Sissy's next curve and possible dose increase question

[Mandy S]

So we've been at the 1.25 dose for 7 days today. Do I curve today or tomorrow? I feel like I have been as consistent with that dose as I can be, but I know she probably didn't get the same exact amount each time. When I do her curve , I know I base any adjustments on the nadir and following the SLGS protocol on the Lantus board. Then, if it changes, do I start that dose in the PM cycle the night of the curve or wait till the next morning? I'm really hoping we can move to a number with a line. I don't like the .25 at all.

I've noticed that ever since Sissy got sick a few months ago, that she licks her lips a lot. She was doing it so much then...but she still does it. She doesn't have any other symptoms of being nauseous. She's eating fine and acting normal. She'll be all snuggled down on me wherever we're at and then I can tell when she is going to move because her body kind of becomes alert and she licks her lips, then she jumps up and goes away. It's like something hits her all of a sudden. This has been going on about 4 months now...but in the first couple it went along with the vomiting and not eating and all her issues...this lip licking just hasn't gone away.

Something weird about Sissy...she has been a happy drooler all her life. We'd keep a little towel and when she snuggled we'd put it under he head because she just drooled so much. I realized a few months ago that she doesn't drool anymore. And I'm not sure when it stopped. But for 13 years the cat drooled and would soak your shirt while she made biscuits...and now none. I am not complaining! But it just seems so strange.

 

[jt and trouble (GA)]

Something weird about Sissy...she has been a happy drooler all her life. We'd keep a little towel and when she snuggled we'd put it under he head because she just drooled so much. I realized a few months ago that she doesn't drool anymore. And I'm not sure when it stopped. But for 13 years the cat drooled and would soak your shirt while she made biscuits...and now none. I am not complaining! But it just seems so strange.

Wow that is strange hopefully someone here will have an answer. Zoe is a drooler I sometimes call her Fido. It will be interesting to hear replies on this part of your post.
Sorry I cant give dosing advice. (BUT I think holding a dose for 7 days should be an action move. ) Dont go by me though .

 

[Critter Mom]

Hey Mandy!

I feel like I have been as consistent with that dose as I can be, but I know she probably didn't get the same exact amount each time. [...] I'm really hoping we can move to a number with a line. I don't like the .25 at all.

Even if your dose measurement were to be 100% iron-clad guaranteed nanometre accurate, there would still be variations in Sissy's response in each cycle. For example, some doses are absorbed better than others. Another variable might be Sissy's acitivity levels on different days and at different times.

Mandy, you are doing famously with Sissy. I've known members here who would give their eye teeth for their cats have such a good response to their Lantus. All is good, and long may it continue that way. (Anti-jinx! I'm fierce superstitious. )

I know I base any adjustments on the nadir and following the SLGS protocol on the Lantus board. Then, if it changes, do I start that dose in the PM cycle the night of the curve or wait till the next morning?

If I needed to increase a dose I would always do it on the morning cycle for all the completely obvious reasons.

Something weird about Sissy...she has been a happy drooler all her life. We'd keep a little towel and when she snuggled we'd put it under he head because she just drooled so much. I realized a few months ago that she doesn't drool anymore. And I'm not sure when it stopped. But for 13 years the cat drooled and would soak your shirt while she made biscuits...and now none. I am not complaining! But it just seems so strange.

I wonder whether that might come back when Sissy's better regulated. As Saoirse's insulin treatment progressed I could actually tell without testing when she was in really good numbers because the consistency of her saliva changed (thickened slightly).

On the lip licking, is there any link between when she displays the behaviour and how long ago Sissy had the previous meal? Does she look for food or water shortly afterwards?


Mogs
.

 

[Mandy S]

Hey Mandy!


Even if your dose measurement were to 100% iron-clad guaranteed nanometre accurate, there would still be variations in Sissy's response in each cycle. For example, some doses are absorbed better than others. Another variable might be Sissy's acitivity levels on different days and at different times.

Mandy, you are doing famously with Sissy. I've known members here who would give their eye teeth for their cats have such a good response to their Lantus. All is good, and long may it continue that way. (Anti-jinx! I'm fierce superstitious. )


If I needed to increase a dose I would always do it on the morning cycle for all the completely obvious reasons.


I wonder whether that might come back when Sissy's better regulated. As Saoirse's insulin progressed I could actually tell when she was in really good numbers because the consistency of her saliva changed (thickened slightly).

On the lip licking, is there any link between when she displays the behaviour and how long ago Sissy had the previous meal? Does she look for food or water shortly afterwards?


Mogs
.

