you!
~ Jill

 

[Marje and Gracie]

Feel free to ask here - it's extremely busy on the L&L forum.

I’m sorry, but I beg to differ. Teresa should be posting on the Lantus/Levemir forum. If she words her subject line as we do there and indicates she needs help, she will get it.

Of course, it is her choice but I find this.....disturbing, to say the least.

 

[Jill & Alex (GA)]

I’m sorry, but I beg to differ. Teresa should be posting on the Lantus/Levemir forum. If she words her subject line as we do there and indicates she needs help, she will get it.

Of course, it is her choice but I find this.....disturbing, to say the least.

Looks like we posted at the same time!
Yes, it is disturbing. I think I've offered a good explanation as to why.

Thank you.

 

[Marje and Gracie]

Looks like we posted at the same time!
Yes, it is disturbing. I think I've offered a good explanation as to why.

Thank you.

Yes....you articulated it much better and more graciously than I did. I was still trying to get over the ...shock, shall I say?

 

[Kris & Teasel]

I'm sorry that I incorrectly recommended something to a member that I have a long history with. I certainly understand the reasons why posting on insulin specific forums is the best way to go. I'm going to go out on a limb here to speak candidly: there is an indisputable wealth of knowledge and experience on the L&L forum but it's very large, very busy and sometimes the advice offered comes across in a tone that the advice givers do not intend. Some members are more sensitive than others to a terse tone. It can make them feel unwilling to post on that forum and I daresay that has probably resulted in some leaving FDMB altogether.

The same communication etiquette should be in place across all forums. We all should choose our words carefully and work hard at optimizing our communication in a medium that can make it difficult. Kindness is always welcome, even when addressing mistakes. Comments that feel abrupt, condescending or abrasive are never welcome.

I'll end by saying that the fact that this issue occurred is a sign that there have been occasional communication difficulties and misunderstandings on the L&L forum. My suggestion to Teresa should not shock or disturb anyone.

 

[Jill & Alex (GA)]

I'll end by saying that the fact that this issue occurred is a sign that there have been occasional communication difficulties and misunderstandings on the L&L forum.

Unfortunately, this happens/has happened on each and every forum... including this one. In many cases, it's the down-side of the written versus spoken word. All we can do is our best... and given that we're all humans... "our best" is different for each and every person.

I certainly understand the reasons why posting on insulin specific forums is the best way to go.

I'm glad we agree.

I'll end by saying, since we agree, how about everyone working together to help acclimate our members to the appropriate forums... where they'll receive the best help the board has to offer?

Let's all become part of the solution!

 

[Marje and Gracie]

Unfortunately, this happens/has happened on each and every forum... including this one. In many cases, it's the down-side of the written versus spoken word. All we can do is our best... and given that we're all humans... "our best" is different for each and every person.

I'm glad we agree.

I'll end by saying, since we agree, how about everyone working together to help acclimate our members to the appropriate forums... where they'll receive the best help the board has to offer?

Let's all become part of the solution!

Excellent. I’m “in”.

 

[StephG]

know the saying "shoot low to stay low" but I do not know if I could do that. How low do you think the number should be before you would either shoot a lower number or no shoot. I am going to try to shoot a lower number the next time, which it will not take long to get. If you shoot a lower number dose the BG rise at all or does it get lower. I know that Steph G is at a high dose, but I think between 10u to 11u is a high dose. Yes, this does help. Do you get up at night to check Teasel's BG, when he has been low and you shoot low.

You have a lot of data, which is great. I follow TR so I've shot as low as 60s before. Chuck almost always goes up after eating so I feel very comfortable shooting low. That said, there are times when he drops earlier than his usual after his shot. Best way to find out how buddy will do is to shoot when you can monitor closely and steer if needed.
There are always the occasional curve ball with Chuck. Like tonight, he got his 16.75 dose on a 170ish (can't remember exact number) preshot and by +4 he was 107. Normally we don't see much movement until +6 to +8. So just be sure you can monitor and steer.

