Confused and need help

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tigersdad

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Suggested I start a thread here, so here it is. I have pasted the comments from my original post here.
Also have opened a spreadsheet, but not much info there yet. Too much conflicting information everywhere and newbie confusion is driving me nuts as all I want to do is help my kitty.
Need advice and willing to go back to square 1. Sorry about the forum hopping, but will post here from now on.


Ok, I'll see if I can give you some more information.
I first took Tiger to the vet in November 2009. Then he was being fed on dry kibble (Purina cat chow) and fancy feast. After the diagnosis my vet said that we should change his diet to low carb and suggested Purina DM dry and Fancy Feast (accepted varieties)
She gave us Lantus and said to put him on 4 units (based on weight) in the morning only.
Not knowing any different I followed these instructions. It soon became apparent that this was not right.
After discussion with the vet I went right back to a low dose. 1 unit morning and evening and built it up to 3 units morning and 2 units evening.
Sometimes this seemed to be ok, but at others his readings were all over the place as was his behaviour.
I do test at home, but not all the time. Have done a couple small glucose curves, but mostly do spot checks.
Current position is that he has 2 units morning (8 am) and 2 units evening (8 pm)
Still doing spot checks of BG.
Feeding Fancy Feast (accepted varieties) and a small amount of DM. Now I know DM is scorned, but he loves kibble and he only has a small amount.

Right, readings.

The small curve I did (now I know this is not correct procedures but here it is. It was on 17th January.
8.00 (pre jab) 275.4
10.00 255.6
12.00 221.4
3.30 158.4
8.00 286.2
This was when he was on 3 units morning and 2 at evening.

More recently on 28th Jan.

8.00 271.8
11.00 219.6
2.00 255.6
7.00 275.4
10.00 (after his evening shot) 214.2

This was when he was on 2.25 units morning and 2.25 evening.

Ok, I know there's no consistency here. I'm frustrated and confused. Don't know whether to increase or decrease dosages.
What I need is a step by step right from the beginning - diagnosis to finding the right dose.

I am so confused that I am taking him to another vet that specializes in small animals on Monday, to see if I can get better help there.
Please help.
Thanks
 
....So, if I go back to square 1, which I am happy to do and give just 1 unit every 12 hours, where do I go from there.
I measure the BG and how do I decide to increase/reduce the dose. This is where I'm stuck.

hi again!
this is what we call forum hopping!

I can help answer a bit of this concern u had in your health thread...how do u decide to increase/reduce?
By collecting data.
You hometest, you're feeding low carb wet food, you've got a spreadsheet that's got a lot of free space to fill in and you've got one of the best insulins around.

From what I know and heard, dose is not based on weight - I will let others more advanced in their lingo explain that.
 
Welcome to Lantus Land!

The dosing protocol that we use is the {url=http://www.tillydiabetes.net/en_6_protocol2.htm]Tight Regulation Protocol for Lantus and Levemir[/url], also called the Tilly Protocol. It will provide you with the basic outline of when to increase or decrease a dose. We actually use a modified version of this protocol that is a little less aggressive.

The initial dose is based on a cat's ideal weight. I'm not sure where your vet came up with 4.0u as an initial dose -- your cat would need to be huge to warrant a 4.0u dose! In many cases, the starting dose in in the neighborhood of 1.0u. If you can post Tiger's ideal weight, we can calculate a starting dose or you'll find the info in the protocol. You've already figured out that Lantus is a twice per day insulin that needs to be given 12 hrs apart. In addition, you should shoot the same amount at both AM and PM. Because Lantus requires that you build a depot or "shed" (basically a steady state amount in the cat's system), if you are shooting differing amounts, you are not going to get a consistent overlap between doses which will also make Tiger's numbers very confusing.

Can you tell us a little more about how dose changes were arrived at and how large or small the changes were? With the protocol we use, most changes are made in 0.25u increments. If you were changes doses in amounts larger than this, it may mean that an ideal dose was missed. However, in the grand scheme of things, Tiger's numbers don't look that bad!

