Chloe is NOT fine 63 this morning
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Stacy & Asia
Member Since 2017
I wish you were able to get some data on the 3/29 pm cycle. The preshot was blue and Chloe likely went low and bounced, which is why you saw the 456 the next morning. I understand you’re wanting to follow your vets instruction and increase the dose, however, considering you just increased the dose amount by 100% when you haven’t a clue how low the dose is taking Chloe (because both of your curves were done on bounces, so they tell you almost nothing other than she bounces), and assuming your vet advised the increase based on the inaccurate curve data...I would proceed with extreme caution to monitor her on this dose so she doesn’t end up hypo. The dosing strategies we work with here increase in .25 increments and you just skipped 4 steps ahead. I know it seems like such a tiny amount, going from 1 unit to 2 units, but we have to think in cat terms and compared to humans, they are tiny! We are using human insulins on them. Do you think a human doctor would ever increase a human diabetic’s dose by 100%?
I hope you are able to keep Chloe safe this weekend until you see what happens with such a large increase.
I hope you are able to keep Chloe safe this weekend until you see what happens with such a large increase.
Does F1 mean a "fat 1.0u" dose? In other words, were you shooting very close to 2.0u?
One important consideration with dose increases is that you need to know how low a given dose is taking your cat's numbers. Since Lantus dosing is based on the nadir (and NOT the pre-shot numbers), if you don't have information based on tests from where your cat's nadir falls, it's not much different than shooting blind. This is one of the hardest changes that someone who is more familiar with Prozinc dosing has to make. We only look at pre-shot values to insure that it's safe to give insulin. Beyond that, you adjust the dose based on the nadir. It's also why we whine at everyone to get spot checks and/or curves so you know where the Lantus nadir falls.
Are you still feeding Chloe the RC glycobalance? If so, it is extremely high in carbs (approx. 32% for the dry and the ingredients include things like cellulose which is wood fiber and the canned is around 28% carb and contains cellulose and wheat flour).
One important consideration with dose increases is that you need to know how low a given dose is taking your cat's numbers. Since Lantus dosing is based on the nadir (and NOT the pre-shot numbers), if you don't have information based on tests from where your cat's nadir falls, it's not much different than shooting blind. This is one of the hardest changes that someone who is more familiar with Prozinc dosing has to make. We only look at pre-shot values to insure that it's safe to give insulin. Beyond that, you adjust the dose based on the nadir. It's also why we whine at everyone to get spot checks and/or curves so you know where the Lantus nadir falls.
Are you still feeding Chloe the RC glycobalance? If so, it is extremely high in carbs (approx. 32% for the dry and the ingredients include things like cellulose which is wood fiber and the canned is around 28% carb and contains cellulose and wheat flour).
srk4cats
Member Since 2017
Yes, thanks for asking before chewing me out.
srk4cats
Member Since 2017
No. I believe that's what caused the bounce. I thought I had to wait a week before doing curves because I just changed insulins. Also, nobody ever answered my question about whether Prozin and Lantus doses were equivalent. btw, I got plenty of mid-cycles yesterday. That's what my vet and I used to determine the dose increase.
srk4cats
Member Since 2017
did not double. The F1 means a fat 1. Maybe I should have just said 1.5 since the notches are so close together on the syringe.
Stacy & Asia
Member Since 2017
Do you have syringes with half unit markings? It helps with the fine dosing a lot if you get them. These are the ones I use, but you can get some inexpensive ones at Walmart too.
https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes
Fat is typically something in between the half unit markings, for instance, something between 1 unit and 1.25 units. I’m relieved to hear it’s not a full unit increase, but I still would be very cautious as the both the 1 unit and fat 1 unit got her blue preshots and you don’t know what happened after any of those shots, it’s still a 50% increase even if you were shooting 1.5 and in cat terms on a dose as low as she is on, it’s still a lot.
srk4cats
Member Since 2017
Most times, I test her right before I go to bed and don't put in the numbers until the next morning. If you had looked at my SS, you would have seen that Chloe was steady in the 300's all yesterday. I did not double her dose. She was already getting fat ones.
