11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 454

[Suzanne & Cobb(GA)]

Hi all,

I'm coming over from the general health board (just joined last Sunday) - hoping to get some lower numbers for my Cobby.

To be honest, I feel like his insulin dose is higher than it should be due to him remaining on dry food post-diagnosis back in April. Since his diet wasn't where it needed to be his dose just kept going up and up with no sign of improvement. In fact, his numbers were initially lower pre-human baby (born in June) when we got off on testing. But now his body is used to these higher doses.

Just switched to Friskies Special Diet flavors yesterday so we're hoping to see better numbers soon!

Thursday:
AMPS: 353
+4: 238
+6: 227
+8: 170
+10: 240
PMPS: 285
+2: 434
+6: 266

Friday:
AMPS:437
+5: 375
+9: 450
+11: 300
PMPS: 385
+1: 468
+4: 387

He seems to be much more active since last week...jumping on our bed at night, purring a ton, and not isolating himself to the bathroom anymore. I also did notice he started grooming himself again -- and his coat is softer than normal. Litter box activities haven't changed really, although he could be peeing less.

Appetite-wise, he is really hungry with the switch off dry. He's eating several large cans of Friskies a day...3-4, and he probably would eat another if I offered it.

I look forward to hearing from everyone on your thoughts and how we can get these numbers lower!

 

[julie & punkin (ga)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338

ohmygoodness - looking at your photo of cobb is like looking at pics of my punkin! you can look at the link to his profile if you want to see some, you just have to be patient while the pics load on the google doc.

good for you for getting a spreadsheet up and going and getting him switched to canned food. that's great progress already!

are you still giving him 10u doses, like it says on the ss? if you've made the switch from dry food with 10u to canned food, he very likely will need less, but we don't want to upset the apple cart too quickly.

in your post here you've mentioned Friskies Special Diet and on his ss it mentions Royal Canin foods - was that previous and now he's on only Friskies?

can i get you to fill out a profile for him too? all that extra information helps us figure out how to best give you advice. Take a look at this link New to the Group? and just down from the top of the page you'll see the link on how to develop a profile.

i'm very glad you came over here. You'll see some of the same names, but there is a lot of activity experience on this forum with people who use Lantus. I haven't checked your previous posts yet, and will do that, but people may have commented on his dose. He's getting a relatively high dose, which might have been appropriate for the dry food, and might even still be appropriate for him, but let's look at it and figure out if that's the case.

when i arrived on FDMB punkin was getting about 7units. he needed it, but a lot of people here are accustomed to cats with 1u doses. so for right now, let's gather info from you and see what the potential next steps might be.

I'd like to know how big Cobb is, the background of him being diabetic - has he continued gaining weight since he was diagnosed or did he lose weight with the initial illness? does he make snoring type sounds when he breathes at all? big feet, tongue or stools?

what time zone are you in - and what time do you shoot tonight? in other words, can you count from my post time here and tell me how many hours until you shoot again? i'd like to discuss his situation with some others and get back to you.

 

[Wendy&Neko]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338

Hi Suzanne and welcome to you and sweet Cobb to the Lantus TR forum. This is a great place to get advice and support. People here love to help.

I'm adding links to some of your other posts in Health:
Introduction
First low number
switching to wet food

We link each posting to our previous post so people can track what has been going on with kitty. Just copy the URL address in your browser, go to URL button in the editor, and paste the address in there.

 

[Sienne and Gabby (GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338

Welcome to Lantus Land!!

It's possible that Cobb is a high dose cat given the 10u dosing. However, from what you noted in your Introduction on the Health Board, your vet was increasing Cobb's dose in 2u increments. If you have had a chance to look at the Tight Regulation Protocol sticky above, you'll note that we recommend increasing the dose in 0.25u increments. In some cases, if increases are done in too large of an amount, you end up missing what could be a good dose. In addition, while it's counterintuitive, your kitty may end up sitting in high numbers.

There may be other causes for high numbers. Do you know what kind of shape Cobb's teeth are in? Any source of infection or inflammation can contribute to higher than desirable numbers.

It may be worth getting Cobb tested for acromegaly and for insulin resistance. The tests are run out of the vet lab at Michigan University. Having the tests will help you to rule out whether either (or both) of these conditions are present and let you know whether the current dose is appropriate.

Please let us know if you have questions. The people here are very generous with their time and their information.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338

Thank you Wendy! I appreciate you linking my previous posts.

are you still giving him 10u doses, like it says on the ss?

Yes, I am still giving him 10u doses. I didn't want to make any dosage changes by myself. And I sent Thursday's curve to the vet and she told me to stay on the 10u. (She also told me to give dry food in toys as treats, so you can understand my hesitation in listening to her now!!)

in your post here you've mentioned Friskies Special Diet and on his ss it mentions Royal Canin foods - was that previous and now he's on only Friskies?

Going forward he will only get Friskies. My husband fed him midday today and didn't realize we weren't going to use the Royal Canin any more. It will be going back and exchanged for Friskies special diet only.

I'd like to know how big Cobb is, the background of him being diabetic

Cobb's background on being diabetic is a bit complicated. We've moved several times from SC to FL to GA. In SC, as a younger cat he topped out weight at 20 pounds and his vet wanted us to get his weight down so he wouldn't end up diabetic. (ironic) I moved to Florida and the vet there put him on wet W/D food because he had previously had a bladder blockage. We fed him what they said and he lost several pounds in a year. They freaked out and put him back on dry w/d. We then relocated to Georgia (where we are now). Our first vet visit was a train wreck. They lost our appointment time and then came in to remove stitches for Toby. Obviously Cobb didn't have stitches, but that didn't keep the vet tech from still trying to find them. They ran a blood test and it came back that he was borderline diabetic, but given our experience we were very hesitant to trust them. Fast forward a year later and our current vet, she ran a blood profile and it came back diabetic. She had taken a lot of time getting to know him before she did anything so we trusted her judgment. So he was an untreated diabetic for a year -- eating dry food. I feel like such an awful mom!

has he continued gaining weight since he was diagnosed or did he lose weight with the initial illness?

