New Member - Guidance Appreciated for Lily

[Kris & Lily]

Lily was diagnosed nearly 2 months ago. She is a tiny (5.5 lb) young girl (1.5 years old), with tons of personality! She seemed to be losing weight over the summer despite being hungry and eating all the time. Suddenly she became lethargic prompting a visit to the emergency vet. She had DKA, and after 4 days, she was sent home on 1U Lantus and Purina DM wet. Shortly after that, she went in for several curves, and she tried two Freestyle Libre sensors. Neither one stayed on long even with the additional Gluture adhesive. Based on the curves and Freestyle Libre readings, her dose was gradually increased to 3U. Now I do home testing with the Relion Premier Classic.

I have been reading everything I can find on this website, and it is so helpful. Perhaps I should post to Lantus group, but I'd love for someone to help guide me. I don't know if I should be doing Tight Regulation, or Start Low and Go Slow. How to I determine which is indicated? I am home basically 24/7 due to covid, so I do have a lot of flexibility on timing and testing.

After high numbers for a long time (5-6 weeks) Lily finally started seeing double digits. I'll be honest, it was very scary to see 50's and I skipped some nighttime insulin shots as I was so worried she'd go too low. I have a hypo kit ready if needed. In hindsight, I realize I dropped her too quickly from 3U down to 1U, and I should have stepped her down in 1/2 unit increments. I was just so shocked/surprised at her low numbers, I thought perhaps her pancreas and liver were finally "getting it" and that she would to go into remission quickly. Now her numbers are creeping up. She is ravenously hungry once again, and I really don't know what dose I should be giving her.

I'm not the most tech savvy, so I hope I did the signature and spreadsheet correctly. Please let me know if you can/cannot see the spreadsheet and if you have any guidance specifically for me. I have learned so much from this site already, but I know I still have tons more to learn. Thanks so much for this website and forum!
Kristy (& Lily)

 

[Vyktors Mum]

You’ve done an excellent job getting set up with your signature and I can see Lily’s spreadsheet I recommend TR as it will give Lily the best chance of remission. You will probably want to be posting a daily thread in the Lantus forum at least while you’re getting the hang of it so the people experienced with that protocol can keep an eye on Lily and help you out.

As a general rule we adjust doses in increments of .25U and adjustments are based on the nadir (lowest number in the cycle) with very little consideration given to the preshot numbers.

I have some concerns for Lily as you have caught her with some pretty low numbers that really needed some follow up to make sure she was safe. I see a note in your spreadsheet today saying that Lily is acting starving again all the time. Are you aware that a cat whose blood glucose is too low will often be ravenously hungry? It’s not just being in consistently high numbers that do that and since she is no longer in consistently high numbers I suspect she has been going too low. The yellow and blue numbers you’ve seen today also seem likely to have been caused by her getting too low. The liver reacts to the danger (sometimes perceived but in this case I think real) by releasing stored sugars to save the kitty.

I would not have put her dose back up to 1.5U tonight. Based on what I can see there I’m not even sure that 1U might not still be a bit much - it’s hard to tell because of the way the depot works. Lantus is a depot rather than an in and out insulin so the cycle that you have now can be affected by what you shot in the last 4-6 cycles not just what you shot this time. So that 53 she got today was almost all 1U depot with perhaps one shot of 2.5U also having some influence and you don’t know if that’s the lowest that she went.

You are shooting some very low numbers - which is a great hurdle to have overcome for TR but I don’t think you’re quite ready to be doing that yet, you definitely need some help with how to manage low numbers (start by reading the ‘sticky’ (a thread stuck at the top of a forum) in the lantus forum) and you also need help with dosing - I think the lantus forum is the place for you and Lily and encourage you to post there

And also, welcome

 

[jt and trouble (GA)]

Welcome to FDMB Kris and Lily Wow WELL DONE! You're already on your way here. I hope you see this, since I see you are moving to the Lantus forum.

I just would like to say,
WELCOME TO OUR FAMILY

You have landed in a safe place for Lily and we all look forward to getting to know you both!

As you may have already ascertained...This is the bast darn site on this planet to learn everything you need to know about feline diabetes and beyond.
We love questions so ask away!
jeanne

 

[Kris & Lily]

You’ve done an excellent job getting set up with your signature and I can see Lily’s spreadsheet I recommend TR as it will give Lily the best chance of remission. You will probably want to be posting a daily thread in the Lantus forum at least while you’re getting the hang of it so the people experienced with that protocol can keep an eye on Lily and help you out.

As a general rule we adjust doses in increments of .25U and adjustments are based on the nadir (lowest number in the cycle) with very little consideration given to the preshot numbers.

I have some concerns for Lily as you have caught her with some pretty low numbers that really needed some follow up to make sure she was safe. I see a note in your spreadsheet today saying that Lily is acting starving again all the time. Are you aware that a cat whose blood glucose is too low will often be ravenously hungry? It’s not just being in consistently high numbers that do that and since she is no longer in consistently high numbers I suspect she has been going too low. The yellow and blue numbers you’ve seen today also seem likely to have been caused by her getting too low. The liver reacts to the danger (sometimes perceived but in this case I think real) by releasing stored sugars to save the kitty.

I would not have put her dose back up to 1.5U tonight. Based on what I can see there I’m not even sure that 1U might not still be a bit much - it’s hard to tell because of the way the depot works. Lantus is a depot rather than an in and out insulin so the cycle that you have now can be affected by what you shot in the last 4-6 cycles not just what you shot this time. So that 53 she got today was almost all 1U depot with perhaps one shot of 2.5U also having some influence and you don’t know if that’s the lowest that she went.

You are shooting some very low numbers - which is a great hurdle to have overcome for TR but I don’t think you’re quite ready to be doing that yet, you definitely need some help with how to manage low numbers (start by reading the ‘sticky’ (a thread stuck at the top of a forum) in the lantus forum) and you also need help with dosing - I think the lantus forum is the place for you and Lily and encourage you to post there

And also, welcome

Thank you for the reply. I will take all of your advice!
I was/am fearful of giving any insulin when numbers are low, but I keep remembering ‘shoot low to stay low’ and ‘you’re not shooting the preshot number, but the number it will be in a few hours’ thus I give insulin even when I’m scared to do it. She eats as she gets gets her insulin, so I know she will go up with food and thus needs some insulin, I just need to hone in on how much. I’ve seen weeks of high, high numbers, so it seemed to make sense that she needed more insulin. Then bam, low numbers just appeared.

I have read some threads and stickies on the depot and how the liver can release glucose (sometimes causing bounce), it’s just a lot of info to take in, connect together, and apply. I can see how much knowledge and experience is on this forum, so I know this is where I’ll find the best help.
Thanks again for the reply, I will post on Lantus.