As for feeding that little bit of dry food, we will probably do whatever we can to persuade you to get rid of it. While DM may not be as bad as some of the other brands out there, it is really bad for your cat. The quality of the protein is awful and it is a nutritional nightmare. If you haven't already seen this website, I'd encourage you to take a look at the site developed by Lisa Pierson, DVM on feline nutrition. If that doesn't convince you about the evils of dry food, very little else will. There are freeze dried treats that will add a bit of crunch to Tiger's food that are much healthier. Adding dry to Tiger's diet may also be playing havoc to his test results and you won't know this until you eliminate it from his diet.

Please ask questions and let us know what we can do to help resolve your confusion!
 
Welcome aboard! This is a hard thing to get used to - the learning curve is steep, and we don't see results right away most of the time. And it's frustrating, really is frustrating. And when it's not frustrating, it's confusing. And bless their hearts, vets don't have a clue sometimes about how to deal with this.

In other words, you're normal. :mrgreen:

There will be people here who can guide you step by step; I'm not one of them, although I can explain the physiology of diabetes if you want. What I'm really good at doing is saying "been there, done that, totally get the hard/frustration/confusion thing, and totally get the I just want to make my baby well thing."

Take a deep breath. Now take another one. And now, relax a little bit. There are some amazing folks here who will be able to get you through things, I promise.

Best-
Michele
 
Thanks everyone so far.
Well, I'm ashamed to say the dosage changes were guesswork. Sorry.
How do I get my cat's ideal weight. Not sure I understand that one. He is a big cat, and as I say overweight as well, so think my vet started him on a dose intended for his actual weight.
I have tried to increment doses slowly by .25. Here are the big questions for me.

How do I get my cat's ideal weight? At the moment he weighs 21lbs (Gasps of horror) He is a big cat as well but it is proving very difficult to get the weight off him even though he is on a diet.
Now should I start again at a dose of 1 unit am and pm or stick at two.
should I just drop it to 1 unit or go down slowly?
What are the important times to test, I certainly want to try not to be testing him 12 times a day?
 
Not to make light of your question about testing, those of us who have written in your condo (that's what we call your thread for the day), are pretty much testaholics. If you look at our spreadsheets (SS), you'll see that. Our testing proclivities aside, I think it would be helpful to get a curve initially. That means testing every 2 hours for one cycle (12 hr period). This will at least give you some preliminary data on how Tiger is responding to a dose of Lantus and when his nadir is likely to be. (Nadirs can and do change so it's an approximate.) As for other times to test, this may depend on your schedule -- whether you are at home or not during the week. I routinely test at +2 (2 hours after I give Gabby her shot.) For Gabby, this usually gives me some clue as to how the rest of the cycle will go. On the weekends, I test more than if I'm at work. So, I'm usually testing before I walk out the door and when I come home. In the evenings, you definitely want to get a test before bed each night. If the PMs are the times when you're home, you may want to get an extra test or two in then. The minimum number of tests is AM/PMPS (morning and evening pre-shot times) and one other test each cycle. The more data you have, the easier it will be to offer guidance on dose changes -- especially if an increase is needed. Much of the dosing issues revolve around data. It's the only way to make sure Tiger is safe as well as getting the appropriate amount of insulin. Otherwise, you are making decisions based on insufficient information. Most importantly, you want to do whatever is humanly possible to not shoot blind (i.e., shoot without a pre-shot test). If it were you who were the diabetic, your physician would never tell you to give yourself a shot of insulin without testing first. The same logic applies to your cat -- it is paramount for keeping Tiger safe even though Lantus dosing decisions are based on the nadir.

At this point, unless you want to call your vet and ask what Tiger's ideal weight is, it is your choice how to proceed. You can essentially start over at 1.0u, although if Tiger is a big cat 1.0u may not be enough insulin. It looks like you have a couple of mid-cycle tests and Tiger was in the 200 range. This may be a fine place to pick up with. I'd like to see what some of the others here have to say, though, about a starting dose. (And don't worry about Tiger being a big cat. I have a kitten at home that at a lean, mean fighting weight will probably weigh in at close to 18lbs when he reaches maturity.)

