3/8 Frankie AMPS 302

[Jay]

It was a sleepless night. (almost)

Its now 5 Am, and we fell asleep at 1:30 AM. All 3 of us. Frankie, his brother Chubby and I were exhausted from a marathon (24 hours testing) session.

At any rate we are closing in on the target


at + 8 from his am ps yeserday which was 468...and rising, along with dosing when I caught him rising, from 8 to 10 hours into the cycle, here is what a sort of curve looked like.

Gave him 2 units (no drop nor duration)
PMPS 468 (+8) 2:30 PM 3/8/10
+2 476
+4 469
+6 197 Finally some movement in the right direction
+8 228,
+10 302
AMPS 302 12:30 AM 2.units
+5 213
+7 291 7:30 AM 2 Units 3/7
+2 235
+4 134

Time for another dose

My earlier post, well, is history. In order to get more then 7 to 10 hours out of this dose, etiher I must shoot at lower Nadirs and PS's or increase the dose. Which may very will give us what we are seeking.

Now, we need to work on getting duration, longer then 10 hours and getting his PS's and Nadir lower (between 60 and 180) without putting him in harms way on the bottom (typically hypos happen somewhere early in the cycle). Later in t he cycle to see a low very low +5 thru whenever, I'd be doing cat stands, wait I mean hannd stands.

I just realized that, its 5 AM, and I'm awake after 3/12 hours of a very restless sleep, and Frankie is in my bed still sleeping. with his brother. I worry about him and his brother and they are both sleeping, while I'm at my desk posting here. Something wrong with that picture.

We spot checked at +5 and he is in absolutely good shape. That makes one of us as I am sooooo tired.

I'm coming back as a cat in my next life. Going to find a sucker just like me to take care of me, have him feed me, and pet me, rollover and he'll rub my belly on demand, send him out to work, so I can then go back to sleep.

I'm going back to bed for a few hours.

Cats Rule.

 

[Blue]

Re: Frankie AMPS 302

Good morning,
Just a quick request here: can you edit your first post here to add the date into the title as you have 2 threads with Frankie and a bg number but we don't know which if for which date.
Put 3/8 Frankie AMPS 302

 

[Jay]

Re: Frankie AMPS 302

Good morning,
Just a quick request here: can you edit your first post here to add the date into the title as you have 2 threads with Frankie and a bg number but we don't know which if for which date.
Put 3/8 Frankie AMPS 302

The days are running into one another as I have had very little sleep dealing with our change from PZI Vet to Lantus.

 

[Blue]

That's OK - I don't think there is a single bean on this site who can't relate to wonder what day it is and which way is up!

I hope you can get a bit of a rest now; often, we need to take short naps, even set alarms to get up for a test here and there.

By putting the date, and changing that subj line of the first message as needed, you will ensure that everyone looks at the right condo. I believe I put my crazy gas tank reply in the wrong post for you yesterday!

 

[Roni and Moonie]

Are you shooting this cat 3 times a day??? You can kill the cat by doing so!! There is no protocol for shooting any cat 3X per day with lantus!!
Please tell me this is a mistake in your post! Did someone tell you to do this??

Sorry to be panicked, but I am somewhat disturbed by this..Hope it's a typo!!

 

[Roni and Moonie]

Jay, just read your other posts in health, & here...I am also here 2 yrs.--I understand your frustration, but as you havent ever had Frankie on lantus, you are in sort of uncharted territory here...My cat was on humilin N which made her sicker, lantus saved her..It took a while to find the right dose, etc.--Once we did, I saw so much improvement--I followed the protocol, and even though it wasnt easy, we did it.
Please consider that there have been 110 cats that went into remission here since 2008, many cats are regulated here, & we have cumulative knowledge of lantus...
Nothing happens in a couple of days with lantus, but it can show in a week...We are all quite knowledgeable here about his insulin & it's effects--
Again, forget other insulins, lantus & levemir are totally different..

 

[Jay]

Are you shooting this cat 3 times a day??? You can kill the cat by doing so!! There is no protocol for shooting any cat 3X per day with lantus!!
Please tell me this is a mistake in your post! Did someone tell you to do this??

Sorry to be panicked, but I am somewhat disturbed by this..Hope it's a typo!!

I appreciate your concern and dont assume that I have little to no experience doing this.
Frankie was dx'ed in 05 (5 years agao) and we had been using PZI Vet for those 5 years.

No one told me to dose excet the following.
A. I know my cat is a high dose kitty and 2 units is a bit too low, but a good starting point.
B. I will not let my cat sit at high numbers while waiting for a dose to "settle". That is exactly the reason why I am still managing his condition. When we started this journey I waited to increase his doses (by very small increments) far too long to get to a dose that does what insulin is supposed to do. The net effect being that Glucose Toxicity that was built up in Frankies blood, destroyed the ability for his Pancreas (particularly his Beta Cells, where the insulin is produced, to heal and regenerate) to prudocue his own insulin.
As you may have seen here, there is a much higher propensity for Newly Dxed kitties to go on a honeymoon as opposed to long termers/lifers like Frankie
C. The past 3 cycles the longest duration he got at 2 units was 10 hours.
D. His plus 5 reading of 213 was his Nadir, the subseqent test at +7 of 291 tells me that the last dose has lost its effectiveness and is virtually gone. If the last dose were effect he would still be dropping below 213 and lingering around 180 to 200.
E. There are several ways to get a consistantly reduced BG level.
1. Follow the protocal that everyone has been sending me.
2. Dose him when he needs a shot. Like I did and paly with the time between shots as opposed to the size of the dose.
3. Increase or decrease the dose.

In Frankies case, going from 3 units of PZI Vet to 2 units of Lantus is a good starting point, and based on the last 3 cycles 2.0 units is obviously too low a dose other wise we'd get longer duration as opposed to 8 to 10 hours.

In 5 years of dosing and testing, there has only been one near incident of HYPO at +3 (4 years ago) he tanked from 178 to 30. Which I immediately brought him back up with Karo and Dry.

F. Lastly, I took a week off of work, knowing full well that getting the right dose quickly, which will keep his BG's from tanking early in the cycle (which is when most Hypos occur from 0 to +4) to keeping his Nadir low and his PS's between 175 and 220. My goal is to find a dose that works, keeps him safe and allows me to Test/Feed/Dose and get out of my apartment without worrying.

I am home and will be spot checking both visually and with my meter.

Again I appreciate your concern here, but there is no need for alarms on this.

Jay

 

[Jay]

Jay, just read your other posts in health, & here...I am also here 2 yrs.--I understand your frustration, but as you havent ever had Frankie on lantus, you are in sort of uncharted territory here...My cat was on humilin N which made her sicker, lantus saved her..It took a while to find the right dose, etc.--Once we did, I saw so much improvement--I followed the protocol, and even though it wasnt easy, we did it.
Please consider that there have been 110 cats that went into remission here since 2008, many cats are regulated here, & we have cumulative knowledge of lantus...
Nothing happens in a couple of days with lantus, but it can show in a week...We are all quite knowledgeable here about his insulin & it's effects--
Again, forget other insulins, lantus & levemir are totally different..

lantus and Levimir may be totally different then PZI Vet, however Frankie is the same ball of loveable fur as he was when he was DX'd.

