3/24 Checkers -where are we in dosing strategy?

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Checkabunny

Checkabunny

Member Since 2011
What is the "normal range of a healthy cat"? Checkers' numbers are a pretty blue since his nice day of surfing. I'm reading the stickies and internet, but am not certain what I'm aiming for or where to go from here. That's not expicitly stated. Increase? Decrease? Stay where we are?

BTW, my current vet is no help (yes, we'll be changing). He was upset to hear about Checkers' nice run in the blues (didn't even mention to him our nice run less than 100's) -- he was saying we should keep him in the 300's and to skip doses since Checkers was in the 100s!
 
Thanks -- I knew it was kind of late to start a condo -- but was wondering what kind of dose to use for my AM. Oh well --- I'm a nightowl. :)
 
Is this what you're looking for? It's in the sticky under Tight Regulation. I can't open Checker's spreadsheet for some reason, but i'm thinking this is what you want.

Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.
A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.
Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
Click to expand...
 
Hiya... here's the dosing protocol

it's amazing to me that your vet wants Checkers in the 300's. Did he give you a reason?

According to the protocol above:

"Phase 3: Holding the dose. Aim to keep blood glucose
concentration within 50-200 mg/dL (2.8 – 11 mmol/L)
throughout the day."
Click to expand...

From your spreadsheed, it looks to me like you're solidly in phase 3.

Phase 4 in the document goes on to describe what series of numbers earns a decrease and what needs an increase. It looks like for now you hold the current dose (until and unless someone more experienced comes along this thread and says different :smile: )

hope that helps!
Sarah.
 
Checkers is looking good! It looks like getting that infection taken care of is really helping his numbers.

Your vet is probably more comfortable with 300's because they aren't used to caregivers who will test and will handle low numbers confidently. The vet probably also doesn't have very many cats go into remission if they handle them that way... In my opinion, with a newly diagnosed cat it is worth the effort to try for remission, especially when you have a cat who is responding very well.
 
The vet was saying that shooting insulin when he's under 300 could make him go hypo! He said that 300s are normal for a cat. It was my husband who spoke directly to the vet, otherwise I would have asked him why my civie cat (who was jealous of the attention Checkers was getting and had me check his bg levels) had 62!

My husband told them that we're home testing and keeping an eye on Checkers. But this is the same vet clinic that bumped Checkers up from 1.0 BID to 2.0 BID after about 3 days, then after the first glucose curve, which they did, took us off the second shot and told me to stop giving Checkers the whole ground cooked food because his numbers went down to 85 after 12-13 hours. When you think about it, it doesn't make sense. Thankfully I had a friend at work who kept saying to me "how does it make sense to make Checkers stop eating food that drops his bloodglucose, so you can give him insulin to drop his blood glucose, so that THEN you can give him food that will help him with having low blood glucose?"

I would have thought this vet clinic would have been more supportive of using a tight regulation since they gave me a print out about diabetes from the FD website. I don't think they are. If it hadn't been that I had another friend at work who used to tell me about her diabetic cat she gave insulin to for 8 years, I would maybe have thought the vet clinic was more "supportive" of euthanizing Checkers right away.

I'm so grateful to have found FDMB and the people here who are so supportive through all of this --- marathon, not sprint ;-)
 
Yup, it is looking as if taking care of that infection is helping with the lower numbers. Yay Checkers!

But he doesn't seem to have much energy yet. And his neuropathy makes it hard for him to be kitten like. I was trying to interest him in some of his ball toys -- but he's no hockey cat yet.
 
Normal BG numbers in a cat are 60-120..
We are here 3 yrs & Moonie was dx'd because of her neuropathy..Couldnt walk & walked on her hocks--I guess you know--It will improve!! As Checkers gets more regulated that helps, also are you giving him
methyl B12?? that also helps a lot--Takes few weeks but you will see improvement. It is a supplement tht will in no way affect Checkers at all except help the neuro..Methylcobalamin--you can buy on line & I put it in their food..

Moonie still has neuropathy, but she can jump on the bed, cat napper, couch, walks on her toes sometimes, but is greatly improved since her DX..IMHO, any vet who thinks that 300 is a safe number is a poor vet!
My vets who have been given our protocol, have accepted all this but still feel that 150 or below is regulated-
Ok I'm not arguing :lol: ;-) ;-)
Hope Checks will be kittenlike again soon...
 
So sorry you're dealing with a vet who isn't supportive. We went through the same thing when Willie was diagnosed. On Christmas Eve, upon learning that while out of town visiting family I had shot a 92 (alphatrak #), the vet very dramatically told me that I had just killed my cat. Seriously. Thankfully, I've now got Willie a team of vets (dermatologist, cardiologist, internal med specialist, AND a new family vet) that at the very least won't undermine my tight regulation efforts even if they aren't completely on board. It has made a world of difference, as has the kindness and support of the members of this board. The LL family is an amazing thing!

When you're ready to start looking, you may want to post over in health to see if anybody knows of a good vet in you area. Worth a shot!
 
Great idea Sarah, I'll get a picture of Checkers in hocky gear! I have him reading a book with a highlighter in his paw, another holding up his civie with a squirt gun, and several in his sophisticat position (paws crossed -- but could use a pipe for that pose). :lol:

Yup Roni, I started with the methyl B12 a few days ago I think. (I forgot to note when I first started that.) He was able to jump up on the couch last night, so that's an improvement. But boy! it looks and sounds painful as he thump-thumps along the floor. I've put lots of carpet pieces down in the kitchen to help him get more purchase with his hind feet, but he's still no where near getting up on his toes. Your response on the neuropathy was a breath of fresh air to me since I tend to get worried and discouraged about that aspect of this disease. I had read something last night about the cat who got completely better after only a few days and thought Checkers will never walk again!

Christie, it was so neat that someone from the Minneapolis area saw a post of mine last week and I asked her in a PM for a recommendation of a vet. It was such a neat coincidence that she happened to see my post about Woody's (food) and responded. Pretty cool! I do look forward to not dreading taking Checkers to a vet and worrying if he knows what he's talking about. My friend at work loves her vet who helped with her diabetic cat, but he's much further away and Checkers hates being in the car.
 
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