Chloe Update

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srk4cats

srk4cats

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I finally got an email back from my vet:

Chloe's blood glucose values appear to be all over the place - some are extremely high, and some are extremely low. This worries me terribly.

You have 2 options here:

1. Change to Lantus insulin. This is supposed to be a "peakless" insulin, with fewer highs and lows. I can't guarantee you'll get more consistent blood glucose results, but it could be a better choice for Chloe.
2. Do a blood glucose curve over 16 hours. To do this, you'd check Chloe's blood glucose every 2 hours, starting when you get up in the morning and continuing until you go to bed at night. You give the insulin normally, and note the times.
From this curve, I might be able to determine if we can continue to use the ProZinc, and at what dosage.

If you would like the Lantus insulin, it's a human medication from any pharmacy. I'd need to know the name and phone number of your favorite pharmacy, and I'd call in a script for 1 bottle, with directions of "inject 2 units SQ BID." But, you'd
also have to purchase new insulin syringes from the pharmacy, as the Lantus uses a different type of syringe from the ProZinc, and you can't use your old syringes.

If you want to do the blood glucose curve, do it in the next few days, and give Chloe the standard ProZinc 2.5 units in the morning and again in the evening. Note the times of the insulin injections and the blood glucose checks, along with the BG
values. Send me all those numbers, and I'll chart it out and see if I can get some useful information from that.

Hopefully, we can get some data on Chloe that will help determine what dosage and type of insulin would work best for Chloe.

Please let me know which of the above options you'd like to try.

Dr. Denise Upchurch
Feline Ltd. Cat Clinic
 
This seems very sensible advice. We've mentioned Lantus to you a number of times as an insulin that might flatten out Chloe's BG numbers. The rules are stricter about keeping to a 12/12 schedule but there's less fiddling with doses because it works best with consistent doses AM and PM for several days at a time. The Lantus forum is large and there are a lot of very experienced people there to guide you. They have two sets of dosing guidelines they use - TR (Tight Regulation) and SLGS (Start Low Go Slow). I suspect that SLGS would be closest to what your vet would advise.
 
Sounds familiar!;)
I think trying lantus would be a good idea. I think you should request the pens-- you might be able to buy just one 300 unit pen vs the 1000 unit vial to start. The curve can help you and your vet decide. Do you send her the link to your spreadsheet?
I replied on your other thread too. I didn't see this one until after I posted on the other.
 
I agree that switching might be best. I know this has been mentioned several times. As your vet said, you might get more flat cycles that keep the BG numbers down for longer periods of time...and with Chloe's history of DKAs, that is probably best. Prozinc is a great insulin and we are definitely not trying to kick you out or anything, but we have plenty of kitties who switch to Lantus for different reasons...including history of DKA or extreme bouncing. Lantus just works better in those cases.
 
Did you send her your spreadsheet? I agree with her about doing the full 16 hour curve, but if you haven't already shared the SS with her, she might find the other data you have helpful in filling out the picture - especially if your curve ends up being on a bounce day.

Here is the place many of us order Lantus: https://rxcanada4less.com/

It's a Canadian pharmacy, less expensive than the US, and they ship quickly and safely. My vet and Mark's had no trouble coordinating the prescription and it got to me very quickly. I just ordered one pen at first to see how Sam would respond to it, so that's one option you can try or you can just order the set of five pens (cheaper and easier than the vial or the single pens). The pens have a little rubber part just like the vials - you insert the needle from u100 syringes and draw out the precise dose just like you would from a vial. The Lantus folks have a video they can share with you to show you how to do it.
 
Teenuh said:
@srk4cats I was just looking at yout SS. Did you not test this morning prior to shooting? Also, it looks like you didn't input a dosing number for last night.

Hoping all is well.
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Thank you. I try to keep up, but then I get distracted and forget the numbers. I go back and enter them later.
 
Djamila said:
Did you send her your spreadsheet? I agree with her about doing the full 16 hour curve, but if you haven't already shared the SS with her, she might find the other data you have helpful in filling out the picture - especially if your curve ends up being on a bounce day.

