4/22 Junior AMPS 498 +6 391 PMPS 390 +5 290 Big Swings

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MauiGuppy

MauiGuppy

Member Since 2011
Hi all,

This is my first post to the Lantus group so I hope I'm doing this right!

I'll put this in a separate doc this weekend but for now, quick background: Junior was diagnosed in Feb and began on 2U of Lantus on 2/21. It wasn't until 3/17 that we increased it to 3U. Vet said to test him once a week and we'd adjust Junior's insulin accordingly.

Monday night I gave Junior a fur shot and posted a question on the main forum. Julia & Bandit were kind enough to provide some add'l thoughts: at 5u his dosage seemed too high, suspected his high numbers was b/c he was on canned food (he was), recommended daily home testing (now being done). Here's the original thread.

Yesterday I switched him to canned (Wellness Lobster & Chicken), his BG dropped 190 points and Julia cautioned about the possibility of hypo b/c he had been on dry. So last I gave him some dry (Evo Chicken & Turkey) but I don't plan on giving him any more for now. Junior had 1/4 canned and 2u this morning. We'll see how this goes.

My general request is if someone could help me keep an eye on his numbers for the next few shots. I don't know if these changes are too drastic and that we'll wind up in the ER again. Would appreciate any advice or insights on what to look for or the right amount of change.

Thanks in advance! Great group here!
Bonnie
 
Re: 4/22 Junior AMPS 498 -- please monitor b/c of big swing

Hi guys and welcome! I know there are plenty of people here who will be more then willing to help you work out the right dose for Junior .. just make sure you start a condo each day (like this one) and keep us informed on what's going on .. doing home testing is really the only way to determine if the dose needs to be adjusted .. Hang tight guys!
 
Re: 4/22 Junior AMPS 498 -- please monitor b/c of big swing

no advice, but welcome! it sounds like you're already on the right track.

posting here in Lantus guarantees people will take a look at what's going on with junior! if you want extra attention, putting the request in the first post's subject line, as you just did, is excellent.
 
Re: 4/22 Junior AMPS 498 -- please monitor b/c of big swing

Welcome!

Please read the starred, sticky notes at the top of the board. They will give you a foundation for how we approach Lantus dosing and how this group works. The info below will give you a guide and links.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
My guess is that Junior was started on a bit high of a dose and you are increasing by too large increments. We typically increase/decrease doses in increments of 0.25u. If you increase by a full unit, it's likely you will miss a good dose. Unless there is a compelling reason, doses also need to be held for 3 days to allow the shed to catch up and to evaluate how well the dose is or isn't working. Also, dosing is based on the lowest point of the cycle, the nadir, not on the pre-shot value. I can't tell if you're basing your dose on the pre-shot or just trying to find a good dose. I would probably encourage you to stick with 1.0u for a few days. The more you move the dose around, the wonkier numbers will be. Lantus likes consistency.

Let's get some additional input on your dose and we will absolutely help you keep an eye on Junior's numbers. Sorry to hit and run but I've got a meeting to head off to. Please ask questions and let us know how we can help.
 
Re: 4/22 Junior AMPS 498 -- please monitor b/c of big swing

Welcome! I'm pretty new at this too and you will find, just as I and others have, that this board is going to be what keeps you sane. The people here are angels on earth!!

I started feeding my at cat Wellness wet also. I noticed on Janet & Binkys food list that the Wellness Chicken and Lobster has pretty high carbs and you want to keep it pretty low. The Wellness Chicken & Herring and Turkey & Salmon are better choices if your kitty wants seafood. The plain Chicken and plain Turkey are very good choices at about 4% carbs. My cat always hated pate food, but loves all of these flavors. My cat always ate dry food, too, but now he gets NONE. It's just really a bad idea when you're trying to get your kitty regulated. Also, if you want to make sure Junior is getting enough water intake, mix his wet food with water so its like a thick soup. He'll lap it up like its flippin nectar. I dipped my finger in it and put it up to Champ's mouth the first couple of times because he didn't understand what it was I was trying to feed him. Now he's diving right in.

I definitely can't advise you about dosing, but I can say that anything Sienne tells you, listen to her. She's AWESOME and knows her stuff. I've been told time and time again here on this board that regulating your kitty with Lantus is a marathon, not a sprint. It's going to take a bit to find the correct dose, increasing little by little, with a whole lot of frustration and impatience on your part, but we're all here together in the same boat so just know we got your back.
 
Re: 4/22 Junior AMPS 498 -- please monitor b/c of big swing

OMG thank you so much for all your support guys! Just knowing that you guys stopped by makes me feel less stressed out.

