19Nov Arnie AMPS 32.9 First Post

[Sandra&]

Hi, I’m Sandra.
Arnie has been on Lantus since July 2020, but he also had hyperthyroidism and pancreatitis, so we haven’t had him at a stable dose, and he has always been in the high teens/ twenties ( Uk AlphaTrak2 monitor)
He had an acute live insult from the thyroid medication also. And has kidney disease.
He had i131 treatment in September and his thyroid is in normal range. As he recovers, we are finding him much sensitive to medication, and having a hard time with his insulin dosage.

I have been reading through lots of posts on here, while trying to get Arnie’s spreadsheet set up. I’m not sure if he is still bouncing, or not getting enough insulin? But when we raise the dose, his numbers drop very low.

Unfortunately, due to his last bloods showing kidney disease that looks to have progressed quickly, our vets have advised that he is on a renal diet. So he has been eating 3 pouches Purina Renal food per day, spilt over 2 meals and 2 snacks. He is due to get blood again in December, so I hope that if there is any improvement in his kidney numbers, that we can change him to a better quality food that will support his diabetes.

Please can I have some dosing advice from one of you lovely, experienced Lantus experts?
Many Thanks
Sandra and Arnie
https://docs.google.com/spreadsheets/d/1iwXn-M3Sbe1yxrhWAJmNMvQP-9z1QyujAEPhxOrcTNQ/edit

 

[JaxBenji]

Hi Welcome Sandra and Arnie ! You all sure are dealing with a lot - hang in there

I am not one to give dosing advice, however, just wanted to send you a quick note that I can't access your SS. Do you know how to change your permissions (click "Share" and make sure it says "anyone with link"...I think that should do it).

I'm sure others will stop by

 

[Sandra&]

Hi Welcome Sandra and Arnie ! You all sure are dealing with a lot - hang in there

I am not one to give dosing advice, however, just wanted to send you a quick note that I can't access your SS. Do you know how to change your permissions (click "Share" and make sure it says "anyone with link"...I think that should do it).

I'm sure others will stop by

Thank you! I think/ hope I have changed the settings now!

 

[JaxBenji]

Thank you! I think/ hope I have changed the settings now!

Yup, I can see it now!

Also, have you had a chance to read the dosing methods yet? Most of us follow one of the two - linked here. Your preference may influence any dosing advice giving. Please note the methods are written using human meter numbers and with US numbers - here's a short post on how the board is US based (though people here are from all over the world we just speak in US numbers on the board mostly) - https://www.felinediabetes.com/FDMB...nverter-calculator-metric-to-us-value.192197/

Also, on either method, if you have a number <68 (US) on the AT2 at shot time, you should not shoot (there are options to not feed and stall to see if kitty is rising but I recommend getting help from the board if you can).

I hope that helps - perhaps @Critter Mom can stop by (Mogs is in the UK too). I'm sure @Wendy&Neko will stop by when she can too (Wendy's in British Columbia).

 

[Sandra&]

Yup, I can see it now!

Also, have you had a chance to read the dosing methods yet? Most of us follow one of the two - linked here. Your preference may influence any dosing advice giving. Please note the methods are written using human meter numbers and with US numbers - here's a short post on how the board is US based (though people here are from all over the world we just speak in US numbers on the board mostly) - https://www.felinediabetes.com/FDMB...nverter-calculator-metric-to-us-value.192197/

Also, on either method, if you have a number <68 (US) on the AT2 at shot time, you should not shoot (there are options to not feed and stall to see if kitty is rising but I recommend getting help from the board if you can).

I hope that helps - perhaps @Critter Mom can stop by (Mogs is in the UK too). I'm sure @Wendy&Neko will stop by when she can too (Wendy's in British Columbia).

Thanks for that! I have read the dosing methods, and to be honest, I would be happy to follow either! I guess I need advice on that too! Arnie doesn’t respond well to dose changes, either up or down. We have been changing his dose by 0.5 units though, so we now need to start working on 0.25 unit changes. My husband does most of the testing, so I need to get him on board with using syringes for 0.25 increments! We currently use a Junior Star pen, which can be used for half units, but we do have a box of u100 syringes.
At the moment, I’m just lost with Arnie’s numbers. I don’t know if he’s having a very prolonged bounce, or not enough insulin! I feel so bad that his bg is so high, and need fresh eyes on this. He’s been diabetic for 6 years- and it took until this year to get a vet to agree to change him from Caninsulin to Lantus. The Caninsulin didn’t work for him at all.
Thank you so much!

