Feeling discouraged

Status
Not open for further replies.
Zappa’s mom

Zappa’s mom

Member Since 2022
Hello,

I am just over one month on insulin and not really seeing improvement. I'm hoping you all can see my spreadsheet - I just completed it. I've been keeping meticulous records via a notebook next to my insulin "kit". This is my cat Zappa, 14 years old, overweight, the love of my life. I was really hoping to get him into remission but I'm feeling like with this little of a change over a month, that might not be in the cards for us. Any comments, suggestions, anything would be appreciated. I do have a great vet, but obviously I can't call or email him every day about this...we just went from 1.5 to 2.0 on Lantus. It's on my spreadsheet...Thank you! Suzanne
 
Would you please fill in the amount of insulin on the ss an when it was raised? Also put no shot or NS if ever you skipped. Your cat is likely bouncing from going under 200. There has been progress. For most this is a marathon and not a race. Feline diabetes teaches us patience so much that patience pants get passed around a lot here.
Having under 250 as a no shot number is a mistake in my opinion. Even using our less aggressive method newly diagnosed cats get insulin if 200 and that number decreases with data. I suggest you read the stickies at the top of the lantus forum. Start with the dosing methods one and read the SLGS guidelines. Let us know how we can help.
 
Thank you. Yes I did read all of those stickies and I’ve been reading many posts and learning quite a lot. I had trouble updating the sheet after I initially put it together. I will try again and add the info as you suggested. I’m aware of the No dose under 200 rather than 250 and will bring it up to my vet. Thank you so much for your feedback! I honestly don’t mind any of this as an inconvenience for me, or however long it takes. I am feeling discouraged for Zappa because I just want him to be healthy. I actually have 3 cats all the same age - he’s the only one with diabetes.
 
Zappa’s mom said:
Thank you! What do you mean by all the PM cycles?

- Suzanne
Click to expand...
Hi Suzanne,
I mean all the cycles that are at night (after the PMPS dose)
If you look at the spreadsheet, it is on the right hand side where there are only 4 BGs.
So if you are able to get one each night that will tell us a lot about what is going on with Zappa.
Dont be discouraged. He is a newly diagnosed kitty and he is doing OK. Once you put in the doses given each day into the spreadsheet we can see things more clearly
 
Yes, I just updated. Took me a minute to figure it out!
Also, the BG’s in the AMPS are after a meal. Should I be testing before I feed him? Thank you.
 
Suzanne
can you add the name of the meter you are using to your signature
Just tap on your name up top then tap on signature and add it then tap save
If you are going to follow the dosing method can you please add that to your signature
@Zappa’s mom
 
You are holding the dose too long which can cause glucose toxicity.
With SLGS you do a curve after 7 days and then ask if you need to increase the dose.
If you think the preshot BG is too low to shot the best thing to do is to stall, dont feed and test again in 20 minutes to see if the BG is rising. And post and ask for help.
 
Diane Tyler's Mom said:
Suzanne
can you add the name of the meter you are using to your signature
Just tap on your name up top then tap on signature and add it then tap save
If you are going to follow the dosing method can you please add that to your signature
@Zappa’s mom
Click to expand...

Thx! Yes starting tomorrow I will test, feed and dose. I also added my meter to the signature line.
 
Welcome to FDMB!

There are a couple of observations I'd like to pass along.

I'm hoping that the 37 on 12/23 was a typo. (Seeing your next numbers, it looks like it may have been a bad test or bad strip.) Even if you're following the more aggressive Tight Regulation (TR) Protocol for Lantus dosing, you would not give insulin with such a low pre-shot number. With TR, once you have sufficient data, you can shoot as low as 50. Giving insulin if numbers are lower than 50 can be dangerous.

We encourage shooting progressively lower numbers. Most vets are apprehensive about suggesting shooting lower numbers since most of their clients do not home test. You have much greater insight into what's happening with Zappas because you're home testing and you're doing a great job with testing. With Lantus, as you get more comfortable with seeing your cat in better numbers, being able to shoot lower will give you flatter curves (i.e., overall lower numbers).

Some of what I'm seeing on your spreadsheet are what we call "bounces." Zappas, like most newly diagnosed cats, isn't used to being in closer to normal numbers. As a result, when he's dropping into those blue numbers, his liver and pancreas panic. (Lower numbers than your cat has become accustomed to, low numbers, or a fast drop in numbers can all trigger a bounce.) When the liver and pancreas react, they release a stored form of glucose along with counterregulatory hormones which cause numbers to spike upward. The data on 1/1 are a good example -- Zappas dropped to 132 at +8 and was back up to 335 by PMPS. He "bounced." It can take roughly 3 days/6 cycles for a bounce to clear. The more time your cat spends in better numbers, the less frequently he will bounce.

Lantus dosing is based on the lowest number in the cycle and not on the pre-shot number. The pre-shot test tells you if it's safe to give a shot. How low the dose bring the numbers can guide your decisions about whether to increase or decrease the amount of insulin. It's also why it's important to get some PM cycle tests. You don't want to miss a dose reduction. In addition, if you're not testing during the PM cycle, you're missing half of your data.

Please let us know if you have questions. We're here to help.
 
Don't despair! I remember feeling the exact same way. It seemed like Hen was stuck in the 200-300s forever and making no progress but you just have to keep on keepin' on and follow the guidance and advice given by the experts here like Sienne. It takes a lot of patience and time, and then more patience. It can be very frustrating and depressing to continue to see those higher numbers but hang in there!!
 