ECID, my cat is a relatively high dose kitty and neither he nor I have the luxury of allowing him to sit at BG levels that are 3x normal. If I was aggressive with his dosing early on, like when he was DX'd, who knows he could have gone on a permanent honeymoon. But hoping a 1/2 unit of PZI Vet would "settle" after 4 or 5 days, while he was sitting in the mid- 300's and then raising his dose by small increments, again while he was sitting at in the mid-300's ( I remember it as if were yesterday) for weeks on end, till we finally raised the dose to a point it worked. The time we spent waiting for his doses to settle killed any chance that he would be able to go on a honeymoon.

Those 110 cats that you refer to here who have gone on honeymoons, happened to have care givers that found a dose of Lantus quickly after DXing that enabled their cats to start producing their own insulin. There is a much higher percentage of Honeymooners with in the first 3 months of diagnosis as opposed to 5 years after diagnosis.

Read about the effects of Glucose Toxicity..

http://www.google.com/#hl=en&source=hp& ... 77e436a6c1

As it happens I know, that after 3 cycles at 2.0 units, check my ss and you will see that we get some positive movement however the dose just tanks out on him at most at +10 which tells me that I am underdosing, High Nadirs, Highr PS's with no longer the 10 hours of duration.

As nimble or as cautious as we are in increasing a dose either slowly or quickly (too quickly for some here) I can be jsut as nimble at reducing his dose as his overall numbers lower. Lower PS's and Lower Nadirs.

 

[Roni and Moonie]

Jay, BUT!!! When you increase or decrease his dose, you need to wait 6 cycles=3 days to see any action, and as Moonie is also an oldtimer here,
she waits till the Very LAST CYCLE OF THE 6 TO SHOW ME ANY ACTION!
Dose increments are done either by 0.25, or 0.5U--And please wait out the 6 cycles,
Just this time, It may make a difference...
AMPS 302 is not terribly high, maybe see where he goes from here? The first 2 hours, the food spike causes the bg to rise, but then by +3 you could see it start to go down--Oh, you know the drill.
We missed our chance for OTJ as I was urine testing Moonie for 11 mths when she was on micro doses, & couldnt test this wild child..
Now, while nothing is out of the realm of possibility, if she did that I'd be very surprised--cats have gone into remission after 3 yrs here, but just a few--Never give up hope, it's what we got here!

 

[Sienne and Gabby (GA)]

For those newbies and lurkers who may be reading this condo, the approach to dosing that is being used here is not supported by the research on Lantus nor is it the way that dosing is done on this Board.

Jay - I realize you are an experienced PZI user. It may be very helpful if you took the time to read about how Lantus works rather than assuming that all insulin is the same. The of pharmacology of Lantus is entirely different than PZI or any other insulin other than Levemir. If you would take some time to look at other spreadsheets, you will note that Frankie is not considered "high dose," at least not on this ISG.

As for our OTJ kitties, they are not all represented by those who went into remission shortly after diagnosis. There are any number who have gone OTJ after 2+ years. You are making assumptions that are not supported by fact.

It is your choice how you approach Lantus use. You're holding the insulin and the syringe. Any number of members who are far more experienced with the use of a long-acting insulin have offered you feedback out of concern for Frankie's safety. There are cats here who have customized dosing programs. Those programs were established after finding that the protocol established by published, peer reviewed research did not work for their cat.

 

[Jay]

Jay, BUT!!! When you increase or decrease his dose, you need to wait 6 cycles=3 days to see any action, and as Moonie is also an oldtimer here,
she waits till the Very LAST CYCLE OF THE 6 TO SHOW ME ANY ACTION!
Dose increments are done either by 0.25, or 0.5U--And please wait out the 6 cycles,
Just this time, It may make a difference...
AMPS 302 is not terribly high, maybe see where he goes from here? The first 2 hours, the food spike causes the bg to rise, but then by +3 you could see it start to go down--Oh, you know the drill.
We missed our chance for OTJ as I was urine testing Moonie for 11 mths when she was on micro doses, & couldnt test this wild child..
Now, while nothing is out of the realm of possibility, if she did that I'd be very surprised--cats have gone into remission after 3 yrs here, but just a few--Never give up hope, it's what we got here!

2 is giving us some movement and I'm going to hold here for a few more cycles to see if in fact there is a cumulative effect.

Right now, I'm in testing mode (trial and error) to get a dose that "works" for Frankie and I. Remeber ECID. Which is why I raised him from 1 unit to 2 after 1 one day, He was a 3 to 3.2 unit dose on PZI Vet. To drop to one, well I was hoping.

You understand then, based on what you experienced with OTJ, why I am more aggressive then most here. I blew it once a long time ago with him and refuse to blow it again. I'm home and monitoring him (his poor ear and good thing I just got 300 strips delviered the other day) and there is nothing that we cant handle if he goes to low too fast.

We want to get duration to go BID, TID is way to much for me and him (he cant/wont eat that much and one of the reasons he developed diabetes was that he is a "pig" not a cat when it comes to food. He eats his, his brothers (you get the picture).

He's sitting in good shape at +2 he is 235.

I wonder about going on a honeymoon., With every shot I have given him I have always hoped that "this is the shot that does it"

Jay

 

[Roni and Moonie]

Jay YOu Are seeing Action!! That's great!!--We do our insulin countdowns to OTJ by increments..Not on one day's numbers--it takes weeks to months, yes ECID! What you want to do is to teach the pancreas to function again and that's what this protocol is all about--
We all need to go to liver training school(LTS) where the cat"s liver function is taught not to spill glucose into the bloodstream as a defense to lower
numbers...but it is just part of the process--Consistancy & patience reign here--Please just give it a try-OK?

 

[Jay]

Thanks

I dont think that what I am doing in attempting to find a dose quickly is right for everyone here and I know its outside of the protocol most use here. You are right I just as I hold the "syringe" so to does everyone here, just as ECID so too are their care givers.

To my way of thinking any amount of insulin is too high as I'd much rather be dealing with Frankie if he were without need of it, again as I think we all would or are here.

As far as my assumption of the propensity to walk away from being insulin dependant being "non factual"

This is a quote from the German TR protocol
"The longer a cat has had diabetes, the less likely it will go into remission. Many long-term diabetics get stuck in Phase 3 or 4. Yet there is a benefit of using this method for such a cat as well: keeping the cat's BG levels as normal as possible is much healthier for it long term. Insulin requirements will often decrease to very low levels too."

http://www.tillydiabetes.net/en_6_protocol2.htm

Scroll down towards the bottom

I do however keep hoping that the next shot will be the one and Frankie walks away as we all do.

Thanks again
Jay

For those newbies and lurkers who may be reading this condo, the approach to dosing that is being used here is not supported by the research on Lantus nor is it the way that dosing is done on this Board.

Jay - I realize you are an experienced PZI user. It may be very helpful if you took the time to read about how Lantus works rather than assuming that all insulin is the same. The of pharmacology of Lantus is entirely different than PZI or any other insulin other than Levemir. If you would take some time to look at other spreadsheets, you will note that Frankie is not considered "high dose," at least not on this ISG.

