4/7 Lucky's Glucose curve results and questions

[Luckyducky]

Hello everyone, and thank you all so much again for your help so far. I started posting on these forums a few weeks ago about my cat Lucky, a stray I adopted that turned out to have diabetes (the posts so far are here, here and here). I've just now finished another full curve (exhausting, but worth it!) after switching to 0.75u twice daily a week ago, and was hoping for some guidance and insight into the new numbers.

AMPS 356
+2 311
+4 222
+6 173
+8 213
+10 365
PMPS 410
+2 397
+4 376
+6 326
+8 352
+10 335
AMPS 320

Here's Lucky's full spreadsheet too.

These are the questions I have, I hope you all can help:

1. Is this a normal curve? It looks like the Lantus is working, but it doesn't look like "a smile followed by a smile" like I was expecting, more like a "smirk followed by a bumpy downward slope." Is there anything I might be doing wrong that could be causing this? It seems like a million small things could go wrong to throw the numbers off, but I also feel like I'm following all the procedures properly and getting the measurements accurately.

2. Would it be good to increase the dosage to 1u twice daily? The numbers have been pretty high for the last few weeks, and Lucky doesn't seem to be dipping very low during his cycles right now. I'm kind of confused by his recent results, since his glucose levels don't seem that much better from when he was on 0.5u twice daily (and I'm worried about going back to 1u twice daily considering how low Lucky's numbers got on that dosage). Then again, I increased his food intake from 2 1/3 cans to 3 1/2 cans over the last few weeks too, so I wonder if that has anything to do with the higher-than-expected numbers.

3. Do you think I ought to continue following my vet's dosing suggestions? My vet is very friendly, with years of experience and a very flexible response to a lot of the information I've brought to her from the FDMB. Still, I've been worried that she might not have very much experience with feline diabetes. She wasn't aware that Solostar pens existed, and she was under the impression that doses could only be given in whole units (which is why part of Lucky's SS shows a dosage of 1u once daily mid-March). She also gave a strange dosage instruction of 0.5u AM and 1u PM at the end of March, which some FDMB members mentioned didn't make sense given Lucky's numbers and was generally bad practice for Lantus users. She was also encouraging me to feed Lucky dry diabetic cat food, which seems to be the opposite of what most sites online have suggested. I hate to break ties with the vet since she's been very empathetic to our case and was knowledgeable enough to make Lucky's initial diagnosis of Diabetes, but still, I hate to put Lucky at risk if she doesn't have enough experience to dose the insulin. Do you guys think my vet is still okay to go with, or do you think maybe I should switch vets? Or alternatively, is it even necessary to talk with the vet every time I change a dose?

4. I recently bought ketone strips (the Walgreen's brand "Ketone Test Strips") to test Lucky's ketone levels, thanks to some recommendations from some of the forum members. Considering Lucky's recent high numbers, it seemed especially important to test and make sure he wasn't becoming ketoacidotic. So yesterday I decided to test his urine, but wound up scratching my head to try and figure out what to make of the reading. I followed the instructions pretty carefully: Lucky went to his litter box and I placed a petri dish to collect his urine, dipped the strip in, wiped the excess off the side of the dish and waited 15 seconds to determine the color. The thing is, the strip wound up with a grayish color that didn't seem to match any of the colors I was supposed to compare against the bottle. Here's a photo, if it helps: http://i1101.photobucket.com/albums/g42 ... 030101.jpg

Thank you all again for your experience and guidance. I'm slowly getting a handle on managing Lucky's diabetes, and a lot of it is thanks to the knowledge and help provided on these forums. You guys are saving Kitty's life, and I'm very much so thankful for it!

 

[Ann & Tess GA]

Hi, mainly giving you a bump up to get more attention.

I'll let others advise on the dose, there are so many variables.

