1/12 Taz, AMPS-434, +1.75-431, +5-399, +9-397, PMPS-417, +2-314, +5.5-104, +7- 72

I would try the Zofran as it is great for nausea. It's given to humans who experience nausea when going through chemo. When Zofran alone does not work, I give it in conjunction with Cerenia, especially if the nausea is accompanied by vomiting. Cerenia is good for vomiting and has anti-inflammatory effects, but not as good with the nausea. When Ruby was really sick and was not eating and puking up every meal, I gave her a cocktail of the two. Both of these meds are constipating though, but it seems like you have a lot of experience in dealing with that!
 
Katherine&Ruby said:
Both of these meds are constipating though, but it seems like you have a lot of experience in dealing with that!
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Oh jeez, I'd really like to avoid that if possible. It's been a while since I've had to deal with it. He's currently taking Bupe but the vet wants to change him over to gabapentin. I've never had experience with either of those. I just know that Taz still isn't himself. :(
 
SaraMV said:
Oh jeez, I'd really like to avoid that if possible. It's been a while since I've had to deal with it. He's currently taking Bupe but the vet wants to change him over to gabapentin. I've never had experience with either of those. I just know that Taz still isn't himself. :(
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If you're concerned about kidney issues, bupe is better than gabapentin. You can manage constipation, but the really important thing is to get him to eat. I would not hesitate to give him either or both Zofran and Cerenia if it helps him. Food helps with the action of the insulin. Right now he's in higher numbers as he gets to the right dose, but if you do wind up with lower than usual numbers, food is the way you get him into safer numbers.
 
Sabrina has a markedly enlarged pancreas and she has pancreatitis flare here and there.

When she feels unwell, I give her Cerenia, Ondansetron, and SubQ fluids. I also have Bupe on hand. I think SubQ fluids help Sabrina tremendously (the injection site should not be too close to the insulin injection site as the fluids would affect blood glucose). Appetite stimulant like Mirataz may also help as long as the nausea is under control.

You can also add some toppers to Taz's food like freeze dried chicken and bonito flakes.
 
Thank you. I'm putting together a list for the vet. Taz goes back tomorrow for a fructosamine test. I'm so thankful to this group for teaching me how to chart his numbers. I made a chart to take to the vet, so he can get a better picture of Taz's numbers on a daily basis. Once Taz feels a little better and I can get him to the schedule that he's going to be on, I'm going to do his curve. Right now, I'm trying to get Taz used to getting his ear pricked without freaking out. I'm getting better at it, which is less stress for both of us.

I have a couple of questions.

Once I go back to work, I worry about having to wake up numerous times every night to do tests. If I only get up once, what hour would you say is the most important to test at?

Also, why do you guys say that 2 meals and snacks are best compared to only eating twice a day? I know the vet is going to give me a hard time about this.

And what is going on with Taz's numbers today? He ate right before his +5 test. Do you think it influenced it? Why is he consistantly higher some days and others he plummets lower, when he eats pretty much the same thing every day? I know that he was bouncing... but yesterday his numbers were flat in the 100s. Today they're flat around the 400s. I don't understand insulin and blood glucose at all.
 
You are not giving consistent doses of lantus which is likely giving you odd numbers. We dint decrease in 1.0 increments but rather .25. I dint know which method you are following. If Slgs you would give 1.75 both cycles. If TR there was no reason to reduce at all and the duse would be 2.0.

I just read yesterday’s condo. Is he eating well? If so choose either 1.5 or 1.75/both cycles and see how he dues.
 
I don't know what method I'm following either. I was told by the vet that if his numbers are below 200 (before insulin), or if he doesn't eat much or vomits, to only give half dose.

How on earth do you find .25 on these syringes? I can do .5 differences, but I can't see any way of doing it by .25 increments.
 
Hi Sara,

I know you are super overwhelmed by all of this, but your vet doesn't want you to shoot a full dose below 200 because they generally like to keep cats hyperglycemic. We aim to get cats at least below renal threshold, which is below 250, and in euglycemic levels, somewhere between 50-100, especially if the goal is remission. Experience and many studies have shown that Lantus works best when consistent doses are given. Because it's a depot insulin, in stays stored in the subcutaneous fat, so that it continues to do its job over a period of time. If you give different doses, the depot does not build evenly, so you will have highs and lows and little in between.

You can eyeball in between the lines to get .25 units. Take a look at this sticky that describes how to give smaller doses of insulin:
Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing
 
Those are not half unit needles. The sticky post I linked has brands you can choose from. I use Sure Comfort that I buy from ADW: https://www.adwdiabetes.com/product/1316/surecomfort-u100-syringes-half-unit-31g-3-10cc-5-16in-100ct. I have used other brands but I find Sure Comforts produce the fewest bubbles and are printed more accurately so that dosing is more consistent. I also use calipers and will never go back to eyeballing tiny doses. Here are the calipers I got from Amazon: https://www.amazon.com/VINCA-DCLA-0...sion/dp/B017KUC6XQ/?tag=felinediabetesfdmb-20
 
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I just spent quite some time digging for a formal paper about feeding but couldn't really find anything beyond cats "in the wild" would eat 10-15 times a day. Easier on the pancreas because you're feeding it a relatively steady stream of carbs vs walloping it with a bunch twice a day and it has to work harder. You do obviously want to limit food after nadir once he's feeling better, since the insulin is wearing off and food past that point will increase BG more

I wouldn't even mention the feeding schedule. I would just say right now that you're trying to get him to eat whatever you can because he's still not feeling well and leave it at that.

