7 units twice a day??

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Kim 'n Shadow

Kim 'n Shadow

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Hi, Shadow and I are Newbs at all this. She is a portly 15+ year old. She was diagnosed 06-07, started on Lantis and we saw the vet or the vet tech every couple days. My vet tried to talk me into hometesting, I was resistant. in denial, I think. Continued to feed dry DM and give insulin as directed to get to this point. I have done enough reading now to see how flawed my thinking was, and she in day 4 total wet food, Purina DM. She actually likes it, but not enough to eat a whole can in one day. More like half to three-quarters. Today, we are at the +6 point of our first curve. The thing is, she is getting 7 units twice daily and I see a GIANT hypo episode looming in our future. AMPS 196, +2 152, +4 118, +6 132

Am I dealing with "storage shed" issues? When I look at other spreadsheets, nobody is doing 7 units. This is worrisome to me.

If Shadow doesn't eat a whole 5.5 ounce can a day, is that problem? If her BG stays like today, can she be a free-feeding wet food eater? She likes small frequent feedings, is this to be discouraged?

I would appreciate links for more reading as I am sucking all this info up like a Hoover Deluxe.

Our spreadsheet is under construction, I am only on day 2 with it. I'll link to it once I read up on how.

I appreciate the help and attention of the FDMB.

Kim
 
Hi Kim
Welcome!
I'm going over to ask the Lantus users to come chat with you. I agree that seems like a very high dose but your #'s don't seems to reflect overdosing. They will know more.
One thing I do know is once you go off the dry kibble you will see a significant drop in #'s and will likly need to decreas that dose.
Lori
 
For feeding, small meals many times a day is good for diabetics. There may be other conditions or circumstances that would make this inadvisable or not feasible, but for most kitties it is a very good way to go.
 
Hi Kim and Shadow

welcome to the FDMB.
You asked for links, so I am including some, a couple on Lantus, you can also find in the Lantus forum.

I've heard that some kitties get "bored" with DM, but the good part is - it's wet food. If you take a look at the food chart links, you will see a variety of store brands - a lot of members here use these. Prescription food is - well, it's not the greatest, as much as the vets want you to believe (and buy). You'll want to choose a variety in the 10% or less range of carbs. Depending on the rest of your data, once it's put together, we'll get a better idea of how the change of food has affected your kitties numbers.

Dr Lisa's Feline Nutrition A must read!
Janet & Binky's Food Charts

Jojo's Hypo Tool Kit
How To Treat Hypo


Lantus & Levemir Insulin Depot AKA Storage Shed
Insulin Depot

In the Lantus forum, we do use a modified version of the Tilly protocol. It has worked well for many kitties coming through the Lantus forum, including my own.

Tilly's Protocol: Modified Version

Others will be by thru the day to offer more feedback on Lantus. So hang in there, read read read and ask all the questions you want.
 
Kim, you are doing a good job. The seven units bid is a little high but your curve us very good. If you change to a lower-carb food your insulin needs may go down so be careful with changing the diet.
 
Hi Kim and welcome to FDMB.

Several of us that have posted spend a lot of our time over on the Lantus board. There is a ton of information in the "sticky" notes that are starred at the top of the Board.

7 units is a lot of insulin. How did you work Shadow up to that dose? (And was Shadow diagnosed in June 2007?) If the dose was arrived at gradually, it is likely to be just fine. I just wasn't entirely clear on how long ago Shadow was diagnosed. We utilize a dosing protocol where increases occur in 0.25u so optimal doses are not missed.

You're also correct in that a transition to low carb, canned food can have a huge impact on blood glucose (BG) numbers. It sounds like you've started home testing. I would be very attentive to BG while you are transitioning to canned food. One thing to keep in mind is that while the D/M isn't bad as far as carbohydrates go, it's a truly poor quality canned food -- lots of animal by-products vs. muscle meat. You will save yourself a small fortune by switching over to low carb (LC) non-prescription cat food. Brands like Fancy Feast are a better quality food. If you want to buy the premium brand canned foods, you will still pay less and get a much higher quality of food.