Re the vet: Most of us have found few vets that are really up to date w/ FD. The deal w/ so many different types of animals and so many conditions, FD is just one. It sounds like she has heard about Lantus, but isn't completely up to date on it. Her recommendations are in sync w/ some of the other insulins. The same holds true for feline nutrition and then they have been brainwashed on the prescription foods. A great book on feline nutrition is Dr. Elizabeth Hodgkins"Your Cat" Maybe a copy for you and your vet?

Many here listen to what the vet says, smile and nod, then do what they feel is best for their cat. There is so much real experience here on dosing, and dosing is a day to day decision. Humans do it for themselves all the time, we do for our cats. Just phrase it politely when you are urged to buy the prescription foods or say you cat refuses to eat it. That is usually a clincher. :lol: I have heard of few cats who willingly eat it. Remember she works for you an cannot make you do what you feel is not best for Lucky.

On the strips: I think the color is neutral, just darker because it is wet.

 

[julie & punkin (ga)]

i agree with ann on the ketone strip - i think you're ok on it.

great job with your ss and getting lots of tests in! one change i'd suggest - instead of getting all of your tests at +6, get them at different times if you can. if you can't, like that's your lunch hour or something, that's cool. sometimes it's helpful to see other times in the cycle.

but you've got lots of data there, so don't think i'm criticizing. i just think of a ss like a jigsaw puzzle, and the more complete the picture is the more accurate we can be with knowing what's going on.

i suspect you hit the nail on the head with your comment about increasing the quantity of food and that's affecting the numbers.

the other thing - i just reread your past posts - if you are still feeding lucky round the clock, i think you'll have better numbers if you feed most of his food with the shot and in the first 4ish hours after the shot. that puts the carbs in his body when the lantus is strongest to deal with it. if a cat is a grazer and it doesn't affect his numbers, then it's fine, but i was feeding punkin at shot, +3, 6 and 9 and when someone suggested to me to keep most of his food earlier in the cycle, we had much better cycles. i still give a little treat after a poke, but all the meals are in the first 3-4 hrs of each cycle. he survives til the next shot/meal! even if he would tell you differently! ;-)

Might be a good idea to add that Lucky had DKA to your signature line. we tend to be a little more aggressive when a cat's had ketones because we sure don't want them to come back.

looks to me like you could increase .25units to a 1unit dose. you've had 16 cycles at this dose, lots of spot checks (YAY!) and the lowest on there is 173.

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

eta - re your vet, your vet is giving you common advice - we hear those things a lot. if you think your vet is good otherwise, that wouldn't make me leave her. FD isn't something they come across that much and there is a ton to learn how to manage it. lantus works differently than the older insulins. if you like her otherwise, i'd give her a little grace on this one.

 

[Libby and Lucy]

it doesn't look like "a smile followed by a smile" like I was expecting, more like a "smirk followed by a bumpy downward slope."

:lol: I love this description!

Don't worry about the shape of the curve. Because Lantus is long-acting in cats, each individual cycle doesn't mean a whole lot by itself. You'll learn to "read" the spreadsheet by looking at waves of action over a period of a few days. It looks like Lucky is doing very well, but with nadirs in blue you do have room for an increase to 1u BID.

He did get low on that dose before, and you reduced the dose like you should. Sometimes dose reductions don't hold, for whatever reason, and the cat has to go back up to the last good dose to get things started again. I would do the increase when you can monitor, just to be safe, because sometimes it only takes a few cycles on the increased dose to get the momentum back again. Then often the reduction will hold better the second time around.

Welcome to Lantus Land!

 

[Vyktors Mum]

I don't think there's any need to update the vet everytime you change dose, when you need to see them about something else you can just email or take a copy of your ss in so they can see what you've been up to. I wouldn't be getting your dosing advice from them but if you're happy with them for everything else I don't see any need to change vets either - you have the board to help you deal with the FD and advise re dosing (I agree with Julie about the increase btw). That's how it works with my vet, they're in charge of other stuff and they leave the FD managment to me. When you have a vet that is receptive and they can see you're not doing anything crazy this works just fine :smile:

P.S. It seems to me that it's not that common to see the 'normal lantus curve' especially in the early stages of the sugar dance :roll:

 

[Sienne and Gabby (GA)]

Lucky's curve: The "ideal" Lantus curve is flat -- kind of like the curve during the PM cycle, except in a lower number range. For roughly 10 days at the 0.75u dose, it looks fine. It looks like Lucky needs more insulin but other than that, I think you're doing fine.

