I need help with my dosing!

[Albert & Ninja]

Hello everyone!

I am still pretty new here. I have been scouring the site for data as often as I can.

Ninja has lost quite a bit of weight and although he is putting it back on, (thanks to diet info from this site!) his strength in his rear legs has suffered. This strength will not be recoverable until he is better regulated. I already plan on getting him on the methyl b12 asap.

I feel like he is on way to much insulin and has potentially been since the beginning of his diagnosis when the vet prescribed two units as his dose. I've noticed several hours after shots most of the cats on this forum seem to start dropping but lately Ninja has not been doing that. I don't know how to go about checking this other than my current 3 day curve I'm doing.

The vet originally started him on 2 units. He went into remission, and came back to diabetes and was put back on 2 units. In accordance to only pre shot tests, I attempted to regulate Ninja and slowly made my way up to his where he is now in the 4-5 unit range. The majority of this was during my pre forum times and only recently have I realized I did this wrong. My vet was not very helpful in explaining proper management and did not emphasize the importance of finding a nadir or any of the proper steps. Ninja's vet upped the dose to 4 units after seeing that hes been high since his visit the month before. I'm starting to have my doubts on my vet's knowledge on feline diabetes. Seems to think its fine to use a Lantus pen and increase dosage by multiple units at a time. I feel like you guys are right in terms of .25 or .5 u increases. I already know I need to correct this and am looking into finding affordable syringes and affordable vials from Canada if possible. I have already broken my bank with my efforts to try and manage his diabetes.

How do I determine what to do with his dose from here? I will be doing a curve for the next two evenings to see where he is. I have thought about doing an "OTJ Trial" as it is called here but I'm worried going from 5 units to nothing would not produce a great outcome. I would appreciate any advice!

 

[Tricia Cinco(GA) & Harvey]

I have thought about doing an "OTJ Trial" as it is called here but I'm worried going from 5 units to nothing would not produce a great outcome.

Taking a cat off the insulin completely to "see how he does" almost never has a good outcome.

You're correct in thinking that making one unit or more dose changes is a bad idea. The reason we make dose changes in quarter units is that, for a cat, that's actually quite a bit of insulin. If you were to book at some other spreadsheets, you would see there are many cats that are actually on doses smaller than a quarter unit. When you make a dose change by a larger amount, you run the risk of going right past the "perfect dose". It may seem hard to understand, but too much insulin can look just the same as too little.

I'm actually about to go to bed right now (I'm a night owl). I will send a message to some of our veterans and ask them to take a look at your spreadsheet and give you some input on where you should go from here. One thing I will recommend, is that you try to get as many tests as you can throughout both cycles. It really isn't necessary to do a curve, unless you have opted to follow the Start Low Go Slow method. What you are trying to pinpoint is when your cat reaches his nadir. Lantus dosing is based on how low the insulin takes the cat, with some consideration giving to the pre-shot numbers.

Keep reading all the information at the top of the page and keep asking questions. Hopefully some others will be along soon to share their thoughts.

Meanwhile, here is a post we put together to help new members become comfortable using this forum. Hang in there. We'll get this figured out.

 

[Sandy and Black Kitty]

Hi there and welcome

I too believe 5u is too high however would not recommend stopping insulin

I will be doing a curve for the next two evenings to see where he is.

this will be a good start in helping to reveal what’s going on between shots and figuring out where to go from here. If you are able today, grab a test between now and PMPS.

Timing is important. Stick as close as possible to shooting every 12 hours and always test before shooting.

Properly managing feline diabetes requires using many strips. To help manage expenses, I strongly recommend you purchase a human meter as strips are much more affordable.

Hang in there and hang in here. We will help you get it sorted out safely.

 

[MyTitan (GA)]

HI Albert and Ninja, welcome. Sorta new here ourselves, take a gander at Titans SS . We had trouble getting him regulated. Started off too low on dosage (didn't know that at the tyme) , had some very ugly numbers early . We finally tested Titan for acromegaly and he was positive. With that info we increased his dosage rather quickly (not recommended without lots of help) and found the dose that got his numbers down. I think we also were dealing with IAA that would explain his drop from 12 units down to 6.5. I offer this just for information and help you not to get discouraged, there are many folks here that will help you get Ninja under control. Good luck and looking forward to progress . Ed.