He has lost maybe 1/4 pound since he was diagnosed. He now weighs 17 pounds. I'm not sure he lost weight with his initial illness. He dropped from 20 pounds several years before he was originally diagnosed, but he may have lost a pound in the last year.

does he make snoring type sounds when he breathes at all?

Yes, he makes snoring sounds when he breathes.

big feet, tongue or stools?

No big feet or tongue. Stools? I don't think they are abnormally large, no. I've never noticed any difference in stool size.

what time zone are you in - and what time do you shoot tonight? in other words, can you count from my post time here and tell me how many hours until you shoot again? i'd like to discuss his situation with some others and get back to you.

I am in eastern standard time. If I'm doing the calculations correctly, you posted at 1:19 (which is 3:19 here). We shoot at 8pm, so that would be...6pm per the post times?

I will work on a profile for you right now!!

 

[julie & punkin (ga)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338

thanks for linking all of those, wendy.

Wendy and I both have experience with diabetes caused by acromegaly and insulin auto-antibodies in our kitties. there are several cats on this forum with high dose conditions, although we can't say for certain that your kitty is one of those yet.

the dry food can make a huge difference. when was his last bite of dry food? we've had people document that in a very carb sensitive cat, literally a few kibbles (3-4) can take their cat's blood sugar into high numbers and keep them there for another couple of days. that's why we encourage people to get rid of the dry food entirely. it's also the reason vets encourage the dry food. with it around, there's not much chance that a cat will ever get into low numbers or have a hypoglycemic experience. there's also not much of a chance that they'll go off of insulin, which is a good possibility with cats who get regulated quickly and follow the Tight Regulation Protocol.

But lest we overwhelm you, let's give you information in smaller amounts.

i think the first step is for you to answer the questions in my last post so we have a better picture of what's going on with Cobb. the cat that was mentioned to you that was overdosed was Casey who was also on dry food at the beginning. you can follow Mel's posts backwards through the links in the first post of the day to follow his story. let's hope that Cobb is going to have a similar story!

oh, and for slowing down his eating, you can add a golf bowl to a large saucer so he has to work around the ball. we like to feed cats most of their food in the first 3-4 hours after their shots of Lantus so that the carbs are there when the lantus is strongest. then minimal food in the second half of the 12 hr cycle coming up to the next shot. that lets us see pretty clearly what the insulin is doing. don't feed him in the 2 hrs prior to a test because then you're measuring blood sugar that's just gotten a shot of sugar (carbs) from his food. sometimes changing food patterns can make an enormous difference in teh blood sugar.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338

Hi Sienne!

It's possible that Cobb is a high dose cat given the 10u dosing. However, from what you noted in your Introduction on the Health Board, your vet was increasing Cobb's dose in 2u increments. If you have had a chance to look at the Tight Regulation Protocol sticky above, you'll note that we recommend increasing the dose in 0.25u increments.

Yes, we've always thought the 2 units at a time was too much!

Do you know what kind of shape Cobb's teeth are in? Any source of infection or inflammation can contribute to higher than desirable numbers.

No vet has ever said anything about any teeth problems. I do know he lost a tooth in the past 2 years, but nothing was ever infected or inflamed to my knowledge.

 

[KPassa]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338

Just wanted to pop in and say, "hi!" You are in great hands here and they'll be able to help you with all of Cobb's needs. You're already doing such a great job with Cobb!

 

[Anne & Zener GA]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338

Welcome to LL, the greatest place you never want to be! We've been here over two years now and know that without all the experience and support from everyone, we would not still have our wonderful gentleman cat Zener. You are getting the benefit of lots of great experience already! Welcome welcome. :YMHUG:

 

[Libby and Lucy]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475

welcome to LL!

I only briefly skimmed your other threads. I'll read them better later. Thank you for setting up your profile and spreadsheet. IMHO you are doing the right thing by switching diet and gathering lots of data so we can help figure out what is going on with Cobb.

I'm in an interesting position because I had TWO cats that came to me on higher than normal doses. One turned out to be a high dose cat, the other was just over dose.

As a disclaimer, I have been here a long time and have a good bit of experience with Lantus and Levemir, so I'm not necessarily recommending that anyone follow my lead in dosing. I knew I could be aggressive with increases because I understand the insulin well and I knew I could stay out of trouble. ;-) Fast-tracking isn't necessarily a technique for newbies.

Jazzy was a foster kitty who was on 7u BID of PZI when I got her. She had been on doses up to about 10 units of PZI. I knew quite a bit about what the rescue had already tried to do for her before she came to me for foster, so I already had a hunch that she had acromegaly. When I got her, I switched her from PZI to Lantus and backed down on her dose a little bit. I tested enough that I could increase her dose somewhat aggressively until she got to a breakthrough. I kind of already knew she was going to need the higher dose, but I wanted to be extra sure, especially because at first she was living in a separate room where I couldn't always see her. When I had a few extra bucks, I got the acro and IAA tests done to confirm my suspicions. Yep, she had acromegaly. I think her highest dose was 14 units BID of Levemir.

