02/19/12 Tommys First Curve trying to understand the numbers

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Tomtomsmom

Member Since 2012
Hi all in Lantusland, yesterday was one month and our first opportunity to run a curve on him since he started Lantus on 2/7. His numbers for yesterday are posted below on his SS and I am hoping for some advice as to how to proceed after this. He is still on DM and Iams kitten. He gets fed 2 5.5 cans of the DM (one in the morning at 7 am/the other at 7pm) and 1 3 oz can (1/2 can at 3 pm and the other half at bed time around 10/11 pm). I am hoping to wean him off the DM once I get rid of the cans I have left and then switch him over to probably FF or other better more affordable brands low carb food.

What do I do now?

Mimi & Tommy
 
Re: First week on Lantus and questions

Hi guys and happy valentines day! For some reason, I am not able to open up your spreadsheet? It says it is invalid?
 
Re: First week on Lantus and questions

Hi Mimi,

I am having problems with your link as well. I don't think you put it in brackets with the URL designation so I'm only getting half the link when clicking it.

Can't wait to see what your guy is up to!

Happy Valentine's Day!
 
Re: First week on Lantus and questions

Tomtomsmom said:
UGH! I was afraid that would happen. Let me give it another try.

Thanks! Mimi

lots of people do not have excel so just export that sheet into google docs
 
Re: First week on Lantus and questions

Welcome to Lantus Land Mimi and Tommy!!! We're glad you are here to join our family. There is just about always someone around 24/7 between the US and Canada members and our dear friend, Serryn, in Australia. Please ask lots of questions and we'll help you and Tommy through the sugardance.

SS link works. Thank you!! It's really difficult to interpret numbers without those mid-cycle tests but it rather looks like Tommy might be going a little lower during mid-cycle and then bouncing up into these higher numbers at the beginning of each cycle.

Can you give us some general info about Tommy....age, what food he is eating, etc etc.

I have to go test my kitty right now but I'll be back shortly with some important info and some links for you.
 
Re: First week on Lantus and questions

if you look at the first couple days on the 1u dose, the before bed tests look not too bad, but by the 2nd day, the 112 looks like you should be watching for maybe lowering the dose as once the shed's full, you will start to see the full effects of the 1u dose.

Later in the week, if you look at your last amps, it's higher than the others which would hint to me that you are hitting ever lower numbers overnite, many cats go lower during the nite, and then you are left with a bit of a bounce in the morn.

If at all possible, see if you can get those before bed tests because you may get one that has you staying up a bit later and cracking open a can of some higher carb foods.

If the before bed is not possible, maybe try for something near the end of the cycle, like at +10 as even that number will be helpful.
 
Re: First week on Lantus and questions

Ok...back to give you some more information. I'm glad Squeem caught the "ccc"...I overlooked it. I can access your SS but you do need to go back and change the "ccc" to "pub". Thank you!

No doubt, you’re feeling more than a little overwhelmed. If you take a look at the number of people in this forum, you’ll realize that there is a lot to learn and a lot to do but it is very manageable once you learn the ropes. The front end of the learning curve is rather steep, though. The people here will answer your questions and help you. All you need to do is ask!

There is a lot of important information regarding lantus that is available for you to read. We suggest you print it, put it in a folder or binder, and then you have it handy if you need it quickly. The info is found at the top of the Lantus TR forum that you are in....they are called "stickys". Here are quick links to them:

New to the Group-provides great, basic information ....a must read first :-D
Tight Regulation Protocol - more on this below
Proper Handling and Storage of Lantus/Levemir - very important as we store our insulin in the frig, do not shake, roll, warm, prefill syringes, etc.
Insulin Depot - discussion on how lantus/levemir work
Dealing with Low Preshots - very important to have on hand
How to Handle Low Numbers - also very important to have on hand

The vast majority of the members of this Insulin Support Group are using a dosing protocol that is based in clinical research and that has been published in leading veterinary journals. It is referred to as the Tight Regulation (TR) Protocol (or by other names as well, the Tilly Protocol or the Rand/University of Queensland Protocol). They are all the same. A modified version of the protocol and links to the formal versions is available in the Tight Regulation sticky. This approach will give your cat the best chance of going into remission or keeping his/her blood glucose numbers in a range that will prevent organ damage.

It is not mandatory that you follow this approach. However, you should be aware that most of us do and it is how we approach dosing decisions. As a result, we are very numbers oriented.

This protocol was developed by lay people who are members of the German Diabetes-Katzen Forum and It has since been published in the Journal of Feline Medicine and Surgery. In other words, there is research to support the use of this dosing protocol. The majority of cats do very well on this protocol; some cats do not. Every cat is different (ECID). Also, results do not occur overnight. Lantus will teach you patience. It is more time-consuming than most other protocols but still definitely doable if you work a regular full-time job. Many people here have challenging schedules.

We strongly urge you to test for ketones regularly to start with and know about diabetic ketoacidosis (DKA). Be aware that ketones don't occur once a cat is (and remains) properly regulated. Most of us buy ketostix at the pharmacy and test urine...it's easy and quick. Tommy should be eating a the right diet: high-quality low-carb canned food or raw food exclusively. It is best to feed your cat lots of small meals spread over the day, free-feeding canned food can be an option for some cats.

