? 07/02 Maggie AMPS 361, +2 299, +4,5 240, +6 261, 3rd day on Lantus, Day 3 on Lantus, consistently high

[hellen_maggie]

Hi everyone,
Here are Maggie’s recent numbers:

Yesterday PM cycle:
PMPS 315, +3 269, +5.4 307.

Today AM cycle:
AMPS 361, +2 299, +4.5 240, +6 261.

I understand that I need to be patient , but I’m concerned because she’s spending almost the entire cycle above the renal threshold (250). At this stage, should I be considering a dose increase or any other adjustment now? Is remaining at these levels too risky for her?
I know that according to the SLGS protocol I should wait one full week before increasing the dose and that the depot needs at least 3–5 days to fill. However, I wanted to ask whether there are any exceptions to this rule when numbers remain consistently high.
Please forgive me if I’m misunderstanding something, this whole transition to Lantus is very new to me and with the current situation and the exhaustion, it’s hard to think clearly.


Thanks so much for your guidance.

 

[Allie & Gen]

You're not misunderstanding, and it makes all the sense in the world that you're feeling anxious! Being patient with the process is hard.

That said, in the scheme of what I've seen since being on this board ... Maggie's numbers are of course higher than ideal, they are far from higher than expected at this stage, nor are they damaging or cause for alarm. Someone with broader experience should feel free to chime in - @Wendy&Neko , @Christie & Maverick , @tiffmaxee , @Sienne and Gabby (GA) - but to me her numbers look normal and reasonable for a cat who has only been on Lantus for three days.

Hang in there. She's working on this.

 

[hellen_maggie]

You're not misunderstanding, and it makes all the sense in the world that you're feeling anxious! Being patient with the process is hard.

That said, in the scheme of what I've seen since being on this board ... Maggie's numbers are of course higher than ideal, they are far from higher than expected at this stage, nor are they damaging or cause for alarm. Someone with broader experience should feel free to chime in - @Wendy&Neko , @Christie & Maverick , @tiffmaxee , @Sienne and Gabby (GA) - but to me her numbers look normal and reasonable for a cat who has only been on Lantus for three days.

Hang in there. She's working on this.

Allie, thank you so much for being here for us and for your reassuring words. They truly help, and I feel a bit more at ease now. These past few days have been consistently high, so the anxiety has been strong. Hearing that this is expected at this stage gives me strength. We’ll keep moving forward with patience and hope. Thank you again from the bottom of my heart.

 

[tiffmaxee]

We pass around patience pants a lot around here. You are seeing yellow bg which is good at this stage. It really does take 5-7 days for the depot to build. Give it 7 days and let’s see what dose is needed. We have all been in your shoes and I know it’s hard to wait. Take some time for YOU while you can.

 

[hellen_maggie]

We pass around patience pants a lot around here. You are seeing yellow bg which is good at this stage. It really does take 5-7 days for the depot to build. Give it 7 days and let’s see what dose is needed. We have all been in your shoes and I know it’s hard to wait. Take some time for YOU while you can.

Hi Elise,
Thank you for the "patience pants", i ll try to wear them! It s just hard seeing her in the yellows/reds for so many hours Let’s hope that as the days go by, things will get better!

Thank you for the support, the good intentions, and your willingness to help

 

[Mary & Jude]

Hi Hellen, Here is yesterday's post for continuity: ? - 06/02 Maggie AMPS 384, +2 294, +4 202, +6 214, +9 274, PMPS 315 /2nd day on Lantus

Just a thought: Wendy mentioned yesterday that because Maggie is still eating dry food she is not able to follow the TR method. How is the transition to the Ziwi going? If Maggie can ditch the kibble and follow TR, she can increase more frequently on that method than she can on SLGS.

 

[hellen_maggie]

Update: Her PMPS was 370 and she is already at 266 at +2! That’s a 100-point drop in two hours. It is possible that her nadir occurs earlier than the typical mid-cycle pattern... I've fed her a small meal to smooth out the curve. I'm watching her closely!"