 

[Stacy & Asia]

Hi Albert and Ninja, and welcome!

Your story is not unlike so many others. I landed here because some of the things my vet suggested didn’t sit right with me (shooting blind, not testing at all being the main one). It took me some time to trust the process over here and make decisions that directly contradicted my vet’s instructions, but, the TR protocol was a pretty compelling read and well, the proof is in the spreadsheets, I saw how well it was working for so many other cats. Several months and a vet change later, here we are and Asia is doing so much better than I ever expected she would!

If I could pass along a bit of advice, read as much as you can, read the stickies and other condos and other cat’s spreadsheets, I learned so much from doing that. Posting every day helps as well, you build a rapport with others in the same boat and people become invested in your cat and his progress and you’ll get so much support that way. I hope to see you around and that Ninja gets back to fighting weight and in some better numbers really soon!

 

[Albert & Ninja]

Hi there and welcome
Properly managing feline diabetes requires using many strips. To help manage expenses, I strongly recommend you purchase a human meter as strips are much more affordable.

Yes you are right. The test strips come in second place in expenses and have drained my wallet. Insulin being in first still. I have really considered a ReliOn meter. They have the cheapest lancets and alcohol swabs so they have been my go to. They also conveniently have the cheapest strips. Good old Walmart. Still trying to decide which one. I was turned off at first due to all the data about human meters not working correctly with felines. I will try and pinpoint a model for purchase today. Suggestions welcome lol.

We finally tested Titan for acromegaly and he was positive.

I have also thought Ninja may be resistant but I feel it is too soon to determine this. I suspected this after I saw his first green and blue after a few days on 5 or 6 units. How Do I go about testing for acromegaly? I assume this is vet work?

Also, any opinions on that time frame (12/7/17) and those numbers? I was thinking maybe his sweet spot was between 5-6 units, but then again it could have been a bounce being his PMPS and still being so low. I am really unsure about this and not educated enough to determine.

I landed here because some of the things my vet suggested didn’t sit right with me (shooting blind, not testing at all being the main one). ....If I could pass along a bit of advice, read as much as you can, read the stickies and other condos and other cat’s spreadsheets, I learned so much from doing that. Posting every day helps as well, you build a rapport with others in the same boat and people become invested in your cat and his progress and you’ll get so much support that way.

I too landed here because I didn't believe he really knew what he was doing (with diabetes, great vet otherwise). No hard feelings since they saved him once but I need an expert! His suggestion of not testing for an entire month at a time after curves to give him a calming period is what got to me. This just didn't seem right after hearing "we have to get him regulated by checking his reaction to insulin," mixed with "testing is stressful and should not be done daily." I can get a reading from Ninja without him even getting up from a nap after I wake him so stress is not an issue as he has an immense amount of trust in me. After asking a close diabetic friend about all of this he said test often otherwise I will be in the dark. He has honestly been more helpful than the vet in terms of answering questions. I'm working on posting every day. I'm a bit of a recluse on forums. I have been studying spreadsheets pretty frequently and learning methods used by others.

 

[Stacy & Asia]

too landed here because I didn't believe he really knew what he was doing (with diabetes, great vet otherwise). No hard feelings since they saved him once but I need an expert! His suggestion of not testing for an entire month at a time after curves to give him a calming period is what got to me. This just didn't seem right after hearing "we have to get him regulated by checking his reaction to insulin," mixed with "testing is stressful and should not be done daily." I can get a reading from Ninja without him even getting up from a nap after I wake him so stress is not an issue as he has an immense amount of trust in me. After asking a close diabetic friend about all of this he said test often otherwise I will be in the dark. He has honestly been more helpful than the vet in terms of answering questions. I'm working on posting every day. I'm a bit of a recluse on forums. I have been studying spreadsheets pretty frequently and learning methods used by others

Very similar experience, I have a good friend that is diabetic and I knew enough that she needed to test at least before every shot to be safe, why would that be any different for cats? My vet’s response was I could test if I wanted to (with an Alphatrak of course) no mention of curves or come back in two weeks, very little help other than here’s some Lantus, go buy syringes and shoot twice a day.