As for our OTJ kitties, they are not all represented by those who went into remission shortly after diagnosis. There are any number who have gone OTJ after 2+ years. You are making assumptions that are not supported by fact.

It is your choice how you approach Lantus use. You're holding the insulin and the syringe. Any number of members who are far more experienced with the use of a long-acting insulin have offered you feedback out of concern for Frankie's safety. There are cats here who have customized dosing programs. Those programs were established after finding that the protocol established by published, peer reviewed research did not work for their cat.

 

[Blue]

Just some info on the differences with the various insulins.

The protocol matters and should be followed. Lantus is different.

http://www.felinediabetes.com/insulin_s ... Nelson.htm
To quote:
Insulin recommendations in newly-diagnosed diabetic cats. Diabetic cats are notoriously unpredictable in their response to exogenous insulin. There is no single type of insulin which is routinely effective in maintaining control of glycemia, even with twice a day administration. The initial insulin of choice ultimately is based on personal preferences and experiences. Commonly used insulin preparations for the long-term management of diabetic cats include NPH, lente, PZI, and insulin glargine. All have potential problems in diabetic cats. Although lente and NPH insulin are consistently and rapidly absorbed following subcutaneous administration, the duration of effect of lente and especially NPH insulin can be considerably shorter than 12 hours, resulting in inadequate control of glycemia despite twice a day administration. Although PZI is a longer acting insulin, the timing of the glucose nadir is quite variable and occurs within 9 hours of PZI administration in greater than 80% of treated diabetic cats. In one study, PZI significantly improved control of glycemia in newly-diagnosed diabetic cats and poorly-controlled diabetic cats previously treated with ultralente or NPH insulin.15 Comparison of efficacy between PZI and lente insulin has not been reported.

Insulin glargine is the longest acting commercially available insulin for treatment of diabetes in humans and is currently a popular initial choice by veterinarians for the treatment of diabetes in cats. A preliminary study identified better glycemic control and a higher diabetes remission rate in newly-diagnosed diabetic cats treated with glargine twice a day, compared with lente or PZI administered twice a day.16 Another study found no difference in glycemic control in diabetic cats treated with insulin glargine once a day versus diabetic cats treated with recombinant human lente insulin twice a day, and a higher diabetes remission rate in diabetic cats treated with recombinant human lente insulin.17 In my experience, the duration of effect of insulin glargine is quite variable, with the glucose nadir occurring as soon as 4 hours and as late as 20 hours after administration. Insulin glargine works well when given once or twice a day in some diabetic cats and does not work very well in others. Problems are usually related to duration of effect.

 

[Jay]

Hi

Thanks

I see the glass as half full which is why I am still testing/feeding and dosing.

If his pancreas ever learns to produce insulin again, that would be great.

There was a time in the distant past that I heard those dreaded words from my Vet. Frankie has diabetes. I thought as we all here did that it was going to be a too quick goodbye. 5 years later we are still saying hello to each other every day and I am gratefull that we have had the 5 years.

I do believe though that given the number of weeks, and months that he was too high that as I mentioned in another post, the level of Glucose Toxicity that accumulated virtually eliminated the possibilbilty

http://www.medscape.com/viewarticle/450151

http://petdiabetes.wikia.com/wiki/Glucose_toxicity

Every time, that I give him a dose though I think that this is the shot that will do the trick and am still hopeful that his PM Shot this evening will do the trick.

Jay

Jay YOu Are seeing Action!! That's great!!--We do our insulin countdowns to OTJ by increments..Not on one day's numbers--it takes weeks to months, yes ECID! What you want to do is to teach the pancreas to function again and that's what this protocol is all about--
We all need to go to liver training school(LTS) where the cat"s liver function is taught not to spill glucose into the bloodstream as a defense to lower
numbers...but it is just part of the process--Consistancy & patience reign here--Please just give it a try-OK?

 

[Jay]

Just some info on the differences with the various insulins.

The protocol matters and should be followed. Lantus is different.

Thanks I'll take that into account

Jay

http://www.felinediabetes.com/insulin_s ... Nelson.htm
To quote:
Insulin recommendations in newly-diagnosed diabetic cats. Diabetic cats are notoriously unpredictable in their response to exogenous insulin. There is no single type of insulin which is routinely effective in maintaining control of glycemia, even with twice a day administration. The initial insulin of choice ultimately is based on personal preferences and experiences. Commonly used insulin preparations for the long-term management of diabetic cats include NPH, lente, PZI, and insulin glargine. All have potential problems in diabetic cats. Although lente and NPH insulin are consistently and rapidly absorbed following subcutaneous administration, the duration of effect of lente and especially NPH insulin can be considerably shorter than 12 hours, resulting in inadequate control of glycemia despite twice a day administration. Although PZI is a longer acting insulin, the timing of the glucose nadir is quite variable and occurs within 9 hours of PZI administration in greater than 80% of treated diabetic cats. In one study, PZI significantly improved control of glycemia in newly-diagnosed diabetic cats and poorly-controlled diabetic cats previously treated with ultralente or NPH insulin.15 Comparison of efficacy between PZI and lente insulin has not been reported.

Insulin glargine is the longest acting commercially available insulin for treatment of diabetes in humans and is currently a popular initial choice by veterinarians for the treatment of diabetes in cats. A preliminary study identified better glycemic control and a higher diabetes remission rate in newly-diagnosed diabetic cats treated with glargine twice a day, compared with lente or PZI administered twice a day.16 Another study found no difference in glycemic control in diabetic cats treated with insulin glargine once a day versus diabetic cats treated with recombinant human lente insulin twice a day, and a higher diabetes remission rate in diabetic cats treated with recombinant human lente insulin.17 In my experience, the duration of effect of insulin glargine is quite variable, with the glucose nadir occurring as soon as 4 hours and as late as 20 hours after administration. Insulin glargine works well when given once or twice a day in some diabetic cats and does not work very well in others. Problems are usually related to duration of effect.

 

[Roni and Moonie]

Jay--Just try our way for a little while, you can always go back to your own--But many cats including mine, are living great lives on this protocol and I am so thankful for that...You have Frankie & he's still doing reasonably well..so....Just try us for a while-OK?

 

[Jay]

Frankie and I promise

Jay

Jay--Just try our way for a little while, you can always go back to your own--But many cats including mine, are living great lives on this protocol and I am so thankful for that...You have Frankie & he's still doing reasonably well..so....Just try us for a while-OK?

 

[Carolyn and Spot]

You can not do this. I know you think you know what you are doing, but I can promise you that you are in very serious trouble with Lantus if you continue this path. A cat *did* die on another site using this dosing method and Lantus due to an inexperienced adviser who was ignorant of the action of this insulin.

What you do not understand yet:

• 
  What you are doing will cause a freight train of insulin to hit all at the same time and you will have a very lengthy hypo that will require emergency care. There are no maybe's here. It WILL happen. Lantus builds up in the system. You did not have that with PZI so you do not have experience with the "shed" behavior of this insulin. Read. Everything. Do not presume, not with this insulin.
  
  With Lantus, you want flat cycles. You don't want to drive the numbers down.
  
  You do not have a high dose cat.
  
