3/2, Susie, Elevated ALT Blood Test. AMPS 277, +2 296, +4 220, +6.50 216 FIRST DAY

Summer and Susie (GA)

Summer and Susie (GA)

Member Since 2020
Last edited:
Hi, welcome to the Lantus forum. :)

It will take the Lantus depot a week to fill, so you hold the dose of 1U for a week. Have you decided on which of the dosing protocols you would like to follow?

A couple of small housekeeping issues:
(a) Your signature still says Vetsulin. Could you change that to something like "Previously Vetsulin, Lantus since 03/02/21"?
(b) If you could insert a row above today's date on your SS and say "Switching to Lantus" in a large, bold font, that would help us easily identify when the switch was made. I can help you with this if you'd like.

Linking your previous thread here:
https://www.felinediabetes.com/FDMB...transitioning-from-vetsulin-to-lantus.243640/
 
Good morning Summer and Susie - it is great you have started Lantus, and as I said before, Susie is adorable. She is 100% "heart kitty":cat:

At the end of this first week on Lantus, you will have a full 1 unit depot, and know your next step. Unless of course you see lower numbers than you like. I hope Susie responds well to her new insulin:)
 
Bandit's Mom said:
Hi, welcome to the Lantus forum. :)

It will take the Lantus depot a week to fill, so you hold the dose of 1U for a week. Have you decided on which of the dosing protocols you would like to follow?

A couple of small housekeeping issues:
(a) Your signature still says Vetsulin. Could you change that to something like "Previously Vetsulin, Lantus since 03/02/21"?
(b) If you could insert a row above today's date on your SS and say "Switching to Lantus" in a large, bold font, that would help us easily identify when the switch was made. I can help you with this if you'd like.

Linking your previous thread here:
https://www.felinediabetes.com/FDMB...transitioning-from-vetsulin-to-lantus.243640/
Click to expand...
I updated my signature. I asked @Marje and Gracie to update my spreadsheet with the row showing my switch. I think she will be doing it sometime soon. If not, I will come back to you. I forgot to link the previous thread. Will try to remember in the future. Thanks.
 
Hercule's mum said:
Good Luck, I have seen the switch to Lantus do amazing things for some cats, let's hope it works out for Susie!
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Thanks, Karen!
Bandit's Mom said:
Hi, welcome to the Lantus forum. :)

It will take the Lantus depot a week to fill, so you hold the dose of 1U for a week. Have you decided on which of the dosing protocols you would like to follow?

A couple of small housekeeping issues:
(a) Your signature still says Vetsulin. Could you change that to something like "Previously Vetsulin, Lantus since 03/02/21"?
(b) If you could insert a row above today's date on your SS and say "Switching to Lantus" in a large, bold font, that would help us easily identify when the switch was made. I can help you with this if you'd like.

Linking your previous thread here:
https://www.felinediabetes.com/FDMB...transitioning-from-vetsulin-to-lantus.243640/
Click to expand...
I think I am going to use SLGS as my dosing protocol.
 
Hi there and congrats on the first day of Lantus.

Summer and Susie said:
The group said go with 1.25 U. My vet said start at 1 U which I did. I will continue to monitor her BG but will I need to wait 5 -7 days to increase the dose if she is getting higher numbers?
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ON TR
Yes you would usually need to hold the initial dose 5 to 7 days, you will let the numbers be your guide.
But I would re assess at 6 cycles, the numbers are always your guide, in TR there is also the provision to take up sooner if kitty is experiencing high flat curves
General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
In Susies case we have some history of insulin reaction, so if for instance, she stays in yellows and no blues, you could change the dose after 5 days, because we already know we were being more conservative with the initial lantus dose.


On SLGS, however, there are no such provisions, you would have to wait the full week, no matter what the numbers said.

See where the numbers take you, and how comfortable you feel with the dosing.
 
Gill & George said:
Hi there and congrats on the first day of Lantus.


ON TR
Yes you would usually need to hold the initial dose 5 to 7 days, you will let the numbers be your guide.
But I would re assess at 6 cycles, the numbers are always your guide, in TR there is also the provision to take up sooner if kitty is experiencing high flat curves
General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
In Susies case we have some history of insulin reaction, so if for instance, she stays in yellows and no blues, you could change the dose after 5 days, because we already know we were being more conservative with the initial lantus dose.


On SLGS, however, there are no such provisions, you would have to wait the full week, no matter what the numbers said.

See where the numbers take you, and how comfortable you feel with the dosing.
Click to expand...
Thanks, Gill. I'm a little confused though. You said I could re asses after 6 cycles (unless a reduction is called for) but then stated I could change the dose after 5 days. I guess we should just watch her numbers to see what they do over the next several days.
 
Hercule's mum said:
Good Luck, I have seen the switch to Lantus do amazing things for some cats, let's hope it works out for Susie!
Click to expand...
I was just looking at Hercule's spreadsheet. When do you sleep? How can you test so much during the day and night and also get sleep. Do you have someone helping you? I have seen several spreadsheets like this and it boggles my mind. For me, unless my kitty were in low numbers, I would want to sleep at night.
 