I'll definitely check out the other types of cat food and all the other links. There's still alot to learn and I plan on doing it this weekend.

After getting 2 units this morning, Junior's +6 today is 391, I do have a few immediate questions:

1. Since he's been on 5 for the last week or so, is it better for him to step down to a lower dosage like 1-2 or go cold turkey to those units?

2. He had 1u last night and 2u this morning. I agree he should be consistent and go through a few cycles but what should it be? His peak is 391 and I'd hate to have him go higher.

3. How would you recommend I talk to my vet about this? I usually call him on Mondays and had been following his direction to the T. He's a good guy, a friend of the family and has been really supportive. I'm planning on sharing with him the "pass this to your vet" info from here. Just feel like I've gone behind his back and changed Junior's dosage without talking to him first. Not sure if I messed up the vet's plan and since every cat is different, what if he really should be at 5u? Has anyone had any similar experiences?

4. Just a netiquette question -- now that I have his +6 numbers, should I have started a new thread or just continue this one like this?

Thanks again! I hope I can pay it forward one day!
Bonnie
 
Re: 4/22 Junior AMPS 498 -- please monitor b/c of big swing

Hi, Bonnie, and welcome!! :) You are truly in good hands here!

As far as the netiquette stuff, we open one thread, or condo per day. Whenever we get a new number, we go to the first post in the thread and click the edit button, then change the subject line to include the new number. This is very helpful to folks who are giving you help... they can quickly look at the subject line on the main page and see Junior's progress throughout the cycle. In our first post of the day, we also refer back to the prior day's condo. This allows helpers to read backwards easily and see what was going on and what advice was previously given. Folks will also use your spreadsheet to get a snapshot of what is going on when advising.

The vet thing is a tricky question, and honestly depends on the vet. Our experience with deviating from our original vet's advice didn't go too well, and we ultimately left the practice (or, rather, we were booted for being "noncompliant!"). I would recommend that you gently say that you have been doing a great deal of research and that you became uncomfortable with the high doses you were giving Junior and the large dose increases that have gotten you there, and with the change in diet to all wet food, you thought it prudent to start over. You can also mention that you have found a group of pet owners using the same insulin and that you wish to follow their protocol because you are impressed with not only their success rate, but also with the fact that you have almost 24/7 support for any situation you might find yourself in. If you meet resistance, I would just gently but firmly state that Junior's care is your day to day responsibility (not the vet's) and that you are making decisions that you feel are the best for his safety and health in the long run with the support of similarly situated individuals who are there for you long after the vet's office is closed, who can provide assistance instantly, not 20 minutes later when the vet's answering service gets ahold of him and he gets around to calling you back. It was hard for me... in person it involved choking back tears and annoying facial ticks, but ultimately, our cats can't speak for themselves and it is up to us to be their advocates. Willie now has a general vet who is very supportive, and an internal medicine specialist who doesn't love our protocol (she thinks it is too time consuming and that owners won't stick with it), but doesn't believe it to be harmful and supports my decision to stick with it. Unfortunately, even great vets are often inexperienced with FD, or haven't kept up on the research. For many practices, using Lantus is a relatively new thing, and unfortunately our vets don't do the legwork in understanding how it differs from previous insulins before giving it to their clients. And there are several key differences!!

I'd encourage you to read through our daily threads (humor is a wonderful thing around here!!), and also look at the spreadsheets of our many kitties. It will give you a good sense of the variety of experiences our cats have on Lantus. While there are some general principles that apply, our motto here is ultimately ECID (Every cat is different!).

One question... are you currently testing for ketones? If you are going to drop dose from 5 units to 1 unit, I don't think there is any inherent danger, other than potentially DKA, which is why testing for ketones is important. Willie never had DKA or significant ketone problems, but the $15 spent on those sticks, making sure we didn't lose him to DKA or spend thousands of dollars to save him, was definitely a worthwhile investment!

Please continue to ask any questions you might have! We are happy to help!
 
Re: 4/22 Junior AMPS 498 -- please monitor b/c of big swing

Hi & Welcome!

Just take and edit your first "condo" of the day and put the +6 number into your subject line. ! Condo per kitty per day makes it much simpler to keep track of everything.