One of the testing issues that you need to be attentive to is getting PM spot checks. Many of our cats have lower numbers in the evenings. If you don't get any tests in at night, you are missing half of your data. As I said above, the bare minimum, especially if you are out of the house during the day, is a before bed test.

Read the stickies (announcements at the top of the Board) and keep asking questions.
 
Greetings and welcome to Lantus Land! I am no expert, but reading your posts takes me back to when my guy was diagnosed almost two years ago. I wish I had known about this board then - it would have helped me,and my kitty immensely, and avoided so many mistakes i made.

You've found the right place - so many knowledgeable people here that will help. As a side note - I have found it helpful when i have time to read others postings, one learns alot that way.

So -- relax, and breathe. We all understand what you are going through - for me: been there and done that more times than I care to admit.

Anyways - WELCOME!
 
welcome to Lantus Land!

Tiger's numbers aren't that bad for now, they give us something good to work with. Once you get a few more days of testing under your belt we'll be able to help you interpret Tiger's numbers. I personally don't see any harm in sticking with the 2 units BID since Tiger's numbers are pretty decent, hold that dose for a few days and get tests before every shot, and whatever tests you can get in between shots. That will give us the data to make good recommendations for Tiger. Make sense?
 
Hi, Just stopping by to say hi and welcome to Lantus Land!

Re the dosing by "ideal" weight, I'm not so sure I agree with the big cat explanation for a higher dose. :-Q My Morris was 26 pounds when we started (he ate Science Diet Light his entire life....so much for "light"), went down to 17 pounds after being off dry food for 6 months, and has now gone down to 14 lb. 14 oz. at last week's weigh-in. He's been sick, and that is NOT a good weight for him and his vet has actually says she wants him to put on some weight. ohmygod_smile

Anyway, I digress...he was started at 1 unit and has never gone above that....before he got sick, he was on .10u....and he's been insulin-dependent diabetic for 10 years. :?

As for the dry food...I just discovered EVO has a low carb (I think 3%) dry food. Here's a link:
http://www.evopet.com/products/default. ... na&id=1500
You can put in your zip code and find a local store maybe. Morris seems to like it OK....and he's sick right now and not liking too much. :cry:

Please bear with it....I promise it will get easier....and this is the absolutely BEST place for you to be! :mrgreen:
 
Hi I am glad to see you over here and willing to take my advice - yes everyone, I suggested on the post on health that it may be a good idea to start over.

Here is the initial post from there - viewtopic.php?f=3&t=4354

I see Libby suggested sticking with the 2 units. For what it's worth, if she suggested this, I'd follow her suggestion and not mine of starting at 1 unit. Libby is considered one of the gurus on Lantus.

Hopefully that will alleviate a little of the confusion.

Now that you are here, the wonderful people who know oh so much about Lantus, will guide you on when and how much to change the dose. Your job, since you took me up on my suggestion, is to test Tiger's BG's and post them.

Regarding weight, for now, how about we concentrate on getting you comfortable with the dose and protocols of Lantus and then we can work on the weight issues. What kind of cat do you have? You only said he's overweight. There are several breeds out there that produce larger cats and it's very possible your cat could have some of that breed in him.

My Buster (not diabetic) is a domestic short hair and she was the largest in her litter. She doesn't have any Maine Coon, Norwegian Forest or any of the other large breed in her. As a kitten she was as big as her mom. Her last weigh in she was about 16 pounds. While that is probably too much weight (and it's due to a dry food diet - my fault for not knowing better), she hasn't lost any weight since changing to the low carb wet foods. I know she doesn't overeat, she was born larger. I even have pics to prove it.

So my point in telling you this, is that she's fluffy, happy and healthy and she doesn't care about her weight. I'm feeding proper foods and will leave her be in all her fluffiness.

