Melissa and Celle
Member Since 2011
I'm starting to really lose hope that I'll ever figure this out. I have no idea what to do now. Send ideas please!
AMPS = 505 Please help!
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Angela & Blackie & 3 Others
Member Since 2010
Unfortunately, I have no dosing advice to give you. I'm sure someone will be along shortly to help you with this. Don't give up hope. It just takes time and a lot of patience. {{{{{HUGS}}}}}
Melissa and Celle said:
OK what are you trying to figure out? You have tried both Lantus and Levemir; what did you find with the two of them, and did either help in different ways?
Are you wanting dosing help?
I am not clear on the history of your trying the two insulins.
You were on Lantus, then switched to Lev for a couple months and then switched back to Lantus again, is that right?
Just looking at the 2 ss, it does not look like you reached Celle's good dose on either of the insulins.
Putting aside the BG numbers, how was Celle acting on the 2 insulins? I ask because my Shadoe acted very 'tense' and not that relaxed when she was on Lantus, but she loosened up more on Lev. My Oliver started on Lantus then I switched him to Lev so they were both on the same insulin, and he never reacted differently to the Lev. Some are better on one than the other, so can you recall how Celle was?
It will be helpful to know so that you can decide which insulin is better for Celle, then stick to it and get the numbers balanced.
On Lev, you got up to 2.75u, but then dropped way down to .85u... I don't understand why you dropped the dose because it explains why you got those high numbers again! I think at the 2.75u with all the 300's and some 200's, you should have increased the dose to 3.25u, not decrease to 0.85u.
Then you switched back to Lantus.
You started from scratch it seems, way down at .5u Lantus. I am not too sure why you are holding each dose for so long because you are getting plenty of tests, so holding for 6cycles / 3 days would be plenty before moving up or down in dose.
On Feb28/12, you decreased from 4u to 3.25u, but I don't see any numbers to support that drop in dose, and you ended up with a 500 amps because of it?
I for sure understand the drop later to 2.5u when a sitter was giving shots, but after that point, I would have raised the dose back up.
As I don't know who has been advising you on dosing, I can't say much except that I truly prefer Levemir for its more gentle curves and longer lasting/later nadirs than Lantus, and it looks to me that you should be increasing your dose when you end up decreasing.
On Feb29/12, you should have increased to 4.25u, not decreased to 3.25u.
I think you need to increase the dose as 3u is clearly not enough; I'd go with 3.5u and hold for 6 cycles.
Laurie and Mr Tinkles
Member Since 2010
Hi Melissa,
I'm taking a look at Celle's SSs and reading back over some posts to get an idea of the history. Any information you can share about Celle's history would be very helpful!
Hang in there, I know it's frustrating when you can't seem to get anywhere. You've come to the right place though!
I'm taking a look at Celle's SSs and reading back over some posts to get an idea of the history. Any information you can share about Celle's history would be very helpful!
Hang in there, I know it's frustrating when you can't seem to get anywhere. You've come to the right place though!
Melissa and Celle
Member Since 2011
I'm looking for any suggestions that might work, but primarily dosing advice. I'm not sure if the dose is too low or too high (and she's bouncing since the high numbers come after relatively low numbers).
With Levemir we could never lower numbers without having wild swings to very high numbers. With Lantus we've at least had periods where things worked, but they are always short-lived because I get numbers that seem too low and lower the dose, but now I can't get back to anything approaching control.
With Levemir we could never lower numbers without having wild swings to very high numbers. With Lantus we've at least had periods where things worked, but they are always short-lived because I get numbers that seem too low and lower the dose, but now I can't get back to anything approaching control.
Hi, Melissa and welcome to TR.
I saw Libby's post from back in January on the Relaxed forum. I'm having a bit of a hard time trying to understand why you've been reducing Celle's dose. It looks like you've seen a good response when you had Celle's dose at 3.75u on Lantus and a bit more on Lev. It looks to me like the reduction in December from 3.75u to 3.5u failed. Sometimes, despite bringing the dose up, which you did (eventually to 4.0u), you still need to go higher. What's not clear is why you dropped the dose from 4.0u to 3.25u at the end of February.
If this were my cat -- and understand that I follow tight regulation -- I would be increasing the dose every 3 days/6 cycles by 0.25u until I was seeing better numbers. If you are going to stick with the SLGS protocol, you would be increasing the dose (by 0.25 vs. 0.5u as noted in the link) every 7 days/14 cycles. From what Celle's SS looks like, 3.0u is just not enough insulin.