I adopted KK from the same rescue earlier this year. He was on 5-6 units BID of PZI. I can't really say why I didn't believe he was really a high dose cat, but I wasn't very confident that he actually needed that much insulin. When I got him, I switched him to Levemir and dialed back to 1 unit BID. I figured I would do the same thing I did with Jazzy - test a lot and fast-track up the dosing scale. I didn't need to. He responded right away and his highest Levemir dose was 2.25 units BID. When he died in October, his dose was only 0.1u and he wasn't even getting that every day.

That's my long way of saying that you have choices. Gathering your data is a good thing and I think the picture will start to become clear. So far I don't see anything on his spreadsheet that screams that he needs an immediate reduction, but the diet change could change that so stay on top of it. Do you know what % carbs the RC is?

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475

Hi! Thanks for sharing!

To be honest, my gut tells me Cobb is not a high dose cat. It isn't denial, but the entire time we were increasing and increasing, I felt like we were doing it too quickly and too much. I could obviously be wrong, but he doesn't really show any other symptoms other than being a Garfield-fat cat!

When I got her, I switched her from PZI to Lantus and backed down on her dose a little bit.

In response to this, and I haven't put this in a profile anywhere...

The vet originally started Cobb on 2u of ProZinc. He was still eating dry food. She increased it by 2units every two weeks until the beginning of June. That's when I had our first baby and the vet figured it would be too much to test while caring for a newborn so she said to curve again when we could. I think by that time he was on 6 units of ProZinc (I can look back to be sure). But his numbers, at the time, were much lower than the HI and 500s that we have recently been getting.

Once we got a handle on the baby, and had some family in town and I could actually get down on the floor with Cobb again, we curved and his numbers were still in the 300s. She had us start increasing again -- 2units every 2 weeks until we maxed out the syringe's 12unit capacity. That's when she switched to Lantus.

The first Lantus dose he received was 6units at the middle of September. Upped every few weeks until about 3 weeks ago which is when we landed on the 10units.

I don't know if any of that information helps anyone else out with their recommendations.

When I had a few extra bucks, I got the acro and IAA tests done to confirm my suspicions. Yep, she had acromegaly.

This is our issue right now regarding the tests. With the new baby and my quitting my job to care for him our funds are stretched as it is -- the insulin is $200 so additional tests at the moment really aren't possible.

When I got him, I switched him to Levemir and dialed back to 1 unit BID.

While I'm pretty sure this isn't the thing I should do, we were just talking about whether this is what we might should do. High numbers (from what I understand) are "better" than low numbers. Would it make sense, with the wet food change, to dial back the dosage a few units and see how he responds to it?

I am SAHM right now so I can dedicate the time to intensive testing, especially during the day, although Cobb won't be thrilled with that! I am not opposed at all to being aggressive to get my little guy in the blue/green zone!

Do you know what % carbs the RC is?

Well, I did the calculation off the can (per a posting on the main page), but was told that wasn't reliable and I'd have to call the manufacturer. I figured I'd just switch to a cheaper, proven low carb food instead.

 

[Chris & China (GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

HI Suzanne!! Glad to see you made it!!

As I promised, you're getting all kinds of good advice and the people here are just great about helping! I won't add anything more at this point since you've already got a lot to digest, but we'll all be with you every step of the way.

The learning curve is steep, so if we start throwing things at you too fast, don't feel bad about saying "Slow down please!!"

Again, welcome to Lantus Land...as you can see, you're in the right place now

 

[Kim & Twice]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

Hi Suzanne & super sweet Cobb!

Just wanted to say hi and welcome you to LL! You're in great hands now, and I see you've already got your profile and ss completed. Well done. Sounds like you are very in tune with your Cobb and that, combined with the knowledgeable people here, is going to make this all a lot less intimidating Looks like you have a lot of 'homework' to read thru right now. Please don't be afraid to ask questions. I look forward to hearing much more about Cobb!
Have a great night!

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338

when was his last bite of dry food? we've had people document that in a very carb sensitive cat, literally a few kibbles (3-4) can take their cat's blood sugar into high numbers and keep them there for another couple of days.

Sorry, just realized I hadn't answered this question. His last dry FOOD was Sunday overnight. I did give him a treat maybe on Monday and Tuesday. I'm guessing they are too high in carbs.

I also updated some of the remarks on the spreadsheet which should give a better picture of when RC wet has been given and how his BG responded.

 

[julie & punkin (ga)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

it's downright eerie looking at Cobb's picture! punkin passed away in May, but of course he's always on my mind. they may not look alike overall, but your pic could be him.

ok, back to Cobb.

the Royal Canin adult has 14% carbs. We use the list at Cat Info.org that is run by a vet (who posts on FDMB sometimes) for our carb references. She updated the lists a year or so ago.

If he hasn't had dry food all week, then he's probably not still being affected by it. however, with the RC adult at 14%, that's pretty high. Most of us, unless we have some reason for needing it otherwise, try to keep carbs under about 7% or so. There are a lot of food choices that fall into that category. There's no reason to try to get to 0% carbs, however, so don't make that your goal. I fed mostly 4-5% foods and that worked well.

Timing of eating matters also. if you can adjust his food intake so most of it is early in the cycle like i described in the earlier post.

Food is everything - eating a high carb diet and trying to give enough insulin to compensate is like a human diabetic trying to get by eating candy and ice cream daily. you'll want to keep all of his diet low carb unless he has low numbers (we consider less than 50 as being low, although dangerous low is not til under 40. we feed carbs to numbers under 50 to bring them up into safe ranges.) You'll want to make sure you have a "toolkit" of cat foods with gravy or karo syrup, along with a spare container of unopened strips, just in case you need them.

