Dose Increase? Booger AMPS 309 +4 327 New Diabetic

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MartinJA527

MartinJA527

Member Since 2014
Hi everyone. I'd like to introduce Booger. She was just recently diagnosed with diabetes and we started Lantus yesterday. We completed our first curve and are on our second day. I've been reading a lot on the forum and have been encouraged to post on here with questions and numbers. I was able to attach the spreadsheet this morning to my signature. Currently, we are monitoring with the Alphatrak2 as per my vet's request. I am also monitoring with a Bayer Contour Next EZ for comparison but my spreadsheet numbers are listed in the Alphatrak only at this time. We switched from dry food free feeding on July 24th to Friskies canned foods. She was diagnosed with a urinary tract infection at that time and completed a course of Clavamox on the 7th. Yesterday, The vet said her infection had cleared and she had gained 3/10 of a pound (brining her to 8.26). But the numbers I had been sending him and her symptoms were cause for Insulin therapy. We discussed Prozinc and Lantus and although he has warned me that remission may come and go (honeymoon?), I know I am not alone with that being my ultimate goal for her. Everyone at FDMB has been so helpful to us this far!
Jennifer and Booger
 
Re: 8/14/14 Booger AMPS 309 +4 327 New Diabetic

Hi Jennifer! Nice to meet you - and welcome to you and Booger! there must be a story with her name! :lol:

Here's the link to your previous post on Main Health: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=123438&p=1282017#p1282017

Great job getting started - you look like you're a serious tester! :-D we never turn down data from tests!

When you're starting on Lantus, the TR Protocol suggests:
Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Click to expand...

If you haven't yet, you might want to read the Lantus: Info, Proper Handling & Storage yellow starred sticky, and watch the video on that page about how to draw up a dose of Lantus without contaminating it. That will help it last as long as possible.

I hope you'll post daily so we can help you learn what you need to know to help Booger. It's good to know that your goal is remission for her. The sooner a cat gets tightly regulated (held between 50-120) the better the chances are for remission. Some cats come out of remission, but often the switch to low carb canned food and a short time on insulin is all it takes. Some stay in remission for the rest of their lives.

The learning curve is steep at the beginning, but we've all been in your shoes and are happy to teach you. Keep asking questions - we're happy to answer.
 
Re: 8/14/14 Booger AMPS 309 +4 327 New Diabetic

Hi there and welcome :cool:

You came to the very best place to learn all you need to know to safely treat your kittys feline diabetes. Glad you found us.

Great job on the ss and testing - the more data, the clearer the picture and the easier it is to figure out next steps.
Regarding the meters, most folks here use a human glucometer, which generally reads lower than the Alphatrack.
Given a choice, I recommend using your Bayer Contour.

Hang in there - and hang in here. :cool:
 
Re: 8/14/14 Booger AMPS 309 +4 327 New Diabetic

Welcome to tight regulation. See, already lots of eyes on Booger. And how did you come up with that name???
 
Re: 8/14/14 Booger AMPS 309 +4 327 New Diabetic

Well.. Booger was named by my niece many years ago because "she looks like she has a booger on her nose". I wish it was more pretty but that's how it happened, lol! She is such a sweet girl, bless her.

I just checked out the storage and handling link, thank you! Yes, I want that bottle to last as long as it can. That stuff's expensive! On changing the dose of the insulin (Down the road) While I am starting out, how do you advise working with the vet? He is open to suggestions and he wants me to talk with him before I change doses. How did you handle vet conversations in the beginning? I sent him data this morning from the curve and am waiting response. I assume he will say to wait a few days before increasing and give me his recommendation. Should I send him a copy of the protocol that I'd like to follow?

I do hope she can go into remission. So, I've been struggling with the glucometers since July. BJM gave me a wonderful tool to compare the human to pet one. My vet won't accept any human glucometer readings (curves). I'm ok with that, if it's what he want that's fine. But I really want to base my readings AMPS and PMPS, spot checks etc.. on a human meter. I don't know if it's the meters I have used (I have used 2 now) or if it's a normal thing but they've been off some 100 points at different times. I just added the Bayer meter data to the spread sheet. Maybe the numbers are fine? Maybe I need to get a different human meter?