Good on you for learning to hometest - it really is the best way to figure out the correct dose for Junior. And don't feel bad for changing the dose to a lower dose than your vet wants. You are the one testing and seeing the numbers. I think most of us have dosed differently than our vets have advised and it will be OK. Junior is your cat so you get to make the decisions ;-) I told my Vet I was choosing to be more conservative and only increase by 0.25 units every 3-6 days (6-12 cycles) and she was OK with it. Now she has told me not to increase any further - but I may go up to 1.5 units (currently at 1.25) in a couple of days, depending on what Zoe's numbers do.

I would start back at 1 unit twice a day with lower carb foods (no dry) and test, test, test! See what his numbers look like and then decide when to go up (or down) the dosing scale. Lantus likes consistency in dosing and timing (every 12 hours).

Good luck and Happy to meet you!
 
Re: 4/22 Junior AMPS 498 -- please monitor b/c of big swing

see, look at all the advice you've gotten and it's only been a few hours. :lol:

i'm in the vet quandry myself - basically i've opted to follow the advice here on dosing & care, and it may be becoming a problem. Every week a couple of cats following this protocol go off of insulin because their owners chose to follow this rather than their vet's advice. it's successful. this is what we all hope for. my vet practice (3 fulltime vets) only has 1 other diabetic cat - and honestly, i love my vet but he keeps making mistakes that could've been serious for my cat. i'm debating about leaving, the trouble is he's considered the best in town.

you will learn so much by just reading people's condos and looking at their cat's spreadsheets. once you have numbers for jr over a period of time you'll be able to see patterns emerging that will help you help junior.

the stickies at the top of the lantus forum - you'll find that you want to re-read those over and over. seriously, i get a little more each time. and don't be afraid to ask questions - we all help each other as much as possible, plus there are a half-dozen experts who will chime in with dosing & other advice when you need a pro.

heehee, do you feel like you just got a load of homework? ;-)
 
Re: 4/22 Junior AMPS 498 -- please monitor b/c of big swing

Bonnie, my experience was a lot like yours with the dose of insulin. My vet put Champ on 3u b.i.d. right from the start. He was on that dose for 11 or 12 days before I found this board. After spending a few hours talking with some of the members, I immediately reduced Champ down to 1u b.i.d. and have been working my way up from there. I don't know if going from 3u to 1u cold turkey was a good idea or not. I would see if you can get Sienne or one of the other dosing experts to let you know. Champ is now up to 1.75u b.i.d. and today has been one of his better days. If you feed him appropriately, his insulin needs will be greatly reduced and he has a far better chance of going into remission sooner. I'll be looking out for your condo every day to see how Junior is doing. If you ever feel stressed or like you're going to break down, let me tell you...been there and done that, many times. The people here will pick you up, dust you off, and make you feel like you can absolutely do this.

By the way, I haven't told my vet yet about how I've changed Champ's care. She's on vacation this week so I'm supposed to get a call on Monday. I'll tell her then and hope she is on board because I really like her. But I have to do what's best for my baby and that's following this protocol.
 
Re: 4/22 Junior AMPS 498 +6 391 Please monitor b/c of big sw

Hi all,

I really cannot thank everyone enough for all your wisdom and support. Junior's treatment began in February and I can't believe I didn't find you guys earlier! You guys have been my guardian angels!

I haven't tested Junior yet but will probably do 1u for awhile and see how the next few days go before I do my weekly Monday call to the vet. Today he's been the best he's been in 2 months. Alert, not excessively thirsty, relaxed. Heck, even his fur is nice and soft again...he showered!

Julie, I literally laughed out loud when I read your last line. Yes, yes I do have alot of homework!

Thanks again everyone!!!
Bonnie
 
Re: 4/22 Junior AMPS 498 +6 391 PMPS 390 Plz monitor big swi

First, I'm completely jealous of how you did your Profile for Junior! (I'm also in Chicago.)

You might want to re-think the l-lysine chews. Take a look at the ingredients: poultry meal, L-Lysine HCL, whey, sorbitol, glycerin, rice, starch, soy lecithin, dried port, glucose syrup, salt, potassium sorbate, ascorbic acid, BHA, citric acid, propyl gallate, ammonium propionate, phosphoric acid, phosphoric acid, sorbic acid, lactic acid, propyl p-hydroxybenzoate. I don't think the carb count on this is helping Junior's numbers. I use l-lysine for sneezing, as well. I've linked the brand I use. I mix 1/8 teaspoon twice a day into the kitties food.

As far as your vet, since this is a family friend, you might want to see if he'll get on board with the protocol we use. You can either print out the version in the Tight Regulation sticky that's on the University of Queensland letterhead. Or, you can bring the following journal article that contains the protocol. I'd ask him what he thinks and whether he'd work with you to help Junior follow the protocol. It's pretty much what I did with my vet and she's become a fan of this protocol.

