Can't get my cats blood levels in control

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milo

milo

Member Since 2011
OMG!! My catr is actually eating fancy feast wet food turkey giblets!! I mixed some chicken with it from the deli and he is licking the plate clean!!!! Im soo excited.. but now what about his insulin, should I keep it the same untill I see a change in his numbers? Or go down on it gradually? I never had luck before with this thanks to all of you and your help I feel soo much better... I edited my first post as metioned to post this<< I hope I did it right, let me know if I didnt!! Stil trying to get my spread sheet loades, I was able to upload it onto google account but having troubling understanding how to do the rest, but I am reading up on it with the posts from everyone helping>> I am also trying to post a picture of MIlo, and it keeps saying I have t have it a certain size>> So I'm working on it!!!! thanks again to everyone!!!
 
Hi, Jennifer. Welcome to the Lantus board and thanks for posting vs. sending a PM to everyone.

It sounds like you are testing at home. That's great!!

I do have some questions that will help us to better understand your situation.
  • When Milo diagnosed, what dose was he started on?
  • In what amounts (e.g., 0.25u? 0.5u? 1.0u?) was Milo's doses increased?
  • Typically, how long did you hold each dose?
  • Do you have any blood glucose (BG) test data that you can share with us? Do you have tests from various points during the day or just pre-shot numbers?
  • What kind of food are you feeding Milo?
  • Does Milo have any medical conditions that we should be aware of? Has he had any recent blood work done? Does he need a dental? Any history of ketones?

What I can tell you, based on the info in your post, is that Lantus is best dosed in the same amount at both shots. Shooting different amounts, especially amounts that differ in such a large amount, is probably having a negative effect on his numbers. Lantus is what is called a "depot" type of insulin. What this means is there is a reservoir of insulin that forms under the skin that causes overlap between doses and allows Lantus to be a long-acting insulin. By shooting different amounts at AM and PM, the amount in the depot is constantly changing and will cause you to have wonky numbers.

I would also encourage you to read the starred, sticky notes at the top of the Board. They will help you to understand how Lantus works as well as the dosing protocol we use. That protocol is based on research published in one of the top feline veterinary journals. You may want to look at the Tight Regulation sticky to see how it differs from what your vet has been instructing you.

There can be very legitimate reasons that a cat needs to be on higher doses of insulin. It will help if you can answer the questions I noted so we can begin to sort out what's going on.
 
Milo started out on 1 unit in the AM and PM, and stayed on it at least 2 weeks during each increase.I have done somewhat of a curve on him this weekend and his numbers keep rising from 329 to 350 and then tonite before his shot it was 393, I haven't seen it that high in a while. The lowest I have seen it was last week it was 228 before his shot so I only gave him 3 units instead of his 6 (my vet said to do that) so latley his units have been all over the place, I was wondering if it was bad to do that ugh...I keep him reading written on my calendar. I was taking him to the vet every week for testing until it got too expesive and started doing it from home, At the vets request he is now eating Purina Vet diet DM. I am really committed to helping milo get better, I have had him since he was hours old>>>>his litter and mother were killed by a dog so I bottle fed him and raised him myself, he is my baby!! But I feel when I talk to my vet its all just a guessing game and it is upsetting... I really appreciate any help.
 
Hi, Jennifer,

Just wanted to say WELCOME to Lantus Land! You're already in good hands with all the information Sienne has offered. There is much to learn, but the people here are giving, knowledgeable, and great people. You'll get great information and support. I know. This place saved my kitty's life.

Kathy
 
Hi Jennifer,

Just wanted to say Welcome :smile:
The people here are great! You've come to the right place to help your baby Milo.
 
Hi Jennifer, I'm so glad you found this message board. Just about everyone here has felt exactly like you are feeling and had similar experiences with vets who mean well but don't really know how to treat FD. This board saved our kitty's life and made a huge improvement in his quality of life. Just these past few days, we are seeing Zener do things that he hasn't done in months and he is clearly feeling good and enjoying life. It's a little crazy and a big commitment to treat a cat with FD but the rewards are well worth it.

There is a lot to learn and absorb and it will take some time and it won't always go smoothly. Like Julie says, this is a marathon, not a sprint. Please start with the information in Sienne's post. She and lots of others will help you along the way to getting Milo and you in a much better place. ((((((hugs))))))

Liz
 
We use a particular format for listing out test data. We don't refer to actual times (e.g., 10:00) because everyone is from different time zones from all over the world. This is the format:
AMPS~179 <---- morning (AM) Pre-Shot test
• +4~140 <---- 4 hours after shot
• +8~70 <---- 8 hours after shot
• +11~62 <---- 11 hours after shot
PMPS~176 <---- evening (PM) Pre-Shot

If you could list out some information in this way and indicate the dose you've been giving, that would help. Alternatively, if you could transfer the data from your calendar to a spreadsheet like the one we all use, that would be even better. Good for you to not rely on curves at the vet's office. Usually, the data collected at the vet's office is artificially higher due to the amount of stress a cat experiences when there.

You're correct -- the constant shifting around of the dose is likely to be contributing to less than ideal numbers. Unfortunately, many vets tend to treat Lantus like the shorter acting types of insulin and base the dose on pre-shot numbers. Lantus dosing is based on the lowest number in the cycle, the nadir, and doses are generally held for three days (unless a dose reduction is earned). Unless we can see your actual test data, it's going to be difficult to provide you with any ideas regarding dose. Probably the best we could suggest is that you lower the dose and keep the dose the same at AM and PM.

