1/6/12 Hobbs AMPS 134, +5 268, PMPS 445

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SabrinaFaire

SabrinaFaire

Member Since 2011
Intro Post

So I'm posting a daily thread here for the first time. Not sure if I'm doing it right, but I'm sure someone will tell me if I'm not. :mrgreen:

Today I was starting with a new meter, took 3 strips to get enough blood. It takes slightly more than the old one (.3 to .5). Last night at the vet for his follow up his BS was literally off the charts so the vet upped his dose to 2 units. This morning he was down to 134. I'm wondering if you folks would adjust the dose on a case by case basis if his BS drops too much at one reading?

Also the vet said to hold off on vaccines until he gets regulated. Anyone hear of that? He's supposed to be due at the end of the month. He doesn't go outside but we do live near a wooded area, and who knows what could happen, I wouldn't want him unprotected from rabies.
 
Re: 1/6/12 Hobbs AMPS 134

Are you home to check him NOW?? He may have been to low to shoot!!! Can you get a test in?? Do you have a hypo kit handy???

Since you are just starting, we recommend no insulin when the glucose is under 200; once you have lots of data, that number may be dropped to 150.

We prefer to make smaller dose changes at a time. Taking him up 0.25 and holidng it for 3-5 days, then checking again to see how its doing. You can't get the insulin back out once it is in.
 
Re: 1/6/12 Hobbs AMPS 134

Sabrina,

Sorry I'm just getting to the computer this morning. With that low of an amps and 2u you are going to need to watch Hobbs today to make sure he isn't going too low today. That 134 is a beautiful number to wake up to but I would also be testing often today especially during the first part of his cycle to make sure he isn't dropping too fast or going too low. Please test Hobbs often today to keep an eye on his numbers, one of the biggest problems with using numbers at the vet's to base dosing on is that almost all cats are completely stressed out at the vets and thus their BGs are inflated by that stress. I have one civie here that if they did an ear prick on him at the vet's he would be declared a diabetic yet at home he barely comes out of the 40s. He just had a very bad experience at the vet's once when he was there to be neutered and now completely loses his mind when I have to take him in for anything. At home he is the most mellow guy you will ever meet, in fact my grandkids dress him up in doll clothes and push him around in a stroller, but take him to the vet's and you would swear he was feral.

I know Musette will drop sometimes as much as 100+ pts during her first 6 hours, but then again ECID and I have months and months of testing behind us to know what she is going to do on a dose. Normally when you are just starting out testing at home we recommend that if they test below 200 to stall 30 minutes without feeding and test again to see if they are rising and if they are at a shootable number. Once you have lots of data to go on then it is easier to shoot lower numbers.

For future reference when you get a low number like that you may want to either post on Health or over in the Lantus TR group for guidance, those of us over here on the Relaxed board are kind of a small group and this board isn't nearly as busy as either the Lantus-TR or Health. Plus most of us over here have cats that have thumbed their noses at normal Lantus protocol so you will see a lot of us doing things that are atypical of how most folks handle cats on Lantus. But you are certainly welcome to post here, just realize that a lot of time you won't get as quick of an answer as you would on health or the Lantus TR board.

Mel, Maxwell, Musette & The Fur Gang.
 
Re: 1/6/12 Hobbs AMPS 134

Well now you guys have me freaked out. I'm at work all day. I mean WTH? The vet said to give him 2. I guess I can run home at lunch, hopefully he'll cooperate and I can take a test on him.
 
Re: 1/6/12 Hobbs AMPS 134

Vets don't live with diabetic cats 24/7. You may be OK; you may not. I understand the freaking out, but I'd rather your cat be safe, that's why I posted what I did.

If you can get home around +5-ish and check him, you'll know how low he is headed. If he drops 100 points from 134, he'd be a 34 - and we really don't want him going lower than 50 on a human glucometer, as you risk a hypoglycemia attack which could be fatal. Many cats appear normal ... until they are not.

Please post what glucose level you get when you test him. Make sure there is plenty of food out for him if you have to leave, possibly even some high carb food.
 
Re: 1/6/12 Hobbs AMPS 134

I'm going to leave in about 15 minutes and head home. It's about a 20 minute drive. It'll be around +5 at that point. I did leave him some extra dry food out this morning. I do have to come back to work though. I'll be home around 5:30 (central) tonight unless lunch takes really long and then I'll have to stay late but DH should be home between 4 and 5.
 
