Decision: Insuline - to change or not to change?

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Re: URGENT!! Insuline - to change or not to change? Please h

Wow, what odd things to say about fdmb and lantus. Oh, and it isn't an american forum...we are international. I am from canada, for example, and we have members world wide!

I would feel much safer giving lantus and barely testing than give caninsulin and test frequently. You do not have to test frequently with lantus but you can choose to if you want more data, just as you can with any other insulin. Lantus does not cause the swings that caninsulin can.

Again, how odd!
 
Hi all,
Thanks for the comments and sorry about the blunt Dutch post. I was a bit taken aback by what she wrote this morning - didn't mean to offend anyone, so I hope I didn't!

Just to give an update...

I have just come back from a visit to the vet - the new one I'm getting since my old one is leaving the practice. He went through their records all the way back to the beginning and we had a look at Neo's numbers and what dosage of Caninsulin he was on at those times. Although the numbers changed a little bit (lowest was 13.3, highest was 20.2 or so) he's pretty much been hanging out with the same BG for the last 4 months. We went back and forth, I asked a lot of questions and he said that he agreed something needed to change and he was happy to change to Lantus, but he wanted me to be the one behind the steering wheel. Because so much is going on right now, change in diet, infection, etc. he was very uneasy about then changing the insulin, especially when he was honest enough to say to me that he didn't have a lot of experience with it.

So we're going to go back to the way things were, and we're going to stick with Caninsulin for the time being, but I'm still going to ask Jasmien to still check his BG 3x/day to make sure nothing changes. And once I'm back, we're going to get together and have another pow-wow, recheck all the numbers that Jasmien has collected for us and then come up with a plan. I'll take in the Tight Regulation protocol with him at that time too, and discuss that with him. And I'll probably be back then to bug you guys for advice.

I hope I don't offend or upset anyone with this decision. I don't want anyone to think I'm making this decision lightly or that I don't appreciate your thoughts and advice. I really do! So I hope that's clear. Especially Julia- you've put so much time into me and Neo already. I really struggled with the decision and I do still think that it's best to switch to Lantus, but the timing isn't good. This is not me not trusting you guys! It's just that I think in the end, it's asking too much of Jasmien (and maybe Neo too).

So I hope no one is upset with me. I think you all are a wonderful, dedicated bunch and I appreciate all the wonderful advice and suggestions I've gotten. And I'm going to follow your advice too! Just a bit later than I had originally planned. :-)

Thank you!
 
You are his caregiver, you must do what you think is best and unless it is flagrantly dangerous I can't see why anyone would have issue, especially with the circumstances :)
 
Thanks for that, Jen. I just feel really guilty after bugging you guys so much! In a weird way I feel like I'm letting you guys down or something. But I always did have a guilty conscience. I hope everyone understands. :)
 
Maya,

As my own vet told me once and it applies to us here as well...Ultimately you are the one that holds the syringe, and know Neo the best...we can only tell you what we would do in any given situation, we can make suggestions but in the end, it is you that has to decide what is best for your boy! And if Canisulin is what your vet knows best, and Jasmein is going to be relying on them for help should she need it then that is probably the best course of action. Once you are back and life has returned to normal, then you can make the switch without having to worry about so many variables. Neo has already had a bunch of changes, and now Momma is going away for awhile, so baby steps really does make the most sense...afterall this isn't a sprint...its a marathon.

Mel, Maxwell. Musette & The Fur Gang
 
interesting post from the Dutch person - but first, maya, it's absolutely OK to continue as you have been doing. you don't have to worry about pleasing us, for one thing!! he's your cat! we're just trying to give you information as far as we know.

regarding the things in the Dutch post - i can see some of what she's saying. the reference to the "scared of double digits" - it might be that what she's seen is a reference to posts of acro cats. it wouldn't apply to your situation at all, at least not at this stage you are in right now. likely your "higher than average" dose is directly related to the dry food. if a cat makes the switch to low carb canned food, has all possibilities of infection ruled out or treated and still needs a higher than average dose, or doesn't respond to increasing the dose of insulin, then we look at medical conditions that might need a high dose of insulin. that's not neo!

however, those of us with cats with acromegaly, who have a high dose of insulin being injected into them are wary of letting them get too low. At least some of the time, a cat with acromegaly has a working pancreas. There isn't unity among us with acro cats on what the cut-off point would be for "too low" to have your cat go. it's a complex set of circumstances that we try to balance. to try to make the explanation simple - with a working pancreas if the cat eats high carb food the pancreas releases insulin to "treat" the carbs. so if your cat gets low and you give high carb food to pull it up, and the pancreas ALSO puts out insulin to reduce the carbs, you can get into a vicious cycle and have a hard time pulling the numbers up. I haven't had that happen. I have heard of people having it happen, though. the other thing with acromegaly - it is caused by a tumor on the pituitary gland that puts out a hormone that makes the insulin not be able to get into the cells. that tumor can switch on and off. what if it switches off today after you've injected, and all of a sudden all of the insulin is able to work? if you're injecting 25 - 50- 75 units of insulin into a cat, you're going to take it very seriously! you would be a fool not to. there are other factors, too, which can make one avoid lower numbers - so she may have seen some of that and thought that applies to the general philosophy of this board. if so, she misunderstood.

in fact, the Lantus protocol we follow is a combination of the German Katzen Protocol and the Rand/Roomp (univ of Queensland, Australia) and Tilly Protocols, which are all very similar - likely they are doing the same things we are doing here. and this is an international forum - she's wrong about it being american. Probably most people on at any given time are from North America - but since i've been on (february) there have been a number of kitties from Australia and we have one right now from Hong Kong.

you have put a lot of effort into figuring out what's best for Neo - kudos to you for being so devoted. it sounds like he'll be in good hands while you're gone. we'll look for your stories when you get back. have a great time.
 