Are you feeding DM canned or dry? DM canned is not terrible with regard to carbs. It's about 7%. Most of us feed canned food that's around 3 to 5% carb. DM is, however, a very poor quality food made up of mostly animal by-products and is expensive. You could be buying a premium, human grade cat food (e.g. Wellness) that is lower in carbs for less than what you are paying for the prescription stuff.
 
Milo is eating the DM Dry dietetic dry food, I will try and take my data on my calendar and start the spread sheet you suggested, I would be lying if I didnt say this seems like soo much to take in and I can't help but feel I'm doing somthing wrong when I get his readings (tonights still being 351 4 hrs after his shot) but I am sooo grateful to you all for the advise you are offering because as mentioned I really feel defeted, adn that I am not doing good by him. I should mention that he seems like he is feeling good, and he is still drinking alot and peeing large amounts but it is not sticky like before. So I am just gonna suck it up, and move forward and be happy that I have found this forum to help me through this!
 
Jennies, you are doing GREAT! Milo is one lucky kitty to have you as his bean from the very beginning of his life. The most important thing is you want to help Milo feel better and he will. It will just take a little time. And we will help you all along the way.
Liz
 
Please don't be discouraged. You've just started walking in the right direction!

There's a lot of information to absorb at first, but very soon, you'll get into a healthy rhythm with Milo. And you have lots of company!
 
Jennie --

There is a huge amount to learn and pretty much all of us have felt completely overwhelmed at first. You're feeling just like we all have felt. We all understand. You don't have to do this solo. Please -- ask questions. (I know. Sometimes it takes a while to figure out what it is you don't know.) I don't think you're doing anything wrong. You've been doing what your vet told you to do. Unfortunately, most vets spend a couple of hours learning about diabetes at some point when they are in vet school and what they learn, is supposed to cover all the species they could possibly work with. Most vets are just not as well versed in feline diabetes the way we are here. It's all we do!

Here's where some of the problem is. DM dry is 13% carb. As I mentioned, most of us feed somewhere in the neighborhood of 3 - 5% carb (and some people here feed even lower carb than that). In addition, dry food is evil. If you think about what's in a cat that lives in the wild's diet, it's not dry food. Cats are carnivores. They eat meat -- no grain, rice, or or starches because they can't process these foods. In all likelihood, you are needing higher doses of insulin to offset the higher carb food you're giving Milo. (FWIW, most vets are idiots when it comes to nutrition.)

Here's what I would suggest. Get some Fancy Feast Classic style flavors. (These are the pate style foods.) Give your cat a little bit to see if he likes the canned food. If he gives you a hard time, there are ways to transition Milo from dry to canned food. Lisa Pierson, DVM's website on feline nutrition has tips for transitioning a cat to canned food. You need to be aware, though, that given the lower carbs of the foods we use, Milo's blood glucose numbers may drop. You will need to test often in order to not get caught by surprise.

Janet & Binky's list is a good place to start for information on the carb content of many foods. You'll want to get some food that are low in carbs for Milo's regular diet. You'll also want to get a stock of high carb food (food that's 18% or more carb that are gravy-based, such as Fancy Feast marinated or roasted varieties). We use the high carb food to steer the cycle should numbers drop into lower ranges.
 
hello and welcome to the group, jennifer and milo!

get that spreadsheet together as soon as you can. i know it'll take some work, but it's really the only way we have a chance at answering your questions about dose.

each and everyone of us was totally overwhelmed when we came here. we understand what you're going through. we've experienced the myriad of emotions that are attached to helping our precious kitties.

hang in there, ok?
:YMHUG: :YMHUG: :YMHUG:
 
Hi Jennie-

I just want to welcome you and Milo to the board. This really is the best place to be...the knowledge and support is unbelievable - and the folks here really know FD and Lantus inside and out. The diagnosis definitely is stressful and overwhelming at first, but it really, truly does get easier. Just keep asking questions and leaning on us - we'll get you through this together!

Amy
 
Welcome to FDMB and Lantus Land.

Don't be discouraged -- the dry food is not the best -- low carb (grain free) canned food is better -- you've already got links in previous posts so enough said.

My first diabetic cat Norton had a condition called Acromegaly that made him need more insulin than "normal". At one point, we were up to 13 units BID while on dry food. After changing to low carb canned food, he only needed 8u BID. Still a lot. Some cats with Acromegaly need even more insulin. Basically Acromegaly is a pituitary tumor that spits out "insulin-like growth factor" which interferes with the normal insulin created by the pancreas. Since the pancreas is actually normal in these cats, the pseudo-diabetes needs to be treated a little bit differently because at any time, the tumor can produce more or less IGF-1. Giving food stimulates the pancreas to kick out more insulin and can cause hypo-glycemia -- so we aim for BG nadir between 100-200 instead of lower.

There is a test for IGF-1 which will confirm whether or not Acromegaly is a factor. There is another group on FDMB devoted to Acromegaly, IAA and Cushings -- "High Dose" conditions. There are informational sticky posts.

Hang in there - you're in the right place for advice and support.
 
