After a second opinion

[Kath]

Hi, first time poster, long time follower...

Kath was diagnosed in October and has been on Lantus since then. She had been on low carb wet food for about a year prior, she'd always been a large girl and lost a little bit of weight with the diet change although I think the damage was already done before we switched. I often wonder if the diabetes kicked in because I had reduced her food to twice a day a few months prior (no grazing) to try to get her to lose more weight.

She started on 1 unit of Lantus 2 x day, increased to 1.5 in January then up to 2 by February. I took her to the vet today with the attached spreadsheet and the vet said to drop her to 1.5, I'm just after a second opinion on that.

At the vets I took a test with my metre (Freestyle Lite) and it was lower than the vet's human metre, mine was 3.3, vets was 4.1 mmol/L (56/59 mgdl) so the whole spreadsheet is probably a little lower than it actually is. I know that's too low, she was due to be fed and was very hungry. She doesn't show any hypo symptoms when low other than hunger, but then again she's always loved her food! When green she bounces back up into the blue very quickly after eating.

Her eating and shot times usually don't line up, as you can see I usually test her about 2 hours before shot because that's when she wants to eat (no one can handle her whinging when she's ready for food). I think she eats more out of habit though, like when I wake up, when I walk in the door etc...

She eats Ziwipeak which is a low carb wet food 2-3 times a day and I leave their low carb (both ~3%) dry food out all day so she can graze if she needs to but she hardly touches the dry. She's behaving like a normal cat, not peeing or drinking excessively and appears to be quite happy. The vet said not to let her post shot +6 hour test go below 10 mmol/L (180 mgdl), if that's correct I'm definitely doing this all wrong.

Appreciate your opinions on the dose reduction,

Thanks,
Kelly

 

[JanetNJ]

Your vet is wrong about keeping the cat over 180. Normal is 68-150 on the vet meter 3.7-8.3

On a human meter normal is 50-120 or 2.8-6.7

You want to get her down into these healing numbers to let the pancreas rest and recover. It's your best chance for remission.

 

[Kath]

Your spreadsheet is rough on the eyes. Have you tried our color coded version? And then got can just share it with a link.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

I'm using the one I downloaded from here, not sure why it's looking like that. I've uploaded a pdf version, that should look ok

 

[Sienne and Gabby (GA)]

I'm not sure what approach to dosing you're following. However, no matter which approach, numbers in the 20s or 30s warrant an immediate reduction in dose. The Tight Regulation Protocol is the more aggressive of the two approaches to dosing we use and any number below 50 (or below 40 if your cat is more than a year past diagnosis) requires that you reduce the dose by 0.25u). You've been seeing several instances when Kath is in those bright green numbers and as such, her dose needs to be reduced.

We typically make changes in dose by 0.25u, not by 0.5u. We also don't recommend holding doses quite as long as you've been holding them.

Unlike Janet, I find the pdf version of your spreadsheet hard to read since it's reduced in size. We attach the spreadsheet to our signatures so you don't have to manually attach it any time that you post. I'm not sure what it was that Janet found to be "rough on the eyes" but setting the spreadsheet up as a link and in a size that's a bit bigger would be helpful.

If you think it would be helpful, you're welcome to post regularly. We're more than happy to coach you with regard to either the TR Protocol or the Start Low Go Slow approach to dosing. Kath's numbers look good overall and perhaps with following a formalized approach to dosing, you have a solid chance of getting her into remission or at the very least, tightly regulated.

 

[Kath]

I'm not sure what approach to dosing you're following. However, no matter which approach, numbers in the 20s or 30s warrant an immediate reduction in dose. The Tight Regulation Protocol is the more aggressive of the two approaches to dosing we use and any number below 50 (or below 40 if your cat is more than a year past diagnosis) requires that you reduce the dose by 0.25u). You've been seeing several instances when Kath is in those bright green numbers and as such, her dose needs to be reduced.

We typically make changes in dose by 0.25u, not by 0.5u. We also don't recommend holding doses quite as long as you've been holding them.

Unlike Janet, I find the pdf version of your spreadsheet hard to read since it's reduced in size. We attach the spreadsheet to our signatures so you don't have to manually attach it any time that you post. I'm not sure what it was that Janet found to be "rough on the eyes" but setting the spreadsheet up as a link and in a size that's a bit bigger would be helpful.

If you think it would be helpful, you're welcome to post regularly. We're more than happy to coach you with regard to either the TR Protocol or the Start Low Go Slow approach to dosing. Kath's numbers look good overall and perhaps with following a formalized approach to dosing, you have a solid chance of getting her into remission or at the very least, tightly regulated.

Thanks for the advice, the syringes I use only have 1 unit increments, it's hard to even do .5 I don't think I could accurately do .25 increments. What type of syringe should I be using?

Usually PDFs can be magnified, but I'll try to attach to my signature. I'm guessing I'll have to copy everything over to a new one?

