? 8/06 Mačka AMPS 558, +2 558, +5 473, change insulin?

[Penelope and Mačka]

Hi there!

http://www.felinediabetes.com/FDMB/...-10-486-no-dose-increase.217732/#post-2419839

I just had a phone call from the internist. She looked at Macka's spreadsheet and curves and thinks that Lantus is just not the right insulin for him. It appears that its duration is not long enough. She advised to change to Prozinc. I asked her about Levemir and she said why not, but Levemir is potent and we would have to give a very small dose (0.5unit) and that could still be risky. She said that if he had an underlying condition, he would be more insulin resistant and would need a higher Lantus dose, which is not the case. He gets nice nadirs (when he's not bouncing), so we can't increase his dose.
She does not think his dental condition is the problem but agrees he is a good candidate for it anyway, since he has some issues chewing.

I had the intuition that it could be what's going on, but not sure if it's the case.

Does anyone have an opinion on this? Thanks so much!

 

[Bobbie And Bubba]

Hi Penelope. If your internist thinks that the duration is not long enough, Prozinc is going to be even shorter. It is a shorter acting insulin compared to Lantus. I would stay with the Lantus. It takes most kitties 6 months for their bodies to learn to work with the insulin. He's been on a little more than 2 months. I would stay with the Lantus.

I think by looking at your SS that he needs a increase. The goal is to get them into safe green numbers and this dose has been held for 10 days with no greens. If he were my kitty, I would switch him to TR so you can raise the dose if needed every 3 days. You test enough to do TR and you could get him out of these higher numbers faster. Especially with a DKA kitty, getting them into better numbers is always a good idea. I would take him up to 2 units tonight as long as you can monitor.

Let's see what others think.

 

[Sam & Oscar]

I had to take Oscar up to 2.5 to get him to come down, and my vet originally started him at 2u.

You know I cant offer any advice as I'm still learning and trying to take in all the kits spreadsheets and progress, but I would probably have another conversation with the internist regarding duration. I popped over to the PZI forum and they have a sticky about the insulin itself. It seems like PZI is also 12hr, the same as Lantus, but it doesn't depot.. you should take a look at that forum and maybe see if anyone there has made the switch and see what their spreadsheet looks like? I have read studies that say that PZI has good rates of remission as well.

You've got to do what's best for macka to get him into some more steady numbers. I know you all will get there!

 

[Crista & Ming]

My opinion is you have not exhausted the full use of Lantus yet. Of course, like the recent thread that was made, there are more ways to use Lantus out of how it is used here at FDMB but there's definitely other things you can try to help Macka work the Lantus. I agree with @Bobbie And Bubba seeing if you're up to giving TR a try.

PZI is a shorter acting insulin and doses are based on PS numbers. It's an in and out insulin vs. depot insulin. But it won't always achieve the flat curves characteristic of Lantus. I switched from PZI to Lantus because Ming is a bouncer and the idea is that Lantus, with its depot, will help smooth out those bounces. Of course, many cats do great on PZI! And even achieve those beautiful flat greens. It is a much more expensive insulin as well and the only insulin designed specifically for cats. If you are curious about PZI, maybe head on over to their forum and explore about and maybe make a post.

Edit: Typical PZI curves look like big valleys. So they will "dive" which is another thing that causes bounces and which is why I was recommended to switch to Lantus.

All insulins can be potent if dosed incorrectly. Insulin is a hormone, after all. But Levemir is dosed differently than Lantus and usually at 70% of the Lantus dose.

Levemir has a later onset. So sometimes it means nadir will be later. I find Ming's nadir sometimes happens DURING shot time! That was definitely scarier in the beginning! So you'll have to get used to shooting low numbers.

 

[Jill & Alex (GA)]

She looked at Macka's spreadsheet and curves and thinks that Lantus is just not the right insulin for him. It appears that its duration is not long enough.

Duration isn't long enough because you have yet to reach a good dose with Lantus.