Taking dose issues one step at a time and evaluating the results would seem a more prudent course of action especially since dealing with the initial stages of feline diabetes is so overwhelming.

There is an adage in medicine: If you hear hoof beats, think horses, not zebras. In other words, what I would suggest is that we begin to sort out the various reasons for Milo's dose -- different doses at AM and PM, drastic reductions because of a lower than expected pre-shot test followed by a return to the dose, dry food, the possibility of needed a dental, etc. I'd suggest getting the most obvious and more frequently occurring issues that you can control evaluated as a necessary first step. Should Milo then need a higher dose of insulin, it would be the time to evaluate high dose conditions.

Hang in there Jennie.
 
Would it hurt to get the tests done now? Looking back at Tigger, I wish I would have sent in for the tests earlier.
Speaking of the IAA and Acro tests.
 
Sienne and Gabby said:
Taking dose issues one step at a time and evaluating the results would seem a more prudent course of action especially since dealing with the initial stages of feline diabetes is so overwhelming.

There is an adage in medicine: If you hear hoof beats, think horses, not zebras. In other words, what I would suggest is that we begin to sort out the various reasons for Milo's dose -- different doses at AM and PM, drastic reductions because of a lower than expected pre-shot test followed by a return to the dose, dry food, the possibility of needed a dental, etc. I'd suggest getting the most obvious and more frequently occurring issues that you can control evaluated as a necessary first step. Should Milo then need a higher dose of insulin, it would be the time to evaluate high dose conditions.

Hang in there Jennie.
Click to expand...

Never heard of that adage before, but published veterinary studies have indicated as many as 1 in 3 diabetic cats may have acromegaly.
ONE.... IN.... THREE. That ain't zebras, honey.

Sure - let's work through the details and the whys and wherefores but let's also reassure Jennifer that if the cat needs more insulin and the BG tests support that need --- it is OK to give Milo the insulin that he needs to feel better and regain his health.

the bottom line: it is OK to give Milo the insulin that he needs to feel better and regain his health.
 
Hey jennifer,
I am glad you are here; you can get some good help to be all set up so that very soon, taking care of your Milo will be as simple as breathing and brushing your teeth.

I wanted to say that the spreadsheet everyone seems to mention is a pretty good tool for you to keep track of milo's BG numbers from your tests. It allows others who have been deciphering many sheets to be able to give you a big hand in knowing how Milo's doing and what you need to dose next. The sheet is also great to show to your vet and it will help your vet to better help Milo! Do what you can with it, and if you have any problems setting it up, just give a shout and someone can help you!

That dry food may be a big cause of the high dose needs for Milo. One of my cats, Shadoe, if she gets even just a mouthful of dry food, her numbers will be higher than Milo's, so if Milo likes the wet foods, it would be good to start to switch him over to all wet low carb foods. The food is a pretty big issue because there are a great deal of cats who are DIET CONTROLLED so taking care of the food will eliminate one cause for high BG.

It's a great relief to hear that you are home testing..... curves at the vet are pretty much useless because poor Milo is likely stressed at just being there. My Shadoe always tests higher at the vet, and my other cat, Oliver, tests low! I was so thankful that I took my own meter and also food with us when I took Oliver to the vet ..... I had to feed him while we were there to bring his numbers up! Stick to your home testing and keep your money in your pocket.

Now it may be an idea to get a quote from your vet on the costs for testing Milo for acromegaly and IAA, insulin resistance. Get the ball rolling so you have the info, just in case you decide to get the tests done. There is one place in N.America that runs the acro (IGF-1) test and the IAA test, and U of Guelph in Ontario also runs the IAA test I think. The conditions are not as rare as some people are led to believe... I had one acro cat, Shadoe, adopted Oliver, then found out that he is acro as well!

A positive acro test just means Milo needs a bit more insulin and he has a functional pancreas. It's not a bad thing at all. Other diabetics may need a small dose like 2units twice a day, and Milo could need 10units or more. So what? It all comes down to testing before each shot, and giving Milo how much insulin he needs, based on his nadir.

But first things first.... fix up the diet, test to see if the diet has made a difference, and give him what insulin he needs.
Testing at 5units twice a day is not testing too early .... I think one person on the site tested at a dose of 5u, and the test was positive.

There are plenty of people around who can help you get set up. You and Milo will be just fine.
 
Welcom Jennifer and Milo!

You came to the right plalce. Lot's and lot's of info to absorb, and changes to make.
Step by step, first things first, you'll get into the swing of things and things WILL get better :-D
 
Hi Jennifer -

Glad you came to get help. About a year ago my cat was diagnosed diabetic. We started on insulin,and got higher doses going pretty quickly. Withing about 6-8 weeks of being diagnosed diabetic my vet suggested we test for Acro (test reference above in other posts). He came back positive. It was the best thing we did. I can't remember exactly, but it cost about $100. I am no expert on FD or Acro, and I actually don't have my kitty well regulated at this point (no fault but my own). We are currently at 8u BID. You just need to know what your cats situation is so that you can treat him properly. There are some people here who are very, very knowledgeable and can help you so much. Set up the spreadsheet and get rid of the dry food - those 2 things will help a ton.