Stacy & Asia
Member Since 2017
I understand, I just didn’t realize your fat 1 was closer to a 1.5, my bad.
I did look at her SS, which is why I am concerned with the blue preshots you’ve had on the prior doses. She was in the 300s yesterday because she was coming down from the high 456 AMPS. Lantus is not good at pulling down high numbers, Prozinc may work that way (I don’t have experience with it), but Lantus was not designed to do that. It was designed as a background insulin for humans to keep them even keel in all the times they are not eating (when they have a meal, they would typically inject a rapid insulin to bring down a food spike). The curve you got with all the pinks is not an accurate representation of how low the dose was taking her. It is a bummer when they bounce on curve day, but it happens. The 456 AMPS could indicate she went low the previous cycle and her body freaked out and she bounced high from that low number. If there is ever a way you can get a curve when you see a low preshot, like those blues, it will tell you a lot more. Even if not a curve, if you set an alarm and got one test in the middle of the cycle after a blue preshot, it would give you a lot of good information.
srk4cats
Member Since 2017
I am using the u-100 syringes I bought when she was first diagnosed. They are Relion 30 gauge 3/10cc with an 8 mm short needle. They are marked in 5 unit increments and there are 2 columns of notches. I believe the ones on the right are full units and the ones on the left are half units. Maybe I'm reading them wrong since those notches are so close together, but the unit markings are very close together.
srk4cats
Member Since 2017
I don't consider 175 low.
Dyana
Member Since 2009
175 is not low, but that is only one test, and at +12 at that. She could have been 110 or 78 or whatever at mid-cycle during the day or the following evening cycle. That is low enough for Chloe to bounce the next cycle.
It's the mid-cycle (nadir) tests that determine dose adjustments. I'm sure you've already heard that, so sorry for repeating.
Stacy & Asia
Member Since 2017
The idea with Lantus is to create seamless, peakless cycles. In reality, that isn’t true for every cat (if it were, the word nadir wouldn’t exist here
) and it typically isn’t true for any cat when just starting on Lantus before you find that magical dose. From the data you’ve gathered thus far, Chloe isn’t flat, she’s bouncy. What the 175, (or any blue preshot at this point) tells you is that if that cycle is an active cycle (as opposed to a bounce), Chloe is likely to go lower than the preshot number. How much lower is not something anyone can predict, that’s why the need for mid cycle tests because they will tell you how much lower. That 56 AMPS on 3/23, she bounced to yellow, red, then black. That’s why the red after the blue preshot on the 29th makes me suspect she went lower overnight. More insulin will not necessarily give you the preshot numbers you are hoping to see, but it will likely lower her nadirs a good bit on a .5 increase. If her lowest point on the fat 1 dose was, say, 75, it could easily be in the 30s on this new dose and that would be scary. She could also do just fine with the large increase, but it’s a risk most aren’t willing to take as if you look at a few other kitties SSs, you will see what a dramatic difference a .25 increase can make, or even less than that for some. You also could easily skip over a good working dose for Chloe and it’s hard to go backwards from that, unfortunately.
Stacy & Asia
Member Since 2017
Those are half unit syringes, you are reading it right, the side with the numbers are the units and the other side are the half units. They are almost impossibly small and close together. Some people here use calipers to measure dose amounts because it’s a little less tricky that way, it’s like holding a ruler up to the insulin line instead of trying to see between the lines on the syringe.
Janine & Floyd (GA)
Member Since 2018
Maybe you've already answered this, but does your vet have access to your spreadsheet and is s/he familiar with the protocol and human glucometer numbers?
I ask because I sure wasn't before going through this with my own cat, and if one of my clients brought me BG numbers like the ones we're shooting for, I wouldn't have known what to do with them. It's a shift in mindset from what we're taught in school.
I’m blessed with a fantastic vet but I’ve come across so many that don’t have your wonderful open mindedness. It’s absolutely refreshing and your patients are so lucky!!!!
Stacy & Asia
Member Since 2017
I completely agree!