  PZI lasts 6-8 hours, maybe 10 in a cat. That is what you are used to. This is not the case with Lantus/Levemir. Lantus has a 12-24 hour duration in cats. That means by the time you have shot 4 doses in 24 hours, the cat could be operating on 8 units of fully potent insulin. The protocol we use takes full advantage of Lantus' lengthy duration with an overlapping strategy.

I am a former PZI user (3 cats), and am now well versed in both Lantus and Levemir (2 cats). It is a very very hard thing for a PZI user to learn, but you have GOT to be patient or the worst absolutely will happen. Please take my advice as it is intended. I understand you are well-versed in feline diabetes, but you are in grave danger dosing your cat like this. Please stop dosing immediately and allow 12 hours for the insulin to clear. You can then restart at 2u and we will help you. If he's a high dose cat, we've got protocol tweaks for that. I know this because I shoot over 20u every morning and every night.

 

[Jay]

Who said I knew what I was doing? Did I.

Does anyone really. We are dealing with living breathing creatures who's bodies are constantly changing.

I am as concerned as much if not more then you.

When you have seen hypos from others here on the board do you see them early in the cycle between 0 and +6 or late in the cycle?

His PM PS reading will be pretty low as at +5 he is at 99 and food is long gone.

Just so you know, the longest duration we have had with 2.0 units is 10 hours and no where near 12 let alone 24 that you suggest here.

You mention that I dont want to drive the numbers down? How do you mean that exactly for the converse is not healthy long term for him. That being consistantly high numbers.

Describe to me in non-medical terms what you mean by shed effect?

Lastly at this point, what do you suggest we do from here on?

Jay

Carolyn and Spot"]You can not do this. I know you think you know what you are doing, but I can promise you that you are in very serious trouble with Lantus if you continue this path. A cat *did* die on another site using this dosing method and Lantus due to an inexperienced adviser who was ignorant of the action of this insulin.

What you do not understand yet:

• 
  What you are doing will cause a freight train of insulin to hit all at the same time and you will have a very lengthy hypo that will require emergency care. There are no maybe's here. It WILL happen. Lantus builds up in the system. You did not have that with PZI so you do not have experience with the "shed" behavior of this insulin. Read. Everything. Do not presume, not with this insulin.
  
  With Lantus, you want flat cycles. You don't want to drive the numbers down.
  
  You do not have a high dose cat.
  
  PZI lasts 6-8 hours, maybe 10 in a cat. That is what you are used to. This is not the case with Lantus/Levemir. Lantus has a 12-24 hour duration in cats. That means by the time you have shot 4 doses in 24 hours, the cat could be operating on 8 units of fully potent insulin. The protocol we use takes full advantage of Lantus' lengthy duration with an overlapping strategy.

I am a former PZI user (3 cats), and am now well versed in both Lantus and Levemir (2 cats). It is a very very hard thing for a PZI user to learn, but you have GOT to be patient or the worst absolutely will happen. Please take my advice as it is intended. I understand you are well-versed in feline diabetes, but you are in grave danger dosing your cat like this. Please stop dosing immediately and allow 12 hours for the insulin to clear. You can then restart at 2u and we will help you. If he's a high dose cat, we've got protocol tweaks for that. I know this because I shoot over 20u every morning and every night.[/quote]

 

[Ronnie & Luna]

Hello

I was looking at your spreadsheet, might be a good idea to mark your spreadsheet with actual dose info of when you are giving shots, besides the preshot times...I see a little red dot at certain points, but for others viewing your spreadsheet, it would be valuable info...u can also use the comments area too.

by the way, you have two lines for todays date in your spreadsheet, typo? using the comments area helps explain a lot about the plan you are using.

 

[Jay]

Those little dots are the way to open up the comment box, which are populated with dosing information etc.

Jay

Hello

I was looking at your spreadsheet, might be a good idea to mark your spreadsheet with actual dose info of when you are giving shots, besides the preshot times...I see a little red dot at certain points, but for others viewing your spreadsheet, it would be valuable info...u can also use the comments area too.

by the way, you have two lines for todays date in your spreadsheet, typo? using the comments area helps explain a lot about the plan you are using.

 

[carolynandlatte]

Lastly at this point, what do you suggest we do from here on?

Honestly, based on what Carolyn and Spot wrote, in addition to the numbers you have just gotten, I would start testing more than ever few hours. he is either about to plummet way down (as Carolyn suggested), or bounce sky high (as it was explained by a Gayle with the tennis ball effect). I would hate to see him go too low and have you catch it late in the game.

She did suggest not giving any more insulin for 12hrs, and then starting over with the 2u twice daily.

 

[Blue]

I have a high dose kitty, and I follow the protocol.
Look at Shadoe's ss, you will see that I track the age of the open insulins I use, two insulins, and I also track the cycles. Our current dose is 13u BID, and I will NOT increase that amount until we have gone through 6 cycles. That's the protocol. It works.

If you were to study some of the ss for other cats, you will see that there ARE some kitties that do NOT react to a dose increase until the 6th shot.
Wait the 6 shots, then if you still see no improvement, increase the dose according to the protocol. On a dose of 2, your increase would be .25u Lantus or possibly .5u. Increases of 1u are not something that is proper for a low dose such as 2u Lantus.

Hypo is not a foreseeable event. You can't just pidgeonhole it to a certain time frame then say oh we are past that point, so it won't happen. ECID.

Food long gone? Maybe the food is gone because Frankie's body is not using it as a normal cat. Once regulated, the appetite drops. Shadoe used to eat more than 4 cans a day, but she is now down to maybe 2.

You want flat, real flat. You don't want the bouncing, you don't want that up and down at all. Wow, 302 down to 99? What are you basing the dose on? The 302 or the 99?
You don't want to have the number brought down so radically, like pounding a ping pong ball down really hard. You know what happens. You want numbers that are similar to skipping a stone along the surface of a pond, not like dropping a bowling ball into that pond.
Flat, you want flat. Slowly but surely wins the race.

Give Frankie some time to adapt to the changeover. Apples and oranges may both be fruit but they are quite different. Best to treat the different insulins in the same manner and approach their uses with caution and respect for their strengths.

 

[tuckers mom]

Jay, my Tucker has been diabetic since 2005 also. We also used PZI for most of his diabetic life, but when I switched to Lev, a similar acting insulin to Lantus, I had to unlearn what I knew about insulin and what I knew about Tucker. My other FD at the time was on PZI and switched to Lev also.

I remember one night in particular that Carolyn and Spot spent hours hand holding, explaining to me about the shed, why I had to unlearn PZI, etc., and I thank her so much for that. I was ready to throw in the towel.

Today Tucker is on his lowest dose yet of Levemir. He gets 0.5U BID. He used to need over 3U of PZI and did get occasional booster shots when needed. Misty passed from stomach cancer, but before she did she was getting micro doses of Lev, so small I bought reading glasses to help me get just a little tiny droplet.

I hope that you can take the time to listen the folks here and let them help you, and I hope that your kitty loves the Lantus as much as Tucker loves his L-insulin.