Again, welcome to the group. You will get all the help you need, including explanations! Thanks for trusting in us and giving this a whirl.

by the way - where are you located? I don't see it on your profile - if you want you can add it under the avatar pic.
 
Hi Tiger and his Dad, Welcome! Stu and I are new to this board, too; have been here for less than 2 weeks. Already the very knowledgeable, compassionate and great people here have helped us immensely. Finally I feel that I am not flying blind! I cannot help you with your specific issues, but just wanted to add my support. Good luck to you and Tiger!

Ella & Stu
 
hey there, good to see you over here in LL.

okay listen your current numbers are safe enough numbers that you do not need to be frustrated. this stuff takes a while, check out other people's spread sheets. like libby posted on this thread, open up her SS and check it out. see the time frame from start until remission?
now in your post you gave 5 tests on 1/28 but only 3 of those are on SS? am confused. suggest not changing dose, stay at that 2.0 units and get some data! i don't see 'pre-jab' tests? oh ya have to get PS tests before every single injection, that one is non-negotiable. testing is what keeps a cat safe. doesn't help if you shoot and then afterwards find out you just gave insulin to a cat who's BG was 33. also if can you add some more 'pre-FDMB doses/BG numbers on SS it would be good, or at least a line on there saying was diagnosed in 11/09 and was on varying doses, just so others that look at your SS in future that ave not read this thread here will have some knowledge that he did not start insulin 3 days ago. k?

don't worry, here you will get a pretty unified voice on suggestions of how to proceed. i know it is all confusing right now but all the people that are posting to you that sound so confident and secure and knowledgeable? they were all right in your shoes once, all said the same thing, 'i'm confused, this isn't working, i'm frustrated, numbers are all over the place, etc etc.' (well except me, lololol, i've been doing this so long i was already an 'oldie' when the board started in 1998 ;-) ).

about the kibble....say you had a kid that was diabetic and asked for some candy bars before bed every night. if you tossed him 10 candy bars into his bed saying 'sure kid, i know you love them' people would gasp. my cat was raised on dry food in a box before i rescued him and he would love love love if i fed him some, but it just is no good for his diabetes (and kidneys and weight and everything else). to satisfy him i give him freeze dried chicken for treats (he likes the halo liv-a-little brand), in fact goes crazy for them and he doesn't miss the dry food at all and these are a fine treat for diabetic cats. maybe give those a try? just saying cause the dry will only add to your frustration, it is a number killer no matter how low carb.

this will get easier and way way better. confusion will turn into knowledge and frustration into happiness. promise. just takes some time...
 
Thanks again all. Funnily enough I feel quite at home here and among friends. I'm not a trusting sort when it comes to my animals, heck I don't even trust my vet! Anyhow, seeing all your stories and comments, I know I can trust everyone here and am willing to take everything on board. I'm listening and will help you help me, by doing everything I can to give the info you need. Sorry about the little info on the ss. I have an awful computer and dial up :( so everything I do takes a while. When I get time I'll sit down and get a bigger history on there. I'm quite ashamed of my results really. Not enough tests and dose hopping due to panic. Anyway I'm happy to come clean and start afresh, admit my sins and listen to you guys. Think I must have messed up the dates on the tests. The ss is right, the ones on my post must be wrong.
I don't know what breed Tiger is. He is a medium hair Tabby, that's all I know. He's 9 years old and we adopted him from a local shelter along with an elderly Maine Coon who is sadly now gone from my life.
Today I have cut down his kibble by half. I'm getting there.
I'll stick with the two for now and get some more data and start posting daily and see where we go.
Thanks again.
By the way I'm from the UK, but now living in Manitoba, Canada.
 
Tigersdad -- what's your name? (We can keep calling you Tigersdad but it sounds so much less personal!)

This is truly a wonderful community of people and thank you for the vote of trust. Like Jojo said, we've all been in your shoes. I know after a few days of posting, I felt a huge sigh of relief. And after this Board prevented two hypoglycemic crises, I knew this wasn't a bunch of internet crazies but a group of very knowledgeable and concerned people who truly care about all of our kitties.

