01/31 Wednesday Questions!

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alexia&wednesday

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A few things, please read all of this if you are going to comment. I hate hearing 'no dry food!!!', when I know this, and she doesn't eat dry food any longer and that is stated in the info posted below. Secondly, I am a medical student, so I do know a lot about DM. Obviously, I need help regulating my cat, but a lot of things don't need to be explained.
*However*, I don't know much about her having *too much insulin* and thus, putting out higher numbers. THIS IS WHY I NEED HELP!
....I use the freestyle freedom lite meter

Here is some brief background info, in sequence of events:

- 11/24/09: Wednesday diagnosed with DM after being rushed to the ED w/ DKA and diagnosed with pancreatitis
- Discharged 5 days later on Lantus 1U BID, eating wellness CORE dry and wellness grain-free wet
- Wednesday's numbers were semi-great, about ~250 AMPS/PMPS, ~120 nadir
- ~1 week after discharge, Wednesday did not like the new dry food and began vomiting it up for 2 days. 2nd day I took her to the vet and she decided to switch her to ID wet/dry diet. MUCH higher carbs....she was worried if she wasn't eating, she couldn't get insulin, etc.
- Wednesday's BG increased to ~325 AMPS, ~200 nadir...obviously because this food was awful for a diabetic cat!
- She was on the food for a few weeks, I don't want to get into why, but she was eating on this food and the vet and I figured we would deal with the higher numbers.
- I increased insulin 0.5 units to 1.5U BID, not knowing this could have been too much too quickly.

NOW...

- Wednesday is off the ID for about 1 month now. She ONLY eats wellness wet food, though she has been able to sneak into the other cats' dry food...a HUGE problem.
- Her numbers are ALWAYS in the mid-high 300's AMPS/PMPS, with very little change at nadir (maybe high 200's)
- Shs has been at 400-440 several times, usually due to me being late with insulin, or her sneaking into the cats' dry food (this has recently been solved, but it took me awhile to get really strict with the other cats). Sometimes it is in the 400s and I don't know why.
- Her dose is now 2U BID

I have gotten MUCH more strict about her not being able to eat the other cats' food, and I do see a decrease in number, now she is around ~320 AMPS, but her nadir is never where it should be.

Here is her SS: http://spreadsheets.google.com/pub?key= ... utput=html

I am frustrated and don't know what to do. She has had blood work and does not have acute pancreas issues (plus, no clinical signs), her numbers should not be this high with the wet food and the insulin....I don't think anyway.
It is a mess!!!
Any ideas? Should I start from scratch at 1U, since she was doing fine, and I assume the only reason her numbers started increasing was due to the high carb food? (even though I really only had a week to chart the low numbers, since she started the ID food 1 week after her discharge.)

Thanks, sooo sooo much,

Alexia & Wednesday
 
Re: Help! Unregulated w/ higher dose of LANTUS

Well..
Everyone else can be on wet food, so no harm switching them. http://www.catinfo.org

Once they have pancreatitis, there's a great likelihood they will ALWAYS get flareups. It's a chronic version. If she had acute pancreatitis upon initial dx, you would never see it again likely. However, with diabetic cats, you're probably always going to have pancreatic flares once you see the first one. Bookmark this, it's too much to take in during one reading :smile: http://www.felinediabetes.com/phorum5/r ... 722,876722 Soon you will recognize the flares as they are coming on and be able to treat accordingly.

Finally, can't get to her SS... URL didn't work. I doubt her dose is too high, but it's possible. Without looking at her numbers, I can't really say if you need to go up or down. It's likely she needs more just knowing there's occasional stolen dry food in the picture. Definitely you are correct in realizing the jump was too large. Any increases/decreases from here on out should be 1/4u.

Edit: I got into your SS from your signature. Lots of stuff got my attn. Late shots, can cause number screw up, kitties not getting insulin every 12 hours can be still be showing a mess-up 2 and 3 cycles from the late dose. One thing that popped to my attention that is a problem is that extra 1/2u you gave her later in cycle. Please don't do that again, it can bring on a hypo.