 

[JaxBenji]

I came across this post with UK Info - I'm not sure if it's the latest and greatest but it does have links to some syringes if you scroll down - https://www.felinediabetes.com/FDMB...-vit-b12-and-other-need-to-know-stuff.137376/

Most of us use insulin pens and dose with a syringe (pull insulin out of the pen with a syringe). To do the 0.25 increments, syringes with 0.5 unit marks are best (they don't make ones with 0.25 unit markings). ETA - make sure you read the Human Insulin section (U-100 syringes)...but sounds like you know that

The thread I linked also talks about glucometers - a lot of us use human meters and save $$ on strips. Some people prefer the pet meters - and that's fine too - but just wanted to give you some food for thought.

Also, my comment will help bump up your post - the lantus board gets a lot of posts. I'll tag Elise too @tiffmaxee incase she stops by this afternoon (well, my afternoon I'm east coast, she's west coast, and then of course you're in the UK ).

Hang in there - we'll get some eyes on Arnie

 

[tiffmaxee]

Welcome. We have members from the UK that can help with food. In looking at your spreadsheet I see you are being pretty consistent with the dosing which is important with Lantus. Do you have a copy of the labs that you could add to the labs section of the spreadsheet? That would be helpful.
Have a look here at the dosing methods we use and see which you prefer. We do make adjustments in .25 increments so the .25 increase was definitely needed.
Here is the link.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

[Critter Mom]

Hi Sandra and gorgeous Arnie (massive soft spot for tuxedos here!).

Unfortunately, due to his last bloods showing kidney disease that looks to have progressed quickly, our vets have advised that he is on a renal diet. So he has been eating 3 pouches Purina Renal food per day, spilt over 2 meals and 2 snacks. He is due to get blood again in December, so I hope that if there is any improvement in his kidney numbers, that we can change him to a better quality food that will support his diabetes.

I just had a look at the Purina Feline NF wet foods and, as renal diets go, they're not too bad carb-wise: salmon and chicken pouches are 11.7% kcals from carbs, and the canned mousse one could potentially be just under the 10% mark. (The website doesn't give a value for crude fibre so I can't say for certain.) They seem to have padded the calories out with fats instead of carbs. (Many renal therapeutic diets have carb %s in the 20s.) Do you know what IRIS stage Arnie is in at the moment? It's possible that the hyperthyroidism had previously been masking the renal insufficiency somewhat. If you would like to do so, there's a 'Labs' tab in the spreadsheet where you can add Arnie's latest test results. Some members here are very good at interpreting labs should you need any help in that direction.

In the unlikely event that you haven't already found it, Tanya's Site is the best resource on the web for all things feline CKD.

I see that Susanne has kindly linked the UK supplies info for you.

I'm sorry it took so long for the vet to agree to a Lantus Rx but better late than never! Hopefully members here will be able to help you manage the dosing side of things better.

Arnie doesn’t respond well to dose changes, either up or down.

In this case, I'd suggest initially looking at the Start Low, Go Slow (SLGS) dosing method because doses are held for a longer time after each adjustment than on the Tight Regulation (TR) method. (You can always switch to TR at any time.) ETA: If you did want to follow TR then you'd need to be feeding a wet diet with less than 10% kcals from carbs. It may be that you need to prioritise Arnie's CKD needs over the diabetes (IRIS stage is key here), but if he's only in an early stage there would be the option to look for a lower carb food that is lower in phosphorus. Tanya's Site has a lot of information on dietary choices for CKD kitties.

FYI, FDMB uses 68mg/dL | 3.8mmol/L as the lower bound of the normal feline BG reference range as measured on an Alphatrak meter (upper bound is 150mg/dL | 8.3mmol/L).


Mogs
.

 

[tiffmaxee]

@Critter Mom Thank you Mogs.