There is no problem whatsoever with free feeding. Many of us feed frequent small meals. I'd love to free feed but I have another cat in the house and I want to make sure they both get their fair share. I use a feeder so if I'm not here, it will open at programmed times.

Once you have your SS set up, if you would like to, please join us on the Lantus board. It's a very active place where people are around almost 24/7. You may also want to complete a Profile. The instructions are in the Tech Center where you found the spreadsheet template. You can link the Profile to your signature, as well.
 
If you are giving 7units BID of Lantus, you may want to consider testing for acromegaly and IAA. You mentioned that nobody is giving that dose, but there are some.

Tonite's doses for my two were 7.5u and 14u, but both of my cats tested positive for acromegaly. You can take a look at their ss and profiles.


I don't know how long since Shadow's dx - did you mean June 2007 or June 07 this year?
As has been said, now that you have changed to wet food, you need to test to watch for a drop in insulin needs. Some cats are very sensitive to the dry foods and their numbers drop alot after food changes.

I would not bother with that food from the vet as it's poor ingredients as Sienne said, and way too expensive. I feed mine Friskies or Fancy Feast which are much cheaper, low carb and better ingredients.
 
Welcome to FDMB...

yes, 7 units is more that the "average" cat needs, but there are some medical conditions that cause "insulin resistance" -- needing more insulin to overcome.

Gayle is blessed with two such kitties. I had one - Norton, who passed away 2 years ago from cancer. There are quite a few "Acrocats" here -- a small percentage compared to all the diabetic cats though.

Please read the sticky posts in the Acromegaly/IAA/Cushings Cats group -- this is a special forum to focus on the "high dose" issues

The first two tests to request are IGF-1 for Acro and IAA. The two tests are run at the same lab in Michigan (the ONLY lab in North America to run the IGF-1 test). These are blood tests and pretty accurate. Cushings is harder to diagnose, so don't bother with that yet.

By the way -- when Norton was eating dry food, he needed 13 units BID. When we switched to low carbohydrate canned food, his insulin needs reduced to 8 units BID.


If you have already reached a dose of 7 units BID after being diagnosed on 6/7/2010 -- it is possible that the dose was increased too fast.

We'll need more details about how the dose was increased (how often, how much each time, etc)

Rule of thumb is an increase of 1 unit BID per week, so to reach 7 units in 4 weeks is pretty fast. BUT -- we need more details.

With Norton, we reached 13 units in about 4 months ~16 weeks.
 
Thanks for the warm welcome and I so appreciate your help.

Shadow was diagnosed 6/7/10, sorry for the confusion. She was started on 1 unit Lanuts b.i.d. and she saw the vet every other day when he increased her insulin dose by one unit b.i.d. til we got to the 7 units b.i.d. that she currently gets. So in a month, she has gone from one unit twice daily to 7 units twice daily.

I am encouraged by the responses I have gotten here, I will continue with my testing and I'll continue to work on profile/spreadsheets as I find time. Doing these curves really is "all hands on deck." Quite time-consuming.

My vet's approach to this has been to suggest that once Shadow began to respond to the insulin, we would begin to back off her dose. Quite a different approach to what I have read in my short time on these boards.

I appreciate the links, I'll be posting some more questions as they come up.

I feel so much better knowing I have some support.

thanks everyone,
Kim
 
What are the BG numbers Shadow is getting when tested now and what/when is Shadow's nadir?

That dose if quite high - can you ask your vet about testing Shadow for acromegaly? I can't think of any cats at such a high dose that have not been tested positive. The test is kind of important because you will know if Shadow's pancreas is functional. This piece of info will make a difference in how you treat Shadow.

Please ensure that you read the info on HYPO so that if Shadow goes too low you will be prepared.

It would be great if you had some BG numbers now that you could post until you have the spreadsheet all set up.
 
The test for acromegaly is a good idea, but given the fact that there has been no hometesting done, the dose really doesn't surprise me...
 
Exactly Jen, if some BG numbers could be posted to see what's really going on, better suggestions could be given.