I saw Libby's post from back in January on the Relaxed forum. I'm having a bit of a hard time trying to understand why you've been reducing Celle's dose. It looks like you've seen a good response when you had Celle's dose at 3.75u on Lantus and a bit more on Lev. It looks to me like the reduction in December from 3.75u to 3.5u failed. Sometimes, despite bringing the dose up, which you did (eventually to 4.0u), you still need to go higher. What's not clear is why you dropped the dose from 4.0u to 3.25u at the end of February.
If this were my cat -- and understand that I follow tight regulation -- I would be increasing the dose every 3 days/6 cycles by 0.25u until I was seeing better numbers. If you are going to stick with the SLGS protocol, you would be increasing the dose (by 0.25 vs. 0.5u as noted in the link) every 7 days/14 cycles. From what Celle's SS looks like, 3.0u is just not enough insulin.
Laurie and Mr Tinkles
Member Since 2010
I agree with Sienne, here's the link to Libby's post. This dose is clearly too low.
I keep seeing comments on the SS about UTI and antibiotics.....has that gotten resolved? Has an ultrasound been done to rule out kidney infection? I'm just wondering if there is more going on there because of the repeated UTIs.
I keep seeing comments on the SS about UTI and antibiotics.....has that gotten resolved? Has an ultrasound been done to rule out kidney infection? I'm just wondering if there is more going on there because of the repeated UTIs.
I forgot to include my question about the UTI and ketones comments while on Lev.
I really wonder if the Lev would have been better if Celle was not sick for the time that you were using Lev. I also recall others having to continue some meds because UTI's seem tough to clear the first time around, but I have no experience with them at all.
I really wonder if the Lev would have been better if Celle was not sick for the time that you were using Lev. I also recall others having to continue some meds because UTI's seem tough to clear the first time around, but I have no experience with them at all.
Melissa and Celle
Member Since 2011
I really don't notice any difference in how she acts on Lantus vs. Levemir (vs. ProZinc) for that matter.Gayle Shadoe & Oliver said:
It seems like in late December 2011 we were doing really well. I'd be happy to just keep her always under 350 at this point, heck even under 400 would be something.Gayle Shadoe & Oliver said:
In terms of my thinking with the dose changes, with Levemir we were increasing every three days and the lows were dropping, but the highs kept getting higher. I went back to Lantus because I at least knew that control was possible and was at a complete loss on where to go with Levemir and had no faith it would ever work. So when back on Lantus I decided to keep to longer hold times, which seemed to generally work in that I was able to drop the lows without increasing the highs. Then after a short period of control in December I ended up confused as to whether we had overshot the right dose and she was bouncing. See, for example, 3/23. That looks like she bounced to me, so I cut the dose again.
Short history is we started on Prozinc. We didn't collect a lot of data back then, but basically we had cycles that bounced from under 100 to over 300, so we switched to Lantus to try for better control.Laurie and Mr Tinkles said:
With Lantus, I felt like we couldn't find a dose I was comfortable with because she was so inconsistent from day to day. What seemed to generally work also came with numbers that were too low for me given that she's alone all day.
Levemir was a complete failure. We never got close to control, and we kept increasing the dose until pre-shots were just way too high (and kept going higher). I went back to Lantus because Levemir was never as good as Lantus was at the point when we abandoned it.
She eats carb-free Fancy Feast and cabbage/lettuce. She's on 1/4 tablet Paxil once a day, but otherwise has not health issues. The paxil is for overgrooming. We tried weaning her off it once, but she started overgrooming again.
She gets a lot of UTIs. It used to be easy to collect samples for testing and for ketone checks when she went in the litter tray outside of the box, but now she's using the box again. Her numbers don't seem too affected by the infections though, at least as far as we can tell.
Laurie and Mr Tinkles said:
No, I haven't wanted to travel and pay for an ultrasound, although my vet has suggested to try it (although I thought it was to check for something else). Mostly I just felt like I didn't know what we would really get out of it. Could we effectively treat a kidney infection?
I really appreciate all the help! It sounds like I should go up again in dose. So do folks over here not really believe in bounces, or do her numbers just not look like that's the issue? Would 3.5 or 3.25 be better?
