Cini Mini - New to Lantus Forum

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Cini Mini's Mom

Cini Mini's Mom

Member Since 2011
Hi,

I am a new FDMB memeber and I have posted Cini Mini's story in the new member section of the forum here -
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=55708

My question from that forum is -

How do I get Cini regulated again after coming home from the emergency Vet? When he was at the Vet's they gave him higher doses of insulin while he was there because he was so stressed and upset. Since he's been back home I now have him on 1 unit of Lantus twice a day but that doesn't seem to be getting him in the right direction. His lowest nadir so far has been 266 (that used to be his high point before his emergency visit). The emergency Vet wanted me to just give him 2 units twice a day but he's never been on that much for years so the thought of that scares me.

I filled out a spreadsheet tracking his readings in my signature. Hopefully I did that correctly.

Any sage advice would be appreciated.

Oh, and P.S. I am reading the stickies at the top of the forum as well.
 
Hi Cathy!!!

Welcome to you and Cini Mini to Lantus Land!!! We are a close-knit group always ready to help out and answer questions. We've got lots of experienced people here with tons of sage recommendations. I read through your Health post...thanks for doing that and also thanks very much for getting your SS up and also reading the stickys.

So....first question is ....is he still on steroids? I'm thinking not since they found out he had toxo but just want to be sure.

IMHO (and I am hoping plenty of others will jump in and give you their thoughts), he got into blue on .5u. I wonder if on the night of 11/2, the carryover from the .5u could have possibly gotten him into low numbers thus resulting in him bouncing into these high numbers. Some spot tests that night would have helped out with that. That could be a bit of a stretch since he's on a low dose (.5u), he didn't go really low on that dose previously, and you reduced his dose that night. But he did get as low as 112 on the .5u. Cats "bounce" from any number they perceive as being lower than what they are used to so he could even be bouncing from the 112. A "bounce" is when the liver secretes counterregulatory hormones and glucagon to bring the BG up to what it considers to be "safe"....bounces can take up to six cycles (72 hours) to clear.

So how do you tell if he's bouncing or not? I would wait the six cycles starting with the a.m. cycle on 11/3 and see what he does. If he's still high after the sixth cycle, then I would increase his dose per the protocol:
Increasing the dose:
•Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

The great thing about Lantus Land is we have lots of great folks with good ideas so let's see what some of the other folks think. Glad you are with us. We look forward to seeing a daily condo!
 
Hi Cathy!

Welcome to Lantus Land! I am not one of the sages (well put!), but there are plenty here who will be glad to answer your questions. I just wanted to step up and say hi to you and Cini.

I read your post on the main health board. Wow, Cini has been through a lot. You have taken great care of him through it all.
 
We just wanted to stop by and welcome you. I agree with Marj in that your kitty might be in a bounce. I would wait for six cycles and see where the numbers are then. Hopefully some of our more experienced members will weigh in soon. Welcome again!!
 
Welcome to Lantus Land and OMG, have you and Cini Mini been through a lot! I think your cat was very lucky when he found you.

Thank you for getting your SS pulled together and for having already having reviewed the sticky notes. Marje's point is well taken -- Cini Mini's liver may have reacted to the blue numbers with a bounce into the higher regions. A bounce can take up to 72 hours to clear. You don't want to increase the dose during a bounce since once it does clear, your cat could be over dose. At this point, I would suggest waiting another day to see what happens with the BG numbers. If they don't improve, it may be time to raise the dose. Marje included the information on how we change dose. We do so gradually so you don't overshoot the mark and are able to find the best dose for your cat.
 
Cathy

Meant to ask you where you are in AZ? There are two of us (Rosalie and Morgaine and Gracie and me) in Tucson and Anne, Liz, and Zener are in Flagstaff. I am not aware of any LL members in the Phx metro area.
 
Wow! You guys are great! Thanks so much for the encouragement and understanding. It's nice to be able to relate what's going on with Cini to people who know exactly what you are talking about.

Marjorie, to answer your question about the steroids....yes and no... he's no longer on a regular steroidal treatment for the feline asthma BUT he was given several steroid injections while at the emergency vet for the inflammation in his throat. Do you think after two weeks they could still be in his system? The Vet said they were short acting steroids that were meant to stay in his system for 8 hours at a time. They gave the injections IV and not under the skin.

And yes, I was reading about the protocol and I agree on what you have below. Before 11/3 I was dosing to a scale that the Vet gave me so if his BG was a certain number then I would give x units of Insulin. Now I am seeing that consistency is the key and not to change up the dose just because he may be having a "low" reading that time. I'm going to stick with giving him 1 unit of Lantus for 6 - 10 cycles and see where that goes.

And I LOVE THIS CHART! :razz: I can see at a glance with the color coding how his day or weeks are looking. I just kept pages and pages of logs in a notebook and I always thought a chart would be better because I knew I needed to see the "bigger picture" in a graphical format. This is perfect!
 