Thanks for doing the profile!

you are right about it being better to be in high numbers for longer, than in low numbers. High numbers aren't great, but for a short time they don't cause permanent damage.

I think you have a couple of paths open before you that you can choose between. Libby outlined her experience and why she did each one as she did. Having increased doses by 2u at a time, it is possible Cobb missed his "right" dose. If you drop back to a starting dose you would be increasing at .25u or .5u, doing at least 4 tests a day (preshot am and pm, at least one test in between - although more tests help us see what's going on.) You would hold each dose for about 6 shots or cycles, depending on what numbers you got.

the downside of that is if Cobb needs a higher dose, he will be spending a couple of weeks in higher numbers while you take him back up in dose. the positive is that if he is overdosed, we'll be able to tell it because he'll be getting better numbers on a lower dose.

the other option is to monitor him now with lots of tests being ready to reduce his dose if he gets under 50. the downside of this is that it can be very hairy and nerve-wracking to go down the dosing scale and dealing with low numbers. it requires more attention than a cat who is going up the dosing scale. the plus side is that if he genuinely needs a higher dose, he's not going to be wasting time sitting in high numbers while you've reduced his dose and gone up slowly.

symptoms of acromegaly include noisy breathing (stridor) and snoring (from excess tissue in the airways), big feet, tongue, sometimes a forehead that goes more vertical instead of at a slant from the nose back to the ears, sometimes the teeth spread out as the jaws grow, large poop (from a colon that has enlarged), sometimes a heart murmur. the most obvious early symptoms are an insatiable appetite and a need for a higher dose of insulin. an unregulated diabetic cat might also be always hungry, too, however, so that alone doesn't say it. one important clue in some cats is a cat that continues growing while the diabetes is still unregulated. most newly diagnosed cats will lose weight, in spite of eating a lot. sometimes cats with acro will continue to grow.

i don't think we can identify iaa, insulin auto-antibodies by anything in Cobb's case at this point. it happens when the body produces antibodies against the insulin being injected. on a spreadsheet that can look like you've hit a good dose, bringing the numbers down, and then it seems to go away and you have to give more insulin to bring the numbers down. in a cat that's gone up the dosing scale it's visible on the ss - but that's not Cobb's situation.

do any of the symptoms of acromegaly seem to fit Cobb?

what questions can we answer to help you sort out what to do next?

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

The only symptom he has is the snoring. But that is not a new development. He has been snoring since he weighed 20lbs. I figured it was because of his weight.

I'm going to discuss the next step with my husband to see what he thinks as well.

I am currently home all day with the baby so I can watch him, but he is usually upstairs while I am downstairs. Also I'd assume that if he did have a hypo episode I'd have to work quickly and maybe even get him to a vet, which would be difficult to do by myself with a baby.

Knowing all of that, what would you do?? I'd love any and all opinions!

 

[julie & punkin (ga)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

because we monitor with home-testing, it's pretty unusual for a cat to need to go to the vet for low numbers. but if he's overdosed and his food carbs have now been reduced from pretty high to very low, we may very well see low numbers in him. if you measure a low number, just post here with the # in your subject line (edit your first post) and say "help" or something like that and people will help you walk through it. it's not hard once you've learned how. basically you give a teaspoon of the gravy part of the cat food, or of karo syrup, wait 20 minutes and retest their blood sugar. then repeat if he's still under 50. that doesn't require a vet.

however, if he's significantly overdose and he does get into seriously low numbers, a hypo event with lantus can last a long time and require a vet. this is a depot-insulin, meaning that when you inject it it forms a precipitate in the body and slow releases. so if there is way too much, it can be a 24 hr event of constant monitoring or a glucose drip to get through.

there isn't a perfect answer. when i came here punkin was getting (i thought) 3.5u. in a discussion about syringes, it came to light that i was using the wrong syringes for Lantus, which is a u-100 insulin. i still had the syringes for ProZinc, which is a u-40 insulin. can't mix the two! what it meant was that punkin was getting about 7u of insulin per shot instead of 3.5u.

we had a similar discussion and because he didn't have high highs or low lows, mostly 200's, we opted to stay with the dose and monitor. we'd already been on here a while so people were familiar with us and i'd gotten the hang of the hometesting and all. there was nothing to say that he was overdosed, although he had not been increased in .25u or .5u increments, he had some time in between his increases - enough to say it was probably not too much.

just fyi - fat alone can increase insulin resistance. if you can get him moving (and as i say that i'm thinking you've got a new baby and a person can only do so much!) and more active, that alone will help his cells be more receptive to insulin. what's his weight right now? if he needs to lose weight, it needs to be done slowly. cats can develop a fatty liver - it literally can clog with fat - if they lose weight too quickly.

what's your husband's take on it?

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

My husband is more concerned about a hypo episode and me having to deal with that with a screaming baby and getting incredibly overwhelmed.

I did the starting dose calculator, and given his current weight of 17lbs (7.7kg), it looks like the starting dose on Lantus should be 2units. We started him at 6 units on Lantus.

 

[Wendy&Neko]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

My non diabetic cat (we call them civie's) also snores when he sleeps, so that's not by itself an indicator of acromegaly. Neko didn't have many signs, the biggest one was her appetite, including fondness for bread products. :roll:

We have a sticky on how to handle low numbers but it basically means feeding higher carb food and/or karo/syrup and monitoring regularly (testing every 20-30 minutes) until the cat is in higher numbers. Trips to the vet for low numbers are not common, but still possible.

I see you started Prozinc on 1-2 units. What size increments were done while on that insulin?