Best of luck!
Kristen
 
So glad you found the FDMB! Cody was a bottle fed baby as well, so I totally understand the bond ;-) and don't feel bad about the difficulty regulating- It took me years unfortunately...and then thanks to this board I found out that he too, has Acromegaly, which explained our difficulty. He is currently on about 10 units 2x/day.

What meter are you using? Many of us use the Relion meters from Walmart and Sams. It is one of the most affordable in terms of replacement strips ($36/50 strips). After years of daily testing those strips become a major expense! In order to figure out whats going on with your baby, you need to test him yourself everyday- especially mid cycle and preshot data.

I also used the dry DM for a long while, then I switched to the canned DM to keep my vet happy, but he's actually done better on Friskies Special diet canned flavors (Ocean whitefish and turkey and giblets) and occasional canned Wellness. He NEVER ever eats any dry food anymore. It causes the numbers to skyrocket. I hope someone warned you however, about watching the blood test data VERY carefully when switching from dry to canned as it can cause a huge drop in insulin needs, and actually cause a hypoglycemic event it is not done under a watchful eye (especially those mid cycle readings!)

Sounds like you will get this straightened out, He is your baby....it just takes the time to READ and LEARN, and follow through with the home testing everyday. and many of the tips you learn here will help you save money AND treat him better. Get that spreadsheet going its SO important. Hang in there!
 
just a friendly reminder, folks...

jennifer arrived on the FDMB's doorstep, in particular the Lantus ISG, already upset and overwhelmed with...

  • NO spreadsheet to look at or analyze

  • kitty is on a DRY food diet

  • the only info we have as of right now are from jennifer's THREE posts

  • ALL we have is limited and random numbers without knowing more about increases than "stayed on it at least 2 weeks during each increase"

  • inconsistent dosing is at play

and this happened... LESS THAN 24 HOURS AGO.
jennifer has not even had a chance to get back to the board since last night.


the usual steps have been recommended.

is it too much to ask everyone who has/had a high dose kitty to step back and remember not only the steps that need to be in place, but to exhibit the same sensitivity and compassion which is extended by members of the lantus isg to all who may find themselves in this situation instead of jumping in prematurely... BEFORE enough information has been gathered... BEFORE any hard data has been presented?

have a heart people. please give jennifer more than a few hours to breathe. how about first things first. there's a lot to absorb... a lot to sort out... before coming to any conclusions. arriving on a high dose IS a red flag, but it does not always mean kitty has a high dose condition.
 
Welcome to LL Jennifer and Milo! You have found the best resource for info on FD.

Food is the biggie for controlling FD. Before dry pet food was introduce FD was virtually unheard of! You will be amazed at the difference once he stars eating wet, canned or homemade (raw or cooked). As others have said, changing over can cause numbers to plummet so test carefully during the switch. Try to gradually introduce wet and give less dry over about a week or two.

You've gotten a big hurdle out of the way since you are already home testing. When are you doing the tests. Lantus is not dosed on the preshot test, it is dosed on how low the BG will go in a cycle. We call that the nadir and it can be anywhere from 4 hours to 8 hours after the shot. So you need to do a fair amount of testing to figure out when Milo is at his lowest and it will vary some from day to day. It is also important to test before the shot to make sure that Milo's BG is not too low to safely give the insulin.

BTW what meter are you using? If it is the Alpha Track from the vet it usually reads 30 points higher than the meters most of us use so knowing that will help us interpret his numbers. It is also much more expensive! Most of us use human BG meters and those are what most of the studies are done with. Strips are much less expensive and much more readily available. Testing strips are the most expensive part of managing FD. We can give you some options on what meters we like.

We usually test > feed > shoot. Always test before feeding and for the preshot test make sure the food is taken away at least 2 hours before the test.You need a "clean test" then, one not influenced by food or the numbers can be a lot higher. With Lantus you need to make sure Milo eats in the first 2 hours of the shot, the earlier the better. Taking food away 2 hours before preshot also makes him hungrier so he will eat when you need him to. Many of us test, get the syringe ready and then shoot while our cats are eating. They are so interested in the food they barely notice the shot! :-D


let us know where you are located too, please, city/state is enough. There may be someone nearby who can help or at least lend a shoulder.
:YMHUG: :YMHUG: :thumbup You can do this and we are here to help.
 
Also - You mentioned you were upset because the reading 4 hours after the shot was still high.

Different Insulins have specific typical curves of action( onset, peak action, duration).

Cody is on now on Levemir, so I can't speak about Lantus specifically, (because it is one insulin I haven't used), but Levemir (which I believe is pretty similar) has an ONSET of 3-4 hours. so for a cat on levemir, a reading at +3 may be the highest reading of the cycle. There are permanent posts up at the top of this forum which describe the typical curve/"mode of action" of Lantus, so you can make more educated guesses on when you should be doing those mid cycle readings to find his "nadir" (or lowest reading of the day).

Hang in there! :-D
 
Wow, I have read alot of great inforamtion here, everyone is so helpful. I am going to try and feed Milo wet food(again) I have tried before and he hates it! Anyone know of any tricks??? lol I also give him boars head trurkey and chicken from the deli as a treat when I give him his shot so I don't know if thats wrong to do or not. I am going to call my vet about the test mentioned because Milo's number just keep rising < 410 reading before food this AM. I and working on gettng my spreadsheet together, sorry I havent posted that yet. My vet suggested I buy the AlphaTrak from through them because thats what they use to test the animals BG so I purchased their home use kit for $150. the test stips are about $1 per strip they said I just ordered more this week so when they come in I will know what cost that will be as well....I think I will be calling the vet to get that test done mentioned, I would rather know what is causes all these weird numbers! If I cant get Milo to eat wet food, any thoughts about Wellness Core? I read that may be a better choice of dry food...
 
