well i'll be - i didn't know about the "read it later" feature. i use google chrome most of the time now, but used to use firefox. cool
here ya go on the links:
Lantus & Levemir New to the Group? Please Read
Tight Regulation Protocol
This is the part of the Protocol that you're going to be following for right now:
WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:
Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
It will be necessary to test kitty's blood glucose levels multiple times per day.
Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
Feed a high quality low carb canned or raw food diet.
Feed small meals throughout the day. Some kitties adapt well to free feeding.
Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.
"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
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.
My gut reaction about your dose is maybe you should go back to the 5units you did last night and this morning and stay there - but i'd like Sienne, Jill or someone more experienced to look at it and tell you. If no one answers you by the time you need to shoot today, i think go with 5u - then stay with it. Your testing is going to tell us how good of a dose that is. once you have a dose tonight you're going to stay with that dose for 5-7 days. i bolded the part above. if i were you i'd probably try to test at +3 and +6 along with the preshot tests during this time - you're going to be changing food and you want to keep a good eye on how sushi's doing with the transition. so only one change at a time - this time it's the food - unless he goes low, then the dose will change too. you get the idea, it's a balancing act and we don't want to tip sushi too far with too many changes at once. safe is the most important thing.
You're going to need to transition sushi off of dry food - but do it over the course of several days. I think i saw someone suggest 5 days earlier for making the gradual transition. Again, see if one of the more experienced people have a thought on that. gradually increase the percentage of canned food and decrease the amount of dry food. if sushi doesn't take to it easily, there are ideas in that link ann gave you for making the changeover. you can pulverize the dry and use it as a sprinkle on the wet.
You can add water to sushi's food. diabetics are considered dehydrated, so water is good. cats have a poor thirst mechanism so it's good for you to help him on that.
as far as the overall health questions - i think grooming seems to be the first signal that a cat doesn't feel good. i think it took about 2 months for punkin to begin grooming again, but he seems to have stopped again. his hair is greasy and icky. i buy pet washclothes at the pet store that are ok for cats and help with that. then i can delude myself into thinking he feels just fine, because other than the greasy coat he does seem fine.
dandruff - it's probably related to not grooming. i also use a fine tooth comb to comb out excess hair. i had a spare human comb from one of my girls - a rattail comb - that is now punkin's.
stinky poop - when you change his food that will change. what goes in is what comes out. hurting when he goes - maybe he's a bit constipated and it just plain hurts. there are folks here who give their cats miralax daily to help them with that. i don't have experience about it. not going in his box - might just be related to him not being regulated. also not sure on that one.
i have no idea about the eye thing. although my vet said punkin could go blind overnight from cataracts from too high of sustained blood sugar. maybe sushi's developing cataracts? i really don't know.
overall - i think he's doing really good. this is a marathon process - when you posted as a possibly hypo the other night i thought he might be in crisis. if you hadn't started hometesting none of us would have known. one thing about lantus is that it's a slower, gentler insulin and sometimes cats don't seem to show hypoglycemic signs until they are in their 20's. that's incredibly dangerous. punkin registered a 32 not long after i started testing him and he had zero other signs of being hypo. you don't want to risk brain damage or death on your cat, so you truly can't just rely on other symptoms besides measuring the BG to tell you how sushi is doing. that's why we're all such testing fanatics. you don't have to go overboard, just have to become educated and test enough to know sushi's safe.
Q: does he breathe noisily? like wheezy at all? he looks pretty good sized in his avatar - are his feet big? how much does he weigh? has he grown any in the past few months? he really is a gorgeous cat - looks positively regal!
i've only been in this since february - so while i'm trying to answer your questions there are people with a lot more experience than me, and if they tell you otherwise, like about the dose, for example, i defer to them. i don't know it all and am just trying to be helpful as far as i do know.
