5/16 Billie PMPS-178 +2-170 +4-155

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Deanna & Billie

Deanna & Billie

Member Since 2014
Hello!

My name is Deanna and I am writing on behalf of Billie. She is 11 years old and was just diagnosed with diabetes 2 weeks ago with a blood glucose reading of 310. We switched her to a low carb/high protein/all wet food diet (Hound & Gatos, Evo 95, Tiki Cat and FF), and the transition went really well, but it did not lower her numbers at all. A week ago, she was at 315, and today, she was at 317. Her doctor prescribed Lantus - 1 unit twice daily. I plan on starting it tomorrow morning and am very interested in Tight Regulation. I read all the stickies on this forum, and everything is starting to make a lot more sense.

I gave her a test injection of a saline solution at the vet, and I feel comfortable with her insulin injections. However, I am off to a rough start with home blood testing. I have all my supplies (thanks to the FDMB shopping list) and made two attempts tonight, but I didn't get blood. The first time, I'm pretty sure I did not poke hard enough. I'm not sure what went wrong the second time. After that, she ran off into hiding, and I don't want to bother her anymore tonight. I watched several YouTube videos, read a lot of tips, and tested myself for practice. I will try again in the morning. I know it doesn't get easy right away. Billie is a very sweet cat and has never tried to bite or scratch me in our 6 years together, but she gets nervous, jumpy, and hard to keep still.

I have a couple questions to ask you all -

1. If I can't get a blood sample tomorrow, should I still start her insulin? Her vet does not think that home testing is necessary at all, and just scheduled her for a curve in a week. My goal is to get her into remission, and I know that home testing and Tight Regulation can help us down that path, so I want to try.

2. What is the difference between Tight Regulation and Relaxed Tight Regulation (like in the other forum)?

Thank you so much for your help!!! I am blown away by how wonderful everyone here has been.
-Deanna
 
Re: New Cat On Lantus - Interested In TR

Hi Deanna

Welcome to you and Billie to Lantus Land. I see you've gotten some great help on the health forum.

I know you've looked at some tips and videos on testing. Are you warming her ear with a warm rice sock or a warm washcloth wrapped in a Baggie? If you gently rub her ear a bit, warm, and then rub, it might help. It's a little difficult at first getting blood but their ears do learn to bleed over time. Here are some additional Testing and Shooting Tips that might help.

The problem with not testing before you shoot for the first time is that you won't know where she starts and what she comes down to. While it usually takes a few cycles for the Lantus depot to build and Billie to start using the insulin you shoot, we have seen kitties come down on the first shot. So it really would be best if you can get a test. I'm sure everyone has told you to give her a treat, lots of love and hugs, and tell her how good she is.

Of course, we disagree that hometesting is not necessary. I wonder if your vet would give his child insulin without first checking his/her glucose? If you look at some of the members' SSs, you will see that sometimes the kitties can get low and if the CG was not testing to catch the low, there is the potential for clinical hypoglycemia. We also don't recommend curves in the vets office because the kitties are stressed; you can get better numbers at home by doing spot checks.

There is a Tight Regulation insulin Support group (ISG) which is this one and then a Lantus Relaxed ISG. Most of the members there do not follow the TR protocol that we do here but follow the Start Low Go Slow Approach (SLGS).

The TR protocol is the only protocol for treatment of FD based on scientific research which was published in a scientific journal. It offers the best chance for a newly dx cat to go Into remission. It is an aggressive approach to management of FD but has a high remission rate for those cats started on Lantus or levemir within six months of diabetes dx.

SLGS Approach was primarily used prior to the TR protocol. It is a much less aggressive approach but cats can and do go into remission using that approach.

Anyone using Lantus or levemir is welcome to post in Lantus Land whether they are using the TR protocol or SLGS. This forum has more members and there is a greater likelihood that someone will be around to help you most hours of the day/night. Relaxed Lantus forum has less members and so less assistance available. You are free to post wherever you are most comfortable.