Re: 1/6/12 Hobbs AMPS 134

Good. We'll be watching your condo for updates.

An important bit of information to understand - Lantus builds up in the body over time; we call this the 'shed' or depot. This means that a dose change doesn't immediately go to work at its full level. It may start to work on the first dose, but as it builds up, it will have more and more of an effect until it levels off. This takes between 3-5 days, or 6-10 cycles of 12 hours.
 
Re: 1/6/12 Hobbs AMPS 134

I'm home. He's fine. He was acting normally, came to the door and meowed at me like normal. Well normal for middle of the day. Groggy I just woke up from a nap why are you home meow. :smile: I tested his BS and it was at 268. Not sure why it would have doubled since this morning. DH is going to be home around 4:30. I need to leave in a bit, pick up something to eat, and head back to work.

Just to let you all know... Hobbs means the WORLD to me. I would do anything for him. I'm just worried about work. DH found out this week that he'll be losing his job sometime in the next year, and I have a production based job. I have a neck injury that's been slowing me down and my numbers have been low. My health issues and Hobbs' health issues and DH's job have me stressed out and distracted at work even more than just the pain accounts for. So I'm not worried about leaving work because I don't care, I'm worried because if we BOTH are out of work then how am I going to pay for all of Hobbs health stuff and my own? Oy. I was hoping 2012 would be better.

Anyway, adrenaline is wearing off and now I'm hungry.
 
Re: 1/6/12 Hobbs AMPS 134

I'm glad he's OK. Because he is on dry, it was less likely he'd hypo, but still not impossible. Also know that a cat may look fine, right up until the time it goes into hypoglycemic seizures; only a blood test will show how low the cat is. When you get a chance, print this out and stick on the refrigerator so you have Hypo instructions handy.

The numbers can be high if a cat goes too low and the liver responds to bring the glucose level back up.

It can also be the pattern of food consumption, if he binges, spacing food opportunities out with a timed feeder may reduce food spikes from that.
 
Re: 1/6/12 Hobbs AMPS 134

Sabrina-

I don't vaccinate Binks, but he is an entirely indoor guy...
my reasoning is not to do with diabetes at all though, so don't know if that is helpful info for you.
I quit vaccinating my indoor kitties many years ago, as they never had contact with other cats.

I have 2 indoor/outdoor kitties that I vaccinate, but I NEVER give vaccinations if they aren't in perfect health,
so that may be your vet's rationale.

good job with Hobbs!

celi & binks
 
Re: 1/6/12 Hobbs AMPS 134

I posted some food info for you on your health thread, so I won't repeat that info here, but I know you're in the midst of a diet change and that can cause over BG to drop quite a bit. I think it's right to be nervous about shooting a dose of 2u, especially since it looks like he had a hypoglycemic incident on 2u on 12/29. I would drop the dose back down to 1u and see what happens in conjunction with the diet change. While we usually hold a dose for at least 3 days before raising by .25u-.5u, you may want to increase more slowly if you don't have the mid-cycle data to make the adjustments.

I didn't realize you were still feeding some dry--this will also cause spikes in Hobb's blood sugar. Can you get rid of the dry completely? I know that stuff is expensive, and usually if you say your cat stopped eating it you can return it to the vet for a refund if it's prescription food. If it's not a prescription food, most pet stores will do the same. When you're not there or sleeping and need to leave food out, you can freeze it. If you have a gobbler like my Bandit who will eat until he barfs if you let him, you can get an auto feeder to put the frozen food in. I have this one and like it a lot, but many people have the petsafe feeder

Has anyone mentioned testing for ketones yet? You can pick the test strips up at any pharmacy, and they're very cheap. You just catch a urine sample (ask for advice on health if you've never done that before) and dip the strip. Since you're going to want to take things slower because of your work situation, you'll want to watch out for them as a preventative measure.

Ok, now BREATHE! I know how overwhelming this all is at first, while you're still trying to absorb all the information and work out a diet and routine for Hobbs. Everything gets MUCH easier, trust me. I was so broke when Bandit was diagnosed with diabetes, and my other cat was diagnosed with kidney disease at the same time, and I was freaking out. Home testing will save you loads of money (you don't need any testing done at the vet if you're doing it at home--apart from his initial testing for diagnosis Bandit has never had ANY testing done at the vet), as will changing the food from the expensive prescription stuff (even the premium foods we discussed earlier are way cheaper--you can get Wellness or EVO for less than the cost of Fancy Feast if you get the big cans).
 