 

[julie & punkin (ga)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

there's nothing wrong with you restarting at 2u if you would like to do that. is that the direction you'd like to go?

if so, just give that for your next shot and let's see what happens. we'll be prepared to increase him quickly if he doesn't respond.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

I see you started Prozinc on 1-2 units. What size increments were done while on that insulin?

2 units. She always increased by 2 units except for right when we had the baby and she thought we wouldn't be up for testing. Then she only increased it by one.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

there's nothing wrong with you restarting at 2u if you would like to do that. is that the direction you'd like to go?

if so, just give that for your next shot and let's see what happens. we'll be prepared to increase him quickly if he doesn't respond.

Yes. I think we're going to do 2units tonight. With the food change, both of us are pretty nervous about him dipping too low. That was our concern when we got our orientation originally too. Right now, I'd rather his numbers be a bit higher and work to get to the right dose than to overdose him (especially starting with a night dose when I'm asleep for much of the night) and him having a hypo episode. A need for a vet or not...I think right now that would be incredibly stressful for all involved.

I'll give him 2units now...get a before bed number, and I'll probably be up twice tonight and can get a test in at least once, if not both times. Good plan?

 

[Chris & China (GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

If you can get a +2, that can give you an idea of how active the cycle might be, so it's a good one to get if you can..or a +3

If the number at +2 is a lot lower than the pre-shot number, that tells you that you need to be ready to test more frequently because it's probably going to be an "active" cycle

If it's about the same or a little higher, you can expect a "normal" cycle and don't need to worry quite so much ..just get another test before bed or somewhere between +5 and +7 to make sure it's safe for you to go to sleep, or if you might want to set your alarm

 

[Dale 'n' Chip]

Re: 11/30 Cobb (newbie) AMPS 266,+2 209,+6 338 +8 475 +10 49

...I'll give him 2units now...get a before bed number, and I'll probably be up twice tonight and can get a test in at least once, if not both times. Good plan?

I didn't notice on the SS are you testing for ketones?

When dropping the dose that much you need to test for ketones often.

Especially when the numbers are high.

 

[Marje and Gracie]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Hi Suzanne

A warm welcome to you, Cobb, your DH (dear husband), and baby boy to Lantus land. You've been doing great with him considering how busy you must be with a new baby

I am a little surprised his numbers didn't come down some when you stopped the dry but, as Julie said, the 14% Royal Canin can also cause numbers to stay high if he's carb sensitive.

A few of us are studying his SS to try and make some more specific suggestions about his dose but it also boils down to what you would like to do or feel you need to do. In the mean time, I would be sure I have plenty of test strips, some high carb food with gravy (like fancy feast gravy lovers), and some karo/honey/ or other syrup around. As you finishing transitioning from the 14% food, we might see numbers coming down and we want to be sure you are prepared if his BG comes down fast or low.

Insofar as his eating, I'd figure out what his calories per day should be that maintain him at a good weight and then I'd feed half of that in the a.m. cycle and half in the p.m. cycle, finishing before nadir as Julie suggested. If he's at a good weight, then just divide his current amount of food into half and feed as above.

If he's overweight or you don't know how many calories is getting, you want to make any changes very slowly. As an example, a good place to start would be about 20 calories per pound. So first, weigh him, figure out how much food 20 calories/pound is. How does it compare with what he has been eating? You don't went to drastically cut his calories if it's a lot less. You don't want him to lose more than about 1% of his weight a week. But the goal is to make small changes and then weigh every week. If he gains, reduce a bit more. If he loses, decide if it's a slow weight loss (1%) or its too fast.

It is importent that you regulate his calories and this post on Feed kitty as much as they want? has a good discussion.

We're here to help....just let us know your questions.

 

[Sienne and Gabby (GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Just an observation...

When you use the formula to calculate the Lantus starting dose, it is based on the assumption that Lantus is the first insulin that a cat has been given. When switching from another insulin to Lantus, the dose of the previous insulin is taken into account.

Since it doesn't seem like this is a good time for you to test for a high dose condition, it's fine to lower the dose. IMHO, dropping the dose to 2.0u may be excessive but I can also appreciate the demands of having a new baby and wanting to avoid a trip to the ER for Cobb. I would not want him to sit in high numbers for overly long, though. I had been thinking of a dose of 5.0u but whatever you feel most comforable with is fine.

Which Royal Canin had you been giving Cobb? It looks like the diabetic formula isn't on Dr. Lisa's food chart. Using a calculator that approximates the values, the diabetic diet is pretty low in carbs.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

I am a little surprised his numbers didn't come down some when you stopped the dry but, as Julie said, the 14% Royal Canin can also cause numbers to stay high if he's carb sensitive.

Well, his numbers did drop by about 300 points initially -- just the switch from dry to wet. And we did get a 170 at one reading. But yes, the 14% RC may have contributed to those numbers not dropping far enough. Also, he has been in the 500-600 range for awhile now. I'm guessing it probably takes his body a minute to adjust and if he's being overdosed, I'm reading that can keep his numbers higher than they should be as well, right?

A few of us are studying his SS to try and make some more specific suggestions about his dose...

I do have my records back from when he first started on ProZinc. Would that be helpful for me to put at the top of my spreadsheet so you can see everything he has done since going on insulin?? I'll be glad to put it in.

Insofar as his eating, I'd figure out what his calories per day should be that maintain him at a good weight and then I'd feed half of that in the a.m. cycle and half in the p.m. cycle, finishing before nadir as Julie suggested. If he's at a good weight, then just divide his current amount of food into half and feed as above.

Currently the half and half is not working. He's just too hungry 6 hours later. I'll work on trying to adjust that though.