I saw that you were given instructions on how to do a SS and that is something we would appreciate you having if you decide to post here (and we hope you do). It helps us make the best suggestions for dosing, feeding, etc to help you and Billie. If you have any problems getting it setup, please send me a private message as I help many new members set up their SSs.

Please let us know how we can help. You will find a warm and welcoming family community here with lots of members willing to help out and offer support.
 
Re: New Cat On Lantus - Interested In TR

Hi Deanna and welcome to the Tight Regulation Forum. For others who are really, here is her introduction post on Health. We like to link back to previous posting for anyone who is trying to follow you story and see what has already been suggested.

I see you are having issues testing - we all did at first. Their little ears do begin to bleed better after a while. Are you using the lancet device or freehanding? And what gauge lancet? Something a bit larger (eg. 28) is better to start. And do make sure you warm and/or rub the ear first. And make sure you praise her and give a treat each time, even if it's a failure. You do want to associate good things with the test. For some people even cuddles or combing works. I have a very food motivated cat so that's what works for her. And you can start by doing everything but just rubbing her ear and not doing the test for a few times (and include the treat), then build up to including the poke.

We do encourage a test before every shot, so I would keep on trying until you can get a reading. Maybe you have to start insulin tomorrow night if you can't get it tomorrow in the morning. I've seen way too many people here finally able to test and have a trial by fire by seeing low numbers right away.

The people in the relaxed forum may or may not follow the Tight Regulation protocol. Some of them cannot test as often as the protocol suggests. Some follow a slower process for increases. But there are also some people who follow SLGS (start low go slow), but still post here because there is more traffic here and likely to be someone around to answer questions more times in the day.

Keep on asking questions, we love to help here.

ETA: I see Marje beat me to it. :lol:
 
Re: New Cat On Lantus - Interested In TR

Hello and thank you for the replies!! I just had a successful blood test (I think...)! The sample I got was small - it didn't fill up the whole testing area on the strip. Does that mean the reading might be in error? We have a ReliOn Micro, and it read 161 for Billie this morning. That is so much lower than what she has been reading at the vet (310-317) that I am confused. Could stress actually make that much of a difference? Could the ReliOn be off by a bit? Or could it not be an accurate reading because I didn't get a big enough drop of blood? I have been testing her urine for ketones and glucose daily and it always comes up positive for 2000+ glucose.

I'm going to hold off on the shot for now and wait on some feedback. I can also try testing again. We have a system now. I wrapped her up in a blanket in my lap, used the rice sock, gave her lots of kisses, and went for it. I am freehanding the lancet, not using the pen. I feel like I have more control of it that way. After the poke, I gave Billie her new favorite wet food. I'm going to boil some chicken to use as treats from now on.

Thank you for your advice!!
 
Re: New Cat On Lantus - Interested In TR

Hi Deanna,

I'm glad to see you made your way over here! Wendy and Marje are great, and they'll help you a lot while you're here. (They helped me tremendously.)

I'm so glad that you were able to get a test this morning. It will get easier as you go! A small sample can give a wonky reading. If you're ever in doubt, you can test again. I have seen some people say that vet stress can raise glucose levels over 100 points. It's amazing to think about that.

I'm going to refrain from advising you on whether or not to give insulin this morning because I don't want to steer you wrong. I'll leave that question to our more experienced users. I don't see any of them online right now, but I'm sure they'll be along soon.

Shelly
 
Re: New Cat On Lantus - Interested In TR

Morning Deanna

Great job on the testing and welcome to the Vampire Club! :mrgreen:

Yes to your questions :-D

The vet is likely using an Alpha Trak made for animals. It can vary from 30-40% more than a human meter but the range of normal numbers for the AT is higher than human meters. So a 310 on an AT would be roughly 230 on a human meter. Yes, the vet stress can cause a pretty good rise in the BG. And yes, the number on the Micro will be off if the strip did not fill. I have found when the strip didn't fill, that it reads about 40-50 mg/dL lower than the actual number. But, we say here "every cat is different" (ECID) and I have also found that every meter is different....to some extent.