I feel like I'm bumbling along and and we're lucky Sissy is having a good response. lol She is SO good. So sweet. So trusting. My husband came home from work this afternoon right as I was getting ready to get a +6 and he said he wanted to try. He's been wanting to learn how to do it. So he tried unsuccessfully a few times to get blood, but finally got it done...but the whole time she just sat there in his lap and let him do it. She deserves all the credit.
I was looking over her sheet and it looks like if her curve goes similar we'll be on this 1.25 for another week at least...*sigh.

That is really interesting about Saoirse's saliva. I wonder if Sissy will go back to happy drooling. I'll be honest and say I hope not. lol

The lip licking seems to go on all the time and I am not sure if it's tied to anything else. I'll start paying more attention to see where she goes when she takes off. she usually almost startles...licks her lips then jumps up like she has some place to go.

 

[Critter Mom]

Gold star for the hubby! Team Sissy is building up very nicely.


Mogs
.

 

[Chris & China (GA)]

I don't know why you're doing SLGS other than maybe it just sounds safer to you. You test more than enough to do TR which would allow you to do dose increases more often if needed which would give her the best chance at remission

It does look like she needs a little more juice....the 1.25 dose is only getting her into blues so I'd go up to 1.5 tomorrow morning if she doesn't do something strange tonight.

 

[Mandy S]

I don't know why you're doing SLGS other than maybe it just sounds safer to you. You test more than enough to do TR which would allow you to do dose increases more often if needed which would give her the best chance at remission

It does look like she needs a little more juice....the 1.25 dose is only getting her into blues so I'd go up to 1.5 tomorrow morning if she doesn't do something strange tonight.

I chose the SLGS because it did seem less scary. Our schedule right now is different than it usually is and we're home more...because of the pandemic. It will likely be like this for a long time, but idk. I'll look over the TR again. I haven't looked at it since we first started and I feel more comfortable now, so won't hurt to double back.

 

[Mandy S]

It does look like she needs a little more juice....the 1.25 dose is only getting her into blues so I'd go up to 1.5 tomorrow morning if she doesn't do something strange tonight.

I'm going to continue testing every couple hours tonight...she just had her lowest number since we started at 103...so very close to that green. I just pulled up the TR info. It does seem more complicated and what about the days that we aren't able to be here to test all day? Can we still do that? There aren't many days, but I do help with my great grandmother some, so at times wouldn't be here.

I've been trying to get her on a more consistent feeding schedule. She's used to free feeding pretty much all day. I've been feeding her every 3/4 hours right now. I want to get another timer feeder so I can be really consistent. I'm trying to figure out the amount she needs to get her to the next feeding without her acting like she's dying. If she wants food and it's not there she'll graze for dog hair or whatever. I sweep, but we have 2 Australian Cattle dogs and wood floors...so there is always hair to be found. She makes us crazy trying to keep it up, but it's impossible.

 

[Critter Mom]

I'm going to continue testing every couple hours tonight...she just had her lowest number since we started at 103... so very close to that green.

With a +10 and a PMPS that's your full curve done, Mandy.

what about the days that we aren't able to be here to test all day? Can we still do that? There aren't many days, but I do help with my great grandmother some, so at times wouldn't be here.

The minimum recommended in the published TR study is three tests per day: AMPS, PMPS and at least one mid-cycle test (either AM or PM), ideally around the time when nadir is expected. IIRC I think the average number of tests per day carried out by the participants in the study was five.

Some people test a lot more but this is a choice, not a requirement of the protocol.

Whichever protocol a caregiver chooses as a guide to treatment, it has to be something that keeps the cat safe but it also has to be one that is manageable for the caregiver, and one that the caregiver feels comfortable with. As an example, I based Saoirse's Lantus treatment on the TR protocol but I didn't follow it to the letter because it didn't suit our specific circumstances. My own health problems had to be factored into the treatment approach. Specifically I have major chronic fatigue problems. There were times when I would not give Saoirse insulin at all because I couldn't guarantee staying conscious to monitor her if she were to run low.


Mogs
.

 

[Mandy S]

With a +10 and a PMPS that's your full curve done, Mandy.



The minimum recommended in the published TR study is a minimum three tests per day: AMPS, PMPS and at least one mid-cycle test (either AM or PM), ideally around the time when nadir is expected. IIRC I think the average number of tests per day carried out by the participants in the study was five.

Some people test a lot more but this is a choice, not a requirement of the protocol.