 

[LynnLee + Mousie]

i have to back up what carolyn has said about dosing lantus like you can with pzi. i witnessed at least one, and i actually believe it was two, cats being dosed with lantus more than BID and sure enough those cats died within a few days of dosing lantus more than BID. please please be careful. unfortunately the posts in which this happened, on another board, were removed so we can't link directly to it but there are many of us that saw this happen. it was very sad

 

[Carolyn and Spot]

You have to give the lantus time. It has to build up in the body for several cycles before you will start seeing action.. Please read the sticky about the shed, it will explain it better than I can. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=150 As the shed fills, you start seeing the duration build. You'll have cycles where your lowest number of the day is one of the preshots, and cycles where he's still dropping after preshot, but as that shed starts filling and you get closer to where you need to be in dosing, you'll see the beautiful shallow curve that Lantus is known for.

The way it's done is that you start at a base dose, then monitor for 3-5 days, wait for signs that the shed is filling, then increase/decrease/hold based on the activity of the cycles, placing great emphasis on nadir numbers. We will help you interpret what is happening at first but you'll start seeing and understanding the patterns quite quickly. The hardest thing is the waiting. With PZI, if for some reason the cat was high before 12 hours was up, we could just jump right in and shoot it. You can not do that with Lantus. You are forced to wait to see action. He will be ok and we'll help you get him to where he needs to be, safely and as quickly as we can without hurting him. If you can post daily and get us spot checks throughout his cycles, we will be able to make quick decisions and explain them to you as we go so you know what we're thinking and we know what you're thinking and everyone's on the same page.

I said you can't force the numbers down because the way lantus works is that you aim to push ALL the numbers in the cycle down simultaneously, rather than just aim for a nice V curve like you did on PZI. Lantus has a much flatter curve, which of course feels very nice to the kitty. As you gently and methodically increase the dose, the whole cycle will come down. It just takes time. And a TON of patience. But he's gonna get there and you will ultimately be extremely happy that you switched. We have a multitude of previous PZI users here on LL, and they can all relate their stories of sitting on their hands in frustration. We all got so used to shooting what we saw that we literally have to unlearn everything we know about treating FD and relearn it with Lantus.

Please test him every 2 hours for now. If you see him start to drop sharply, post immediately please.

 

[Jay]

I have been testing every 2 hours, you mean test every hour?

Are you sure he is about to plummet or rebound?

I didnt see the suggestion about not giving any more insulin and I wont give him a shot if he is under 220. That was my cut off with PZI Vet. Which is exactly my goal here. I work, and wont be home to be able to do this a week from today. The goal is to find a dose that I can safely shoot at 220 and up with him tanking on it while giving me some duration.

So far its been at most 10 hours and the insulin is gone, which is why his BG is rising again. If the previous dose were still effective the number would be hovering with a very tight range, unless food goes on board. Correct me if I'm wrong but when the dose is petering out and his numbers are rising and food goes in, then the next time you test you get a much higher reading.

I'm still trying to grapple with the "shed effect" and flat curve comments that were made neither make much sense to me at this point.

A flat curve could be 300-280-300 from PS to PS..not a good picture, but a safe one short term (just an example) and what constitutes a flat curve? How many points from PS to Nadir to PS?

If there is a rebound, its my understanding that his BG wil spike dramatically and stay high regardless of how much insulin goes in at the next shot. Yet a drastic reduction of insulin will reverse the rebound. Is that true with Lantus?

I didnt really grasp the concept of shed effect the other day, can you give me another way of looking at without using medical terms?


Jay

Lastly at this point, what do you suggest we do from here on?

Honestly, based on what Carolyn and Spot wrote, in addition to the numbers you have just gotten, I would start testing more than ever few hours. he is either about to plummet way down (as Carolyn suggested), or bounce sky high (as it was explained by a Gayle with the tennis ball effect). I would hate to see him go too low and have you catch it late in the game.

She did suggest not giving any more insulin for 12hrs, and then starting over with the 2u twice daily.

 

[Carolyn and Spot]

And more info for the impending cycles.

You are going to think I'm a big fat liar when you see what happens next.. so I am going to prepare you. I am telling you I think he needs to clear for 12 hours, but in the very front of my mind, I am concerned he will need to clear for 24 hours. So please please post your number before deciding to shoot that next PS ok?

What you are going to see is going to be ugly. Reds, pinks and quite possibly a nasty streak of very low numbers. Have Karo ready, have wet high carb food (FF grilled in gravy - 18% works very quickly) available and get your seatbelt on. You're going to want to shoot the entire vial of insulin when you see the numbers that come next. Just let it happen. His liver is going to respond and you will have to ride it out. With PZI, you tend to see liver response quickly. Numbers drop too fast, liver gets mad and starts producing it's hormones and the numbers go flying back up. With Lantus, which I call the "under the radar" insulin, the numbers drop so smoothly that the liver fails to notice.. and when it does, you can have 2-3 cycles of pure pink and red numbers. You just have to keep on keeping on and you'll see the liver stop doing that soon enough.

I have been testing every 2 hours, you mean test every hour?

Are you sure he is about to plummet or rebound?

I am not sure of anything other than if you keep shooting that he will hypo. Hard.

I didnt see the suggestion about not giving any more insulin and I wont give him a shot if he is under 220. That was my cut off with PZI Vet. Which is exactly my goal here. I work, and wont be home to be able to do this a week from today. The goal is to find a dose that I can safely shoot at 220 and up with him tanking on it while giving me some duration.

You're thinking like a PZI user here, which you are. Now you have to think like a Lantus user. Most of the people on this board work out of the homes during the day cycle, and we can help you figure this out whether you are home or not, but it is nice you will be home this week. Unfortunately Lantus doesn't work that fast, and it will likely take more than a week to get him to a perfect dose.

So far its been at most 10 hours and the insulin is gone, which is why his BG is rising again. If the previous dose were still effective the number would be hovering with a very tight range, unless food goes on board. Correct me if I'm wrong but when the dose is petering out and his numbers are rising and food goes in, then the next time you test you get a much higher reading.

Again, you can not know the insulin is petering out. It is also likely that the liver is trying to protect the body and concealing something else. Every cat handles food response differently and you will know better when he's been doing this for more than a few days.

I'm still trying to grapple with the "shed effect" and flat curve comments that were made neither make much sense to me at this point.

A flat curve could be 300-280-300 from PS to PS..not a good picture, but a safe one short term (just an example) and what constitutes a flat curve? How many points from PS to Nadir to PS?

Did you read the link I gave you about the shed? A flat curve would be about 70-100 pts. We don't want to see a whole lot more than that, but initially you *might* see not so shallow curves and that's just the cat getting to learn how to use the insulin. Ultimately, you will have flat curves.

If there is a rebound, its my understanding that his BG wil spike dramatically and stay high regardless of how much insulin goes in at the next shot. Yet a drastic reduction of insulin will reverse the rebound. Is that true with Lantus?

No. Don't do that with Lantus. Just hold your dose unless someone says "don't shoot", "decrease X amt" or "increase X amt" -- as you see us saying that to you, you will begin to see the rationale and you'll be able to make these decisions on your own.

I didnt really grasp the concept of shed effect the other day, can you give me another way of looking at without using medical terms?