Many people use the relion meters, the strips are very inexpensive. I don’t have a Walmart so I use the same meter that is rebranded for Walmart, you get a free one when you buy 200 strips. You can also use the Walmart strips for this meter since it’s the same one. I also buy syringes from this site, prices are better than what I can get locally. Syringes:

https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes

Strips with free meter:

https://www.adwdiabetes.com/product/4045/arkray-glucocard-01-blood-glucose-monitoring-kit

 

[Wendy&Neko]

The Relion Confirm and Micro are decent prices, but most important for me, they take the smallest drop of blood. So less problems getting that drop of blood.

They have the cheapest lancets and alcohol swabs so they have been my go to.

Skip the alcohol swabs. Don't think many people here use them. So that's a savings. Walmart apparently has very cost effect Relion syringes with 1/2 unit markings. I didn't use them, since I'm in Canada where they don't carry the Relion syringes, but I did go across the border for cheaper strips. Next time you need insulin, ask here and you'll find out how to order on line from Canada at much cheaper. That's the one thing we had going for us in our stores.

How Do I go about testing for acromegaly? I assume this is vet work?

We suggest that when someone gets to 6 units, and is on low carb wet food with no other medical issues, they get testing done for both acromegaly and IAA (insulin autoantibodies). You get the vet to do it. They draw blood and send it to Michigan State University. One in four diabetic cats has acromegaly, so it's not uncommon. My Neko had both IAA and acromegaly. Oh, and my vet knew nothing about either condition. What I learned I got from here, then taught her, and she subsequently found another acrocat in her practice.

 

[Albert & Ninja]

We suggest that when someone gets to 6 units, and is on low carb wet food with no other medical issues, they get testing done for both acromegaly and IAA (insulin autoantibodies). You get the vet to do it. They draw blood and send it to Michigan State University. One in four diabetic cats has acromegaly, so it's not uncommon. My Neko had both IAA and acromegaly. Oh, and my vet knew nothing about either condition. What I learned I got from here, then taught her, and she subsequently found another acrocat in her practice.

Just called my vet to check pricing on blood work. Instead of simply giving me the price they pushed to sell me on re-evaluating Ninja and his dosage before I could even think about getting blood work done. I may be finding a different doctor soon.

Edit:
Just called again. Not sure if someone was having a bad day but I got hung up on. The third call I finally got my vet's tech on the line and she took the note of the tests I am interested in. Acromegaly and IAA for sure and potentially a fructosamine test since his blood will be sent off anyways I might as well.

 

[Stacy & Asia]

Just called my vet to check pricing on blood work. Instead of simply giving me the price they pushed to sell me on re-evaluating Ninja and his dosage before I could even think about getting blood work done. I may be finding a different doctor soon.

That might help a good bit. I left the vet that diagnosed Asia, they only saw her once for a crisis situation and I didn’t like their approach or FD instructions. It was easier with the next vet (that I paid to in person interview before ever bringing Asia in) because I arrived and basically said my cat is diabetic, I’m using Lantus and following the TR protocol. He gave his opinion on dosing (sliding scale) and I just said thanks for that, and went home and continued following TR. Fast forward a couple months when I brought Asia in and he reviewed her SS again, he thought I was doing a good job and we basically talk about the diabetes stuff, but I do my own thing and he hasn’t given me grief about it.

Good luck whatever you decide, I’ve found you can find an awesome vet (for the everything else) and probably the best you get with FD is that they are willing to listen to what you want to do and leave you be about it mostly.

 

[Sandy and Black Kitty]

I have also thought Ninja may be resistant but I feel it is too soon to determine this

It is too soon.
First things first. Read the information on the TR protocol as well as the SLGS method to help you determine which may be the best fit going forward.
Regardless of which you choose to follow, with Lantus dosing decisions are made based on knowing how low a given dose is taking your kitty during the course of a cycle.