Roni and Moonie
Member Since 2009
Your cat's last best dose was 3.25U on lantus this year...You Know that any infection will raise your kitty's BG's--You cab keep raising the dose hoping for a bg decrease, but any infection or UTI will just override that--Please take your baby to the vet & have a urine check...It could make a tremendous difference..
Please tell me why your cat eats cabbage & lettuce?? Could that be affecting her as well??
Moonie has been on lantus for 4 yrs & eats ff classic chicken feast with great success..
You need to check out all variables, as I love lantus & have a pretty good understanding of it for My cat..
I feel control can be achieved if diligence is given. Levemir is better for some cats as well, but maybe not yours. Not to say that MANY have great success with it & it's similarity to lantus!
As I said, please check out any infection, UTI, dental problems, etc in order to get your kitty into good numbers..
Please tell me why your cat eats cabbage & lettuce?? Could that be affecting her as well??
Moonie has been on lantus for 4 yrs & eats ff classic chicken feast with great success..
You need to check out all variables, as I love lantus & have a pretty good understanding of it for My cat..
I feel control can be achieved if diligence is given. Levemir is better for some cats as well, but maybe not yours. Not to say that MANY have great success with it & it's similarity to lantus!
As I said, please check out any infection, UTI, dental problems, etc in order to get your kitty into good numbers..
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 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 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 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 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.
Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.
A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.
Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
--- Hold the initial starting dose for 5 - 7 days (10 - 14 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 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 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 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.
Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.
A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.
Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
Squeaky and KT (GA)
Member Since 2011
May I insert one thought as you're trying to figure this out? Remember, insulin is NOT a chemical medicine where you 'take 2 and call me in the morning', it's a hormone that we're trying to balance with the food being fed as well as the environmental issues that affect their bodies. Sure would be nice if it was like thyroid medicine - figure out the right dose and stay there!
Good luck and BIG hug,
Good luck and BIG hug,
julie & punkin (ga)
Member Since 2011
it sounds hugely frustrating, melissa! i'm sorry you're struggling so much.
i like the others' idea of making sure first that there is no further infection. yes, kidney infections can be treated.
the second thought i have is that a year ago she had a a run of 5.0unit doses that actually looked pretty good. a year is a world away in a cat with diabetes and much could've been different at that time. but it's part of the picture.
punkin has acro and when i the diagnosis came, people told me to not look at the size of the dose, look at the BG numbers and at punkin's overall "how's he doing?" report. i don't know if you're having a bit of a mental block about dose size like i had - didn't want to pass certain numbers because they seemed "too much." but staying focused on getting good BG's, having punkin appear healthier and more playful to me, those things have helped me not care about the size of the dose.
if i were you, i'd check for infection and if none, i'd follow the TR protocol of increasing every 6 doses with my eye on the prize - the prize being better overall health. not just under 300, but all in greens and blue numbers. consistency wins in this game - staying the course, not getting scared of lower preshot numbers and not backing away from the dose. if you are gone to work during the days, catching a test when you walk in the door at +10 or whenever will give you valuable information about that cycle.
don't feel like you have to do this alone, either. you're welcome to post anytime and ask for another opinion about whether or not you should adjust the dose. sometimes it helps to have fresh eyes look. and it always helps to have a little company on the journey.
hang in there! we can help you get her better regulated. :YMHUG:
i like the others' idea of making sure first that there is no further infection. yes, kidney infections can be treated.
the second thought i have is that a year ago she had a a run of 5.0unit doses that actually looked pretty good. a year is a world away in a cat with diabetes and much could've been different at that time. but it's part of the picture.
punkin has acro and when i the diagnosis came, people told me to not look at the size of the dose, look at the BG numbers and at punkin's overall "how's he doing?" report. i don't know if you're having a bit of a mental block about dose size like i had - didn't want to pass certain numbers because they seemed "too much." but staying focused on getting good BG's, having punkin appear healthier and more playful to me, those things have helped me not care about the size of the dose.
if i were you, i'd check for infection and if none, i'd follow the TR protocol of increasing every 6 doses with my eye on the prize - the prize being better overall health. not just under 300, but all in greens and blue numbers. consistency wins in this game - staying the course, not getting scared of lower preshot numbers and not backing away from the dose. if you are gone to work during the days, catching a test when you walk in the door at +10 or whenever will give you valuable information about that cycle.
don't feel like you have to do this alone, either. you're welcome to post anytime and ask for another opinion about whether or not you should adjust the dose. sometimes it helps to have fresh eyes look. and it always helps to have a little company on the journey.
hang in there! we can help you get her better regulated. :YMHUG:
julie & punkin (ga)
Member Since 2011
couple more thoughts
~looking at her ss, looks like she started lantus in march 2011 - is that right? so she was on pzi before then? when was she diagnosed?