Summer and Susie said:
Thanks, Gill. I'm a little confused though. You said I could re asses after 6 cycles (unless a reduction is called for) but then stated I could change the dose after 5 days. I guess we should just watch her numbers to see what they do over the next several days.
Click to expand...
All of those those options, it's data dependent.
. If she was in the pinks and reds we could take her up (on TR) after 6 cycles (though I don't think that is located Kelly to be the case)
After 5 days (10cycles) if she hadn't seen blue, it may be appropriate to take her up.
If she sees blue you would perhaps hold the full week.(14 cycles)

It's all in the numbers, :) (those are all TR options if you decide to go that route)
 
I do not have anyone helping, and I am a bit low on the sleepmeter, I must confess. I keep hoping he will hit some stable pattern at some point and I will be able to get some sleep. the reason why I keep waking up is because there is no numbers at th moment that are very predictable, but he is a bouncy cat. Others are much more predictable!
Also, I guess I have been pushing for him to be as much on the green as possible, and i like to think that as a result his dose has reduced a lot. But with that "agressive" approach comes the responsability of keeping an eye, because it can be quite a fine line between low and too low.... But you can decide to keep your kitty running a bit higher, or she might turn out to have the smile cycles as the majority does! Fingers crossed!
 
Gill & George said:
All of those those options, it's data dependent.
. If she was in the pinks and reds we could take her up (on TR) after 6 cycles (though I don't think that is located Kelly to be the case)
After 5 days (10cycles) if she hadn't seen blue, it may be appropriate to take her up.
If she sees blue you would perhaps hold the full week.(14 cycles)

It's all in the numbers, :) (those are all TR options if you decide to go that route)
Click to expand...
Sounds like Tight Regulation is a more flexible way to go even though the name would imply otherwise. I'll have to look at the differences again and, as Marje says, be patient. Thanks!
 
I just got a call from the vet. Susie's ALT blood test was very high. A problem with her liver. She is going back in on Thursday to get an ultrasound. Folks, please say a prayer for this kitty. My last two rescues, including Susie, have had serious medical problems. Lost a cat to CKD two years ago and I can't go through this again. I'll keep you all informed.

Alanine aminotansferase (ALT): This test may determine active liver damage, but does not indicate the cause.
 
tiffmaxee said:
Max had chronic pancreatitis and when it was active his ALT would go up. That alone does not necessarily mean anything unless double the high normal. What was it?
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I think my vet said it was in the 500's. I was/am in a state of shock. I asked him to email me the complete blood/urinalysis test. I have not received it yet. Will let you know when I receive it. Thank you.
 
tiffmaxee said:
My vet also never bases anything on one lab test. You can post the results here if you like or enter them on her ss. Does she act sick? :bighug::bighug::bighug:
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She doesn't act sick but she acts lethargic. As soon as I get the results I will post them here if I can. I don't know how to post on my spreadsheet.
 
Hugs Susie :bighug: Any news like this is always very scary, especially when it's unknown what is going on.

Fortune had high AST back in 11/2016, and was diagnosed with cholangeohepatitis after an ultrasound. He was put on ursodiol - which originally came on the market as a supplement but has such great efficacy it is now used clinically - and we have had normal blood work since. We wound up never doing a biopsy until he had renal cancer, and the liver was biopsed to check for metastasis - that was 4.5 years later, and the liver was normal!

Just to say, there is hope. :bighug::bighug:
 
RachelG said:
Hugs Susie :bighug: Any news like this is always very scary, especially when it's unknown what is going on.

Fortune had high AST back in 11/2016, and was diagnosed with cholangeohepatitis after an ultrasound. He was put on ursodiol - which originally came on the market as a supplement but has such great efficacy it is now used clinically - and we have had normal blood work since. We wound up never doing a biopsy until he had renal cancer, and the liver was biopsed to check for metastasis - that was 4.5 years later, and the liver was normal!

Just to say, there is hope. :bighug::bighug:
Click to expand...
Thank you, Rachel. Those are encouraging words. I guess I am a "glass half empty" person. Always wondering when the other shoe is going to drop. I need to be more optimistic.
 
tiffmaxee said:
Max had chronic pancreatitis and when it was active his ALT would go up. That alone does not necessarily mean anything unless double the high normal. What was it?
Click to expand...

ALT was 499, GLU was 357, CHOL was 268, AST was 315, TRIG was 537. All high. A couple super high.

I went to the labs section on her spreadsheet but it wouldn't let me enter the information and I don't know what to do.
 
Summer and Susie said:
ALT was 499, GLU was 357, CHOL was 268, AST was 315, TRIG was 537. All high. A couple super high.
Click to expand...
Summer and Susie said:
ALT was 499, GLU was 357, CHOL was 268, AST was 315, TRIG was 537. All high. A couple super high.
Click to expand...
RachelG said:
Hugs Susie :bighug: Any news like this is always very scary, especially when it's unknown what is going on.