 

[Teresa & KitKat]

I will be glad to post on the L&L forum, but as Kris said we have a long history and I agree with everything she said about the L&L forum. When I first came to FDMB, Kris was the one to help me and she continued to help me as long as she was on the Prozinc forum and so was I. I don't know what Buddy would have done without her and I have known of other members to say the same thing. There was no ill intent meant with this conversation, I just wanted to talk to Kris about Buddy and giving a shot on a low BG, I did not feel that anyone else could help me with this. I have talked to a few people on the L&L forum about this with no success. I have been going around in circles not knowing for sure what needed to be done. One of the motto's of the L&L forum is to shoot low. For some reason it seems that Kris can communicate ideas about the whole spectrum of a diabetic cat, and using insulin to me better than anyone else. I do believe Kris helped me this evening to help Buddy get regulated. I am very sorry that I caused so much trouble or shocked anyone for wanting to ask Kris a few questions.

 

[Kris & Teasel]

I will be glad to post on the L&L forum, but as Kris said we have a long history and I agree with everything she said about the L&L forum. When I first came to FDMB, Kris was the one to help me and she continued to help me as long as she was on the Prozinc forum and so was I. I don't know what Buddy would have done without her and I have known of other members to say the same thing. There was no ill intent meant with this conversation, I just wanted to talk to Kris about Buddy and giving a shot on a low BG, I did not feel that anyone else could help me with this. I have talked to a few people on the L&L forum about this with no success. I have been going around in circles not knowing for sure what needed to be done. One of the motto's of the L&L forum is to shoot low. For some reason it seems that Kris can communicate ideas about the whole spectrum of a diabetic cat, and using insulin to me better than anyone else. I do believe Kris helped me this evening to help Buddy get regulated. I am very sorry that I caused so much trouble or shocked anyone for wanting to ask Kris a few questions.

Thanks, Teresa!

 

[Teresa & KitKat]

Thanks, Teresa!

It is all the truth, you have always helped and I did have a few bad experiences on the other forum.

 

[Jill & Alex (GA)]

I will be glad to post on the L&L forum, but as Kris said we have a long history and I agree with everything she said about the L&L forum. When I first came to FDMB, Kris was the one to help me and she continued to help me as long as she was on the Prozinc forum and so was I. I don't know what Buddy would have done without her and I have known of other members to say the same thing. There was no ill intent meant with this conversation, I just wanted to talk to Kris about Buddy and giving a shot on a low BG, I did not feel that anyone else could help me with this. I have talked to a few people on the L&L forum about this with no success. I have been going around in circles not knowing for sure what needed to be done. One of the motto's of the L&L forum is to shoot low. For some reason it seems that Kris can communicate ideas about the whole spectrum of a diabetic cat, and using insulin to me better than anyone else. I do believe Kris helped me this evening to help Buddy get regulated. I am very sorry that I caused so much trouble or shocked anyone for wanting to ask Kris a few questions.

Teresa, thank you for posting.

As far as I know, Kris/Teasel hasn't lost her posting privileges in the L & L Forum. She can reply to your Lantus questions there as she has here... in a place where her comments, as well as everyone else's replies will be subject to peer review by those who are the most familiar with Lantus and Buddy's medical condition. It's one of the marvelous safeguards we have built into our system. It's for the benefit of each and every member!

Please don't feel like you've caused any trouble. You haven't. As a matter of fact, your post brought the makings of a potential problem out in the open. Now I think others will understand the reasons behind the concern. That's a good thing and I thank you.

Going forward, happy to hear you'll be posting in the appropriate forum. I'm sure Kris and any other friends will not have any trouble finding you over there.

Wishing you the best!
Thank you and goodnight,
~ Jill

 

[Djamila]

Jill- I find your response a bit perplexing. In no small part because I have loved reading the archives of so many of your posts and you have always struck me as one of the wiser people on the board. However, I think the problem this highlights is that the L/L forum is overwhelmingly arrogant, rude and thoughtless in the way they respond to people. Almost without exception in the past year, as we have recommended folks try Lantus when their kitty hasn't responded well to Prozinc, they have posted a few times and then dropped off the board completely after too many ugly responses. I myself had that experience during the time when I was using the L's. My threads were either ignored or met with boiler-plate, terse advice or outright scoldings if I dared to deviate from the laws of L/L.

As you well know because I've read a large number of your posts, the protocols are guidelines that are used as you get to know your cat and his/her individual responses. However, the forum doesn't treat it that way. They are treated as if they came down from heaven on stone tablets and folks over there don't seem to mind bullying or berating anyone who doesn't fall into line.

Theresa came over here seeking to connect with people she knows and trusts. That highlights not a problem here in that we welcome her and anyone else who wants to post, but it highlights a problem over in L/L that people don't feel comfortable seeking counsel in that setting. So perhaps instead of scolding us for being too welcoming, you might want to address the climate issues in the other forum that would make things like this needed in the first place.