~are you giving her anything to help with the bladder inflammation tendencies? i give punkin cosequin 2 capusules a day (he weighs 13.6 lbs) for arthritis (apparently most cats over age 7 have some arthritis) and i've learned that it's good for healing the bladder lining as well. punkin had recurrent bladder infections, probably 8-10 total pre-diabetes and none since then. i add water to his food as well, and every dinner he gets the 2 capsules opened and mixed with his food. cosequin is a cat form of Glucosamine Chondritin that people take for joint issues. you can buy the cosequin from Petco or other pet stores, and it's also available from Amazon. i think it's really helped, and it certainly wouldn't hurt anything.
this is the particular one we buy: http://www.amazon.com/s/?tag=felinediabetesfdmb-20
~looking at her ss, looks like she started lantus in march 2011 - is that right? so she was on pzi before then? when was she diagnosed?
~are you giving her anything to help with the bladder inflammation tendencies? i give punkin cosequin 2 capusules a day (he weighs 13.6 lbs) for arthritis (apparently most cats over age 7 have some arthritis) and i've learned that it's good for healing the bladder lining as well. punkin had recurrent bladder infections, probably 8-10 total pre-diabetes and none since then. i add water to his food as well, and every dinner he gets the 2 capsules opened and mixed with his food. cosequin is a cat form of Glucosamine Chondritin that people take for joint issues. you can buy the cosequin from Petco or other pet stores, and it's also available from Amazon. i think it's really helped, and it certainly wouldn't hurt anything.
this is the particular one we buy: http://www.amazon.com/s/?tag=felinediabetesfdmb-20
Melissa and Celle
Member Since 2011
It started when she was quite young. I dropped a piece of kale on the ground, and she ate it like it was tuna. She loves anything green and crunchy. Does anyone know if it could be affecting her BG? I'd hate to keep it from her. Not only does she love it, but it's also a tried and true method to get her to eat. She'll make her own little salad of cabbage and Fancy Feast.Roni and Moonie said:
As of December, no dental problems, and as of mid-February no UTI. Since her numbers weren't any better then, I'm skeptical that a UTI could explain it. I'm still wondering about the value of an ultrasound though. It's a huge hassle and expensive, so I'm wondering how likely it is we'd find something we could do anything about.Roni and Moonie said:
Another question -- She doesn't seem to like to sit on her bum and will kind of keep it hovered over the ground sometimes. We've noticed this since the diabetes, and she does it whether she has a UTI or not. Could that mean something (like a kidney infection)? Anyone know what that is? My vet didn't think it was anything.
I expected to go up again to near 5 units, but after seeing the numbers in December on 3.75, I AM wary of going higher than that. I know we're at a different spot now, but still.julie & punkin said:
She was diagnosed December 2010 and on PZI until march 2011 when we switched to Lantus.julie & punkin said:
We gave her cosequin for arthritis when she was heavier (long ago), and she loved it. Would it raise her BG?julie & punkin said:
Roni and Moonie
Member Since 2009
I give Moonie Dasuquin which is the next step from Cosequin, it's new improved glucosamine thingy--
It has soybean & avacado in it which is supposed to improve Bladder & kidney health & it does!
So look it up on line & read about it--It's quite good & I buy it online..
Also, Could kitty have a anal problem?? Impaction? constipation, diahrrea , hard stools?? and that's why
she cant sit down right??? Better have vet or yourself check under there-Those anals can get pretty clogged & inflamed--Inflammation can also raise BG's & pain or stress....
So there's no for sure answer--All greens I believe have carbs
Could you skip the greens for like 24 hrs. to see if that's doing a number on the BGs??
I know they get to love some things--Moonie loves marsmallows eats them right up--Pre-Diabetes of course--- :lol: :lol: :lol: :lol: Hope you find the answer-Hugs from us!
It has soybean & avacado in it which is supposed to improve Bladder & kidney health & it does!
So look it up on line & read about it--It's quite good & I buy it online..
Also, Could kitty have a anal problem?? Impaction? constipation, diahrrea , hard stools?? and that's why
she cant sit down right??? Better have vet or yourself check under there-Those anals can get pretty clogged & inflamed--Inflammation can also raise BG's & pain or stress....