If he's overweight or you don't know how many calories is getting, you want to make any changes very slowly. As an example, a good place to start would be about 20 calories per pound. So first, weigh him, figure out how much food 20 calories/pound is. How does it compare with what he has been eating? You don't went to drastically cut his calories if it's a lot less. You don't want him to lose more than about 1% of his weight a week. But the goal is to make small changes and then weigh every week. If he gains, reduce a bit more. If he loses, decide if it's a slow weight loss (1%) or its too fast.

Given his current weight of 17 pounds, he should be eating around 340 calories. That is roughly 2 cans of the Friskies Special Diet a day. We haven't had a full day off the RC and on the Friskies, but I know -- having given him the Friskies last night, he was starving about 6 hours later. I will work on adjusting that as well. It may take a little bit of time. So he should be eating less, but he is too hungry to do that at the moment.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Just an observation...

When you use the formula to calculate the Lantus starting dose, it is based on the assumption that Lantus is the first insulin that a cat has been given. When switching from another insulin to Lantus, the dose of the previous insulin is taken into account.

Since it doesn't seem like this is a good time for you to test for a high dose condition, it's fine to lower the dose. IMHO, dropping the dose to 2.0u may be excessive but I can also appreciate the demands of having a new baby and wanting to avoid a trip to the ER for Cobb. I would not want him to sit in high numbers for overly long, though. I had been thinking of a dose of 5.0u but whatever you feel most comforable with is fine.

Which Royal Canin had you been giving Cobb? It looks like the diabetic formula isn't on Dr. Lisa's food chart. Using a calculator that approximates the values, the diabetic diet is pretty low in carbs.

I had initially been thinking 5.0u as well, but then thought -- maybe it's best to just start at the beginning. I also don't want him to sit at overly high numbers either for very long -- his lingering high numbers is what brought me to you in the first place!

Someone else had calculated the RC diabetic turkey and giblets (it was in a gravy) at 14% carbs. The Friskies that I picked out is between 4-7%.

What would you recommend if his numbers don't show marketed improvement on the lower dose and low carb wet food? How quickly would you go up? Obviously we've been going up at 2units at a time, so .5u or 1u would make more sense to us, depending on his new numbers.

 

[Sienne and Gabby (GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Just a quick note. Dale made a very good point about testing for ketones. If you don't have them, Ketostix are a great means of prevention. If you are dropping Cobb's dose, no matter by how much, I would suggest testing for ketones as often as you can.

 

[julie & punkin (ga)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

good, i'm glad others have weighed in on his situation.

you can give him plain boiled chicken to help him make it through the second half of the cycle. that has almost no carbs and not too many calories.

the 14% i mentioned for the RC was for the adult formula. i didn't find a diabetic formula for RC on the catinfo.org site. so if he was getting something other than the adult formula, that carb amount may not be right.

you could also go to 5.0u. there isn't a clear-cut answer on this. if you drop to 2u, you'll just want to be prepared to increase him fairly quickly, according to protocol guidelines. the protocol would have him increasing at either .25u or .5u, depending on the low points (nadir) of the cycles. the most frequently we increase is every 4 cycles (shots) if we see constant high numbers.

we don't increase by 1u until a cat is at least over 6 units. punkin got to 15.5u and i rarely increased him by more than .5u. i found that even at a higher dose he did respond to a dose increase that was fairly small.

a lot of this we take case by case and decide things as we go along. if you can post daily, we'll help you each day with it.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Just a quick note. Dale made a very good point about testing for ketones. If you don't have them, Ketostix are a great means of prevention. If you are dropping Cobb's dose, no matter by how much, I would suggest testing for ketones as often as you can.

A question about ketones...if his current dose of 10u was not enough to bring his BG down, would he have ketone issues now? He doesn't have any symptoms of DKA (thankfully!). The vet originally said we didn't need to worry about ketones, but the symptoms would be similar to hypo so whichever it ended up being he'd be at the vet anyway.

 

[julie & punkin (ga)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

just so you know, we give all dosing advice in public, posting on a "condo" like this so that others can see what advice is given. none of us are vets but we all have experience with diabetic cats. some people here have been taking care of diabetic cats for years, 24/7, 365 days a year and really understand how it all works in a cat's body.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

if you can post daily, we'll help you each day with it.

I'll be here. I update the spreadsheet any time I do a test anyway. It's a much easier way to keep track than on my phone.

 

[Ella & Rusty & Stu(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Hi Suzanne and Cobb and welcome to Lantus Land!

You have received a lot of good information and Cobb is in a good place here in Lantus Land.

Stu, my previous diabetic kitty, was overdosed by his new vet when we had to switch to Lantus from PZI Vet (an insulin that was discontinued). Every week or two the vet raised his Lantus dose by 2 units. We were up to about 8 units bid when he "crashed" and I found the FDMB and learned that Lantus was not dosed the way the older insulins are (many vets still don't know this!). At first I tried lowering Stu's dose gradually, but then decided just to start at 1 unit bid and follow the protocol. This worked for us. By switching from a relatively "low carb." dry food (EVO) to an all-wet food diet, 4 or 5% carbs, we were able to get Stu fairly well regulated. Stu had been diabetic for 4 years, but we did not know about home testing and had always shot the PZI Vet insulin "blind". It was not a depot insulin so it was in and out.
I know now that if I had home tested from the start and if I had found this board Stu would have fared much better. As it was, the years of diabetes masked other serious health issues. Still, the great advice and support we received here on the FDMB gave Stu many happy months of life that I do not think he would have had otherwise.

Anyway. You are doing a great job getting Cobb's spreadsheet up and running and creating a profile.