I’ll also add that Roberta and I both live in Tucson and I’ve discussed FD with many of the local vets including a feline only board certified IM specialist who, upon looking at Gracie’s SS, told me Gracie was not diabetic. Early on, she wanted me to take her off insulin but the most I would do is decrease the dose for over six cycles and the BG went up into pink and stayed there. This vet also had a diabetic cat that she shot blind.....no testing. This whole attitude seems to be very prevalent in Tucson.
However, I’ve given Roberta the name of the vet/clinic I use so the ball is in her court. This group of vets is so amazing that they actually let me give them a presentation on FD with SSs and they were surprised, like you, at what they saw. It modified their thinking on treatment of FD.
Have you tested her ketones today? If you have problems testing her urine, I have a blood ketone meter that I can get to you since we are both in Tucson. I’d be glad to give it to you but you’ll need to order strips.
Janine & Floyd (GA)
Member Since 2018
Sorry if we're hijacking your thread, Roberta.
You would be hard-pressed in my experience to find a vet who wouldn't shoot blind (just look at the first 10 months of Floyd's SS - all the missing dates mean no testing was done.) It's just not what we're taught. And to follow a TR protocol developed by laypersons (gasp!)? Again, a new mindset. But when you see real results with real people getting cats into remission- hard to argue with that.
Having said that, many clients are simply unable or unwilling to do what it takes for various reasons. The last cat I dx with FD before Floyd was euthanized because the owner just couldn't handle the commitment. So, kudos to Roberta and everyone here trying to learn.
Very very sad but true. I have heard this. I’ve had friends that have been eager to learn until they realized the commitment and then they shoot blind. All we can do is educate.
Although Kirsten Roomp is a Ph.D biophysicist or something along that career field and Jacquie Rand is a veterinarian. But yes, Kirsten is not a vet and she partnered with Jacquie to get the TR protocol published for more credibility. The data is based on layperson collection.
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srk4cats
Member Since 2017
I include the SS link every time I email her. I went through 4 vets before I found her. She is a cats-only vet. I think she is wonderful.
srk4cats
Member Since 2017
That would be great! Do you need any u40 syringes and Prozinc?
Janine & Floyd (GA)
Member Since 2018
Great! I would hate to be making recommendations without that info.
Tricia Cinco(GA) & Harvey
Member Since 2011
I had my cats treated at UC Davis Veterinary Teaching Hospital, and a third year student there told me that they got exactly five hours of training on diabetes, and it covered both cats and dogs! I was horrified, but then I remembered that vets have to learn about hundreds of diseases and conditions in multiple species, so I guess it isn't too surprising. Like Marje, I have encountered many that were not open minded enough to consider anything other than what they learned in school. Luckily, I have a team now that trusts me and works WITH me to keep my kitties safe and healthy.
Roberta, it's wonderful that you love your vet. That relationship is so important. I hope she, like Janine, is open to learning and thinking outside the box. Together, you can get this sugar dance figured out and keep Chloe safe. We aren't vets here (except for Janine), but we have a lot of experience with FD, so please don't take our suggestions as criticism. We only want to help.
srk4cats
Member Since 2017
I had heard of a cat being euthanized after being diagnosed with diabetes. The owner said "she didn't have time" to deal with it. In fact, the vet who diagnosed Chloe asked if I wanted to do that. She also said that they only live 1.5 years after being diagnosed.
Tricia Cinco(GA) & Harvey
Member Since 2011
Cinco almost died from DKA right after diagnosis. He lived another 5 years and his death had nothing to do with FD - his third bout with cancer got him. I'm glad you left that vet.
Janine & Floyd (GA)
Member Since 2018
I have no idea where the 1.5-year figure would have come from. I guess if not being regulated properly, sure.
I have that conversation with every owner of diabetic pets I diagnose. Sounds horrible, I know. I certainly don't recommend it, but I explain in detail the commitment required, and the financial burden involved. If someone does not have the time/money/commitment, sometimes euthanasia is the kindest thing for the pet. I don't want any pet to suffer into DKA because the owner cannot/will not treat, so I will euthanize if there is no other option.
It's hard, but I also don't judge. You never know the extent of someone's personal issues and limitations.