You will also find a warm welcome and a community of people who are devoted to their cats and just as interested in yours and who will generously share their knowledge with you.

If you can't find the means to incorporate these steps into your cat’s diabetes management, for whatever reason, using a TR protocol may not be right for you. As overwhelming as it may seem right now, these steps are not that hard to carry out and we've seen many people who didn’t think they could do this, slide into a TR approach once they got started. Home testing is a critical part of this approach. As with any other insulin, in order to insure that blood glucose levels are high enough to safely give a shot, you need to test prior to injecting.

There is an alternative protocol called "Start Low Go Slow" and the link to it is here: SLGS Approach

I've given you alot of info and we don't expect you to absorb it all at once. But it helps us to know which protocol you prefer to follow so we know best how to make suggestions for Tommy. We ask that if you get a low number during the cycle, please post and we will help you with it. If you get a low preshot, please DO NOT FEED, but post and ask for help and we'll walk you through it.

Welcome and please let us know how we can help you. If you are able to get a test before you leave in the morning and when you get home and a +2 and/or before bed test or as Gayle suggesed, a +10 ...it would help immensely.

One of the things that would help us help you and Tommy the most is if you could please do a profile for Tommy in the next week. Here are the instructions and if you have any questions...please PM me and I'll walk you through it:
Creating a Profile

Happy Valentine's Day!!
 
Re: First week on Lantus and questions

Welcome to Lantus Land!!

Good job with getting the hang of home testing and with getting the Google spreadsheet (SS) working.

As Marje initially noted, without at least one spot check per cycle, in addition to your pre-shot tests, there's no good way to know what's happening with Tom's numbers. It's certainly possible that you are getting a good response to this dose and there are blue and green numbers at nadir, much like you saw on 2/8. Lantus dosing is based primarily on the nadir (i.e., the lowest point in the cycle). This is why it's important to get sopt checks. I would not be comfortable making any suggestions about Tom's dose until there's more data. Many of us work and it's difficult/impossible to get spot checks during the day. Obviously, getting a curve on a weekend or days off is great. Would it be possible to routinely get some spot checks during Tom's PM cycle? At the very least, a "before bed" check will give you an idea where his numbers are heading and you won't be losing a full day's worth of data.

If you want to use the Tight Regulation protocol, there are a few things to know.
[url=http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581:vfdzrdlh][b:vfdzrdlh]Tight Regulation Protocol[/b][/url] sticky said:
REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

  • Kitty should be monitored closely the first three days when starting Lantus or Levemir. Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9. More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
  • Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet.
  • Feed small meals throughout the day. Some kitties adapt well to free feeding.

The people here are incredibly generous with their time and information. Please ask questions and let us know how we can help. I hope you will continue to post often.
 
Re: First week on Lantus and questions

I found an initial lantus post with some info: 2/8 Condo

Looks like we already gave you some info :-D

Just so you know, we link our previous condo....whether it is day before or week before....in our current one. That helps us quickly access the previous condo to review information before we make suggestions. To link your previous condo, just open it, copy the browser, then click on the "new topic" button, put your cursor in the text box, click the "url" tab above the text box and paste the link in between the brackets so it looks like this: PASTE LINK HERE

We do one condo per day per cat so all of your AM and PM info will be on that one condo and if you have questions....just put them all in that condo. The subject line usually looks like this (example):
2/14 Tommy AMPS 223 +6 119 +10 200

Then when you start the evening cycle, change the subject line to look like this:
2/14 Tommy PMPS 210 +6 95 +9 110

Any time you want to make changes to your subject line, open the FIRST post of the day in the current condo, click the "edit" button, make your subject line changes, and then click "submit". If you have questions, then open the FIRST post of the day in the current condo, click the ? button above the subject line and then you can write something in the subject line to catch our attention. An example:
2/14 Tommy AMPS 223 +6 119 Help Pls or 2/14 Tommy AMPS 223 +6 119 Dose ??

Always remember to hit the "submit" button when you are done.
Once someone has answered a question to your satisfaction, then take the off the "?" by clicking on the "none" button (always by opening the first post of the day and clicking "edit") and take the question text out of your subject line. Then click "submit".

:-D :-D
 
Re: First week on Lantus and questions

Welcome! You're doing great! My kitty has made so much progress since early January. The LL folks are super helpful.

You probably have most of the basics in the links above. One thing that may help give you some peace of mind on work days is an auto feeder. You can leave out some timed mini meals that he will eat if he needs. It's an adventure at my house because I have to make sure Simon gets it (not the nondiabbetic cat or dog!)

You will be cruising in a week! You will learn fast ;-)

I have one like this and one with 2 compartments.
http://www.amazon.com/PetSafe-5-Meal-Electronic-Pet-Feeder/dp/B000GEWHNS?tag=felinediabetesfdmb-20
 
Re: First week on Lantus and questions

Thank you all again and I believe I have fixed the problem with the SS and profile.

Please see below and thank you all for your help!

Mimi
 
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