If the numbers show as high and flat, and not too much insulin, then for sure get the blood draw for acro and IAA. Lately, it seems there have been quite a few being tested and coming back as positive. Just something to keep in mind for high doses.

Let us know when you have some numbers Kim.
 
On the google spreadsheet in the top right corner, click on the pulldown for Share and select publish as a web page.
Check the box for Automatically republish and click on start publishing
 
Hiya Kim! I see from your profile that you are in Dallas. I'm in Coppell - I would be happy to come chat with you, show you how to test (although it sounds like you can do it now) or help out in any way possible. I also have a "high-dose" cat (acromegaly), although she's no longer on insulin. Do you have a picture of your baby?
 
Re: 7 units twice a day?? fixed my spreadsheet

I think I have it now, if someone would check it and see if it opens correctly. It opened for me when I checked it, but I guess it would since I'm the owner - not very familiar with HTML codes.

thanks for helping walk me through all this.

Kim
 
Do you, by chance, have the numbers for the curves done at the vet? Your numbers right now are looking great, but entering those other numbers could help confirm that your dose really is "correct".
 
7u twice a day is very, very high. Getting there from 1u twice a day to 7u twice a day in 1 month is really not a very good plan. nailbite_smile She may have been out of hypo at 7u twice a day because you were feeding dry food.

I just noticed on your spreadsheet that you gave 7u today at testing of 166!!!!!!!!!!! And you are on all wet food?????????? nailbite_smile nailbite_smile

PLEASE UPDATE



You do not need any type of prescription food or “special” diabetic food. Use Janet & Binky’s chart for canned food at http://binkyspage.tripod.com/canfood.html. . Low carb is best for diabetics. I try to stay around 10% or under. I feed Whiskas, 9-Lives and mostly Friskies canned food. Diabetes is very treatable and does not cost as much as you would think. If you are giving a high dose of insulin and feeding dry, be careful with switching to canned food. You MUST reduce the insulin at the same time you switch to canned food.

Remember that your cat is YOUR cat, and YOU are paying your VET to help you take care of him; diabetes was probably a day or two worth of notes when the vet was in college; it is probably NOT a day-to-day existence with his own cat trying to maintain a quality of life. Sorry to say, but I would have overdosed my guys on insulin if I followed my vet's advice. Vets, unfortunately are not as knowledgeable as they should be on diabetes.

Sometimes, as I did, you have to take a leap of faith and trust these people on this board who deal with diabetes day in and day out. Trust me. You will not be disappointed. OK………..breathe again……….get some chocolate…….. cat_pet_icon

Also, please realize that it takes insulin about a week to settle. START LOW AND GO SLOW!! The usual starting dose from our experiences is 1u twice a day for at least a week. Insulin in cats is NOT and I repeat NOT based on weight. This is a misconception that a lot of us have gotten from our vets here. pc_work

You have to be patient, as I also had to learn!! Do not adjust the dose upwards based on one test. Don’t freak out based on one test result. As long as the levels stay on the high side, keep the same dose twice a day for at least the initial week period and you should see improvements. When you have some time (hee hee), read my profile doc at http://docs.google.com/View?id=dfqss8sg_1cpgwhbd9 .


If you are not hometesting already, you really need to start!! Hometesting is VERY important. Most of us here use any human meter. Think of it as a human diabetic does. *If it were you or a child of yours, you'd be testing blood glucose levels at home prior to each shot; you'd be working with your doctor to determine a proper dose based on those shot results, correct?* Some vets do not agree with hometesting and I cannot for the life of me understand why. Most vets, sadly are not knowledgeable enough in feline diabetes. Insulin is a VERY powerful drug and you NEED to hometest before giving a shot. This is very important. The vet would rather have you bring the cat to them, stress it out more, which may spike the levels anyway and then they can charge you $$. Hometesting saved me a lot of money and it is VERY important for you personally to know the cat’s levels and how it is reacting to the insulin before you shoot so you do not pass up your ideal dosage.

