Cindy:
Here is what a typical lantus curve looks like:
+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 (may dip around +10 or +11).
+12 - PreShot number.
Insofar as how big of a difference between nadir and PS tests....it varies by cat, by cycle. If the cat is a diver (drops quickly early on), it could be a big difference. If the cat glides down, it could be lower but not drastically so. That's why, after the first week or so when you are filling the depot, we like caregivers with cats on lantus to get a +2 as much as possible. If the +2 is much higher than the PS, it will probably be an uneventful cycle. If the +2 is similar to the PS, you can expect an active lantus cycle as shown above. If the +2 is much less than the PS, you should be prepared for a possible early drop and a very active cycle.
Obviously, one way to tell if the depot is full is if numbers come down. But if kitty is not yet at a high enough dose, it's going to just look like high numbers. That's why we do the incremental increases per the protocol. I also agree that you should take her dose up to 1.5u with nighttime tests.....even a midcycle test would be helpful each evening.
On the blood in her urine, here is some info from Dr. Lisa's website:
Important: The presence of blood in the urine does *not* necessarily mean that an infection is present.
Cystitis can be a very painful condition! The patient will often start to associate the litter box with his/her pain. This can lead to litter box aversion which causes the patient to urinate elsewhere. In these cases, there may be fewer urine balls in the litter box than usual.
We also know that 99% of cystitis cases in otherwise-healthy patients are *not* due to a bladder infection - contrary to popular belief. The erroneous belief that cystitis is always secondary to an infection leads to the rampant abuse of antibiotics. It is very troubling to witness the very common practice of 'shotgun' treating these patients with antibiotics when most of these cases are 'sterile' (sterile = no infection) cystitis. It is also very frustrating to see these poor cats leaving the veterinary clinic with no pain medication!
To repeat a very important point: Bladder infections are not a common cause of cystitis. Sadly, the rampant abuse of antibiotics when addressing feline urinary tract issues in cats shows that this fact is being ignored. The most important 'treatments' are increasing water consumption and lowering stress.
There is a joke in veterinary medicine that states: "Sterile cystitis patients get better in 1 week with antibiotics and in 7 days without antibiotics."
The good news is that cystitis often resolves within a few days to a week. The bad news is that it tends to recur - especially in patients that are fed dry food and/or continue to live in a stressful environment.
Here is the link to her entire discussion on bladder infections and I hope you will read it....it is extremely informative:
Urinary Tract Health
I've been in your shoes with a cat (Gracie) with what vets kept treating as a bladder
infection when it was bladder
inflammation from stress. They always wanted to throw ABs at it without doing a culture and sensitivity to determine if there was any infection there. That's why it's important to find out what tests your vet ran, did they find bacteria, and what ABs were shown to not be effective. Gracie always had blood in her urine when she had a cystitis event but she never had bacteria.
Other than that, all seems well, the shed still seems to not be filled yet. But I did not get to do a small curve today as I fell back asleep and forgot to change it to wake me up in 3 hours. No questions yet today.