Hi - Just a quick reply...don't buy the AlphaTrak! It's way more expensive than necessary! I started off with the One Touch Ultra, but just switched to the Relion from WalMart last week, and I love it. The meter was $9, and I just ordered new strips online for about 27 cents each. A human meter works perfectly fine for home testing Milo, and will save you a lot of money.

I know that Dr Lisa's website has lots of tips on how to convert a dry food junkie....
Converting Dry Food Addicts

Keep posting!

Amy

ETA - Ooops...just re-read your post and saw that you already bought the AlphaTrak...any chance you can return it? Don't get me wrong...it's a fine meter - it just makes FD more costly than it needs to be.
 
I also was thinking, if I do get the acro test done, if I am reading correctly unless they do radiation therapy, the answer to the high readings is still increasing the dose correct?? Also I was wondering with Lantus being a long acting insulin, is it true it can build up in his system>>>and overlap?? What does this mean.... Sorry about all the questions, I know I sound paranoid lol But I promise Im very normal lol!!! to answer the other question above as to where I am.. I live in Lakeland Florida.
 
Hey, no problems with the questions, i had the same questions as you did! Tigger is Acro and IAA and i'm still trying to figure it out, but from what I gather is changes how the dosing goes. If you go up by .5u every 6 doses you will never get ahead of the IAA and/or Acro (if you are positive for them).

I guess IAA (Insulin Resistance) and Acro compete with the insulin so very little gets into the cells. Others can probably give you better info, but being a Newb myself I'll tell ya what i've learned so far. :-D
They also say that Acro trumps IAA I guess, but still don't fully understand that but I follow it I guess. Lantus builds a "shed" as they say, and others can better explain that portion, I don't want to add confusion. :lol:

Now, you may not have either, but it wouldn't hurt to get the tests done so you can rule them out. Good luck and hang in there and you'll get this figured out. :-D
 
You don't sound paranoid, and you ARE very normal - you love your cat and want to do the best by him!!

I think Julie and Punkin would be your best bet about Acro right now, since she's off in CO getting the treatment for him this very week. I'm sure she would be a major help for you, if that is what you're looking at.

Others will be able to better answer your questions about overlap, etc. I "get it" at this point, but not well enough to explain it :-D !

Keep asking questions! And, if you have time, pop into the condos of other kitties, too - there's always lots of information and tidbits to be learned that way as well!
 
Morning, Jennifer, and welcome to LantusLand! :-D

You have definitely come to the right place. I, too, was once in your shoes when it came to the amount of insulin, and the food that Blackie was getting. In the beginning, she was getting 8u BID (16 units/day) of ProZinc before someone suggested that I start using Lantus. She was getting Hill's Prescription W/D formula (first dry, then wet), but she went into a hypoglycemic episode after the last vet visit. I had already joined the board after the last vet visit, and found the list of foods that I could choose to give Blackie and get her off the vet's stuff. Here's the 2 lists that may help you:

http://binkyspage.tripod.com/CanFoodOld.html

http://binkyspage.tripod.com/CanFoodNew.html

I went with Fancy Feast Turkey & Giblet in the beginning, but you can choose whatever you want to feed Milo. The vet's food isn't great for a diabetic kitty as it's very high in carbs.

One other thing was my vet didn't believe in giving my cat Lantus, but I've proved otherwise. Once you get a spread sheet set up, and show your vet on occasion how Milo is doing on the Lantus, he/she will be convinced, also.

If you're tight on a budget, you can always use a human monitor (Relion is one of them... I can't remember the names of the others right now). And you can always get the strips from the same place, or Walmart, or wherever you choose to get yours. A lot of us use the ones that you buy at the store.

You'll do fine. Again, welcome!
 
Ask away!! The only means we have to help you understand is for you to ask questions.

There are two things I would suggest you consider before anything else. First, at the pace that Milo will tolerate, make the switch to low carb, canned food. If the insulin you're giving doesn't have to fight with the carbs in dry food, there is a very good chance that Milo will need less insulin. Even the lower carb dry foods may effect Milo's insulin needs.

Second, stabilize your insulin dose. You need to be giving the same amount of insulin in both AM and PM for several days in order to get Milo's cycles to even out more. Switching the dose at each shot will result in weird numbers.

Lantus is a long acting insulin and it does build up in the system. Pharmacologically, this is called a "depot" (and we refer to this as a "shed"). It's like having a reservoir. Because there is this storage shed, there is some overlap between doses. With short acting insulin, you give a shot and anywhere from 4 - 8 hours, all of the insulin you've given is gone. This can cause big swings in numbers. With Lantus, once a cat is regulated, you don't see these big swings. So with overlap, as one dose is beginning to peter out, the Lantus that's in storage keeps BG levels more constant until the new dose kicks in. Every time you change a dose, it effects the amount that's in the shed. When you raise a dose, some insulin needs to go into the shed so it keeps the increased dose constant. When you decrease, the shed needs to lose some insulin. This is why doses need to stabilize.