Renal threshold for each cat varies. Some spill glucose into the urine at 150 or so and some closer to 250. But...it also takes time for the glucose to clear so even if numbers are coming down, there still may be glucose in the urine.

I forgot to tell you last night that the starting dose for Lantus TR is 0.25u/kg of the cats ideal weight unless the kitty is underweight and then it is actual weight. There are 2.2 kegs to the pound. It would be a good idea to double check the dose as some vets seem to just start all cats at 1u. I am going to see if I can read back and find her weight and figure it for you.

So I would retest, see if you can get a full drop, and if she's above 150, go ahead and shoot. You can also post for help.
 
Re: New Cat On Lantus - Interested In TR

Hi Deanna! Welcome!

I'm pretty new to Lantus and Tight Regulation as well, and I can tell you it's an awesome place to be. :-D Like Shelly said, I'm sure some of the experienced users will be along shortly to help with shot advice. One thing you might do is to change the topic title of your first post in this thread to something along the lines of "New Lantus user - do I shoot?" and use the question mark button to help get some attention to your question on whether to shoot or not.

On the numbers variation, it may be that the vet was using an animal-specific meter which can read up to 30-40% higher than a human meter in those higher ranges. It could also be the vet stress variation. I can tell you that with my sugar kitty Eddie, his last in-vet-office pre-shot reading was just over 500 on a human meter, and the next day, when we got our first successful home test a day later, his pre-shot number was 300, so that vet stress variable can be significant.

Edited: I cross-posted with Marje...she's got you covered! :-D
 
Re: New Cat On Lantus - Interested In TR

I couldn't find her weight so you can calculate or post it and we can calculate just to double check. If she is around 10 lbs, then 1u is good if the 10 lbs is her ideal weight or actual weight if she is thin.

One other thing I saw on your first post is that your vet said she can't hypo on 1u. I do not mean to scare you and clinical hypos on Lantus and levemir are rare but they can occur and I have seen them occur on doses less than 1u. I've also seen extremely low BGs (e.g. 20 on a human meter) on 0.1u but the cat, thankfully, had no clinical signs. This is why we test. With testing and food to manage the curve, you are in control.
 
Re: New Cat On Lantus - Interested In TR

Welcome, Deanna! This is the best place you never wanted to be.

You've gotten a ton of great information. Unlike what some of the others posted, I've been around here for a while. What I can share is my opinion -- testing is the best way to keep your kitty safe and for you to have the best possible insight into your kitty's numbers and the knowledge of when to intervene. Like Marje noted,we hae seen cats drop into very low numbers on 1.0u. In fact, take a look at Gabby's spreadsheet. She likes to keep me on my toes!

Please let us know if you have questions. People here are very generous with their time and knowledge.
 
Re: New Cat On Lantus - Interested In TR

Thank you for the quick and helpful responses!! I can't get over how awesome everyone here is.

Billie has weighed between 8 and 8.5 lbs over the past couple weeks. She has weighed around 10 lbs for most of her life, but dropped to 8 over the course of 6 weeks as her appetite increased, and that's what got me worrying in the first place. So, with that math, it sounds like the proper starting dose should be more like 0.75 or 0.8 rather than 1 unit. I'm really glad you mentioned that. I definitely want to play it safe at first, so should I start with 0.75 and see how that goes?

Thank you for clearing up the reading differences between the vet's meter and my meter. I can add 30-40% to my readings just to get a sense of what the AlphaTrak would read. With a ReliOn, what numbers would indicate a normal range for Billie?

I'm thinking that I will wait a couple hours since she just ate, and then test her again. I want us to be on a 10:45am/10:45pm schedule, because I generally work shifts from 2pm-10pm. I'll plan on testing her tonight around that time and shooting if she's over 150 like Marje said. Let me know if you think I should start with 0.75 or even 0.5 instead of the full unit.
 
