8/18 Buddha -- on Lantus for a year and not regulated

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Donna & Buddha

Donna & Buddha

Member Since 2009
Good morning! Lantus is the 3rd insulin Buddha has been on and we're still not getting fantastic results. For the first year he was on Vetsulin. I was not hometesting then, and I remember this year fondly. His symptoms were gone, he shed his extra weight gradually, and he seemed like a happy and healthy cat. Then a bit before the recall, drinking/excessive peeing returned along with a UTI and then horribly DKA. After a touch and go week in the ER, Buddha was switched to Prozinc and fancy feast canned food and I began daily hometesting. After 9-10 months of trying to regulate with ProZinc, we switched to Lantus.

We've been using Lantus almost a year. Buddha's bg levels still swing pretty dramatically. I'm very near the end of the last pen in the box. I need to decide ASAP if I'll buy another box of Lantus pen's or switch to Levemir.

Life gets busier in the fall. It becomes very difficult to give shots consistently 12 hours apart. I understand that Levemir might be more forgiving with my schedule. Any advice?
 
hi donna, i don't know much about levemir but there are several levemir users on this forum. hopefully someone will be able to speak to that for you.

is buddha (great name!) still eating low-carb fancy feast?

we do try to catch the nadir - usually somewhere mid-cycle - is it possible for you to do any testing between +5 and +7 to see what his lowest numbers are?

it actually looks from his spreadsheet that you are doing a pretty good job of staying close to 12/12. he really hasn't had his dose changed - ever, almost. the protocol that we follow has us changing doses by .25 every few days to fine tune the kitty's BG. i wonder if you would have better luck following that. Have you read the sticky at the top of the lantus forum regarding the protocol? i found it helpful when people explained it to me for the first little while. This would be the part that would apply to Buddha at this phase:

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.
Click to expand...
 
Hi guys .. I don't know much about levemir, but I think I have read it can be a little more forgiving in regards to the strict 12/12 schedule, but I'm not 100% positive on that.

Mocha started out on vetsulin as well, and then after joining this site we learned about lantus. We soon made the switch and we danced the sugar dance on lantus for close to 20 months .. Her BG's were all over the place .. sure, we had streaks of blues or greens, but always went right back up to yellows, pinks, reds and even black once or twice .. It was hard to watch, but we stayed steady on track and all of a sudden, her numbers leveled out more and more .. and the next thing we knew, we were starting her OTJ trial! Im not saying your kitty will or will not go OTJ, but I can say lantus takes time sometimes ..
 
Thanks for the comments.

Buddha still eats Fancy Feast. We stick with low carbs unless his numbers are low. I used to record snacks on the spreadsheet, but don't any more. When bg numbers are low or lower than I'm comfortable with for where he is in his cycle or if his appetite is really reduced (which happens now and again), then he has a snack of medium or high carb fancy feast. Occasionally he bullies my big scary dog away from his food dish and steals kibble.

My summer schedule is different from the school year schedule. Evening activities will soon make keeping to 12/12 shots difficult, hectic, nerve wracking and sometimes down right impossible. If I felt like a strict 12/12 lifestyle made a difference for Buddha I would continue trying. But to do so requires a lot of family commitment and compromise, and the results don't seem to indicate that it's worth it.

In the beginning of our Lantus experience, I was precise about following tight regulation or Tilly's protocol or whatever it's called. So for the first say six months or so, I was pretty careful about dose increases and dose decreases. I found that smaller dose changes (less than a 1/4 unit) would have big impact on bg numbers. There are also times when I shoot a bit more aggressively and see more green on the spreadsheet, but after dipping too many times into the 30's I get anxious and back off.

The spreadsheet. I update the spreadsheet every week or two from readings from my meter. The 1fu that I put down is not strictly accurate. It can fatten up or skinny down depending on the bg levels. I mostly follow the guidelines, but am more relaxed about interpreting them and recording them. In very general terms, 1.5u is too much for Buddha, 1.0u isn't quite enough. I am not a patient person and drawing up an insulin amount that is exactly and consistently 1.13u or 1.25u or 1.375u is impossible for me. It just is.
 