Finally, breathe. :) Lantus is slow going, but you will absolutely get there. I think she needs a dose increase... which should be done in 1/4u increments no sooner than 8 cycles. BUT I need to hear what kinda symptoms we are dealing with. Still peeing and drinking like crazy? Ravenous? Still losing weight? Still dandruffy? If not.. then we have to look at starting over.


EDIT: Don't freak out, I missed that part where you said you fixed that problem about her getting into others' food. How did you fix it?
 
Re: Help! Unregulated w/ higher dose of LANTUS

I am not clear exactly what is your question.

I did look at Wednesday's ss, and what puzzles me are the comments where you say you give .5u if you see a red BG number. According to the protocol, you stick to the dose for 6 or 10 cycles, then adjust as needed, if needed. Jumping up and down with the dosing will not have the greatest effect on Wednesday's shed.
I don't think giving more because of a number is a good idea, but that's just my understanding.
Hopefuylly, someone will say more on that area.

Also, I don't get the comment about too much insulin and high BG numbers.
Wednesday has been on the same dose 2u for quite some time, so if following the protocol, the dose may have needed to be increased.
I don't consider a dose of 2u high, but then Shadoe was just increased to 6u tonite, and ECID.

I am sure others will be along to better reply; just wanted to comment, and I did read the entire post, glad to see that the dry is gone with the exceptions of of sneaks from the others. I understand that part of feeding; I have a civvie, Booboo, who eats only dry, and I must remove it whenever I am away. How I see it is this: if Booboo is hungry then she is more than welcome to eat some of Shadoe's wet haha_smiley

That dry is like a big bowl of candy! Of course Wednesday want to sneak a bit of it. :lol:
 
Alexia...ur question from other thread in LL

Hello,

If I want to start this regimen.....how do I decrease from my current 2U BID to shoot with the 0.25U/kg, as directed?
This would drop her to about 0.75U...Do I just stop the 2U BID and start with this new dose and then hold it for a few days?

Just need help starting this process from where we are at now!

Thanks,

A&W
Click to expand...


from your other thread...this will get confusing very fast if you open a new thread for a new question, so let's keep it all in one thread.
This is good for now, k? This keeps things all together and your questions won't get lost and mixed up.
 
Re: Help! Unregulated w/ higher dose of LANTUS

not freaking! and i don't mean to sound rude...i have just posted here before and then received a few comments all telling me how bad dry food is.
i realized this, and that is why i switched her to wet only, which the readers don't seem to read when i mention this.

i fixed the cat food issue by consistently removing it from the floor after the other cats eat (same time as her), i also locked up the bags, because they were scratching them open and eating while i was gone. i need a plastic container!
basically, getting really strict about it. i felt bad for the other cats, but now i don't! they won't starve, if she doesn't, and i don't leave any food out for her when i am at work.
unfortunately, i work 10-12 hour days, (almost) EVERY DAY (ah, medical school!)...so snacks are hard on weekdays.

i am just really curious if i am giving too much insulin, since i went up too quickly, and now she is throwing out glucose in anticipation of hypoglycemia?
Humans don't do this!! So, trying to get a handle on this.

Thanks!
 
Re: Help! Unregulated w/ higher dose of LANTUS

alexia&wednesday said:
not freaking! and i don't mean to sound rude...i have just posted here before and then received a few comments all telling me how bad dry food is.
i realized this, and that is why i switched her to wet only, which the readers don't seem to read when i mention this.

i fixed the cat food issue by consistently removing it from the floor after the other cats eat (same time as her), i also locked up the bags, because they were scratching them open and eating while i was gone. i need a plastic container!
basically, getting really strict about it. i felt bad for the other cats, but now i don't! they won't starve, if she doesn't, and i don't leave any food out for her when i am at work.
unfortunately, i work 10-12 hour days, (almost) EVERY DAY (ah, medical school!)...so snacks are hard on weekdays.

i am just really curious if i am giving too much insulin, since i went up too quickly, and now she is throwing out glucose in anticipation of hypoglycemia?
Humans don't do this!! So, trying to get a handle on this.

Thanks!
Click to expand...

Thanks :) Ok I found your SS and updated my previous post with some observations and questions, can you take a look at them and see what you can give us for info? It's gonna be the only way we can determine what's happening..