As for fructosamine...I wouldn't bother, save the money. He's been home tested or hospitalized for the better part of a week+, that frustosamine isn't going to tell you anything you don't already know
 
FrostD said:
I just spent quite some time digging for a formal paper about feeding but couldn't really find anything beyond cats "in the wild" would eat 10-15 times a day. Easier on the pancreas because you're feeding it a relatively steady stream of carbs vs walloping it with a bunch twice a day and it has to work harder. You do obviously want to limit food after nadir once he's feeling better, since the insulin is wearing off and food past that point will increase BG more

I wouldn't even mention the feeding schedule. I would just say right now that you're trying to get him to eat whatever you can because he's still not feeling well and leave it at that.

As for fructosamine...I wouldn't bother, save the money. He's been home tested or hospitalized for the better part of a week+, that frustosamine isn't going to tell you anything you don't already know
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I was thinking that once he's feeling better, I'll feed at AMPS, + 5.5, PMPS, + 5.5. Would something like that work? It would be the closest that I can do to his original feeding (he was fed every 8 hours), except this would have one extra feeding.

What is nadir? Is that the lowest peak?

I didn't know what the frustosamine test was until today. We scheduled it last week, but now that I've been testing and keeping record, I agree. I don't think we need to have it done because I can basically tell him what Taz's numbers have been.
 
I’d feed at +3 and again at +5.5. I fed Max at preshot, +2 + and 4-5.
Yes, the nadir is the lowest point in the cycle and how the dose is determined. I’m glad you won’t waste your money on a fructosamine as you have real time tests. Max only had one done once because my vet thought he was going into remission. It was after he stopped insulin for a month and I hadn’t started testing. He wasn’t in remission. It was never suggested again as my vet saw my spreadsheet.
 
Starting next week, I'll have to leave for work at 8:30, so I won't be able to test anymore after that time, until I get home around his +5. I only work part time but it still messes up trying to track how he's doing. I can either give insulin at 7:30 and do a +1 (instead of a +2) before leaving. Or I can give insulin at 8, and just wait to test him at + 4.5? :(

I have an automatic feeder now. I just didn't know if I should feed him before taking his afternoon reading when i get home.
 
I would get the +1 although he won’t have onset yet. It would be better to get up a little earlier and test as close to +2 as possible. The only time you need to pick up food is two hours before insulin. It’s good to feed while you are at work. That way you won’t need to worry about him going low while you are at work.
 
I'm usually up pretty early. My problem is in the evenings. We can't give insulin to him earlier than 7:30 on a daily basis. I'd prefer to do insulin even later than that, but my job doesn't allow for it. :(

What is onset, and why is it important?
 
Part of that process is getting a feel for basic concepts:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
Many people on Lantus find that getting a +2 can be an early indication of how the cycle may go. If it is significantly lower, it means you'll need to continue to monitor , but if the +2 is higher than preshot, it usually means that you can take a break from testing.

As Elise said
It’s good to feed while you are at work. That way you won’t need to worry about him going low while you are at work.
 
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Diane Tyler's Mom said:
Can you shoot at 6 AM then test him @+2 (8AM)
Are you home at 6 PM so you can test ,feed then shoot
Would that work
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Unfortunately we're not always home at that time. We're usually really busy in the evenings and even spend a lot of time out of town. If I'm being honest, I feel overwhelmed because I have no idea how we're ever going to handle this long term. I feel like we're never going to be able to go anywhere because we'll miss tests or insulin. How do you guys go spend time with family/friends, or enjoy a day/evening out of the house?
 
Diane Tyler's Mom said:
Many people on Lantus find that getting a +2 can be an early indication of how the cycle may go. If it is significantly lower, it means you'll need to continue to monitor , but if the +2 is higher than preshot, it usually means that you can take a break from testing.

As Elise said
It’s good to feed while you are at work. That way you won’t need to worry about him going low while you are at work.
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I didn't realize this until you said it. Very interesting, and yet scary as we're sitting here at +5.5 and his number is 104. When they drop significantly, do you monitor hourly? Every other hour?

Feeding lowers the chances of them going too low?
 
SaraMV said:
Unfortunately we're not always home at that time. We're usually really busy in the evenings and even spend a lot of time out of town. If I'm being honest, I feel overwhelmed because I have no idea how we're ever going to handle this long term. I feel like we're never going to be able to go anywhere because we'll miss tests or insulin. How do you guys go spend time with family/friends, or enjoy a day/evening out of the house?
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ya, life changing, i sympathize, its hard to get out of house depending on numbers. Honestly, I felt that too, me n hubby used to go out around 2x per week. Now if i cannot be home by 755pm i just dont go (which is usually.) It was a BIG change for me. But it is do-able. Eventually you will be able to tell if he is likely to stay steady or if you should stay home to test. Once you get a lot of numbers and get on a steadier dosing and get advice that you can learn from. But ya, you need to be there to give him his insulin every 12 hrs. (you can try to teach someone you trust how to fill and shoot if they are willing to help you)

And yes, when you feed, his Blood sugar goes up depending on how high the carb level is. That is why when our babies dip low, we give diff carb levels of food and keep testing until they are safe. Good bet is get an Autofeeder, i have the 5 slot one from chewy.
 
Also, check the Supply Closet under Forums to see if anyone is giving or selling any half unit U100 syringes, this is how i got some good ones. Vet can prescribe to buy them off chewy, or u can go to walmart ask at pharmacy for U100 .3cc half marking (i have a box of relion brand and that is how i got them, no script needed)
 
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