Tricia Cinco(GA) & Harvey
Member Since 2011
Are you familiar with DCIN? They try to find homes for diabetic cats when the owner can't/won't care for them, as well as helping those that can't afford to treat. Perhaps suggesting the owners contact them might help eliminate a few euthanizations.
Olive & Paula
Member Since 2015
One time when I had Smokey at the ER for an ultrasound, the IM asked how much insulin he was getting. I said 1.25 or 1.75 (whatever it was at the time) she said that was impossible you can only give insulin in whole units. I replied I use 1/2 unit syringes and calipers. She said it was to much work to do that. I asked how they treat FD. She said they like to keep cat's glucose in the 300's because it's safe. At that point I just smiled and nodded.
To be fair to vet practices. They can't have every type of syringe out there. It would not be cost effective. The see so little FD on a daily basis to stock the 1/2 u short needle syringes. They would keep a few sizes that they could use for anything.
To be fair to vet practices. They can't have every type of syringe out there. It would not be cost effective. The see so little FD on a daily basis to stock the 1/2 u short needle syringes. They would keep a few sizes that they could use for anything.
Tricia Cinco(GA) & Harvey
Member Since 2011
I would have responded: Not for the kidneys! You were probably smart to just nod and smile.
Janine & Floyd (GA)
Member Since 2018
I guess after having clients balk at the idea of even GIVING insulin twice a day, on a set schedule, you get a little discouraged. Then you have to talk about home testing, diet change, monitoring ketones, periodic visits for blood panels, UA, urine C & S, etc, etc. You never have a chance to get to microdosing. It's easy to fall into a mindset of "good enough".
We special order 3-4 different kinds of syringes for our diabetic owners! All based on what they need for dosing and what the owners prefer for handling. And we're a small practice - so we only have 2 cats and maybe 4 dogs that we're managing (including Floyd)
Janine & Floyd (GA)
Member Since 2018
I have never heard of DCIN - I will keep them in mind. Thanks!!
We have also started working with a fabulous cat rescue recently, so I have a bigger network of "crazy cat ladies" (And I use that term with the utmost respect!)
to work with on rehoming "special needs" kitties.
Olive & Paula
Member Since 2015
My kitty Olive I adopted from Canada in February with DCINs help. It seems finding one in the States is quite difficult. It seems you have be local so they can meet with you. I understand the reasoning but so many are overlooked because rescue/shelter will not allow a long distance adoption, even to an experienced pet owner.
Tricia Cinco(GA) & Harvey
Member Since 2011
Just FYI: Diabetic Cats in Need. Wonderful organization!
Ana & Frosty (GA)
Member Since 2018
So I’ll pitch in only bc I’m a (human) health professional. It IS a lot to take care of a diabetic cat the way that people on here do. Knowing how difficult it is for people to handle their own diabetes, and how few of them check their sugar and are able to adjust their own insulin dose (most adults don’t) I can understand why vets haven’t dived head over heels for our methods yet. A lot of people cannot and will not do this. A lot of people would rather give a steady dose and bring their cat to the vet for a curve every few weeks or whatever. In that case, of COURSE it’s safer for these cats to be in the 300s.Like, duh, the vets know that hypoglycemia = death, and The renal threshold for cats is 250 so if the cat is between 250-300 it’s really not terrible. I personally can’t blame or judge others the way they choose to manage their pets’ (or even their own) chronic disease. It’s a lot of work, overwhelming, time consuming, and we don’t know their situation. Not to mention people’s fears of blood and needles, and what if their cat doesn’t tolerate the testing well? It doesn’t make them a bad pet owner. It doesn’t mean their cats will have bad life quality. But it is important to tailor the treatment to the patient and their situation, otherwise everyone will be miserable, including the cat.
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Jill & Alex (GA)
Member Since 2009
Roberta, good to see you. I'm glad you opened another thread.
For those who are actually offering suggestions/advice to Roberta...
I'd like to bring you up to speed:
For those who are actually offering suggestions/advice to Roberta...
I'd like to bring you up to speed:
- Chloe is a ketone prone kitty.
- She's been in DKA 3 times... the last time being a little over a month ago.