Dose: Like I mentioned above, I think you're instincts are on target -- Lucky could use a dose increase. I'd increase to 1.0u. If you're using the TR protocol, we generally increase the dose after 3 days/6 cycles if you aren't seeing numbers that are consistently below 200. 3-1/2 cans of food seems like a lot. I realize that Lucky is a Maine Coon but 12.5lbs is small for that breed. You might want to calculate Lucky's food needs based on calories:

Required calories per day = [13.6 X optimal lean body weight in pounds] + 70​

Relationship with your vet: We all need to have a vet for our cat(s). Even with your own physician, I suspect there are areas where your doctor is excellent and areas that are not his/her forte. It's the same with vets and their task is so much bigger. Vets need to know the gamut of illnesses across a range of species. To be honest, I have rarely discussed Gabby's dose with my vet. She has the link to her spreadsheet and is comfortable with my managing Gabby's diabetes. Most humans adjust their insulin as they need to rather than calling or going in to see their MD. And, just like with humans, we test our cats. I don't see any reason to be going in to see the vet to discuss dose changes when this is something you can easily do at home. If there is something unusual, then the people here will be the first to encourage you to see your vet. There is a huge collection of wisdom about feline diabetes here. It's much easier for us to become knowledgeable about one topic (diabetes) than to have to know everything about feline health.

Ketone test: I would check the expiration date on the strips. Also, one quick way to check if the strips are a problem, is to test yourself. If when you test yourself, the strips look OK, the other thing I would do is see if you can sneak a piece of paper towel under Lucky when he pees. The only thing I can think of that might turn the strip a brownish color is if there is some blood in his urine. He could have a urinary track infection which often can produce blood in the urine. If there's blood in his urine you'll see it on the "paper towel test."

 

[Luckyducky]

Thank you all so much for your replies, it's really helped clear some mental fog I've had for a while now and puts a lot of things into perspective. I've read through the thread and absorbed the advice as best I can (I'll likely have to read through it again later to keep it fresh), and am considering how to make certain changes in the coming weeks based on what I've read (adjusting food intake, spot checks at different times, and several other ideas that were brought up). I'm sorry that I couldn't write back sooner --- life is so busy for me right now, what with work and keeping up with Lucky, that it was difficult even making the posts I've written so far. I want to reply to every person and thank you all for your advice, but the time constraints make it hard to do even that, and I feel guilty for it. I'll continue to keep up as best I'm able, and hopefully post more glucose reading threads soon too.

I decided to change Lucky's dosage to 1u twice daily. His readings so far aren't changing quite as well as I'd hoped (though I haven't taken many spot checks throughout the day recently, so I'm not sure how low the shots are taking him). Which has made me rack my brains recently whether or not I can do the tight regulation approach. Unfortunately, the costs and time commitment required from tight regulation might be beyond my abilities atm (it's not impossible though, so I'm still thinking through it). For now I'm trying to go with the slow as you go approach while I try to make that decision.

As for my veterinarian, I'm leaning towards sticking with her thanks to everyone's advice. She's very nice and it's understandable that she can't keep up-to-date with every advancement in the world of pet health. Though, I'm not sure how she'll take my changing the dosage on my own for the past week or so, we'll see.

My current plan is to wait for the 7 days to pass (since the last dose change) and to do another 24-hour curve before I change the dose again, so hopefully I'll post Lucky's numbers again come Sunday morning (I also need to do more spot checks throughout the day too). Thank you all so much again for your help with Lucky, I can't tell you how much it's appreciated and you all have my deepest gratitude.