Welcome!!

Ella & Rusty

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

One other question...how did all of you discuss your dosing changes with your vet? I'm sure mine won't be thrilled that I cut his dose - although she isn't strict on when she gets a curve. It's kind of like, curve in 2 weeks -- if you get a chance to. But I'm sure if I continue to provide her with curve information she'll want to know why I've changed the dose. Or is it pointless to give her a curve since I'm not taking her dosing recommendations anyway?

 

[Tigger's Friend]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Hi Suzanne & Cobb, Welcome to LL!

I don't have anything extra to add re. dosing or food, other than to say you're doing a great job already with your SS & profile. Also, my Tigger is often in another room while I'm working in the office or elsewhere - I have a horrible memory, so I just keep a timer with me & set it to check on or test Tigger so I don't forget. Only problem I have then is forgetting to set the timer :lol: :lol: :lol: You'll definitely want to keep a 'hypo toolbox' for those unexpected dives, & now you're testing more, you'll start to see patterns with Cobb develop that 'll also help you.

 

[julie & punkin (ga)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

ugh, no, ketones are very serious and almost always require a vet's help to survive them. they are not solely brought about by high numbers and can appear in lower numbers as well.

the recipe for ketones is not enough insulin + infection + not enough food. it is good to check often (a couple of times a day) for them when he is unregulated like this.

the one thing you can do is to add water to his food to keep him well-hydrated.

low numbers are different than a symptomatic hypo. low numbers can be dealt with at home.

we don't know if 10u wasn't enough to bring his numbers down. a cat that is overdosed can have a very zig-zag cycle - the insulin brings them down and the liver reacts to let loose stored sugars and hormones to counter the drop, sending the BGs soaring. that's why there is some rationale for him possibly being overdosed. there is also the possibility that he has a high dose condition and actually needs more than 10u, which is why his numbers are still high. we don't know which case it is.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Hi Suzanne and Cobb and welcome to Lantus Land!

You have received a lot of good information and Cobb is in a good place here in Lantus Land.

Stu, my previous diabetic kitty, was overdosed by his new vet when we had to switch to Lantus from PZI Vet (an insulin that was discontinued). Every week or two the vet raised his Lantus dose by 2 units. We were up to about 8 units bid when he "crashed" and I found the FDMB and learned that Lantus was not dosed the way the older insulins are (many vets still don't know this!). At first I tried lowering Stu's dose gradually, but then decided just to start at 1 unit bid and follow the protocol. This worked for us. By switching from a relatively "low carb." dry food (EVO) to an all-wet food diet, 4 or 5% carbs, we were able to get Stu fairly well regulated. Stu had been diabetic for 4 years, but we did not know about home testing and had always shot the PZI Vet insulin "blind". It was not a depot insulin so it was in and out.
I know now that if I had home tested from the start and if I had found this board Stu would have fared much better. As it was, the years of diabetes masked other serious health issues. Still, the great advice and support we received here on the FDMB gave Stu many happy months of life that I do not think he would have had otherwise.

Anyway. You are doing a great job getting Cobb's spreadsheet up and running and creating a profile.

Welcome!!

Ella & Rusty

Wow...Ella that sounds eerily similar. We have also been shooting blind (until this week, at least). We were told daily home testing was unnecessary. Cobb was also eating EVO for awhile until the vet wanted him on the RC diabetic. I was telling my husband last night that I never wanted to be an expert in feline diabetes, but it looks like I'm going to have to be the one that does it!

 

[Marje and Gracie]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Sienne and I discussed the drop back to 5u and I do agree with her but if you feel more comfortable with 2u, that's your decision. We can help you fast track. Yes...if he's overdose, his numbers might be high and flat (see the SS I linked below).

Obviously we've been going up at 2units at a time, so .5u or 1u would make more sense to us, depending on his new numbers.

When you drop the dose back because you think he's overdose, we call it a "rebound check". Generally, (but keep in mind ECID), you want to give at least six cycles at the lowered dose to let the depot drain from the higher dose. A higher dose can affect up to six subsequent cycles (and we've seen it affect a couple cats a little longer....see Teronto's SS). If he's high and flat then, I think we have a couple options....but we need to stay flexible. Depending on his numbers, you could increase by .25u every four cycles or .5u every six cycles. We would not go up by 1u....that's just too fast and defeats the purpose of taking him down.

I keep boiled chicken breast around so if Gracie gets hungry later in the cycle after all her food is gone, I can give her a small, very low carb "treat".

The more numbers we have, the more helpful but we don't want to take up a lot of your time unless it would also help you to see it on a SS. I can only imagine how busy you are with a baby but we would never look a gift horse in the mouth when it comes to more numbers

 

[julie & punkin (ga)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

re the vet . . . many people don't provide a spreadsheet that they keep for here to their vet. then they nod and say "uh huh" to the dosing info the vet gives. you don't have to tell them what you're doing.

for whatever reason, although the protocol put out by Rand/Roomp is the only published protocol for treating diabetic cats, vets don't seem to use it very often. most vets don't see very many diabetic cats. my vet practice of 3 vets had one other diabetic cat besides punkin - and honestly, if punkin hadn't had acromegaly their dosing might've killed him. that mix-up with the wrong syringes could've spelled death for another cat.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Sienne and I discussed the drop back to 5u and I do agree with her but if you feel more comfortable with 2u, that's your decision. We can help you fast track. Yes...if he's overdose, his numbers might be high and flat (see the SS I linked below).