This is how it was explained to me. Please do not take the comic aspect of this description as lack of seriousness, it was the ONLY way I could learn to understand this insulin when I switched from PZI. Courtesy of Jojo:

Imagine you have a garden storage shed in your cat. Every time you dose insulin, the body uses half of that dose, and places the other half of the dose into the storage shed. Initially, the cat is not getting enough insulin because insulin is not being used, but rather stored. As the doses go by, and the storage shed fills, one the cat gets to use the whole dose and you see a change in response. The shed is not considered truly full until the cat is at its proper dose. If something happens and the insulin needs go up (ie: you were late for a shot one day), the cat can go into the storage shed and take a little out. Then the next dose or 2 or 3, a little bit will go into that shed to fill it back up.

 

[Jay]

I'm all yours.

So now that we got to this point, (just did a +6 test and he was at 52) what do you suggest when we get to +12?

Jay

You have to give the lantus time. It has to build up in the body for several cycles before you will start seeing action.. Please read the sticky about the shed, it will explain it better than I can. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=150 As the shed fills, you start seeing the duration build. You'll have cycles where your lowest number of the day is one of the preshots, and cycles where he's still dropping after preshot, but as that shed starts filling and you get closer to where you need to be in dosing, you'll see the beautiful shallow curve that Lantus is known for.

The way it's done is that you start at a base dose, then monitor for 3-5 days, wait for signs that the shed is filling, then increase/decrease/hold based on the activity of the cycles, placing great emphasis on nadir numbers. We will help you interpret what is happening at first but you'll start seeing and understanding the patterns quite quickly. The hardest thing is the waiting. With PZI, if for some reason the cat was high before 12 hours was up, we could just jump right in and shoot it. You can not do that with Lantus. You are forced to wait to see action. He will be ok and we'll help you get him to where he needs to be, safely and as quickly as we can without hurting him. If you can post daily and get us spot checks throughout his cycles, we will be able to make quick decisions and explain them to you as we go so you know what we're thinking and we know what you're thinking and everyone's on the same page.

I said you can't force the numbers down because the way lantus works is that you aim to push ALL the numbers in the cycle down simultaneously, rather than just aim for a nice V curve like you did on PZI. Lantus has a much flatter curve, which of course feels very nice to the kitty. As you gently and methodically increase the dose, the whole cycle will come down. It just takes time. And a TON of patience. But he's gonna get there and you will ultimately be extremely happy that you switched. We have a multitude of previous PZI users here on LL, and they can all relate their stories of sitting on their hands in frustration. We all got so used to shooting what we saw that we literally have to unlearn everything we know about treating FD and relearn it with Lantus.

Please test him every 2 hours for now. If you see him start to drop sharply, post immediately please.

 

[Jay]

Thank.

Now I am getting somewhere in my understanding of this insulin.

Jay

And more info for the impending cycles.

You are going to think I'm a big fat liar when you see what happens next.. so I am going to prepare you. I am telling you I think he needs to clear for 12 hours, but in the very front of my mind, I am concerned he will need to clear for 24 hours. So please please post your number before deciding to shoot that next PS ok?

What you are going to see is going to be ugly. Reds, pinks and quite possibly a nasty streak of very low numbers. Have Karo ready, have wet high carb food (FF grilled in gravy - 18% works very quickly) available and get your seatbelt on. You're going to want to shoot the entire vial of insulin when you see the numbers that come next. Just let it happen. His liver is going to respond and you will have to ride it out. With PZI, you tend to see liver response quickly. Numbers drop too fast, liver gets mad and starts producing it's hormones and the numbers go flying back up. With Lantus, which I call the "under the radar" insulin, the numbers drop so smoothly that the liver fails to notice.. and when it does, you can have 2-3 cycles of pure pink and red numbers. You just have to keep on keeping on and you'll see the liver stop doing that soon enough.

I have been testing every 2 hours, you mean test every hour?

Are you sure he is about to plummet or rebound?

I am not sure of anything other than if you keep shooting that he will hypo. Hard.

I didnt see the suggestion about not giving any more insulin and I wont give him a shot if he is under 220. That was my cut off with PZI Vet. Which is exactly my goal here. I work, and wont be home to be able to do this a week from today. The goal is to find a dose that I can safely shoot at 220 and up with him tanking on it while giving me some duration.

You're thinking like a PZI user here, which you are. Now you have to think like a Lantus user. Most of the people on this board work out of the homes during the day cycle, and we can help you figure this out whether you are home or not, but it is nice you will be home this week. Unfortunately Lantus doesn't work that fast, and it will likely take more than a week to get him to a perfect dose.

So far its been at most 10 hours and the insulin is gone, which is why his BG is rising again. If the previous dose were still effective the number would be hovering with a very tight range, unless food goes on board. Correct me if I'm wrong but when the dose is petering out and his numbers are rising and food goes in, then the next time you test you get a much higher reading.

Again, you can not know the insulin is petering out. It is also likely that the liver is trying to protect the body and concealing something else. Every cat handles food response differently and you will know better when he's been doing this for more than a few days.

I'm still trying to grapple with the "shed effect" and flat curve comments that were made neither make much sense to me at this point.

A flat curve could be 300-280-300 from PS to PS..not a good picture, but a safe one short term (just an example) and what constitutes a flat curve? How many points from PS to Nadir to PS?

Did you read the link I gave you about the shed? A flat curve would be about 70-100 pts. We don't want to see a whole lot more than that, but initially you *might* see not so shallow curves and that's just the cat getting to learn how to use the insulin. Ultimately, you will have flat curves.

If there is a rebound, its my understanding that his BG wil spike dramatically and stay high regardless of how much insulin goes in at the next shot. Yet a drastic reduction of insulin will reverse the rebound. Is that true with Lantus?

No. Don't do that with Lantus. Just hold your dose unless someone says "don't shoot", "decrease X amt" or "increase X amt" -- as you see us saying that to you, you will begin to see the rationale and you'll be able to make these decisions on your own.

I didnt really grasp the concept of shed effect the other day, can you give me another way of looking at without using medical terms?

This is how it was explained to me. Please do not take the comic aspect of this description as lack of seriousness, it was the ONLY way I could learn to understand this insulin when I switched from PZI. Courtesy of Jojo:

Imagine you have a garden storage shed in your cat. Every time you dose insulin, the body uses half of that dose, and places the other half of the dose into the storage shed. Initially, the cat is not getting enough insulin because insulin is not being used, but rather stored. As the doses go by, and the storage shed fills, one the cat gets to use the whole dose and you see a change in response. The shed is not considered truly full until the cat is at its proper dose. If something happens and the insulin needs go up (ie: you were late for a shot one day), the cat can go into the storage shed and take a little out. Then the next dose or 2 or 3, a little bit will go into that shed to fill it back up.

 

[Carolyn and Spot]

I'm all yours.

So now that we got to this point, (just did a +6 test and he was at 52) what do you suggest when we get to +12?

Jay

Get the Karo ready, I don't like this at all. Do you have High Carb wet food? Dry food is not nearly as quick, takes a while to get into the blood stream. Test in 15 minutes.

Do not shoot him tonight ok? Please let him go off insulin til morning.

 

[carolynandlatte]

Jay,
Thank you for testing sooner and getting the +6.
Carolyn will be a great help and there are many others out here supporting you.