Brent & Tigger said:
If you go up by .5u every 6 doses you will never get ahead of the IAA and/or Acro (if you are positive for them).
Click to expand...
That's not entirely correct. The size of the dose increase depends on how much your dose is. Right now, there are cats here with acro and/or IAA that are on relatively small doses of insulin. It all depends on what your cat's needs are and every cat is different (ECID).
 
the STICKY: LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ... contains a ton of links to information which will be helpful in understanding how Lantus works. in particular:

Carryover - insulin effects lasting past the insulin's official duration
Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
Insulin Depot - (aka "storage shed" in Lantus Land) "spare tank" of insulin, which has yet to be used by the body
Lantus & Levemir: Insulin Depot aka "Storage Shed"


the action of Lantus is cumulative, meaning one dose can affect what you see up to the next 3 days.

you'll also want to learn how milo is responding to insulin:

Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir - the lowest point in the cycle
Duration - the length of time insulin continues to lower blood glucose

all the "stickies" (starred posts near the top of the forum) will provide you with pertinent information.


as far as testing for a high dose condition...
it's never a bad idea. in a perfect world all diabetic kitties would be routinely tested for acromegaly and IAAs.

ask any questions you may have. hope to see you posting often!
 
Meters-It sounds like you have already bought the animal testing meter. Frequent home testing is critical to helping him become regulated no matter why his blood glucose is high. I know some people start with the animal meter and later supplement it with the far more affordable Relion human meter to collect more data. If money becomes an issue, its a fine alternative, and is what many of us use. There is some variance between the 2 but another thing you must realize is that these are not precision hospital instruments and do have a 20% allowable accuracy. When in doubt, I test twice (or even more)

I hope you get that ss up soon :smile: and introduce canned. In my opinion, these should be your first priorities. Hometesting, spreadsheet, and food.

To answer your last question about acro & increasing insulin:
IF a cat is acromegalic, the GOAL of insulin use is different than in Feline Diabetes,- we increase the insulin until he gets to our target blood sugar readings that range from 150-250 for most of the day. The reason for this is that the physiology causing the high blood sugar is completely different. In FD, the goal is to bring sugar levels down to a normal range, and hopefully go "off the juice". 2 different diseases.
My cat did not have the stereotactic radiation treatment, and he has been receiving insulin for the last 4 years. In acro the tumor output does fluctuate, and therefore the insulin needs also fluctuate, therefore testing everyday is required. In hindsight, the SDR treatment may have been cheaper than 4 years of high dose insulin, other acro meds, and testing 4-10x/day.
 
I opened my the site for my spreadsheet today and was unable to upload it, it may be because I have not loaded the microsoft excel onto my computer yet, but will be buying it this weekend for sure, I have bought the fancy feast mentioned and Milo turned his nose up, but I am reading some helpful hints on how to transition him and I think we will be fine there eventually....I was dissapointed when I spoke to my vet today and asked her about the Acro test and she said she wouldn't look there frst, but maybe the adreneal glands etc.. but she would do some researcha dn call me on Friday...ugh in the mean time we are upping Milo's dose 1 unit...7 in the PM and 6 in the AM, so I guess I'll just see how that goes and work on the canned food....Oh, and as fr as my test strips go, I picked them up today and the cost was $60 for 50 of them>>> for the AlphaTrac... WOW I almost fell over!! I just may consider buying another one like suggested.. it will surly save me money in the end!
 
hi jennie!

ohmygosh i'm sending you a hug. it's overwhelming for everyone to arrive at this point. it's true that most of our vets don't know a lot about feline diabetes - but you are now in the spot where we all do this 24/7 all year round - you now have the benefit of YEARS of experience at your fingertips.

first things first - follow the tips in the links that people have given you to transition milo off of dry food.

stick with a human glucose meter - that's what 98% of us use. the strips are cheaper, the meter is cheaper, the numbers are fine.

get the spreadsheet going.

and the best advice i ever got was to remember that this is a marathon, not a race.

and yes, punkin (and our civvie, anya and the DH & me) is at Colorado State University getting treatment for acromegaly. my opinion is that it's a little too soon for you to worry about this. get the food changed and that will tell us a lot - and we'll be better able to help you get to the bottom of things as quickly as possible. we'll help you figure out what's going on in milo's little body!

:YMHUG: it really does get easier.

ps - just saw your post. you don't have to download anything in a google doc. you're working online - so i don't think you have to have excel on your computer.

oh - please don't increase his dose by another unit! not yet - the food is the first issue - work on finding something for him to eat. that Janet & Binky's list has other low-carb foods - you can also grind up his dry food and sprinkle it on the top of the fancy feast you've already got. you can sprinkle on parmesan cheese.

there is time to increase the dose later - for now, try to get the food issue resolved.
 
any way you can return the alpha track and strips? those are so expensive! we use about 5 strips a day if nothing's going on - so that's a minimum that i use with punkin. there are any number of human meters that cost a fraction - most of us buy strips online - American Diabetes Wholesale is where we get ours, i know a lot of people use Hocks or ebay also. The strips cost less than 1/2 the cost in a store if you buy online.
 
You don't need Excel!!

The spreadsheet template is for a Google document. Not everyone has Excel so not everyone could read your spreadsheet. You do, however, need a Google account. Please take a look at this link for the instructions on setting up Milo's spreadsheet.