- Chloe was throwing trace ketones yesterday, posted here, but I don't see it recorded on her spreadsheet as of yet.
srk4cats
Member Since 2017
I think Chloe is stablizing on the Lantus. I also want to add that I have 3 additional cats to worry about as well. Fuzma, also a senior, who is afraid of everybody. When she's not in her room, she's hiding on top of the kitchen cabinets or on the heap of clothes on the dryer. I don't blame her because a cat I had who has since passed on tore her to pieces one day. She almost died. My 2 boys are bullies, with Chico being the more dominant. They pick on the girls. This picture is from a few days ago when I accidentally locked Cheddar in the pantry all day when I was at work.
Dyana
Member Since 2009
I'm glad she seems to be stabilizing on Lantus. It's good to see that she didn't zoom up today. Please try to get an extra test or two in tonight's cycle.
Have you tested her for ketones today, yet? Make sure and keep her hydrated, by adding as much water to her food as she will allow.
Have you tested her for ketones today, yet? Make sure and keep her hydrated, by adding as much water to her food as she will allow.
StephG
Member Since 2016
I actually answered this before. I told you normally they switch to Lantus from ProZinc at the same dose. I told you that Chuck switched at almost the same dose, we just decreased to get rid of the partial dose.
I thought switching at the same dose or at 2 units would be safe with monitoring. It's hard to predict for each cat.
I agree with getting a curve or mini curve on a active cycle vs a bounce cycle. I've suggested it before, getting a curve on a cycle starting with a blue preshot.
Ana & Frosty (GA)
Member Since 2018
I definitely understand your stress. I have 2 other cats and a dog in addition to my diabetic one. None of them get along, everyone wants to eat each other’s food, etc. and I’m out of the house 12+ hours every day for work. I’m glad Chloe is improving and that you have you vet available and working with you.
srk4cats
Member Since 2017
My vet originally told me 2u, but on the morning I switched, she started at 78. The few days prior, on Prozinc, I was starting to see consistent blues, but you guys sid I should start the Lantus anyway. Then she began to bounce.
Frosty is beautiful and so are you.I definitely understand your stress. I have 2 other cats and a dog in addition to my diabetic one. None of them get along, everyone wants to eat each other’s food, etc. and I’m out of the house 12+ hours every day for work. I’m glad Chloe is improving and that you have you vet available and working with you.
StephG
Member Since 2016
She bounced regularly on prozinc too. Chuck still bounces on lantus. They're just not as bad as they were on prozinc because he gets longer action lantus.
Getting more tests will only HELP. You can see how low she's going and how long it's lasting.
If you decide to follow tight regulation, you can shoot on lower numbers BUT you MUST get tests so you know what you might see.
The yellow stickies will give you a lot of info. Read them over and over-- then read again. Chuck's been on lantus for a year and I STILL go back to the yellow stickies and read them. There's a lot of info that might not be relevant on this day but when you come to the day you need the info, you'll know where to find it.
For the curves, if you can get a +3 ish test and it's looking like it will be an active cycle-- set alarms to get a +6 and +9. It's only 2 test that you'd have up get up for .
Chuck is a strange case, sinc days he drops at +3 or +4 and other days we don't see any movement until +6. So every day is not the same in this dance.
I like to think of it as, what will Chuck's body throw at me today?! I expect every cycle to be different and accept the challenge to figure out what needs to be done to make future cycles better.
I have another cat and a very attached dog (she's a momma's girl) so I get the frustration of having so much distraction and so much to do.
If you make yourself a schedule and be very careful to follow it-- it will become a routine and cause less stress.
srk4cats
Member Since 2017
I'm still working on my schedule at work. I hate schedules. What's 5 minutes here or there? I'm just surprised that eating can make her jump from the 70's to the 400's in such a short time.
Kris & Teasel
Member Since 2016
Did you immediately do a second test after either/both the green and the red? It's best to do that to make sure it wasn't a wonky reading.
srk4cats
Member Since 2017
No, I was expecting her to be low based on the readings I got in the PM. It was on a downward trend. It may be a bounce from increasing the dose. I'll test again at +3 and +5.
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