 

[Blue]

And that's why it's important to stick with the 12/12 dosing;
If you shoot early or late, it's like a increase or decrease.

And going in the other direction with the dose, when you are decreasing, it has that shed to drop too.

I still like my spare gas tank example, but jojo's storage shed is very good!

 

[Jay]

I'm with you

I'm all yours.

So now that we got to this point, (just did a +6 test and he was at 52) what do you suggest when we get to +12?

Jay

Get the Karo ready, I don't like this at all. Do you have High Carb wet food? Dry food is not nearly as quick, takes a while to get into the blood stream. Test in 15 minutes.

Do not shoot him tonight ok? Please let him go off insulin til morning.

 

[Carolyn and Spot]

what wet foods do you have in the house Jay? You need to feed this number. No more than 1oz, you don't want him full.

 

[Jay]

I gave him some EVO, ( a few kibbles, a little less then a smalll handfull) and he is up to 89 at 6 1/2

For the moment he is rising and in no danger on the down side.

Unfortunately though, he may just rebound. If he does go very high by +12, do I clear him out for a cycle and start the process over again? Tomorrow morning? and if so at 2 unis or 1.5? Just trying to get a clear picture of a plan for the next 24 hours.

Jay

I'm all yours.

So now that we got to this point, (just did a +6 test and he was at 52) what do you suggest when we get to +12?

Jay

Get the Karo ready, I don't like this at all. Do you have High Carb wet food? Dry food is not nearly as quick, takes a while to get into the blood stream. Test in 15 minutes.

Do not shoot him tonight ok? Please let him go off insulin til morning.

 

[Jill & Alex (GA)]

i'm responding to jay's PM here in order to keep all advice on the board and subject to peer review...

first of all, the "shed" is nothing more than the INSULIN DEPOT: http://petdiabetes.wikia.com/wiki/Insulin_depot'

JAY: A. As quick as I can raise his dose, the dosing protocal you had posted only deals with increases in dosing. If Lantus does act (I'm still waiting for it to happen) the way everyone describes here, then decreasing his dose would also be doable, yet there is no protocol for that scenario that I have seen.

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.
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581


JAY: B. Its 4 8 hour cycles now, and each dose (2.0) units tanks out on Frankie (loses its juice, its effectiveness) so far the longest 10 hours, which is why I have been dosing TID. I'd like to get this to BID which may mean, a slight increase in the dose.

under "normal" circumstances, yes. an increase in dose may be needed to extend duration, but we don't have a normal scenario going on here so i cannot recommend a dose increase (even slight) at this time.

jay, we need to talk. you're not giving enough time to allow lantus to build up in frankie's system. let me use this as an example: are you familiar with allergy shots? you don't get ones shot from the doc and problem solved. it takes quite a few shots to build up an immunity in the system before you find any relief. the same is true with lantus. lantus has to build up in the system before you're going to see what it can really do. kwim?

shooting 2u every 8 hours is not the way to go about doing this. i know you're experienced. i know frankie is not a newly diagnosed kitty. i know the starting dose was set too low for a kitty who had been receiving 3u bid of pzi. i also know the idea is to bring the numbers down as quickly as possible. i get it... and so does everyone who has been around here for any length of time.

forgive me if i'm wrong, but it appears you're not understanding the cumulative effect of lantus. it can take 2-5 days to see the results of what any particular dose is doing when shot BID <----- notice i said BID. shooting 2u TID can get you in trouble real fast... before you know it. this is where everyone's concerns are coming from.

i respect the fact that you're not to this, but you have to accept the fact that lantus works differently than the pzi you've grown accustomed to. trust us. we're not fighting you. we're on common ground here. we're all fighting for your cat.

having said that, there is a very aggressive lantus dosing approach which has not yet been published which may better suit your style. i have no stats on it. have no idea if it's good or bad. have never tried it and even though i consider myself somewhat experienced... probably never will because imo, the method is extremely aggressive... more aggressive than necessary and has the potential of being far too dangerous to advise over the internet. i can send you the vet's email addy if you'd like to talk to him to find out more information. the method may or may not be good for frankie. i know little about the method except the vet has had some success.

 

[Deb & Spot]

Hi Jay and Frankie. I'm not going to echo what Carolyn, Ronnie, and Cindy have said but I do agree with them. The reason why I am stopping by is to say that Spot was on Humulin N for 8 months and hardly ever go to a decent number. We switched to Lev and here we are, one year later, and he's on an OTJ trial. So, nothing is really impossible. If Spot can't achieve OTJ, I at least know that he needs only the tiniest amount of insulin to keep him in the good numbers.

 

[Jay]

Thanks

Its only been the last 3 cylces of 8 hours doses...just so you know.

i'm responding to jay's PM here in order to keep all advice on the board and subject to peer review...

first of all, the "shed" is nothing more than the INSULIN DEPOT: http://petdiabetes.wikia.com/wiki/Insulin_depot'

JAY: A. As quick as I can raise his dose, the dosing protocal you had posted only deals with increases in dosing. If Lantus does act (I'm still waiting for it to happen) the way everyone describes here, then decreasing his dose would also be doable, yet there is no protocol for that scenario that I have seen.

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.
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581


JAY: B. Its 4 8 hour cycles now, and each dose (2.0) units tanks out on Frankie (loses its juice, its effectiveness) so far the longest 10 hours, which is why I have been dosing TID. I'd like to get this to BID which may mean, a slight increase in the dose.

under "normal" circumstances, yes. an increase in dose may be needed to extend duration, but we don't have a normal scenario going on here so i cannot recommend a dose increase (even slight) at this time.

jay, we need to talk. you're not giving enough time to allow lantus to build up in frankie's system. let me use this as an example: are you familiar with allergy shots? you don't get ones shot from the doc and problem solved. it takes quite a few shots to build up an immunity in the system before you find any relief. the same is true with lantus. lantus has to build up in the system before you're going to see what it can really do. kwim?

shooting 2u every 8 hours is not the way to go about doing this. i know you're experienced. i know frankie is not a newly diagnosed kitty. i know the starting dose was set too low for a kitty who had been receiving 3u bid of pzi. i also know the idea is to bring the numbers down as quickly as possible. i get it... and so does everyone who has been around here for any length of time.

forgive me if i'm wrong, but it appears you're not understanding the cumulative effect of lantus. it can take 2-5 days to see the results of what any particular dose is doing when shot BID <----- notice i said BID. shooting 2u TID can get you in trouble real fast... before you know it. this is where everyone's concerns are coming from.

i respect the fact that you're not to this, but you have to accept the fact that lantus works differently than the pzi you've grown accustomed to. trust us. we're not fighting you. we're on common ground here. we're all fighting for your cat.

having said that, there is a very aggressive lantus dosing approach which has not yet been published which may better suit your style. i have no stats on it. have no idea if it's good or bad. have never tried it and even though i consider myself somewhat experienced... probably never will because imo, the method is extremely aggressive... more aggressive than necessary and has the potential of being far too dangerous to advise over the internet. i can send you the vet's email addy if you'd like to talk to him to find out more information. the method may or may not be good for frankie. i know little about the method except the vet has had some success.