Here is the place many of us order Lantus: https://rxcanada4less.com/

It's a Canadian pharmacy, less expensive than the US, and they ship quickly and safely. My vet and Mark's had no trouble coordinating the prescription and it got to me very quickly. I just ordered one pen at first to see how Sam would respond to it, so that's one option you can try or you can just order the set of five pens (cheaper and easier than the vial or the single pens). The pens have a little rubber part just like the vials - you insert the needle from u100 syringes and draw out the precise dose just like you would from a vial. The Lantus folks have a video they can share with you to show you how to do it.
Click to expand...

Thanks, I emailed my vet this morning and gave her the website. I said I want to try Lantus.
 
419 to 130 in 4 hours is a big drop. That could be causing a bounce... I would get the curve done this weekend and see if that is the issue.
 
srk4cats said:
Thanks, I emailed my vet this morning and gave her the website. I said I want to try Lantus.
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I'm really hopeful this will give you some better results for Chloe. The way Lantus is managed is quite different than Prozinc, even though on the surface it can seem similar. The folks over in Lantus are very knowledgeable and will be able to help you get it figured out. Looking forward to seeing if this stabilizes her numbers better!
 
Oh, Chloe.

Are you not getting a before the bed test?

I would suggest testing every couple of hours today if you can and testing for ketones.

I'm really glad you agreed to switch to Lantus. Like Djamila stated above I am hopeful that this will give more positive results. Chloe's body deserves a break.
I'm sure you would like some relief.

Did the vet send the script over?
 
Teenuh said:
Oh, Chloe.

Are you not getting a before the bed test?

I would suggest testing every couple of hours today if you can and testing for ketones.

I'm really glad you agreed to switch to Lantus. Like Djamila stated above I am hopeful that this will give more positive results. Chloe's body deserves a break.
I'm sure you would like some relief.

Did the vet send the script over?
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ketones - Chloe didn't pee in her litter box yet. last night - just too tired.
 
Teenuh said:
Understandable Roberta. I hope you were able to get some sleep last night.
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yes. I gave Chloe 2.5 u at 9am when she reached 388, so I just tested her again 4 hours later, and she's at 164. Am I supposed to count hours from the time she gets her insulin or from her first am reading?
5 am - 51 ns
9 am -388 gave 2.5 u
2 pm 164 (+5 from time of injection)
next test due at 5 pm would be PMPS (+8 from time of injection), will not give an injection until 9 pm, right?
 
I would count from the time she received her insulin shot.

Is there a reason why you did a 4+ after insulin? I would have tested at +1, +2 + and every 2-3 there after until her evening PMPS. Then I would do a before the bed test.

You must wait 11-12ish hours before giving the next dose. 9am would be fine--as long she isn't low.
Maybe they have a different opinion?

@Kris & Teasel @Djamila @StephG @Rachel @FurBabiesMama
 
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Her PMPS was 49. She ate a lot. I thought that the Prozinc doesn't kick in until +2. I'll do another test now.

She's at 94 at 7:30 my time. still eating
 
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She's increasing. I would check again before going to bed. Also, she is will likely not need a 2.5 dose tonight--unless she jumps up again.
 
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Yes, Teenuh is correct - you count from the time you gave the shot. so if her AM shot was at 9am, then her PM shot would be at 9pm in your time zone. So if I remember right, it's just now getting to 9pm for you, so if you test her soon, this would be your PMPS.

Are you doing the curve for your vet tomorrow? If so, your AMPS will need to be 12 hours from now, so 9am, and then the curve will run 16 hours from then. Did she say if she wants you to test every hour, or every two hours?
 
Teenuh said:
She's increasing. I would check again before going to bed. Also, she is will likely not need a 2.5 dose tonight--unless she jumps up again.
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She jumped up again so I gave her 2 units. She's still eating. I think she has an eating disorder.
 
I don't think her cells are getting glucose--she is always hungry.