Thanks tiffmaxee for sending me over. I can see why you suggested to come here!
 
Re: 8/14/14 Booger AMPS 309 +4 327 New Diabetic

I send my vet the ss weekly. I must confess I have two of them, one just for him. He was actually quite impressed with it. Since he is not quick to respond at times as he is soooo busy and not in the office to talk with after 6 or on weekends, I soon realized I would need to change doses without him. We haven't talked in weeks now come to think of it.
 
Re: 8/14/14 Booger AMPS 309 +4 327 New Diabetic

Ok, thanks. That is helpful. He is supportive and quick to respond this far.. but I assume with time this may change. He has responded to my initial curve.. with "Increase insulin from 1 unit BID to 1.5 units BID. Send new data when available". This scared me because it seems like a big increase in a quick time. So I went back to the protocol.

I see that it says "Cat's that are getting high flat curves should have their dose raised earlier (after 24-48 hours)" and for increasing it says "Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl."

So, the protocol is based off of lab data, correct? and If I am using my human glucometer to base my dosing on, the nadir doesn't remain above 200. So I go back to BJM's sheet and know that the +4 reading of 186 is comparable to 210-310 on the alphatrack which does correlate (at 249 +4) and means a dosage increase may be needed? Is my thinking right?

The increase of 0.5 seems a little high for me not knowing how she's going to respond. So should I plan to keep the current 1 unit dose tonight and change in the morning when I can test another full curve and be alert to any changes?

See.. I'm a pest already.. :oops:
 
Re: 8/14/14 Booger AMPS 309 +4 327 New Diabetic

We use our meters to decide when and how much to increase. I took .25 increases but my vet was conservative with them. If you edit your first post of the day with a question mark in the bar of the first post and write dose increase? Someone will get back to you to advise.
 
Hi Jennifer and extra sweet Booger!

The quick answer to your question on increasing is Not yet. Right now, you're in the initial phase and the protocol says:

"Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles)."

Right now, you're already getting into blues on 1 unit and that's very encouraging! (since the vast majority of us use human meters, I'm referring to your human numbers) If Booger hasn't had problems with ketones, you'd want to hold that starting dose for the full 10-14 cycles.

Lantus is a "depot" insulin, and it takes time to "Fill the depot"...Think of it like this..as you start, a little of each shot goes to work in that cycle and the rest goes "in the depot"....as you continue, the depot eventually "fills up"...at that point, you'll see the true result of that dose with some of each new shot being used in that cycle, and the rest being released slowly from the depot.

When the depot is full, he'll start getting the true benefit of the 1 unit dose...right now, some of each shot is going to "fill the depot"

Understand? The depot is the hardest part to explain but there's more information on it here What's the insulin depot?

Good luck to you and Booger and we look forward to helping you!
 
Re: 8/14/14 Booger AMPS 309 +4 327 New Diabetic

Hi Jennifer!! Welcome to you and Booger to our Lantus Land family!!!

We would suggest you pick a meter and stick with it and don't worry about comparisons. You'll drive yourself crazy (speaking from the voice of experience with that :lol: :lol: ).

If I were you, I would take the TR Protocol and also this attachment to my vet (if he's good, he will read them and discuss with you):
The TR protocol and the attached study are the only ones upon which a scientifically researched, based, and published protocol (the TR protocol was published in the Journal of Feline Medicine and Surgery) for treatment of diabetes in cats has been accomplished. I would show my vet that the TR protocol includes use of a human glucometer. I would also tell my vet that the AT is too expensive in terms of strips and if you run out of strips, you can't just go to Walmart to get them. I, personally, would not let my vet dictate the meter I use. If you decide you want to continue to use the AT, we can easily work with that. We ask only that you put "ALPHA TRAK" in bold and larger letters in your signature block so we can remember when we look at Booger's condo and SS that you are using an AT. Thanks :-D :-D

Many of us here manage our kitty's diabetes here in this forum and we don't share our SSs with our vets or have them manage it because many of them don't understand how to read a SS. They don't understand bouncing; they think it always means the dose is too high but it isn't always the case. They suggest increases in too large of increments which may get the kitty overdosed. And they definitely don't understand how depot insulins like lantus and levemir work vs non-depot insulins like PZI.