Also, any opinions on that time frame (12/7/17) and those numbers?

its likely he has been green and blue before.

I can get a reading from Ninja without him even getting up from a nap after I wake him so stress is not an issue as he has an immense amount of trust in me.

This is huge-take full advantage. You want to break up those empty spaces on your ss by sprinkling as many tests as possible.

As you accumulate some solid data a truer picture will emerge.

A fructosamine test is of little value. I recommend you skip it and save your $$.

 

[Gill & George]

Hello and Welcome,
You've gotten some great advice, once you get set up with your Relion Meter and strips and can fill in those midcycle blanks as Sandy suggested I think things will start to become clearer.


I just wanted to add

potentially a fructosamine test since his blood will be sent off anyways

Most of us once we are up and running with testing save our pennies/cents since with regular daily home monitoring, including Pre shot tests, and at least a couple of midcycle tests in both am and pm cycles we know how they are doing.
The Fructosamine test is not really useful to help with dosing, as it gives an average BG over the previous couple of weeks, so it won't necessarily highlight any lows kitty may be having, especially when a cat drops low and then bounces back up into high numbers. But we have seen some vets attempt to use the Fructosamine result to make dosing decisions, even though it is not recommendable.

I've taken the note below from the vetsulin website

Advantages of measuring fructosamine

• Distinguishes hyperglycemic, non–diabetic cats from diabetic cats with chronic hyperglycemia.
• Not influenced by stress hyperglycemia in cats.
• Useful in confirming diagnosis in cats.
• Helps evaluate long-term control and owner compliance with insulin treatment.

Limitations of fructosamine measurements

• Unable to detect short-term or transient abnormalities in the blood glucose concentration, eg, transient daily episodes of hypoglycemia. This would require serial measurement of blood glucose concentrations.
• Hyperthyroid cats with diabetes mellitus may have decreased fructosamine concentrations despite having normal serum protein concentrations. This results from an increase in the protein turnover rate (decreased protein half-life) caused by increased thyroid hormone concentrations.
• Globulin and fructosamine concentrations are correlated in cats. Hypoglobulinemia will result in decreased fructosamine concentration—consult the laboratory performing the analysis as to whether a correction is required and whether this has been done.

The point I highlighted above is why it is not useful for dosing with Lantus, since it is precisely those lows that help us determine the dose. With Ninja being so chilled out about testing, my George is the same, and with home monitoring, stress hyperglycemia is not going to influence the data you gather at home.

We are here to help you help Ninja.
Any questions, fire away.

 

[Tricia Cinco(GA) & Harvey]

I too landed here because I didn't believe he really knew what he was doing (with diabetes, great vet otherwise).

You won't believe how common this is. When I had my cats treated at the University of California at Davis, which is rated the number one vet school in the country, I found out, by talking to a third year vet student, that they get exactly FIVE hours of training on diabetes, and that covers both cats and dogs.

In defense of the veterinarians, I should add that they have to learn about about a lot of different diseases and conditions in many different species, so it really isn't surprising when they don't know a great deal about any one specific disease. Also, many owners choose to euthanize their cats upon diagnosis, because they don't want to be bothered with the hassle and expense of treatment. Most owners don't want to deal with home testing, so many vets don't push it. A lot of us here have learned to nod and smile when the vet talks about diabetes and how we should be treating our cats and then we go home and continue following what we have learned here.

 

[Albert & Ninja]

Most of us once we are up and running with testing save our pennies/cents since with regular daily home monitoring.....The Fructosamine test is not really useful to help with dosing, as it gives an average BG over the previous couple of weeks, so it won't necessarily highlight any lows kitty may be having, especially when a cat drops low and then bounces back up into high numbers. But we have seen some vets attempt to use the Fructosamine result to make dosing decisions, even though it is not recommendable.

We are here to help you help Ninja.
Any questions, fire away.