I asked her about Levemir, and she said why not, but Levemir is potent and we would have to give a very small dose (0.5unit) and that could still be risky.

I don't understand that thinking. We follow the same dosing methods on this forum for both Lantus and Levemir. Sure, when a caregiver switches from using Lantus to Levemir we suggest starting with a Lev dose which is 70% of the current Lantus dose, BUT it's only because some cats have a marked response to Lev when switching from Lantus. That's why we start with a little less Levemir (for safety), but most cats end up requiring an increased Lev dose.

On a somewhat related subject, many caregivers have found Lantus actually pulls high numbers down better than Levemir. That sounds wonderful, except it often doesn't help when a kitty is known to be a bouncer. On a side note: for years we referred to Levemir as "the gentle giant".

He gets nice nadirs (when he's not bouncing), so we can't increase his dose.

I respectfully disagree. There's plenty of wiggle room for increasing the dose.

She does not think his dental condition is the problem but agrees he is a good candidate for it anyway, since he has some issues chewing.

The sooner one can correct dental problems (issues chewing is a red flag), the better. IMHO, having a dental done is the first place I'd start. Once the dental is done, you may or may not want to re-visit the subject of switching insulins.

Just my thoughts for your consideration...

 

[tiffmaxee]

Jill said it all. I think you test enough to give TR a try and continue with lantus. Macka needs to get used to lower numbers and increasing more often just might achieve that goal. Max was a bouncer for nearly a year but his highs got lower and lower until he was tightly regulated. I’ve seen cats here make huge movement in the right direction after a dental. Just my two cents.

 

[Bobbie And Bubba]

I forgot to address the dental. I agree with Jill, the sooner the better to get the inflammation and /or bad teeth out of the picture, both of which will keep a kitty in higher numbers. Dental issues have taken Bubba out of remission twice.

 

[Bron and Sheba (GA)]

Hi Penelope!
I agree with the others.
IMHO....Definitely address the dental, especially if he has chewing issues.....poor boy, it's probably hurting him to eat.
Also an increase in dose and personally I would stay with Lantus at the moment. And try TR as you are doing plenty of testing.
Is there a reason you done won't to try TR? Maybe you find it scary, but it's really not ....it's always one day at a time.

 

[Penelope and Mačka]

Hi all,

Thank you SO MUCH for taking the time to reply to this thread. Your experience and advice are much appreciated;
I will call the dental specialist tomorrow (there's a specialized dental vet clinic in Portland). I am projecting a lot, and so very scared of anesthesia on his behalf. What if it's too much? what if he's not going to make it? what if.... you know. Do they always wake up from it?

Regarding insulin, I am very confused with what the vet said versus what I read here. She sounded pretty confident with her suggestion of switching to Prozinc. All, what are the pros and cons of Levemir?

I am reading some posts in the Prozinc forum and will likely post there. For now, I can increase the dose to 2 units tomorrow. @Bron and Sheba yes, I am SO scared of TR, because I am anxious by nature and cannot handle stress well at all. I still don't sleep much so imagine if Macka starts going into greens, let alone lime greens! I don't feel like I am in control, I feel like I am going to live in fear even more than now (and it's already borderline nuts in my mind right now). I don't want to test as much, actually I want to test less, but always fear the worst, so I continue testing!
At the same time, I see so many good results on cats' spreadsheets that it is tempting. I understand that ultimately, that's what we want, to have kitties in the greens. But what if it happens when I am not around to look at him? Sorry everybody to share all my concerns and fears all the time; I wish I could just sing you a happy song instead .

 

[Ti-Mousse (GA) Pepe (GA)]

Don't forget that you can try TR and if you're not at ease with it, you can always go back to SLGS!
As for the insulin, I agree with all what was said before!
If you look at Ti-Mousse's SS, you'll see the progress he has made, starting with Black and Red for a very long time (I left him too long on the same dose ) and now he's in blue and green lately! The goal is to have safe green kitties asap!
We all have our concerns and fears of not making the right choice or not doing the proper thing but we have to do it for our little kitty!
Don't forget that you're not alone and when you'll sing a happy song, it could be for Macka OTJ party!