And the others can be on wet food too so it's easier on you :)
 
Re: Help! Unregulated w/ higher dose of LANTUS

Ok, there might be some confusion.

I am not using any 'protocol' currently. I would like to, though!

I have read so many posts where people say that maybe the cat is getting too much insulin, if the trend is totally wacky.
I think Wednesday's trends are totally all over the place, and she has absolutely NO nadir.
So, I thought maybe I should try and start over and see if I can hit her target, since i think I went up to 2U too quickly?

Perhaps I should just be patient and see what happens.
You are right, I shouldn't have given her extra insulin when she has a high number.....

- A
 
Re: Help! Unregulated w/ higher dose of LANTUS

why don't we just call it a fresh start today? First question, are you testing for ketones? If you're going to drop the dose then it is VERY important to test for ketones, especially since Wednesday has had DKA. Has she had ketones again since then? That will determine whether you should start over at 1 unit, or just continue from where you are.

Second, no more shooting extra! When you shot the extra 0.5 units last night, what + hour was it?

Wednesday's numbers aren't bad, you can look at my spreadsheet to get an idea of what most Lantus cats go through at first. Lucy took longer to regulate because she was really sick at first, and because we wasted a lot of time on other insulins before switching to Lantus. But many cats go through the same patterns that Lucy did, they just don't hold onto them for as long as she did! It's a process and one that requires a lot of patience, but it's worth it to have a healthy, well regulated cat.
 
Re: Help! Unregulated w/ higher dose of LANTUS

also, can you please change the title of your first post in this thread to 1/31 Wednesday questions? As you know, this is a busy forum and that will make it easier for everyone to find you again. Thanks!
 
Symptoms:

Lots of urine. In fact, before she was diagnosed she did not show signs of pancreatitis, except I remember HUGE masses of urine in the litter box.
It is still pretty bad, if I don't clean it everyday 1/3 of the litter will be urine (I usually do clean it every day, but when I forget I surely notice how much urine has clumped)
I have started going through a 35 lb. bucket of tidycats almost every week, when this used to last about 2 weeks. I have 3 cats and 2 litter boxes.
** I test her urine when I can, and there have never been ketones since November when she was diagnosed...but the highest number on the dipstick for glucose registers. That is awful, right?

I don't notice her drinking that much, honestly. More than the other cats, but not excessively.

She is not ravenous with her food. I feed her about 1/2 a can of wellness grain free (turkey and salmon), and she doesn't finish it all the way. I do feed her snacks b/w meals and she enjoys that. This is a HUGE accomplishment, she hated wet food before she became diabetic!

Otherwise, she seems ok.
 
Re: Help! Unregulated w/ higher dose of LANTUS

I am still stuck on the food thing and wanted to mention that an auto feeder may be helpful for you during the day for Wednesday!

We all know how important it is to have the food balanced through the day, but it's really tough when you are gone for long periods of time. I am also out the door after testing Shadoe and giving her shot in the morns and often I am home just before her PM test and shoot, so I have an auto feeder set up and it's made a big difference for her.

I use a 5compartment auto feeder I got at PetSmart, and I set the timer to turn every few hours. Now, when I am at work, I know that there is going to be a little something for Shadoe to eat while I am away.

It may be just the thing to give you peace of mind while at school.

The others will be able to give you much more guidance on setting Wednesday on a good routine with Lantus.
 
Re: Help! Unregulated w/ higher dose of LANTUS

I agree with Libby and meant to say that.. her numbers really aren't THAT bad. I know she's been dx since Nov, but I think you can get her on track relatively quickly. I do not believe, based upon your report that you have missed your proper dose. I personally think she needs to be increased. Dumping glucose and urine like that is not a sign of overdose. And no, it's not awful, it's totally normal :)

However, I understand if you want to start over, and if you do, we'll teach you how to read her patterns. You must be patient though, because if we go the wrong way, she will go much higher and we'll have to get her back to a more controllable level. Have faith, and she'll get there. Lantus is not the insulin for impatient people, and we're ALL impatient so we know what it feels like to see crappy number after crappy number. One day, the clouds will part and the sun will shine and the angels will sing and you'll finally be paid back for all that patience you've had to endure LOL

PS what an AWESOME kitty name!!
 