Also, please look over the information in the Tight Regulation sticky. Increasing Milo's dose by 1.0u is too much. In addition, you really need to be giving the same dose twice a day. Injecting different amounts of insulin in the AM and PM will pretty much guarantee that you will see less than desirable numbers. The protocol that's described there is based on published research.

I'm also concerned that if you are shifting Milo over to lower carb food, you will need to be very careful about increasing the insulin dose. You will need to be carefully monitoring. The lower the carbs you're feeding, the greater the chance that Milo will need less insulin.
 
Don't go down the adrenal glands path -- Cushings is fairly common in dogs but uncommon in cats - there is no one perfect test that gives an absolute yes or no. So lots of testing is done, and you still have no solid answer. So -- does your vet treat dogs and falling back on the more common dog route?

In cats, Acromegaly is more common than Cushings, and the IGF-1 test is really accurate predictor - get the test and you will have a definite yes/no answer.

EVO has the lowest carbohydrate dry food at 8%. I changed my cats (all) over slowly - originally from Science Diet to Wilderness (18% carbs) then to EVO (8%) -- all the time offering more and more low carb canned food. Now they all eat low carb canned food, and I use EVO for treats for my non-diabetic kitties.
 
hi jennifer!

i was thinking about you & milo over dinner and was wondering - we haven't asked you yet about your insulin. that can make a difference.

is your insulin less than one month old? (yes = good)?
is this the same insulin you started with in may? (no = good)
has it been kept in the fridge but not gotten frozen (yes = good)
has it been shaken, rattled or rolled (no = good)?
have you injected anything back into the vial or cartridge? for example, if you're giving a dose of 5 units and you drew up 6 units, did you shoot the excess 1 unit back into the original container? (no = good)

Lantus is stable if it gets taken care of the way it needs, but vets who are used to other insulins that need to be mixed will sometimes tell people to roll or shake it to mix it. lantus doesn't need to be mixed.

the manufacturer says that Lantus has a lifespan of 28 days. many of us get more than that, but only if it's been taken care of.

modern syringes have a lubricant in the syringe to make the plunger glide easily. that lubricant can contaminate the lantus and make it ineffective.

if your lantus has been shaken, left out overnight, had anything injected back into it, or is older than 1 month old - we should consider that it may not be effective. Let us know about that, because if you think the lantus might not be good, you would want advice from us on what dose to use when you get a new vial/cartridge.

Can you comment on the lantus?

thanks!
 
I just got a new bottle of the Lantus on Monday, making the use of the one I had 3 months old, the vet taught me to roll it, and I was not told about not shotting the insulin back into the bottle which I have done many many times, But I recently read that I was not to roll it, so I no longer do that nor do I shoot back into the vile... So if kept properly (refirdgerated etc...) how long can I expect it to last?
 
1 more thing...I did up his dose tonight before reading not too....ugh he was 340 at 7 PM ( I promise I'll get the lino down) and I gave him 7 units upping it 1 from 6 so of course I"m very worried and watching him like a hawk..ugh...and Im still having trouble loading the spreadsheet.. it keeps saying unable to load.. but i keep trying it.. I really would love to track it all my information on it.. I followed all the directions that were given to me.. and thank you so much for thinking of us...all of you have no idea how gratfull I am to have found this!!!
 
Welcome to LL from Do Lou and I :mrgreen: and just take your time reading and absorbing all info it takes time @-) Do Lou also hated wet food it took me many months of slow transition to get him to wet I would mix his wet at first with dry on top and that helped as well as using things like freeze dried salmon or chicken or tuna flakes on top and he loves his wet now he was actually on raw for a time until he got sick from it and it scared me away from it but I know many here use raw for their guys and they do wonderful I am just scared of it now but Do Lou ate raw for about 6 months or so and loved it hope to see you get settled in here and take your time you have been given a lot of info to absorb at one time
 
jennifer, i'm sure this is overwhelming. lisa's right - take your time to absorb all of this. you're not in a crisis - milo didn't just get this way and he won't get well overnight. the only thing that is a real crisis is if you test him and he's 50 or under. then post here immediately and someone will help you through it.

in the meantime, thanks for responding so quickly regarding the lantus. no more shooting anything back into the vial. if you need 7 units, draw a little more and shoot the excess in the air or in a paper towel. don't roll the vial. store it in a crisper drawer or in the back of the fridge, but not where it will get frozen, just to keep it cold and constant temperature.

post for tech help & while you are working on the spreadsheet, why don't you post here in the text box in the format sienne gave you above?

so you tested him tonight before shooting, that's his pmps. use her format and post for us to watch. you can also edit your subject line by editing the first post of the thread - that will let people know you've posted.

also, just so you know - often when a dose is increased we see a "new dose wonkiness" where the numbers might go higher instead of dropping down. it's counterintuitive to think that you increase the dose and the numbers go up, they should go down - and they will, but they have to settle. we usually don't increase more than every 3 days unless there is some compelling reason to.