Perhaps I gave him his PM shot too soon and should have waited for more opinions. I really want to do the right thing here. Like I said, I originally thought about 5u, but then also figured maybe we should just start over. Since I've given the 2u tonight, does everyone feel like I should stick with that or should I do 5u instead? Honestly we have never been comfortable with the 10u that he's been on.

The more numbers we have, the more helpful but we don't want to take up a lot of your time unless it would also help you to see it on a SS. I can only imagine how busy you are with a baby but we would never look a gift horse in the mouth when it comes to more numbers

Regarding the spreadsheet...am I providing enough numbers? Is there a time period I need to cover more often? I know I don't have many +2 readings - is this a better reading than a +4? I can only really get a good drop out of his right ear, so all the testing this week has left it a little raw. I'm hoping it heals quickly. I've never gotten a good drop out of his left ear.

 

[julie & punkin (ga)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

you said earlier that you have the data from earlier with his diabetes adventure. it would be fantastic if you could add some lines at the beginning of his ss and include it in, as best as you can. it all helps fill out the picture.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

you said earlier that you have the data from earlier with his diabetes adventure. it would be fantastic if you could add some lines at the beginning of his ss and include it in, as best as you can. it all helps fill out the picture.

Absolutely! Give me about 30 minutes to get it all in.

 

[julie & punkin (ga)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

:lol: boy are you fast on the responses!

get some Neosporin ointment with pain relief to help his ears. it'll help them heal overnight. the stuff works incredibly well at taking out the owie. wipe off most of it before you test so it doesn't goo up the strip.

don't give him more insulin now. let us talk about morning. i think having that earlier data will help fill out the picture.

as far as the testing goes, it really helps to get random tests here and there at this phase. so maybe get a +2, 4, 6, 8, 10 one cycle and 3-5-7-9 another cycle. just vary it. we like to see a +1 here and there so we can see if he gets a spike from the carbs in his food.

you don't have to test every couple of hours all the time. but you're offering, and as Marje says, we'll never turn down extra tests! :lol: i think of the spreadsheet like a jigsaw puzzle. the more pieces there, the clearer the picture is. but reality of time, energy and costs of strips, not to mention cooperativeness of the cat, factors in too. i usually did about every 3 hrs til i understood what punkin's body was doing with the insulin, then figured out which tests i didn't need.

 

[Chris & China (GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

Suzanne, something I just remembered from one of your first posts....Are you using the iPet meter with Cobb?

Although right now, it's probably not so critical since he's so high, if you plan on continuing to use it, please add "Using iPet meter" to your signature...it wouldn't hurt to change the font color to something else to make it stick out.

We're so used to human glucometers here, that it's important that we know which one you're using. It wouldn't hurt for you to add it to the Remarks section on your spreadsheet too

Since you've already started back at 2 units, I'd suggest just staying there for 4 cycles and then see how it's going...Marje and Sienne (among others that have chimed in) have said you could be fast tracked if necessary.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

FYI...Cobb's SS has been updated with all of his previous curves.

Note there is not always a PMPS - if we couldn't get it, the vet didn't have an issue and sometimes after getting the HI number on the meter at the 6 hour mark I would stop sticking him since that was when I was told the BG would have bottomed out. (obviously I'm pushing through that now that I know Lantus works differently)

 

[julie & punkin (ga)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

suzanne - you're fantastic. thanks for doing that.

was he diagnosed on 4/26 or had he been on insulin prior to that?

i see on 5/22 he had a 45 and a 38 and then that evening he was increased to 3u. is that right? was that all measured on an iPet?

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

suzanne - you're fantastic. thanks for doing that.

was he diagnosed on 4/26 or had he been on insulin prior to that?

i see on 5/22 he had a 45 and a 38 and then that evening he was increased to 3u. is that right? was that all measured on an iPet?

He was diagnosed April 6th. He started on the insulin on April 12th. 2 units to start. I think his BG at the vet when they took it was like 568? That number stands out in my mind. I know it was in the 500 range.

That is correct. On 5/22 he had a 45 and 38 (we were excited) but then he jumped up to 392. At one point we were concerned that we weren't getting enough blood for an accurate reading, although everyone including the vet agreed the glucometer shouldn't read anything if there isn't enough blood. But yes, then she increased it to 3units that evening.

I am about to do his +2 test...I'll update his spreadsheet in a few minutes.

 

[julie & punkin (ga)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

when he jumped up to 392 on that day, that was his body reacting to the 40's and 30's. his body had gotten accustomed to higher numbers and it let loose with the stored sugars and hormones to save his life. here's a description of a bounce on the second post in the thread.

New Dose Wonkiness

If he'd been following the Tight Regulation protocol that we follow here, at that point he would have had a decrease to 1.75u. the high number was a temporary response to his low numbers, not a reflection of the dose not working. Lantus dosing is based upon the nadirs, not the high numbers. he would've settled down from the bounce within about 3 days.

 

[Suzanne & Cobb(GA)]

Re: 11/30 Cobb AMPS 266,+2 209,+6 338 +8 475 +10 491 PMPS 45

when he jumped up to 392 on that day, that was his body reacting to the 40's and 30's. his body had gotten accustomed to higher numbers and it let loose with the stored sugars and hormones to save his life. here's a description of a bounce on the second post in the thread.

New Dose Wonkiness

If he'd been following the Tight Regulation protocol that we follow here, at that point he would have had a decrease to 1.75u. the high number was a temporary response to his low numbers, not a reflection of the dose not working. Lantus dosing is based upon the nadirs, not the high numbers. he would've settled down from the bounce within about 3 days.

So, if he's being overdosed, do you think that is when it began? His second curve?

That curve was done on ProZinc, not Lantus. Does that change anything?