Re: 1/6/12 Hobbs AMPS 134

OK I'm back at work and calmed down. LOL

So... what SHOULD I have done this morning with that reading? Not given him any insulin at all? Is there a set "If BG is X give Y amount of insulin"?
 
Re: 1/6/12 Hobbs AMPS 134

Generally we tell new people not to shoot if the preshot is below 200. That's because you don't have any data to tell you how your cat is responding to the insulin. Once you have more data, you can make more informed decisions on what to do based on your tests.

As it turned out, Hobbs happened to be rising from the 134, but if he had been falling he might have had a hypoglycemic incident. Once you gather enough data, you can predict those sorts of rises and falls. The more data you have, the easier it is to predict and make dose adjustments accordingly. However, understanding your schedule, you'll have to work out testing to the best of your ability without burning you out or causing you to lose your job!

Are you allowed to leave for your lunch breaks every day, and are they at the same time? If that's the case, maybe you can work out so that you go home for your lunch breaks (planned of course, not rushing at the last minute like you had to today!). That would allow you to get a mid-cycle number during the day, and then you could grab an early cycle test before you go to bed. Not trying to stress you more, just trying to help brainstorm a solution for you.

If that's not possible, I know there are people here and in the Levemir forum who did not have any possible way to get mid-cycle checks during the week because of work, so maybe they could work with you on putting together a testing schedule that works for you and you're comfortable with. I know there are a few over in the Lantus-TR forum as well. In my experience, I found that things got a lot easier once I put together a schedule and established a routine with feeding, shots, and testing with Bandit.
 
Re: 1/6/12 Hobbs AMPS 134

Julia & Bandit said:
Are you allowed to leave for your lunch breaks every day, and are they at the same time? If that's the case, maybe you can work out so that you go home for your lunch breaks (planned of course, not rushing at the last minute like you had to today!). That would allow you to get a mid-cycle number during the day, and then you could grab an early cycle test before you go to bed. Not trying to stress you more, just trying to help brainstorm a solution for you.

If that's not possible, I know there are people here and in the Levemir forum who did not have any possible way to get mid-cycle checks during the week because of work, so maybe they could work with you on putting together a testing schedule that works for you and you're comfortable with. I know there are a few over in the Lantus-TR forum as well. In my experience, I found that things got a lot easier once I put together a schedule and established a routine with feeding, shots, and testing with Bandit.
Click to expand...

I was thinking about this on the way back. I think my options are: 1. Stay up until I get a second reading at night. I get home around 5:30 so he's getting a reading/fed/shot within about a half hour/45 minutes of that. So I could concievably stay up until midnight to do that. 2. Come home at lunch. Right now Omaha is enjoying a mild period this winter. Going home is fairly easy (though I made it in 15 minutes by treating the interstate number as the speed limit!), however if we get snow or ice, going home mid day won't be an option. Another possibility is working from home. Right now it's not allowed on our team but they were "looking into it" and I think might need testers. I have a 1/1 with my manager next week and might bring it up, though in general you need to be here a year before they let you WFH and I started in September. (Though I was a temp a lot longer than that)

Anyway. I was also going to try doing a curve this weekend but I need to find out our plans first to make sure that I'll be around enough to do it.
 
Re: 1/6/12 Hobbs AMPS 134

So are you shooting at 530am as well? Lantus really works well with consistency, so if you can shoot the same time every day (e.g. 7am/7pm, or 530am/530pm) it helps a lot. Ideally, you don't want to move the shot time around by more than 15 minutes. That said, you do things as your schedule will allow you. I don't know what time you have to be at work, but if it's 8-9am, a 7am/7pm shot schedule might work out better for you (That's what worked best for me--I left for work at 745am). That way if you do have to get up to test some nights you're still getting 5-6 hours of sleep.

Maybe what you could do is run home to test if the weather is nice, and just skip the days when it's not? Or you can stay up late on those nights and test during the PM cycle on those days. It's better to get some tests from both cycles occasionally anyway, even if you're rotating the days--so that would give you the opportunity and you would only miss some sleep once in a while, rather than every day.