Whichever protocol a caregiver chooses as a guide to treatment, it has to be something that keeps the cat safe but it also has to be one that is manageable for the caregiver, and one that the caregiver feels comfortable with. As an example, I based Saoirse's Lantus treatment on the TR protocol but I didn't follow it to the letter because it didn't suit our specific circumstances. My own health problems had to be factored into the treatment approach. Specifically I have major chronic fatigue problems. There were times when I would not give Saoirse insulin at all because I couldn't guarantee staying conscious to monitor her if she were to run low.


Mogs
.

Yeah, I figured just go ahead and finish out the curve since I had gotten almost all of it already. And I'm home the entire day...so might as well.
Nine days ago when we did her first curve by the end of the day she was a grump and fighting me...what a difference a week made. I'm so glad she takes it so well now. Makes it so much easier.

I feel like the TR method would benefit her, and I know it is the better shot for remission, but it seems more stressful/confusing. But I'll read over it some more and try to get familiar with it. My anxiety holds me back some each time there is something new or a change, so I just need to get more comfortable with it that's all. Plus it seems more likely she'll go way low and it scares me. I see stories of people coming home and finding their babies unresponsive and shooting lower numbers feels terrifying to me right now. :/ I know it could happen no matter the method...just my nerves speaking.

Her numbers have stayed more stable today. I wonder if it's because I've been more careful about a feeding schedule...or it's just a lucky day. Either way, I'm glad to see it.

 

[Chris & China (GA)]

I feel like the TR method would benefit her, and I know it is the better shot for remission, but it seems more stressful/confusing.

You might want to take a look at the "Is TR possible with a full time job" thread. There are some good ideas there! If you have auto-feeders, that's even better!

 

[Critter Mom]

I feel like the TR method would benefit her, and I know it is the better shot for remission,

The Roomp-Rand study reports higher remission rates in newly-diagnosed cats who commence treatment following TR using Lantus or Levemir within 6 months of Dx.

The RVC has also fairly recently run a study comparing remission rates for Lantus (depot insulin) and Prozinc (long-acting, in-out insulin). The RVC study observed comparable remission rates for the two insulins. (I don't know details of the dosing protocol(s) they used.)

TR may perhaps increase the chance of remission, but it is not the only way for a cat to achieve remission. We have had cats here who achieved remission on Caninsulin/Vetsulin and Novolin, neither of which is really that well suited to treatment of feline diabetes. ECID.


Mogs
.

 

[Mandy S]

Well, just finished her curve and this was the first time a PS was below 200. Barely, but there. I gave her the 1.25...and didn't even realize it was below 200 til I came to put in her chart. Two weeks ago I would have freaked out. lol Progress....

Do you think that timing her food out better today made a difference?

 

[AliceR]

I've known members here who would give their eye teeth for their cats have such a good response to their Lantus.

Right here! Eye teeth. Take both! Those are amazing blues!

 

[Diane Tyler's Mom GA]

Nice PMPS tonight for Sissy, try feeding her the same way you did today and see if that made the difference. She's looking really good. She is a cutie pie.

 

[Mandy S]

@Chris & China (GA) , You said last night that today you would up Sissy's dose to 1.5. Is that based on TR? Because for SLGS I would stay the same, right?

Just trying to see the differences.

I am reading the TR information on increasing a dose...I'm going to do it I think. We shoot at 10am.

Sissy didn't eat very well in the night, which is unusual. She usually finishes most of what is set out for her, but last night only about 1/3 of it. But when I tested her at +11 she was 292...so kind of on track where she has been. She's also meowing and carrying on like she's hungry...idk why she didn't eat. Silly cat.

 

[Critter Mom]

Hi Mandy.

Attached below is the Roomp-Rand TR study.

I agreed with our vet that I would use the protocol laid out in that document at Tables 2 and 3. In the early stages of Saoirse's Lantus treatment, I (mostly) followed their dosing method as laid out in table 3 of the attached document. (Later on in Saoirse's treatment when I had more experience and Saoirse was much better regulated I need to use a custom dosing method tailored to our our particular circumstances, but when necessary I would refer back to the R-R rules to inform my dosing decisions.

Even if you choose to follow some of the more aggressive modified TR methods used by some members here, the tables in the published study give a fairly helpful bird's eye view of the principles of TR dose adjustment and how the protocol is intended to work.


Mogs
.

 

[Critter Mom]

I'd need to reread SLGS to get a refresher as to all of the differences between it and TR, but one of the key differences is that the lower nadir BG limit where dose reductions are earned is 90 rather than 50 (human meter, mg/dL). IIRC, while there may be variations in how long a dose is held under TR depending on the status of an individual cat, IIRC this is the general gist of what regulation using Lantus SLGS looks like for most cats:

* Hold current dose for a week UNLESS a dose reduction is earned during that time.
* Get AMPS, PMPS and mid-cycle BG tests each day.
* On Day 7, run a curve and review the results in conjunction with the rest of the data gathered during the week.
* Make any necessary dose adjustment based on the criteria laid out in the Lantus SLGS protocol.