 

[Wendy&Neko]

All, what are the pros and cons of Levemir?

As Jill described Lev, it really is the gentle giant. For me, it wasn’t good at yanking numbers down, which it was good thing that it did not yank numbers down. Cycles were much flatter and more predictable than Lantus. I also thought had better duration than Lantus for Neko. Flatter cycles meant I could go longer between tests at night if she was low, on Lantus I was up every hour.

Lantus has an acid base, which for some cats means it stings, especially those getting higher doses, but also some smaller dose cats. There is a thread in the think Tank forum about the differences noticed when switching. Neko purred through Lev shots, sometimes walked away during Lantus shots.

The possible down sides are later onset and nadir. Depends on your schedule. Neko onset after I went to sleep, but nadir was later in the morning, often when I was getting up for rowing. And sometimes nadir was at preshot- I was always home for that. The late onset meant I could once again go to dinner parties and movies after PMPS, and got to go back to bed for a good sleep after AMPS.

One of the cons of Levemir is that less vets know anything about it. Some think it’s stronger than Lantus, heard that one before, and it might be in dogs.

As others have said, address the issue of a dental first. We have seen a lot of changes for the positive if a dental is needed. You probably will need a referral from your vet to the dental specialist. Usually dental specialists have someone focussed on just the anesthesia part of the operation and monitoring vitals. Some will even use a veterinary anesthiologist specialist if you wish. Addressing pain/inflammation and getting to a better dose will both improve Macka’s BG.

 

[Olive & Paula]

With my 1st kitty, I was scared to death of TR. I worked at that time and he was notorious for diving.

With Ollie here, it was clear very early she needed help faster than TR. So for her, we (FDMB recommend) bumped up faster, (had no fear of it at all, because you could see she needed it) changed to levemir, had a dental done with a specialist.

Now we know why she is difficult, but she needs what she needs and you see patterns, learn when you need to be monitoring more closely. Just the other night she was 88 when I went to bed. A year ago I would be giving syrup, high carb and up all night. But because of her patterns, I knew she was safe, autofeeders were set up to open at certain hours, and microchip feeder was set that she can access anytime she wants it. I set alarm to wake and get another test later (slept through it).

You will figure it out. TR isn't really scary. I say try it for 2 rotations and then decide.

 

[CandyH & Catcat]

dental for Catcat made a subtle difference but he was a happier cat afterwards .. had some sores in his mouth (I had thought they were only the black-spotting that affects some ginger cats) which have slowly drained .. and getting those four rotten teeth out had to be a relief for him

vets check very carefully to make sure cat is suitable for anesthesia, Catcat sailed through that, with a specialist you have even more assurance as they take pride in their work

can't speak to the dose, I'm still fidgeting around trying to find the right one myself -- ECID -- still trying to figure out how to feed the curve so we can get Catcat down to green a little oftener than every 3 weeks ...

not to mention that my aging eyes need a LOT of help to portion out .75 rather than .5 .. strong LCD light, 2 pairs of 3.00 reading glasses from the dollar store, one on top of the other -- and an impatient cat wanting foooooood nowwwwwww

 

[Penelope and Mačka]

Again, thank you ALL for your help and kindness.

The sooner one can correct dental problems (issues chewing is a red flag), the better. IMHO, having a dental done is the first place I'd start. Once the dental is done, you may or may not want to re-visit the subject of switching insulins.

Yes, after sleeping on it, that's what I decided to do. It's just so heart breaking to see Macka losing steam because of the AM and PM high numbers that stay high even with increases. So switching insulin looked like an interesting option. I'll give it a few more tries and also get an appointment with the dental specialist.

Max was a bouncer for nearly a year but his highs got lower and lower until he was tightly regulated.