There is a good sized group of Canadians here if you need information about what low carb foods are available or about what products may or may not be available. This is also an international group. What that means is there is usually someone on the message board 24/7.

Don't worry about dose changes, mistakes, etc. Many of us have put faith in vets who knew far less than the people here about diabetes management and we've made missteps. You'll get on track.
 
Welcome to LL. As has already been said, you are in good company here. Post daily and ask questions. No questions are "dumb" questions. We all learn something from them. Maybe someday the vets will catch up to what goes on here, meanwhile, progress is made on this board. Relax, Breathe and you will do fine. Guess we have all had "kitty crack addicts" (dry food) but, you will resolve that issue too.
 
Welcome to LL. As has already been said, you are in good company here. Post daily and ask questions. No questions are "dumb" questions. We all learn something from them. Maybe someday the vets will catch up to what goes on here, meanwhile, progress is made on this board. Relax, Breathe and you will do fine. Guess we have all had "kitty crack addicts" (dry food) but, you will resolve that issue too.
 
Hi Peter!

Just as an FYI, every day open a new thread (we call them "condos") for Tiger. There's one condo per cat per day. In the subject line, note the date, your cat's name, your AMPS (morning pre-shot test #) and then you can add test values throughout the day (well, up to a point). You make changes to the subject line by editing your first condo. If there is an emergent issue or if you have a question, also edit the subject line of the first condo since this is the only line that is visible to everyone on the Board. To bump your condo to the top, you have to post a note to your condo.

For today, your condo/subject line would read:
1/31 Tiger AMPS-293 If you wanted to add your next test, it would then read, 1/31 Tiger AMPS-293, +2-247.

There is more information about Board posting conventions, slang, dosing (with pictures of syringes), etc. in the "New to Lantus" announcement at the top of the Board.
 
:mrgreen: Hi Peter!!! So happy you are here! :thumbup
I had to smile to myself while reading your comments about yourself... :lol: You are your own worst critic, eh? :YMHUG: Guess we have all made mistakes in judgment at times...just forget about all that now...
You love your Tiger and that is the bottom line...build up from there. You will find that we all
love our sugarbabies and give suggestions based on each individual kitty. We want to hear all about
Tiger's day...how he seems to be doing; is he playing, did he poop...is he eating a lot or not...
We call that our WCR..Whole Cat Report...in the first condo of each day. Our kitties are more than just the insulin dose they are getting, right?

Oh, and speaking of eating...my little girl Raja is big boned... :lol: ok, maybe she is just plain old chubby!! But she was a dry food addict...loved her carbs. I didn't know any better and took them away one day after reading that canned was better for them. No gradual thing here...no, it was cold turkey! She loves to eat at regular intervals and likes warm water added to her canned Fancy Feasts. She was used to munching whenever she wanted to all day long. Carbohydrate addiction is the same in humans...we crave them if we are trying to give them up. We can be carb addicts too. They have to be fed so why not give them the best food for their bodies...they cannot really choose...they depend on us to feed them the right stiff. So as long as I feed her on time (she seems to have a little watch that she checks often. :lol: ) she is just fine. They adjust. You will not be denying him anything wonderful....it's not like they can really whine, right?
I think of the dry foods as Twinkies....might taste good if you are addicted to them but they are not doing good things for your body.... :lol:

So, try to put the past behind you. With your SS and keeping comments in the far right column there, you will be able to track what is happening with Tiger from day to day. And everyone here will come by and say hello....one big happy family. Each day things get better and better and you will learn a lot and so will Tiger!
(a side note here....I did give up the prescribed doses my two kitties were on from the vet...and I began to listen to all the wonderful folks here on this board. Libby and Jojo and all the people who commented to you have years of experience..and they are terrific!! They have checked your SS and given you their thoughts...I would follow them if I were you.....)
You are doing well Peter...give a hug to Tiger for us and keep posting, k? :-D
 
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