Gotcha I will skip the fructosamine test then. Thank you for that, I was actually wondering whether it was worth while after asking them.

My last question is where I can get a reasonably priced vial of Lantus ordered for him from Canada. I'm currently paying about $90 for a single Lantus pen. I would like to stop using the pen and dose with regular half unit marked slim syrines and a vial to manage dosing better.

A lot of us here have learned to nod and smile when the vet talks about diabetes and how we should be treating our cats and then we go home and continue following what we have learned here.

Once I explained I had a few "specialists" working on his individual diabetic needs and that I "just needed tests results to review and send off" they were much more willing. I've experienced this already though. Not been sure of what to say at the vets and just agreed with them and going home and doing it the proper way that I've learned from here.

 

[Stacy & Asia]

My last question is where I can get a reasonably priced vial of Lantus ordered for him from Canada. I'm currently paying about $90 for a single Lantus pen. I would like to stop using the pen and dose with regular half unit marked slim syrines and a vial to manage dosing better.

A lot of us here use the pen with syringes and not the pen needles. It can act just like a vial with the advantage of usually being less expensive, less breakable, and they contain less insulin and you use them up quicker (which I like because I don't have to question potency as much). If you get the syringes, you can continue to use the pen you have and just pull doses with the syringe from it, you don't need to use the dial mechanism at all this way.

Here's Marks Marine in Canada where many people order from. You'll need a prescription, of course, but once it's on file with them you won't ever need another one:

https://rxcanada4less.com/

 

[Tricia Cinco(GA) & Harvey]

Once I explained I had a few "specialists" working on his individual diabetic needs and that I "just needed tests results to review and send off" they were much more willing.

 

[Gill & George]

Gotcha I will skip the fructosamine test then. Thank you for that, I was actually wondering whether it was worth while after asking them.

My last question is where I can get a reasonably priced vial of Lantus ordered for him from Canada. I'm currently paying about $90 for a single Lantus pen. I would like to stop using the pen and dose with regular half unit marked slim syrines and a vial to manage dosing better.


Once I explained I had a few "specialists" working on his individual diabetic needs and that I "just needed tests results to review and send off" they were much more willing. I've experienced this already though. Not been sure of what to say at the vets and just agreed with them and going home and doing it the proper way that I've learned from here.

I found this post for you that @Chris & China wrote, it's a little old so prices may have changed, she like others order from Marks Marine
I found a great place in Canada to get our insulin at that's a lot cheaper than it is here in the US. It's a real pharmacy, not one of those "website pharmacies". You can even call and talk to the pharmacist if you need extra help (not some salesperson) They do require a prescription, but it can be faxed or emailed. Their customer service is wonderful!

The pharmacy is Marks Marine Pharmacy

A lot of people from the Facebook group have used them and are very happy. It has taken about a week to get delivery (even as far away as Texas and Florida) and insulin is shipped with a medical grade icepack as well as enclosed in a special envelope designed to control temperature. I ordered from them first in late June and even though there were 2 postal holidays during that time, still got it within 10 days

They carry both Lantus and Levemir (and now Basaglar)

As of 1/15: As of 5/15: As of 1/16 As of 5/17: As of 8/17
Lantus Solostar pen (box of 5) $133.99 $144.99 $149.99 $164.99
Lantus vial $91.99 $99.99 $110.99
Individual pens $49.99 (plus expedited shipping $19.95)
Cartridges (like pens but without the extra plastic) $152.99 (no longer available)

Levemir Flextouch $169.99
Levemir penfill $164.99
Basaglar (box of 5 pens) $124.99

Shipping is $25 for vials/5 packs of pens

Tell them Chris sent you...LOL

They've added a video explaining their shipping here www.canshipinsulin.com

During the winter they will want to know what kind of temperatures you're expecting in your area before they ship so there's no chance of your insulin freezing in transit, so if you can, plan ahead and order when it's not going to be any problem!!

In the summer, it's best to try to order when your temps are forecast to be under 90 for the upcoming week, but as I said earlier, I had no choice but to order in late June my first time and although our temps were in the 90's, I was still able to use every drop of the pens I got.