Re: New Cat On Lantus - Interested In TR

My calculations show a starting dose of 0.9u. So you can round up or down to either give 0.75u or 1u. Like you, I started lower just because my Gracie has always been so sensitive to meds of any kind. I did have to go up in dose but it made me feel more secure.

I think 0.75u is reasonable and then you would hold the starting dose for at least 3 days. If she's high and flat, we'd increase after three days. If she shows some response, we'd have you hold the dose at least 5 days. We can see as we go.
 
Re: New Cat On Lantus - Interested In TR

PS: I absolutely do feel like a vampire. The moment I saw blood, I got excited and went for it, which I think is why I didn't get that big of a sample.
 
Re: New Cat On Lantus - Interested In TR

Thank you!! That sounds like a good plan to me. I think I will start by filling just shy of the 1 unit mark. The u100 needles I was given don't have half marks on them, unfortunately.
 
Re: New Cat On Lantus - Interested In TR

If you have a Walmart nearby, they carry Relion U100, 0.3cc, 1/2u marking syringes. Many of us use 31g and needle length is up to you. Billie might prefer the short needles to start. It will make your dosing so much easier and consistent.

Here is what 0.75u looks like:


3quartersunit.jpg
 
Re: New Cat On Lantus - Interested In TR

Thank you! I'm going to pick up some of those now. The ones we were given don't have the half unit markings, and I think they will help me to be accurate.
 
Re: New Cat On Lantus - Interested In TR

Thank you so much for checking in. That's really thoughtful. I just gave her the first dose. I went for 0.75 just to be cautious. I tested right before, and her glucose was at 178. Then, I gave her some food and gave the shot. She ate maybe an ounce and a half of food, and I'll encourage her to eat more. I'm going to stay up late and keep an eye on her. I have read about the signs of hypo. Is there any time in particular when the insulin hits strongest that I should be most attentive? Let me know if there's anything else I'm missing for tonight. Again, thank you!!! I would be lost without this forum!
 
Re: New Cat On Lantus - Interested In TR

Hi Deanna,

Great job getting that test before you gave the shot!

If you don't mind, go back to your very first post in this thread. Change the subject line to: 5/16 Billie PMPS 178. This will let others know that you gave a shot. As you go through the evening, you can keep editing your subject line to add the new numbers. For example, if you got a test in two hours from now, your new subject line would be: 5/16 Billie PMPS-178, +2-XXX. Just make sure you edit your subject line in the very first post here. (If you edit the subject line in a different post, people can't see the subject line until they actual "enter" your condo.) Let me know if that doesn't make sense. We do this just to help others keep up with what's going on with our kitties as they scroll through the board.

You're doing great!
Shelly
 
Re: New Cat On Lantus - Interested In TR

Deanna

I would get a +1 and a +2 test if you can. That's a surprising number so we want to be vigilant.

Good job shooting.
 
Re: 5/16 Billie PMPS-178

Perfect, Deanna! Sorry I didn't respond to your last post - we posted at the same time. You're in great hands with Marje! She's one of the many angels here! o:-)

Was tonight's test any easier to get? It will keep getting easier and easier, I promise!
 
Re: 5/16 Billie PMPS-178

Hi! I think I successfully changed the post subject. Are you saying that the 178 is surprisingly low? I am also surprised. I definitely got enough blood this time, so it's accurate as long as the ReliOn is accurate. If the vet's meter reads 30-40% higher than the ReliOn, this would be between 230 and 250 at the vet. Her vet readings have been 310-315, but does that make sense when you factor in the stress of the vet visit? I will try to get blood at 1+ and 2+. It shouldn't be too hard. So far, she's acting totally normal. She just went back and ate a bit more food, and now she's lying down in one of her usual spots.
 