 

[hellen_maggie]

Hi Hellen, Here is yesterday's post for continuity: ? - 06/02 Maggie AMPS 384, +2 294, +4 202, +6 214, +9 274, PMPS 315 /2nd day on Lantus

Just a thought: Wendy mentioned yesterday that because Maggie is still eating dry food she is not able to follow the TR method. How is the transition to the Ziwi going? If Maggie can ditch the kibble and follow TR, she can increase more frequently on that method than she can on SLGS.

Hi Mary,
The transition is going very well so far. This is actually the first time Maggie has accepted a different food without any gastrointestinal issues, which makes me very hopeful. At the moment, though, we are still only at about 10%.
For now, and until we complete the first week on Lantus, I’m following the advice I received here and pausing the transition so Maggie can adjust to the new situation. I plan to resume the transition and I’m hopeful we’ll be able to complete it smoothly and without any problems.
I do have one question. The transition is not to wet food, but to an air-dried food that is very low in carbs (Ziwi, around 3%). I know that TR is typically followed only with wet food, so I’m not sure whether it can also apply in our case with this type of food.
My tentative plan, if this makes sense, is to become a bit more comfortable with SLGS first and, once I feel more confident with the overall process, to then consider moving to TR.

 

[Mary & Jude]

It looks like Maggie is one of those cats that dives at onset (onset=when insulin begins working). You've done the right thing by feeding a little LC to flatten the curve a bit. Even though she isn't in lower numbers right now (which can become more dangerous if/when a cat dives at onset) you still want to try and flatten the curve with food because those big dives can lead to bouncing. Here is a sticky that talks about manipulating the curve with food: 8/10 TASHIE pmps=HIGH! +Questions***. You can experiment with different carb values, depending on how carb sensitive Maggie is. Catching a +1/+2/+3 test will help you to keep an eye on her and monitor the diving.

I'm not sure about the food. That's a great question. Let's tag @tiffmaxee or @Sienne and Gabby (GA)

 

[hellen_maggie]

It looks like Maggie is one of those cats that dives at onset (onset=when insulin begins working). You've done the right thing by feeding a little LC to flatten the curve a bit. Even though she isn't in lower numbers right now (which can become more dangerous if/when a cat dives at onset) you still want to try and flatten the curve with food because those big dives can lead to bouncing. Here is a sticky that talks about manipulating the curve with food: 8/10 TASHIE pmps=HIGH! +Questions***. You can experiment with different carb values, depending on how carb sensitive Maggie is. Catching a +1/+2/+3 test will help you to keep an eye on her and monitor the diving.

I'm not sure about the food. That's a great question. Let's tag @tiffmaxee or @Sienne and Gabby (GA)

Unfortunately, I don’t have many feeding options because Maggie has a proven history of a very sensitive stomach. To be honest, this is something that really worries me. The only foods I can safely use are the ones she already eats on a daily basis, either high-carb dry food or Ziwi (or a combination of the 2).

In that sense, it feels like I’m missing an important tool in this process. I know that most people here manage low numbers or flatten the curve by using medium or high carb wet food, but unfortunately that isn’t an option for us at the moment.

Given this situation, I’ll have to work with the options I have and do the best I can within those limits.

Thank you for the sticky and for tagging the most experienced members

 

[tiffmaxee]

You can always adds little honey or Kari instead of high carb food. Often the issue is the protein in the food. Fir you a slow transition first to the wet. One of mine out of nowhere was very sick. Everything she ate went through her the other end. She was always able to est anything. I had fed her lamb and beef when it happened to try and give her the same food as her sister. Switched to other proteins and after a few months on low dose prednisolone she was able to get off that. All this to say sometimes a novel protein helps.

If you find she drops fast at onset sec a couple teaspoons of wet at -+1 and +2 . See what that does. Trial and error.

 

[hellen_maggie]

You can always adds little honey or Kari instead of high carb food. Often the issue is the protein in the food. Fir you a slow transition first to the wet. One of mine out of nowhere was very sick. Everything she ate went through her the other end. She was always able to est anything. I had fed her lamb and beef when it happened to try and give her the same food as her sister. Switched to other proteins and after a few months on low dose prednisolone she was able to get off that. All this to say sometimes a novel protein helps.

If you find she drops fast at onset sec a couple teaspoons of wet at -+1 and +2 . See what that does. Trial and error.