 

[JanetNJ]

I'm not sure what approach to dosing you're following. However, no matter which approach, numbers in the 20s or 30s warrant an immediate reduction in dose. The Tight Regulation Protocol is the more aggressive of the two approaches to dosing we use and any number below 50 (or below 40 if your cat is more than a year past diagnosis) requires that you reduce the dose by 0.25u). You've been seeing several instances when Kath is in those bright green numbers and as such, her dose needs to be reduced.

We typically make changes in dose by 0.25u, not by 0.5u. We also don't recommend holding doses quite as long as you've been holding them.

Unlike Janet, I find the pdf version of your spreadsheet hard to read since it's reduced in size. We attach the spreadsheet to our signatures so you don't have to manually attach it any time that you post. I'm not sure what it was that Janet found to be "rough on the eyes" but setting the spreadsheet up as a link and in a size that's a bit bigger would be helpful.

If you think it would be helpful, you're welcome to post regularly. We're more than happy to coach you with regard to either the TR Protocol or the Start Low Go Slow approach to dosing. Kath's numbers look good overall and perhaps with following a formalized approach to dosing, you have a solid chance of getting her into remission or at the very least, tightly regulated.

All the zeros make it harder to read on a phone which is what many of us use. Plus it's missing the color coding which makes it easier to see trends. That's why I said it was rough on the eyes.

 

[JanetNJ]

I'm not sure what approach to dosing you're following. However, no matter which approach, numbers in the 20s or 30s warrant an immediate reduction in dose. The Tight Regulation Protocol is the more aggressive of the two approaches to dosing we use and any number below 50 (or below 40 if your cat is more than a year past diagnosis) requires that you reduce the dose by 0.25u). You've been seeing several instances when Kath is in those bright green numbers and as such, her dose needs to be reduced.

We typically make changes in dose by 0.25u, not by 0.5u. We also don't recommend holding doses quite as long as you've been holding them.

Unlike Janet, I find the pdf version of your spreadsheet hard to read since it's reduced in size. We attach the spreadsheet to our signatures so you don't have to manually attach it any time that you post. I'm not sure what it was that Janet found to be "rough on the eyes" but setting the spreadsheet up as a link and in a size that's a bit bigger would be helpful.

If you think it would be helpful, you're welcome to post regularly. We're more than happy to coach you with regard to either the TR Protocol or the Start Low Go Slow approach to dosing. Kath's numbers look good overall and perhaps with following a formalized approach to dosing, you have a solid chance of getting her into remission or at the very least, tightly regulated.

Oh! It looks different from when I looked at it before!!! When I looked at it the first time there was a 0 in every space without a reading and no color at all!!!! It's totally different now!!! I think before it was an excel file and lost all the formatting on phones.... She changed the file.

 

[Kath]

Oh! It looks different from when I looked at it before!!! When I looked at it the first time there was a 0 in every space without a reading and no color at all!!!! It's totally different now!!!

I re-loaded a pdf. The excel sheet looks fine on my laptop, no zeros and has all the colour coding.

 

[JanetNJ]

I re-loaded a pdf. The excel sheet looks fine on my laptop, no zeros and has all the colour coding.

Must lose the formatting on phones. This file works great

 

[JanetNJ]

You have a couple of TOO LOW readings in there. You should have reduced the dose when you for the light green numbers.

 

[JanetNJ]

You need to get syringes with half unit markings. Makes smaller dosing much easier.

 

[Tricia Cinco(GA) & Harvey]

What type of syringe should I be using?

There are syringes that have half-unit markings (then you eyeball the 1/4 unit), but I'm not sure if they're available in your part of the world - If I'm reading your location correctly, you're in New South Wales?

The excel sheet looks fine on my laptop, no zeros and has all the colour coding.

The one most of us use is in Google, not Excel. Here's a link to it. If you'll notice, down at the bottom there are tabs for World and US - you enter your numbers on the World page, and it converts them for the US page.

 

[Kath]

You have a couple of TOO LOW readings in there. You should have reduced the dose when you for the light green numbers.

I was reducing the doses in January and she'd always bounce straight up into the reds, then I read somewhere on here that you don't do it that way with Lantus as it's a 12 hour time release so doses should be consistent. Since then I've been using food to get her back up, which she does very quickly. You can see I often test her a couple of hours pre-shot if that's when she wants to eat so when she's too low I test again her after her food before giving the shot and it's always back up. I don't record those after food shots as it's confusing because she's always high after eating.

 

[Kath]

There are syringes that have half-unit markings (then you eyeball the 1/4 unit), but I'm not sure if they're available in your part of the world - If I'm reading your location correctly, you're in New South Wales?

Yes I'm in NSW. Pretty sure I've seen on Facebook posts we can't get them here.

 

[Kath]

Thanks for your help everyone, I'll reduce her dose to 1.5. I can't by .25 as my syringes make it impossible.

 

[Sienne and Gabby (GA)]

If you can track down a set of 4 inch digital calipers it will allow you to fine tune your doses if you can't find syringes with half unit increments. We do have a few people from your side of the world here we'll have to see if we can reach out and see what they've used for syringes. I think BD syringes are available worldwide and unless something has changed, they should have the kind of syringes we use.