Rinse 'n' repeat.

Note: if a dose reduction is earned, the clock then gets reset to Day 1.

Please refer to the actual SLGS sticky for full details. As mentioned above, I'm a bit rusty.


Mogs
.

 

[Mandy S]

Hi Mandy.

Attached below is the Roomp-Rand TR study.

I agreed with our vet that I would use the protocol laid out in that document at Table 3. In the early stages of Saoirse's Lantus treatment, I (mostly) followed their dosing method as laid out in table 3 of the attached document. (Later on in Saoirse's treatment when I had more experience and Saoirse was much better regulated I need to use a custom dosing method tailored to our our particular circumstances, but when necessary I would refer back to the R-R rules to inform my dosing decisions.

Even if you choose to follow some of the more aggressive modified TR methods used by some members here, the tables in the published study give a fairly helpful bird's eye view of the principles of TR dose adjustment and how the protocol is intended to work.


Mogs
.

Thanks for all the info! I appreciate it...although I'm going to be honest...it's still confusing and I need to study it more before I will get it. I at least have 3 days at this dose for TR though, right? I upped her dose this morning as @Chris & China (GA) suggested. I think she's done pretty well today. I'm nervous about tonight though. I hope I can stay awake or hear the alarm to get up and test her in the night just to be sure. I tested her quite a bit today because I wanted to know how she reacted to the dose change. We saw green once today for the first time! That was exciting.
Sissy is so funny. I told you how she comes and gets in my lap when it's testing time, now she's taken to purring and pushing her little sweet face against my hand while I try to load the lancet and get her stuff ready. She settles in and after it's done and she gets her treat, she'll just settle on down and purr like she's perfectly happy. I have to make her move when I need to get up. She melts my heart. lol

 

[jt and trouble (GA)]

Thanks for all the info! I appreciate it...although I'm going to be honest...it's still confusing and I need to study it more before I will get it.

Oh good lord! I dont think I EVER "got it" lol you're doing fine.

I must admit I'm a little bit jealous of Sissy and her testing. Trouble absolutely hated testing, fought us every test. Oh, after he was a big mush but during he was a different cat. Lil stinker

 

[Mandy S]

Oh good lord! I dont think I EVER "got it" lol you're doing fine.

I must admit I'm a little bit jealous of Sissy and her testing. Trouble absolutely hated testing, fought us every test. Oh, after he was a big mush but during he was a different cat. Lil stinker

Honestly I don't think I will get it either, but trying to be positive! ha...it's so freaking confusing! lol

I am really SHOCKED about Sissy. I totally was expecting her to be one of those cats that just fights it every step of the way. She has such an attitude...and while she looks sweet in her pics and she IS very sweet and lovey...she has a total RBF and looks like she totally thinks you're an idiot half the time. lol She can have the sweetest looks...but RBF for real. We have 2 Australian Cattle dogs...they are pretty rowdy at times. Today they were playing and one of them got too rough and the other yelped and told the other one what for...and Sissy heard it and she came RUNNING out of the bedroom, runs up to the dogs hissing and slapping and they scatter. They hide from her. Every time she does this, which is often because the dogs are nutso sometimes, I laugh so hard, she is SO sassy and she RULES the roost!
I wish I could get it on video. After the dogs scatter she just struts off like..ha...dumb dogs.
Picture of Sissy and the dogs she rules. lol they're on my lap. She gets between me and them. lol

 

[jt and trouble (GA)]

Hee hee heee she looks like shes thinking you idiots!

 

[Critter Mom]

RBF

Learned something new today!


Mogs
.

 

[Mandy S]

Learned something new today!


Mogs
.

LOL

 

[Critter Mom]

We saw green once today for the first time!

First visit to the lawn. Fingers and paws crossed Sissy'll soon be there long enough to have a picnic.


Mogs
.

 

[Critter Mom]

I told you how she comes and gets in my lap when it's testing time, now she's taken to purring and pushing her little sweet face against my hand while I try to load the lancet and get her stuff ready. She settles in and after it's done and she gets her treat, she'll just settle on down and purr like she's perfectly happy. I have to make her move when I need to get up. She melts my heart.

I am really SHOCKED about Sissy. I totally was expecting her to be one of those cats that just fights it every step of the way.

Cats are smart. She has worked out that what you're doing is making her feel much better.

she is SO sassy and she RULES the roost!

That's the natural order of things.

Great picture.


Mogs
.