there is a second phenomena that can cause numbers to go up seemingly without reason. if a kitty's BG drops lower than their body is used to, for example, if their body is used to 350 and their BG drops down to 200, the cat's liver can release counterregulatory hormones and a stored form of glucose (think he just got a shot of sugar) and it will cause their BG to soar. We call that a bounce. the body becomes accustomed to a higher range of BG, and if they drop low, the liver thinks the cat's gone hypoglycemic and boom, releases that sugar and hormones to save the cat's life. a bounce can take up to 3 days to clear.

this is why it's so critical to see the pattern of numbers. if milo was 340 at pmps tonight and we could look at the pattern of his numbers and see that he hit a 200 this morning, we might think "ah ha, milo is bouncing!"

also, testing is what will tell you how he's doing. if the vet told you to watch him for possible hypoglycemia, that's somewhat helpful, but we've seen cats on lantus get pretty low (too low for safety) without obvious hypo symptoms. lantus is a more gentle insulin than older insulins, where the hypos were more obvious, i believe. it seems like cats on lantus who get too low show mental signs first, like they are mentally checked out, dull, or confused. if you test then you know for certain what's going on. a non-diabetic cat numbers range from 50-120, so anything above there is ok.

in your case, where we don't really know what's going on, i think everyone here would agree that decisions are going to be made at what will seem to you like the last minute, only because we need more information.

so be patient, he's not in a crisis. nothing needs to be done tonight. you don't even need to understand it all tonight - just test as often (every 2-3 hours if possible) as you can over the next few days, record and post them here. the information will emerge on what tactic to take for milo to get better.

btw, you might ask your vet about his/her experience with lantus and with feline diabetes. from everything you've said it sounds like they know other insulins and dogs better. my vet practice with 3 vets has exactly 1 other diabetic cat - and my vet made so many mistakes with punkin's diabetes it's a miracle he survived it.

:YMHUG: it's a marathon not a sprint. we're all here to help each other.
 
Since your previous vial of insulin might have gone bad, it is possible that the dose is too much with brand new insulin.

Eventually, by testing every day, you will know when the insulin is going bad because the BG numbers will start creeping upward for "no reason". So then it is time to start a new cartridge or vial. The 3ml pen cartridges are cheaper in the long run -- more at first because you buy a 5-pack.
 
i agree with phoebe's comment about when you're testing you'll be able to tell lantus is losing its potency by the numbers starting to rise.

3 month old lantus that had been rolled and had insulin moved in and out of the vial was likely no good at all. i'm wondering if you had any better numbers at the beginning of the vial.

if you take care of the lantus some people have had a vial last as much as 6 months. many people buy the pens because they contain about 1/3 of the volume and cost less. for now, just use what you have and if you care for it, it will last you a while. we'll know what's going on with milo by then.

could you call your vet and ask for details - i called mine and they were fine giving it out. you want to know dates, BG numbers and what time of day those numbers were (so you can give us a guesstimate of how many hours after the shot) and what the dose increases were - by how much and on what days. that should tell us quite a bit.

so it might look something like this:

5/1 BG 400 at vet's - no insulin yet
5/5 1unit at 8am
5/8 BG 300 at vet's at noon (guess that would be +4)
5/15 BG 400 at vet's, vet increased to 2units

etc.
 
Hi there! Jennifer?is it

Hooray your kitty is starting to eat canned food- and yes I would be very vigilant and retest tonight because the numbers can realllllly change with a switch to canned. It may take awhile (days) because the dry food is still in his intestines, but you should see a change. Its probably not the best time to increase the dose... 1 change at a time is easier to interpret.

I noticed you edited your first post in this thread. Its actually best to leave that post alone so the replies people post make sense. At some point you will be able to start a new post whenever you want. and the info in the profile helps folks remember your details, and you can give a brief history if you like OR link back to this thread by copying and pasting the www. info box above.

Picure/Avatar:
Way back when I joined, I wrote this in simple terms to remember how I got Codys picture posted- maybe it will help you.


I went to my pictures (iphoto) and found one I liked that the shape was kind of square
photoshopped and brightened it a bit
then
I went to shrinkpictures.com
clicked make avatar
then in this exact order 1 2 3
1 click choose picture- brings up my photos and I find the one I brightened- click it
2 type" 90" in where it asks for size
3 click resize and wait
then choose the 1 of 3 you like best
click download below that one
save it to your desktop
open user control panel in the FDMB
select profile tab
select edit avatar
shrink the open window enough to expose the avatar on your desktop
drag it onto the box that says upload from your machine, wait till you see a plus sign appear(+), and drop that baby
click submit and hold your breath
Last night when I hit resize the picture came up black everytime
today I choose a different picture and ta da!
Hope this helps
 
Thanks for the advise on uploading a picture, I was wondering when I posted earlier if it would do that, but I must have read it wrong but someone who posted on here said it would be best to do it that way... but I probly read it wrong, Im just happy I have help with all this now. I will soon get the hang of everything and get it all up so I can have people help with his readings etc....everyone has been so helpful. I even told my vet about this site and how much help and information I have been given, and I was able to share some tings with her that she didn't even know...so I thought that was awsome! Milo's numbers have been good today AMP - 375 @7 AM ..+6 292 @ 2:30 PM PMPS 206 @ 7:00 PM +3 231 @ 10:00 PM....and he had his fancy fest for dinner as well, I am so shocked still at how easy it was for him to eat it.. im still giving him a little of the PurinaDM food as well so I am not just jumping into the wet all together but I think he will trasnision nicely!!
 
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