We have an awesome vet. She does not get involved in managing Gracie's diabetes. We've discussed it; I occasionally share the SS and explain to her what I'm seeing. She has called or emailed me with questions about FD because she knows we live and breathe it 24/7. She sees an occasional FD kitty.

At this point in time, I would suggest you do not raise Booger's dose yet. She needs time for her depot to fill.

We're glad you are here and hope you will ask lots of questions.
 

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Welcome to Lantus Land!

Marje beat me to the punch! I was going to attach the same journal article for you to share with your vet. Like many people here, I don't consult with my vet when it comes to adjusting Gabby's insulin dose. The first time her numbers dropped and I called the vet's office only to get an answering machine, it made me realize I could get my questions answered here almost immediately and I'd get a ton more support, as well. That said, it's always good to try to find an effective way to collaborate with your vet.

As several others have noted, the initial dose of Lantus is held for 5 - 7 days in order for the insulin depot to form. Booger's numbers are in a reasonable range that there's no need to worry about a sooner than usual increase
 
Thanks so much for all your help. I could partially see the rationalization and I do want to get her under control, but I don't want to crash her either if I can help it. So we'll see how it goes for the next few days!
 
We always keep an eye out for new people and will help you decide when to raise the dose. We do a lot of counting cycles. Right now you want to count from the first shot and likely you'll be holding the 1.0u dose for 10 cycles, ie shots, and then reevaluate the dose.

One important factor is whether or not Booger has a history of ketones. Did she have ketones, DKA, ketoacidosis at diagnosis - any of those words familiar?
 
Oh, and most people nod their heads about the dosing directions and then follow the protocol for adjustments. You want a good relationship with your vet, but it would be ok to ask how many cats they have treated with lantus, how many have gone into remission and what protocol he is using to decide on dose changes.

You are the consumer and he works for you. As a smart client you are getting educated so you can be a partner in taking care of Booger.
 
I am forever thankful for that and your support! She had glucose and bacteria on the first day but no Ketones. She had glucose again the second visit.

Since my lurking around on this forum for the past few weeks I am already leery about the dosing he has proposed. Not that I'm knocking my vet because I love him. I have used him for years, just not for diabetes. There was mention of increasing by 0.5-1unit very quickly here in what I gather are the first few days. I am looking to avoid symptomatic hypoglycemia like the plague and give her good control. I want to be smart about it (That's why I came to the experts :-) ) but I don't know enough about it to make those kind of adjustments alone. I don't want to upset him but I want my cat alive. So I'm going to take your advice, send him my numbers and nod my head. I'm going to take his proposed dosing increases as the blessing to increase here in the next few days (or cycles) as her numbers warrant.

On a side note, I am taking care of her brother tonight as well. We all went outside this evening to hang out on the porch. He thought it would be a good idea to swat a wasp out of the air....
 
We are happy to help you and Booger any way we can. When you have a question, open the first post of the condo for that day, click on the "?" Button, put your question in the test box, and hit "submit". All we ask is they you remove the "?" once your question is answered. You can also put a note in your subject line like "dose advice?".
 
Glucose and bacteria in the urine are both very common. Until Booger's under better control, the extra sugar in her bloodstream is being spilled over into her urine, and since sugar is such a good growth medium for bacteria, Urinary Tract Infections are also very common.

It's good that she didn't have the bacteria the second time, but watch her for signs of an infection. UTI's are one of the big reasons that it's hard to regulate their blood glucose. Any infection or inflammation in any part of the body can raise BG levels

It's not necessarily that your vet is a "bad" vet at all...it's just that most vets don't have the time to stay up to date on the latest treatments for every disease, for every type of animal they see. The people here do nothing but deal with diabetes and the diseases that tend to come with it, so we keep up to date on the latest treatments available and even our protocol has been "tweaked" to be more aggressive than the original (but still safe as long as you're home testing)

Keep asking questions and stick with us. We can help you learn all you need to know to do this sugardance!
 