Did you confirm with vet about the Lantus? Chloe needed to start that yesterday.
 
Actually, she seems to be leveling out today. I decreased her dose to 2 units last night. She woke me up at about 5:30 and she was at 224. I forgot to wait until 9:00 and gave her 2u at about 5:45 and went back to sleep. When I woke up at 8:30, she was at 124 and I gave her another can of food, which she is devouring right now. I'll test again in 2 hours.
I called Mark's and left a message but they're closed on weekends. My vet said she had checked out that pharmacy and emailed them for a request. I'll call them tomorrow to verify and pay.
 
Teenuh said:
I don't think her cells are getting glucose--she is always hungry.
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Is that because of the pancreatitus? I actually reduced her dose last night and she's doing better today, so far. I'm doing another curve today.
 
srk4cats said:
Is that because of the pancreatitus? I actually reduced her dose last night and she's doing better today, so far. I'm doing another curve today.
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No, an unregulated diabetic is often hungry. Although Chloe has had some low numbers she's definitely not regulated. Good regulation on ProZinc would be PSs in the low to mid 200s and nadirs in the high double digits to low 100s day in and day out on doses that are very similar. There wouldn't be any spiking and diving and her SS would be mostly low yellow PSs with a nice array of blue and dark green nadirs.
 
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nadir is the lowest point in the cycle - it's not a set time. So it might be +6, but it might also be +4, +5, +7, +9, etc. It varies by cat, and can vary from day to day with the same cat.
 
Djamila said:
nadir is the lowest point in the cycle - it's not a set time. So it might be +6, but it might also be +4, +5, +7, +9, etc. It varies by cat, and can vary from day to day with the same cat.
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Well, maybe +4 was her nadir, because she tested 307 at +6. All she's been doing is sleeping.
 
Ugh. Poor Chloe! That can't feel good. Curious to see the +8 and if she comes back down a little.
 
You've done a great job getting this curve done today. Just one more test to go for the 16 hours. How has Chloe done with all the extra tests?
 
Please test for Ketones as often as you can. Those black numbers are not pretty.
I think she's probably bouncing from the lows this weekend.
Great job on the curve. Unfortunately, it looks like it was a bounce cycle. It turned into one very fast.
Hopefully the lantus will help control those bounces. It really did help Chuck with his bounces. He still bounces but they're better controlled and less often.
 
That was a pretty dramatic cycle, but good to see both the kind of insulin response she's getting, the duration (way too short) and the climb. And you could see from the tests last night that she was on her way back down again. I think this really confirms the need for a different insulin. Prozinc just doesn't give her the kind of duration she needs, and that dramatic of a response can't feel good. Hopefully you can get the new insulin soon and get her on a better path.
 
What a rough day Chloe had yesterday and now a rough start to today. Her body needs a break.

The pharmacy should be open today--as well as your vet. Hoping for some progress with Lantus.
 
Teenuh said:
What a rough day Chloe had yesterday and now a rough start to today. Her body needs a break.

The pharmacy should be open today--as well as your vet. Hoping for some progress with Lantus.
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I'm a bit peeved with both the pharmacy and the vet. I've called both twice today. The vet wants some sort of form faxed to them and the pharmacy just wants the prescription faxed to them. Hopefully, they'll get it sorted out by tomorrow.
Ketones are negative.
 
Teenuh said:
Sounds super frustrating.

Yay for negative Ketones!!
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Got an email from Dr. Upchurch this morning. She looked at my curve and said the Prozinc works, but the Lantus would be better. She sent in a scrip for a whole vial, so she must be pretty sure. A vial costs about $300, even at Mark's, doesn't it?
 
srk4cats said:
Got an email from Dr. Upchurch this morning. She looked at my curve and said the Prozinc works, but the Lantus would be better. She sent in a scrip for a whole vial, so she must be pretty sure. A vial costs about $300, even at Mark's, doesn't it?
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Actually, it doesn't. The cost from Marks will be about half that or a little less. If it was the same cost you could just take your script to your usual human pharmacy.
 
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