So are yo saying that once they go into the greens, the ends of the cycle start going down too, but the greens don't necessarily get greener? ^^;

I had to take Oscar up to 2.5 to get him to come down, and my vet originally started him at 2u.

Oscar's progression is quite fascinating, such a good job you did! It's as if one certain dose triggers something in the body, and tells it to calm down. I am so hopeful that it happens to Macka too.

Edit: Typical PZI curves look like big valleys. So they will "dive" which is another thing that causes bounces and which is why I was recommended to switch to Lantus.

I don't think this is what we want!!! No more diving please. However, is it possible that some, not many, cats do not do well on Lantus? That there is some incompatibility?

Dental issues have taken Bubba out of remission twice.

Seriously! If that was Macka's only reason for diabetes, it would be amazing though!

If you look at Ti-Mousse's SS, you'll see the progress he has made, starting with Black and Red for a very long time (I left him too long on the same dose ) and now he's in blue and green lately! The goal is to have safe green kitties asap!

Wow, I see that! Is he going into remission finally? What made you change from Lantus to Levemir? DO you think it make THE difference?

The possible down sides are later onset and nadir. Depends on your schedule. Neko onset after I went to sleep, but nadir was later in the morning, often when I was getting up for rowing. And sometimes nadir was at preshot- I was always home for that. The late onset meant I could once again go to dinner parties and movies after PMPS, and got to go back to bed for a good sleep after AMPS.

Said like that, Levemir sounds dreamy!!!!! I need sleep and peace of mind so bad.

changed to levemir,

Again, what made you decide to switch to Levemir? Is it better with her condition?

not to mention that my aging eyes need a LOT of help to portion out .75 rather than .5

Oh I feel you... so hard to see anything. Why don't you increase the dose to 1u?

Thanks again!!!

 

[CandyH & Catcat]

Oh I feel you... so hard to see anything. Why don't you increase the dose to 1u?

Thanks again!!!

doing SLGS -- waiting to see if this dose gives me any more greens, it seems to take awhile for Catcat to adjust to new dose -- if I go up to 1u I will probably see all yellows again, he's great at doing the NDW dance

 

[Olive & Paula]

I switched before we knew of the acro. Ollie was up to 8 units lantus. After awhile she started getting aggressive when I would give her shot. Lantus will sting or burn at higher units. The vet wouldn't script lev, he didn't know anything about it and was told it's to dangerous. That's what he use to think about lantus when I started it on previous kitty without his approval. Now it's his preferred.

So I googled on it. Found it is more potent than lantus but normally you use less of it. It supposedly will have later nadirs so eventually you are shooting lower numbers which helps level them out. Not the case with Olive. Lev works on her like lantus nadirs between 5-7 hrs. And she can bounce with the best of them. It also seems any change in her routine can and has set her back.

Anyway, I got lev from various sources and switched her myself with help here. I had to change vets so I could get the cabergoline to treat the acro. Current vet is fine with it, since Ollie was on it before we went there. But she said she isn't familiar with it and wouldn't have considered it. Now she still isn't sure about it but does admit it seems to work for Ollie. And she will give me a script which I sent to Marks in Canada for filling.

There isn't any one answer that makes lantus or lev the best choice. I had/have 2 diabetics, each one reacted differently on lantus. Smokey I did SLGS method, it didn't work well with him but I was intimidated by TR. With Ollie, I knew very early something was wrong. Without hesitation I went TR and 3 months after being on lantus, switched her to lev and modified the TR method to suit her. ***ANY LURKERS this was for Olive only, do not follow what we did*** and now I wonder why TR was frightening to me.

You will do what is best for you. And there are enough people here to help you no matter what you decide.

 

[Bobbie And Bubba]

Seriously! If that was Macka's only reason for diabetes, it would be amazing though!

What I meant was the dental inflammation and bad tooth knocked Bubba out of remission. It didn’t cause the diabetes.