Before my body adjusted and I was able to fall right back asleep after I got up to test, it was absolutely exhausting for me to stay up until 1am every day. So I ended up bribing a college student I met through my second job to come to my house at 1pm M, W, and F and test, and then I only stayed up on T and Th. And you'd be surprised how cheaply you can get a student to do something like that.
 
Re: 1/6/12 Hobbs AMPS 134

Here's my schedule:

AM:
I get up around 6:30
Take his BS and feed him 6:35-6:45
Shot by 7-7:15 (I give him about 20 minutes to eat)

PM:
Get home around 5:30
BS & Feed soon after
Shot by 6

I feed him right when I get home for a couple of reasons. For one, to him, mommy home = dinner time. For two, if I get busy doing other things, I'll forget. And I have.

There are variations. For instance, I've had PT appts at 7AM which means everything is shifted back an hour and a half in the mornings. Further, I've also had evening appts for various medical things and an occasional haircut, which shifts things at night too. I only have one more PT appt though and only a couple of scattered appts coming up in the evenings coming up. Thankfully. I'm tired of being at Dr's offices.
 
Re: 1/6/12 Hobbs AMPS 134

Lantus really does work best if shot on a consistent 12/12 schedule. Could you set an alarm to remind you to give the shot and feed him at 7-715 like you do in the am? If you set an auto feeder to feed him around 1pm when you're gone during the day, he's not going to be as super hungry when you get home. Also, it has the benefit that if his blood sugar happens to drop a little low while you're gone, he'll have some food to give him boost and hopefully avoid hypoglycemia.

Cats are pretty good at adjusting to schedules. If you feed him every day at 7pm, as long as he get's a meal while you're gone so he's not super starving, you'll find that after a week or two he could stop begging when you get home and start begging you at 7pm. And if he begs anyway, give him a low carb treat when you get home instead of feeding him.

On the occasions when you have no choice but to shoot early or late because of appointments, you can get back on schedule by moving the shot up or down in 15 minute increments for each shot, or move the shot in one 30 minute increment once a day. For example, let's say your shot schedule is 7am/7pm, and you have to shoot a 8pm because of an appointment. You would shoot at 7:45 the next morning, then 7:30 pm the next evening, then 715 the next morning, then you're back on schedule with the next shot.

And if something happens that doesn't let you move the shot back in increments like this because of circumstances beyond your control, it's not going to be the end of the world. But if you can keep things regular, you'll get the best results from the insulin.
 
Re: 1/6/12 Hobbs AMPS 134

Something I just thought of... do I adjust his dose based on his readings? So OK he's under 200 this AM so I give him no insulin (or shouldn't have). Let's say tonight it's 300. Do I give him the 2 units per the vet's instructions?
 
Re: 1/6/12 Hobbs AMPS 134

With Lantus, doses aren't adjusted by the preshot values, but by the nadir (the lowest number of the cycle, usually about 6 hours after the shot). That's why those mid-cycle tests are important. Here's a the Lantus sticky that explains how dose adjustments are made: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

In my opinion, I think 2u is too high a dose for him, since he appeared (I'm guessing based on the low preshot) to have a hypo on it while he was still eating the high carb food. If you're switching to low carb canned, that could be very dangerous for him. I would go back down to 1u and hold the dose for a bit until you have enough mid-cycle tests to see how he's reacting to it. You have no idea if he's staying high during his cycle on the 1u (which would mean an increase to 1.25u, not 2u), or if he's getting some normal numbers which would mean you'd keep holding the dose while his body adjusts to the normal blood glucose numbers.

Lantus requires a lot of patience, and consistency is key with this insulin. You might hold the same dose for weeks at a time despite high preshot numbers if you're getting some good numbers mid-cycle.
 
Re: 1/6/12 Hobbs AMPS 134

Last night he was 500 and the vet said to give him the 2u, so I did when I got home and then he was down to 134 this morning.

As for food, I mixed 1/4 of a can of the K/D with a 1/4 of the can of the DM last night and then mixed 1/3c (total) of the DM and K/D dry. So I guess it's only partially high carbs? I'm going to go this weekend to a couple of places in town that have the food I want to give him and see what it costs. Or I guess I could let my fingers do the walking...
 
Re: 1/6/12 Hobbs AMPS 134

I guarantee that any of the premium foods you want to feed be will be cheaper than the prescription foods.