Thank you so much for your advice, it's very helpful! I will try feeding her a bit earlier at +1 and +2 to see if it helps smooth out that sharp drop at the beginning of the cycle. I'm also glad to hear that a novel protein can help, as the Ziwi Peak I'm introducing is Venison, which she seems to enjoy. Once we complete the transition to Ziwi, I might try to introduce some wet food again as well, with the same protein

 

[Sienne and Gabby (GA)]

A couple of basics which may have already been covered in other posts.

When starting with Lantus, it takes 5 - 7 days for the insulin depot to form. You may not see much of an effect on numbers until the depot is stable. You also reduced the dose from 3.0u of Caninsulin to 1.0u of Lantus. Given the magnitude of the dose reduction, Maggie may not be getting enough insulin. You still need to wait for the depot to form before changing the dose. If you try to do too much at once, you won't have a clear idea about what is having an effect on the dose.

I'd encourage you to used this time to review the sticky notes at the top of the Lantus forum. There's great information in those notes about how Lantus works as well as what the dosing methods involve so you can choose a method. It may also be helpful to read some of the posts in the forum where people are discussing dosing as well as look at spreadsheets to get a feel for how Lantus works.

 

[Mary & Jude]

A couple of basics which may have already been covered in other posts.

When starting with Lantus, it takes 5 - 7 days for the insulin depot to form. You may not see much of an effect on numbers until the depot is stable. You also reduced the dose from 3.0u of Caninsulin to 1.0u of Lantus. Given the magnitude of the dose reduction, Maggie may not be getting enough insulin. You still need to wait for the depot to form before changing the dose. If you try to do too much at once, you won't have a clear idea about what is having an effect on the dose.

I'd encourage you to used this time to review the sticky notes at the top of the Lantus forum. There's great information in those notes about how Lantus works as well as what the dosing methods involve so you can choose a method. It may also be helpful to read some of the posts in the forum where people are discussing dosing as well as look at spreadsheets to get a feel for how Lantus works.

@Sienne and Gabby (GA), what about the Ziwi freeze dried food? Is that allowable under TR??

 

[hellen_maggie]

A couple of basics which may have already been covered in other posts.

When starting with Lantus, it takes 5 - 7 days for the insulin depot to form. You may not see much of an effect on numbers until the depot is stable. You also reduced the dose from 3.0u of Caninsulin to 1.0u of Lantus. Given the magnitude of the dose reduction, Maggie may not be getting enough insulin. You still need to wait for the depot to form before changing the dose. If you try to do too much at once, you won't have a clear idea about what is having an effect on the dose.

I'd encourage you to used this time to review the sticky notes at the top of the Lantus forum. There's great information in those notes about how Lantus works as well as what the dosing methods involve so you can choose a method. It may also be helpful to read some of the posts in the forum where people are discussing dosing as well as look at spreadsheets to get a feel for how Lantus works.

Hi Sienne,
The Caninsulin dose Maggie was receiving before the switch was measured using U-100 syringes. After converting the dose, the 3 units of Caninsulin correspond to approximately 1.2 units on a U-40 scale. This is why we started Lantus at 1.0 unit, following the guidance I received here.
I’ve spent many hours reading and re-reading all the very important and helpful information posted in this forum, and I’ve also printed the protocols. I’m starting with SLGS due to the limitation of dry food still being part of Maggie’s diet, as the full transition to the air-dried food has not yet been completed. I’m also reviewing other members’ posts and spreadsheets to gain a better overall understanding of how Lantus works in practice. Please forgive me if anything has already been mentioned. There is a lot of information to take in, along with the stress and fatigue, especially since I haven’t been able to find a veterinarian familiar with Lantus who can guide me properly, which does add an extra layer of uncertainty. This is a completely new path for us, and I’m doing the best I can for Maggie. I’m truly grateful for all the help and support you’re giving us

 

[Sienne and Gabby (GA)]

No worries. If you are unsure or have questions, please ask. There's a huge amount to absorb at first. It does become more routine it that's any sort of reassurance.

Thanks for clarifying about the u100 syringes.

