Hi Chris,
I just wanted to add my welcome. It can be overwhelming to start out with a diabetic cat - so just keep asking questions and people will help you figure things out.
I'm wondering if anyone has talked to you about the 2 dosing options for using lantus. What people choose affects the dosing advice we give them. Some of us wrote a little blurb for people who are new to help them figure out how to start moving ahead and I'm posting it below. If it's confusing, just say so! The reason I'm mentioning this is because starting dose is determined by which direction you want to go. If you are wanting to do the Start Low, Go Slow, a cat is started at 0.5u. With the Tight Regulation Protocol, it's a weight based formula - for 5lbs (2.3kg) the formula is weight in KG (2.3) x 0.25u = 0.57u. So actually both dosing guidelines would put her starting dose at about 0.5u per shot. Is she completely on the Purina DM canned - no dry food in the picture? She's pretty tiny - 5lbs isn't big so you probably do have too high of a starting dose. If you want, you can just decrease the dose to the 0.5u. For most people it's less nerve-wracking to go up in dose than to start with a dose that's too high.
Welcome to Lantus and Lev land – the best place you probably never wanted to be! If you are like most of us, if this is your first few weeks of trying to wrap your head around the fact that your kitty has diabetes, you’ve no doubt been terrified, in tears, in a state of shock, and completely overwhelmed. Don’t worry. It gets easier. It really does.
None of us here are veterinary professionals but many of us have been working with our cat’s diabetes for a long time. Even those of us who have been here for a short time are here to help. This is a wonderfully supportive community.
There are a few first steps. We firmly believe that home testing is the best way to keep your cat safe. We keep a record of our cat’s blood glucose (BG) data on a spreadsheet (SS) which you can create using these instructions:
http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/. If you’ve not mastered home testing, we’re happy to offer suggestions or you may want to spend some time on the Health board mastering the basics of testing, low carb diet, and getting your SS set up. We’re happy to help you with those things, but you should be aware that this is a busy board and if there’s an emergency, everyone’s attention goes to helping the caregiver and his/her kitty.
Once you’ve got a handle on the basics, you will have the option of following the Tight Regulation Protocol or the Start Low Go Slow (SLGS) method for managing your cat’s diabetes. You don’t have to stick with whichever approach you initially choose but it is helpful to give your choice a chance so you can evaluate the results fairly.
The Tight Regulation protocol was developed based upon the premise that a cat's pancreas may be able to heal and return to producing insulin if the cat's BG is kept in a normal range (i.e., 50-120}. Caregivers following this protocol adjust insulin doses following the protocol guidelines to aim for that range. Basic information on the TR is here:
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol.1581/. The advantage of this approach is that it is based on research published in a leading veterinary journal and has an admirable track record of getting cats who are within the first year since diagnosis into remission.
The Start Low Go Slow (SLGS) approach has caregivers start with an initial dose based upon the BG at diagnosis and whether kitty has been transitioned to a wet low carb diet, hold that dose for a week or two while testing for ketones regularly, being consistent with food and testing before shooting every 12 hours. Once a week a curve is done (test every 2 hours for one cycle) to check for the lowest point. the low number in that curve determines any dose change for the following week. This approach was the original method used in the FDMB prior to the TR protocol. It is an alternate approach if TR is not the right fit for you or your kitty. Basic information on the SLGS approach is here:
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/.
Both approaches require that you test at pre-shot times and do your best to test at least once each 12-hour cycle. Lantus and Lev dosing is based on the lowest number in the cycle (i.e., the nadir) so getting at least one spot check is important to guide your dosing decisions.
If you are switching to lantus or levemir from any other insulin, please post for suggestions on the starting dose before you change insulins. You should also get your vet’s recommendation.
Amy&Trixie, Dyana&(GA)J.D., Julie&(GA) Punkin, Marje&Gracie, Sandy&Black Kitty, Sienne&Gabby, Wendy&Neko
Regarding your question about overnight - i think everyone can relate to that. Is she with all the rest of your kitties at night or is there any way to leave her food? A timed feeder can be your best friend if you're able to make sure she actually gets the food. It might be that you'll want to isolate her overnight and get a timed feeder to go off. If she's a grazer, you can just leave out food, but if she'll eat everything as soon as it appears, then a timed feeder can help.
Since you're using the AT, you need to know that the number that you are looking for is 68 if you are interested in following Tight Reg - you already test enough to be able to do that if you want. Everything above 68 is safe, once she dips below 68 you want to take action. She's not in danger just under that, but in general the process is to let a cat go under that threshold if they are headed that way, then give carbs (gravy from a high carb canned cat food, karo syrup, maple syrup, honey) and pull them back up. That's the process that signals to us that the cat then needs a dose decrease.
If you choose to go with the Start Low Go Slow, the threshold for taking action as I described above is 90.
I've given you lots of information to start with so I'll stop there. This is typically a busy forum and you can get answers fairly quickly. If you aren't getting an answer, you can cross-post on the Main Health board as well.
I'll check in on Queenie tomorrow!