 

[Wendy&Neko]

Hi Teresa, good to hear from you. I hope Buddy is otherwise doing well. Nice to see quite a bit of blues and some greens on Buddy's SS.

I agree the L/L forum is the best place to post for Lantus/Lev experience and we have plenty of people going through the "shooting low" conundrum. Another alternative is the high dose forum, though it's a lot more quiet. I do monitor anything posted there. As for L/L, I want to dispell a few myths. First, when I started there, there were more people posting than are now, so it's less busy, though more busy than the P forum. But when I started I was the only person with a high dose cat with IAA posting regularly. So for me, it felt very lonely in that regards. But at least there were people there who knew the insulin and what to expect and could guide me. And now, there are quite a few people with high dose kitties, so we have a lot of shared experiences and knowledge.

On the topic of your original post, cause I want this to be about you and Buddy, I am glad Buddy came up enough you felt comfortable shooting. I see you've shot full dose quite a few times with mid blues. Sometimes it's helpful to think of a "don't shoot full dose below" number for yourself, then gradually lower that number over time and experience. You do an excellent job testing, so you have lots of data. And yes, it scared the heck out of me the first times I was shooting low. But I had some wonderful people holding my hand as I did so.

 

[Marje and Gracie]

I am sad that anyone has felt berated in the L/L forum. I was not around for several months, and since I’ve been back, I haven’t seen any terse comments but I haven’t visited every condo either.

I’ve seen condos with questions that have been unanswered or those condos seem to be “ignored”. I believe the reason is because people aren’t comfortable answering a question because their knowledge base is not there. It would be great if they’d say “this is past my experience level but I’ll help you find someone that might know”. I do see that happening, which is great, but it also happens that the condo goes ignored if there isn’t an experienced person around.

The other reason I feel it is important for you to post in L/L forum or in the high dose forum, Teresa, is because we do need to modify the guidelines for high dose Kitties from time to time. At a certain point, 0.5u increases and reductions are not enough. We handle reduced doses differently, too, because of the size of the depot.

To advise high dose kitties, one must not just understand how the insulin works but how the acromegaly or IAA affects how the insulin might work.

Because I’ve never had a high dose kitty, I’m very careful about advising anyone who does and I’ve been on this board over 7 years. Wendy is definitely my “go to” person if I’m seeing something on a high dose SS that I need a second opinion on. If I had a high dose kitty, I’d be careful that the advice I took was from people who had a thorough knowledge of the action of the insulin, the high dose conditions, how insulin affects them, how they might affect the action of the insulin, and ideally, it would be even better if they had experience with high dosing, acro, IAA.

I also want to assure you that you’ve done nothing wrong. We’d like to see you back in the L/L forum.

 

[Jill & Alex (GA)]

Jill- I find your response a bit perplexing. In no small part because I have loved reading the archives of so many of your posts and you have always struck me as one of the wiser people on the board. However, I think the problem this highlights is that the L/L forum is overwhelmingly arrogant, rude and thoughtless in the way they respond to people.

There's nothing perplexing about my comments. Please read my thoughts in Post #6. I was very clear when I explained the reasons why this was not a good idea. It's not a good practice in any of the insulin support groups for the reasons given. Even Kris admitted she certainly understood the reasons why posting in the appropriate insulin support group was the way to go. This is/was the problem highlighted today.

As far as problems you or others may encounter in the L & L Forum or any forum on the FDMB...
If someone is being (in your words) "overwhelmingly arrogant, rude and thoughtless in the way they respond to people" on a message board, standard procedure is to report the post so it can be dealt with in a timely manner. As far as I know, this procedure has always been in place on the FDMB. It allows for an un-involved/neutral party to take an objective look at the situation and deal with it... or not.

Theresa came over here seeking to connect with people she knows and trusts. That highlights not a problem here in that we welcome her and anyone else who wants to post, but it highlights a problem over in L/L that people don't feel comfortable seeking counsel in that setting.

If there's a problem, report the post! That's how the problem, if there is one, will become "highlighted"!

So perhaps instead of scolding us for being too welcoming, you might want to address the climate issues in the other forum that would make things like this needed in the first place.

Djamila, you were not being scolded in any way shape or form. Even if all of what you're saying is spot on... two wrongs don't make a right. Like I said earlier, let's all become part of the solution!

I believe all the principles have said what they have to say.
On that note, I'm closing the thread before it gets ugly.