Re: Help! Unregulated w/ higher dose of LANTUS

Carolyn and Spot said:
I do not believe, based upon your report that you have missed your proper dose. I personally think she needs to be increased.
Click to expand...

That's what I was thinking too, Carolyn. But of course the bean's comfort is important too so we'll help you with whichever way you decide to go.

I see a couple of notes on the spreadsheet that you were off schedule - are you now back on the schedule you want to be on? If not, then I would work on adjusting that before you increase the dose. It's easier to change only one thing at a time.
 
Re: Help! Unregulated w/ higher dose of LANTUS

One day, the clouds will part and the sun will shine and the angels will sing and you'll finally be paid back for all that patience you've had to endure LOL
Click to expand...



LOL!!!
what is it with all the Carolyn's around here? So poetic!
o:-)
 
Re: Help! Unregulated w/ higher dose of LANTUS

Hi Alexia and welcome to the Lantus ISG.

The protocol that we use, although we do modify it slightly, is at the top of the board. I've also linked the dosing protocol here.

Libby has made several good points. It is especially important to test for ketones. Being a med student, you should be familiar with Ketostix and how to use them. Alternatively, there is a glucometer, the Precision Xtra, that can test for blood ketones. Both the BG and BK strips for this meter are expensive, though. You should not be seeing more than a trace reading on a Ketostix. More than a trace is of concern. Likewise, Lantus is not a bolus insulin and should not be used in that manner. It's half life is too long to function as a bolus dose.

Many people who are familiar with other insulins will look at Lantus/Levemir and think that they have an hour window on either side of their shot time. This is not the case with these long acting insulins. You have about 15 min. grace. Otherwise, you are playing havoc with dosing since this is a depot drug. You will need to do whatever you can to stick to a 12/12 schedule.

Please let us know if you have specific questions. There is a great deal involved in the hands on management of a diabetic - both human and feline - that you won't get from textbooks. This forum is a huge resource of people with a great deal of practical, clinical experience in managing feline diabetes whether it is food, adjusting shot times, or pathophysiology of FD or related illnesses.
 
Alright, friends!

This is what I am going to do!
I am going to stay on schedule and stay strict with the dry food (can I tell you when I hear sneaking away from her food to eat their food in the next room, and I run in to redirect her, she runs away before I even get there- totally knows she should not be eating that stuff!).
I will not add 0.5U when I get nervous about her high numbers. I think i am too used to treating humans with sliding scale insulin. And I never want to see his cat in the ED again! Plus, I can't afford another 3,000$ vet bill! :)

When should I start to increase her insulin, since it seems like some of you think I did not miss her ideal dose....she HAS been with 2U for a few weeks now.

Wednesday thanks you for the complements on her name, she wants you to know her sister and brother have cute names, too: clementine and winter!

- A & W
 
a tuxedo, my favourite :-D

ur pic disappear thou! lol, u can learn how to do ur AVATAR (pic) in the TECH forum when u have lounge time.

she's very cute thou!
 
alexia&wednesday said:
Alright, friends!

This is what I am going to do!
I am going to stay on schedule and stay strict with the dry food (can I tell you when I hear sneaking away from her food to eat their food in the next room, and I run in to redirect her, she runs away before I even get there- totally knows she should not be eating that stuff!).
I will not add 0.5U when I get nervous about her high numbers. I think i am too used to treating humans with sliding scale insulin. And I never want to see his cat in the ED again! Plus, I can't afford another 3,000$ vet bill! :)

When should I start to increase her insulin, since it seems like some of you think I did not miss her ideal dose....she HAS been with 2U for a few weeks now.

Wednesday thanks you for the complements on her name, she wants you to know her sister and brother have cute names, too: clementine and winter!

- A & W
Click to expand...

No point in waiting, if you want to go to 1u, do it next dose and if you want go up, increase immediately to 2.25u. :) There's info in the stickies on how to eyeball that. This increase (or decrease) can cause New Dose Wonkiness (NDW) which is laid out in a post Jill & Alex has up today but basically it can cause the numbers to start doing really crazy things for the next cycle or two. Don't panic and try not to read anything in to it. :mrgreen:
 
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