So there's no for sure answer--All greens I believe have carbs
Could you skip the greens for like 24 hrs. to see if that's doing a number on the BGs??
I know they get to love some things--Moonie loves marsmallows eats them right up--Pre-Diabetes of course--- :lol: :lol: :lol: :lol: Hope you find the answer-Hugs from us!
Libby and Lucy
Member Since 2009
We believe in bounces, but we also believe that they are a normal part of the process. For the most part, the best way to teach the cat not to bounce is by showing them the lower numbers over and over again until the body learns not to overreact. Some cats learn faster than others (and some REALLY take their time!), and some cats will bounce even off of numbers that aren't low at all. It's a process and it's hard to say how long it will take for any individual cat to stop bouncing. Sure, there are some cats that we will try to help along using food manipulation or some other techniques (especially if they are a cat that likes to take steep dives early in the cycle), but for most of them it's best just to keep giving them the right amount of insulin until one day the bouncing stops. You can look at my Lucy's spreadsheet to see how that can happen. Another great example is Mocha (PeterDevonMocha). Mocha took a long time to learn, but she did get there and is now OTJ!Melissa and Celle said:
About her dose, it's the weekend, will you be able to test more this weekend? Normally I would increase only by 0.25u since she has had some yellow on this dose, but if you want to be aggressive and will be home to test, then I wouldn't be opposed to going to 3.5 and monitoring. I don't think 3.5 will be too much (her breakthroughs in the past have been at higher doses than that), but I wouldn't increase that much unless you can be on top of things just in case. I always used to like to take advantage of weekends when I had an opportunity to be a bit more aggressive, but not everyone feels the same way. ;-)
This is kind of off topic, but it seems like a good place to throw this thought in. Lots of people on FDMB seem to get worried when doses get above 3 units or so. In LL we see plenty of cats at that dose, and in the German forum doses of 5u or even 10u are common. It is also very common for a cat to work up to a high-ish breakthrough dose, then immediately earn a bunch of reductions. It's almost like they need a higher dose to get things started, but a lower dose for maintenance. We just follow their lead and give them what they need.
Good luck! Post any time, we'll be happy to try to help out.
Angela & Blackie & 3 Others
Member Since 2010
Hang in there, Melissa! You're definitely at the right place to get the help you need to regulate your kitty. These people will help you and will watch very closely, and will assist (or advise) whenever, and wherever possible. Following the protocol has helped many of us, and it still is.
Good luck!
Good luck!
Melissa and Celle
Member Since 2011
We don't give them 100% of the time, so I can be more methodical in looking at what effect I see. I don't know why I never tried to look this up before, but here's what I just found:Roni and Moonie said:
Spinach, asparagus, broccoli, cabbage, string beans and celery are among the so-called "Food Exchange Group A" vegetables that the American Diabetes Association (ADA) says can be generously included in the diabetic diet. What makes these complex carbohydrates special is their ability to slow down the body's absorption of carbohydrates by helping to delay the emptying of the stomach and thereby smoothing out the absorption of sugars into the blood.
Could it be that the cabbage is somehow helping?? Obviously not enough!
I think I'll give the Cosequin/Dasuquin a try. I need to do something new.
Thanks, this is incredibly helpful. The bounce thing has confused me from the start.Libby and Lucy said:
This is so much help. Thank you everyone!! I was feeling pretty down about things, but the help I've gotten has me feeling a little more optimistic.
julie & punkin (ga)
Member Since 2011
going it alone is a horribly discouraging way to go - maybe if your cat was humming along in all under 100's it would be fine, but i think when you feel your cat is struggling and don't know how to help, being alone is the worst.
for some reason the advice comes sometimes that if there is bouncing, there must be too much insulin and you should start over. that might be true when a person comes on brand new and had been started on a dose that was too high and then had it increased by too great of increments. but once you're gathering data, in general, that's not going to be the problem. most of the time people need to either hold (if the cat is bouncing from 50ish type of numbers) or increase the dose.
for some reason the advice comes sometimes that if there is bouncing, there must be too much insulin and you should start over. that might be true when a person comes on brand new and had been started on a dose that was too high and then had it increased by too great of increments. but once you're gathering data, in general, that's not going to be the problem. most of the time people need to either hold (if the cat is bouncing from 50ish type of numbers) or increase the dose.
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