I wouldn't hold onto that dose 6-10 cycles. His nadirs are not below 200. After six cycles, I'd see what he is doing. If he isn't coming down, THEN I'd increase per the protocol. On a cat that is not newly diagnosed, you don't want to hold onto those doses too long....just long enough to see if it is a bounce and let the bounce clear (72 hours = six cycles). If you want to see what he does on the 7th cycle and then decide, you can. Sometimes they might need all six cycles to clear and then on the 7th cycle, they come down. So let's take it a cycle at a time and see where he goes.

We'll be here for you!!!

Hmm...on the steroids...I wonder if it was dexamethasone. I always wonder about giving a diabetic cat steroids like that HOWEVER, sometimes...you gotta do what you gotta do and then deal with it with the insulin.
 
Hi Cathy, yep everyone here in LL is pretty much as crazy about their cats as you are about yours. :lol: :lol: Isn't it nice to be normal? Where are you in AZ?
Liz
 
Hey Marjorie,

I was looking at this part "•After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit." He's had 4 cycles so far so that's how I was interpreting what that part said? Give anything new 6 cycles? I was going to increase to 1.5 if he's still above 300 for a nadir tomorrow. If that's wrong, let me know. I am the n00b and you are the pros, so learn me something so I can help Cini :-D

Hi Anne,

Sorry, forgot to mention I live in Chandler. Love it here, been here for 6 years now. But next year is a big decision for us all (me, the animals, and my kids), my son is the last out the house and is going away to college so it will be just me and the animals. I was thinking about relocating, but I don't know where yet.
 
Hello and Welcome!

Yes, you are on the 4th cycle. After 6 cycles you evaluate if an increase is needed and how much.
So,2 more cycles for this dose to settle in.

from the protocol:
Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
 
cathy, i'd suggest that you post here every day, ask lots of questions and when you think you should change the dose post the question in the subject line of your first post "dose advice?" or "increase dose?" or something like that.

if you post every day then people get to know your cat and it's easier to remember all the bits and pieces of their story, plus you'll learn a ton. and i found that people would teach me how to read punkin's ss so that i could learn what a bounce looked like, or the "new dose wonkiness" until i could read them for myself, then i could tell when i should hold or when i should change the dose.

and yes, these spreadsheets are awesome. i was celebrating them the other day - you can see the patterns so well when it's laid out in a chart like this.
 
Cathy --

Remember that the nadir is the lowest number in a cycle. It's not always the mid-cycle number. While Cini has had red and pink numbers, he's also been in the yellows and blues. If nadirs are under 300, you increase by 0.25u.
 
Cathy:

Both Julie and Sienne make really important points:

-- If you post here each day and do a condo as we all do, we can help you track what's going on with his numbers and help you decide when and how much to increase.
-- It's the nadir that controls the increase. So it's important to get those mid-cycle checks to see what his nadir is; it could be +4, +5, +6, +7...who knows. To that end....if he's feeling like it, it might not be a bad idea to do a curve this weekend and see if we can figure that out.

We used to live in Phx.....so glad we moved...too darn hot there and it is actually cooler in Tucson. Plus...all the concrete and grass drove me crazy :lol: :lol: :lol:
 
Marjorie - What's a "condo"? Getting used to all the slang and I didn't see it in the site dictionary.

Sienne - Hi! OK, I thought we were just going by the lowest nadir score in the current cycle, I didn't realize we were looking at all the runs combined.

All - Definitely will be posting here every day :-D Should I make an entirely new post every day or just keep adding to this one?
 
this is your condo - it's a thread or conversation. we open a new one every day using the formula you can see on people's subject lines: date-cat's name-am preshot number, and then through the day we edit the first post's subject line to update it. that way people can track what's going on with each cat throughout the day. if you want to ask anything, just post it in your subject line and keep re-editing it through the day. we encourage people to only have 1 condo or post per day mostly because there are a lot of people and it is more manageable, plus it keeps all of your story for that day together.

then when you open a new condo tomorrow, copy the URL for this post today and include it in the first post of your new condo. it creates a link backwards that people can look backwards to see what advice/issues have been going on.

there's a nadir to each cycle - the nadir is the lowest point. sienne's point is that it isn't necessarily at the middle of the cycle, it's whatever the lowest point is. looking at the protocol to make decisions about increasing the dose we look at the nadirs over the past 6 cycles. a cycle is the 12 hours after a shot. so every day we have 2 cycles.

you're doing great. just keeping asking away on whatever seems unclear!
 
You might want to just check out some other condos so you can see what's happening in Lantus Land!! People do their condos differently but we all try to be consistent with our subject lines and including the link to the last condo.

Yup....Julie, my friend, is right...you're doing good and asking good questions.
 
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