Hey-someone who's SS is as long as ours!! :lol:
I have never used lev., but the nadir is usually later than on lantus--You seem to be doing the mini curves,
but on your day off you might want to do a regular curve to see where he is really going!
You may want to increase to a skinny 1.25U or reg 1.25U, But I would not do this unless you will be home
to monitor several times during the day for a few days!--We do have dosing helpers, but you need more data on your SS, that would help them help you..
 
I do feel like I may have missed something yesterday afternoon. I'm home a lot so I don't always test compulsively. If the cat looks fine and acts fine, I'll leave him alone. I've also got the feeling that my Lantus has pooped out. I'm at the end of the cartridge and need to make a snap decision.

My gut feeling is stick with Lantus. I do know that I can fatten up his dose and see better results. I just wish I could fatten his dose and see lower highs but without the scary low lows.

I was shooting/testing more aggressively in February through April of this year. It keeps me on a short leash and I like to be able to sleep uninterrupted and leave the house at will.
 
One thing I see as a possible problem (and I hope someone with more experience can chime in about this), is that you're not taking a lot of reductions that you should have. To me, it looks like Buddha keeps going to low, and then bouncing high, and then going too low again, etc. When you have a number that's 50 or less, you should reduce the dose by .25u. Keeping a cat on too high a dose, even if it's just a little too high, can be counterproductive. Sometimes a dose reduction needs to be held for a bit to see where it goes. I would stick with the Lantus and take some of those earned reductions and see what happens.
 
Thanks Julia. The dose decrease number is lower for cats that have been diabetic for a long time than for newly diagnosed cats. Since Buddha has been diabetic for a long time, I use a lower number, 40 instead of 50, as my dose decrease number. Also, for cats that have a history of not holding to dose decreases, the number needs to dip below 40 3 times before a decrease is taken.

I haven't read the guidelines recently, and maybe they've changed since then, but those are the rules that I try to follow. Now, sometimes we dip below 40 and its because I thought Buddha ate all his breakfast, I left the house, came back and found out that no he hadn't eaten after all. Or later I'm told the dog ate it. Grrr. I usually don't take these "human errors" into account when evaluating his numbers.
 
I've never heard of using 40 as the decrease number for cats that have been diabetic longer (Bandit was never on insulin longer than a year, though). From his data, it appears to like it could be bouncing.

Bandit's normal blood sugar range is high for a cat, about 80-130. He has a very panicky liver and has been known to bounce from numbers in the 60s. I know that this is a little unusual situation, but maybe aiming at maintaining nadirs in the 80-120 range rather than in the lower greens might give Buddha's liver a chance to chill out and get used to a normal range, if that is the problem. Also, I have much better luck with decreases with Bandit (who seems to be very sensitive to decreases) by easing into the decrease gradually--for example, decreasing from a .75u to a .5 by shooting .75s for a couple days, then .5f, then .5.

I had no idea Bandit had a higher than normal blood sugar range until he went OTJ. Once I realized this, it was an "aha!" moment on why he would get a random high number every now and then after he was regulated, and I adjusted his dosing to be generous with decreases, make them gradual, to try and maintain slightly higher nadirs the second time around. I'm not saying Buddha is the same as Bandit, but that some cats seem to need their BG approached from underneath the regulating dose rather than over top, if that makes sense.

Again, I hope some more people will come weigh in on this, because these are just my thoughts.

EDIT: I want to add have NO experience with a kitty on insulin long term, so this is all conjecture. Hopefully someone more experienced will be along to give you advice.
 
Hello! I am just going to chime in and agree...unfortunately I think you missed your chances for a .25 decrease... please stick with Lantus and give it a shot! I am doing a combo of the stickies and Tilly's page and it seems to be working on my Stella. I want Stella to stay steady because of my crazy work schedule. FYI I am not supposed to be giving advice so why don't you just take a peek at Stella's SS...

Good Luck! You are terrific for keeping at this for so long...that is a GREAT thing!!! :-D
 
You could consider switching to Levemir as one of my cats is better on Levemir.
Shadoe started on Caninsulin, I switched her to Lantus, then Levemir when dx with acro.
I did a trial on both Shadoe and Oliver, to try them on Lantus, and found that Oliver did not care, but Shadoe was visibly more tense and had urine issues and worse numbers, but all problems disappeared as soon as she was back on Levemir again.
 