 

[Sandy and Black Kitty]

Hello again

I see your PM shot was 14 hours after your AM shot on 01/10. Keep in mind that Lantus is going to work best if you shoot every 12 hours consistently. It is within the 12 hour cycles you will need to spot your kittys Lantus onset, nadir and duration, key elements in treating FD.

Because the action of a shot of Lantus wears off in about 12 hours, waiting longer before the next shot can result in a substantially higher BG.
Additionally in an attempt to compensate, the depot may then drain a bit resulting in a need to refill with subsequent shots.

Getting back to your regular schedule following a 2 hour delay for safety sake must be done incrementally; either 15 minutes early each cycle or 30 minutes early once each 24 hours until you get the 2 hours back. If you instead took back the 2 hours all at once shooting 10 rather than 12 hours following the previous shot, the resulting overlap could result in unexpected lows.

 

[Albert & Ninja]

I see your PM shot was 14 hours after your AM shot on 01/10.

Because the action of a shot of Lantus wears off in about 12 hours, waiting longer before the next shot can result in a substantially higher BG.
Additionally in an attempt to compensate, the depot may then drain a bit resulting in a need to refill with subsequent shots.

Getting back to your regular schedule following a 2 hour delay for safety sake must be done incrementally; either 15 minutes early each cycle or 30 minutes early once each 24 hours until you get the 2 hours back. If you instead took back the 2 hours all at once shooting 10 rather than 12 hours following the previous shot, the resulting overlap could result in unexpected lows.

Yes the scheduling has been the most difficult for me. I'm out of a vehicle until tmrw so I did not get home until a bit later and then screwed up again and fell asleep before his AM shot today. I was expecting a much higher number for the PMPS. I was unsure what to do today when I woke up and realized he'd missed his shot so I fed at noon and went ahead and gave him the shot then and there (before I read this..) and will continue at 12 unless directed otherwise by the group here.. Probably not the best but I figured he hadn't had his shot in 17 hours and needed to eat and of course the shot comes after the meal... Behavior has been wonderful today despite the change.


Edit:
Also thank you for the info on timing and how to move the scheduled time if need be. A friend who is a nurse said in humans you could move the shot back by an hour, two max. I didn't know it was different for a smaller animal but it makes sense. This is valuable information and another unanswered question that I've had. I will only adjust time as stated above from now on and try and keep a tighter schedule.

 

[Gill & George]

I was unsure what to do today when I woke up and realized he'd missed his shot so I fed at noon and went ahead and gave him the shot then and there (before I read this..) and will continue at 12 unless directed otherwise by the group here.. Probably not the best but I figured he hadn't had his shot in 17 hours and needed to eat and of course the shot comes after the meal... Behavior has been wonderful today despite the change.

How does that new shot time work for you?
Give us a shout if you need to change it back to a 6am/6pm time.

 

[Albert & Ninja]

How does that new shot time work for you?
Give us a shout if you need to change it back to a 6am/6pm time.

It should work pretty well for him. I feel like lunch at noon is more rewarding to him because I'll likely be eating too. He doesn't like being left out so this will probably make him a bit happier.

I start a new job on the 29th and will be up earlier like my previous few months had been so I will need to move it earlier into the morning. Not sure what my schedule is yet but his shots will likely be around 7-8am.

I'm going to move it up in 15 minute intervals as suggested.

 

[Tricia Cinco(GA) & Harvey]

Albert, a little housekeeping note: could you please start a new thread (we call them condos) tomorrow morning? We ask everyone to do a new thread every day, and link the last one in their first post. If you're not sure how to do that, just ask. Otherwise, threads get too long and unwieldy. Thanks.

 

[Albert & Ninja]

Albert, a little housekeeping note: could you please start a new thread (we call them condos) tomorrow morning? We ask everyone to do a new thread every day, and link the last one in their first post. If you're not sure how to do that, just ask. Otherwise, threads get too long and unwieldy. Thanks.

Yes absolutely. I was thinking it was getting kinda long earlier today actually. Consider it done.