I understand that the vet told you to give the 2u, but your vet is not following the correct dosing protocol for Lantus. I'm attaching an article and linking you the dosing protocol for Lantus. You might want to print out and bring to him if you want him to be on board with what you're doing. My vet did not give correct dosing advice either...but after I gave her the article and said "This is how I want to do Bandit's dose adjustments," she was on board with me, and now she understands gives the correct dosing advice to all her diabetic cats. She's a fantastic vet, but she simply wasn't aware that dosing for cats was different than dogs--this article just came out a few years ago, and the AAHA I think didn't update their guidelines until 2010. Vets have to know about many different diseases for many different animals. Even great vets can't possibly keep up to date on every detail for every disease for every animal.

http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf
 

Attachments

Re: 1/6/12 Hobbs AMPS 134

I feed him right when I get home for a couple of reasons. For one, to him, mommy home = dinner time. For two, if I get busy doing other things, I'll forget. And I have.
Click to expand...

My lifesaver for this problem is one of those kitchen timers - whenever I remember it's nearing time, I set the timer for that long. Sometimes it's an hour or two, sometimes 15 minutes. I always THINK of it sometime before.... :roll:
 
Re: 1/6/12 Hobbs AMPS 134

Julia & Bandit said:
I guarantee that any of the premium foods you want to feed be will be cheaper than the prescription foods.
Click to expand...

Oh, for certain. :) I just figured I might as well get the best price! Also because I'm not sure who has what and not every store carries every product even if the manufacturer's website says they carry the brand.
 
Re: 1/6/12 Hobbs AMPS 134

SabrinaFaire said:
Julia & Bandit said:
I guarantee that any of the premium foods you want to feed be will be cheaper than the prescription foods.
Click to expand...

Oh, for certain. :) I just figured I might as well get the best price! Also because I'm not sure who has what and not every store carries every product even if the manufacturer's website says they carry the brand.
Click to expand...

Shopping around is smart--I've found some wicked deals by comparing prices around town! I save $6 a case by buying food at my local feed store vs PetCo.
 
Hi Sabrina,

I'm guessing that's your name? I'm new to Lantus but not diabetes. It looks like the others aren't on so I thought I would jump in. No matter what his PS is right now don't give him anymore than 1 unit.....well, if it's lower than 200 you don't want to shoot but over that shoot 1 unit for now.

Barbara
 
Thanks, Barbara. :) I went with 1.5. He was on 1 all last week and his numbers were in the mid 300s the whole time. I kind of thought the vet would put it at 1.5 instead of putting it back to 2.

I should say that I've seen 3 vets at the practice. Not sure if it makes a difference.

Dr. J - She dx Hobbs with the kidney disease and with the diabetes, saw her at the first week FU, she set Hobbs at 2u
Dr. G - He's new to the practice, saw him for 3 FUs, he lowered Hobbs' dose to 1u
Dr. K - Saw him last night, he raised it back to 2u, first time Hobbs' seen him
 
Lantus and Levermir work very differently than a lot of other insulins as it has to build up a shed. It also likes consistency, you hold a dose for at least 5 days if not longer some cats take awhile to 'settle' into a new dose. The problem with using the numbers you have is that most of them were gotten at the vet's office and more than likely influenced by vet stress, so are much higher than they will be at home. Also for awhile when a cat starts finally getting into normal numbers their bodies have to relearn what normal is, so when it hits a normal number their livers release stored sugar to try to save itself what it now precieves as a low number. So they will shoot way up for several days or what we call bounce. As they adjust to those normal numbers again the bouncing slows down and then stops.

My little Musette is a pro at bouncing, mainly because before I adopted her, her previous owner only gave her insulin every now and then when they thought about it, so she was constantly running high, so high in fact that she went into DKA once, recovered and almost went into DKA again. That was when they decided that she was too much bother after owning her for 11 years and surrendered her to be put to sleep. Luckily DCIN stepped in and contacted me about adopting her. Even after 6 months of getting insulin on a regular basis her liver will still freak out when she hits double digits and we are back to fighting off a bounce, that is one of the reason she is on an atypical dosing schedule.

The other problem we see a lot with newly dxed or new to home testing is too much insulin looks exactly like too little insulin until you start getting mid-cycle tests to see exactly how low they are really going.

Mel, Maxwell, Musette and The Fur Gang
 
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