Asher 9/6/13 wondering if you guys can help

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donnahc

donnahc

Member Since 2011
Hi everyone:
I haven't posted here for quite sometime. I was here back when we were trying to decide what insulin to switch to after PZI. We went to Lantus and it was working well for us...until recently.
With being self employed and traveling a lot, plus trying to take care of my Mom, I just couldn't keep up with checking in on the Lantus board every day. It was just impossible.

Long story short, we're trying to go it alone with Asher. Our vet is nice, young, good with other things, but clueless about feline diabetes. She just happily writes us a script for Lantus and we take care of dosing on our own. We have tried to follow the Lantus protocol.

In the last month or so with the crappy numbers we have faltered a bit and fell off the protocol wagon a few times out of frustration of not knowing what to do. I did try posting on the Lantus board recently but only got one response since I gathered they were none too pleased with me.

So here I am begging for help if someone might have time to take a look at our current spreadsheet. Right now I stare at it and see nothing but lousy numbers mostly. I know Lev is similar and maybe you guys might have some insight here.

All the P's and behavior is good and normal. No ketones. Just had teeth done this spring.

I am wondering...are we on too high a dose somehow? Mid day numbers have been especially bad. Any suggestions on what we might do, would be much much appreciated. I am kind of at wits end.

Should I try to get a consult with Dr. Lisa?

Thank you in advance for taking a look.
 
I sent you a pm - call & we can discuss.

I'm no expert with Lantus, and the numbers don't look that bad, although they seemed really good at 4 and 5u. Lev is pH neutral, so it doesn't seem to be as harsh as Lantus at higher doses. A switch may be warranted. Have you asked your doc about it?

Is Asher ketone-prone? any other conditions going on?

Lu-Ann
 
I have had some better luck with Lev, since Cedric changed over in May. He had an incendent in July and was in the hospital receiving an insulin drip for 2 days, but he's coming around. I was advised to try Lev as the Lantus didn't seem to be lasting the full 12 hours for Cedric. He's been a bit crappy lately, but i bought a new pen on Thursday (with a little bit of sticker shock, price went up) and I think it is helping. I work 7 days a week, with a full time job during the week (gone from about 7:15 am to about 5:45pm) and on the weekends, my p/t job at WDW varies, but i am usually gone 8 hours (6 hour shift plus 1 hr drive time each way). I use an auto feeder with him.

Good luck with your baby!
 
He may be getting too much insulin. I think that 40 back in July (2nd?) earned a decrease of 10-15% - so down to 4.5u. Instead, you held the dose and then raised the dose on the following 200s about a week later.

That's when his numbers started climbing - and the dose followed. The only other way to handle it is to keep raising until he shows another below 50 and then lower. Always remember to let numbers settle after a low as there is often a short period of rebound. If the number is low enough, decrease the dose and give it 3-5 days to settle.

You might try 5u and see if there are better numbers after 3-5 days.
 
Hi Donna! I don't get on the board much anymore but just wanted to stop by your thread and say hi to you and CoverBoy! I'm sorry to see his numbers aren't so hot but am glad to hear he's doing well and is happy.

I feel bad for you guys because you've been at the sugar dance for so long and have tried very hard to do everything "right" - if there is such a thing according to the SugarGoddess.

This is just a thought, has Asher ever been tested or has anyone ever suggested he be tested for either IAA or Acromegly? I am not highly experienced with these conditions (Lu-Ann is) but just the fact that Asher is a big boy, has been on insulin for several years and is on high doses makes me wonder if these two conditions should be ruled in or out. Whether or not Asher is IAA or Acro, I wonder if he might do better on Levemir - for the same reasons Lu-Ann mentioned.

Whatever you decide to do, we're always here for you!

Laura
 
Donna

I'm very sorry you didn't get more responses when you posted in Lantus TR ISG. We don't want anyone to slip through the cracks.

When I looked at Asher's SS, I thought he looked best around the 6.5u dose. When the nadirs are getting into green, you want to hold the dose a little longer. Although he had a BG of 41 on 8/13 a.m. cycle, he's a long-term diabetic so that is not a number you would reduce the dose for. For long-term diabetics, the reduction comes when they go below 40 once or between 40-50 on three separate days.

That might have been where you got off the protocol and the increases haven't helped after that. When I then look at Siennes response on 8/27, she had the same thoughts as I do. You held the 6.5u dose for 9 cycles (good job!) but then raised when he got good numbers. I would have continued to hold that dose instead of raising him on 9/1.

Libby gave me some very simple advice once: when the nadir gets to where you want it, hold the dose. Ignore the bounces. If you want the nadir higher, fine tune the decrease. If you want it lower, fine tune the increase. But if you want his nadirs at 70 and he gets there, the protocol would have you hold the dose and you might have to hold it w long time for him to stop bouncing.

IMHO, where you go from here is to hold this current dose until he earns a reduction because hes getting green nadirs.

I'm also hoping others will provide you with some additional thoughts. And I just went to add that off-board advising is against the rules of the board so if you decide to have a conversation with a member, it should not involve dose advice :-D it's for your protection and theirs.
 
hi donna!

just wondering when your lantus pen or vial was started. i don't think that's a huge issue or the answer to your question, but sometimes it can make a difference if it's old. if it were really kaput you wouldn't have seen greens on the 14th, but it might be a factor. you might want to add that to your ss in the comments.
 
Dear Donna,

I don't see how you're able to cope with all that you do. Seems to me that, most of all, you need some peace of mind. If finances are no issue, consult with dr. Lisa. Secondly, consider switching to Levemir because it provides smoother curves than Lantus, in addition, to the possibility that you might never again feel comfy & warm on the Lantus TR forum -- and to repeat: you need peace of mind. Your mom & your sugar boy are more than enough of a counterbalance. There are lovely & warm people on Lantus TR but the high volume of daily requests is more than even the kindest of hearts can satisfy. My Pudge, also a big boy at 15 lbs & about 14 y/o, went into his second remission after a very brief time on Levemir, his first was on ProZinc where we met. I remember you fondly.

Best wishes,
Sophie
 
Donna,
I forgot to add that my Pudge was also a Hoover kitty until his FD was better controlled & he turned into a grazer. I don't know how to help Asher to become a grazer, but I'm convinced that small meals is what helped Pudge into remission. He was 18 lbs at diagnosis in Dec. 2011. I don't restrict his food, he can have as much as he wants.

Best wishes,
Sophie
 
Give yourself some credit for persisting! There are many people who won't take an active role in caring for a cat with a chronic condition. Those of us that do, are doing the best they can.

{{hugs}}
 
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