Re: New Cat On Lantus - Interested In TR

Lantus onset is typically at around +2 and nadir is at +6. That's providing Billie has read the rule book. Not all cats follow that pattern. Some cats can have either an early or later nadir. And just to make your life even more interesting, nadirs can and do change.

I encourage people to get a +2 or +3 test. In the ideal curve, your +1 is higher than your pre-shot due to the influence of food. The +2 is at about the same as your pre-shot. If your +2 is considerably lower than your pre-shot test number then it's likely that numbers will continue to drop and you want to monitor more closely. If you're shooting a lower number than you've shot previously, then getting a +1 and testing often can insure you have control over the cycle.
 
Re: 5/16 Billie PMPS-178

Shelly, tonight's test was actually a bit harder than the one we did this morning, but I think I know the strategy that will work best for us - wrap her up in a blanket, give lots of kisses, warm her ear with a rice sock, then go for it and hold on tight, because she tries to run away and she is very good at escaping. Tomorrow, I'm going to make a lot of chicken to use as treats, because she loves plain chicken breast.
 
Re: 5/16 Billie PMPS-178

Deanna

I am just checking in but it might be too soon for the +1. I have to run out for about 45 mins but just post the +1 in the subject line like you changed it earlier. It should be higher. If it's 150 or below.....ask for help in your subject line. I'll check back as soon as we get back.
 
Re: 5/16 Billie PMPS-178

Hi Marje! Thank you for checking in. Billie is under the couch right now, which is normal for her - it's one of her caves. I'm going to give her a bit longer to chill out, then try to lure her out with some food and test her. I keep peeking under at her, and she is just hanging out. Her eyes are open and she seems alert/normal. I'll post after I have blood. Thanks!!
 
Re: 5/16 Billie PMPS-178

Billie is out of hiding, and I'm about to get a +2 reading. She just went back to her food and ate a bit more. I'll report back soon.

I have a clarification question about the readings that I'm posting in both threads - which numbers are the actual accurate numbers? The numbers on the vet's meter, or the numbers on my human meter? I'm assuming that the vet's meter would be more accurate for a cat, but please correct me if I'm wrong. If that's the case, should we be doing the math to translate our home readings into readings the vet would get?
 
Re: 5/16 Billie PMPS-178

No just enter the numbers you get. You don't need to put the vets numbers on there or convert to the AT scale.

You usually want to test and then let her eat :-D
 
Re: 5/16 Billie PMPS-178 +2-170

Very good.

A typical lantus cycle when the depot is full can look like this:

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
Click to expand...

We like +2 tests because if the +2 is similar to the pre shot (PS), there is potential to see an active lantus cycle as shown above. If the +2 is much less than the PS (less than 20% meter variance), then you should expect a very active lantus cycle. Since she's getting used to tests, how about getting a +4 and posting? That will give her a bit of a break.

Good job getting the SS set up! One note on these threads which we also call "condos". We do one per day per cat so tomorrow with the A.M. pre shot (AMPS), you'll start a new one for her and link this one. To link this one, open it, copy the browser address, then close it, click on "new topic", and put the cursor in the text box. Then click on the "url" box above the text box and paste your link in between the two boxes that appear in the text box. It will look like this: PASTE LINK HERE. Here is some additional info on Making the Most of Your Lantus ISG Experience.

Also, things can move quickly in your condo with lots of people posting. Sometimes we post at the same time. This can cause you to miss important posts so I always recommend you scroll back up through the posts and make sure you saw each one and read it. :-D

Pls let us know if you have questions and, if not, we'll see you at +4.
 
Re: 5/16 Billie PMPS-178 +2-170

Cool, I'm glad her number is looking okay! I will test again at +4 and report back. I gave her some more food after the +2 test, and now she is hanging out in the window enjoying the breeze. Thanks for letting me know to start a new thread in the morning. I will do that.
 