You need to do with what you think the best decision is, and if you truly feel that is staying the way he is while you're gone, then that is what you should do. Like I said in my other message, my concern with sticking to the Caninsulin is mainly with complications due to high BG while you're gone. I think the odds are pretty good that is BG will stay in the same range as it has so far on the Caninsulin/Dry Diet, which is a bit high. Please make sure there is a vet nearby, and that Jasmien is testing for ketones, and that if he's not eating right she doesn't shoot a full dose of insulin and takes him into the vet if the inappetence is for more than 24 hours, and that she's testing at least the preshots and +4s (although if she can get additional +2s that would be good as well, especially if there are eating issues). I would say these things are absolutely necessary if you're keeping him on the Caninsulin/dry food.

Also, I would set up a feeding schedule so that you know Jasmien is going to feed him at the appropriate times to prevent hypos. This is a very important passage from the Caninsulin user guide that you should pay attention to:

Please make sure that there is always food on board before you inject this insulin. Schedule is best with test, feed, shoot, within about 30 minutes
You will read a lot about the benefits of a low carb diet and it is true. However, please do not make any quick changes from what you are currently feeding until you are testing and have some data.
A low carb diet can dramatically decrease the amount of insulin needed. Be prepared with data and know your onset, peak and duration before making those diet changes. Dr. Lisa has a great site with info on the role diet and diabetes play.. http://www.catinfo.org/


A feeding schedule as follows has served many very well. "Every Cat Is Different" though so tweaking to suit your cat's needs is always encouraged once you gather some info. This is based on a BID shooting schedule of 7:00am and 7:00pm.
If you must leave the house, (once again that darn life gets in the way) a timed feeder or freezing "pucks" of canned food to thaw for that snack can really help.

6:30am
-20-30 minutes prior to shot, test and give 2/3 breakfast , ideally a low carb canned food, please refer to Janet and Binky's food charts. http://binkyspage.tripod.com/index.html
7:00am
-give insulin dose,
(if test showed numbers under 180, refer to faq 4.4 http://www.felinediabetes.com/fdmb-faq.htm and ask members of the board for advice, cross posting on health)

8:30am-9:00am
-1 and 1/2 hours later or what we refer to as "+1.5", or 2 hours later, +2, offer a snack of 1/3 breakfast...(As the insulin works to lower the blood glucose, offering a snack will help balance a drop that is happening too fast.)

*edited-
I have changed the snack times to a little earlier than original post of +2.5, as have seen many with fast onset of this insulin and the need to have that snack in this +1.5 to +2 hours area to balance the drop more effectively.

~spot check through out the day (test) as you can eg: 1 hour after shot, 3 hours, 5 hours after shot and right through 10 hours after shot.
This does not have to happen all in the first day though , you can spread this out and many of us need to work ( I know it feels like managing this syndrome is already a full time job) and we do this in the evening and on weekends.

7:00pm repeat

The spot checks will show you when the insulin starts to work "onset", when it is peaking "nadir" and how long it is lasting in your cat's system " duration"
With that info you can move the snack up or down as necessary to avoid food spikes and to support the dropping blood glucose.

* Important note;
If your cat is recovering from DKA or other issues that involve a weakened liver, please note that extra calories are necessary for that liver to heal and you should be feeding when hungry and/or as advised by the Vet.
Click to expand...
 
Btw, I just checked out his spreadsheet and YAY no ketones! :-D :-D :-D That was my big worry last night with his numbers and the infection and him not eating.

Oh, one last thing about his care at Jasmiens--even though you should feed him the dry food because of the Caninsulin doesn't mean ALL his food has to be dry food. Some canned food mixed with water every now and then will help keep him hydrated (which can help prevent ketoacidosis), so you might want to think about feeding half canned and half dry, and mixing water with the canned to get as much moisture in him as possible.
 
Thanks, Julia! I had him on mixed dry and wet so I was indeed thinking about going back to that. He was actually on that for weeks (maybe even a month) before I switched him to just dry. Thanks for confirming it will probably be safe to do again!

I think I gave him too much dinner tonight. Shame on me, but he wouldn't stop begging so I gave him 100g extra food than I normally would. And now his BG has shot right up.

So I'd obviously better read up on how food affects BG and insulin!
 
Don't worry about feeding him extra! Unregulated cats should be given extra food if they want it. Their poor bodies are literally starving. The only thing you want to watch out for is making sure they're hungry and eating when the Caninsulin is in effect. So if you want to feed him extra just try and do it in the first half of the cycle when it will help control his BG better.
 
Ah ok, phew! His numbers have already come back down, so I wonder. Maybe he and Groovy were having a disagreement and I didn't notice? I will keep an eye on him, anyway. :-)
 
That was the one article I knew I read and I was hunting everywhere for it but couldn't find access to it to send her. Thank you Sienne! I have it saved now. :-)
 
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