 

[Carolyn and Spot]

He can still be in danger. You will have to test throughout this cycle and possibly through the night if he continues to drop, which Lantus can do, dropping 2 and even 3 times long past +6. Do not let your guard down. I hope very much that this will not happen and that he will just go straight into an ugly rebound, but hypo is an extreme possibility. Right now, test in 1/2 hour. Just to let you know how concerned I am, I almost had you pick the cat up and go straight to the vet. If he continues to drop, that may still be a necessity. When the cats died on the other board, one cat was hypoing long after +12.

Next 24 hours. You were at 2u on PZI? Our normal modus operandi is suggest the new member start at 1u but you have a cat that has been diabetic for a very long time so I would be open to you starting at 1u, 1.5u or 2u. Your choice. We'll be able to see if 2u is a problem very quickly and be able to "drain the shed" by skipping a dose and restarting at a lower one. Restart that at AMPS tomorrow. Lots of tests tonight ok? We want to make sure he doesn't drop suddenly. High numbers can be due to a temporary liver response and you should keep that in the forefront of your mind and be watchful of it wearing off. Again, you're gonna be seeing some serious ugly for at least 2 or 3 cycles so the next 2-3 days are going to be very hard on you and you're going to get very frustrated. You are in data collection mode though, just keep saying that to yourself. We'll be weighing in on your daily posts to tell you what we think of his response and stuff so you won't be alone on a life raft drifting hopelessly into the great blue

 

[Jay]

Here is what I keep on Hand
Friskies a few cans of Tender Cuts with Chicken and Gravy
High Carb Dry
Low Carb Evo
FF Beef Feast
Chopped Grill Feast
Turkey and Giblets Feast

Jay

what wet foods do you have in the house Jay? You need to feed this number. No more than 1oz, you don't want him full.

 

[Carolyn and Spot]

Friskies a few cans of Tender Cuts with Chicken and Gravy <---this one ---this is the food he gets for the rest of the day and night ok? I don't care if he goes to 900 and stays there for 9 straight hours.

 

[Jay]

We had him at 3.0 units of PZI.

I plan on being vigilant as I have been since I started on this ride.

Yeah it could be ugly numbers, but as my Vet once said, its better to have a cat that is a living diabetic with high numbers as opposed to the converse.

Jay

He can still be in danger. You will have to test throughout this cycle and possibly through the night if he continues to drop, which Lantus can do, dropping 2 and even 3 times long past +6. Do not let your guard down. I hope very much that this will not happen and that he will just go straight into an ugly rebound, but hypo is an extreme possibility. Right now, test in 1/2 hour. Just to let you know how concerned I am, I almost had you pick the cat up and go straight to the vet. If he continues to drop, that may still be a necessity. When the cats died on the other board, one cat was hypoing long after +12.

Next 24 hours. You were at 2u on PZI? Our normal modus operandi is suggest the new member start at 1u but you have a cat that has been diabetic for a very long time so I would be open to you starting at 1u, 1.5u or 2u. Your choice. We'll be able to see if 2u is a problem very quickly and be able to "drain the shed" by skipping a dose and restarting at a lower one. Restart that at AMPS tomorrow. Lots of tests tonight ok? We want to make sure he doesn't drop suddenly. High numbers can be due to a temporary liver response and you should keep that in the forefront of your mind and be watchful of it wearing off. Again, you're gonna be seeing some serious ugly for at least 2 or 3 cycles so the next 2-3 days are going to be very hard on you and you're going to get very frustrated. You are in data collection mode though, just keep saying that to yourself. We'll be weighing in on your daily posts to tell you what we think of his response and stuff so you won't be alone on a life raft drifting hopelessly into the great blue

 

[Jay]

Thats why its here.

Arrggggg. My metere, does any meter read that HI?

Drain the shed tonite. pick it up again in the AM at a reduced dose. and start all over again 12/12.

Sounds like a plan.

Jay

Friskies a few cans of Tender Cuts with Chicken and Gravy <---this one ---this is the food he gets for the rest of the day and night ok? I don't care if he goes to 900 and stays there for 9 straight hours.

 

[Carolyn and Spot]

You are right about that

Don't worry, we'll help you get him all patched up and you'll be wondering why you didn't switch to lantus sooner when you see how he does.

Since he was at 3u, I think 2u would be a very reasonable dose for you to start with. That dose will have to be held for an absolute minimum of 6-10 cycles. If I were to theoretically see that his spreadsheet looks like a wall of red and pink I might recommend an increase after the 6th cycle, but it is quite likely there will be calls for you to hold 8 cycles at minimum so we can be sure he's rid of all "fake" numbers brought about by the extra insulin, the skipped shot, intervention foods and rebound.

Arrggggg. My metere, does any meter read that HI?

Thankfully, no :lol:

 

[Jay]

at +7 he is at 90

I'll keep an eye on him and test.

Just so you know. I had been dosing him at 2 untis.

2 other scenarios.

If he is hovering at or about non diabetic numbers up to meal time (Hi Carb Wet for dinner) or just let him ride it out with FF thru the AM.

If he is hovering around the Renal Threshold 175 at dinner..still hi carb wet (real ugly numbers on this one) or FF and let him ride it out till the AM.

Jay

You are right about that

Don't worry, we'll help you get him all patched up and you'll be wondering why you didn't switch to lantus sooner when you see how he does.

Since he was at 3u, I think 2u would be a very reasonable dose for you to start with. That dose will have to be held for an absolute minimum of 6-10 cycles. If I were to theoretically see that his spreadsheet looks like a wall of red and pink I might recommend an increase after the 6th cycle, but it is quite likely there will be calls for you to hold 8 cycles at minimum so we can be sure he's rid of all "fake" numbers brought about by the extra insulin, the skipped shot, intervention foods and rebound.

Arrggggg. My metere, does any meter read that HI?

Thankfully, no :lol:

 

[Carolyn and Spot]

Hi carb today and through the night. It is the safest advice I can give you, I just can't feel safe enough to say "feed LC at this number" and then his numbers come crashing down while you're sleeping. We can always get rid of the carbs with the insulin and a couple days max to ride it out.

 

[Jay]

Hi carb today and through the night. It is the safest advice I can give you, I just can't feel safe enough to say "feed LC at this number" and then his numbers come crashing down while you're sleeping. We can always get rid of the carbs with the insulin and a couple days max to ride it out.

In the beginning whether being DX or Switching as I am in the process of doing, does any one really sleep?

I got 3 hours of "iffy sleep" last nite to keep an eye on him.

Let me see if I totally understand the Shed effect.

Assuming I were to feed him low carb tonite ( I said assuming, for the moment though that wont happen at least till I get some more miles under my belt with this) without a dose.

He will be drawing down the reserve to keep his number stable, or drop him lower (like an automatic water or food feeder) and the next dose would refill the reserve. Is that a correct assumption?

Jay

 

[Carolyn and Spot]

It's close, but not quite.

It wouldn't keep him stable for long, but it would prevent his numbers from rising very high initially. You probably would have a few hours before they started creeping up. And this can only happen once his shed is full and he's at a good maintenance dose, and he would never drop much while on the shed's insulin.. just maintain or creep up, rather than fly up.