I agree with what everyone is saying and what tiffmaxee said about the no shot values. You can see how high she was the next morning when you skipped her shots at night. Lantus requires consistency and not shooting when she’s 250 is really not a good idea. It always made me nervous skipping shots so I’d always give Minnie at least a token dose if I felt the pm preshot number was lower than usual and was afraid she’d go to low overnight. Getting that additional pm test Bron recommended will help you see where she’s headed for the night. Be prepared for you vet to disagree. Vets dose based on the preshot numbers, which we think is a mistake. As explained by others already, we dose by the lowest she goes during a cycle.

Don’t be discouraged. One month in is really not that long at all and you’re off to a great start here. We like to say that feline diabetes is a marathon not a sprint. It can take months to get them regulated. If your hope is to get her into remission, I’d follow the advice you’re given here because these guys are experts and vets tend to not be that well versed on feline diabetes, let alone remission. If you can test often and your goal is remission, I’d also consider at some point switching to the TR protocol which has a higher remission rate. It’s a bit more aggressive so you have to be comfortable shooting at much lower numbers, which again, your vet will disagree with. It’s weird at first to go against a vet’s advice, but the more you learn here, the more empowered you’ll feel to make your own decisions regarding her diabetes. Just remember you’re the owner and you know your cat better than anyone so advocate for what is best for her and you’ll both be fine :bighug:
 
Last edited:
All the above is true. Start by gradually decreasing the the no shot number. Start with 200. If lower shoot a decreased dose of 20-25%. Before doing that, STALL, DO NOT FEED and test again in 20-30 minutes. If BG is going up you might be able to shoot the full dose. Shooting 20-30 minutes late will not affect the time of the next shot.

If you skip when 250 you likely won’t see progress and will need to keep increasing the dose.

What do you think?
 
tiffmaxee said:
All the above is true. Start by gradually decreasing the the no shot number. Start with 200. If lower shoot a decreased dose of 20-25%. Before doing that, STALL, DO NOT FEED and test again in 20-30 minutes. If BG is going up you might be able to shoot the full dose. Shooting 20-30 minutes late will not affect the time of the next shot.

If you skip when 250 you likely won’t see progress and will need to keep increasing the dose.

What do you think?
Click to expand...

I appreciate the feedback and guidance. I actually love my vet - he is experienced and has been great for my cats. I do trust him so not following his directions would be a problem for me. However, what everyone is saying makes sense to me and I will talk to my vet about this. I also have been doing Zappa’s preshot after he eats breakfast, so that’s a problem. I’m working on adjusting that as well as getting BGs after the pm shot.

Again, super grateful to all of you who took the time to provide such thoughtful feedback. This site has been an incredible resource.
 
It takes 20-30 minutes for food to raise the bg and about 15 when giving honey. So depending on how much after eating you tested for preshot bgs it might be accurate. Remember dosing of lantus is based upon the nadir, how low a dose takes our cat, and not Ambg/pmbg. The reason for the preshots testis to make sure the bg is not too low to shoot. Looks like Zappa is still bouncing from the 135 a couple of times ago. It should end soon and then you will likely have extra momentum on the bounce clearing cycle. I’m glad you like your vet. I feel the same about my vet but he had me stop insulin for 3 weeks when he thought Max was in remission which in hindsight was a mistake. We should have lowered the dose. I had a lot going on and wasn’t home testing so he was right to be cautious. We just should have not gone from 1.0 to no juice.
 
Zappa’s mom said:
I appreciate the feedback and guidance. I actually love my vet - he is experienced and has been great for my cats. I do trust him so not following his directions would be a problem for me. However, what everyone is saying makes sense to me and I will talk to my vet about this. I also have been doing Zappa’s preshot after he eats breakfast, so that’s a problem. I’m working on adjusting that as well as getting BGs after the pm shot.

Again, super grateful to all of you who took the time to provide such thoughtful feedback. This site has been an incredible resource.
Click to expand...
I guess the point I’m making is that even good vets may not know enough about feline diabetes because that’s not all they focus on. It doesn’t mean they’re bad vets, they’re just not experts on it and haven’t kept up with it. I have vets I trust completely here for anything except Minnie’s diabetic treatment. It was obvious to me she only improved and got regulated once I started following everyone’s guidance here and so it became clear I needed to go a different way than what they wanted me to do, which was dose based on the preshot numbers and not home test daily. Also, during the 6 months I did follow all the vet’s advice she ended up developing severe neuropathy, which can happen to unregulated diabetic cats. Lantus needs consistency and skipping doses will not help get him regulated.

All I’m saying is keep an open mind and do your own research so you’re not following their advice blindly. Especially if you are, and you’re not seeing the results you were hoping for. And also especially if your goal is remission because the longer a cat is unregulated, the harder it is to get them into remission.
 
Last edited:
I just wanted to chime in and let you know that you are definitely not alone, many many members have been in your shoes.

For me, coming to terms with the fact that following the dosing methods and guidance provided by the experts here was better for my cat than following the advice of my freaking vet was gut-wrenching to me. my stomach was in knots over this.

I just always trusted the vet to be the expert, to have the knowledge and experience I did not. I could not imagine doing something counter to a vet's instructions.

Once I read all the data and research about the dosing methods and their success however, and learned how about the hundreds of cats that have gone into diabetic remission over the years following the FDMB experts' instructions...I was sold. I informed my vet we would be following the Tight Regulation protocol for dosing and shared Hendrick's spreadsheet with her. 6 months later Hendrick went into diabetic remission following the TR dosing method, using Lantus/Basaglar.
 
Status
Not open for further replies.
Back
Top