Also, remember to give them a treat after the test. Here is a link to a member videos on hometesting:

http://www.youtube.com/watch?v=_zE12-4fVn8
http://www.youtube.com/watch?v=cZ6iXetR398



PLEASE keep us informed.
 
Hi Kim

just wondering if you're home to monitor Shadow today?
Please do keep an eye on those numbers, ok?

Lots of good people on the board to guide you along should you need it.
 
This chart might help you with a curve and spot checks Kim....
You can find in the Lantus forum stickie New To The Group I've included all the links for Onset, Peak, Duration etc.


Learn how YOUR kitty is responding to insulin:
Onset ---> the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir ---> the lowest point in the cycle
Duration ---> the length of time insulin continues to lower blood glucose

How to do a Curve: you don't have to test every hour. Typically curves are every 2 hours in a 12/12 cycle. Or a mini-curve, about every 3 hours.
Depending on where the numbers are, you may have to re-test frequently and offer food to help steer numbers.

Example of a typical curve:
+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.

Carryover ---> insulin effects lasting past the insulin's official duration
Overlap---> the period of time when the effect of one insulin shot is diminishing & the next insulin shot is taking effect
Insulin Depot ---> (aka "storage shed" in Lantus Land) "spare tank" of insulin, which has yet to be used by the body
More on the Shed ---> Lantus & Levemir Insulin Depot AKA Storage Shed

Do update when you can Kim.
 
Re: +4 168, AMPS 166.

I am home this morning, working this afternoon but I'll be here to catch her nadir. While I'm at work, I leave wet food out for her if she wanders thru the kitchen and needs a bite. What I dont understand, after looking at other spreadsheets, she doesn't really do the dip that other cats do. Here she is +4 168, AMPS 166.

I'll get numbers from the vet when I see him again. He never did a curve, just spot checks when I had her in there. She has never been in the 400's although she has had a few mid-300's. most of the time she was in the upper 200's.

It took a long time for the insulin to ever even make the slightest dip in her BG. It wasn't until she got to 7 units bid that she began to budge downward. But until I found this board, I had know idea what havoc I was wreaking on her to still be giving her crunchies. After some reading here, I started the transition to all wet and we started that in earnest over the recent holiday so I could be here to watch her carefully.

Another question, once people find you guys and the "Slow and Low" protocol, do they quit getting advice from their vets? Do they manage their cats' diabetes strictly from the protocols outlined on this board? I have had many cats over the years but none with diabetes and so when this started in June, I only had the vet's recommendations for her treatment. The things he has recommended fly in the face of all I've read here.

I have never juggled her dose without instructions from my vet and to take that on myself feels scarey. I've read the recommendation to not shoot below 200 but the vet never gave me any instructions like that. I'm going to contact him this morning and see if he even has "don't shoot" numbers for her.

This is confusing and more than a little scarey.

And I really appreciate everyone's advice and encouragement.

Kim
 
I do not get ANY diabetic info/suggestions/guidance on dose or anything else from my vet office. Seriously, what do they have to offer me that I don't already know? Nothing at all.

My vet office is for blood draws, tests, dental, Xrays, ultrasounds, etc. I get stuff like needles for SQuids, meds, etc. but that is it.

Ask a human diabetic if they EVER give themselves a shot without testing first. You know the answer to that! Of course they don't! So why is your vet telling you what dose to give if it's not known how the cat is reacting?

When the dose is too low, you are likely to see a pretty high and flat curve; when you start to get close to a dose that suits your cat's needs, you are then going to get a reaction.

As for the nadir ... ECID. I have one, Shadoe, who has her nadir around about +5, but my other, Oliver, is closer to +10 or even +11! That's what makes testing so important; you need to know when YOUR cat has his/her nadir.

Ronnie gave you some great info.

If you don't want to alienate your vet, listen but do what you are seeing is working.
keep your vet updated by taking a copy of the ss on each visit and explain what you are doing and point out how you are seeing changes on the ss with the different doses.

My vet did not think I should test shadoe for acro. I demanded it and her result was positive.
The next time I went in saying I wanted Ollie tested, they did not say boo; they just drew the blood and sent off the tests. Again positive. Show your vet that what you are doing works and you may turn your vet into a believer.
 