I'd suggest either using one of the carb calculators that we have or using one that will give you an approximate value that you can find on the web. The problem is that most of the information you can find on a food label is the guaranteed analysis. For exact values you either need the "as fed" numbers or you need to contact the manufacturer. I suspect the Ziwi Peak is fine but I don't have exact values.

You might want to see if there is a cat only specialty clinic in your area. I've found that feline specialists are more up to date with diabetes treatment. It helps that they only have one species to focus on versus dogs, cats, ferrets, snakes, etc. This post on interviewing new vets may also help.

 

[hellen_maggie]

No worries. If you are unsure or have questions, please ask. There's a huge amount to absorb at first. It does become more routine it that's any sort of reassurance.

Thanks for clarifying about the u100 syringes.

I'd suggest either using one of the carb calculators that we have or using one that will give you an approximate value that you can find on the web. The problem is that most of the information you can find on a food label is the guaranteed analysis. For exact values you either need the "as fed" numbers or you need to contact the manufacturer. I suspect the Ziwi Peak is fine but I don't have exact values.

You might want to see if there is a cat only specialty clinic in your area. I've found that feline specialists are more up to date with diabetes treatment. It helps that they only have one species to focus on versus dogs, cats, ferrets, snakes, etc. This post on interviewing new vets may also help.

Hi Sienne!
Thank you so much for your understanding. I am already using the carb calculators from the forum to calculate the % calories from carbs (CFC). Ziwi Peak Air-Dried Venison is around 3% CFC. My main concern right now is that my only 'weapons' for dealing with potential hypoglycemia are high-carb dry kibble and honey, rather than high-carb wet food. Are these options okay for now? I just want to be prepared until I can find a high-carb wet food that she can tolerate.

Also, unfortunately, there are no feline specialists in Athens as far as I’ve searched, and I’ve been looking extensively for the past two months. Other forum members from Greece face the exact same issue: it’s incredibly difficult to find a vet who truly understands feline diabetes. It’s hard to believe, but it’s true! As for the 'Interviewing New Vets' article, I believe you’ve sent it to me before, and it’s actually what I’m using as my guide right now!
Thank you for being here for us, once again

 

[Sienne and Gabby (GA)]

I forgot you were in Greece. The reality is that as long as a vet is good at everything other than feline diabetes, you have us to help out with the diabetes. It's helpful if the vet doesn't like to micromanage and won't give you a hard time if you make dose changes without "consulting" him or her. To be honest, I moved several years after Gabby was diagnosed. My new vet took one look at my spreadsheet, gave my kitty a check-up, and basically told me she was happy to write the prescription I needed for Lantus and to let her know if I needed anything else but I was managing the diabetes just fine. My previous vet and I had a discussion about the Tight Regulation Protocol -- their practice wasn't yet using it, I gave her a copy of the journal article, and I worked with people here to learn about diabetes management.

A couple of thoughts about high carb for managing low numbers. If there is anything that Maggie likes that's not dry food? If so, that may be a place to start. Many cats like baby food. Would that be an option? You need a baby food that doesn't have any vegetables (onions and garlic aren't good for cats). You can always add honey or corn syrup or even sugar water to anything that is the consistency of baby food. In the US, there are churros which are treats that are the consistency of baby food. If Maggie will eat "people" food -- for example, cooked chicken, ham -- you can always add some syrup to that as an option. Frankly, vanilla ice cream can also be an option as long as milk products don't upset her stomach.

 

[hellen_maggie]

I forgot you were in Greece. The reality is that as long as a vet is good at everything other than feline diabetes, you have us to help out with the diabetes. It's helpful if the vet doesn't like to micromanage and won't give you a hard time if you make dose changes without "consulting" him or her. To be honest, I moved several years after Gabby was diagnosed. My new vet took one look at my spreadsheet, gave my kitty a check-up, and basically told me she was happy to write the prescription I needed for Lantus and to let her know if I needed anything else but I was managing the diabetes just fine. My previous vet and I had a discussion about the Tight Regulation Protocol -- their practice wasn't yet using it, I gave her a copy of the journal article, and I worked with people here to learn about diabetes management.