Oops! I may not have made myself clear. Her brother as in the kittie's brother... Panther swatted the wasp. His paw is pretty swollen and he's limping on it and licking it a little but he's not showing any other signs of distress.

I am trying to stay on top of watching her. I have to get some urine sticks to make sure the infection stays at bay. I feel so bad for sticking her so many times. I try not to hit the same place twice but sometimes I'm sure I do. I find myself trying to nurse her ears as well now.

Well I am thankful for you both. I know he is trying and is a valuable resource for me as well.
 
Are you using Neosporinpoint meant ointment with pain relief on her ears?? That will help. You can also alternate ears and move up and down the edge.

The ketone strips won't tell you anything about the bacteria. The only way to know if bacteria is present or not is to do a cystocentesis which is a sterile sample.

Keep the questions coming!
 
I think Marje meant Neosporin Ointment with pain relief....LOL It's great stuff! A little dab each night and by morning, a lot of times you won't see any signs of poking!

You can also use a little about 10 minutes before poking...the "pain relief" part will numb the ear a little...Just don't use so much that you gunk up the test strip.

Might want to tell Panther that maybe he should stick with crickets and leave the wasps alone...they're just as much fun without that OUCHIE part!
 
I have been alternating, yes. I started with Neosporin today but I only have the plain kind. I'll pick up the pain relief kind. Haha, that was at least a good giggle :-)

For the strips, I had in mind more of a Multi-stix kind of strip rather than a ketone dedicated one. That would give pH, WBC, Ketone, Glucose, Etc.. Wouldn't be a totally sterile sample, no as I'm not cathing her but I guess I was envisioning a "clean catch" kind of fantasy.. it's late.. lol

Yes, I'll pass the word along to him.. Poor boy. The catnip he was rolling around on musta given him a sense of false confidence, poor boy. He did catch it.. and let it go rather quickly, bless him.. Now he's conked out king of his castle on the top of the cat tree.

Panther:

Huggs:
 

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Poor Panther. I'm sure he'll think twice before swatting a bug out of the air! I'm not really up on wasps - they don't leave their stinger in like bees do, do they? If he's still limping when you get the neosporin with pan relief, he might appreciate a little, too.

It's okay to love and respect your vet and want to keep him in the loop. Just don't let him talk you into doing anything you're not comfortable with, just because he's the "expert". We don't want to damage his ego, but as Chris said, most vets don't know a lot about FD. They have to know about a lot of different diseases, conditions, etc., for multiple species and can't possibly keep totally up to date on everything unless they are specializing in that area. As you start seeing results from following the TR protocol, your vet should become more comfortable with your being in control, and if he's a really good one, will want to learn more about what you're doing. I, too, have nodded at my vet's advice, then gone home and done what the board advised instead. The result was that my kitty went OTJ (Off the Juice- into remission). Once the vet saw how well he was doing, she didn't question me much about how I was managing Cinco's FD.

We are glad you, Booger, and the rest of your herd are here, and we look forward to helping and encouraging you in your FD journey. You've already heard from some of the most knowledgeable people on the board. You are in good hands.
 
No, they do not. I wasn't sure either I had to look it up after getting a good look at this one. He's not really limping today but he's still licking at it a good bit.

I can appreciate that. My job requires me to know a lot about many subjects as well. I consider myself much more knowledgeable about certain things than others and some things still leave me puzzled. There are still times when I need to speak with someone who deals with a certain situation day in and day out, knows every detail about it, doesn't just deal with certain aspects of it.. a specialist. I think you've explained it beautifully and I'm hoping that through the guidance of the specialists here and learning my own kitty my vet and I can become that sort of team.

Thanks again for all of your support and helping us to feel welcome and a little more at ease!
 
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