Re: 5/16 Billie PMPS-178 +2-170

Just want to add my welcome, deanna! I got a chuckle from your "i feel like a vampire now" comment! WAY TO GO! Ya got blood! As you poke her ears they will grow more capillaries. It takes about 2 weeks and you'll get blood pretty much every time. We had to wrap punkin up in a beach towel burrito to do the testing at first, but he eventually gave up fussing and was willing to sit still - as long as we always ended with a treat! We boiled chicken breasts, diced and froze most of them, keeping a couple of tablespoons in the fridge to dole out.

Has anyone suggested Neosporin ointment with Pain Relief to you yet? it's great for numbing the ears and helping them heal. I put it on punkin's ears every night and they would heal by morning. i also tried in on myself where the cats had scratched across my feet and the stuff is amazing for taking out the sting. just wipe it mostly off before you test so it doesn't goo up your test strip.

Looks like Billie is doing great for the first day. I'd completely forget about the vet's blood sugar testing equipment - just go with yours. It'll be accurate enough for you and most everyone here "speaks" in human meter numbers.

Glad you and Billie are here - keep asking whatever you don't know. It's also helpful if you read other kitty's posts - Tux, Pixie, Polly, Trey and Zack are all pretty new so their posts might have some good info for you.
 
Re: 5/16 Billie PMPS-178 +2-170

Hi Julie & Punkin! Thank you so much! I am so grateful that this forum exists with so many wonderful people on it.

Shelly gave me a great shopping list that included Neosporin with pain relief, and I am using that on Billie. Her ear does look a bit bruised :(

I will check out the other new cats' posts and spreadsheets! That's a very good idea.

I have another question about the meters - on a vet's meter, what numbers are considered in normal range? And on a human meter like the ReliOn Micro, what numbers are considered normal?
 
Re: 5/16 Billie PMPS-178 +2-170

normal numbers on the human meter is 50-120 (for a cat getting insulin). A non-diabetic cat might test in the 40's, but we use the 40's to take action so we have the safety zone to keep our kitties safe.

on the Alpha Track, it's roughly 68-160. We've had people compare the AT to a human meter and honestly, there's quite a bit of variation. The meters seem to compare fairly close in numbers in the lower ranges, but the difference between human/AT is often measured greater in the high numbers. The newest protocol says 68 is considered the low range of normal - and really, the low number is the most important for safety. Your vet is probably thinking the 68-160 range is what they would like to see. You could ask to double-check.

You can download and read the latest update here on the TR yellow-starred sticky. Go about 5 "paragraphs" down from the top of the post and look for the PDF that's called "Management of Diabetic Cats Using Long-Lasting Insulin." There are some references in there about using the AT.
 
Re: 5/16 Billie PMPS-178 +2-170

Thank you for clearing that up, and thank you for that link! Everything is starting to make a lot more sense. I'm waiting 45 minutes, then doing a +4 test.
 
Re: 5/16 Billie PMPS-178 +2-170

On the bruising, one thing that has helped Gracie is I bought a pack of baby washcloths. Before I test, I hold one under cold water and then as soon as I finish testing. I hold the cold, wet cloth on the poke spot. Her ears have never bruised.
 
Re: 5/16 Billie PMPS-178 +2-170

Hello! After our most difficult blood draw yet, we're back. She's at 155 right now. How is that?
 
looking good! Not sure what time zone you're in, but that's a slow enough drop that he's not too likely to go under 50 in the next couple of hours. If you're tired, you could probably call it a night.

I'm sharing this post with all of our new kitties tonight - there is a video on how to draw up your insulin and keep it viable as long as possible. Lots of good information on the entire post about how your insulin works too. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=151
 
Thank you!! Yes, I think Billie and I would both love to go to sleep soon. That last blood test definitely stressed her out. I'm glad we're in good shape. Thanks for the link! I will check that out tomorrow. Thank you all for everything!
 
I think Billie likes Lantus! Because she has responded so well the first shot, I'd probably get up and test her in a couple hours.
 
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