A couple of thoughts about high carb for managing low numbers. If there is anything that Maggie likes that's not dry food? If so, that may be a place to start. Many cats like baby food. Would that be an option? You need a baby food that doesn't have any vegetables (onions and garlic aren't good for cats). You can always add honey or corn syrup or even sugar water to anything that is the consistency of baby food. In the US, there are churros which are treats that are the consistency of baby food. If Maggie will eat "people" food -- for example, cooked chicken, ham -- you can always add some syrup to that as an option. Frankly, vanilla ice cream can also be an option as long as milk products don't upset her stomach.

Hi Sienne,
The truth is that my vet is good at everything (or at least that’s what I believe), since I’ve always been very happy with the way he handled my animals (both dogs and cats). However, he has no experience with Lantus, so I asked him to prescribe it for me and to monitor Maggie for anything else that might be needed, and of course he agreed. But he made it clear that he can΄t guide me when it comes to dosing. So in that area, I really only have you guys and you can’t imagine how reassuring it is to have that confirmed. Thank you so much for that!!
As far as food is concerned… Maggie ate dry food exclusively her entire life. When diabetes came up and I tried to transition her to wet food, even though she liked it and ate it eagerly, we kept having repeated episodes of vomiting and diarrhea (even though the transition was extremely gradual). As soon as I stopped the wet food, everything resolved immediately.
So I had to look for another type of food, and after a lot of research I managed to find Ziwi, even though it’s not available in Greece, not even through online ordering. Luckily, I have a German colleague who sends it to me by courier! Maggie seems to tolerate it very well so far, so I think the daily feeding issue will be solved soon.
Regarding high-carb food that I may need to use in the future to manage low numbers, I’m very afraid that diarrhea and vomiting will return if I use wet food again (or anything else that she is not used to). In addition, because she suffers from very severe skin allergies on her ears and face, I decided to try novel proteins to see if that might help (Ziwi is venison).
So I was wondering whether I could find a single-protein wet food with venison, high carbs and suitable for sensitive stomachs. There is none. The only option that comes close to these requirements is Trovet Hypoallergenic VRD wet (I don’t know if it’s available in the U.S.), but it contains 15% of calories from carbohydrates.
What do you think, is it worth trying? Would that 15% help in case of low numbers, possibly in combination with honey? (Since I know that high-carb foods are usually considered to be around 16–24%.)
I hope I’m being clear and that everything above makes sense!!!

 

[Sienne and Gabby (GA)]

What happens if you add water to the air dried Ziwi? does it soften enough that you could add some syrup or use sugar water to soak it in if you need high carb.

Another option may be to use sugar water and syringe it into Maggie's mouth. You would need a feeding syringe -- it's a syringe that doesn't have a needle.

I'm not familiar with Trovet. Ziwi does make a canned venison -- it's what I feed my cats! If you have raw venison available, you can always feed a bit of raw or cooked venison and add syrup since you know that Maggie will tolerate it.

 

[hellen_maggie]

What happens if you add water to the air dried Ziwi? does it soften enough that you could add some syrup or use sugar water to soak it in if you need high carb.

Another option may be to use sugar water and syringe it into Maggie's mouth. You would need a feeding syringe -- it's a syringe that doesn't have a needle.

I'm not familiar with Trovet. Ziwi does make a canned venison -- it's what I feed my cats! If you have raw venison available, you can always feed a bit of raw or cooked venison and add syrup since you know that Maggie will tolerate it.

All three of the options you suggested could work for us. If none of those work, then I’ll go with the Trovet. This is the description of the food, in case you’d like to share your opinion with me!

Thank you so much for the alternatives and for the support, I really appreciate it!

 

[Sienne and Gabby (GA)]

It looks like a good food! Even with the rice, it's still low in carbs.

Gabby was sensitive to gluten. As a result, all of the gravy-based high carb foods would cause her to vomit. I added either corn syrup or honey to her usual low carb food to bump up the numbers. And trust me, her numbers could drop like a rock! Do whatever works for your cat.

 

[hellen_maggie]

It looks like a good food! Even with the rice, it's still low in carbs.

Gabby was sensitive to gluten. As a result, all of the gravy-based high carb foods would cause her to vomit. I added either corn syrup or honey to her usual low carb food to bump up the numbers. And trust me, her numbers could drop like a rock! Do whatever works for your cat.

Thank you so much!