My vet based dosing on fructosamine results and one aborted curve at her clinic. I finally decided to test at home and politely told her that I needed to. I shared my results and decided dosing on my own, based on input from the group here (years ago...). She is still my vet and we are friends now.

Your cat is your responsibility, and if your vet advocates 7 units of any kind of insulin no matter what the test results show, then you have a responsibility to think critically about whether it is a good idea or not. Hopefully we've given you some information that gives you some idea of how to approach the decision making process, and we'd love to help you with more info. Your testing today will add a piece of information to the puzzle and so on...

FWIW, I am very nervous about the dose you've given but considering you are there and testing, I'm not going to freak nailbite_smile

Jen
 
thanks, Ronnie, Gayle and Jen.

I'm freaking out enough for all of us. nailbite_smile

I'll test SHadow one more time before I leave for work and then be back home at 5 pm. She'll be on her own for 4 nerve-wracking hours.

Calling all angels!

Kim

you know what's crazy? when she was first diagnosed, I would leave out a bowl of DM dry and sashay off to work without a care. now her numbers are much better and I've become obsessed with her well-being.

She's becoming so much sweeter, since she has started treatment. She is a sugarcat in all respects.
 
Well, the first year that I had a diabetic cat (Norton, now gone ahead), I did not find FDMB, and only got advice from my vet.

After a couple of mild Hypo episodes (we were not home testing), and some unusual behavior I started searching online for info.

Norton was getting 13u BID at the time. From the reaction to your 7u, you can imagine the comments that I got as a "newbie".

I learned about acromegaly here, and had Norton tested. He came up positive - proving that he did need the amount of insulin.

I learned about home testing - and started. Norton;s blood sugar improved, because we had a better understanding of his needs.

I learned about the low carb canned food -- Norton was able to go down from 13u BID to 8u BID when we changed his diet (over a couple of months -- he was a dry food addict).

My vet did not believe that Norton had acromegaly, did not believe that home testing was necessary and did not think a diet change was helpful.

At my request (I'm paying for it!!), she finally did the acro test and was surprised at the positive result.

She is still a good vet and I still take my cats there -- but I don't get dosing advice anymore. (I've adopted two diabetic cats from this board / DCIN). My cats are well regulated -- I proved that to her last summer by requesting a fructosamine test, so she trusts that we can handle the diabetes care.

Anyway -- if you like and respect your vet, go ahead and approach these things openly and have a discussion about what you want to try and why.
 
I actually lost my original vet over Boo's diabetes/acro. She was very angry that I was following Internet advice and she absolutely refused to draw the blood for the acro test. I switched vets (www.hebroncats.com in Carrollton). My new vet, while she doesn't follow the German Tight Regulation Protocol that we follow in Lantus, was very interested and supportive. She even sends her new diabetic clients to talk to me if they are interested in hometesting and the TR protocol. Many vets are still set in the "old ways"...vet curves, dry prescription food, and high numbers. Over in the Lantus ISG (and most of the board), we do hometesting, wet food, and shooting low numbers (provided you have the data to back it up).
 
Hey Kim. I don't post a lot any more, but your post caught my eye because of the title!

Given the facts you've shared -- which include:

1. The vet increased the dose from 1u BID to 7u BID in the span of a month;
2. This dose increase was based on only spot checks, no curves;

The dose does concern me. True, there are high dose cats becuse of medical conditions. True, your numbers don't look bad.

But now that you are hometesting, I would be tempted to:

1. Cut the dose and plan on doing a curve after the first few cycles. (If it were me, I'd consider cutting to somewhere between 2 and 3.5 u)
2. Look into more appetizing low carb food options.

You can always start raising dose again if things clearly go south.

While they do say "if it ain't broke don't fix it", I'd still want to base my dosing decisions (especially doses this size) on more data than what they've been based on to date.

And the acro test is a good idea, too.

That's just my 2 cents, I could be wrong, but that is what I'd be inclined to do.

You've a good cat mom!
 
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