Fortune had high AST back in 11/2016, and was diagnosed with cholangeohepatitis after an ultrasound. He was put on ursodiol - which originally came on the market as a supplement but has such great efficacy it is now used clinically - and we have had normal blood work since. We wound up never doing a biopsy until he had renal cancer, and the liver was biopsed to check for metastasis - that was 4.5 years later, and the liver was normal!

Just to say, there is hope. :bighug::bighug:
Click to expand...
Susie has high AST too. Her number was 315 and the norm is 10 -100.
 
Good morning. There is something going on with her liver it appears. Did she by any chance eat something she shouldn’t have? I would definitely get the ultrasound. You want it done by a board certified radiologist if at all possible. I’ll spare you my long story about having anyone not extremely qualified don’t. I’ll just say Max had two dine a week apart. The first found everything wrong and recommended exploratory surgery but did say his pancreas was normal. The second found all within normal limits. Max had pancreatitis and never needed surgery and biopsies. He never developed cancer.
 
tiffmaxee said:
Good morning. There is something going on with her liver it appears. Did she by any chance eat something she shouldn’t have? I would definitely get the ultrasound. You want it done by a board certified radiologist if at all possible. I’ll spare you my long story about having anyone not extremely qualified don’t. I’ll just say Max had two dine a week apart. The first found everything wrong and recommended exploratory surgery but did say his pancreas was normal. The second found all within normal limits. Max had pancreatitis and never needed surgery and biopsies. He never developed cancer.
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Susie has had a penchant for eating my Mom's silk plants and then throwing up. In fact I saw her three days ago eating the silk plants in the Florida Room. I just removed all of them from the Florida Room but she still has access to others in the house that my Mom wants to keep. I mentioned this to the vet and he said this wouldn't be causing her liver problems but I don't know. My vet is doing the ultrasound and I don't know how "certified" he is but I trust him. My labs say "Acute pancreatitis is unlikely. Chronic pancreatitis is not excluded by a normal Precision PSL". I don't know what all this means. I will find out tomorrow what he sees. Thanks, Elise.
 
I have a cat that has eaten all kinds of things including pant cuffs,jacket sleeves, towels, and chocolate. Everything is out away. My towels are where they cat be reached and closets have locks, lol.
The thing about ultrasounds is they need to be done by a specialist to be accurate. My vet is a internist and if he is concerned he has a radiologist do them. If not concerned he takes a look himself. He didn’t trust Max)s first one that was done at a different practice because he was out of town. That’s why I had two done a week apart. He said the disc shown to another radiologist would not be trusted.
Good luck. Hope nothing serious is happening.
 
There is a blood test called SpecFPL that can pick up chronic pancreatitis. I highly recommend getting a copy of the report so you can understand the situation alongside the vet's recco. Thinking of you both and hoping it's very boring results. :bighug:

My boys are notorious for eating plastic to get to what they think is food. :rolleyes: It's nerve wracking!
 
George had High AST and ALT (not as high as Susie) this was at diabetes diagnosis
When we rechecked some months later he was normal, and have not been a problem since.

Sending prayers for a boring report
 
tiffmaxee said:
I have a cat that has eaten all kinds of things including pant cuffs,jacket sleeves, towels, and chocolate. Everything is out away. My towels are where they cat be reached and closets have locks, lol.
The thing about ultrasounds is they need to be done by a specialist to be accurate. My vet is a internist and if he is concerned he has a radiologist do them. If not concerned he takes a look himself. He didn’t trust Max)s first one that was done at a different practice because he was out of town. That’s why I had two done a week apart. He said the disc shown to another radiologist would not be trusted.
Good luck. Hope nothing serious is happening.
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Funny what a cat will eat. Thanks for the well wishes.
 
RachelG said:
There is a blood test called SpecFPL that can pick up chronic pancreatitis. I highly recommend getting a copy of the report so you can understand the situation alongside the vet's recco. Thinking of you both and hoping it's very boring results. :bighug:

My boys are notorious for eating plastic to get to what they think is food. :rolleyes: It's nerve wracking!
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Plastic? No that is strange. Thanks for thinking of us both and thanks for the tip on the SpecFPL test.
 
Gill & George said:
George had High AST and ALT (not as high as Susie) this was at diabetes diagnosis
When we rechecked some months later he was normal, and have not been a problem since.

Sending prayers for a boring report
Click to expand...
Thanks, Gill. I can't figure out why her cholesterol and triglycerides are so high too. She is on a pretty strict diet. Her glucose was really high as well but I'm thinking that might have been from stress. I entered her labs on my spreadsheet. By the way, I got my first "blue" testing Susie this afternoon at +8.50. It was 175. Hope her nadirs aren't going to be really late in her cycles. Hard to picture getting up around 1:30 or 2:00 am to test but we do what we have to.
 
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