The Tilly/Tight Regulation Protocol is identical for Lantus and Lev. One is no more forgiving than the other. The pharmacology of the two insulins is different and from that perspective, Buddha may do better on Lev vs. Lantus. One other aspect of Lev to factor in is that the nadir is later in the cycle. I don't know if that will have an impact on your schedule, should you decide to switch.

The protocol has been modified since you started using Lantus. Another option, with respect to a dose reduction, is that if Buddha dips in to the 40s on three occasions, you can reduce the dose.
 
Donna & Buddha said:
I do feel like I may have missed something yesterday afternoon. I'm home a lot so I don't always test compulsively. If the cat looks fine and acts fine, I'll leave him alone. I've also got the feeling that my Lantus has pooped out. I'm at the end of the cartridge and need to make a snap decision.

My gut feeling is stick with Lantus. I do know that I can fatten up his dose and see better results. I just wish I could fatten his dose and see lower highs but without the scary low lows.

I was shooting/testing more aggressively in February through April of this year. It keeps me on a short leash and I like to be able to sleep uninterrupted and leave the house at will.
Click to expand...


I was just talking about this with my daughter. I mentioned to her that there are days when I just wish I could have Champ stay flat blue all day and all night, no better and no worse. That way, I could still have a life outside my home and not spend a fortune on test strips. However, as you have already figured out, in order to have that, you also pretty much rule out remission. The only way to get your kitty to go OTJ is to follow the protocol aggressively. It does limit your free time and you do have to deal with low greens and learn what works for your kitty to pull them up, but not send them bouncing. Right now, I suffer from severe lack of sleep and I have absolutely no life other than work (thank God I work at home) and FD. It's my 50th birthday on Saturday and I get to spend it at home, though I will sneak out at the end of Champ 's AM cycle for an early dinner (because that's when his numbers are sneaking back up and I don't have to worry about being gone from home). I don't plan on doing this forever, that's for sure. If it looks like Champ is going to be an insulin-requiring diabetic for life, I'll no doubt back off from the tight regulation protocol and go more for just nice level blues. Lantus is really a great insulin for just keeping level if that's your aim, though. It's very gentle and long-lasting. Ann (of Ann & Tess) switched Tess to Levemir. She might be able to give you some idea of how late the nadir falls for her so you have more info to base your decision on.
 
IMO I would cut out snack even on low bg days. We had sparky otj for 6 years on the lowest carb friskies pates. Last month i started giving him a slightly higher carb friskies wirh chunks and gravy, and now we are back on insulin :( I can't swear it was the diet, but the timing sure makes sense for us,
 
hi donna. i know you have to be concerned about ketones if you drop the dose, but those red numbers signal a huge bounce. if i were in your shoes, i would begin to gradually lower the dose by shaving the dose rather than decreasing in increments of 0.25 unit.

you could switch to levemir if you like. it's another good choice for diabetic cats.
although, i have a feeling you'll end up with similar results if you hesitate to take reductions when they're indicated.
 
One more word-I also feel that Moonie is sleeping so nice, why wake her up for a test??
BECAUSE it is essential for you to monitor on lantus to see where he is going, at what time of the day, or
it will be very hard for you to correctly adjust the dose--PLUS, Buddha will get a pure protein snack like
freeze dried chicken(or real boiled chicken) for a treat for letting you test him!
You should see Moonie hop up to get her treat & a tes!
Also I also wait for 3 40's numbers as Moonie is a long term diabetic before I reduce the dose--that is protocol also. Try the shaves and see what happens!--Please please do test, it will be very benefical for you both!
 
I too wonder if you're seeing some bounces - shaving the dose and sitting back to see how it plays out would be my first inclination. If you need to bump it back up you always can but I am really curious to see if Buddha's numbers wouldn't level out a bit for you with a slightly lower dose.

Also...when are you feeding & how much at each meal? Kazi's never been one to have a huge food spike, but I've found that splitting her food up has helped level her out. She is offered 1/2 a 5.5oz can for dinner *and eats most* and then a 1/4 can at her +3 or +4 right after I check her BG before bed. During the day its 1/2 can for breakfast, 1/4 can at +3 and 1/4 can at +8 via the timed feeder for snacks.
 
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