As for dose, the protocol we use suggests that the initial dose of Lantus can be based on a cat's ideal weight. From your SS, I'm guessing Junior's weight should be around 14 lbs. The formula for calculating initial dose is: initial dose = 0.25 x ideal weight in kilograms. For a 14 lb cat, this would be approximately 1.5u. If you want to keep Junior at 1.0u, that's fine.

Just an FYI. You noted on your SS that your vet's goal is to have Junior in a range of high 100s to 250. We aim for and do better. The protocol we use aims for tight regulation or remission. We want to keep a cat in as close to normal numbers as possible. Most vets have panic attacks over our having our cats in numbers below 100. For them, because most people don't home test, having a cat in this range is a liability. The cat could easily become hypoglycemic so they want the cat in higher numbers. Because you're home testing and will learn how to steer the numbers using high carb food, you can have Junior in better and lower numbers than your vet may be comfortable with. You'll notice from the subject lines that we shoot low numbers. You'll be able to do this once you have the data. (You don't have the data yet.)
 

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Hello Sienne, fellow Chicagoan!

Aww, thank you for your nice thoughts on Junior's profile. I had alot of fun putting it together. It was definitely a stress reliever!

But a big DOH! No wonder why Junior loves it! Seriously, that cat has a nose for carbs. I just ordered more lysine from amazon.com but hopefully I can return it.

You know, after I said I was giving Junior 1u, I read some of the links people have been sharing with me and I'm glad I had read about the calculation. Junior did get 1.5u and I'm cautiously optimistic about his numbers. On one hand I don't know if this is still residual from the 5u these last 2 weeks. On the other hand, he's been acting more like his old self. He spent this evening napping on the couch, something he hasn't done since January.

I really appreciate you sharing what we should be aiming for. When he told me that higher range, I wondered why there should be a difference. Great to know we can aim lower.

And thank you for sharing your experiences with your vet. If the rest of the weekend is like today, I feel more confident when I talk to him. If it doesn't work out, I might just be asking for a referral to yours!

Thanks again and have a great night!
Bonnie

Thanks again
 
One other thought...

I noticed you're using an AlphaTrack meter. If you are going to use this meter permanently, please add that info to your signature. That particular meter uses different cut offs for dosing (i.e., a dose reduction is earned with a drop below 80 vs. below 50 with a human glucometer). The AlphaTrack and human glucometer are calibrated differently. Having the info in your signature will help us remember to use the appropriate cut offs.

Most people here do not use the AlphaTrack. It's a good meter -- that's not the issue. The hassle is that the strips are expensive and only available through your vet. If you are running out of strips in the evening or on a holiday, you're SOL if the vet's office is closed. Many people here use the Walmart brand meter -- Relion. I don't get to those areas outside of the city where there's a Walmart. There are many other meters that are very good. I use a Bayer Contour. Others have been liking the Freestyle Lite. Strips are best purchased on-line (e.g., around $26 on Amazon or Hocks vs. double that at Walgreens for 50 strips).
 
Sienna,

Yes I noticed that alot of people didn't use Alphatrak and agree -- it's quite expensive! That's one of my frustration points with my vet. I'm learning alot of things here that make me wonder, why didn't my vet know this? Also delicate since he's a family friend, but still!

Thanks for pointing this out. Will be posting Junior's AMPS next!
Bonnie
 
No advice, but welcome to Lantus Land, the place where future non-diabetic kitties gather! I had the very same thing happen meterwise with our former vet. I can advise on that subject: do yourself a favor 1) trust the advice given here by the dosing experts-you'll not regret it 2) while following their lead, do some research and get yourself a vet who is familiar with Lantus or is open to learning from you. Again, welcome.
 
The advantage of the AlphaTrack is that the calibration is the same as a serum chemistry analyzer that is often used in the vet's office.

Many vets get their info from the reps that come through their office. Since Abbott is in the Chicago area, I'm sure they blanket the vets and push that they have the only meter that is specific for companion animal testing. My guess is your vet hasn't a clue about the price of strips on the AlphaTrack vs. a human glucometer. There are also any number of vets who will tell you that you can't get accurate results using a human glucometer with a cat.

As to the latter point, if you print out the article I linked or the version that's in the Tight Regulation sticky (it's on University of Queensland letterhead), there are 2 tables. The first table is based on a human glucometer and the values in the second table are for an AlphaTrack or serum chemistry analyzer. Hopefully, that will allay any concerns your vet may have.
 
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